SIGNET-RING CELL-CARCINOMA OF BOTH OVARIE S OF UNKNOWN ORIGIN IN AN 18-YEAR-OLD PATIENT - ATTEMPT OF AN IMMUNOTHERAPY WITH THE MONOCLONAL-ANTIBODY-B72-3

We report on the case of an eighteen-year old female patient with lymp hedema of both legs. Lymphography showed a secondary lymphedema and en larged inguinal lymph nodes. Computed tomography of the pelvis reveale d ovarian tumors of approximately 6 cm diameter. Histological examinat ion of both ovaries removed by laparotomy showed a stromal infiltratio n of cancer cells of the signet ring cell type. The histological, immu nohistochemical and clinical aspects of the signet ring cell cancer of the ovaries are discussed. An effective systemic therapy of this dise ase is not available so far. Since elevated plasma levels of the tumor marker CA 72-4 and the corresponding tumor-associated antigen TAG 72- 2 on tumor cells analysed immunohistochemically were present, radioimm unotherapeutic approach was attempted. For this purpose the murine mon oclonal antibody B72-3 labelled with In III was applicated intravenous ly in a test dose. An enrichment of the radiolabelled monoclonal antib ody could not be visualized, neither by planar scintigraphy nor by SPE CT. Therefore, the unlabelled monoclonal antibody was applicated twice . By means of radio and enzyme immunoassays the concentration of HAMA and CA 72-4 in the serum of the patient were determined during the cou rse of therapy. The serum levels of the HAMA increased twentyfold in c omparison to the concentration before therapy. In May 1994, a thrombos is of the right leg and pelvis and a malignant pleural effusion on bot h sides appeared. Therefore the patient was treated by polychemotherap y with Leucovorin and 5-FU. Staging examinations made in June 1994 sho wed no tumor except an enlargement of the upper mediastinum and pleura l effusions on both sides. The patient died on 16 September 1994, 15 m onths after the operation and 21 months after the first symptoms had a ppeared. No autopsy was performed.