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

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.

Download Full-text

Abdominal skin metastasis in endometrial cancer

Majalah Obstetri & Ginekologi ◽

10.20473/mog.v27i22019.84-89 ◽

2019 ◽

Vol 27 (2) ◽

pp. 84

Author(s):

Eccita Rahestyningtyas ◽

Pungky Mulawardhana ◽

Tomy Lesmana

Keyword(s):

Endometrial Cancer ◽

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Low Grade ◽

Endometrioid Adenocarcinoma ◽

Comprehensive Management ◽

High Risk Factors ◽

History Of ◽

Anatomical Pathology

Objectives: Surgical wound metastases in stage 1 endometrial cancer are possible, with a variety of different pathophysiological possibilities. Comprehensive management is needed to keep the patient on the possibility of a good prognosis.Cases Report: During January 2015 – January 2018 at dr. Soetomo Hospital, there were 2 cases of metastatic endometrial cancer in the laparotomy wounds by which the condition is very rare. Case 1, The patient was diagnosed with endometrial carcinoma following the results of curettage. Anatomical pathology examination was done and obtained grade 2 endometrioid adenocarcinoma. In Case 2, the patient underwent Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy in 2013 at Mojokerto General Hospital, indicating Uterine Fibroids and Ovarian Cysts. The results of anatomical pathology examination were unknown. On April 2017, the patient complained abdominal swelling since 3 months ago.Conclusion: In January 2015 - January 2018, 2 cases of metastatic endometrial cancer was found in a former laparotomy operation where this condition is very rare in endometrial cancer cases with low grade ,so that follow-up, monitoring and more vigilance are required in patients with low-grade endometrial Ca who have finished undergoing a surgery and chemotherapy. Rapture or mass resection, followed by external radiation, may be performed in patients with recurrence in the laparotomy wound area or in patients with high risk factors for endometrial cancer such as a history of estrogen use, tamoxifen, nullipara, obesity, diabetes mellitus, and family history of endometrial cancer. Currently, there is no fixed procedure (guideline) in RS. Dr. Soetomo to overcome recurrences especially in the scars of cancer surgery.

Download Full-text

Does Big Mean Evil? Giant, but Benign Uterine Leiomyoma: Case Report and Review of the Literature

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1721351 ◽

2021 ◽

Vol 43 (01) ◽

pp. 066-071

Author(s):

Luiz Gustavo Oliveira Brito ◽

Natalia Lysei Ueno ◽

Maira Rossmann Machado

Keyword(s):

Case Report ◽

Uterine Leiomyoma ◽

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Review Of The Literature ◽

Extrinsic Compression ◽

Molecular Studies ◽

Atypical Cells ◽

Gynecological Tumor

AbstractUterine leiomyoma is the most prevalent benign type of gynecological tumor. It affects more than 80% of women worldwide and, within this group, more than 50% may be asymptomatic. However, large fibroid volumes may be associated with symptoms of extrinsic compression, and most of the cases do not present atypical cells. We present the case of a 49-year-old woman who underwent a total abdominal hysterectomy of a 13.5-kg uterine leiomyoma with no malignancies at histopathology and review the literature about giant uterine leiomyomas and their clinical repercussion. We concluded that large volumes do not always pose a threat regarding malignancy; however, future molecular studies are needed to investigate giant uterine fibroids.

Download Full-text

Large cervical fibroid: a rare case report

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193577 ◽

2019 ◽

Vol 8 (8) ◽

pp. 3414

Author(s):

Sunanda N.

Keyword(s):

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Large Mass ◽

Abdominal Hysterectomy ◽

Reproductive Age ◽

Pelvic Tumors ◽

Rare Case Report ◽

Tender Mass ◽

Restricted Mobility ◽

Reproductive Age Group

Although leiomyomas are the most common pelvic tumors presenting in the reproductive age group, cervical fibroids are rare accounting for 2% of all uterine fibroids. We report a case of 40 year old lady presenting with a firm, non-tender mass of 22-24 weeks size pregnant uterus with restricted mobility. Laparotomy showed a large mass arising from the anterior lip of cervix, with a small uterus pushed posteriorly. Enucleation followed by total abdominal hysterectomy was done. Large cervical fibroids are rare, presenting with surgical difficulties. Careful dissection by expert hands is needed in the management of such cases.

