Malignant female adnexal tumor of probable wolffian origin relapsing after pregnancy

Atallah, David; Rouzier, Roman; Voutsadakis, Ioannis A.; Sader-Ghorra, Claude; Azoury, Joseph; Camatte, S.; Morice, Philippe; Duvillard, P.

doi:10.1016/j.ygyno.2004.07.042

Cited by 29 publications

(22 citation statements)

References 6 publications

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“…A number of chemotherapy regimens, including cisplatin/cyclophosphamide, etoposide/ifosfamide/carboplatin, cisplatin/paclitaxel, carboplatin/paclitaxel with leuprolide, and irinotecan alone, have been used to treat recurrent and metastatic FATWO (4,15,17). However, only paclitaxel used in combination with cisplatin induced temporary stabilization of the disease (17).…”

Section: Discussionmentioning

confidence: 99%

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Recurrent female adnexal tumor of probable Wolffian origin treated with debulking surgery, imatinib and paclitaxel/carboplatin combination chemotherapy: A case report

et al. 2017

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In view of the small number of recurrent and metastatic cases of female adnexal tumors of probable Wolffian origin (FATWO), there is a distinct lack of evidence to support recommendations regarding treatment. In the present study, a 37-year-old female was diagnosed with a left adnexal tumor and underwent a left salpingo-oophorectomy (SO). The tumor was found to arise from the left tubal fimbria and extend to the posterior leaf of the broad ligament. Pathological examination identified a number of solid, tubular and cystic architectures, with areas of hyalinization, hemorrhage and necrosis. Immunohistochemistry detected that the tumor cells were positive for cytokeratin (CK)7, vimentin, inhibin and calretinin, and negative for CK20, epithelial membrane antigen, and the estrogen and progesterone receptors. Thus, the patient was diagnosed with FATWO. Following 15 months, the patient developed recurrent tumors and subsequently underwent a total abdominal hysterectomy, a right SO and extirpation of the disseminated tumors, but with incomplete debulking. The tumor cells were immunoreactive for KIT. As there are a limited number of treatment options and few reported cases, limiting the therapy recommendations, imatinib mesylate was administered for 6 months and the tumors were temporarily stabilized for 4 months until the disease progressed. The patient underwent a further debulking surgery that did not achieve complete debulking and was subsequently administered a combination chemotherapy of paclitaxel and carboplatin. This regimen resulted in an almost complete response after 10 cycles. The tumors continued to decrease in size, and the tumors in the left side of the Douglas pouch and the right para-colic gutter were no longer detectable. To the best of our knowledge, the current study is the first to report carboplatin and paclitaxel combination therapy demonstrating a response of this degree to recurrent FATWO following the failure of imatinib treatment. However, surgical debulking remains the most effective treatment for FATWO when is it is possible. The precise role of chemotherapy, radiotherapy and molecular-targeting therapy in the treatment of recurrent or metastatic FATWO remains to be elucidated, and therefore, novel strategies to overcome this disease must be prioritized.

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Section: Discussionmentioning

confidence: 99%

“…However, only paclitaxel used in combination with cisplatin induced temporary stabilization of the disease (17). To the best of our knowledge, the current study is the first report of carboplatin and paclitaxel combination therapy yielding a marked response in recurrent FATWO following the failure of imatinib treatment.…”

Section: Discussionmentioning

confidence: 99%

Recurrent female adnexal tumor of probable Wolffian origin treated with debulking surgery, imatinib and paclitaxel/carboplatin combination chemotherapy: A case report

et al. 2017

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“…FATWO is an uncommon lesion and approximately 80 cases have been reported in the literature including case reports (3). However, the presence of necrosis, capsular invasion and especially a high number of mitoses are elements justifying caution regarding their prognosis (4,8,9). These tumors usually express a benign behavior.…”

Section: Discussionmentioning

confidence: 99%

“…The age at diagnosis ranged from 18 to 81 years, with a mean of 50 years (7). However, recurrence could occur in the absence of the aggressive histological character and even after several years following the initial diagnosis (8,10). However they have recently been considered to have malignant potential.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and management of female adnexal tumor of probable Wolffian origin (FATWO) arising from ovary: a case report

Turkcapar¹,

Seckin²,

Güngör³

et al. 2013

J Turkish German Gynecol Assoc

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Female adnexal tumor of probable Wolffian origin (FATWO) is a rare neoplasm which is usually considered as benign, although in some cases metastasis or recurrences have been reported even after a long interval following the initial diagnosis. Preoperative diagnosis of FATWO is very difficult because of the rarity of the disease and the limited literature available. In this case report, we present a case of FATWO arising from the ovary and review the literature based on the clinical characteristics and management of this rare condition. A 51- year- old postmenopausal woman was referred to our clinic for evaluation of an adnexal mass. After diagnostic evaluation, the patient underwent explorative laparotomy. Intra-operatively, a solid- cystic mass was found in the right ovary, the rest of the abdomen and the pelvis were normal. The ovarian mass was removed and examined with frozen-section (FS). When the frozen section proved negative for malignancy, total abdominal hysterectomy and bilateral adnexectomy were performed. The anatomic study revealed a well-capsulated mass which was 3.5×1.5 cm in diameter. Based on pathological and immunohistochemical results, the final diagnosis was concluded to be FATWO. Adjuvant therapy was not administered. Te patient was followed up after discharge from the hospital. One year after surgery she was asymptomatic. No evidences of recurrence were observed throughout this period. Although FATWOs are rare tumors, they should be kept in mind in women with an abdominal mass. They can present diagnostic difficulties and the diagnosis is based on the exclusion of other neoplasms. FATWO has malignant potential, after the initial surgical treatment patients should be appropriately followed up for possible recurrence and metastasis.

