Case Report About Extraperitoneal Metastasis of Cervical Adenocarcinoma In Situ

Background: adenocarcinoma in situ(AIS) cells are often misdiagnosed, and recognizing AIS in cervical cytology is challenging. Here, we present a case of extraperitoneal metastasis 5 years after a missed diagnosis of AIS.Case presentation: We report a 49-year-old Chinese woman who presented with a retroperitoneal mass 5 years after cervical conization for AIS. The retroperitoneal mass was composed of glands lined by malignant mucinous epithelium; these tumors were metastases from her previous AIS which were misdiagonised cervical intraepithelial neoplasia(CIN) III in 2013. The patient is alive and well 2 years after resection of the tumors.Conclusions: An experienced pathologist or multiple pathologists should take part in endocervical AIS diagnosis. We should follow these patients for over 15 years. When Cancer Antigen 125(CA125) or Carcinoembryonic antigen(CEA) levels are elevated, the occurrence of metastases should be strictly monitored.

Mucinous Cystadenoma of the Ovary Associated with Hyperplasia of Stromal Leydig Cells in Pregnant Woman

Background: The hormonally induced non-neoplastic lesions of ovarian stroma during pregnancy must be recognized by pathologist in order to avoid mistaking them for true tumors. Case report: A 28-year-old woman was delivered of a healthy infant by cesarean section. As an incidental finding, a multicystic tumor in the left ovary was found and resected. Histopathology was consistent with benign mucinous cystadenoma. In addition, within the stroma beneath the lining mucinous epithelium, a dense population of cohesive polygonal cells with abundant eosinophilic cytoplasm, typically resembling the Leydig cells, was seen. They were uniform without atypia, accompaning by minimal proliferative activity. They strongly expressed vimentin, inhibin, CD99 and calretinin. The final diagnosis of mucinous cystadenoma associated with hyperplasia of stromal Leydig cells was made. Conclusions: Leydig cell hyperplasia belongs to the specific changes of ovarian stroma associated with pregnancy. The present case stresses that in such situation the pathologists should be aware of it and not confuse it with a tumor.

Successful pregnancy in an ovarian Sertoli-Leydig cell tumor patient with heterologous elements: case report and literature review

Background: Ovarian Sertoli-Leydig cell tumor (SLCT) is an extremely rare sex–cord stromal tumor of the ovary. Notably, ovarian SLCT with mucinous epithelium and liposarcoma is even rarer.There is also evidence that the presence of heterologous elements is a poor prognostic factor of SLCTs. Very often, ovarian SLCT patient first presents with high androgen levels and sometimes a clarge mass in the pelvic cavity, making it difficult for early diagnosis. Case presentation: In this study, we reported a SLCT patient with heterologous elements and elevated the serum alpha-fetoprotein (AFP) levels. A 22-year old nulliparous female was first admitted with clinical symptoms of abdominal pain, a large mass in the pelvic cavity and elevated serum AFP levels, and for this she underwent left adnexectomy. Pathological examination revealed ovarian SLCT with intestinal type mucinous epithelium and liposarcoma, and immunohistochemical staining revealed positive staining for AFP in the intestinal type mucinous epithelium. The patient became pregnant naturally four years later, but SLCT was found in the opposite ovary with liposarcoma but no significant increase in serum AFP levels.Further, we reviewed the literature in order to improve preoperative diagnosis and evaluation of long-term prognosis of SLCTs with heterologous elements.Conclusion: The increase in serum AFP levels could be used for preoperative diagnosis of the presence of heterologous elements and the postoperative recurrence.

