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Oxyphilic clear cell carcinoma ovary.

1 O xyphilic clear cell carcinoma of the ovary is a rare variant of clear cell carcinoma with abundant eosinophilic cytoplasm. The importance of recognizing this entity lies in distinguishing it from diverse other primary and metastatic oxyphil cell tumors of the ovary. A 60-year-old postmenopausal female presented with complaints of heaviness in the abdomen associated with loss of weight and appetite. There were no urinary complaints or bleeding per vaginum. A vague mass was palpable in the lower abdomen measuring about 8x5 cm. Multiple bilateral inguinal lymph nodes were palpable. On per vaginal examination, a firm solid mass measuring 8x4 cm was felt through the right and posterior fornix, extending into the left fornix. CA-125 was markedly elevated at 18,250 U/ml. Pap smear revealed benign reactive changes of inflammation. Ultrasonography revealed a cystic lesion in the right iliac fossa measuring 9.4x3 cm with multiple hypoechoic solid areas measuring 4x4 cm in the right adnexal region. Contrast enhanced computerized tomography Pelvis revealed a complex right abdominopelvic mass predominantly in the right iliac fossa showing cystic component with multiple enhancing mural excrescences and an ill-defined solid component. There was extensive small bowel and omental involvement with anterior rectal wall infiltration, ascites and paraortic lymphadenopathy. An impression of pelvic malignancy, most likely, ovarian was made. Barium meal follow-through did not reveal any significant abnormality. A staging laparotomy with ovarian biopsy was performed. On peroperative examination, abdominal surfaces were studded with metastatic deposits. The tumor was unresectable, with sigmoid colon, uterus and both ovaries forming a single jammed up mass. Paraaortic lymph nodes were enlarged and firm. Friable tissue bits from the tumor were sent for histopathology. Histopathological findings: Microscopic examination revealed tumor cells arranged in nests, sheets [Figure 1], tubules and acini. Occasional papillary structures [Figure 2] were also noticed. The individual cells were large, round to polygonal with abundant eosinophilic cytoplasm, vesicular pleomorphic nuclei with coarsely clumped chromatin and one to two prominent eosinophilic nucleoli. Occasional giant cells were also seen. The tumor cells were separated by thin fibrovascular septa infiltrated by neutrophils, with focal areas of hemorrhage. Mitotic activity was 5-10/10 HPF. Also seen were foci of conventional clear cell carcinoma [Figure 3] and the characteristic hobnail cells. Tumor cells showed focal PAS positivity. Immunohistochemically, the tumor cells were cytokeratin (CK) and epithelial membrane antigen (EMA) positive and alfa fetoprotein (AFP) negative. The diagnosis of oxyphilic variant of clear cell …