General thoracic and cardiovascular surgery cases
Müllerian-type high-grade serous carcinoma presenting exclusively with pleural lesions and no detectable abdominopelvic primary tumor: a case report
By Kaneko Y, Yanagawa N, Tomoyasu M and 7 others.
Abstract
Background
Müllerian-type high-grade serous carcinoma (HGSC) most commonly originates from the fallopian tube, ovary, or peritoneum and usually presents with abdominopelvic disease. Thoracic presentation without a detectable abdominopelvic primary tumor is extremely rare and poses a diagnostic challenge.
Case presentation
We report the case of a 60-year-old woman who was referred to our hospital after pleural thickening was detected during a routine medical checkup. Chest computed tomography (CT) revealed left pleural thickening with mild pleural effusion. Thoracoscopic pleural biopsy was performed. Histopathological examination demonstrated spindle-shaped cells with mild nuclear atypia, with scattered calcifications and osteocyte-like elements. Immunohistochemical staining showed positivity for PAX8, WT-1, AE1/AE3, CK7, p16, and p53, and negativity for calretinin, D2-40, TTF-1, and Napsin A, supporting a Müllerian-type HGSC. Diagnostic/staging laparoscopy with bilateral salpingo-oophorectomy revealed no macroscopic tumor or disseminated lesions. Both ovaries and fallopian tubes were carefully examined pathologically, with the fallopian tubes examined using the SEE-FIM protocol. No malignant lesion or serous tubal intraepithelial carcinoma (STIC) was identified. Peritoneal washing cytology was negative. p53 and Ki-67 immunohistochemistry of the tubo-ovarian specimens was not performed.