Year : 2021 Month : December Volume : 10 Issue : 45 Page : 4065-4067,

Primary Carcinoid Tumour of Ovary Presenting with Severe Constipation - A Case Report

Nimi Shabeer1, Krishna G.2

1 Department of Pathology, Government Medical College, Thiruvananthapuram, Kerala, India.
2 Department of Pathology, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, Kerala, India.

CORRESPONDING AUTHOR

Dr. Krishna G., Professor, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram-695607, Kerala, India.
Email : drkrishnagovindan@gmail.com

INTRODUCTION

Carcinoid is an uncommon tumour in ovary comprising 0.1 % of primary ovarian neoplasms and 1 % of all carcinoid tumours. It was first described by Stewart et al. in 1939 following which many case reports have come out.1They usually occur in the peri-menopausal age. Primary ovarian carcinoids are usually unilateral, but can show a cystic teratoma or mucinous neoplasm in the same or opposite ovary. Histological variants include insular, stromal, trabecular, and mucinous among which insular is the most common type, and around 30 % of them are associated with a carcinoid syndrome. Insular type is reported to be more common in western countries, whereas trabecular / stromal cases are more reported in Asian countries. Most carcinoids in ovary are diagnosed as an incidental radiological finding as an abdominal or pelvic mass or they may present with typical carcinoid syndrome - diarrhoea, flushing, bronchospasm, oedema, increase skin pigmentation, carcinoid heart disease. Another uncommon presentation is severe constipation associated with peptide YY production in the tumour. The clinical behaviour of carcinoid ranges from indolent unrecognisable to highly active metastatic secretory tumours. Carcinoid ovary being an uncommon tumour presenting in an uncommon site with varied presenting features, clinical confusion may lead to delayed diagnosis and management for patient. This case report aims to describe the clinicopathologic features of primary carcinoid ovary presenting in a female with severe constipation.

PRESENTATION OF CASE

48-year-old female presented with complaints of constipation for 8 months in the surgery clinic. She has previous history of haemorrhoidectomy before one year. On evaluation, she was found to have abdomen swelling and ultrasound revealed a left ovarian complex cystic mass suggestive of dermoid cyst. Thyroid stimulating hormone (TSH) was normal and other tumour markers were within normal limits. Patient underwent total abdominal hysterectomy with bilateral salpingooopherectomy and was discharged on postoperative day 7. No adjuvant therapy was given; she underwent laparoscopic appendicectomy after 2 months. Patient is alive, cxv healthy and free of disease 21 months later.


Pathological Findings

On gross examination, left ovary appeared as an enlarged tense cystic mass measuring 6 x 5.5 x 4.5 cm filled with yellowish pultaceous material admixed with hair. No solid areas were identified. Uterus showed multiple fibroids, both tubes were normal. Right ovary appeared mildly enlarged and cystically tense, cutting open clear straw colour fluid was let out. A yellowish homogenous lobulated solid area measuring 2.5 x 2.5 x 3 cm was identified.

Microscopically, left ovarian cystic mass showed cyst wall with lining by stratified squamous epithelium with adipose tissue, hair follicles and sebaceous glands. Right ovary showed a neoplasm composed of cells arranged predominantly in ribbons, cords, trabeculae separated by fibrous septa. Individual cells had moderate to abundant eosinophilic cytoplasm, round vesicular nucleus, stippled chromatin. There was no evidence of a carcinomatous or teratomatous element in the right ovary. Immunohistochemically tumour cells were strongly positive for synaptophysin and neuron specific enolase. Chromogranin was found to be negative. A diagnosis of carcinoid tumour in right ovary and mature cystic teratoma in left ovary was given. After clinical discussion, an appendicectomy was done for the patient after 2 months to rule out the possibility of a metastatic carcinoid from appendix, but the appendix showed normal histology.