Abstract
Background : Small-cell carcinoma of the ovary, hypercalcemic type, has been identified as a specific histopathologic entity. This rare, highly aggressive malignant neoplasm affects young women, and there is no effective therapy.
Case : A 24-year-old unmarried gravida 0 woman complained of feeling a tumor in her abdomen. Her consciousness was mildly impaired, and laboratory tests showed high serum calcium (20.0 mg/dl) and PTHrP (29.5 pmol/l) levels. Section of a left ovarian tumor at laparotomy revealed a solid, cream-colored to gray neoplasm (20 cm, 2100 g), and since a microscopic metastasis was detected in the omentum, the postoperative diagnosis was stage IIIa small cell carcinoma of the ovary, hypercalcemic type. Imprint cytology showed, relatively diffuse arrangement of small cells in sheets or clusters with gland-like or rosette formations. The cell nuclei were round or ovoid, contained fine and granular chromatin, and a solitary nucleolus or a few small nucleoli, and they exhibited mitotic figures and nucleal grooves. Immunohistochemical staining showed that the cells were weakly positive for PTHrP. The hypercalcemia improved postoperatively, but the patient rejected chemotherapy and died of peritonitis carcinomatosa within 2 months.
Conclusion : In addition to the clinical findings attributable to hypercalcemia, the imprint cytology findings and immunohistochemical positivity for PTHrP are useful for making the diagnosis of small-cell carcinoma of the ovary, hypercalcemic type.
