1/24. Radical resection and intraoperative radiotherapy for a recurrent endometrial cancer after prolonged remission following aggressive salvage therapy: case report.The prognosis of recurrent endometrial carcinomas is generally poor, except for isolated vaginal relapse. We report a case of recurrent endometrial cancer in a 58-year-old woman who initially received a type I extended hysterectomy with bilateral salpin-go-oophorectomy and bilateral para-aortic and pelvic lymph node dissection. The first recurrence occurred in the left parametrium 7 months after the primary surgery. The salvage therapy consisted of radiotherapy combined with hormonal therapy (tamoxifen and Megace). Complete remission was achieved initially. Subsequently, the patient accepted six courses of chemotherapy (cisplatin and Adriamycin) for progressive elevation of cancer antigen 125 (CA-125). The CA-125 levels remained elevated with titers fluctuating around 100 U/ml until a second recurrence at the left iliac 75 months following salvage therapy. The second salvage treatment consisted of maximal debulking of the pelvic mass and intraoperative radiotherapy (IORT) followed by four courses of chemotherapy with paclitaxel and carboplatin. Complete remission was again accomplished, with clinical investigations and molecular markers returning to normal. The patient has been clinically free of disease for more than 2 years since the second relapse of cancer. In this particular case, we found that repeated recurrence could occur after a long complete remission following salvage therapy; however, the disease could be recontrolled with further aggressive salvage efforts. A multimodality approach with combinations of radical resection, IORT, and paclitaxel-based chemotherapy can be offered to patients with localized recurrent or repeatedly recurrent endometrial carcinoma after previous cisplatin-based chemotherapy and pelvic radiation.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/24. Mucinous endometrial adenocarcinoma simulating microglandular hyperplasia of the cervix.A case of endometrial adenocarcinoma simulating microglandular hyperplasia (MGH) of the cervix is presented. A postmenopausal 53-year-old woman, with no previous history of taking exogenous hormones, presented with vaginal bleeding. An endometrial biopsy exhibited a tumor composed predominantly of a microglandular proliferation of tightly packed glands with mild to moderate atypia and mitotic figures. The majority of the tumor cells contained intracytoplasmic mucin. There were numerous neutrophils within the microglandular lumens and in the stroma. The tumor was focally positive for carcinoembryonic antigen and vimentin. The MGH-like proliferation, focally, had a transition to a conventional mucinous adenocarcinoma. hysterectomy specimens showed a residual mucinous endometrial adenocarcinoma with no myometrial invasion, the uterine cervix was unremarkable. Four years following her hysterectomy the patient was well, with no evidence of disease. Pathologists need to be cautious about MGH-like changes in the endometrial biopsy of postmenopausal women and be aware of this type of endometrial cancer as it may be misdiagnosed.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
3/24. Cervical cytology and immunohistochemical features in endometrial adenocarcinoma simulating microglandular hyperplasia. A case report.BACKGROUND: The histology of a few cases of adenocarcinoma simulating cervical microglandular hyperplasia (MGH-AdCa) has been reported. However, the cytologic features of MGH-AdCa in cervical smears and the immunohistochemical profile have not been described. CASE: A 73-year-old female presented with vaginal bleeding. The cervical Pap smear was initially interpreted by the cytotechnologist as "reactive endocervical cells" and was referred for cytopathologist review. The final interpretation was atypical glandular cells of undetermined significance (AGUS), probably neoplastic. Endometrial biopsy and total abdominal hysterectomy with bilateral salpingo-oophorectomy showed International Federation of Gynecologists and Obstetricians grade 1 endometrial carcinoma. The superficial component of the tumor resembled cervical microglandular hyperplasia (MGH); the deeper component had an endometrioid pattern. The Pap smear predominantly showed a glandular component with features of MGH. However, the presence of scattered single cells with hyperchromatic nuclei, one to three nucleoli, easily detectable mitotic figures, randomly scattered apoptotic bodies and focal, watery diathesis suggested a neoplastic process. immunohistochemistry was studied on paraffin sections. In addition to other markers, the tumor cells were immunoreactive for carcinoembryonic antigen (CEA). CONCLUSION: Although the cervical Pap smear in this case had an MGH-like pattern, some features were atypical enough to suggest a diagnosis of AGUS, probably neoplastic. CEA immunoreactivity of MGH-AdCa could also help to differentiate it from MGH.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
