BackgroundTumor-to-tumor metastasis (TTM) is a rare but well-established phenomenon where histologically distinct tumors metastasize within each other. Here we report the first “known” case of follicular lymphoma that metastasized and extended to a mature ovarian teratoma.Case
presentationA
59-year-old Japanese postmenopausal woman visited our hospital for a detailed
examination of an ovarian tumor. Clinical imaging suggested it to be either
teratoma-associated ovarian cancer with multiple lymph node metastases, or
tumor-to-tumor metastasis from malignant lymphoma to ovarian teratoma. A
bilateral adnexectomy and retroperitoneal lymph node biopsy were performed.
Lined with squamous epithelium, the cyst constituted a mature ovarian teratoma,
and the solid part showed diffuse proliferation of abnormal lymphoid cells.
Immunohistochemically, the abnormal
lymphoid cells were negative for CD5, MUM1, and CyclinD1, and positive
for CD10, CD20, CD21, BCL2, and BCL6. Genetic analysis using G-banding and
fluorescence in situ hybridization identified a translocation of t(14;18)
(q32;q21), and we diagnosed tumor-to-tumor metastasis from nodal follicular lymphoma
to mature ovarian teratoma. Twelve months after surgery, the patient showed no
progression without adjuvant therapy.ConclusionsThe present case suggests that
molecular approaches are useful in the diagnosis of TTM in mature ovarian
teratomas when morphologic and immunohistochemical findings alone are insufficient
for diagnoses.