Transitional cell carcinoma (TCC) of the ovary is a recently recognized subtype of ovarian surface epithelial cancer. It was first defined by Austin and Norris.1 In addition to not having a benign Brenner tumor (BT) component, TCC lacks the prominent stromal calcification. The true incidence of TCC of the ovary remains unknown. Patients with TCC have better prognosis compared with patients with all other types of ovarian carcinomas following cisplatin-based chemotherapy.
A 44-year-old woman presented with gradual abdominal distension and loss of weight of 6-month duration. On examination, she had ascites. Abdominal ultrasound and computed tomography showed bilateral ovarian masses, suggestive of ovarian malignancy. There was no evidence of abnormal lymphadenopathy. Urinary bladder was normal. Her routine investigations were within normal limits. Peritoneal fluid analysis was negative for malignant cells. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and infracolic omentectomy were performed. Uterus with cervix measured 6 × 4 × 2.5 cm. Cut section showed patent endocervical canal with uterine wall measuring 2 cm. The left ovary measured 8 × 7 × 4 cm and the right ovary 4 × 3 × 2 cm. Cut section showed solid and cystic areas (Fig. 1). Microscopically, endometrium showed proliferative phase; myometrium adenomyosis; and cervix, chronic nonspecific cervicitis with papillary endocervicitis. Both the ovarian masses showed similar features – papillae lined by malignant transitional epithelium. The cytoplasm of the cells was pale and granular. Nuclei were oval, vesicular, and showed nucleoli (Fig. 2). Search was made for benign Brenner component, which was not evident. Omentum did not show any malignant deposits. A diagnosis of TCC involving both ovaries was given, with International Federation of Gynecology and Obstetrics staging stage Ib, grade III. The patient was referred to the oncology center for chemotherapy.
The TCC of the ovary is a recently recognized subtype of ovarian surface epithelial cancer. These tumors are rare and account for 1 to 2% of all surface epithelial tumors of the ovary. Ovarian tumors containing cells with transitional cell morphology are recognized in the 1990 World Health Organization classification and include benign BT, borderline and malignant BT, and TCC.2 Karnezis et al3 reported transitional cell-like growth in 10 tumors (14%), out of 71 ovarian endometrioid carcinoma, which did not appear to independently affect patient outcome. Common presenting symptoms of TCC of ovary are abdominal pain, abdominal swelling or distension, and weight loss. Occasionally, uterine bleeding, back pain, and bowel or urinary symptoms can occur. Microscopically, it shows undulating, diffuse, insular, and trabecular growth patterns.4 Our case showed large blunt papillae, which was also observed by Eichhorn and Young5 in 63% of their cases.
Primary TCC of ovary needs to be differentiated from metastatic TCC from urinary bladder. Logani et al2 used urothelial markers to distinguish between these two. The TCC of the ovary was cytokeratin (CK) 20 –ve, Uroplakin III (URO III) –/+, Wilm’s tumor protein (WT1) +, while invasive TCC of bladder metastatic to ovary were CK20 +, URO III +/–, and WT1–. Austin and Norris have concluded that ovarian TCC arises from the pluripotent surface epithelium of the ovary and from cells with urothelial potential, rather than from a benign or proliferative BT precursor. Cancer antigen 125 was positive in all malignant BTs and TCCs, but not in benign and borderline tumors. Surgical resection is the primary therapeutic approach, and patient outcomes after chemotherapy are better than for other types of ovarian cancer.6
Here, we report the rare occurrence of primary TCC involving both the ovaries. Extensive literature search did not reveal reports of bilateral involvement.