Surprise Lymph Node Histology in a Patient with Ovarian Serous Carcinoma

We report a case of a sixty-three-year-old Chinese female with a known past history of primary, biopsy-diagnosed, ovarian high-grade serous carcinoma. Following three cycles of chemotherapy, she underwent total hysterectomy, bilateral salpingo-oophorectomy cytoreductive surgery with lymphadenectomy, and multiple peritoneal biopsies. In this situation, the lymph nodes would be expected to demonstrate possible residual metastatic serous carcinoma with or without chemotherapy effect. The final diagnostic assessment in the lymph nodes, in this patient, however, was a rare combination of the following pathologies: metastatic serous carcinoma, with areas of chemotherapy effect, and incidental PEComatosis, focally in association with endometriosis, both within lymph nodes and surrounding connective tissue. PEComas have been described in patients with the tuberous sclerosis complex, but the current patient was not known to suffer from this condition. This case is also unusual, as although PEComas have been described as arising in the female genital tract, the associated phenomenon of endometriosis is exceedingly rare, and this is the first known reported case of lymph nodes harbouring a similar combination of pathologies.

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Rotura Uterina às 18 Semanas de Gravidez no Contexto de Útero Malformado

Acta Médica Portuguesa ◽

10.20344/amp.7150 ◽

2016 ◽

Vol 29 (10) ◽

pp. 667

Author(s):

Emídio Vale-Fernandes ◽

Neusa Teixeira ◽

Alexandra Cadilhe ◽

Maria José Rocha

Keyword(s):

Uterine Rupture ◽

Female Genital Tract ◽

Obstetric Outcomes ◽

Placenta Increta ◽

Abnormal Placentation ◽

History Of ◽

Uterine Malformations ◽

The Right ◽

Congenital Uterine Anomaly ◽

Female Genital

Birth defects of the female genital tract are relatively common and often asymptomatic. Despite the pregnancy outcome can be favorable, adverse obstetric outcomes are described in women with uterine malformations. The authors report the case of an obstetric emergency which enhances the possibility of a very adverse and rare outcome of uterine rupture in a left hemi-cavity of a bicornuate uterus away from the term, at 18 weeks of pregnancy, in a pregnant woman with history of caesarean in the right hemi-cavity and with placenta increta. A malformed uterus with a primitive type cavity has lower distensibility of the wall with the progression of the pregnancy and facilitates the development of abnormal placentation forms, increasing the risk of uterine rupture in the first and second trimesters. The knowledge of the existence of a congenital uterine anomaly in the preconceptional period is of primary importance.

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Lymphoepithelioma-like Carcinoma of the Ovary: A Case Report and Review of the Literature

Archives of Pathology & Laboratory Medicine ◽

10.5858/2007-131-1715-lcotoa ◽

2007 ◽

Vol 131 (11) ◽

pp. 1715-1718 ◽

Cited By ~ 2

Author(s):

Sun Lee ◽

Sang Yoon Park ◽

Eun Kyung Hong ◽

Jae Yoon Ro

Keyword(s):

Lymph Nodes ◽

Female Genital Tract ◽

Undifferentiated Carcinoma ◽

Ca 125 ◽

Epithelioid Cells ◽

Supraclavicular Lymph Nodes ◽

Node Metastases ◽

The Right ◽

Carcinoma Of The Ovary ◽

Female Genital

Abstract Lymphoepithelioma-like carcinoma is an undifferentiated carcinoma morphologically characterized by sheets of pleomorphic epithelioid cells with an intense lymphoid infiltrate. A 51-year-old woman presenting with low abdominal pain was found to have a right ovarian mass and enlarged pelvic, left para-aortic, and left supraclavicular lymph nodes. Based on a clinical diagnosis of right ovarian carcinoma with lymph node metastases, she received 9 cycles of chemotherapy, resulting in a reduction of her ovarian tumor, disappearance of the enlarged pelvic and para-aortic lymph nodes, and normalization of serum CA 125 level. The residual mass was removed surgically. The histology of the multinodular tumor resembled that of lymphoepithelioma of the nasopharynx and was observed in the right ovary. However, there was no viable tumor in either supraclavicular or para-aortic lymph nodes. Seven months after surgery, the patient has no evidence of disease. Lymphoepithelioma-like carcinoma appears to be rare in the female genital tract.

