A 52-year-old woman with a 15-year history of laparoscopically confirmed endometriosis develops pelvic pain and a complex left adnexal mass. Surgery reveals a large chocolate cyst with mural nodules, and histology shows malignant glands lined by hobnail cells with abundant clear cytoplasm. Which ovarian carcinoma is this, and why does its recognition matter therapeutically?
- A Clear cell carcinoma, relatively chemoresistant with higher thromboembolic risk ✓
- B High-grade serous carcinoma, responds well to platinum chemotherapy
- C Endometrioid carcinoma, always low grade and indolent
- D Mucinous carcinoma, treated primarily with hormonal therapy
Correct answer: A. Clear cell carcinoma, relatively chemoresistant with higher thromboembolic risk
Explanation
Clear cell carcinoma is strongly linked to endometriosis, with malignant transformation estimated at around 1 percent of endometriotic cysts, and shows hobnail cells and tubulocystic architecture. It behaves aggressively despite early-stage presentation because it is relatively resistant to platinum-based chemotherapy and carries a marked predisposition to venous thromboembolism. Serous carcinoma is unrelated to endometriosis, arising from fallopian tube epithelium.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.