Pathology: Diagnostic Expert Forum
ovarian cancer
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ovarian cancer

here is a copy of my pathology report

FINAL DIAGNOSIS

A) PERITONEUM, BIOPSY:
- Metastatic adenocarcinoma consistent with papillary carcinoma (thyroid
type); see Comment.

B) LEFT OVARY AND FALLOPIAN TUBE, SALPINGO-OOPHORECTOMY:

A, B) OVARY SYNOPTIC REPORT

SPECIMEN: Left ovary and fallopian tube, peritoneum.
PROCEDURE: Left salpingo-oophorectomy, peritoneal biopsy.
LYMPH NODE SAMPLING: Not performed.
SPECIMEN INTEGRITY:
- Right ovary: Capsule ruptured, specimen fragmented.
PRIMARY TUMOR SITE: Left ovary.
OVARIAN SURFACE INVOLVEMENT: Present.
TUMOR SIZE:
- Left ovary: 7.5 cm in greatest dimension; however, papillary carcinoma is
multifocal and each focus is less than or equal to 0.4 cm.
HISTOLOGIC TYPE: Carcinoma in teratoma [microfoci of papillary carcinoma
(thyroid type) arising in struma ovarii].
HISTOLOGIC GRADE: G1 (well-differentiated)
EXTENT OF INVOLVEMENT OF OTHER TISSUE/ORGANS: Left ovary and peritoneum are
positive for involvement; left fallopian tube is negative for involvement.

The patient's history of microfoci of
papillary carcinoma involving struma ovarii in a left ovarian cyst from an
outside hospital in 2006 and reviewed at Cleveland Clinic in 2008
(S08-42559, 6/13/08) is noted in the electronic medical record.  The
current findings are virtually identical to the tumor description from that
pathology report and are from the same ovary.  Therefore, the current
specimen most likely represents residual/recurrent disease.  It is not
clear from the electronic medical record from which site of the peritoneum
the specimen in part A was obtained.  If it was obtained from outside the
pelvis, the stage would be pT3b(r) [IIIB].  Correlation with intraoperative
findings is necessary for accurate staging.  

what is Metastatic adenocarcinoma? what does it all mean and what would be a good course of action? I am 38 with 3 children
6644139_tn?1384789257
Hi SpookyKim11,
I would first like to thank you for posting in the forum, hopefully your question will help to educate all of us who visit.  Metastatic adenocarcinoma is cancer that has spread outside of its site of origin.  Adenocarcinoma is a word that helps us define what cell type the cancer came from when looked at under the microscope, with these cells being glandular in origin. In your case the cancer has spread outside of the ovary, where it appears to have started, to your peritoneum, which is a membrane that lines the inside of the abdomen and pelvis, hence the term metastatic.  To add further complexity to your diagnosis, you had thyroid tissue in your left ovary (teratoma with struma ovarii), which in itself is not cancer.  Per the report, it appears that this thyroid tissue then become cancerous.  The comment made by the pathologist towards the bottom of the report refers to staging, which is how much the cancer has spread.  In ovarian cancers, and in reference to the peritoneal biopsy, the staging would depend on whether the biopsy was performed within your pelvis or outside of it, which is why the report recommends correlating with what was found at the time of your operation.  Your left fallopian tube was not involved by cancer.  As I'm not a oncologist, my expertise on treatment regimens is limited and I will have to defer on making any recommendations.  I hope that you find this information useful and empowering, if there's any further clarification I can provide or additional questions I can answer please don't hesitate to ask.  I wish you the best in your health and treatment.
Sincerely,
John  
19 Comments
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1737879_tn?1386205914
thank you for the very fast response. I was very confused what Metastatic adenocarcinoma was. the last time I seen my gyn/onc last month was when I found out about it and was in too much shock to think of any questions.
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1737879_tn?1386205914
Transcription FAIRVIEW HOSPITAL
DEPARTMENT OF PATHOLOGY

SURGICAL PATHOLOGY REPORT
SF13-11204

Submitting Physician:  Peter Rose, M.D.
Procedure Date:  10/10/2013
Received:  10/11/2013
Reported:  10/15/2013 13:53

SPECIMEN(S) RECEIVED
A: Peritoneal Biopsy
B: Left Ovary


FINAL DIAGNOSIS

A) PERITONEUM, BIOPSY:
- Metastatic adenocarcinoma consistent with papillary carcinoma (thyroid
type); see Comment.