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Diffuse Malignant Peritoneal Mesothelioma Presenting with Psammomatous Calcification on a Cervical Smear

Acta Cytologica ◽

10.1159/000443389 ◽

2015 ◽

Vol 59 (6) ◽

pp. 498-504 ◽

Cited By ~ 2

Author(s):

Adeline Tan ◽

Paul Cohen ◽

Mooska Raoofi ◽

Jason Tan ◽

Nima Mesbah Ardakani ◽

...

Keyword(s):

Female Genital Tract ◽

Laparoscopic Hysterectomy ◽

Peritoneal Mesothelioma ◽

Malignant Peritoneal Mesothelioma ◽

Cervical Smear ◽

Psammoma Bodies ◽

Cervical Smears ◽

Diffuse Malignant Peritoneal Mesothelioma ◽

History Of ◽

Female Genital

Background: Psammoma bodies in cervical smears are rare but may be associated with benign and malignant diseases of the female genital tract. Case: A 52-year-old nulliparous woman presented with a 2-month history of intermittent vaginal spotting and post-coital bleeding. A cervical smear showed an inconclusive high-grade glandular lesion with psammomatous calcification. Previous cervical smears had been normal. This smear contained papillary tissue fragments, occasional spheres of gland-like cells and frequent psammoma bodies. The patient underwent a laparoscopic hysterectomy, bilateral salpingo-oophorectomy and omentectomy. The surface of the omentum and both ovaries contained psammoma bodies with groups of cells identical to those in the cervical smear. Within the omentum, there were invasive malignant epithelioid cells positive for CK7, CK5/6, calretinin, D2-40, WT-1, CK5/6, p16 and EMA. Desmin and PAX-8 immunostains were negative. There was also evidence of BRCA1-associated protein 1 (BAP1) dysfunction compatible with diffuse malignant peritoneal mesothelioma (DMPM). Conclusion: We describe the first reported case of DMPM presenting with an abnormal cervical smear, a rare but important differential diagnosis to consider in abnormal cervical smears showing psammomatous calcification.

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Breast metastasis from pelvic high-grade serous adenocarcinoma: a report of two cases

Surgical Case Reports ◽

10.1186/s40792-020-01090-7 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Yurina Harada ◽

Makoto Kubo ◽

Masaya Kai ◽

Mai Yamada ◽

Karen Zaguirre ◽

...

Keyword(s):

Genital Tract ◽

Abdominal Cavity ◽

Female Genital Tract ◽

Serous Carcinoma ◽

High Grade ◽

Peritoneal Cancer ◽

Cancer Tumor ◽

Stage Ivb ◽

The Right ◽

Female Genital

Abstract Background Metastatic tumors to the breast reportedly account for 0.5% to 2.0% of all malignant breast diseases. Such metastatic tumors must be differentiated from primary breast cancer. Additionally, few reports have described metastases of gynecological cancers to the breast. We herein report two cases of metastasis of pelvic high-grade serous adenocarcinoma to the breast. Case presentation The first patient was a 57-year-old woman with a transverse colon obstruction. Colostomy was performed, but the cause of the obstruction was unknown. We found scattered white nodules disseminated throughout the abdominal cavity and intestinal surface. Follow-up contrast-enhanced computed tomography (CT) showed an enhanced nodule outside the right mammary gland. Core needle biopsy (CNB) of the right breast mass was conducted, and immunohistochemical staining of the mass suggested a high-grade serous carcinoma of female genital tract origin. We diagnosed the patient’s condition as breast and lymph node metastasis of a high-grade serous carcinoma of the female genital tract. After chemotherapy for stage IVB peritoneal cancer, tumor reduction surgery was performed. The second patient was a 71-year-old woman with a medical history of low anterior resection for rectal cancer at age 49, partial right thyroidectomy for follicular thyroid cancer at age 53, and left lower lung metastasis at age 57. Periodic follow-up CT showed peritoneal dissemination, cancerous peritonitis, and pericardial effusion, and the patient was considered to have a cancer of unknown primary origin. Contrast-enhanced CT showed an enhanced nodule in the left mammary gland with many enhanced nodules and peritoneal thickening in the abdominal cavity. CNB of the left breast mass was conducted, and immunohistochemical staining of the mass suggested a high-grade serous carcinoma of female genital tract origin. After chemotherapy for stage IVB peritoneal cancer, tumor reduction surgery was performed. Conclusions We experienced two rare cases of intramammary metastasis of high-grade serous carcinoma of female genital tract origin. CNB was useful for confirming the histological diagnosis of these cancers that had originated from other organs. A correct diagnosis of such breast tumors is important to ensure quick and appropriate treatment.

