EP.TH.717Triple tumour: A myriad of serial incidental findings in a patient presenting with Gallstone pancreatitis

Abstract Aim To present a rare incidental synchronous triple tumours - colonic adenocarcinoma, endometroid ovarian adenocarcinoma and benign Brenner tumour in a patient admitted with acute gallstone pancreatitis. Methods A 75-year-old female presented with epigastric pain. Blood-tests and USS abdomen confirmed gallstones and pancreatitis. She was treated conservatively. USS also showed incidental pelvic mass which was further characterised by CT and MR scans. These scans confirmed heterogeneous lobulated mass in the left adnexa. CT scan also picked-up incidental mass in transverse colon, which was confirmed as cancer by colonoscopy. She was offered therapeutic resection after discussion in Colorectal and Gynaecology MDT. Intra-operatively, transverse colonic tumour was invading into the proximal ileum. Laprascopic surgery concluded with extended right hemicolectomy, small bowel resection-anastomosis, omentectomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy. Results The patient had gradual recovery without any complications. Histopathology showed T4N2 poorly differentiated adenocarcinoma of colonic mass, FIGO grade 1 stage 1c endometrioid adenocarcinoma of left ovary and benign brenner tumour of right ovary. Post-operative MDT did not offer adjuvant-therapy due to slow recovery and fraility. So far, two-years of follow-up did not show any recurrence. Conclusion This report adds to the limited literature of triple synchronous tumours, including rare Brenner accounting for 5% of benign ovarian tumours and endometrioid ovarian tumour with an incidence of 4 -7%. Multi-disciplinary approach and combined surgery can achieve a desirable outcome in such complex cases. It is crucial to identify the primary status of the tumours as it will guide the adjuvant treatment.

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Hydropic leiomyoma presenting as a rare condition of pseudo-Meigs syndrome: literature review and a case of a pseudo-Meigs syndrome mimicking ovarian carcinoma with elevated CA125

BMJ Case Reports ◽

10.1136/bcr-2018-226454 ◽

2019 ◽

Vol 12 (1) ◽

pp. bcr-2018-226454 ◽

Cited By ~ 1

Author(s):

Mehrnoosh Pauls ◽

Heather MacKenzie ◽

Ravi Ramjeesingh

Keyword(s):

Pleural Effusion ◽

Ovarian Carcinoma ◽

Pelvic Mass ◽

Rare Condition ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Tumour Marker ◽

Cancer Antigen 125 ◽

Cancer Antigen ◽

Surgical Specimen

The clinical scenario of a female patient with a pelvic mass, elevated CA125 tumour marker, pleural effusion and ascites is often associated with malignancy. However, not all cases are malignant. Non-malignant diseases, such as Meigs syndrome and pseudo-Meigs syndrome, must be part of your differential. We present a 56-year-old woman with dyspnoea secondary to a right pleural effusion. After further investigations, a serum cancer antigen-125 was found to be elevated at 437.3 U/mL. CT of her abdomen and pelvis showed a large heterogeneous mass in the pelvis measuring 13.2×9.7×15.1 cm with mild ascites. She was initially thought to have ovarian carcinoma and underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with omental biopsy. Pathology from the surgical specimen revealed a hydropic leiomyoma and after removal of pelvic mass her pleural effusion and ascites completely resolved. She was ultimately diagnosed with the rare pseudo-Meigs syndrome.

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Borderline Clear Cell Adenofibroma of the Ovary

Case Reports in Pathology ◽

10.1155/2017/3860107 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Pilaiwan Kleebkaow ◽

Apiwat Aue-aungkul ◽

Amornrat Temtanakitpaisan ◽

Chumnan Kietpeerakool

Keyword(s):

Clear Cell ◽

Pelvic Mass ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Ca 125 ◽

Stromal Invasion ◽

Post Operation ◽

Clear Cytoplasm ◽

Gross Examination ◽

Clear Cell Adenofibroma

Borderline clear cell tumors are extremely rare, and few cases have been reported in the literature. Herein, we present a case of borderline clear cell adenofibroma of the ovary in a 58-year-old woman who presented with a pelvic mass and constipation. Physical examination revealed a 10 cm solid midline pelvic mass. Computed tomography showed an 8 cm heterogeneous enhancing mass attached to the left posterolateral wall of the uterus. The patient’s serum CA 125 levels were slightly elevated (80.9 U/ml). The patient was given a total abdominal hysterectomy with bilateral salpingooophorectomy. On gross examination, it was found that the left ovarian tumor was an 8.0 × 7.5 × 8.0 cm solid multilobulated mass containing tiny cysts. Histologically, the tumor was composed of small glands in dense fibrous and myxoid stroma. The glands were lined with cuboidal cells with clear cytoplasm and mild to moderate nuclear atypia. No stromal invasion was observed. The pathological diagnosis was borderline clear cell adenofibroma of the left ovary. There was no reoccurrence 36 months post operation.

