scholarly journals High Grade Serous Carcinoma Presenting as a Huge Pelvic Mass with Normal Looking Ovaries: A Diagnostic Challenge for Pathologist

2020 ◽  
Author(s):  
Vaishali Walke ◽  
Amrapali Gaikwad ◽  
Madiha Shaikh ◽  
Balwant Kowe
Keyword(s):  
Correct Diagnosis ◽  
Diagnostic Delay ◽  
Delayed Diagnosis ◽  
Pelvic Mass ◽  
Clinical Findings ◽  
Serous Carcinoma ◽  
High Grade ◽  
Diagnostic Challenge ◽  
Immunohistochemical Markers ◽  
Specific Symptoms

High-grade serous carcinoma represents 50-60% of all ovarian cancers and is the most common type of malignant surface epithelial tumour. Serous carcinoma is often diagnosed in the sixth and seventh decade, while the mean age for high-grade tumours is 63 year. It’s not only the non-specific symptoms like vague abdominal pain, nausea, gastrointestinal disturbances, but also the unusual presentation which is responsible for delayed diagnosis. This diagnostic delay can become the reason for increased mortality, despite advances in surgical management and chemotherapy. Here, authors discuss a case of 60-year-old postmenopausal women who presented with a huge pelvi-peritoneal mass and with grossly normal ovaries. Considering clinical findings and histomorphology, the possibility of malignant mesothelioma was considered as the first differential diagnosis; however extensive sampling of ovaries and supportive immunohistochemical markers helped us to arrive at a definitive diagnosis. The present case emphasises the importance of extensive tissue sampling and ancillary techniques in arriving at a correct diagnosis.

Carcinosarcoma of the ovary: MR and clinical findings compared with high-grade serous carcinoma

2020 ◽  
Author(s):  
Tsukasa Saida ◽  
Kensaku Mori ◽  
Yumiko Oishi Tanaka ◽  
Masafumi Sakai ◽  
Taishi Amano ◽  
...  
Keyword(s):  
Clinical Findings ◽  
Serous Carcinoma ◽  
High Grade

scholarly journals Gynecologic Serous Carcinoma: An Immunohistochemical Analysis of Malignant Body Fluid Specimens

2018 ◽  
Vol 143 (6) ◽  
pp. 677-682
Author(s):  
Shuyue Ren ◽  
William Klump
Keyword(s):  
Body Fluid ◽  
Germ Cell Tumors ◽  
Immunohistochemical Analysis ◽  
Serous Carcinoma ◽  
Low Grade ◽  
High Grade ◽  
Gynecologic Malignancy ◽  
Immunohistochemical Markers ◽  
Immunohistochemical Studies ◽  
Positive Results

Context.— Evaluation of fluid specimens involved by serous carcinoma might potentially include PAX8, GATA3, Uroplakin II, SOX2, and SALL4 antibodies. Those markers are commonly employed for diagnosing carcinomas of various types, including urothelial malignancies and germ cell tumors. There have been no comprehensive immunohistochemical studies, to our knowledge, for those markers on fluid specimens involved by serous carcinoma. Objective.— To evaluate immunohistochemical markers PAX8, GATA3, SOX2, uroplakin II, and SALL4 in the diagnosis of high-grade serous carcinoma in fluid specimens. Design.— We examined 113 fluids (96 ascites specimens and 17 pleural fluid specimens) that were positive for carcinoma. Most (94 cases; 83.2%) consisted of high-grade serous carcinoma of Müllerian origin. Nineteen cases of non–high-grade serous carcinoma (including one case of low-grade serous carcinoma) of gynecologic origin were also included as anecdotal data. Results.— In 113 fluid specimens with positive results for carcinoma, including nonserous types, 99 (87.6%) had positive results for PAX8, 19 (16.8%) for GATA3; 19 (16.8%) for SOX2, 23 (20.4%) for uroplakin II, and 8 (7.1%) for SALL4. Of 94 fluids (83.2%) involved with high-grade serous carcinoma, 84 (89.4%) had positive results for PAX8, 18 (19.1%) for GATA3, 17 (18.1%) for SOX2, 22 (23.4%) for uroplakin II, and 8 (8.5%) for SALL4. Some of these specimens showed reactivity for more than one immunohistochemical marker. Conclusions.— Most fluids involving high-grade serous carcinoma showed positive results for PAX8, and some cases expressed GATA3, SOX2, uroplakin II, and SALL4. Serous carcinoma in fluids may be positive for immunohistochemical markers not thought of traditionally as associated with gynecologic malignancy, an important consideration in avoiding misdiagnosis.

