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Transitional Cell Carcinoma of the Ovary
Urmi S Chakravarty - Vartak*, Shailesh S Vartak*
Abstract
Transitional cell carcinoma of the ovary is a relatively recently established entity. The pure form of transitional cell carcinoma (TCC) accounts for only 1% of surface epithelial tumours, mixed carcinomas with a predominant TCC component comprise 5% and those with a minor TCC component make up 3%.1,2 The major clinical impetus for accepting TCC as a distinct entity was provided by M.D. Anderson Cancer Centre’s finding that these carcinomas respond better to chemotherapy than most other surface epithelial cancers.3
Because of the positive outcome to chemotherapeutic agents it is mandatory to recognize this distinct morphologic type of ovarian cancer since these patients have a 5 year survival rate as high as 41%.1,4.
Introduction
Transitional cell carcinoma of the ovary is
a relatively recently established entity. The pure form of transitional cell carcinoma (TCC) accounts for only 1% of surface epithelial tumours, mixed carcinomas with a predominant TCC component comprise 5% and those with a minor TCC component make up 3%.1,2 The major clinical impetus for accepting TCC as a distinct entity was provided by M.D. Anderson Cancer Centre’s finding that these carcinomas respond better to chemotherapy than most other surface epithelial cancers.3
We present this case since the occurrence of pure transitional cell carcinoma is extremely rare.
Case Report
This case was referred to us in August 2002 from a peripheral hospital in the city. The patient was a 40 year old married woman who, presented with pain and fullness in the lower abdomen. Ultrasonogrpahy of the abdomen revealed a right ovarian mass. The status of the other ovary and uterus were unremarkable. Since the patient had completed her family a total abdominal hysterectomy with bilateral salphingoophorectomy was performed.
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| Fig. 1 : The ovarian neoplasm which was predominantly cystic showing two nodular areas arising from the cyst wall (arrows). |
Fig. 2 : Microphotography showing broad papillae with central fibrovascular core and layers of neoplastic epithelial cells resembling transitional cells (100 x). |
Fig. 3 : Photomicrograph of an old infarct showing ghost villi. |
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Histopathology Report
The right ovary measured 10 X 7 cms. and showed no evidence of any capsular breech. Sectioning the ovary revealed, a predominantly cystic tumour. The cyst contained a slimy blood stained fluid. The cyst wall was thickened and at one site were seen two creamish white nodules having a granular surface, arising from the cyst wall and projecting into the cyst lumen (arrows, Fig. 1) the left ovary and uterus showed no significant findings.
Histology revealed more than 65% of the tumour to be composed of thick broad papillary projections having a central fibrovascular core and a smooth surface (Fig. 2). The tumour cells had moderate amount of eosinophilic cytoplasm, showed prominent nucleoli nuclear chromating clumping, and a large number of mitotic figures (Fig. 3). They resembled in appearance the transitional cells as seen in the urinary tract. Since there was no evidence of any other surface epithelial tumour in all the sections studied this tumour was reported as a high-grade pure transitional cell carcinoma. Staging of the tumour could not be done as staging laparotomy had not been performed. Sections of the left ovary and uterus revealed no finding of histological significance. The patient received two cycles of chemotherapy after which she was lost for follow up.
Discussion
Most high-grade, high stage ovarian carcinomas do not respond well to chemotherapy. However of the different epithelial tumours of the ovary, carcinomas with a predominant transitional cell pattern appear to respond to chemotherapy better than other types. It has been documented that the likelihood of complete response to chemotherapy is 83% in case of tumours having a predominant TCC component as compared to 33% in case of nontransitional cell surface epithelial tumours.4 Because of the positive outcome to chemotherapeutic agents it is mandatory to recognize this distinct morphologic type of ovarian cancer since these patients have a 5 year survival rate as high as 41%.1,4
References
1. Robey SS, Silva EG, Gershenson DM, et al. Transitional cell carcinoma in high-grade high-stage ovarian carcinoma. Cancer 1989; 63 :
839-47.
2. Silva EG, Robey - Cafferty SS, Smith TL, et al. Ovarian carcinomas with transitional cell carcinoma pattern. Am J Clin Pathol 1990; 93 : 457-70.
3. Hollignsworth HC, Steinberg SM, Silverberg SG, et al. Advanced stage transitional cell carcinoma of the ovary. Hum Pathol 1996; 27 : 1267-72.
4. Gershenson DM, Silva EG, Michell MF, et al. Transitional cell carcinoma of the ovary : a matched control study of advanced - stage patients treated with eisplatin - based chemotherapy. Am J Obstet Gynecol 1993; 168 : 1178-87.
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