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case_images: Gross appearance of tumors A and B at laparotomy. Tumor A was composed of yellowish exophytic nodular excrescences, and the adjacent tumor B showed white exophytic papillary excrescences.
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case_images: Laparotomy revealed the adherence of the right fallopian tube to the right ovary and the presence of exophytic papillary excrescences on the surface of the right ovary (tumors A and B in Fig. 1).
case_images: Tumor A. Hematoxylin and eosin (H&E) stain showing exophytic papillary growth composed mostly of a flat proliferation of cells (panel A; x 200) and mild unclear atypia of the lesional cells (panel B; x 400). Immunohistochemical staining of Ki-67 expression. The Ki-67 proliferation index of the tumor cells was 20% (panel C; x 200). Immunohistochemical staining showing the patchy expression of p53 (panel D; x 200).
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case_images: Histopathology revealed tumor A to be an atypical proliferative (borderline) serous tumor with tubal type epithelium containing a mixture of ciliated and secretory cells (Fig. 2, panels A and B). Immunohistochemical analysis of tumor A showed patchy p53 positive staining and a Ki-67 proliferative index of 20% (Fig. 2, panels C and D).
case_images: Tumor B. H&E stain showing complex papillary growth consisting of stratified atypical tumor cells (panel A; x 40) and exophytic growth of heterogeneous tumor cells with high-grade nuclear atypia, stratification, loss of polarity, and absence of stromal invasion (panel B; x 200). Immunohistochemical staining of Ki-67 expression. The Ki-67 proliferation index of the tumor cells was 55% (panel C; x 200). Immunohistochemical staining showing the patchy expression of p53 (panel D; x 200).
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case_images: Therefore, serous carcinoma in situ was our final diagnosis, which was confirmed by intradepartmental reviews and extradepartmental consultations (Fig. 3, panels A and B). Tumor B stained more diffusely and strongly for p53 and Ki-67 (proliferative index, 55%) than tumor A (Fig. 3, panels C and D).