Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2020; 8(19): 4488-4493
Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4488
Extremely rare case of successful treatment of metastatic ovarian undifferentiated carcinoma with high-dose combination cytotoxic chemotherapy: A case report
Hong Beum Kim, Hee Jeong Lee, Ran Hong, Sang-Gon Park
Hong Beum Kim, Department of Premedical Course, Chosun University School of Medicine, Gwngju 505717, South Korea
Hee Jeong Lee, Sang-Gon Park, Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju 505717, South Korea
Ran Hong, Department of Pathology, Chosun University Hospital, Gwangju 505717, South Korea
Author contributions: Kim HB contributed to manuscript drafting; Hong R confirmed the pathology; Park SG advised manuscript drafting; Lee HJ proofread and revised the manuscript as a corresponding author; all authors issued final approval for the version to be submitted.
Supported by the National Research Foundation of Korea, funded by the Ministry of Science, ICT, and Future Planning, No. NRF-2017R1D1A1B04031741; and grants from the Chosun University Hospital, No. 2019.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflict-of-interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hee Jeong Lee, MD, PhD, Assistant Professor, Doctor, Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwang-ju 505717, South Korea. hjangel21c@hanmail.net
Received: March 3, 2020
Peer-review started: March 3, 2020
First decision: July 25, 2020
Revised: August 9, 2020
Accepted: September 2, 2020
Article in press: September 2, 2020
Published online: October 6, 2020
Abstract
BACKGROUND

Ovarian undifferentiated carcinomas are significantly rare and have an aggressive clinical course. Surgical resection is the only curative treatment in early-stage ovarian undifferentiated carcinomas that has a favorable prognosis. In case of recurrent and metastatic disease, palliative chemotherapy is the only available treatment. However, the effectiveness of standard chemotherapy regimen is not well-known, specifically in the case of extra-ovarian spread. We report an ovarian undifferentiated carcinoma of recurrent and inoperable advanced stage that was successfully treated with high-dose combination chemotherapy.

CASE SUMMARY

A 52-year-old woman presented with a 1-mo history of right lower quadrant and epigastric pain. A computed tomography (CT) scan of the abdomen revealed a multicystic mass with extensive internal necrosis of the right ovary without evidence of metastatic disease. A total hysterectomy with bilateral salpingo-oophorectomy and omentectomy was performed, but the surgery had a positive resection margin. Pathologically, it was diagnosed as ovarian undifferentiated carcinoma with sarcomatoid change. Although adjuvant chemotherapy was planned, it was delayed for 6 wk because of postoperative recovery, and the patient complained of abdominal pain. A CT scan and positron emission tomography-CT revealed a huge mass with multiple nodules in the pelvic cavity and para-aortic lymph node metastasis. Instead of standard therapy such as paclitaxel and platinum, combined chemotherapy with etoposide, ifosfamide, and cisplatin was administered. The patient experienced no recurrence for 5 years.

CONCLUSION

This is a case of metastatic ovarian undifferentiated carcinoma with sarcomatoid change that was successfully treated with high-dose combination cytotoxic chemotherapy.

Keywords: Ovarian undifferentiated carcinoma, Sarcomatoid change, Chemotherapy, Etoposide, ifosfamide, cisplatin, Case report

Core Tip: Palliative chemotherapy is the only available treatment for metastatic ovarian undifferentiated carcinoma. However, we used a high-dose combination chemotherapy of etoposide, ifosfamide, and cisplatin instead of the widely used paclitaxel and platinum and successfully treated an extremely rare case of inoperable metastatic ovarian undifferentiated carcinoma.