Ovarian Endometrioid Adenocarcinoma with Ectopic Production of α-Fetoprotein

doi:10.1006/gyno.1998.5119

Gynecologic Oncology

Volume 71, Issue 1, October 1998, Pages 133-136

https://doi.org/10.1006/gyno.1998.5119 Get rights and content

Abstract

α-Fetoprotein (AFP) is well known as a tumor marker of ovarian endodermal sinus tumor or embryonal carcinoma in gynecological malignancies. However, AFP production is extremely rare in ovarian epithelial cancers. Here we report a case of a 53-year-old woman with an AFP-producing ovarian endometrioid adenocarcinoma. The serum AFP level was elevated up to 2759 ng/ml preoperatively, with a subsequent decrease to the normal range after treatment. Histological examination of the tumor revealed a well-differentiated endometrioid adenocarcinoma with small foci of clear cell components. None of endodermal sinus tumor, hepatoid carcinoma, or embryonal carcinoma components were observed. Immunohistochemical analysis revealed that AFP was expressed in the cytoplasm of the endometrioid glandular lesions, but not in the clear cell components. This is probably the first case of a pure type of ovarian endometrioid adenocarcinoma with significant levels of AFP expression.

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Cited by (16)

Alpha-fetoprotein-producing ovarian clear cell adenocarcinoma simulating fetal gut in a postmenopausal woman
2014, Gynecologic Oncology Reports
Citation Excerpt :
However in elderly, postmenopausal women, AFP-producing ovarian malignancies are rarely encountered and their histology varies. Some AFP-producing ovarian tumors in postmenopausal women have been documented, such as endometrioid adenocarcinoma with a yolk sac component, mucinous adenocarcinoma with a yolk sac component, CCA with a serous adenocarcinoma component, and endometrioid adenocarcinoma with a clear cell component (Abe et al., 2008; Kamoi et al., 2002; Esheba et al., 2008; Cetin et al., 2007; Maida et al., 1998). However, the ovarian tumor in our case, which was largely composed of clear cells, was different from these other tumors histopathologically in terms of lacking a YST component and forming glands similar to a gland-like fetal gut.
α-Fetoprotein-producing ovarian tumor in a postmenopausal woman with germ cell differentiation
2013, Annals of Diagnostic Pathology
Citation Excerpt :
However, in postmenopausal women, APOT is a rare entity. The review of the English literature showed that postmenopausal APOTs that have been reported were hepatoid carcinoma [3-9], epithelial malignancy [10-15], combined epithelial malignancy and germ-cell tumor [16-19], and another uncertain type [20]. Recently, it has been reported that SALL4 and glypican 3 (GPC3) are the novel markers in the differential diagnosis between yolk sac tumor and clear cell adenocarcinoma [21,22].
α-Fetoprotein (AFP)–producing ovarian tumors (APOTs) are rarely encountered in postmenopausal women, irrespective of whether they are of the germ cell or non–germ cell type. The APOTs that do occur in postmenopausal women are characterized by variable histologies such as hepatoid carcinoma, yolk sac tumor, and epithelial malignancies, most of which are combined. We herein present a case with APOT, which arose in a 58-year-old, gravida 2, para 2, postmenopausal woman. Preoperatively, the tumor, which was in the right ovary, was found to produce AFP (102768.0 ng/mL). The tumor was evenly composed of glands mimicking secretory endometrial gland or fetal gut accompanied by abundant stroma. Immunohistochemically, these glands were positive for SALL4, glypican-3, and hepatocyte nuclear factor 1β. We considered the present case as an AFP-producing adenocarcinoma with adenofibroma showing germ cell differentiation, but it seemed controversial that this tumor should be designated as a yolk sac tumor of the glandular type. The expression profiles of SALL4, OCT4, glypican-3, and hepatocyte nuclear factor 1β were thought to provide interesting implications to characterize the present case.
Alpha-fetoprotein-producing non-germ cell tumours of the female genital tract
2010, European Journal of Cancer
Citation Excerpt :
