Yamanashi Med. J. 9(S), ll5t-l18, 1994
Primary Squamous Cell Carcinoma ofthe Ovary Associated
with Primary Adenocarcinoma ofthe Fallopian Tube
Atsush iIKEGAMi, Takehiko YAsuMizu, Akihiko HAsRi, andJL}nzo KATe Department ofObstetrics and Gynecology, YamanashiMedical Unive7sdy, Ta77zaho, Yamanashi 409-38,laPan
Abstract: Primary squamous cell carcinoma of the ovary is one of the rarest of all ovarian malignancies, and most cases originate in a cystic teratoma or a Brenner tumor. We are aware of only 8 reported cases of primary squamous cell carcinoma of the ovary without the above associations. We present what appears to be the first reported case of a primary squamous cell carcinoma of the ovary to be associated with a primary adenocarcinoma of the fallopian tube. The patient was a 63-year-old woman and had an operation on September 27, 1990. She remained well with no sign of recurrence at 4th year.
Key words: squamous cell carcinoma, ovarian
cancer
tumor, tumor of the fallopian tube, collision
CASE REPORT
A 63-year-old woman (gravida 1, para l) was referred to the Yamanashi Medical URiversi￡y
Hospital with an abdominal mass and lew
grade fever. Gynecological examiRatioRs re-vealed a right ovarian tumor. A pelvic sono-gram showed a solid tumor in the pelvic cavity. Endome￡rial and vaginal cytology were nega-￡ive. An explorative iaparotomy oR September 27, 1990, revealed a right adnexal ￡umor thathad penetrated the fallopian tube and was deBsely adherent to the ileocecal portioR ofthe intestine. The uterus and left adRexa appeared Bermal. A small amount ofascites was present. On gross inspection, no metastatic disease was present in any other intra-abdominal organs. The serum level of squarr}ous cell carcinor{}a * Corresponclence: Takehiko Yasurnizu, ment of Obstetrics and Gynecology, Yamanashi Medical University, Tamaho, Yamanashi Received Jtme 25, l994
Accepted October 21, 1994
aRtigen (SCC), a useful marker of squamous cell carciRoma, was 80 nglml. We performed a total hysterectomy, bilateral
salpingo-oophorec￡omy, omentectomy, ileocecal resec-tion with ileo-ascending coles￡oning accerding to end-to-end fashion, and pelvic Iymph-adenectomy below the commoi3 iliac artery.
Cytological examinatioR ofthe ascites obtained at surgery revealed a few squamous carciRorna cells. Pos￡operatively, three courses of che-motherapy coksisting of cisplatin (5e mg/m2),
adriamycin (40 mglm2) aRd cyclophosphamide
(400 mglm2) were administered. She remained well with no sign of recurrence at 4th year.
PATHOLOGICALFINDINGS
The turnor, which measured 10×9×9 cm,
originated in the right ovary. Its surface was smooth but a portion had reiptured revealiRg papillary growth from the capsule (Fig. I). The cut surface was seft aRd cyearny wlth focal necrosis aRd some focal areas of hemorrhage.
The tumor stroRgly adhered to the right
116 A. Ikegami, et ag.
Fig. 1. The tumor originated in the right ovary (10×9X9 cm). Its surface was smooth but a
portion had ruptured revealing papillary growth ofthe capsule.
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Fig. 2. Squamous celi carcinoma of the ovary. Cells were polygonal with pleomorphic lei and abundant cytoplasm (hematoxylin-eosin, × 100).
Squamous cell carcinoma of the ovary 117 " ,stwn rzaq as
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i?{gk- itVii2i/i;' .., s;eYsl,rs･i't･{ri//,'El,A'XFig.S. Well-differentiated papillary (hematoxylin-eosin, × 100).
adenocarcinoma arlsmg
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epithelium
fa11opian tube which was a little turgid, and thus part had ruptured (Fig. 1). The border
between the ovarian tumor and the turgid
fa11opian tube could not be clearly recognized (Fig. 1). Histological examination showed this tumor to be composed of sheets and nests of well-differentiated squamous cell carcinoma (Fig. 2). I･n some areas, the squamous cellsinvolved the serosa of the fallopian tube, There was no evidence to support either a
teratoma or Brenner tumor as the primary
pathology. No areas of endometriosis were identified microscopically. Sections of the tur-gid right fallopian tube revealed a
well-differentiated papillary adenocarcinoma that arose from the tubal epithelium (Fig. 8); the lumen was fi11ed with that neoplasm without
evidence of squamous differentiation. The
myometrium of the right fallopian tube
showed no neoplastic invasion. Sections of the endometrium, cervix and left ovary were nega-tive for tumor.DIscussloN
This appears to be the first reported case of a simultaneously occurring squamous cell car-cinoma of the ovary and a well-differentiated papillary adenocarcinoma ofthe fallopian tube which were detected at the initial laparotomy. Warren and Gates established three criteria for diagnosing multiple primary malignancies: (1) each tumor presents a definite picture of malignancy, (2) each tumor is distinct, and (8) the possibility of one tumor being a metastasis of the other is excludedi). All three criteria were met to this case.
While primary ovarian squamous cell carci-noma has been reported previously, it is very
rare2-9). The most common explanation for
such an ovarian carcinoma is that it had
metastasized from a distant site such as the uterine cervix. Webb et al., in a series of 375 tumors metastasized to the ovary, found that only 2.5% were of the squamous cell typeiO). Most nonmetastatic squamous cell carcinomas of the ovary arise from teratomas or Brenner118 A. Ikegami, et aL
￡umors. To our kRowledge, only 8 cases of
primary squameus cell carcinoma of the ovary have beeR reported previouslyL'9), aRd three ofthese were associated with carciRoma in situ of the uterine cervix2ww4). AIthough there is Bo clear explanation for this associatioB, it raises the possibility of microiRvasion from the cervlx.
Most malignancies that arise from ovarian endometriosis are endometrioid aRd clear cell,
buta￡leastfourcasesofsquamouscellcarcino-rr}a have beeR reported5-8). Our patien￡ had no evidence of eRdemetriosis.
Primary carcinoma of the fallopian tube is one of the rarest geni￡al tract carcii3omas, ancl is classically foLmd at laparotomy at an adv-anced stage with metastases to such sites as the uterus and ovaries. In our patient, it was easy to diagltose a simultaReous carcinoma of the ovary and fallopian tube, because the carcino-ma of the fallopian tube presented as an early lesion, and the coexisting ovarian carcinoma exhibited differing histological features. Primary squamous cell carcinomas of the
ovary were reported to be highly agg}nessive,
with death usual}y occurring within a {'ew
months ofthe first symptoms, regardless ofthe
choice of surgical procedure and
chemo-therapy9). However, ￡his case indicates that complete local excision with adeqLiate postop-erative chemotherapy is an effective treatment. MeasuremeRt of the serum SCC may be veryuseful iB diagnosing recurrence of this
carci-Roma.
REFERENCES
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Am J Cancer 1932; l6: 1385-IS92.
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5) McCullough K, Froats ER, Falk HC.
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9) Macko MB,Johnson LA, Primary squamous ovarian carcmoma: A case report and review of the literature. Cancer l983; 52: ll17-1119. IO) Webb Mj, Decker DG, Mussey E. Cancer metastatic to the ovary. Obstet Gynecol 1974; 45: S91-396.