Primary mixed large cell neuroendocrine and high grade serous carcinoma of the endometrium

2020 ◽  
Vol 13 (9) ◽  
pp. e234977
Author(s):  
Liesel Elisabeth Hardy ◽  
Zia Chaudry ◽  
King Wan ◽  
Chloe Ayres
Keyword(s):  
Abdominal Pain ◽  
Neuroendocrine Carcinoma ◽  
Pelvic Mass ◽  
Large Cell ◽  
Serous Carcinoma ◽  
High Grade ◽  
Second Line ◽  
Vaginal Mass ◽  
Loss Of Weight ◽  
Line Chemotherapy

Endometrial large-cell neuroendocrine carcinoma admixed with a high-grade serous (HGS) adenocarcinoma is extremely rare with only one reported case in the literature. We present the second reported case in a 47-year-old woman who presented with abdominal pain, distension and loss of weight. On examination she had a fixed pelvic mass and vascular left vaginal mass. Imaging confirmed a 13 cm solid cystic rectouterine pelvic mass, omental disease and retroperitoneal lymphadenopathy. She underwent a modified posterior exenteration, partial posterior vaginectomy, omentectomy and Hartmanns procedure with suboptimal debulking. Histopathology revealed a stage 4B mixed carcinoma with large cell neuroendocrine (70%) and HGS carcinoma (30%). Eight cycles of adjuvant cisplatin and paclitaxel were given with a complete radiological and biochemical response after 7 months. Unfortunately, she developed widespread recurrence at 9 month and was offered second line chemotherapy.

scholarly journals Occipital Condyle Fracture with Associated Hypoglossal Nerve Injury

2006 ◽  
Vol 33 (3) ◽  
pp. 322-324 ◽  
Author(s):  
Shaan Chugh ◽  
Kambiz Kamian ◽  
Bart Depreitere ◽  
Michael L. Schwartz
Keyword(s):  
Hypoglossal Nerve ◽  
Correct Diagnosis ◽  
Delayed Diagnosis ◽  
Clinical Signs ◽  
Occipital Condyle ◽  
Rare Injury ◽  
Occipital Condyle Fracture ◽  
Condyle Fracture ◽  
Occipital Condyle Fractures ◽  
Specific Symptoms

Occipital condyle fracture (OCF) is a rare injury that was first described by Bell in 1817. In fact, there have been only 96 more reported cases of occipital condyle fractures from 1817 to 1994 of which only 58 survived. Occipital condyle fractures can sometimes go unnoticed or under-diagnosed as they are not always evident on plain radiographs of the cervical spine. Also, in rare cases OCFs can cause damage to the hypoglossal nerve which passes through the hypoglossal canal which is near the occipital condyle. The presence of specific symptoms and clinical signs should lead to the correct diagnosis. This paper describes a patient who was diagnosed with OCFs, but not hypoglossal nerve damage until 20 days following admission to hospital. We point out many factors that contributed to this delayed diagnosis, which ultimately caused severe discomfort to the patient.

scholarly journals Bernard Soulier Syndrome: Presenting As High-grade Fever In A Young Male

2019 ◽  
Vol 09 (03) ◽  
pp. 247-249
Author(s):  
Syed Parvez Asghar ◽  
Rida Ali Asghar ◽  
Syed Sajid Abbas Jaffari ◽  
Zehra Akhtar ◽  
Naveed Siddique
Keyword(s):  
Blood Clotting ◽  
Correct Diagnosis ◽  
Young Male ◽  
High Grade ◽  
Bleeding Disorders ◽  
Diagnostic Challenge ◽  
High Grade Fever ◽  
Common Causes ◽  
Life Threatening ◽  
Bernard Soulier Syndrome