Immunohistochemistry confirmed that the carcinomatous component of this biphasic tumour was the seat of AFP production.17 Nogales et al. also reported a case of carcinosarcoma with a yolk sac component.14 The commonest AFP-producing non-germ cell tumour of the ovary is sertoli-leydig cell tumour (SLCT).
Elevated levels of alpha-fetoprotein (AFP), a foetal serum protein, occur mainly on the development of hepatocellular carcinoma (HCC) or germ cell tumours, including yolk sac tumour (YST) and embryonal carcinoma of the ovary. Rarely, other tumours of the female genital tract produce AFP. This article reviews the AFP-producing non-germ cell tumours reported in different parts of the female genital tract to date. These include different types of carcinomas and carcinosarcomas of the uterus, ovary and cervix and sex cord stromal tumours of the ovary. It is important for both pathologists and oncologists to be aware of such cases and the clinicopathological distinction from germ cell tumours, as the diagnosis would affect the management plan for the patient. The reviewed cases suggest that regardless of the patient’s age when no lesion is detected in the liver and stomach of a woman whose serum AFP level is abnormally high, the female reproductive system should be examined as a possible site of AFP-producing tumour. Biochemical, physiological and pathological features of AFP are briefly presented.
CA125 and Other Tumor Markers in Screening and Monitoring of Ovarian Cancer
2003, Diagnosis and Management of Ovarian Disorders, Second Edition
A wide variety of serum tumor markers have been investigated in the context of screening, differential diagnosis, prognosis, and monitoring of response and recurrence in ovarian cancer. One of the oldest among them is CA125 and it still remains the tumor marker with the most well-defined and validated role in the management of this disease. The focus of this chapter is on the role of CA125 in ovarian cancer. In combination with transvaginal ultrasound, serial CA125 monitoring is undergoing evaluation in randomized controlled trials of ovarian cancer screening. It is of increasing value in the differential diagnosis of adnexal masses and changes on serial monitoring are a reliable indicator of response or progression of disease. It's clinical value as a prognostic indicator is still to be defined. New technologies including expression array and mass spectroscopy are likely to identify a wealth of new candidate markers over the next few years.
α-Fetoprotein production by a malignant mixed Mullerian tumor of the ovary
2000, Gynecologic Oncology
Elevated levels of α-fetoprotein (AFP), a fetal serum protein, usually signal the development of hepatoma or germ cell tumors, including endodermal sinus tumors. We report the case of a 52-year-old woman with an α-fetoprotein-producing malignant mixed Müllerian tumor (MMMT) of the ovary. Serum AFP was 5348 ng/ml at diagnosis. Immunohistochemistry confirmed that the carcinomatous component of this biphasic tumor was the seat of AFP production. After three cycles of combination chemotherapy, the patient achieved a complete remission. Serum AFP was strongly correlated with response to treatment. This is the first report of AFP production by a MMMT of the ovary without a yolk sac component.
Immunohistochemical and molecular analysis of an α-fetoprotein-producing cervical adenocarcinoma with clear cell morphology
2023, Medical Molecular Morphology

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Case ReportOvarian Endometrioid Adenocarcinoma with Ectopic Production of α-Fetoprotein

Abstract

Gynecol Oncol

Am J Obstet Gynecol

Gynecol Oncol

Hum Pathol

Detection of embryo-specific globulin in the blood sera of patients with primary liver cell tumor

Vopr Med Khim

Brief report: immunofluorescent localization of alpha-fetoprotein synthesis in endodermal sinus tumor (yolk sac tumor)

Acta Pathol Microbiol Scand

Serum alpha-fetoprotein as a marker for endodermal sinus tumor (yolk sac tumor) or a vitelline component of “teratocarcinoma.”

Acta Pathol Microbiol Scand

Ovarian endometrioid tumors with yolk sac tumor component, an unusual form of ovarian neoplasm

Am J Surg Pathol

Case Report
Ovarian Endometrioid Adenocarcinoma with Ectopic Production of α-Fetoprotein