4/24. Alpha-fetoprotein producing uterine corpus carcinoma: A hepatoid adenocarcinoma of the endometrium.A case of alpha-fetoprotein (AFP) producing endometrial carcinoma in a 60-year-old Japanese woman is presented. The patient complained of abnormal vaginal bleeding of 10 days' duration. On admission a uterine corpus mass and high serum AFP concentration (31950 ng/mL) was noted. There was no tumorous lesion in any other organ radiographically and endoscopically. Histologically, the biopsy specimen taken from the uterine mass showed a poorly differentiated endometrial carcinoma and a radical hysterectomy was subsequently performed. The postoperative serum AFP value transiently decreased with chemotherapy, however, lung metastases were found and the patient died 12 months following surgery. The resected uterus had a necrotic tumor, 6 x 5 x 4 cm in size, filling the endometrial cavity, characterized by exophytic growth with infiltration in the myometrium. Histologically, the tumor was composed of the main medullary carcinoma area with microcysts and admixed small areas of well-differentiated endometrioid adenocarcinoma, accompanied by a smooth transition with one another. In both the areas, the tumor cells had immunoreactive AFP, alpha-1-antitripsin, albumin, transferrin, carcinoembryonic antigen, CA19-9, and epithelial membrane antigen. There was no histologic evidence for a germ cell tumor. Based on these findings, this uterine corpus tumor was regarded as hepatoid variant of endometrial carcinoma. Although the histogenesis remains controversial, we assume the hypothesis that the tumor may arise in the endometrium per se in association with abnormal differentiation of muellerian duct elements.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
5/24. Bilateral diffuse uveal melanocytic proliferation associated with extraocular cancers: review of a process particularly associated with gynecologic cancers.We reviewed cases of a paraneoplastic syndrome in which uveal melanocytes proliferated and led to blindness. Eighteen cases were derived from the literature, and two were taken from our institution. The average patient age at the time of the diagnosis was 63 years (range, 34-89 years). There were 13 women and 7 men. In approximately half of the cases, the ocular symptoms antedated those of the inciting tumor. Most of the inciting tumors were poorly differentiated carcinomas. The most common tumors were from the female genital tract (ovary and uterus) among the women patients and from the lung among the men. Tumors from the breast were rare (one possible case), and tumors of the prostate were conspicuously absent. All five inciting tumors whose histopathology was reviewed expressed neuron-specific enolase, but none prominently expressed antigens more specific for neuroendocrine carcinomas such as chromogranin or synaptophysin. It is our experience that many general pathologists are not aware of this unique paraneoplastic syndrome. Our report is the first to document a statistically significant association between this syndrome and gynecologic cancers.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
6/24. Endometrioid adenocarcinoma arising from adenomyosis: report and immunohistochemical analysis of an unusual case.A case of endometrioid adenocarcinoma arising from adenomyosis is reported. The patient was a 53-year-old woman who complained of vulvar itching. Smear cytology of the endometrium revealed adenocarcinoma. magnetic resonance imaging of the pelvis revealed a lesion with a slightly high intensity in the uterine fundus on a T2-weighted image. Semiradical total hysterectomy and bilateral adnexectomy were performed, followed by chemotherapy. Histologically, the lesion in the uterine fundus was composed mostly of adenocarcinoma with stromal invasion. There were many adenomyotic foci in and around the carcinoma, including some showing transition to adenocarcinoma. There was no malignant finding in the normally situated endometrium. The carcinoma invaded in the myometrium, involving the uterine serosa, but no dissemination to the peritoneal cavity was found. The carcinoma was, therefore, considered to be endometrioid adenocarcinoma arising from adenomyosis. immunohistochemistry showed expression of p53 oncoprotein and ki-67 antigen in the carcinoma cells. The value of immunohistochemistry in predicting prognosis is discussed.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