Bernard-Soulier syndrome (BSS) is a rare inherited disorder of blood clotting (coagulation). They may be life-threatening and demand immediate attention. Congenital bleeding disorders especially pose a diagnostic challenge to the clinician because of their rarity and the need to be differentiated from the other common causes of bleeding in children. We present a case of young male presenting with generalized weakness, high grade fever with chills, dry cough and black tarry stools (2-3 stools/day). No response to steroids and further evaluation by platelet, ADP, collegen, epinephrine and defective response to ristocetin led to the correct diagnosis – Bernard soulier syndrome (BSS). However, it is imperative to have arrived at correct diagnosis in order to save unnecessary therapy and to take due precautions for prevention of bleeding

scholarly journals Ovarian Serous Carcinoma Associated With a Distinct “Corded and Hyalinized” Pattern

2013 ◽  
Vol 137 (2) ◽  
pp. 275-279 ◽  
Author(s):  
Jeannelyn S. Estrella ◽  
Judith K. Wolf ◽  
Michael T. Deavers
Keyword(s):  
Distinct Pattern ◽  
Serous Carcinoma ◽  
Second Primary ◽  
Low Grade ◽  
High Grade ◽  
Diagnostic Challenge ◽  
Unique Case ◽  
Spindle Cell Neoplasm ◽  
High Grade Carcinoma ◽  
Collagenous Stroma

The “corded and hyalinized” pattern, described in endometrioid carcinoma, has not been previously reported in association with serous carcinoma. We describe a unique case of serous neoplasm of low malignant potential with low-grade serous carcinoma combined with a distinct pattern of high-grade carcinoma characterized by cords of epithelioid and spindled cells enmeshed in a hyalinized, collagenous stroma. This pattern was the predominant architecture in the patient's recurrence and caused a diagnostic challenge, as the splenic recurrence was initially diagnosed as a second primary high-grade spindle cell neoplasm. Both ovarian and splenic tumors displayed positive immunohistochemical staining for cytokeratin 7, cytokeratin 8/18, estrogen receptor, and paired box gene 8 (PAX-8) in the conventional serous carcinoma and the corded and hyalinized component, confirming the diagnosis of recurrent carcinoma. The behavior in this unique case of serous carcinoma associated with a distinct corded and hyalinized pattern was more aggressive than low-grade serous carcinoma, but more favorable than malignant mixed mullerian tumor.

scholarly journals Primary High-grade Serous Carcinoma of the Fallopian Tube as an Incidental Intraoperative Finding: A Case Report

2021 ◽  
Vol 18 (3) ◽  
Author(s):  
Nasim Shokouhi ◽  
Sara Saeedi ◽  
Soheila Sarmadi ◽  
Behnaz Moradi ◽  
Elham Feizabad
Keyword(s):  
Fallopian Tube ◽  
Frozen Section ◽  
Gynecologic Cancer ◽  
Total Abdominal Hysterectomy ◽  
Serous Carcinoma ◽  
Histopathological Diagnosis ◽  
High Grade ◽  
Delay In Diagnosis ◽  
Left Fallopian Tube ◽  
Specific Symptoms

: Primary carcinoma of the fallopian tube is a rare, but fatal gynecologic cancer. The preoperative diagnosis of this carcinoma is challenging due to the absence of specific symptoms and signs, and in most patients, it is an intraoperative finding. A 55-year-old patient (G3Ab1P2) was referred to the urogynecology clinic of our hospital with the chief complaints of heavy, prolonged menstrual bleeding and a persistently abnormal yellow discharge, which could not be distinguished by the patient from urinary leaks. After a complete diagnostic work-up, the patient was identified as a candidate for hysterectomy due to abnormal vaginal bleeding resistant to megestrol acetate, family history of malignancy, and abnormal vaginal discharge. Laparotomy revealed unusual left fallopian tube features (large, bulky, and vegetative), suggesting malignancy. The intraoperative frozen-section analysis of the left fallopian tube and the ovarian specimens indicated the mass as a high-grade serous carcinoma of the fallopian tube. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and partial omentectomy were performed for the patient. The definitive histopathological diagnosis was high-grade serous carcinoma of the left fallopian tube (stage 2b) with omental involvement, without any evidence of lymphovascular invasion. High-grade serous carcinoma of the fallopian tube is likely to have non-specific symptoms, causing a significant delay in diagnosis and treatment, which negatively affects the prognosis and survival of these patients.

