1/26. Endometrial carcinoma presenting as hematometra mimicking a large pelvic cyst.Large pelvic cysts are commonly seen in gynecologic practice; their heterogeneous origin is reflected in their pleomorphic clinical features. We report the case of a 64-year-old multiparous postmenopausal woman with an unusual manifestation of endometrial adenocarcinoma that presented as hematometra mimicking a large pelvic cyst. In this case, hematometra was well demonstrated by transabdominal sonography, but transvaginal sonography allowed better visualization of the endometrial lining and suggested the correct diagnosis of endometrial cancer. Abnormal vaginal bleeding or hematometra in postmenopausal women should lead to assessment of the endometrial mucosa. Transvaginal sonography can be used to visualize neoplastic lesions in the endometrium when hematometra is detected through transabdominal sonography.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
2/26. Large pelvic accessory spleen mimicking an adnexal malignancy in a teenage girl.A large pelvic accessory spleen in a teenage female is rare and may be misdiagnosed as an adnexal tumor. A 17-year-old girl, gravida 0, had suffered from intermittent and dull pain in the lower abdomen for 1 month. Laboratory evaluation showed a low platelet count (136,000/microL). Abdominal sonography showed a large solid mass situated at the right pelvis, containing abundant vascular supply with low resistant blood flow. At laparotomy, an accessory spleen fed by a tortuous vascular pedicle from the omentum was found and then excised. Histopathologic examination revealed congestive accessory splenomegaly. Follow-up platelet count returned to normal levels (374,000/microL). The importance of including accessory spleen in the differential diagnosis of a solid adnexal tumor with thrombocytopenia is emphasized.- - - - - - - - - - ranking = 16.697160493827keywords = spleen (Clic here for more details about this article) |
3/26. Elevated serum cancer antigen 125 levels in advanced abdominal tuberculosis.A 48-yr-old female presented with a 1-yr history of pain in the hypochondrium and epigastrium. All routine investigations and computed tomography (CT) of the abdomen were done. CT findings revealed a well-defined cystic mass in the right ovary, and ascitis with features suggestive of secondaries over the omentum and peritoneal surface. The serum CA125 was 1255 U/mL (normal range 0-35 U/mL), which was indicative of ovarian malignancy. An exploratory laparotomy was performed. Histopathological examination of organs revealed the presence of granuloma. The patient was advised to undergo antitubercular treatment (ATT) and follow-up every month. After 1 mo of ATT, the CA125 level came down to 42 U/mL, which was near normal. As tuberculosis requires only a conservative management, we suggest that in cases of abdominopelvic mass with or without ascitis, high serum CA125 should always raise a suspicion of tuberculosis and a laparoscopy combined with peritoneal biopsy should be performed to confirm the diagnosis. This will prevent unnecessary laparotomies. Moreover, serum CA125 can be used to monitor the response of disease to antitubercular treatment.- - - - - - - - - - ranking = 4keywords = cancer (Clic here for more details about this article) |
4/26. Extensive pelvic endometriosis with malignant change in tamoxifen-treated postmenopausal women.The aim of this study was to document a case of tamoxifen-associated extensive pelvic endometriosis and attract the attention to this side effect of tamoxifen use in the postmenopausal patient. A 74-year-old woman with a history of breast carcinoma who received tamoxifen therapy for 2 years was admitted with uterine bleeding. Hysteroscopic polypectomy revealed a hyperplastic polyp. Extensive pelvic endometriosis was detected at the operation and due to dense adhesions, subtotal hysterectomy and bilateral salpingo-oophorectomy were performed. The patient continued to use tamoxifen. A supracervical pelvic mass was detected 14 months later. The cervix, rectum, and the accompanying mass were resected. Histopathologic examination revealed endocervical adenocarcinoma and endometriosis involving cervix uteri and the rectal muscular wall. The patient had two normal cervical smears within the last 3 years and no abnormal appearance was detected within the cervical canal in the hysteroscopic examination. As cervical cancer occurred in a short period, it might be speculated that tamoxifen might have stimulated the proliferative and mitotic activity of cervical endometrial tissue which has progressed into invasive cancer in time.- - - - - - - - - - ranking = 2keywords = cancer (Clic here for more details about this article) |
5/26. Four ovarian cancers diagnosed during laparoscopic management of 1011 women with adnexal masses.OBJECTIVES: This study was conducted to assess the value of laparoscopic management of adnexal masses. Two concerns we wish to address are the failure to diagnose early ovarian cancer at laparoscopy and worsening the prognosis of stage I cancer by spilling fluid during surgery. STUDY DESIGN: The setting is a predominantly referral-based, private subspecialty practice. All operations were preformed in the outpatient surgical suite of a large suburban hospital. After extensive patient screenings, which included history and physical examination, preoperative serum CA 125 levels (since 1988), and pelvic ultrasonography, 1209 adnexal masses were managed laparoscopically. RESULTS: Of 1011 patients with surgical management, ovarian cancer was discovered intraoperatively in four. CONCLUSIONS: Our findings indicate that with consistent use of frozen sections of all cyst walls and suspicious tissue, laparoscopic management did not alter the prognosis. Neither CA 125 level, pelvic ultrasonography, nor peritoneal cytologic testing had sufficient diagnostic specificity to predict malignancy. Experienced surgeons using intraoperative histologic sampling may safely evaluate adnexal mass laparoscopically.- - - - - - - - - - ranking = 7keywords = cancer (Clic here for more details about this article) |
