A Case Report: Bilateral Ovarian Clear-cell Carcinoma

A 66 years old female presented with persistent deaf pain in small pelvis, enlarging abdominal and periodic dysuria. She had a past gynecological history of endometriosis. According to the results of transvaginal ultrasonography, small pelvis CT and the check-test answers of OC oncomarker CA125, clinical diagnosis of unknown origin ovarian cancer was offered. The patient underwent an exploratory laparothomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy. An intra-operative frozen section of the pelvic mass was positive for OC. During the post-operative examination of ovaries and uterus, in addition of solid ovarian tumor a cut surface of uterus showed a whorled intramural nodule. Microscopic features on cytology examination of ascetic fluid was negative for malignant cells. Microscopically, both ovaries showed typical features of CCC. Apart from this, according to the additional IHC analysis the diagnosis of bilateral ovarian clear cell carcinoma was confirmed. Ovarian clear cell carcinoma is a rare subtype of epithelial ovarian cancer and comprises about 5-10% of ovarian carcinomas. To elucidate of molecular mechanisms underlying the malignant transformation of ovaries and investigate its relationship with past-history of endometriosis or chronic pelvic inflammation, it is essentialto observe the genetic pathways such a ARID1A-loss mutation role in genesis of OCCC, as well as, specific immunohystochemical markers by which OCCC is characterized to differentiate CCC from other types of OCs for an early diagnosis in clinical practice. Furthermore, greater understanding of molecular pathways of OCCC provide opportunities to develop alternative treatment strategies with the aim of improving survival chances of patients with OCCC, also for an early diagnosis of OCs to introduce and implement a screening program, which despite many attempts, remains a significant challenge in oncology.

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