Mesenteric and Retroperitoneal Mucinous Cystic Neoplasms: A Case Series

Aims. Mucinous cystic neoplasms (MCNs) are cystic neoplasms with mucinous epithelium surrounded by ovarian-like stroma. Extraovarian MCN occurring in the liver and pancreas have been well characterized. However, only rare case reports of MCN arising outside of these locations have been reported. MCNs arising in unusual locations should enter the differential diagnosis of mucinous intra-abdominal tumors and must be distinguished from more common mimics. Therefore, we aimed to examine a series of MCNs of the retroperitoneum and mesentery to characterize the clinicopathologic features of this entity. Methods and results. Seven MCNs arising in the abdominal mesentery or retroperitoneum were retrospectively identified. A clinicopathologic, histologic, and immunohistochemical (keratin 7, keratin 19, keratin 20, calretinin, inhibin-α, steroidogenic factor-1 (SF-1), estrogen receptor (ER), progesterone receptor (PR), PAX8, CDX2, and CD10) analysis was performed. All 7 MCNs were from females with a median age of 41 years old and a median size of 8 cm. All cases demonstrated mucinous with or without concomitant non-mucinous epithelium overlying spindle cell ovarian-like stroma. Luteinized cells were noted. The epithelium was positive for keratin 7 and keratin 19 in all 7 cases, while the stroma expressed ER, PR, and SF-1 in all cases stained. Calretinin was focally positive in the stroma of 3 of 7 cases, while inhibin-α was focally expressed in 5 of 6 cases. Conclusions. These results highlight the clinicopathologic, histologic, and immunophenotypic similarities between MCNs of the mesentery, retroperitoneum, pancreas, and liver. Overlapping features suggest a common histogenesis for all MCNs, which could include periductal fetal mesenchyme, aberrant migration of primordial germ cells, or abnormal differentiation or metaplasia of the embryonic coelomic epithelium.

Clinicopathological Characteristics of Low-Grade Appendiceal Mucinous Neoplasm

Introduction: Recently, “low-grade appendiceal mucinous neoplasms” (LAMNs) have been proposed as one subtype of appendiceal mucinous neoplasms, characterized by a villous or flat proliferation of mucinous epithelium with low-grade cytologic atypia. The aim of this study was to clarify the clinicopathological characteristics of LAMN. Methods: In this multi-institutional cohort study, we retrospectively analyzed the clinicopathological characteristics in appendiceal neoplasms patients who underwent treatment from 2000 to 2017. Results: In total, 922 patients were enrolled, with 279 (30.3%) cases of LAMN, and 93 (10.1%) cases of non-LAMN disease. In comparison with patients with non-LAMN disease, those with LAMN had significantly lower levels of CA19-9 (p = 0.045), a lower frequency of T4 tumors (p < 0.0001), a lower frequency of lymph node metastasis (p < 0.0001), and a lower frequency of distant metastasis (p < 0.0001). Survival analysis revealed that patients with LAMN had a significantly better prognosis than did those with non-LAMN disease (p < 0.001). Among the patients with distant metastasis, those with LAMN had a significantly better prognosis than did those with non-LAMN disease (p = 0.0020), but among the patients without distant metastasis, the difference between the 2 groups was not significant (p = 0.26). However, among patients who underwent complete resection, the difference in prognosis between the 2 groups was not significant (p = 0.10). Conclusions: A multicenter retrospective study revealed that the clinicopathological characteristics of LAMN was different from those of non-LAMN.

Mucinous cystic neoplasm of the liver with biliary communication: case report and surgical therapeutic option

Background Mucinous cyst neoplasm of the liver (MCN-L) comprise less than 5% of all cystic liver lesions and is characterized by the presence of ovarian stroma and absence of bile duct communication. Case presentation Here, we discuss a 45-year-old woman who presented with symptomatic liver mass. Diagnostic workup detected a 4.2 × 3.6 cm septate cyst located in segments I, V, and VIII of the liver in communication with the right hepatic duct. An open right liver resection with total bile duct excision and hilar lymphadenectomy was performed. Pathology revealed a multiloculated cyst with lined mucinous epithelium and ovarian-like stroma, consistent with low-grade MCN-L. Conclusions This case shows that unusual location and bile duct communication can be present in MCN-L.