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Peritoneal Keratin Granulomatosis Associated with Endometrioid Adenocarcinoma of the Uterine Corpus in a Woman with Polycystic Ovaries: A Potential Pitfall—A Case Report and Review of the Literature

Case Reports in Obstetrics and Gynecology ◽

10.1155/2017/1863215 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6

Author(s):

Helen J. Trihia ◽

Maria Papazian ◽

Natasa Novkovic ◽

John Provatas ◽

Sotiria Tsangouri ◽

...

Keyword(s):

Female Genital Tract ◽

Rare Condition ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Pelvic Lymphadenectomy ◽

Endometrioid Adenocarcinoma ◽

Polycystic Ovaries ◽

Squamous Differentiation ◽

Uterine Corpus ◽

Multiple Biopsies

Peritoneal keratin granulomatosis is a rare condition included under granulomatous lesions of the peritoneum. It can be secondary to neoplasms of the female genital tract and can mimic carcinomatosis intraoperatively. A case of a 40-year-old woman with a history of polycystic ovaries and a chief complaint of vaginal bleeding is presented. She was diagnosed with endometrioid adenocarcinoma with squamous differentiation in endometrial curettings. Intraoperatively, many peritoneal nodules were found, interpreted as peritoneal carcinomatosis. The woman underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy, bilateral pelvic lymphadenectomy, and appendicectomy. Multiple biopsies were taken, as well as peritoneal washings. Microscopic examination revealed multiple keratin granulomas on the serosal surface of the ovaries, fallopian tubes, appendix, and omentum. Lymph node metastasis was not found. Peritoneal keratin granulomas (PKGs) have been reported in cases of endometrioid adenocarcinoma with squamous differentiation of the uterine corpus, ovary, and atypical adenomyoma. It should be noted that the prognosis of cases of peritoneal keratin granulomas without viable tumor cells is favourable and that the histologic examination is essential for its diagnosis. We report a case of PKG in a patient with endometrial carcinoma with squamous differentiation, being the first in a woman with polycystic ovaries.

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Synchronous Ovarian and Endometrial Endometrioid Adenocarcinoma Presenting with Nonbacterial Thrombotic Endocarditis and Pulmonary Thromboembolism: Adenocarcinoma with Thrombotic Events

Case Reports in Obstetrics and Gynecology ◽

10.1155/2015/825404 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

N. K. Erturk ◽

A. Erturk ◽

D. Basaran ◽

N. Ozgul

Keyword(s):

Gynecologic Oncology ◽

Tumor Resection ◽

Pelvic Mass ◽

Malignant Neoplasms ◽

Endometrioid Adenocarcinoma ◽

Thrombotic Complication ◽

Anticoagulant Treatment ◽

Ovarian Adenocarcinoma ◽

Cerebral Lesions ◽

Nonbacterial Thrombotic Endocarditis

Introduction.Nonbacterial thrombotic endocarditis (NBTE) is a rare manifestation of hypercoagulability in patients with malignant neoplasms.Case Report.A fifty-six-year-old woman presented to the emergency service; the clinical workup revealed deep vein thrombosis in right leg and bilateral massive PTE. As the abdominal sections on the spiral CT revealed a giant pelvic mass of ovarian origin, she was referred to our hospital’s gynecologic oncology department. She was scheduled for surgery under enoxaparin. She described numbness on one side of her face. Cranial imaging findings revealed acute ischemic cerebral lesions and transesophageal echocardiogram showed vegetation on the aortic cusp. Under anticoagulation treatment, she underwent hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy. After tumor resection, her neurological symptoms dissolved with aggressive anticoagulant treatment. Pathology result was synchronous endometrial and ovarian adenocarcinoma.Discussion.NBTE is a rare condition often associated with advanced malignancies. Peripheral embolism and venous thrombosis are complications that have been associated with NBTE due to hypercoagulable state. These disorders could be resistant to routine anticoagulant treatment. In case of a thrombotic complication due to ovarian malignancy, surgical resection of the primary tumor may increase the effect of anticoagulant treatment.

