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.

Inguinal lymphadenopathy secondary to adenocarcinoma of caecum: A case report

Various tumours have been reported to metastasise to inguinal lymph nodes. To our knowledge, caecal cancer has never been reported to metastasise to inguinal nodes. We present a case of a woman who had caecal cancer with large contralateral inguinal lymphadenopathy. She underwent right hemicolectomy with excision of the inguinal lymph node. Histology confirmed adenocarcinoma of caecum metastasising to contralateral inguinal lymph nodes.

B-Chronic Lymphoproliferative Disorders (BCLD) Presenting with Splenomegaly: Differential Diagnosis and Outcome.

BACKGROUND: The differential diagnosis of BCLD in patients (pts) presenting with splenomegaly as the sole clinical finding is extremely difficult, due to the lack of lymph node histology. The diagnosis is based on morphology and immunophenotype (IF) from the blood and/or bone marrow. However, the reproducibility of morphology is limited and there is considerable overlap in IF findings. AIMS: The comparative analysis of pts with BCLD presenting with sole splenomegaly. METHODS: All pts presented to our Unit with a probable BCLD and splenomegaly as the sole clinical finding, between 1980 and 2005 were retrospectively analyzed. Pts were classified into 4 groups according to their IF: Group A: CD5+/CD23+ [B-CLL phenotype], Group B: CD5+/CD23− [Mantle cell lymphoma phenotype], Group C: CD5−/CD23+, and Group D: CD5−/CD23− [Groups C and D: Splenic marginal zone lymphoma phenotype]. Hairy cell leukemia cases were excluded from the analysis. Pts’ characteristics, first line treatment, disease specific survival (DSS), freedom from 1st treatment (FF1T)and freedom from 2nd treatment (FF2T) were analyzed. RESULTS: 71 pts (41 males) with a median age of 63 years (range: 39–83 y) were recorded. The 4 groups differed significantly in all their main characteristics, except of age, platelet count and frequency of lymphocytosis as shown in the table. 6 pts have not received any treatment, 27 were splenectomized, 16 received chlorambucil, 11 Rituximab and the remaining 11 other first-line treatments. The median follow up of the currently alive pts is 44.7 months (3–303). 34 pts have not required 2nd therapeutic intervention. The 10-year DSS of all 71 pts was 71±7%. The 10-year DSS and 5-year FF2T did not differ significantly between the 4 groups. However group B had a worse DSS (p=0.05) and FF2T (p=0.0036) compared to all other groups together. Cases who were CD38+ (p=0.055), CD11c− (p=0.001) and had Hb ≤12g/dL (p=0.03) had a worse prognosis. CONCLUSIONS: Pts with BCLD and splenomegaly can be classified into different clinicopathologic entities according to basic IF characteristics. CD5+/CD23− splenomegalic BCLDS seem to have a worse outcome. CD38+, CD11c− and anemia are poor prognostic features. The best therapeutic strategy remains to be established. Characteristics of the 4 Splenomegalic Groups Group A Group B Group C Group D p N 19 16 20 16 Spleen (cm) 14 (6–20) 16 (9–34) 10 (5–30) 10 (4–20) 0.03 Hb (g/dL) 12.0 11.0 10.0 12.4 0.02 WBC (×10 ^9/L) 30 10.8 10.1 10.8 0.02 CD38+ 28% 75% 5% 6% <0.001 CD25+ 63% 38% 19% 0% 0.002 CD11c+ 56% 27% 47% 80% 0.03