1. Introduction

Primary ovarian carcinoid tumor is a very rare type of ovarian germ cell neoplasm. It constitutes about <0.1% of all ovarian malignancies. Gastro intestinal tract and lungs are the most common site for carcinoid tumor [1]. Carcinoid tumor can present with four different types of histopathology, which are Insular, trabecular, strumal and mucinous. The most common presentation is of insular pattern (26-53%) [2] but clinical carcinoid syndrome is usually associated with trabecular type and it also has a favorable prognosis. We are reporting a case of primary trabecular type of ovarian carcinoid tumor.

2. Case Report

A 44-year-old lady presented to the department of Delhi with complaints of pain in lower abdomen for 1 year. On examination, a 18-20 weeks mass was felt in lower abdomen, firm to hard in consistency and lower limit of mass could not be reached. Her general physical examination and Obstetrics and Gynaecology, Lok Nayak Hospital, New routine investigation revealed no abnormality. Ultrasonography showed a normal size uterus with an irregular cystic mass of 17x12 cm in left adnexa with echogenic fluid and few septae. Left ovary could not be identified separately. Right ovary was normal. Serum CA-125 was 30 U/ml. On MRI, a large solid cystic mass of 14.3x10x14 cm was seen with incomplete septations and thick enhancing wall. This mass was closely abutting the left broad ligament and adnexa. On staging laparotomy, a 15x10 cms ovarian mass was present on left side, solid in consistency with few septations. This ovarian mass was sent for frozen section, which reported as malignant epithelial neoplasm of ovary. Therefore, total abdominal hysterectomy, bilateral salpingoopherectomy, bilateral pelvic and paraaortic lymphadenectomy with infracolic omentectomy was performed. Patient was stable post operatively. Final histopathology report revealed unremarkable uterus and cervix with trabecular carcinoid of left ovary. Microscopic picture of the ovarian cyst showed a tumor in form of nests, trabeculae and ribbons. The cells were monomorphic, bland appearing elongated with abundant granular eosinophilic cytoplasm with a centrally placed elongated nucleus and stripped nuclear chromatin. Mitotic activity was less than 1/10. Further immunohistochemistry showed a strong expression of symptophysin and focal expression of chromogranin and cytokeratin. Tumor cells were negative for inhibin and calretinin. Ovarian capsule was free of tumor involvement. Patient was investigated for carcinoid elsewhere in the body which included upper, lower GI endoscopy, CECT chest, USG whole abdomen and TFT. All reports were found to be normal. Final diagnosis of ovarian carcinoid tumor stage IA was made. Adjuvant chemotherapy was not planned as patient is stage IA. Patient is currently under follow up without any symptoms and signs of recurrence.

3. Discussion

Primary ovarian carcinoid tumor is rare ovarian neoplasm, constituting <0.1% of all ovarian neoplasm. It commonly occurs in peri-menopausal and postmenopausal age group [3]. Primary ovarian carcinoid is more common as compared to secondary ovarian carcinoid, which is usually secondary to gastrointestinal carcinoid. Primary ovarian carcinoid is mostly associated with mature cystic teratoma. Ovarian carcinoid either presented with abdominal mass or features of carcinoid syndrome, eg episodic cutaneous flushing, cyanosis, abdominal cramps, diarrhea, carcinoid heart disease. Surgery is the mainstay of treatment for ovarian carcinoid [4]. Role of chemotherapy is not very well defined for it. And our patient was also staged as stage 1A and not given adjuvant chemotherapy and patient had not shown any signs of recurrence.

Histopathology slides

Figure 1