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Ovarian metastasis from renal clear cell carcinoma: a case report with an intraoperative, immunohistochemical study, and a review of the literature
1 Department of Medicine and Surgery, Pathology Unit, University of Parma, Italy
2 Department of Gynaecology and Obstetrics, Hospital of Fidenza, Parma, Italy
Eur. J. Gynaecol. Oncol. 2018 , 39(6), 1022–1027; https://doi.org/10.12892/ejgo4194.2018
Published: 10 December 2018
This case report refers to ovarian metastases from renal clear cell carcinoma (RCC) in a 46-year-old woman with a history of abdominal pain and urinary incontinence. A pelvic ultrasound revealed a heterogeneous, large, right-sided solid/multi-cystic ovarian mass, suggesting diagnosis of borderline or malignant epithelial ovarian tumor. At staging, abdominal CT incidentally revealed an enlarged left kidney with a lesion, consistent with renal carcinoma. At the time of surgery, a frozen section of ovarian neoplasm was performed to confirm diagnosis of primary epithelial borderline ovarian tumor or metastatic renal carcinoma. Macroscopically, the right ovary had been entirely replaced by a multiloculated cystic lesion with clear serous fluid, solid septa, and centrally, a solid gray area. Imprint cytology, performed during an intraoperative study of the lesion, showed cohesive clusters of neoplastic cells with clear abundant and vacuolated cytoplasm, pleomorphic, medium or large nuclei, and evident nucleoli. Histological examination revealed an epithelial neoplasm, characterized by large cells with clear optically empty cytoplasm that lined the alveolar and cystic spaces. A prominent vascular component with sinusoidal features was also present. These findings and the clinical data of the simultaneous renal lesion were consistent with an intraoperative diagnosis of ovarian metastatic renal carcinoma. Permanent sections revealed that the ovarian lesion showed the same pathological features as those observed in frozen sections. Immunohistochemical analysis of the ovarian tumor showing positivity for CD10 and renal clear cell marker (RCC Ma), while the presence of RCC in a nephrectomy specimen confirmed ovarian metastatic renal carcinoma. In conclusion, although ovarian metastasis of RCC is very rare, diagnosis can be made by careful histological examination, immunohistochemical study, plus clinical data.
Renal clear cell carcinoma