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Immunohistochemistry: A diagnostic aid in differentiating primary epithelial ovarian tumors and tumors metastatic to the ovary

South Asian Journal of Cancer ◽

10.4103/2278-330x.119888 ◽

2013 ◽

Vol 02 (04) ◽

pp. 254-258 ◽

Cited By ~ 3

Author(s):

Divya Kriplani ◽

Mandakini M. Patel

Keyword(s):

Wilms Tumor ◽

Female Genital Tract ◽

Serous Carcinoma ◽

Cancer Antigen 125 ◽

Significant Development ◽

Epithelial Tumors ◽

Ovarian Pathology ◽

Carcinoma Of The Ovary ◽

Serous Tumors ◽

Female Genital

Abstract Introduction: Among cancers of the female genital tract, the incidence of ovarian cancer ranks below only carcinoma of the cervix and the endometrium. Recent years have witnessed significant development in the use of immunohistochemistry in diagnostic ovarian pathology. Materials and Methods: We received 95 specimens and biopsies of primary ovarian neoplasms and neoplasms metastatic to the ovary in a period of 2 years. Of these 30 cases were of the primary surface epithelial neoplasms and seven of metastatic tumors. Discussion: The most common tumors metastasizing to the ovary originate from the gastrointestinal tract followed by the endometrium. We used a panel of six markers including cytokeratin-7 (CK7), CK20, carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), estrogen receptor (ER) and Wilms’ tumor 1 (WT1) to help classify various surface epithelial tumors as well as to differentiate them from tumors metastatic to the ovary. Conclusion: CK7 is the most helpful marker to differentiate primary ovarian carcinoma from metastatic colorectal carcinoma of the ovary. Nearly, 96% of ovarian adenocarcinomas were positive for CK7 in contrast to metastatic colorectal, which showed only 25% positivity. We also found that CK7, CK20 and CEA are useful markers to differentiate primary serous tumors from primary mucinous tumors; however, these are less helpful in differentiating ovarian mucinous adenocarcinomas from colorectal adenocarcinomas metastasizing to the ovaries. WT1 helps in typing primary surface epithelial tumors of the ovary and is also significant in determining whether a serous carcinoma within the ovary is primary or metastatic.

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Uterine serous papillary carcinoma: Histopathologic changes within the female genital tract

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200107000-00005 ◽

2001 ◽

Vol 11 (4) ◽

pp. 283-289 ◽

Cited By ~ 4

Author(s):

L. B. Jordan ◽

M. Abdul-Kader ◽

A. Al-Nafussi

Keyword(s):

Papillary Carcinoma ◽

Fallopian Tube ◽

Genital Tract ◽

Female Genital Tract ◽

Serous Carcinoma ◽

Tumor Spread ◽

Histopathologic Changes ◽

Serous Papillary Carcinoma ◽

Female Genital

Abstract.Jordan LB, Abdul-Kader M, Al-Nafussi A. Uterine serous papillary carcinoma: Histopathologic changes within the female genital tract.The histopathologic features of 25 patients with uterine serous papillary carcinoma (USPC) were presented, with particular emphasis on the changes seen in the remaining müllerian epithelium. The mean age at presentation was 68.9 years; 52% of patients were stage III at the time of presentation and 40% died of their disease within 24 months of diagnosis. Histologic assessment revealed: 1) pure serous carcinoma in 56% of patients and mixed differentiation of serous and endometrioid in the remainder; 2) malignant epithelium reminiscent of that of USPC and akin to carcinoma in situ, frequently seen in the remaining endometrium, cervix, and, less commonly, the fallopian tube; 3) residual endometrium that, when identified (11/25 cases), was atrophic in all cases; 4) various types of cervical involvement in 17 cases (68%) ; 5) tumor within the fallopian tube in three cases (12%); and 6) carcinoma with in situ-like features in five cases (20%). In conclusion, it appears that USPC is frequently associated with malignant epithelial changes (as with carcinoma in situ) in the remaining müllerian epithelium. This finding suggests either a field change or, more likely, a transepithelial tumor spread. The latter theory is preferable, because this type of spread is frequently seen on serosal surfaces in cases of serous ovarian carcinoma. Uterine serous papillary carcinoma is, therefore, biologically more akin to its ovarian counterpart.

