An autopsy case of hepatoid carcinoma of the ovary with PIVKA‐II production: Immunohistochemical study and literature review

Abstract

A case of hepatoid carcinoma of the ovary in a 61-year-old Japanese woman, who showed high serum levels of alpha-fetoprotein and CA125, is reported. Grossly, the left ovarian tumor, which measured 12 x 9 cm, was solid and multinodular. Histologically, the tumor resembled hepatocellular carcinoma by its architectural and cytological features. Liver cell differentiation was indicated functionally by the immunohistochemical detection of alpha-fetoprotein and protein induced by vitamin K absence or antagonist II (PIVKA-II) and by positive bile production, and the hepatocellular differentiation was structurally in accord with keratin 7, 8 and 18 expression. CA125 expression, commonly present in ovarian surface epithelial carcinomas, suggested that this neoplasm originated from ovarian common epithelial cells. There are only nine such cases in the literature. A review of these cases reveals that hepatoid carcinoma of the ovary occurs exclusively in postmenopausal women (mean age, 62.7 years) and that the prognosis is poor.

Hepatocellular Carcinoma with PIVKA-II Production in a Young Laboratory Monkey.

“…This finding agrees to the previous reports; though a progressive increase of serum AFP is seen i n s e v e r a l c a s e s o f c h e m i ca l ly -in d u c e d HC C i n primates 14,15,19 , neoplastic cells do not always show a positive reaction for AFP immunohistochemically 11 . In contrast, usefulness of immunohistochemical analyses for PIVKA-II has been reported in human HCC and ovarian hepatoid carcinoma 31,32 . Our results suggest PIVKA-II may be a useful HCC marker in monkey HCC, as same as is the case in humans.…”

“…Additional serial sections of the hepatic tumor were stained with periodic acid-Schiff (PAS), azan, phosphotungstic acid hematoxylin (PTAH), silver reticulin, Berlin blue for iron, and Hall's method for bile. R e p r e s e n t a t i v e s e c t i o n s w e r e s t a i n e d u s i n g immunocytochemical technique [31][32][33] for PIVKA-II (MU-3, Eisai, Tokyo, Japan), cytokeratin 18 (CK18; DC-10, DAKO, Glostrup, Denmark), carcinoembryonic antigen (CEA; polyclonal, DAKO), epithelial membrane antigen (EMA; E29, DAKO), proliferating cell nuclear antigen (PCNA; PC-10, Novocastra, Newcastle upon Tyne), vimentin (V9, DAKO), alfa-fetoprotein (AFP; polyclonal, DAKO), factor VIII-related antigen (F8/86, Nichirei, Tokyo, Japan), alfasmooth actin (HHF-35, Enzo, USA), and p53 (DO-7, Nichirei) (Table 3). Additionally, some specimens of the hepatic tumor were post-fixed in 2.5% glutaraldehyde and 1% osmium tetroxide solutions, then dehydrated in ethanol and embedded in Epon 812.…”

Hepatoid carcinoma of the ovary: A case report and review of the literature

“…The two basic diagnostic criteria are abundant eosinophilic cytoplasm of the tumor cells that resemble hepatocellular carcinoma, and positive immunohistochemical AFP staining (2). HCO has been known for 25 years, but to date, only 24 cases have been reported (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). The clinical features are listed in Table I and II.…”

“…CK19 and CK20, which are commonly positive in normal gastrointestinal epithelial cells, bile duct cells and certain adenocarcinomas, including ovarian surface epithelial carcinomas, but negative in normal hepatocytes and hepatocellular carcinomas, may occasionally be positive in HCO. CK7 was positive in certain cases (8,12,14), and a diffusely positive staining for CK7 is considered to be highly consistent with HCO (14). The expression profiles of CK reflect the origin of HCO (11), and the degree of staining of hepatocyte paraffin (Hep Par) 1 may be related to the differentiation of the tumor.…”

“…The majority of patients received postoperative chemotherapy with or without irradiation, but the prognosis is poor. A total of seven (1,2,4,7,8) out of nine patients were followed up until mortality; 7 succumbed within two years, while the other two patients (2,9) succumbed within five years. Pandey et al (18) reported that sorfenib, a first line drug for hepatocellular carcinoma, administered postoperatively, had no effect on HCO therapy.…”