Cases reported "Neoplasm Metastasis"

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11/22. sarcoidosis mimicking recurrent endometrial cancer.

    BACKGROUND: sarcoidosis is a multisystem disease and can be confused with benign or malignant tumors. In patients with recurrent gynecologic cancer, liver and intrathoracic lesions should undergo a biopsy to rule in metastatic malignancy, as clinical findings and CAT scan results may represent other disease processes. CASE: A 67 year old woman had a total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and periaortic lymphadenectomy, and peritoneal cytology in 2001 for Stage I B grade 1 adenocarcinoma of the endometrium. She developed a vaginal recurrence in 2005. A CT scan of lungs, abdomen, and pelvis revealed extensive mediastinal adenopathy and multiple space occupying hepatic lesions worrisome for metastatic disease. A needle biopsy of the largest liver lesion revealed sarcoidosis. CONCLUSION: Sarcoid lesions may mimic metastatic disease in patients with malignancy, potentially leading to delayed and/or inappropriate therapy.
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ranking = 1
keywords = gynecologic
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12/22. perivascular epithelioid cell neoplasms of soft tissue and gynecologic origin: a clinicopathologic study of 26 cases and review of the literature.

    PEComas, occasionally associated with the tuberous sclerosis complex, are defined by the presence of perivascular epithelioid cells that coexpress muscle and melanocytic markers. This family of tumors includes angiomyolipoma (AML), clear cell sugar tumor of the lung (CCST), lymphangioleiomyomatosis (LAM), and very rare tumors in other locations. Because non-AML/non-LAM PEComas are extremely rare and their natural history and prognostic features undefined, we present our experience with 26 PEComas of soft tissue and the gynecologic tract, the largest series to date. We also performed a detailed review of the literature, with special attention to features predictive of clinical behavior. All PEComas exclusive of AML and LAM were retrieved from our consultation files. immunohistochemistry for pan-cytokeratin (CK), S-100 protein, smooth muscle actins (SMA), desmin, vimentin, HMB45, Melan-A, microphthalmia transcription factor (MiTF), TFE3, CD117, and CD34 was performed. Clinical follow-up information was obtained. Fisher's exact test was performed. The median patient age was 46 years (range, 15-97 years); there was a marked female predominance (22 females, 4 males). Sites of involvement included the omentum or mesentery (6 cases), uterus (4 cases), pelvic soft tissues (3 cases), abdominal wall (2 cases), uterine cervix (2 cases), and vagina, retroperitoneum, thigh, falciform ligament, scalp, broad ligament, forearm, shoulder, and neck (1 case each). The tumors ranged from 1.6 to 29 cm in size (median, 7.8 cm). Tumors were epithelioid (N = 9), spindled (N = 7), or mixed (N = 10). Multinucleated giant cells were present in 18 cases. High nuclear grade was noted in 10 cases, high cellularity in 7 cases, necrosis in 8 cases, and vascular invasion in 3 cases. Mitotic activity was 0 to 50 mitotic figures (MF)/50 high power fields (HPF) (median, 0 MF/50 HPF) with atypical MF in 6 cases. IHC results were: SMA (20/25), desmin (8/22), HMB45 (22/24), Melan-A (13/18), MITF (9/18), S-100 protein (8/24), CK (3/23), vimentin (12/14), TFE3 (5/17), c-kit (1/20), and CD34 (0/7). Clinical follow-up (24 of 26 patients, 92%; median, 30 months; range, 10-84 months) showed 3 local recurrences and 5 distant metastases. At last available clinical follow-up, 2 patients (8%) were dead of disease, 4 patients (17%) were alive with metastatic or unresectable local disease, and 18 patients (75%) were alive with no evidence of disease. No patient in our series had a history of tuberous sclerosis complex. recurrence and/or metastasis was strongly associated tumor size > median size (8 cm), mitotic activity greater than 1/50 HPF, and necrosis. We conclude that PEComas of soft tissue and gynecologic origin may be classified as "benign," "of uncertain malignant potential," or "malignant." Small PEComas without any worrisome histologic features are most likely benign. PEComas with nuclear pleomorphism alone ("symplastic") and large PEComas without other worrisome features have uncertain malignant potential. PEComas with two or more worrisome histologic features should be considered malignant. Occasional PEComas express unusual markers, such as S-100 protein, desmin, and rarely CK. The role of TFE3 in PEComas should be further studied.
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ranking = 6
keywords = gynecologic
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13/22. Benign metastasizing leiomyomatosis with massive brachial plexus involvement mimicking neurofibromatosis type 1.

    We report the case of a patient who presented with right arm and shoulder pain due to compression of the infraclavicular brachial plexus due to benign metastasizing leiomyomatosis (BML). She was initially and had been repeatedly misdiagnosed as having neurofibromatosis type 1 (NF 1). The diagnosis of BML was not obvious due to its rare nature, the patient's not detailing the specifics of her gynecologic history of having undergone resection of a large uterine leiomyoma and followed by disseminated pelvic leiomyomatous nodules, histologic misinterpretation of an extrauterine lesion of the spine and the brachial plexus as a neurofibroma and the radiologic diagnosis of lung nodules as being "non-specific" in nature. In addition and importantly, no clinical, radiographic or histologic features of NF 1 were present. Although a rare condition, BML should be considered in the differential diagnosis of NF and in patients having a history of uterine leiomyoma. The remarkable, selective involvement of the brachial plexus in this case is unexplained.
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ranking = 1
keywords = gynecologic
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14/22. dermatomyositis. disease associations and an evaluation of screening investigations for malignancy.