Morphologic and Immunohistochemical Analysis of Mesenteric and Retroperitoneal Mucinous Cystic Neoplasms

Introduction/Objective Mucinous cystic neoplasms (MCN) are neoplasms with mucinous epithelium surrounded by ovarian-type stroma, occurring in the pancreas and liver. Reports of MCN arising outside the liver and pancreas are rare. We aim to perform a clinicopathologic, morphologic and immunohistochemical analysis of mesenteric and retroperitoneal MCN arising separate from the pancreas and liver. Methods Seven mesenteric or retroperitoneal MCN (n=7) were identified and clinical and radiologic information obtained, where available. The following immunostains were performed on each case: keratin 7, keratin 19, estrogen receptor, progesterone receptor, calretinin, inhibin-α, and SF-1. Results All seven MCN were from women with a median age of 41 years (range: 28-70 years). The median size of the MCN was 8cm (range: 8-14.5 cm) involving the retroperitoneum (n=5) and mesoappendix (n=2). One patient was diagnosed with a synchronous right ovarian mucinous cystadenoma. Morphologically, all MCN displayed mucinous or mixed non-mucinous-mucinous cuboidal to columnar epithelium without dysplasia. Ovarian-type stroma was identified underlying the epithelium with foci of luteinized stromal cells. The ovarian-type stroma expressed estrogen and progesterone receptors in all seven cases, two cases stained with SF-1 showed diffuse strong stromal positivity, and one case stained with inhibin showed focal strong stromal positivity. Additional immunohistochemical analysis with CK7, CK19, calretinin, inhibin-α, and SF-1 on all cases is pending. Conclusion Clinicopathologic, morphologic, and immunohistochemical characteristics of mesenteric/retroperitoneal MCN are similar to their pancreas and liver counterparts. Familiarity with this entity and knowing it can arise in mesenteric/retroperitoneal locations is important for accurate diagnosis and to distinguish it from mucinous carcinoma, teratoma, endometriosis and other differential diagnoses which have different implications. We propose that mesenteric/retroperitoneal MCN may possibly arise from primordial germ cells that underwent aberrant migration during their retroperitoneal descent through the fetal dorsal mesentery which gives rise to the neck and body of the pancreas as well as the mesentery and mesoappendix.

Mucinous Cystadenoma Arising From Renal Pelvis

Primary mucinous cystic tumors occurring in the renal pelvis or the entire pelvicaliceal system are uncommon. Most are mucinous cystadenoma and less frequently mucinous cystadenocarcinomas. In fact, the publications on these neoplasms are limited to a few cases. Because mucinous cystadenomas of kidney are exceedingly rare, little is known about their natural history, pathogenesis and clinicopathologic features. Herein, we describe a case of mucinous cystadenoma arising from the renal pelvis, which resembled hydronephrosis. The patient presented with a history of intermittent dull pain on the left loin for 6 months. He had no history of removing urinary calculus or long- standing chronic infection in urinary system. The histopathology was unique since the inner surface of the cyst was covered by a mucinous epithelium connected to a urothelium, a transition from non- neoplastic urothelium to mucinous epithelium. This suggests that mucinous cystadenoma of renal pelvis, like its malignant counterpart, may arise in foci of metaplastic mucinous areas. Faridpur Med. Coll. J. Jul 2019;14(2): 104-106

Mucinous cystic neoplasm of the liver: a case report

A 50-year-old woman was investigated for epigastric pain. Imaging revealed a multilocular cyst with multiple thin septae within segment IV of the liver, measuring up to 140 mm in diameter. There was associated bile duct dilatation. Given the patient’s symptoms, the size of the cyst and malignant potential, a hemi-hepatectomy was performed. Histopathology demonstrated a cyst lined by columnar mucinous epithelium with underlying ovarian-type stroma. Therefore, the diagnosis was mucinous cystic neoplasm of the liver (MCN-L). MCN-L is a rare disease, and the presence of bile duct dilatation is an even rarer finding. This article presents a case report and review of literature of this entity.