|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 4 | Page : 529-530
Primary ovarian carcinoid tumor simulating virilizing tumor of the ovary: A rare entity
B Gupta1, A Suneja1, NB Vaid1, A Bhatia2
1 Department of Obstetrics and Gynecology, University College of Medical Sciences and GuruTeg Bahadur Hospital,
New Delhi, India
2 Department of Pathology, University College of Medical Sciences and GuruTeg Bahadur Hospital, New Delhi, India
|Date of Web Publication||1-Feb-2016|
Dr. B Gupta
Department of Obstetrics and Gynecology, University College of Medical Sciences and GuruTeg Bahadur Hospital,
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta B, Suneja A, Vaid N B, Bhatia A. Primary ovarian carcinoid tumor simulating virilizing tumor of the ovary: A rare entity. Indian J Cancer 2014;51:529-30
Primary ovarian carcinoid is a rare neoplasm of low malignant potential and accounts for 0.1% of all ovarian tumors. They are predominantly classified into four histological subtypes; namely insular, trabecular, strumal and mucinous. Apart from unilateral mass in post-menopausal women, insular carcinoid may be associated with the carcinoid syndrome. Its presentation as a post-menopausal virilizing neoplasm is extremely rare as described in the present case.
A 62-year-old lady, P5L5, presented with an abdominal lump, complaints of early satiety, constipation and mild virilization. She was a known hypertensive controlled on beta blockers. On examination, her vitals were normal; chest, cardiovascular, thyroid and breast examination were within the normal limits. She had male pattern of baldness, thickening of eyebrows, increased upper lip hair and mild clitoromegaly. There was a 6 cm × 7 cm, firm-solid, non-tender, immobile mass in the left iliac fossa. The same mass was palpated in the left fornix, uterus was normal size and there was no nodularity in the pouch of douglas. Levels of CA-125, inhibin A and B were normal while serum testosterone (195 ng/dl, range; 15-62) and DHEAS (166 ug/dl, range; 13-130) were elevated. Ultrasound and contrast enhanced computed tomography imaging revealed a left ovarian solid mass with necrotic area 6 cm × 8.7 cm × 8.3 cm with no ascites, organomegaly, pelvic or para-aortic lymphadenopathy and normal uterus and contralateral ovary.
With a provisional diagnosis of leydig cell tumor, a staging laparotomy with hysterectomy, bilateral salpingo-opherectomy with omentectomy with bilateral pelvic lymph node sampling was performed. Intra-operatively, there was a left ovarian mass 8 cm × 7 cm, solid, nodular, with bosselated surface, no papillary excrescences and an intact capsule. Rest all organs were normal and lymph nodes were not palpable. On cut section, the tumor was solid brown with cystic and hemorrhagic areas [Figure 1]. On histopathology, the tumor consisted of sheets of monomorphic cells separated by fibrovascular septa, stained positive for chromogranin A, suggestive of carcinoid tumor, insular variety [Figure 2]. There was stromal hyperplasia of the contralateral ovary. Post-diagnosis a complete work-up was carried out to exclude the carcinoid syndrome. 24 h urinary 5-hydroxyindoleacetic acid (5HIAA) levels were 2.9 mg/day (2-8 mg/day) and 68 Ga-DOTATOC positron emission tomography (PET) computed tomography scan was normal. Serum thyroid stimulating hormone, adrenocorticotropic hormone, cortisol and Ca 2+ was normal. Baseline echo was normal. Patient is on a 6 monthly follow-up.
|Figure 1: Cut section: Solid, yellow brown, small cystic areas and foci of hemorrhage|
Click here to view
Solid masculinizing ovarian tumors in post-menopausal women consist of sertoli leydig cell tumors, thecomas and occasionally granulosa cell tumors. Hence, we had kept a provisional diagnosis of a leydig cell tumor. Trabecular variant of carcinoid maybe associated with hirsutism and constipation due to secretion of peptide YY. The present case did not have any trabecular element and the virilizing features could be explained by the presence of stromal hyperplasia. Urinary 5HIAA levels and Ga-DOTATOC PET scan was performed to rule out the subclinical carcinoid syndrome. Since the mainstay of management of any neuroendocrine tumor is surgical resection with negative margins, a radical surgery was carried out for complete treatment and the patient is on close follow-up.
Although rare, but carcinoid of the ovary must be kept as a differential in virilizing tumors of the ovary especially, in post-menopausal women.
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[Figure 1], [Figure 2]