    Fifty-three adult patients (19 men, 34 women) with dermatomyositis were studied. Two had dermatomyositis associated with benign disorders. Twenty-three (43%) had a malignancy; the risk of malignancy increased with age, but there was no sex difference. Seven malignancies were recurrences and 9 were diagnosed during investigation of dermatomyositis; these 16 were suspected clinically or from abnormal results of simple investigations. Extensive screening tests did not increase the number of malignancies diagnosed. In 7 patients, a diagnosis of malignancy was made more than 9 months after onset of dermatomyositis, although a relationship between malignancy and dermatomyositis was uncertain in two cases; the diagnosis of gynecological malignancy was missed in 2 patients despite appropriate investigations, 1 patient had poorly controlled dermatomyositis, and in 2 patients late diagnosis of malignancy was due to failure to reinvestigate relapse of previously stable dermatomyositis.
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ranking = 1
keywords = gynecologic
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15/22. Recurrent endometrial adenocarcinoma: presentation as a splenic mass mimicking malignant lymphoma.

    We report the case of a 72-year-old woman in whom the sole manifestation of recurrent endometrial adenocarcinoma was a large splenic mass. The clinical presentation mimicked that of malignant lymphoma. Although as many as 9% of carcinomas are associated with splenic metastases, such involvement is typically encountered only at autopsy and associated with widespread extrasplenic metastases. In contrast, we have found only three other reported cases of gynecological malignancy in which a splenic mass was the sole presenting manifestation of recurrent tumor.
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ranking = 1
keywords = gynecologic
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16/22. Management of patients with gynecologic cancer by serum sialic acid determination.

    With an enzymatic technique, serum sialic acid (SA) levels were determined in patients with gynecologic tumors. Since the SA level for healthy females was 57.4 /- 7.3 mg/dl, we set the upper normal limit of this parameter at 72 mg/dl. The SA level became larger in ascending order of uterine myoma, benign ovarian tumor, cervical cancer, corpus cancer, and ovarian cancer. The SA level proved to be significantly higher in cancer patients showing poor prognosis than in those having good prognosis irrespective of the category of therapy and it reflected well the clinical course of cancer patients. In patients who receive a combination therapy and need to be followed up for a long term, complete follow-up is sometimes impossible with tumor-derived markers alone. Even in such cases, the sialic acid level will work as a useful follow-up marker because it is nonspecific to histologic types of cancer.
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ranking = 5
keywords = gynecologic
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17/22. Herpetiform cutaneous metastases following negative second look laparatomy for ovarian adenocarcinoma.

    Cutaneous metastases from gynecologic malignancy are rarely reported, and when present are invariably accompanied by intraperitoneal disease. In the present case extensive metastases to the skin of the abdomen, groin, thigh and perineum appeared six weeks following extensive "second look" laparotomy which revealed no evidence of intraperitoneal or retroperitoneal disease. The appearance of cutaneous metastases was preceded by only a one month history of leg swelling, erythema, and a markedly elevated serum CA-125. Problems in the differential diagnosis and management of this clinical situation are discussed.
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ranking = 1
keywords = gynecologic
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18/22. superior vena cava syndrome associated with gynecologic malignancy.

    superior vena cava syndrome is an infrequently noted complication associated with gynecologic malignancy. Three cases illustrate modern diagnostic and management methods. patients developed superior vena cava syndrome secondary to mediastinal metastatic endometrial carcinoma, uterine leiomyosarcoma, and secondary to thrombosis induced by a subclavian hyperalimentation catheter. awareness of this condition on oncology units and by physicians using central venous catheters is important to afford the prompt diagnosis and appropriate management of this life-threatening condition.
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ranking = 5
keywords = gynecologic
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19/22. Sister Joseph's nodule: seven cases of umbilical metastases from gynecologic malignancies.

    Seven cases of patients with gynecologic cancer and Sister Joseph's nodule, umbilical metastases from intraabdominal malignancy, are presented, making a total of 44 such cases in the literature. One such case, uterine leiomyosarcoma with umbilical metastases, is the first such lesion reported. Although the prognosis is generally poor, a few long-term survivors have been reported, and aggressive therapy may be warranted, particularly in patients with ovarian malignancy.
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ranking = 5
keywords = gynecologic
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20/22. Cutaneous decidualized endometriosis. A pseudomalignancy.

    Mistaking a benign neoplasm for a malignant one is usually the result of the benign neoplasm having cytologic atypia or of normal tissue of one organ being present ectopically in another. In some instances the pathologist is simply not familiar with the lesion. A case of decidualized cutaneous endometriosis is described in which the histologic features included cytologic atypia, circumscription of epithelial nodules, glandular spaces, mononuclear cells within the around the endometrial nodules, and no mitoses. This histologic pseudomalignancy is not common and can be misinterpreted as metastatic is not common and can be misinterpreted as metastatic malignancy by dermatopathologists not familiar with gynecologic pathology.
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ranking = 1
keywords = gynecologic
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