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Obstetrics & Gynecology 2002;100:1129-1133
© 2002 by The American College of Obstetricians and Gynecologists
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CASE REPORTS

Metastatic Endocervical Adenocarcinoma Presenting as a Virilizing Ovarian Mass During Pregnancy

John L. Powell, MD, Kimberly A. Bock, MD, Jason K. Gentry, MD, Warren C. White, MD and Brigitte M. Ronnett, MD

Departments of Obstetrics & Gynecology and Pathology, New Hanover Regional Medical Center, Coastal Area Health Education Center, Wilmington, North Carolina; and Departments of Pathology and Gynecology & Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland

Address reprint requests to: John L. Powell, MD, Director of Gynecologic Oncology, Coastal Area Health Education Center, PO Box 9025, Wilmington, NC 28402-9025; E-mail: john.powell{at}coastalahec.org.

ABSTRACT

BACKGROUND: We report a case of metastatic endocervical adenocarcinoma that presented as a virilizing ovarian mass in a young pregnant woman and simulated a primary ovarian endometrioid tumor.

CASE: A 34-year-old woman underwent cesarean delivery and right salpingo-oophorectomy at 34 weeks’ gestation for a 32-cm androgen-producing ovarian mass. The ovarian tumor, initially interpreted as a primary ovarian endometrioid carcinoma, was demonstrated to represent metastatic endocervical endometrioid adenocarcinoma based on detection of human papillomavirus 16 (HPV-16) deoxyribonucleic acid in the tumor by in situ hybridization. The hysterectomy specimen demonstrated an endocervical adenocarcinoma associated with adenocarcinoma in situ that also contained HPV-16.

CONCLUSION: Human papillomavirus is considered an etiological agent in the development of endocervical adenocarcinomas, having been demonstrated in greater than 90% of tumors. In contrast, recent studies have concluded that HPV is unlikely to play an etiological role in ovarian neoplasia. The demonstration of HPV-16 in both the endocervical and ovarian carcinomas in this patient supports the interpretation that the ovarian tumor is a metastasis.






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