Download Full-text

Uterus-sparing myomectomy for idiopathic uterine pyomyoma in a young woman: A case report

Aegean Journal of Obstetrics and Gynecology ◽

10.46328/aejog.v2i2.43 ◽

2020 ◽

Vol 2 (2) ◽

pp. 19-22

Author(s):

Ugur Sen ◽

Tuğba Karadeniz ◽

Emrah Beyan

Keyword(s):

Risk Factor ◽

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Proper Treatment ◽

Imaging Findings ◽

Cervical Stenosis ◽

Mortality And Morbidity ◽

Risk Of Mortality ◽

History Of

Pyomyoma, or suppurative leiomyoma, is a rare but serious complication of uterine fibroids. The mechanism of pyomyoma is an infection caused by microorganisms coming from ascending or hematogenously on the ground of necrosis following ischemia and infarction. It can be seen during the course of pregnancy or after abortion and birth. It can also develop after uterine instrumentation or due to cervical stenosis. Patients often present with pain and fever. It should be considered in cases had no other etiology of fever and had a history of uterine fibroids. Diagnosis and treatment are often delayed due to non-specific presentation and imaging findings. This delay increases the risk of mortality and morbidity such as fertility loss. In the vast majority of these cases, total abdominal hysterectomy is required. The case we presented is a premenopausal and sexually inactive woman without any history of pregnancy or uterine instrumentation or immunocompromised. This patient is the 5th case of pyomyoma without risk factor and the 3rd case that was successfully treated with myomectomy. Knowing the proper treatment of pyomyoma will be beneficial to prevent potential mortality and morbidity.

Download Full-text

CLINICAL PROFILE AND MANAGEMENT OPTION OF FIBROID UTERUS PATIENTS OF OBSTETRICS AND GYNAECOLOGY DEPARTMENT OF DMCH, LAHERIASARAI, BIHAR

10.36106/ijsr/0137418 ◽

2020 ◽

pp. 1-2

Author(s):

Sangeeta Singh ◽

Renu Jha ◽

Seema Seema ◽

Debarshi Jana

Keyword(s):

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Management Options ◽

Fibroid Uterus ◽

Number Of Patients ◽

Study Results ◽

The Mean ◽

Benign Tumours ◽

Symptomatic Uterine Fibroid

Background: Fibroids are the most common benign tumours of smooth muscle cells of uterus in females and typically found during the middle and later reproductive years. As fibroid is an estrogen and progesterone dependent tumour, it gradually decreases in size during starting of menopause. The objective of this presented study was to determine management options among fibroid uterus patients. Methods: 50 number of patients were included in this study those who’s age of 20-55, with symptomatic uterine fibroid and undergone hysterectomy or myomectomy. Postmenopausal, Pregnancy and Asymptomatic fibroid were excluded from this study. Results: The study showed that 52 percent of patient having fibroid uterus were belonged to 31-40 years of age. The mean age was 41.2±6.07. The majority 74% of patients in this study presented with menstrual abnormalities, 40% presented with abdominal lump. Dysmenorrhoea was 26%, 6% patient had primary subfertility and 14% secondary subfertility. Total Abdominal Hysterectomy (TAH) with unilateral salpingo- oophorectomy done in 10% cases, TAH with bilateral salpino-oophorectomy in 22% cases, non descent vaginal hysterectomy in 6% cases, myomectomy done in 20% cases and polypectomy was done in 2% cases. Conclusion: Uterine fibroids are very common in women and frequently in late reproductive and perimenopausal years. It is also a common gynecological problem in our country, which frequently disturbs the lives of woman. Women now have choice of therapies for the treatment of fibroids.

Download Full-text

Delayed presentation of giant uterine fibroids in a Nigerian private specialist health facility

SAGE Open Medical Case Reports ◽

10.1177/2050313x211063137 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110631

Author(s):

Joseph Ifeanyichukwu Ikechebelu ◽

Boniface Chukwuneme Okpala ◽

George Uchenna Eleje ◽

Cyril Emeka Nwachukwu ◽

Louis Anayo Nwajiaku ◽

...

Keyword(s):

Low Income ◽

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Low Income Countries ◽

Delayed Presentation ◽

Abdominal Drain ◽

Abdominal Myomectomy ◽

Major Operation ◽

Private Specialist

Giant uterine fibroids (leiomyoma or myomas) which are fibroid masses greater than 11.4 kg are very rare. Although benign in nature, it may present with symptoms that impact negatively on the quality of life and health of the patient and impose greater management challenges. We present two cases of giant uterine fibroids that were successfully managed in a private specialist hospital without complications. Case 1 was a 38-year-old nulliparous Nigerian woman who presented with giant uterine fibroids (11.6 kg) who initially had delay of surgery due to fear that after surgery she may lose her “womb” or not be able to conceive after the operation. Later, she had successful open abdominal myomectomy, with the use of Foley catheters as improvise equipment for tourniquet and abdominal drain. Anti-adhesion agent was not used. Case 2 was a 47-year-old nulliparous Nigerian teacher with giant fibroids (13.2 kg) who also initially had delayed surgery due to fear that fibroid surgery is a major operation that it may get complicated and she may die. Also, she was afraid that she may not have her womb in her next world if she gets reincarnated. She had total abdominal hysterectomy and bilateral salpingo-oophorectomy without complications. For both cases, pre-surgery leiomyosarcoma assessment with computed tomography scan or magnetic resonance imaging and anti-adhesion agent were not used due to very unaffordable high costs. These reports of giant uterine fibroids (leiomyoma or myomas) are very rare gynecological entity, and management can be successful despite overwhelming challenges in low-income countries. Cheaper, affordable and available alternatives (improvises) can be resorted to for tackling its challenges in low-income settings.

