1. SPLIT,Croatia AMR Slide Seminar Case # 76 Ovarian tumor
Ivan Damjanov, MD, PhD
Department of Pathology
The University of Kansas School of Medicine, Kansas City, Kansas

2. Case # 76 Clinical History
60-year-old woman complaining of lower abdominal and pelvic pain
Past history: 30 years ago had “her uterus and tubes removed”
Left ovarian mass measuring 15 cm was found partially attached to the loops of the large intestine. Several tumor nodules on the mesentery and several pelvic lymph nodes contained tumor on frozen section. Right ovary contained an adenofibroma. Radical removal of all the neoplastic tissue was attempted.
She received chemotherapy. Two years after surgery she was found to have liver metastases. Lost to follow up, presumably died of spreading tumor.

3. Case # 38 Macroscopic and Intraoperative Pathology
Macro: Tumor received in several parts .Tissue soft friable and partially necrotic.
Partial colectomy with tumor attached to the intestine.
Partial omentectomy and lymph node dissection with apparent tumor.
Frozen sections: Malignant tumor, favor adenocarcinoma.
Metastases in the submitted lymph nodes and omentum.

6. GFAP

7. Grooved nuclei- cellular ependymoma
Mitotic activity-anaplastic ependymoma
(loss of ependymoma markers)

17. EMA

18. Fibrillary cytopalasmic processes, tapering of cytoplasm

19. GFAP

20. S100

21. CAM5.2

22. Ependymoma-extra-axial
Michael O. Idowu, MD, MPH, Marc K. Rosenblum, MD, Xiao-Jun Wei, MD, Mark A. Edgar, MD, and Robert A. Soslow, MD
Ependymomas of the Central Nervous System and Adult Extra-axial Ependymomas are Morphologically and Immunohistochemically Distinct—A Comparative Study With Assessment of Ovarian Carcinomas for Expression of Glial Fibrillary Acidic Protein
Am J Surg Pathol 2008;32:
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Extra-axial ependymomas preferentially express cytokeratins (which may be expressed in the CNS axial ependymomas as well, but less commonly)
Extra-axial ependymomas-histologic patterns: solid,pseudopapillary,papillary, trabecular, cribriform

23. Vimentin

24. CD99

25. Case # 76 Diagnosis
Ependymoma (malignant) of the ovary with extension to the left colon and metastases to the omentum and pelvic lymph nodes.
Other diagnoses considered:
Cellular ependymoma
Ependymoblastoma
Anaplastic ependymoma

26. Cellularity and grooved nuclei- cellular ependymoma—not papillary carcinoma of thyroid
Mitotic activity-anaplastic ependymoma

27. Return to the classic paper!
Kleinman GM, Young RH, Scully RE. Primary neuroectodermal tumors of the ovary. Report of 25 cases. Am J Surg Pathol 1993; 17:
Neuroectodermal tumors –ovary or testis
Three groups
A. Differentiated – ependymomas, astrocytomas, oligodendrogliomas
B. Primitive tumors-neuroblastoma, medulloblastoma, ependymoblastoma
C. Anaplastic tumors- glioblastoma like

28. Take home message Ependymoma can be typically axial or paraxial
Paraxial ependymoma described in essentially any and all organs
In the female genital tract—ovary or parametria
Origin- either from teratoma or embryonic remnants
Clinical prognosis –guarded or malignang

29. The END
Thank you for your attention.