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Microperforated Hymen Presenting Spontaneous Pregnancy with Cesarean Delivery and Hymenotomy Surgery: A Case Report

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.123 ◽

2018 ◽

Vol 6 (3) ◽

pp. 528-530

Author(s):

Brikene Elshani ◽

Heroid Arifi ◽

Armond Daci

Keyword(s):

Cesarean Delivery ◽

Perioperative Complications ◽

Female Genital Tract ◽

Sexual Life ◽

Imperforate Hymen ◽

Vaginal Sex ◽

History Of ◽

Vaginal Anatomy ◽

Female Genital

BACKGROUND: Female genital tract anomalies including imperforate hymen affect sexual life and fertility.CASE PRESENTATION: In the present case, we describe a pregnant woman diagnosed with imperforate hymen which never had penetrative vaginal sex. A 27–year-old married patient with 2 months of amenorrhea presented in a clinic without any other complications. Her history of difficult intercourse and prolonged menstrual flow were reported, and subsequent vaginal examination confirmed the diagnosis of imperforate hymen even though she claims to made pinhole surgery in hymen during puberty. Her urine pregnancy test was positive, and an ultrasound examination revealed 8.3 weeks pregnant. The pregnancy was followed up to 39.5 weeks when she entered in cesarean delivery in urgency. Due to perioperative complications in our study, a concomitant hymenotomy was successfully performed. The patient was discharged with the baby, and vaginal anatomy was restored.CONCLUSIONS: This case study suggests that even though as microperforated hymen surgery in puberty can permit pregnancy and intervention with cesarean section and hymenotomy is a good option to reduce the resulting perioperative complications which indirectly affect the increase of the fertilisation and improvement of later sexual life.

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Antibodies and Antibody-Secreting Cells in the Female Genital Tract after Vaginal or Intranasal Immunization with Cholera Toxin B Subunit or Conjugates

Infection and Immunity ◽

10.1128/iai.66.2.514-520.1998 ◽

1998 ◽

Vol 66 (2) ◽

pp. 514-520 ◽

Cited By ~ 117

Author(s):

Eva-Liz Johansson ◽

Carola Rask ◽

Margareta Fredriksson ◽

Kristina Eriksson ◽

Cecil Czerkinsky ◽

...

Keyword(s):

Antibody Response ◽

Lymph Nodes ◽

Cholera Toxin ◽

Genital Tract ◽

Female Genital Tract ◽

Antibody Responses ◽

B Subunit ◽

Genital Tissue ◽

Antibody Secreting Cells ◽

Female Genital

ABSTRACT We studied the antibody response including antibody-secreting cells (ASC) in the female genital tract of mice after mucosal immunizations with the recombinant B subunit of cholera toxin (rCTB) perorally, intraperitoneally, vaginally, and intranasally (i.n.). The strongest genital antibody responses as measured with a novel perfusion-extraction method were induced after vaginal and i.n. immunizations, and these routes also gave rise to specific immunoglobulin A (IgA) and IgG ASC in the genital mucosa. Specific ASC in the iliac lymph nodes, which drain the female genital tract, were seen only after vaginal immunization. Progesterone treatment increased the ASC response in the genital tissue after all mucosal immunizations but most markedly after vaginal immunization. We also tested rCTB as a carrier for human gamma globulin (HGG) and the effect of adding cholera toxin (CT) as an adjuvant for the induction of systemic and genital antibody responses to HGG after vaginal and i.n. immunizations. Vaginal immunizations with HGG conjugated to rCTB resulted in high levels of genital anti-HGG antibodies whether or not CT was added, while after i.n. immunization the strongest antibody response was seen with the conjugate together with CT. In summary, vaginal and i.n. immunization give rise to a specific mucosal immune response including ASC in the genital tissue, and vaginal immunization also elicits ASC in the iliac lymph nodes. We have also shown that rCTB can act as an efficient carrier for a conjugated antigen for induction of a specific antibody response in the genital tract of mice after vaginal or i.n. immunization.

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