6/26. Genital and peritoneal tuberculosis: potential role of laparoscopy in diagnosis and management.Genital and peritoneal tuberculosis are rare in developed countries and can mimic ovarian cancer. We report two different cases that came to our attention, both in a month. The first patient was referred to us for an asymptomatic pelvic mass. The second patient came to us because of weight loss, abdominal swelling, and ascites. Unfortunately, the imaging findings were misleading, and the laboratory analyses were not helpful. Only the laparoscopic approach was useful for final diagnosis. We conclude that the symptoms of abdominal tuberculosis vary greatly, and laparoscopy can be essential for its diagnosis and management.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
7/26. Appendiceal mucocele: a rare differential diagnosis of a cystic right adnexal mass.CASE REPORT: We present the case of a 42-year-old woman with an incidental finding of a large right adnexal mass during pelvic ultrasound scan for a spontaneous miscarriage. Ultrasound suggested the mass was ovarian in origin and serum Ca125 was normal. laparotomy, however, revealed normal ovaries with no ovarian pathology. The right adnexal mass was appendiceal in origin and was delivered intact with no spillage. histology confirmed a diagnosis of mucinous cystoadenoma of the appendix. DISCUSSION: Pre-operative diagnosis of this condition is difficult. Various radiological tools including CT scans, MRI, and ultrasound scans have been used with poor results. Pre-operative diagnosis would be useful, as extra measures could be taken to avoid intra-peritoneal rupture during surgery with the consequent development of pseudomyxoma peritonei. For a similar reason, needle aspiration should be avoided. In malignant cases co-existing ovarian neoplasm must be excluded as this will be present in 2-24% of cases. Simple appendicectomy is curative in uncomplicated, unruptured cases. CONCLUSION: Although relatively rare, appendiceal tumours should be considered in women who present to gynaecologists with a right adnexal mass.- - - - - - - - - - ranking = 1.530915217939keywords = neoplasm (Clic here for more details about this article) |
8/26. Endometrioid carcinoma of the fallopian tube resembling an adnexal tumor of probable wolffian origin: a report of six cases.Six adenocarcinomas of the fallopian tube that resembled the female adnexal tumor of probable wolffian origin are described. The tumors, which occurred in patients from 38 to 66 (average 55) years of age, typically formed intraluminal masses. One was an incidental finding on microscopic examination. On microscopic examination, the tumors were characterized by a predominant pattern of small, closely packed cells punctured by numerous glandular spaces, which were typically small but occasionally were cystically dilated. Many of the glands contained a dense colloid-like secretion that was positive with the periodic acid-Schiff stain. Small amounts of intracellular mucin were present in all cases. In the solid areas of three cases, spindle cells that focally formed concentric whorls were present. In all cases, small numbers of tubular glands typical of endometrioid adenocarcinoma were identified. The cytologic atypia and mitotic activity of the tumors were variable, but they exceeded that usually seen in wolffian duct tumors. The evidence indicates that this neoplasm represents an unusual form of endometrioid adenocarcinoma. It is important that it is distinguished from a tumor of wolffian duct origin.- - - - - - - - - - ranking = 1.530915217939keywords = neoplasm (Clic here for more details about this article) |
9/26. female adnexal tumor of probable wolffian origin: morphological, immunohistochemical, and ultrastructural study with c-kit gene analysis.female adnexal tumors of probable wolffian origin (FATWO) are rare neoplasms believed to originate from mesonephric (wolffian) remnants. Rarity and variable location of FATWO make the diagnosis difficult. Although most cases follow a benign clinical course, approximately 10% of them either recur or metastasize and are thought to be resistant to chemoradiation therapy. In 2004, imatinib therapy, a tyrosine kinase inhibitor known to be effective against gastrointestinal stromal tumors, was reported to be effective also in a case of KIT-positive FATWO. However, c-kit gene mutations in FATWO have never been studied. Herein is reported the case of a 50-year-old Japanese woman with FATWO arising in the right paratubal site. The tumor had typical characteristics of FATWO in both morphology and immunohistochemistry. KIT protein was diffusely and weakly expressed, but dna analysis revealed no mutational change in exon 9 or 11 of the c-kit gene. It is believed that accumulation of such genetic data of FATWO are essential from a therapeutic standpoint, although the present case had no mutation. In addition, the cytological features of this rare tumor are presented, which have not been described previously.- - - - - - - - - - ranking = 1.530915217939keywords = neoplasm (Clic here for more details about this article) |
10/26. skin adnexal neoplasm closely resembling adenomatoid tumor: a unique occurrence.We describe a primary skin neoplasm located in the left chest wall that closely resembled adenomatoid tumor of male and female genital tract. It occurred in a 52-year-old woman who had undergone a left quadrantectomy with regional lymphadenectomy for invasive ductal carcinoma of the breast 7 years previously. The tumor involved the dermis and subcutaneous tissue and measured 0.7 cm in greatest diameter. Immunohistochemical evaluation showed strong positivity for cytokeratin pool and negativity for CD31, calretinin, WT-180, and for estrogen and progesterone receptors. We are unaware of a previous description of this morphologic pattern in a primary skin tumor, which we have interpreted as of skin adnexal and specifically of eccrine sweat gland origin.- - - - - - - - - - ranking = 7.6545760896951keywords = neoplasm (Clic here for more details about this article) |
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