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Endometrioid Adenocarcinoma in the Native Ureter of a Renal Transplant Patient: Case Report and Review of the Literature

The Scientific World JOURNAL ◽

10.1100/tsw.2010.166 ◽

2010 ◽

Vol 10 ◽

pp. 1714-1722 ◽

Cited By ~ 1

Author(s):

Kelly A. Healy ◽

Kenneth J. Carney ◽

Adeboye O. Osunkoya

Keyword(s):

Renal Transplant ◽

Renal Transplant Patient ◽

Transplant Patient ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Filling Defect ◽

Malignant Degeneration ◽

Endometrioid Adenocarcinoma ◽

Benign Condition ◽

Grade Ii

Endometriosis is characterized by endometrial-like tissue outside the uterus, primarily on the pelvic peritoneum, ovaries, and rectovaginal septum, and, in rare cases, within the urinary tract (1–3%). Although endometriosis is a benign condition, malignant transformation of endometriosis is a well-described phenomenon. Malignancies arising in endometriosis are uncommon at extragonadal pelvic sites. A case of endometrioid adenocarcinoma in the native ureter of a postmenopausal renal transplant patient presented with painless gross hematuria and hydroureteronephrosis. The patient had a history of total abdominal hysterectomy and bilateral salpingo-oophrectomy 14 years prior for menorrhagia and had since been on unopposed estrogen replacement therapy. Workup revealed a filling defect in the native left mid-ureter secondary to a large 2.5-cm ureteral tumor. Endoscopic biopsies of the native left ureteral mass showed endometrioid adenocarcinoma, grade II-III. The patient ultimately underwent an open native left nephroureterectomy and temporary diverting colostomy. Final pathology confirmed endometrioid adenocarcinoma, grade II-III, arising in a background of endometriosis with negative perirectal lymph nodes. This case of ureteral endometrioid adenocarcinoma highlights the importance of obtaining a careful history and maintaining a high index of suspicion for malignant degeneration, especially in the context of hyperestrogenism.

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Uterine Carcinosarcoma with Alpha-Fetoprotein-Producing Hepatoid Component: A Case Report and Literature Review

Case Reports in Pathology ◽

10.1155/2018/3972353 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Joshua J. X. Li ◽

Jacqueline H. S. Lee ◽

Vicky T. C. Chan ◽

Mei-yung Yu

Keyword(s):

Myometrial Invasion ◽

Subsequent Development ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Disease Recurrence ◽

Alpha Fetoprotein ◽

Endometrioid Adenocarcinoma ◽

Uterine Carcinosarcoma ◽

Arginase 1 ◽

Serum Alpha Fetoprotein

A 67-year-old woman presented with postmenopausal vaginal bleeding. Full body imaging demonstrated an intrauterine mass with deep myometrial invasion but no nodal or other metastatic disease. Uterine curettage was performed. Histologically, the tumor was an endometrioid adenocarcinoma with sarcomatous element and a hepatoid component, the latter was immunohistochemically positive for alpha-fetoprotein, HepPar-1, and arginase-1. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Serum alpha-fetoprotein level decreased from 31896 ug/l preoperatively to 2063 ug/l postoperatively. Eight weeks later, a rise in serum alpha-fetoprotein was detected, and a biopsy-proven vaginal recurrence was diagnosed. Palliative chemotherapy led to tumor shrinkage and a concurrent decrease in the serum alpha-fetoprotein level. A rise in serum alpha-fetoprotein, refractory to second-line chemotherapy, was accompanied by subsequent development of ureteric obstruction, ascites, and radiological evidence of peritoneal metastases. This is an unusual case of uterine carcinosarcoma with an alpha-fetoprotein-producing hepatoid adenocarcinoma component. Serum alpha-fetoprotein level corresponds to disease recurrence and progression.

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Lipoleiomyoma of the Uterus and Primary Ovarian Leiomyoma in a Postmenopausal Woman: Two Rare Entities in the Same Individual

Case Reports in Pathology ◽

10.1155/2015/564846 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Sefa Kelekci ◽

Serenat Eris ◽

Emine Demirel ◽

Serpil Aydogmus ◽

Nese Ekinci

Keyword(s):

Smooth Muscle ◽

Postmenopausal Woman ◽

Histopathological Examination ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

First Case ◽

Benign Ovarian Tumours ◽

Rare Tumours ◽

Tender Mass ◽

Benign Tumours

Uterine lipoleiomyomas are rare benign tumours that are composed of various mixtures of smooth muscle and mature fat tissue. Leiomyomas, which arise primarily in the ovary, are extremely rare tumours that account for 0.5–1% of all benign ovarian tumours. To the best of our knowledge, we present the first case of an ovarian leiomyoma coexisting with a uterine lipoleiomyoma in the postmenopausal period. A 59-year-old, gravida 4, para 3, postmenopausal woman exhibited pelvic discomfort and increased frequency of micturition. A pelvic examination revealed a solid, tender mass on the left side that could not be clearly separated from the uterus. She underwent a laparotomy with an initial diagnosis of a left ovarian mass. She had previously undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy. A histopathological examination revealed a uterine lipoleiomyoma, composed of variable amounts of smooth muscle cells and mature adipocytes and a right ovarian leiomyoma composed of interlacing bundles and fascicles of spindle cells. The coexistence of these two rare entities in the same individual may represent a common pathway as a stimulating agent. This case may help to clarify the pathogenesis of these lesions.

