{"paper_id":"bf6124c7-8041-4cee-8d3e-7e5609e9ce1f","body_text":"Clear Cell Carcinoma Ovarii with Metastasis to the \nPeritoneum: A Case Report and Literature Review \nIntan, SA1, Yenita2 \n{shintaayuintan@med.unand.ac.id1, yenita@med.unand.ac.id2} \n \nAnatomical Pathology Department of Anatomical Pathology Medical Faculty, Universitas Andalas. \nJl. Perintis Kemerdekaan No. 94, Padang 25127, West Sumatra, Indonesia \nAbstract. Clear cell carcinoma (CCC) ovarii was a tumor of the ovary that was pertaining \nto endometriosis the ovary and the pelvis .At the time diagnosed many of CCC  have \nmetastasized on the surface of the pelvis, an abdomen or the bladder.Clear cell carcinoma \nalso had tendency implantation in cavum peritoneum of the diaphragm, paracolic channel \nand omentum. Cytology could serve as an instrument that is useful in the diagnosis of \ncystic and dense lesions of the ovary . Peritoneal washing was a part of the procedure to \ndefine stadium ovary neoplasm, and it was one of important implementation of cytology. \nThe aim of this study to describe the clinical approach for determination stage and patient \nprognosis with clear cell carcinoma ovarii. This is a case report with literature review. The \npatient had an illness history of endometriosis and adenomiosis that never resected. \nClinical examination showed a mass at quadrant of th e bottom right of the abdomen with \nthe dimension 15x11x8 cm. Imaging examination of ultrasound graphy (USG) showed \ncystic mass with the dimension 13x10x10cm. The surgeon reported there were mioma \nlooked the uterus as much as, also a cyst in the ovary right . The ovary left there was \nadhesion of the intestine and omentum. Histopathology was clear cell carcinoma ovarii. \nPeritoneal washings clear cell carcinoma ovarii.  Clear cell carcinoma when diagnosed is \nfound to have been metastasized.  Confirmation cytology with histopathology was \nobligatory in interpreted peritoneal washing because it is an important to factor in \ndetermination stage and prognostic patients. \nKeywords: Clear Cell Carcinoma Ovarii, Histopathology, Peritoneal Washing. \n1   Introduction \nClear cell carcinoma (CCC) ovarii is a tumor of the ovary that is pertaining to endometriosis \nthe ovary and the pelvis . At the time of diagnosed many of  CCC have metastasized on the \nsurface of the pelvis, an organ the abdomen or the bladder . Clear cell carcinoma also has \ntendency implantation in  cavum peritoneum of the diaphragm, paracolic channel and \nomentum.[1]. \nLesions of cyst or a mass frequent found in the ovaries. Observation usually found on cyst \nsized about 5-10 cm, while laparotomy suggested for supersized cyst or if there are components \nsolid. In addition, laparotomy also suggested when fluid is in the pelvis enter the abdominal \ncavity, this peritoneal liquid needed for cytology analysis.[2],[3] \nCytology can serve as a useful  instrument for diagnosis cysti c and dense lesions of the \novary. Peritoneal washing is a part of the procedure to define stadium on an ovary neoplasm and \nit is one of important implementation of cytology. One of a cytology sample that used for \nICOMHER 2018, November 13-14, Padang, West Sumatera, Indonesia\nCopyright © 2019 EAI\nDOI 10.4108/eai.13-11-2018.2283685\n\n \n \n \n \ndiagnostic a n ovary neoplasms is peritoneal washin g. Classifications stadium from the \nInternational Federation of Gynecology and Obstetrics (FIGO) for ovary neoplasms have been \ncombining the results of peritoneal washing cytology as a part for determining an optimal \nstadium.[2],[3] \nConfirmation cytology with histopathology is obligatory in interpreted peritoneal washing \nbecause it would be classified as into stadium IC. Hence, determination of the stadium is one of \nthe important factors in stadium determination and patients prognosis.[2],[4] \n2   Result \nA 45 years old female complained a lump on the bottom right abdom en got measurably \nbigger since 2 years ago  without decreased body weight, nausea and vomited. Clinical \nexamination showed a mass at quadrant of the bottom right abdomen with the dimension  \n15x11x8 cm, pain tenderness, and dullness percussion. The patient has a past illness history of \nendometriosis and adenomyosis that never resected. Until now the patient does not have a child. \nImaging examination of ultrasonography (USG) showed cystic mass with the dimension 13x10x \n10cm. The surgeon reported there is mioma looked the uterus as much as, looked a cyst in the \novary right . The ovary left difficult for graded (adhesion of the intestine and omentum). \nMacroscopy examination showed a piece of a cyst tissue, white brownish, the dimension 11x8x5 \ncm, cross section looked a  multilocular cyst contains a pellucid fluid, the diameter of 6 -9 cm, \nthere were looked: solid parts, white brownish, hemorrhagic, thick and thin wall (figure.1). \n \n \nFig. 1. Macroscopy examination \nHistopathology, there were tubulocystic, papillary and solid patterns. The tumor cells vary \nfrom polygonal to cuboidal ; the cytoplasm ranges from clear to less commonly eosinophilic. \nThe most tumor also contains cells with apical hyperchromatic nuclei ( Hobnail cells). Other \n\n\n \n \n \n \nparts contain endothelial leukocyte cells (figure.2) — the definitive diagnosis is clear cell \ncarcinoma ovarii.  \n \n \n \n \nFig. 2. Histopathology of the tumor is clear cell carcinoma (Hematoxylin-Eosin, original magnification \na. tubulocystic patterns 10x10, b. papillary and solid patterns 20x10, c. hobnail cells20x10, d. endothelial \nleukocyte40x10). \nPeritoneal washing examination showed a group of tumor cells polygonal to columnar; the \ncytoplasm ranges from clear to less commonly eosinophilic. The most tumor also contains cells \nwith hyperchromatic and eccentric nuclei — that suspicious of malignancy (figure.3).  \n \n \n \n \nA B \nC D \nB A \n\n \n \n \n \n \n \nFig. 3. Peritoneal washing examination (Giemsa, original magnification a,b. columnar cells 20x10, \n40x10, c,d. polygonal cells20x10,40x10). \n3   Discussion \nIn this case report, a patient with a lump on the bottom right abdominal. Symptoms inflicted \nusually associated with a mass in the pelvis or abdomen which is about 50-70 % cases.[4]Based \non social and economic history patients do not have a child . According to Nucci and Oliva in \n200, about 2/3 of women who suffer CCC is nullipara. Based on the past illness history known \nthat patients diagnosed endometriosis and adenomyosis. Clear cell carcinoma ovarii is closely \nrelated to endometriosis. More than 50 percent of cases pertaining to atypical endometriosis.[5] \nMacroscopy examination showed a piece of a cyst tissue, white brownish, the dimension \n11x8x5 cm, cross section looked a cyst have many cavities contains a pellucid fluid, the diameter \nof 6-9 cm, there are parts of solid, white brownish, hemorrhagi c, the wall is thick and thin . \nClement and Young state that CCC is varying from a cyst unilo cular until multilo cular to the \nmass of cystic until solid and some accompanied by cyst endometriosis.  The contents of a cyst \ncould be a pellucid fluid, mucin or brownish color.  \nHistopathology, this tumor displays tubulocystic, papillary and solid patterns with cells \nvary from polygonal to cuboidal also contain cells with apical hyperchromatic nuclei ( Hobnail \ncells) and the cytoplasm ranges from clear to less commonly eosinophilic. It is in accordance \nwith literature which a clear and cytoplasm and a hobnail cell were a most common cell that \nfound in CCC.[1],[6] The result of the accumulation of glycogen not from mucin  at clear \ncytoplasm. While it was emphasized that clear cytoplasm should not be used as the main criteria \ndiagnostic because a n ovary  tumor has many cell type s, there is a cell with eosinophilic \ncytoplasm but not all consist of that. A CCC supposed to be diagnosed histopathology based on \ncuboidal identification shape of the cell, distinctive nuclei and the most important of distinctive \narchitecture.[7] \nPeritoneal washing examination showed a group of tumor cells polygonal to columnar, the \ncytoplasm ranges from clear to less commonly eosinophilic. Most tumor also contains cells with \nhyperchromatic and eccentric nuclei. That suspicious of malignancy. After the result confirmed \nwith histopathology, preparation gives the impression of a metastasis clear cell carcinoma ovarii \non liquids peritoneum . Based on stadium FIGO is a stage I C. World Health Organization \n(WHO)stage IC having a bad prognostic.[1] \nD C \n\n \n \n \n \nSomewhat less than 1/3 patients diagnosed CCC at the time were diagnosed  in the \nperitoneum, or the lymph has metastasized. Clear cell carcinoma has tendency implantation in \ncavum peritoneal diaphragm, paracolic channel and omentum [7],[8]. These patients, CCC only \noccurred in the ovary dekstra.A tumor the ovary with the location of unilateral around 98 % in \nstage I.[9],[10] \n4   Conclusion \nClear cell carcinoma is a case when diagnosed is found to have been metastasized . \nConfirmation cytology with histopathology is obligatory done in interpreting peritoneal washing \nwhere later on is an important factor in the determination of stage and prognostic patients. \n \nReferences \n[1] Kauman RJ et al.: Tumours of The Ovarium. In Kauman, Will, Smith. WHO Classification of \nTumour Female Reproductive Carcinoma 4 th  ed. Lyon.33-6 (2014) \n[2] Chieng et al. Epithelial Neoplasms of Ovarii. Chien, John, Smith, ed. Cytology and Surgical \nPathology of Gynecologic Neoplasms. Humana Press. 145-57 (2011) \n[3] Wilikinson.: Overview of Epithelial Carcinoma Ovarium. Pathology of The Ovarian Fallopian \nTube and Peritoneum. UK: Springer.189-92 (2014) \n[4] Kurman et al .: Surface Epithelial Tumours of The Ovary. Blaustein’s Pathology of Fe male \nGenital 6 th  ed. London. Springer. 2011: 693-772 (2011) \n[5] Fletcher CD.: Tumours of the Female Genital Tract. Diagnostic Histopathology of Tumours 4 th  \ned. Vol 1. Elsevier. 682-4 (2016) \n[6] Clement and Young. Surface Epithelial - Stromal Tumours. Atlas of Gynecologic Surgical \nPathology 3 rd  ed. Elevier.392- 95 (2014) \n[7] Soslow RA and Thomos. Pathology of Clear Cell Carcinoma. Diagnostic Pathology of Ovarium. \nSpringer. 91-7 (2011) \n[8] Prat J. Pathology of Cancers of The Female Genital. International Journal of  Gynecologic and \nObstetric. 810-19 (2012) \n[9] Crum et al. Pathology Based Managemen and Outcome of Epithelial Tumour Ovary. In: Crum, \nRoger, Nucci, ed. Diagnostic Gynecologic and Obstetric Pathology 2 nd ed. Philadelphia: \nElsevier. 901-10 (2011) \n[10] Barakat et al. Epithelial Carcinoma Ovarium. In: Barakat, George and Thomas, ed. Principle  \nand Practise of Gynecologic Oncology 5 th  ed. London: Lippincott Williams Walkins. 809 -23 \n(2009)","source_license":"CC0","license_restricted":false}