78 y/o female admitted for vague abdominal pain and increasing abdominal girth. Initial imaging work-up revealed bilateral adnexal masses, right larger than left. No significant pelvic adenopathy. Laparoscopic right salpingo-oophorectomy revealed poorly differentiated Sertoli-Leydig cell tumor confined to the right ovary. Right fallopian tube is negative for involvement.
Is this reportable?
Here are my thoughts…
Sertoli-Leydig cell tumor of the ovaries is not reportable. However, if poorly differentiated, it has a behavior code of /3, making it reportable. Patient was scheduled for completion total hysterectomy and left salpingo-oophorectomy as planned first course of treatment. Pathology of the left ovary revealed carcinoid tumor. Endometrium, myometrium, cervix and left fallopian tube were all negative for involvement. No tumor deposits seen. 00/08 bilateral pelvic lymph nodes.
Is this a second primary?
Carcinoid tumors of the ovary are uncommon, accounting for only 0.3% to 1% of all carcinoid tumors. Primary carcinoid tumors of the ovary are divided into insular, trabecular, strumal and mucinous types. The insular type is most common, followed by the strumal type. The majority of primary ovarian carcinoids occur in association with mature cystic teratoma (non-reportable), but a considerable number present in pure form. Primary carcinoids of the ovary are invariably unilateral. They form a solid nodule within a cystic teratoma, or when pure, a solid yellow-grey mass and vary from microscopical to large tumors measuring in excess of 20 cm in the longest diameter. The metastatic carcinoids are nearly always bilateral and scattered tumor deposits are present throughout both ovaries. Primary ovarian carcinoids metastasize only occasionally.
Without metastasis, primary ovarian carcinoids should be treated as ovarian tumors of low malignant potential.
Since ovarian tumors of low malignant potential is not a reportable cancer according to Massachusetts State reportability requirements, this is not a second primary. However, in other States, ovarian tumors or low malignant potential are reportable by agreement. If your hospital requires incidence counts of ovarian tumors of low malignant potential (by agreement), abstract the case but do not send to the Massachusetts State Registry.
Therefore, report only the right ovarian poorly differentiated Sertoli-Leydig cell tumor. Since ovarian tumor of low malignant potential is not reportable to the Massachusetts State Registry, the left ovarian primary carcinoid tumor is not considered a second primary.
Seq 00 – Right ovary with PD Sertoli Leydig cell tumor with morphology code of 8631/33.