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1/133. dermatomyositis and peritoneal papillary serous carcinoma.

    We describe an unusual case of peritoneal papillary serous carcinoma (PPSC) arising in a female patient with dermatomyositis (DM). Despite periodic extensive searches for an underlying malignancy, no malignancy had been detected in this patient during the first 2.5 years after the diagnosis of DM. It was only when the patient presented with pleural effusion and ascites that the underlying intra-abdominal malignancy was detected by laparoscopy. Treatment with four cycles of pre-operative chemotherapy (taxol and cisplatin) resulted in tumor regression with amelioration in the muscular manifestation of the DM, but without parallelic amelioration in the skin manifestations of the DM. Explorative laparotomy confirmed the presence of papillary serous carcinoma in the omentum, surface of the left ovary and the retroperitoneal lymph nodes, and established the diagnosis of PPSC. Following two cycles of postoperative chemotherapy, the patient is alive with no evidence of internal malignancy. However, although muscle strength and enzymes have remained normal, no effect on the skin manifestation of DM has been observed. This case illustrates that, alongside the more frequently occurring ovarian carcinoma, PPSC should also be considered in the differential diagnosis of the underlying malignancy that may occur in the female patient with DM. ( info)

2/133. 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. ( info)

3/133. Papillary serous carcinoma of the cervix: ultrasonographic findings.

    BACKGROUND: Papillary serous carcinoma of the uterine cervix is a rare malignancy only recently described. Optimal treatment is unknown. CASE REPORT: A 65 year old white female, approximately 15 years postmenopausal, presented with a recent history of postmenopausal bleeding. Cervical cytology was negative for any abnormalities. ultrasonography of the pelvis revealed a thickened anterior endometrium with fluid present along with a papillary mass in the endocervix. hysteroscopy, dilatation and curettage revealed a low uterine segment mass consistent with a pathologic diagnosis of grade 2 endometrioid adenocarcinoma of the endometrium. A total abdominal hysterectomy, bilateral salpingo-oophorectomy and bilateral pelvic and paraaortic lymphadenectomy revealed a papillary serous carcinoma of the cervix metastatic to pelvic and paraaortic lymph nodes. CONCLUSION: Cervical papillary serous carcinoma can be discovered pre-operatively by ultrasonography. Because of its relatively recent description and relative rarity, optimal treatment is unknown. ( info)

4/133. Complete response of a stage IV uterine papillary serous carcinoma to neoadjuvant chemotherapy with Taxol and carboplatin.

    Uterine papillary serous carcinoma (UPSC) is an aggressive histologic subtype of endometrial cancer. Currently, no effective chemotherapy regimens exist. We report a case of complete response of a stage IV UPSC to neoadjuvant chemotherapy with Taxol and carboplatin. ( info)

5/133. A case of fallopian tube carcinoma: successful preoperative diagnosis with MR imaging.

    We report a case of fallopian tube carcinoma, successfully diagnosed preoperatively. The patient was a 64-year-old woman. Transvaginal sonography and computed tomography showed a cystic and solid tumor on the left side of the uterus, suggesting ovarian cancer. The tumor was, however, suspected to be a fallopian tube carcinoma on MR imaging. MR images showed a solid mass surrounded by a tube-shaped cystic part. At surgery, a solid and cystic tumor was found in the left fallopian tube. MR imaging may be useful to assist in the diagnosis of fallopian tube carcinoma. ( info)

6/133. life-threatening tracheal metastasis complicating ovarian cancer--a case report.

    BACKGROUND: Tracheal metastasis is a rare manifestation of recurrent ovarian cancer. CASE: We describe tracheal metastasis causing increasing respiratory distress in a patient with progressive stage IIIc undifferentiated serous-papillary cancer involving the peritoneum and pleura and the retroperitoneal, diaphragmatic, parahilar, mediastinal, pretracheal, paratracheal, and supraclavicular lymph nodes. The situation necessitated rapid endoscopic laser ablation. CONCLUSION: Malignant tracheal obstruction should be considered in the differential diagnosis of patients with advanced ovarian cancer and respiratory distress. ( info)

7/133. Cystogastric transmural drainage for the treatment of symptomatic cystic metastases from ovarian carcinoma.

    Approximately 80% of ovarian cancers are discovered when they have already progressed to stage III or IV lesions. The prognosis is, therefore, poor despite intensive treatment. Intraperitoneal dissemination is one of the most frequent pathways of distant spread ovarian cancer and pseudocystic metastases usually occur. When such cystic metastases remain symptomatic despite antitumor treatment, viable options are limited because palliative surgery generates high operative morbidity and mortality. For many years, in patients in whom the risks associated with surgery are high, percutaneous drainage and sclerosis under radiologic guidance has been performed as an effective alternative option for various forms of abdominal fluid collection. Such a collection in pancreatic pseudocyst benefits from cystogastric transmural drainage to avoid external drainage and achieves the same results as surgical cystogastrostomy. We report this transmural drainage technique under image guidance used to drain a symptomatic cystic metastasis, which was compressing the stomach. ( info)

8/133. Papillary serous carcinoma of the ovary following prolonged tamoxifen treatment.

    We present a patient with breast cancer who developed papillary serous adenocarcinoma of the ovary after 13 years of tamoxifen use. The possible association is explored and the literature is reviewed. ( info)

9/133. Multiple nodular metastases in mesenteric panniculitis by uterine papillary serous adenocarcinoma (UPSC): CT appearance of a case.

    Intra-abdominal panniculitis is a thickening of the mesentery of the small/large intestine due to infiltration of lipid-laden macrophages associated with a variable amount of fibrosis. This condition is rarely associated with malignant neoplasms. We report the computed tomography (CT) findings of a patient treated for uterine papillary serous adenocarcinoma (UPSC). She had mesenteric panniculitis where metastatic tumor nodules implanted. This was the only intraperitoneal recurrence. To our knowledge, no such finding has been reported in the gynecologic and radiologic literature to date. On CT images, the differential diagnosis is with cystic dilatations of mesenteric lymph vessels. ( info)

10/133. Immunohistochemical and ultrastructural study of a papillary cystadenocarcinoma arising from the sublingual gland.

    Immunohistochemical and ultrastructural findings in a rare case of papillary cystadenocarcinoma arising from the left sublingual gland of a 55-year-old Japanese man are reported. Histologically, the tumor tissue was found to be composed of various-sized cystic cavities in which papillary epithelial projections with thin fibrovascular cores were observed. The papillary projections consisted of a single layer to several layers of high columnar epithelial cells. Invasion to the surrounding fibrous tissue and into the lymphatics was observed, thus suggesting an aggressive potential in the present case. The possibility of the involvement of myoepithelial cells could be excluded based on the immunohistochemical and ultrastructural findings. The immunohistochemical and ultrastructural findings also suggested that this type of salivary gland tumor, at least the present case, may arise from striated or excretory ducts. There was positive immunostaining for tumor markers CA19-9 and CA125. However, the biological role of these carbohydrate antigens in salivary gland tumors is unclear at present. Further investigations are, therefore, called for to solve this issue. ( info)
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