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1/15. A case of biliary cystadenocarcinoma of the liver.

    We describe a case of biliary cystadenocarcinoma of the liver, a very rare malignant tumor, in a 40-year-old man referred to our hospital because of sporadic abdominal pain. A left lobectomy of the liver was performed, and macroscopic examination of the resected specimen revealed prominent papillary projections in a multiloculated cystic tumor containing mucinous material. Histologic examination of the specimen showed a biliary cystadenocarcinoma without mesenchymal stroma, associated with a cystadenoma. cystadenoma with mesenchymal stroma (CMS), which occurs exclusively in women, is generally regarded as a precancerous lesion, and patients with biliary cystadenocarcinoma with mesenchymal stroma have a good prognosis. cystadenoma without mesenchymal stroma arises in both men and women. However, the origin and precancerous lesions of cystadenocarcinoma are unknown. Moreover, the prognosis of patients with biliary cystadenocarcinoma without mesenchymal stroma is poor, especially in men. The cystadenoma without mesenchymal stroma in our patient was considered a precancerous lesion. The present patient has shown no evidence of recurrence in the 8 years after hepatic resection. Previously reported cases of cystadenocarcinoma without mesenchymal stroma, especially those in men, have had a poor outcome. A good outcome in men is very rare.
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ranking = 1
keywords = cystadenoma
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2/15. Synchronous mucinous tumors of the ovary and the appendix associated with pseudomyxoma peritonei: CT findings.

    BACKGROUND: To present the computed tomographic (CT) findings of synchronous mucinous tumors of the ovary and the appendix associated with pseudomyxoma peritonei (PMP). methods: Imaging studies, mainly abdominal CT scans, of three women aged 49-75 years were reviewed. attention was directed to the ovarian masses, peritoneal seeding, and the presence of an appendiceal mucocele. RESULTS: The ovarian tumors and the appendiceal mucocele were clearly demonstrated in two cases, and they were part of the extensive PMP in the third patient. ascites was found in all cases, with internal septation in one. Associated scalloping of the liver margins and hypodense peritoneal implants, with extensive bowel involvement, were seen in another one. Pathologically, there was one case of right ovarian mucinous cystadenoma and villous adenoma of the appendix, one case of right ovarian and appendiceal mucinous cystadenocarcinoma, and one case of bilateral metastatic ovarian implants of appendiceal mucinous cystadenocarcinoma. PMP was found in all. In the case with benign tumors of the ovary and the appendix, the PMP was classified as a benign mucinous spillage. This patient returned 33 months after surgery with PMP, in which epithelial cells were found. CONCLUSIONS: Radiologists should be familiar with the clinical occurrence of synchronous mucinous tumors of the ovary and the appendix associated with PMP and with the typical CT findings of the latter two entities. Alternatively, when the imaging findings suggest ovarian cystic tumor with PMP, the radiologist should be alerted to the probability of a clinically unsuspected appendiceal mucocele and should search for it.
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ranking = 0.5
keywords = cystadenoma
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3/15. "Ductectatic" mucinous cystadenocarcinoma of the pancreas: a case report, 5-year follow-up period.

    It is unknown whether the "ductectatic" mucinous cystadenoma and cystadenocarcinoma of the pancreas will develop into the classical megacystic type, and there is no report of long-term follow-up of this entity. A case of mucin-producing cystic tumor of the pancreas with pancreas divisum in a 65-year-old man is presented who was followed-up for 5 years prior to diagnosis of cancer and surgery. Computed tomography, ultrasonography and endoscopic retrograde pancreatography during the 5-year period had demonstrated insidious growth of the tumor. The histopathological diagnosis after surgery was the "ductectatic" mucinous cystadenocarcinoma of the pancreas. It was difficult for us to differentiate it from the classical megacystic type. The patient died of liver metastasis 54 months after surgery.
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ranking = 0.5
keywords = cystadenoma
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4/15. Simultaneous mucinous cystadenoma of ovary and mucinous cystadenocarcinoma of pancreas.

    Mucinous cystic tumors were discovered synchronously in the tail of the pancreas and in the right ovary of an adult female. Both tumors were amenable to surgical resection. The pancreatic tumor was a noninvasive mucinous cystadenocarcinoma and the ovarian tumor was a mucinous cystadenoma. We feel these tumors represent two primaries, an uncommon occurrence, and not a single primary tumor with metastasis.
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ranking = 2.5
keywords = cystadenoma
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5/15. Heterogeneous genetic alterations in ovarian mucinous tumors: application and usefulness of laser capture microdissection.

