Desafortunadamente las fotos no nos ayudan mucho, pero el aspecto papilar, la bilateralidad y la aparente extensión extraovárica sugieren una neoplasia maligna epitelial y si se puede excluir la posibilidad que se trate de metástasis ovárica, pensaría a un Carcinoma de Células Transicionales -no Brenner ( Transitional cell carcinoma - non Brenner), con las reservas derivadas de la iconografia. Espero que otros tengan ideas más acertadas que la mia y podamos resolver el enigma.

A pesar de las fotos nomuy claras pensaría en carcinoma probablemente endometrioide del ovario.

Saludos

Francisco

Krukenberg tumor/ Tumor de Krukenberg

Mi primera impresión es de un Carcinoma Endometriode Ovárico.

Saludos. Esther.

Me adhiero a la opinión de Bayardo en cuanto a la probabilidad de un Carcinoma de células transicionales de ovario, bilateral. Se observan grupos macropapilares con un patrón sólido, con células de citoplasma claro. Las fotos no son muy buenas y no muestran acercamientos que permitan observar las características nucleares. No obstante, no hay glándulas de aspecto endometrioide. La IHQ con E-CADHERINA, S-100, CA 125, CK 20 y CD117 podrían resultar útiles.

Saludos desde Atlanta, GA, USA en el magnífico congreso de la USCAP!

Cara Dra. Diana

A figura 1 mostra estruturas papilares largas e curtas revestidas por epitélio que lembra epitélio transicional. Os grandes aumentos mostram microespaços com aspecto "punched-out" e minúsculas fenestrações fendiformes. Portanto, concordo com os colegas Bayardo e Reynaldo que pensaram em um carcinoma de células transicionais.

Veja o abstract abaixo.

Am J Surg Pathol. 2004 Apr;28(4):453-63

Transitional cell carcinoma of the ovary: a morphologic study of 100 cases with emphasis on differential diagnosis.

Eichhorn JH, Young RH.

James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, and the Department of Pathology, Harvard Medical School, Boston, MA 02114, USA. jeichhorn@partners.org

Transitional cell carcinoma (TCC) of the ovary is a recently recognized subtype of ovarian surface epithelial-stromal cancer, and studies of its morphology are few. As a result, the criteria for its diagnosis and spectrum of its morphology are not clearly established. One hundred consecutive consultation cases of ovarian carcinoma with a pure or partial transitional cell pattern (excluding malignant Brenner tumor) diagnosed between 1989 and 2001 were evaluated for the frequency of various pathologic features and the relation of TCC to other surface epithelial-stromal carcinomas. The women were 33 to 94 years of age (mean, 56 years). A total of 47 tumors were stage I, 21 stage II, 31 stage III, and 1 stage IV; 13% of the stage I tumors and 41% of tumors of all stages were bilateral. The tumors ranged from 3.0 to 30 cm in greatest dimension (mean, 10 cm); 60% of them were solid and cystic, 24% solid, and 16% cystic. TCC was the exclusive or predominant component in 93% of the tumors and showed undulating (93%), diffuse (57%), insular (55%), and trabecular (43%) patterns. In four tumors with an insular growth, the pattern focally mimicked a Brenner tumor. Necrosis was present in 57% of the cases. Features that were seen in the tumors that in aggregate produced a relatively consistent appearance were "punched out" microspaces (87%), often the size of Call-Exner bodies, large cystic spaces (73%), and large blunt papillae (63%). Features that were sometimes seen, usually as a focal finding, included slit-like fenestrations (49%), bizarre giant cells (35%), small filiform papillae (18%), gland-like tubules (17%), squamous differentiation (13%), and psammoma bodies (4%). In 23 cases, TCC was a component of a mixed epithelial carcinoma, the additional components being serous adenocarcinoma in 16, endometrioid in 5, mucinous in 1, and clear cell carcinoma in 1. The tumor cells of the TCC component often were relatively monomorphic; 6% of the tumors were grade 1, 43% grade 2, and 51% grade 3. The nuclei were oblong or round and often had large single nucleoli (69%) or longitudinal grooves (48%). The cytoplasm was typically pale and granular but was rarely strikingly clear or oxyphilic. TCC of the ovary usually occurs in pure form but is also common as a component of a surface epithelial carcinoma of mixed cell type. In either situation, TCC has a constellation of architectural and cytologic features that readily distinguish it in most cases from other types of ovarian cancer. Recognition of these features will lead to a more consistent diagnosis of this tumor and aid in determining whether it has distinctive clinical features, particularly with regard to its behavior.

Abraços

Romualdo Lins

Caruaru - Pernambuco - Brasil

Concordo, também, com os colegas Romualdo, Bayardo e Reynaldo que pensaram em Carcinoma de células transicionais do ovário.

Consideramos que este caso corresponde a UN CARCINOMA TRANSICIONAL BILATERAL DEL OVARIO, de ambos ovarios, y es el criterio de los Patólogos del Hospital Nacional de Ciudad Habana al observar las fotos que se enviaron.

La inmunohistoquímica sería lógicamente de mucho valor.

Consideramos que el diagnóstico diferencial es con otros carcinomas de ovario, que además pueden estar presentes en algunas otros láminas.

Caso muy interesante.

Me inclino por un carcinoma de cèlulas transicionales. No tiene imagen histològica de los otros diagnòsticos diferenciales mencionados.

Gracias.

Victor argueta

Penso em um Tumor de Brenner maligno.

Inté.

Quiero agregar al comentario anterior, que siguiendo con el patrón histológico de carcinoma de células transicionales, no debemos olvidar metastasis de carcinoma urotelial, pues la lesión es bilateral. No se llamaría Krukenberg, por no tener células en anillo de sello.