B) LEFT OVARY AND FALLOPIAN TUBE, SALPINGO-OOPHORECTOMY:

OVARY:
- Foci of papillary carcinoma (thyroid type), each less than or equal to
0.4 cm in greatest dimension, arising in struma ovarii (see Comment).  

FALLOPIAN TUBE:
- No pathologic change.  

MJM/kll  10/15/2013 13:35

COMMENT

A, B) OVARY SYNOPTIC REPORT

SPECIMEN: Left ovary and fallopian tube, peritoneum.
PROCEDURE: Left salpingo-oophorectomy, peritoneal biopsy.
LYMPH NODE SAMPLING: Not performed.
SPECIMEN INTEGRITY:
- Right ovary: Capsule ruptured, specimen fragmented.
PRIMARY TUMOR SITE: Left ovary.
OVARIAN SURFACE INVOLVEMENT: Present.
TUMOR SIZE:
- Left ovary: 7.5 cm in greatest dimension; however, papillary carcinoma is
multifocal and each focus is less than or equal to 0.4 cm.
HISTOLOGIC TYPE: Carcinoma in teratoma [microfoci of papillary carcinoma
(thyroid type) arising in struma ovarii].
HISTOLOGIC GRADE: G1 (well-differentiated)
EXTENT OF INVOLVEMENT OF OTHER TISSUE/ORGANS: Left ovary and peritoneum are
positive for involvement; left fallopian tube is negative for involvement.

PATHOLOGIC STAGING:
At least pT2(r) [II] (see Note)
pNX(r)
pM - Not applicable

NOTE: The following immunohistochemical stains were performed on a
representative section of ovary: synaptophysin, chromogranin, calcitonin,
and CEA (mono) - all negative. The patient's history of microfoci of
papillary carcinoma involving struma ovarii in a left ovarian cyst from an
outside hospital in 2006 and reviewed at Cleveland Clinic in 2008
(S08-42559, 6/13/08) is noted in the electronic medical record.  The
current findings are virtually identical to the tumor description from that
pathology report and are from the same ovary.  Therefore, the current
specimen most likely represents residual/recurrent disease.  It is not
clear from the electronic medical record from which site of the peritoneum
the specimen in part A was obtained.  If it was obtained from outside the
pelvis, the stage would be pT3b(r) [IIIB].  Correlation with intraoperative
findings is necessary for accurate staging.  





Mark J. Melaragno, M.D.
(Electronic Signature)
CLINICAL HISTORY
Left Ovary Mass
Laparoscopy with Oophorectomy and Salpingectomy

GROSS DESCRIPTION
A) Received in formalin designated "peritoneal biopsy" is a single
tan-brown irregular and ragged fragment of soft tissue that measures 0.6 cm
in greatest dimension.  The specimen is filtered through a mesh bag and
totally submitted in one cassette.

B) Received in formalin designated "left ovary" is a fallopian tube and
markedly fragmented ovary that weigh 80 grams and aggregates to 7.5 x 7 x
3.5 cm.  The fallopian tube measures 6 cm in length and 0.4 cm in diameter.
The external surface is tan-white and glistening.  The fimbriated end is
unremarkable.  Sectioning through the tube reveals a patent lumen.  No
masses or lesions are grossly identified. The fragmented ovary aggregates
to 7.5 x 7 x 3.5 cm.  The external surface is tan-white and glistening.
Within the ovarian cyst is a pink-tan gelatinous tissue.  Normal ovarian
parenchyma is present.  Representative sections are submitted in nine
cassettes.

