A case of hepatoid carcinoma of the ovary and review of the literature

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1 Akita J Med 38 : 75-79, , received 30 May 2011, accepted 26 July A case of hepatoid carcinoma of the ovary and review of the literature Yuki Shimoda 1,2, Satoko Kagabu 1, Toshiki Kawahara 1, Mitsuhiro Kato 1, Toshio Fujimoto 2 and Yukihiro Terada 2 1 Department of Obstetrics and Gynecology, Nakadori General Hospital 2 Department of Obstetrics and Gemecology, Akita University Hospital Abstract Hepatoid carcinomas are a rare group of neoplasms that are a particularly uncommon among gynecologic malignant tumors. Here, we describe a case that originally presented as occult primary cancer with multiple liver metastases. We arrived at a diagnosis of hepatoid carcinoma based on preoperative levels of serologic tumor markers and postoperative tissue analysis. We also describe our therapeutic approach for this patient. Of note, few clinical findings indicated the patient was suffering from ovarian cancer, and the differential diagnosis was difficult. In addition, we provide a review of currently available studies about the diagnosis and treatment of this disease. Key words : hepatoid carcinoma, ovarian carcinoma, α - fetoprotein, cytokeratin hepatoid carcinoma of the ovary 6 Correspondence : Yukihiro Terada, M.D. Department of Obstetrics and Genecology, Akita University Hospital, Hondo, Akita , Japan Tel : Fax : E - mail : teraday@obgyn.med.akita - u.ac.jp cm CT computed tomography 75

34 A case of hepatoid carcinoma 1. CT : Ring Enhancement low density 3.

0 U/ml CEA Carcinoembryonic antigen CA - 19-9 CA72-4 2 cm 3 cm AFP CK

2 34 A case of hepatoid carcinoma 1. CT : Ring Enhancement low density 3. : 3 cm 2. CT : Ring Enhancement Class V adenocarcinoma AFP alfa - fetoprotein 51.2 ng/ml CA U/ml CEA Carcinoembryonic antigen CA CA cm 3 cm AFP CK Cytokeratin 7 20 FIGO IV pt3cn1pm1, HEP 1 14 TC PTX 175 mg/ m 2 +CBDCA AUC5, d1, AFP 68.3 ng/ml CA U/ml 3 5 CT ERCP Endoscopic Retrograde Cholangio Pancreatography

3 35 4 : Adenocarcinoma : CK7 : CK TC 2 12 TC 3 17 ERCP 4 9 PTCD percutaneous transheptatic cholangio drainage 4 5. HE AFP Ishikura and Scully 1 AFP 2 AFP AFP 3 AFP 59 77

4 36 A case of hepatoid carcinoma 2 Ring enhancement hypovascular CK7 CK20 CK7 CK20 77% 93% Stage III FIGO 5 1 Stage Ia 16 study TC Case Age Site Size cm FIGO stage Chemotherapy Follow-up I II BEP I III PTX IIIc PTX+CDDP GEM+CDDP 24 DXR III PTX+CDDP IV PTX+CBDCA IA PTX+CBDCA IIIc CY+CDDP CY+CDDP +Radiotherapy 60 PTX+CBDCA IA CY+CDDP III IIIc BEP BEP : bleomycin + etoposide + cisplatin 7 Case number

5 Ishikura, H. and Scully, R.E Hepatoid carcinoma of the ovary. A newly described tumor. Cancer, 60, Vol. 8, 10, Ghada, E. Esheba, MSc, Lisa, L. Pate and Teri, A. Longacre 2008 Oncofetal protein glypican - 3 distinguishes yolk sac tumor from clear cell larcinoma of the ovary. Am. J. Surg. Pathol., Vol. 32, 4, cytokeratin Vol. 20, 7, Antonio D Antonio, Gianfranco De Dominicis, Maria Addesso, Alessia Caleo and Amedeo Boscaino 2010 Hepatoid carcinoma of the ovary with sex cord stromal tumor ; a previously unrecognized association. Arch Gynecol Obstet., 281, Isonishi, S., Ogura, A., Kiyokawa, T., Suzuki, M., Kunito, S., Hirama, M., Tachibana, T., Ochiai, K. and Tanaka, T Alpha - fetoprotein AFP - producing ovarian tumor in an elderly woman. The Japan Society of Clinical Oncology, 14, Zizi - Sermpetzoglou, A., Petrakopoulou, N., Nikolaidou, M.E., Tepelenis, N., Savvaidou, V. and Vasilakaki, Th Hepatoid carcinoma of the ovary. A case report and review of the literature. Eur. J. Gynaecol. Oncol., 30 3, Simona Stolicu, Ovidiu Preda, Monica Dohan, Lucian Puscasiu, Olga F. Garcia - Galvis and Francisco F. Nogales 2008 Pseudoglandular Hepatoid Differentiation in Endometrioid Carcinoma of the Ovary Simulates Oxyhilic Cell Change. International Journal of Gynecological Pathology, 27, Ozan, H., OzturkNazlioglu, H. and Ozuysal, S A case of hepatoid carcinoma of the ovary. Eur. J. Gynaecol. Oncol., 29 5, Eva Tejerina Gonzalez, Miguel Arguelles, Jose A. Jimenez - Heffernan, Patricia Dhimes, Blanca Vicandi and Fernando Pinedo 2008 Cytologic Features of Hepatoid Carcinoma of the Ovary. ACTA CYTO- LOGICA, 52, Jesus Lazaro, Dolores Rubio, Manuel Repolles and Luis Capote 2007 Hepatoid carcinoma of the ovary and management. Acta Obstetricia et Gynecologica, 86, Chao - His Lee, Kuan - General Huang, Chir - Hwa Ueng, Hsueh Swei, Ho - Yen Chueh and Chyong - Huey Lai 2002 A hepatoid carcinoma of the ovary. Acta Obstet. Gynecol. Scand., 81, Yigit, S., Uyaroglu, M.A., Kus, Z., Ekinci, N. and Oztekin, O Hepatoid carcinoma of the ovary ; immuno histochemical finding of one case and literature review. International Journal of Gynecological Cancer, 16, Kwon, J.E., Kim, S.H. and Cho, N.H No ancillary finding is valid to distinguish a primary ovarian hepatoid carcinoma from metastatic hepatocellular carcinoma. International Journal of Gynecological Cancer, 16, Watamabe, Y., Uemoto, M., Ueda, H., Nakai, H., Hoshiai, H. and Noda, K Cytopathologic and Clinicopathologic Features of Ovarian Hepatoid Carcinoma. A Case Report. ACTA CYTOLOG- ICA, Vol. 47, 1,

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