Long survival in papillary serous cystadenocarcinoma of ovary with sarcoid-like granulomas—an immunological phenomenon?

A patient 22 years old when right ovarian enlargement was first detected survived 13 years, latterly with unresected, peripherally calcified, bilateral papillary serous cystadenocarcinoma (psc). At laparotomy 3sol12 years before death, peritoneal metastases were rich in calcospherites. Two years before death, cervical lymph node biopsy revealed sarcoid-like granulomas about which microscopic metastases of psc were fibrosing. Death resulted from ureteral obstruction causing uremia; the ovarian neoplasms were sharply circumscribed within pelvis and lower abdomen. At autopsy, enlarged cervical, mediastinal and abdominal lymph nodes were diffusely fibrosed, with calcospherites and Schaumann bodies deemed to represent regressed neoplasm and end-stage sarcoid-like granulomas. Viable ‘mini-metastases’ occupied foci in one mediastinal lymph node. Pulmonary interstitial fibrosis enclosed Schaumann bodies and calcospherites appearing as relics of sarcoid-like granulomas and defunct metastases. Reaction to tumor antigen may evoke sarcoid-type granulomas. Specific antigens can arise from psc. The apparent suppression of carcinomatosis with long survival accompanied by sarcoid-like granulomas was attributed to host reaction to neoplasm in which abundant calcospherites appeared as hallmarks of regression. Should calcospherite formation reflect immune reaction to neoplasm, immunosuppressants might aggravate growth of calcospherite-rich psc, for which adversity radiodensities in neoplastic tissues should offer warning.