CASSETTES:
B1: Fallopian tube
B2-B9: Ovary
WE/sab
that was the whole report, It would not allow me to post it all
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1737879_tn?1386205914
I wanted to ask what  Right ovary: Capsule ruptured, specimen fragmented means?
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6644139_tn?1384789257
Hi Spookykim,
Sorry I'm just now getting back to this.  The capsule being ruptured means that there is an increased chance that cancer cells have spread to the inside of the pelvis and abdomen.  In your case this doesn't mean as much as cancer cells have already been proven to be outside of the ovary (your positive peritoneal biopsy).  So your peritoneal biopsy positive for metastatic adenocarcinoma trumps the possibility of cancer spreading outside the ovary caused by rupture of the capsule.  I realize this explanation is a little convoluted, hopefully it makes sense.  Let me know if I need to rephrase it, okay?
Thanks,
John
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1737879_tn?1386205914
I never got an email of the reply. yes I understand what you said, thank you. when I called the Dr. office they said hat it meant I had an egg  in there. I just had a few scans yesterday and found out I had nodules in my lower abd. thank you again for your reply
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6644139_tn?1384789257
You're quite welcome.  Thank you for the update on your scans, I know that can cause a lot of fear and anxiety.  When is your next appointment?  Please let us all know how you're doing and stay in touch, okay?
John
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1737879_tn?1386205914
I had an apt yesterday with my gyn/onc and he told me the same thing that he had said on 10/28 and that is that they have to find me a endocrinologist. the waiting part is what is driving me crazy because my surgery was done on 10/10. He did say that there is a 100% chance of me being fine from it but, I remember in 2006 when I was first diagnosed with it they also said that it does not spread. they want to kill my thyroid so they can kill the other thyroid tissue. Now another scary thing to me. my Dr. wrote up a case report called Malignant Struma Ovarii: Recurrence and Response to Treatment Monitored by Thyroglobulin Levels. in this case report he is suggesting that you can tell if it has came back by checking the thyroglobulin levels. My levels were never elevated. A few days before surgery mine was 0.1. I did call and spoke to the nurse about my concern with this and, she is suppose to get back with me in a few days. She did check my chart from all the way back in 2006 and it has never been elevated. It has also said that with 12 metastatic disease cases that three have died. that is 25%. not good numbers to me. anyway on with what the report said. I will just post the result because it is not on my echart yet to just copy and paste.

it was a I-123 uptake whole body scan.

the I-123 uptake is 20.5% at 30.5 hours

the neck and scan demonstrates normal thyroid gland.

the whole body scan shows a cluster of iodine-avid mesenteric nodules in the mid lower abdomen, witch is compatible with patient's known  metastatic adenocarcinoma. No other definitive evidence of iodine-avid metastases.

physiologic activity is noted in the salivary glands, nasopharynx, stomach, gastrointestinal tract and the urinary bladder.

I do have a question on that also. what does the last line about physiologic activity mean? also another question is this cancer ovarian cancer or thyroid cancer? I have heard it was thyroid cancer but my echart says ovarian. will copy and paste what it says.


Health Issue

Date Noted


Malignant neoplasm of other specified sites of uterine adnexa 08/26/2006
Adnexal mass 09/21/2013
Ovarian cancer 10/29/2013