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Leiomyoma as a cause of urinary retention

Urogynaecologia ◽

10.4081/uij.2013.e4 ◽

2013 ◽

Vol 27 (1) ◽

pp. 4

Author(s):

Kemal Sarsmaz ◽

Asli Goker ◽

Naci Kemal Kuscu

Keyword(s):

Urinary Retention ◽

Pelvic Mass ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Uterine Wall ◽

Reproductive Age ◽

Mri Findings ◽

Pelvic Masses ◽

History Of ◽

Magnetic Resonance Imaging Mri

Urinary retention is uncommon in reproductive age women. The frequent causes for obstructive retention are pelvic masses and a history of surgery. We report a case of intermittent urinary retention caused by a leiomyoma. A 47-year old patient with voiding difficulties for the past four months was referred to the gynecology outpatient clinic. She had urinary retention and had been catheterized several times for bladder emptying. She had been evaluated by the urology clinic and a cystoscopy was performed with normal findings. Magnetic resonance imaging (MRI) revealed a pelvic mass at the anterior uterine wall with a diameter of 10 cm. Her physical examination confirmed the MRI findings. Total abdominal hysterectomy was performed with a complete resolution of the patient’s complaints. Women with urinary retention should be consultated with a gynecologist in order to rule out pelvic masses.

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Uterine torsion with necrosis of bilateral adnexa in a postmenopausal woman

BMJ Case Reports ◽

10.1136/bcr-2019-229311 ◽

2019 ◽

Vol 12 (6) ◽

pp. e229311 ◽

Cited By ~ 1

Author(s):

Katherine Jane Chua ◽

Ricky Patel ◽

Armina Eana ◽

Joyce Varughese

Keyword(s):

Postmenopausal Woman ◽

Frozen Section ◽

Pelvic Mass ◽

Longitudinal Axis ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Gravid Uterus ◽

Uterine Torsion ◽

Acute Pelvic Pain ◽

Uterine Fundus

Uterine torsion is an uncommon entity that is defined as a rotation of greater than 45° around the longitudinal axis of the uterus. Although cases of uterine torsion among pregnant patients have been mentioned in the literature, torsion of a non-gravid uterus is a rare occurrence. A 73-year-old nulliparous woman with a known fibroid uterus underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy with frozen section of a 17–18 cm pelvic mass seen on CT imaging. The source of the pelvic mass was unclear on imaging, and benign and malignant possibilities were discussed. During the procedure, necrosis of the uterine fundus and bilateral adnexa were seen due to the fundus being torsed with the uterine fibroid being the pivot point. Uterine torsion, though rare, can be the cause of acute pelvic pain in a postmenopausal woman.

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Primary Malignant Mixed Müllerian Mesodermal Tumor Mimicking a Rectosigmoid Carcinoma: A Case Report and Review of the Literature

Case Reports in Oncological Medicine ◽

10.1155/2014/948908 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Sakshi Kapur ◽

Levin Miles

Keyword(s):

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Endometrioid Adenocarcinoma ◽

Review Of The Literature ◽

Rectosigmoid Colon ◽

The Past ◽

Positive Expression ◽

Surgical History ◽

Disease Free

We report a case of a 53-year-old female who presented with chronic constipation and abdominal discomfort for six months. Her past surgical history was significant for a total abdominal hysterectomy with bilateral salpingooophorectomy, performed eight years ago, for uterine fibroids and endometriosis. Workup revealed a mass measuring 5 × 4.5 × 2 cm in the rectosigmoid colon. Patient underwent a low anterior resection and a fungating, centrally ulcerated rectosigmoid mass with a positive mesorectal margin was removed. Histopathology revealed a heterologous mixed mesodermal tumor (chondroid and osteoid elements). The epithelial component was compatible with a grade 2 endometrioid adenocarcinoma. Immunohistochemical stains were supportive, with positive expression for CK7 and ER, negative for CK20, and only very focally and weakly positive for both CDX2 and p63. Chromogranin, synaptophysin, and TTF-1 were negative. Following surgery, she was treated with five cycles of carboplatin (AUC 6) and paclitaxel (175 mg/m2), followed by irradiation. Twenty-six months later, patient continues to be asymptomatic and disease-free. Mixed müllerian mesodermal tumors mimicking colorectal cancer have been reported in the past. Our case highlights the rarity and the challenges encountered in diagnosing and treating these rare tumors.

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