7/24. Poorly differentiated endometrial sarcoma with clear cell features.A case of poorly differentiated endometrial sarcoma with clear cell features in a 46-year-old female is presented. A 9 x 8 x 6 cm, transmural, white solid tumor in the uterine fundic wall was characterized histologically by infiltrative growth and a solid arrangement of tumor cells with clear cytoplasm. The tumor showed vascular invasion, moderate to severe cellular atypia, mitotic activity of 20 per 10 high-power fields and necrosis. It was immunohistochemically positive for vimentin and negative for CAM5.2, epithelial membrane antigen, desmin, alpha-smooth muscle actin, muscle actin, estrogen and progesterone receptors. Electron microscopy showed that the clear cytoplasm was attributed to the presence of numerous dilated mitochondria and lipid droplets. flow cytometry showed a diploid phenotype. Pathologists should be aware of the existence of this type of endometrial sarcoma with clear cells and should not confuse it with other neoplasma showing clear cell features.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
8/24. Polypoid endometrial adenomyoma in a postmenopausal woman, mimicking cervical cancer, associated with ovarian thecoma.PURPOSE: Atypical polypoid adenomyoma (APA) usually occurs in premenopausal women and arises from the endometrium. APAs protruding into the external os may lead to diagnostic problems. CASE: We present a case of APA in a 62-year-old postmenopausal woman, prolapsing through the external os, clinically mimicking cervical cancer FIGO IB2 (4.5 cmx3 cmx3 cm). Histologically the tumor was composed of endometrioid-like with slight cellular atypia and endocervical-type mucinous glands admixed with smooth muscle bundles, exhibiting low ki-67 antigen immunostaining. The the left adnexa contained an ovarian thecoma. CONCLUSIONS: To the best of our knowledge, this is the first case of APA in a postmenopausal woman, mimicking cervical cancer and associated with ovarian thecoma. Pathogenetically it is proposed, that hyperestrogenism and, in the present case accompanied by progestin production of questionable source, may play an important role in the development of APAs with the admixture of endometrial and endocervical glands.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
9/24. Primary in situ squamous cell carcinoma of the endometrium, with extensive squamous metaplasia and dysplasia.BACKGROUND: Primary squamous cell carcinoma of the endometrium is exceedingly rare. It has been described in association with pyometra but its etiology is still unclear. CASE: The authors report the case of a 75-year-old woman who presented with pelvic pain and pyometra. No gross tumor was identified in the uterus; however, extensive epidermalization of the endometrial mucosa was noted. Microscopic findings were consistent with a primary in situ squamous carcinoma of the endometrium associated with extensive squamous metaplasia and areas of dysplasia. HPV antigen and dna detection were negative in both the endometrial lesions and the cervix. CONCLUSIONS: These results support the sequence of change with squamous metaplasia, progressing through dysplasia to carcinoma as a possible pathogenetic process. HPV's role, however, remains uncertain.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
10/24. Rare case of neuroendocrine small cell carcinoma of the endometrium with paraneoplastic membranous glomerulonephritis.Small cell carcinomas are well-recognized tumors known to occur predominantly in the lung. These neoplasms are occasionally associated with a variety of paraneoplastic syndromes. Four cases of paraneoplastic glomerulopathy associated with small cell lung carcinoma have been reported. However, there have been no reports in the literature indicating an association between endometrial small cell carcinoma and paraneoplastic glomerulopathy. We report a case of neuroendocrine small cell carcinoma of the endometrium associated with membranous glomerulonephritis (MGN), which appeared to be a component of an unusual paraneoplastic syndrome. A 33-year-old multiparous woman presented with abnormal vaginal bleeding and abdominal bloating. Endometrial biopsy revealed neuroendocrine small-cell carcinoma of the endometrium. On the eighth day of hospitalization the patient suddenly developed renal failure. Renal biopsy revealed MGN, probably due to tumor-antigen-related immune complex deposition. Small cell carcinoma of the endometrium may be associated with paraneoplastic MGN. medical staff should take into account the possibility of a preexisting glomerular injury when managing a patient with small cell carcinoma of the endometrium.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
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