Abstract
Background : Ovarian clear cell adenocarcinoma with malignancy-associated hypercalcemia is rare and associated with a poor prognosis. Perioperative management is therefore significant.
Case : This menopausal woman presenting with genital bleeding, thirst and generalized malaise was found to have a left adnexal mass and hypercalcemia. The serum level of parathyroid hormone related protein (PTHrP) was found to be elevated. Endometrial cytology showed columnar cells with irregular nuclear distances, dense chromatin and nuclear anisocytosis were seen in a serum background. It showed a Marimo-like arrangement. That cells might migrate from the ovary. After surgery and staging, the postoperative diagnosis was stage IIc clear cell adenocarcinoma of the ovary with humoral hypercalcemia of malignancy. Immunohistochemical staining showed that the cells were weakly positive for PTHrP. She received adjuvant therapy with carboplatin and paclitaxel. On long-term follow-up, the patient has remained well.
Conclusion : This rare paraneoplastic manifestation of ovarian cancer may be associated with a poor prognosis. Immunohistochemical positivity for PTHrP is useful for making the diagnosis. In the current case, PTHrP became a useful marker of recurrence. It is important to detect this malignancy with its complications in the early stage by laboratory tests, cytology and immunostaining.
