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case_images: Whole abdomen CT (a-c) and radionuclide bone scintigraphy (d-f). (a) Plain abdominal CT scan. Arrows indicate two enlarged ovarian tumors with uneven density at two sides of the uterus. (b) Enhancement phase of full abdominal CT. The boundary and solid portion of the two ovarian tumors are enhanced in the arterial phase. (c) Bone window showed a discontinuous border and soft tissue density mass in front of the sacral promontory, indicating lesion invasion. (d-f) Radionuclide bone scintigraphy also showed focal radionuclide concentration of the first sacrum at transverse and median sagittal and coronal sections.
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case_images: Radionuclide bone scintigraphy showed focal radionuclide concentration of the first sacrum (Figure 1).
case_images: Bilateral ovarian masses (a and b) and their microscopic appearance (c and d). Gross appearance of the ovarian tumors. (a) Left ovarian tumor showing a solid mass. (b) Right ovarian tumor showing a solid mass with apparent necrosis. (c and d) Tissues stained with hematoxylin and eosin. (c) Tumor growth was in sheets and nests in which spotted and focal necrosis were observed (100x). (d) Tumor cells were mainly small, with scant cytoplasm; round to spindle-shaped hyperchromatic nuclei with inconspicuous nucleoli (400x).
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case_images: Most of the tumor cells were small- or medium-sized with scant cytoplasm, and round or spindle-shaped hyperchromatic nuclei with inconspicuous nucleoli (Figure 2).
case_images: Immunohistochemical staining of tumor tissue. All original magnifications, 400x. Top row, left to right: CK(AE1/AE3), with dot-like pattern (x400); CgA, tumor cells were negative for CgA; Syn, tumor cells were weakly positive for synaptophysin; CD56, tumor cells were positive for CD56; TTF-1, tumor cells were positive for TTF-1. Bottom row, left to right: Ki67, tumor cells were positive for Ki67 with a positive rate of 60%; CK20, tumor cells were negative for cytokeratin 20. PAX-8, tumor cells were negative for PAX-8; ER, tumor cells were negative for estrogen receptor; PR, tumor cells were negative for progesterone receptor.
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case_images: Immunohistochemical staining showed the following: CK (AE1/AE3) (focal positive), CgA (-), synaptophysin (weak +), CD56 (+), TTF-1 (+), Ki67 (60%), cytokeratin 20 (-), paired box-8 (PAX-8) (-), estrogen receptor (-), and progesterone receptor (-) (Figure 3).