Thank you again for your time. You really do seem to care about people.
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1737879_tn?1386205914
Also I don't understand what mesenteric nodules in the mid lower abdomen means
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6644139_tn?1384789257
Hi Kim,
I'm sorry I'm behind on this. Thanks for the compliment, I do my best. My understanding is that you have ovarian cancer.  The cancer looks like thyroid cancer under the microscope but technically the site of origin is in the ovary.  They might be trying to keep tabs/getting rid of all of the thyroid tissue in your body being that your ovarian cancer was actually thyroid tissue (I know this might not make sense, I think I explained it a little better in my previous post). I suppose the thought would be that increased thyroglobulin levels would correspond to more thyroid tissue (in your case from your ovarian cancer) and these levels would be expected to increase with any growth in your tumor.  It doesn't sound like you fit this rule though.  The increased iodine avid mesenteric nodules (the mesentary is a form of supporting tissue on the inside of our abdomen) may represent areas of recurrent ovarian cancer in your mesentary, although I would encourage you to discuss this with your doctor.  Thyroid tissue can be detected by iodine uptake and we don't usually have this in our omentum.  Physiologic uptake just means that certain organs or tissues in the body will always have a background of activity.  This is nothing to worry about.  If I took this test I would also have physiologic activity, it's just the way our tissues work.  When do you meet with your physician to discuss your radiology report?  Sorry if I missed it if you said it.
Thanks,
John  
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1737879_tn?1386205914
I went to see him on 12/2 I finally got an apt with the endocrinologist that is 12/12 I will let you know what he/she says
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1737879_tn?1386205914
That's ok I understand that you have your own life going on. thank you for your time.
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6644139_tn?1384789257
What did the endocrinologist say?  
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1737879_tn?1386205914
well I went there and they said to have my thyroid removed not just killed with radiation. She said that it would be too much radiation because I would need 2 doses. I had a ultrasound in the office of my thyroid and was told that it was normal. not enlarged no goiters. I had surgery to remove it on 12/18. I really am upset about having it removed. I know I can take the medicine and it will be fine but its not the same. I don't understand why I am worried about it. I think maybe if it was not a healthy thyroid I would not care. I woke up in so much pain in the front and back of my neck and the worst headache I ever had. I see online that they say the surgery is not painful. that's a lie. I don't understand why they don't like to give endocrine patients pain pills except for Tylenol and motrin. sometimes that is just not enough. I think a muscle relaxer would have helped because my muscles was/are so tight and sore. I do notice now that I will gulp for air like every 5 minutes or so and I have never done that before and it happens on its own. I don't know if its from the swelling in my neck or what but it is getting a little scary now. I know this is not your area sorry. happy holidays to you and your family.
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1737879_tn?1386205914
also I wanted to add that I got the test wrong with the thyroglobulin levels. I was looking at another one, the atb test. my level is high

Component Results

Component

Your Value

Standard Range

Units

Flag


Thyroglobulin 118.0      0.8 - 49.0 ng/mL      H
TG Antibody Screen 1.0      <14.4 IU/mL

I also noticed that I have a few labs that are off.. they did labs 2 days before surgery.

BUN  5      8 - 25 mg/dL   L
Creatinine  0.58      0.70 - 1.40 mg/dL   L
Potassium  3.4      3.5 - 5.0 mmol/L   L
CO2   22      23 - 32 mmol/  H
ALT   55      0 - 45 U/L H BC   11.26     3.70 - 11.00 k/uL   H

I did have a ultrasound of my liver and gallbladder last week because I swell up so much when I move around a lot. this never happened before I had my ovary/tube removed. I am hoping that will tell my why my ALT is elevated. I don't drink I don't use drugs and I don't really ever use Tylenol.

oh they said they will give me the radioactive iodine around 6 weeks after surgery. then maybe I can get my life back.

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1737879_tn?1386205914
sorry I know I keep adding more. I worded the gasping for air wrong. it is more of gulps of air. It's hard to explain. it has almost stopped now.
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1737879_tn?1386205914
the morning after surgery



PTH, Intact     8             15 - 65 pg/mL L
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1737879_tn?1386205914
just got off the phone with my pcp with the results of my ultrasound of the liver and gallbladder, they said it showed cholelithiosis. what is that? they are sending me to another Dr. not sure what kind he is.. I go see him on the 17th of this month. could that cause the abdominal swelling? I get swollen if I stand too long or ride in the car too long or if I do anything longer then 10 minutes like cleaning
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1737879_tn?1386205914
sorry another reply.. just found out from my pcp that they are sending me to a general surgon to deal with the gallbladder. now I have had surgery on 10/10 12/18 and now another one? is that even safe? will that effect my radioactive iodine treatment if they remove my gallbladder? I know they wanted to wait about 6 weeks after removing my thyroid but I am not sure if its because of the thyroid. this is so stressful. I forgot to go for my breat ultrasound. I feel like everything is making other things happen. it is one thing after another! I am almost ready to say forget everything and just not go back to the Dr. because they keep finding things wrong. i am sorry it just feels never ending. would that cause my liver levels to be elevated? sorry, I know I am being a pest now. I just dont know who else to ask
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