Download Full-text

Uterine-like Mass With Features of an Extrauterine Adenomyoma Presenting 22 Years After Total Abdominal Hysterectomy–Bilateral Salpingo-oophorectomy: A Case Report and Review of the Literature

Archives of Pathology & Laboratory Medicine ◽

10.5858/2005-129-1041-umwfoa ◽

2005 ◽

Vol 129 (8) ◽

pp. 1041-1043 ◽

Cited By ~ 6

Author(s):

Rachel Redman ◽

Edward J. Wilkinson ◽

Nicole A. Massoll

Keyword(s):

Smooth Muscle ◽

Case Report ◽

Benign Tumor ◽

Broad Ligament ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Rare Entity ◽

Review Of The Literature ◽

Hormonal Stimulation ◽

Pelvic Organs

Abstract Adenomyoma is a benign tumor composed of smooth muscle and benign endometrium. These tumors typically originate within the uterus. An extrauterine adenomyoma is a rare entity. We report a uterine-like mass consistent with an extrauterine adenomyoma presenting 22 years following a total abdominal hysterectomy and bilateral salpingo-oophorectomy. The mass was pear-shaped with uterine-type smooth muscle and a cavity lined by functional endometrial glands and stroma. To our knowledge, only 4 other cases of an extrauterine uterine-like mass are reported in the literature. Three involved the ovary, while one was located adjacent to the broad ligament with normal pelvic organs. Although none of these other uterus-like masses were described as adenomyomas with uterine-like features, the histologic findings are strikingly similar. An understanding of the müllerian system suggests that either an embryologic malformation or a differential multipotentiality existing in the subcoelomic tissues in response to hormonal stimulation results in a supernumerary müllerian structure like a uterus, as observed in this case. The presence of endometrial glands and stroma in the mass confirms that the tissues in this mass are hormonally responsive. It is most likely that this uterine-like mass arose from the tissues of the secondary müllerian system in response to estrogenic stimulation.

Download Full-text

The Imaging and Pathological Features of Metastatic Leiomyosarcoma in the Gallbladder

Rare Tumors ◽

10.4081/rt.2016.6618 ◽

2016 ◽

Vol 8 (4) ◽

pp. 179-181 ◽

Cited By ~ 2

Author(s):

Yi Guo ◽

Eleanor Chen ◽

Darin J. Davidson ◽

Venu G. Pillarisetty ◽

Robin L. Jones ◽

...

Keyword(s):

Metastatic Disease ◽

Uterine Fibroids ◽

Exploratory Laparotomy ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Metastatic Lesion ◽

Uterine Leiomyosarcoma ◽

High Grade ◽

Initial Management ◽

Pelvic Radiation

Uterine leiomyosarcoma is a rare and aggressive malignancy with poor overall prognosis. There have been few reports of metastatic leiomyosarcoma in the gallbladder. We report a case of a 41-year-old female who underwent total abdominal hysterectomy due to presumed uterine fibroids. The postoperative pathology revealed high-grade pleomorphic leiomyosarcoma, with involvement of the uterine serosal surface. She subsequently underwent exploratory laparotomy, followed by pelvic radiation and chemotherapy. Since initial management she has developed metastatic disease and has been under treatment and surveillance for 11 years. She has undergone multiple surgical procedures and numerous lines of systemic therapy for metastatic leiomyosarcoma, including cholecystectomy for a metastatic lesion in the gallbladder. There have been no previous reports of metastatic leiomyosarcoma in the gallbladder. Despite extensive metastatic disease this patient has had prolonged survival with multi-modality management.

Download Full-text

Mucoepidermoid variant of adenosquamous carcinoma arising in ovarian dermoid cyst: a case report and review of the literature

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200602001-00069 ◽

2006 ◽

Vol 16 (Suppl 1) ◽

pp. 379-384

Author(s):

A. Karateke ◽

A. Gurbuz ◽

G. Kir ◽

B. Haliloglu ◽

C. Kabaca ◽

...

Keyword(s):

Case Report ◽

Lymph Node ◽

Dermoid Cyst ◽

Adenosquamous Carcinoma ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Review Of The Literature ◽

Lymph Node Sampling ◽

Aortic Lymph Node ◽

Ovarian Dermoid Cyst

A 40-year-old woman with mucoepidermoid variant of adenosquamous carcinoma arising in dermoid cyst in left ovary is presented. The patient was staged as IC. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic and para-aortic lymph node sampling were carried out. The disease recurred in postoperative 12th month. To our best knowledge, this is 12th case of adenosquamous carcinoma in dermoid cyst and third case of mucoepidermoid variant of adenosquamous carcinoma in the literature.

Download Full-text