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“…The presence of FATWO types exhibiting malignant potential in both young and old patients increases the need for defining more accurate diagnostic criteria to identify malignant Wolffian duct tumors. The presence of necrosis, capsular invasion, a high number of mitoses, cellular pleomorphism, and immunohistochemical positivity for CD117 and, probably, Ki-67 are the currently known properties of FATWO with malignant potential [10]. Recurrence or initial malignant behavior can occur in the absence of these negative prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

Female Adnexial Tumor of Probable Wolffian Origin (FATWO) without Ki-67 Expression Reflecting Low Malignant Potential in a 55-Year-Old Woman

Kahyaoğlu

Şirvan

Şengül

et al. 2012

EAJM

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Female adnexial tumors of probable Wolffian origin (FATWO) are rare tumors derived from the remnants of the mesonephric duct. These tumors generally exhibit a low malignant potential, but recurrence and or metastasis is possible during the course of the disease according to the tumors' possible malignant potential. We report a case of FATWO without estrogen and progesterone receptors and with negative immunostaining for Ki-67 (a proliferation marker) as a probable low-malignant-potential tumor. A 55-year-old woman presented with a complaint of heavy menstrual bleeding and pelvic pain. Preoperative ultrasonographic evaluation revealed an intramural uterine leiomyoma of 4 cm in diameter and a right adnexial solid mass measuring 5 cm in diameter. Following total abdominal hysterectomy and bilateral salpingo-oophorectomy, immunostaining based on the labeled streptavidin-biotin method was performed on sections from representative blocks of paraffin-embedded tissues sampled from the mass, revealing a low mitotic index with negative Ki-67 immunostaining. Immunohistochemical staining with promising new markers and pathological investigation of the entire tumor are needed to determine the malignant behavior of an individual FATWO. Ki-67 is a helpful marker for determining Wolffian duct tumors' potential malignant behavior.Key Words: FATWO, Immunostaining, Ki-67, Low malignant potential, Rare ÖzetMuhtemelen Wolff kaynaklı dişi adneksial tümörleri (FATWO) mezonefrik kanal artıklarından kaynaklanan nadir tümörlerdir. Bu tümör-ler genellikle düşük malign potansiyel gösterirler fakat olası malign davranışa göre rekürrensler ve/veya metazstaz da hastalığın gidişatı esnasında mümkümdür. Östrojen ve progesteron reseptörleri olmayan ve bu tip tümörler için düşük malign potansiyel özelliği olan Ki-67 proliferasyon işaretçisinin immün boyamada negatif olduğu bir FATWO olgusu sunuyoruz. Elli beş yaşında bir kadın ağır menstrüel kanama ve pelvik ağrı şikayeti ile başvurdu. Preoperatif ultrasonografik değerlendirme 4 cm uterin intramural myom ve sağ adnekste 5 cm çaplı solid bir kitleyi gösterdi. Total abdominal histerektomi ve bilateral salpingooforektomiyi takiben kitleden alınan doku örnekle-rinden hazırlanan parafin iliştirilmiş temsili bloklardan kesitler alına-rak işaretli streptavidin-biotin metodu bazlı immün boyama yapıldı ve Ki-67 ile immün boyanma göstermeyen düşük mitotik indekse sahip olduğu gösterildi. Hastanın fertilite isteğine bağlı olarak total abdominal histerektomi ve bilateral salpingooforektomi ile birlikte yapılan cerrahi debulking en uygun ilk cerrahi işlemdir. Bir FATWO hastasının malign davranışına karar vermeden önce yeni ümit verici işaretçilerle immünhistokimyasal boyanması ve tüm tümörün patolojik incelemesi gereklidir. Ki-67 Wolff kanalı tümörünün potansiyel malign davranışını tespit etmede yardımcı bir işaretçidir.

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Malignant female adnexal tumor of probable wolffian origin relapsing after pregnancy

Cited by 29 publications

References 6 publications

Recurrent female adnexal tumor of probable Wolffian origin treated with debulking surgery, imatinib and paclitaxel/carboplatin combination chemotherapy: A case report

Recurrent female adnexal tumor of probable Wolffian origin treated with debulking surgery, imatinib and paclitaxel/carboplatin combination chemotherapy: A case report

Diagnosis and management of female adnexal tumor of probable Wolffian origin (FATWO) arising from ovary: a case report

Female Adnexial Tumor of Probable Wolffian Origin (FATWO) without Ki-67 Expression Reflecting Low Malignant Potential in a 55-Year-Old Woman

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