Georgian Telemedicine Union (Association)

Patient: 37 years old female

1993 year – Laparotomy of right ovary. Cystoma.

07.03.2007 – Laparotomy operation

Preoperative diagnosis – Adreno-genital syndrome, secondary policystosis, tubo-peritoneal sterility, scar process in small pelvis cavity, impermeable right fallopian tube in interstitial part, primary sterility.

Postoperative diagnosis – Scar process in pelvis cavity, 4^th grade genital tuberculosis (?), neoplasia of left ovary (?), tubo-peritoneal sterility of unknown genesis.

Operation – Laparoscopy, mini-laparotomy, dissection of scars, left side adnexectomy, right side salpingo-ovariolysis, and biopsy of right ovary.

Micromorphology: Left ovary - In H&E preparations solid centers of tumor cells with connective tissue fibers, small sized hemorrhages and necrosis are observed. There are small sized multiple tumor cell infiltrates in serous membrane of left fallopian tube. Right ovary – on the background of wide necrosis the large solid areas of tumor cells surrounded by connective tissue are observed. Cells of obvious atypia, little amount of pathologic mitosis.

Immunohistochemistry: CEA – negative; EMA – negative; S100 – positive in 70% of cells; MNF116 – negative; p53 – positive in 7% of cells; CD45 – negative; vimentin – positive in most cells; synaptophysin – negative; epithelial antigen – negative.

Pathology diagnosis: adult granulesocellular tumor (ICD-0 codes 8620/1) with local extension in serous membrane of fallopian tube, negativity of oncoprotein p53 and moderate proliferative activity.

Clinical: Patient is treated by Euthirox (50 mg per day) - two nodes of 1,2 cm and 0,8 cm size are revealed in thyroid, but the level of TSH is of normal value.

Hormonal analysis

Dates

Hormones

25.09.2006

(7^th day of cycle)

06.11.2006

(9^th day of cycle)

15.12.2006

(4^th day of cycle)

12.01.2007

(32^nd day of cycle)

Prolactin; ng/ml (N - 1.2-19.5)

10.3

FSH; IU/l

(N - I phase – 3-12; II phase – 2-12)

11.1

7.2

5.4

LH; IU/l

(N - I-II phase 0.8-10.5)

23.5

TSH; mIU/I (N - 0.4-4.0)

1.3

Estradiol; pg/ml

(N - I phase – 30-200; II phase – 50-250)

10.0

Progesterone; ng/ml (N - I phase – 0.2-1.4; II phase – 4-25)

Free testosterone; ng/ml (N - female – 0,5-2,3)

3.7

0.6

S-(DHEA-S); mg/dl (0.4-2.2)

2.4

1.3

17aOHP; ng/ml (N - I phase – 0.3-1.0; II phase – 0.2-2.9)

0.6

Immuno-reactive insulin; m IU/ml (N - 5-19)

1.2

13.04.2007 (23^rd day of cycle). The amount of CA-145 is 45.4 (optimal value is 1-15; maximal – 35).

Comments: Please, write about this case, prognosis and further treatment strategy to Eka Kldiashvili, Ph.D. kldiashvili@georgia.telepathology.org, Georgian Telemedicine Union (Association), Tbilisi, Georgia

Left ovary H&E images

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Right ovary H&E images

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IHC images

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p53
p53
p53
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
S-100
Vimentin
Vimentin
Vimentin
Vimentin
Vimentin
Vimentin
Vimentin
Vimentin
Vimentin
Vimentin
Vimentin

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p53