    Histologic observation of ovarian mucinous tumors suggests that there is a multistep transition through the accumulation of genetic alterations. We analyzed loss of heterozygosity (LOH) and replication error (RER) on TP53 and D17S855 as well as K-ras point mutations of the heterogeneous histologic areas of the same tumor in 26 cases of ovarian mucinous tumor. The laser capture microdissection (LCM) technique has been applied to the study of K-ras point mutation in 10 cases. As for genetic alterations for LOH or RER on TP53 and D17S855, 2 (1 borderline tumor and 1 carcinoma) of 14 cases and 4 (1 borderline tumor and 3 carcinomas) of 12 cases, respectively, showed genetic heterogeneities in different histologic areas. Six (2 borderline tumors and 4 carcinomas) of 18 cases showed heterogeneity of K-ras point mutation in the different histologic areas of the same tumor, and 5 (1 cystadenoma with brenner tumor component, 2 borderline tumors, and 2 carcinomas) of 10 cases showed heterogeneous K-ras mutation pattern in the same tumor when the LCM technique was used. Atypical areas tended to show K-ras point mutations frequently. Out of 3 cases of mixed mucinous cystadenoma and brenner tumor, 1 case showed K-ras point mutation in the brenner tumor area but not in the area of mucinous cystadenoma. These preliminary results suggest that a subset of ovarian mucinous tumors occur through multistep carcinogenesis and show that LCM is useful for molecular pathologic studies.
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ranking = 1.5
keywords = cystadenoma
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6/15. Pancreatic mucinous cystadenoma associated with celiac disease and polycystic kidneys. Case report and short review of the literature.

    We report a case of giant benign pancreatic mucinous cystadenoma in a 19-year-old woman with celiac disease and polycystic kidneys. She presented with a history of moderate episodic left flank pain evolving for a few weeks before becoming acute the night before her admission. We provide radiological and histological material and a short review of the literature.
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ranking = 2.5
keywords = cystadenoma
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7/15. hand-assisted laparoscopic resection of serous cystadenoma of the pancreas.

    It is difficult to exclude the possibility of malignancy of pancreatic cystic tumors because a biopsy of the pancreas is hard to obtain. The indication of open surgery for those cystic tumors without evidence of malignancy is controversial. Therefore, laparoscopic or laparoscopically assisted procedure would be an adequate choice of treatment for cystic tumors of the pancreas. hand-assisted laparoscopic distal pancreatectomy with preservation of the spleen and the splenic artery and vein was performed for two cases of pancreatic cystic tumors. Three ports and one hand port were used. After careful dissection and accurate hemostasis between the pancreas and splenic vessels, laparoscopic distal pancreatectomy was carried out using an endoscopic linear stapler. There were no perioperative complications. The pathological diagnoses were oligocystic serous cystadenoma and solitary cystic serous cystadenoma, respectively. hand-assisted, spleen-preserving laparoscopic distal pancreatectomy with preservation of the splenic artery and vein is a feasible procedure for the treatment of benign or borderline-malignant cystic lesions of the distal pancreas.
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ranking = 3
keywords = cystadenoma
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8/15. CT presentation of ruptured appendicitis in an adult with incomplete intestinal malrotation.

    Intestinal malrotation is defined anatomically as a developmental anomaly. It may cause atypical clinical symptoms in relatively common intestinal disorders because of the altered anatomy. A 64-year-old man presented with acute mid-abdominal pain. Underlying incomplete malrotation prevented the correct clinical diagnosis of ruptured appendicitis. Computer tomography demonstrated typical signs of malrotation, i.e., right-sided duodenojejunal junction, left position of cecum, inverted position of the superior mesenteric vessels, and pathology revealed a ruptured appendix with an abscess and a coincident mucinous cystadenoma.
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ranking = 0.5
keywords = cystadenoma
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9/15. Mucinous cystadenoma of colonic mesentery: report of a case.

    Cystic tumors of the retroperitoneum, omentum, and mesentery are extremely rare lesions. We report a case of one such lesion in the mesentery of the left hemicolon that was mistaken on imaging to be an ovarian tumor. Development of this tumor at this site has been described only twice before in the literature.
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ranking = 2
keywords = cystadenoma
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10/15. The spectrum of pulmonary mucinous cystic neoplasia : a clinicopathologic and immunohistochemical study of ten cases and review of literature.

    We describe 10 new cases and review 66 previously reported cases of primary pulmonary mucinous cystic neoplasia (PMCN). The 3 men and 7 women were 44 to 73 years old (mean, 60.0 years) at diagnosis. Lesions were found by chest radiograph (featuring a solitary, lobulated nodule with soft tissue density that enlarged slowly), or patients had major bronchial occlusion by mucus or hemoptysis. Tumors were well-circumscribed, lobulated soft masses with a central cavity filled with gray to greenish translucent mucus and were 1.5 to 5.5 cm in greatest dimension (mean, 3.3 cm). Microscopically, confluent lakes of mucin characterized all cases. Tumor epithelium ranged from bland to focal cytologic atypia to frankly malignant. The adjacent lung parenchyma was stretched, compressed, or showed an inflammatory reaction to dissected mucin. After 1- to 10-year follow-up (mean, 3.7 years), 3 patients died of metastasis and 1 of amitriptyline toxic effects; 6 were alive without tumor. Combined analysis of our cases and previously reported cases suggests a histologic spectrum from benign cystadenoma to mucinous cystic tumor with atypia to well-differentiated mucinous cystadenocarcinoma. The histomorphologic criteria derived from this analysis can help distinguish PMCN from other types of primary or metastatic mucinous tumors and predict outcome.
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ranking = 0.5
keywords = cystadenoma
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