Napsin A and WT 1 are useful immunohistochemical markers for differentiating clear cell carcinoma ovary from high-grade serous carcinoma

Apmis ◽  
2017 ◽  
Vol 126 (1) ◽  
pp. 45-55 ◽  
Author(s):  
Bharat Rekhi ◽  
Kedar K. Deodhar ◽  
Santosh Menon ◽  
Amita Maheshwari ◽  
Jyoti Bajpai ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Serous Carcinoma ◽  
High Grade ◽  
Immunohistochemical Markers ◽  
Napsin A ◽  
Carcinoma Ovary

scholarly journals Mucinous appendiceal adenocarcinomas: a diagnostic challenge

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
Ekta Sharma ◽  
Shyam Ajay Gokani ◽  
Jonathan Neville ◽  
Ashish Sinha ◽  
Tushar Agarwal
Keyword(s):  
Diagnostic Laparoscopy ◽  
District General Hospital ◽  
Low Grade ◽  
High Grade ◽  
Diagnostic Challenge ◽  
Mucinous Neoplasm ◽  
Post Surgery ◽  
Appendiceal Neoplasms ◽  
Specific Symptoms ◽  
Radiological Studies

Abstract Mucinous appendiceal neoplasms are rare and diagnosis is often difficult as patients present with non-specific symptoms often suggestive of appendicitis only and most diagnoses are made following post-surgery histology examination. Here we present a case of a mucinous appendiceal adenocarcinoma with areas of both Low-grade Appendiceal Mucinous Neoplasm and High-grade Appendiceal Mucinous Neoplasm, in a ruptured appendix at a district general hospital. Without early detection and treatment these pathologies can lead to pseudomyxoma peritonei, a syndrome of progressive mucinous ascites. This case highlights the limitations of radiological studies, benefits of diagnostic laparoscopy and provides a rationale for removing the mesoappendix with the appendix during routine appendectomies.

scholarly journals Misdiagnosis of Cerebellar Infarctions

2014 ◽  
Vol 41 (5) ◽  
pp. 568-571 ◽  
Author(s):  
Navdeep Sangha ◽  
Karen C. Albright ◽  
Hui Peng ◽  
Farhaan Vahidy ◽  
Amelia Boehme ◽  
...  
Keyword(s):  
Neurological Examination ◽  
Correct Diagnosis ◽  
Delayed Diagnosis ◽  
Cerebellar Infarction ◽  
Stroke Registry ◽  
Diagnosis Group ◽  
Intravenous Tissue Plasminogen Activator ◽  
Critical Components ◽  
Cerebellar Infarct ◽  
Specific Symptoms

AbstractBackgroundThis retrospective study addresses for the first time the differences in clinical features and outcomes between those individuals with a cerebellar infarct who were correctly diagnosed on initial presentation compared to those who experienced delayed diagnosis.MethodsA retrospective review was conducted of our stroke registry from 09/2003 to 02/2011. Forty seven patients had an isolated cerebellar infarction confirmed by MRI. Misdiagnosis was defined as the diagnosis given by the first physician.ResultsAmong 47 patients identified, 59.6% had delayed diagnosis. Five patients in the correct diagnosis group received intravenous tissue plasminogen activator, compared to none in the delayed diagnosis group. Complaints of weakness were protective from delayed diagnosis (OR 0.087, 95% CI 0.019-0.393, p=0.001).ConclusionPatients with an isolated cerebellar infarction need to be considered when patients present with acute non-specific symptoms. Critical components of the neurological examination are omitted which are imperative to diagnose cerebellar infarcts. A thorough neurological examination may increase clinical suspicion of an ischemic stroke.

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