Cases reported "Mixed Tumor, Malignant"

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1/7. Suprasellar malignant mixed germ cell tumour presenting as craniopharyngioma.

    A 15 year old boy presented with diminution in vision of both eyes, diabetes insipidus and hypopituitarism. MRI was suggestive of a large suprasellar and retrosellar craniopharyngioma with stretching of the optic chiasma. Histopathological findings on the first surgical specimen were interpreted as a craniopharyngioma. He was reoperated on account of clinical deterioration and increase in tumour size. Histological examination this time revealed derivatives of all three germ cell lineages along with areas of embryonal carcinoma, and yolk sac tumour besides squamous cysts, establishing the diagnosis of malignant mixed germ cell tumour. serum and CSF were strongly positive for alpha foetoproteins.
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2/7. Malignant mixed mullerian tumor of the ovary and bilateral breast cancer: an argument for BRCA3, or a coincidental cluster of unconnected cancers?

    OBJECTIVES: Malignant mixed mullerian tumors (MMMTs) of the ovary are a rare, aggressive subtype of ovarian cancer without a clear relationship to familial breast-ovarian cancer syndromes. CASE: We present the case of a woman with bilateral breast cancers who subsequently developed a stage IIIc MMMT of the ovary. The patient had a first-degree female relative with breast and ovarian cancer (not MMMT), as well as second- and third-degree female relatives each with bilateral breast cancers. BRCA1 and BRCA2 sequencing of germline dna revealed no evidence of a heritable mutation. CONCLUSIONS: Ovarian MMMTs may be a hallmark of breast/ovarian cancer secondary to genetic risk independent of classic BRCA1/2 pathways.
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3/7. Mixed micropapillary and trophoblastic carcinoma of bladder: report of a first case with new immunohistochemical evidence of urothelial origin.

    The micropapillary variant of urothelial carcinoma has a reported incidence of 0.7%. Trophoblastic urinary carcinoma is very rare, with roughly 30 cases reported during the last century. This is the first report of mixed micropapillary and trophoblastic bladder carcinoma. A 45-year-old man presented with gross hematuria. His tumor contained choriocarcinomatoid areas with syncytiotrophoblasts, classic micropapillary carcinoma, conventional high-grade urothelial carcinoma, and flat carcinoma in situ. He underwent radical surgery; tumor stage was T4N2M0. Despite postoperative combination chemotherapy, he developed pulmonary and retroperitoneal metastases and died 20 months after presentation. The tumor was immunopositive for human chorionic gonadotropin and human placental lactogen in trophoblast and for cytokeratin 20 and high-molecular-weight cytokeratin in all tumor components. Because high-molecular-weight cytokeratin is expressed by urothelium but is rarely found in placental trophoblast or germ-cell choriocarcinoma, its presence in trophoblastic bladder carcinoma is new evidence that the latter is a transformed neoplasm of urothelial origin.
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4/7. Mixed testicular germ cell tumor presenting as metastatic pure choriocarcinoma involving the maxillary gingiva.

    Gingival metastases are infrequent and invariably associated with a widespread disease and a poor prognosis. Because of their unremarkable clinical appearance, they can be difficult to distinguish from more common gingival hyperplastic or reactive lesions, such as pyogenic granuloma, peripheral giant cell granuloma, and peripheral ossifying granuloma. We are reporting here an unusual case of a 36-year-old man with a mixed testicular germ cell tumor presenting as a metastatic pure choriocarcinoma involving the maxillary gingiva, extending from the first left premolar to the left second maxillary molar, mimicking a 'benign looking' gingival mass. Gingival metastases may be the first manifestation of a widespread metastatic disease and therefore particular attention must be paid to gingival lesions associated with atypical clinical symptoms and/or signs.
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5/7. Ovarian mixed germ cell tumor composed of polyembryoma and immature teratoma.

    We report the case of a 41-year-old woman with ovarian mixed germ cell tumor which was composed of polyembryoma and immature teratoma and who had high serum levels of alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG). By immunohistochemical methods, AFP was found in yolk sac cells of the embryoid bodies and immature hepatoid tissues, and hCG was found in giant syncytiotrophoblastic cells. She was treated with surgery followed by cisplatin-based combination chemotherapy. She is well, and her serum levels of AFP and hCG have not been elevated for more than 4 years after the treatment.
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6/7. Recurrent mixed germ cell-sex cord-stromal tumor of the ovary in an adult.

    A 32-year-old woman underwent laparotomy and right salpingo-oophorectomy for a right adnexal mass. Examination of the specimen revealed a 77 g well-encapsulated tumor that was diagnosed as a mixed germ cell-sex cord-stromal tumor with annular tubules. Sixty-seven months after an uneventful recovery, a large recurrence was treated by total abdominal hysterectomy, left salpingo-oophorectomy, removal of peritoneal implants, lymphadenectomy, omentectomy, and chemotherapy. Histologically, the neoplasm was identical to the one found in the right ovary. To our knowledge, no similar case has been previously reported.
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7/7. Systemic mast cell disease associated with primary ovarian mixed malignant germ cell tumor.

    A 12-year-old girl with a mixed malignant germ cell tumor of the ovary, treated by surgery and chemotherapy, developed systemic mast cell disease (SMCD) approximately 3 months after chemotherapy. Hematologic malignancies have previously been noted in patients with mediastinal germ cell tumors but this is the first report of a primary ovarian germ cell neoplasm associated with SMCD.
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