Syringoma - An Unusual Cause of Pruritus Vulvae

A case of syringoma of the vulva causing severe vulval pruritus is presented. The patient was thought to have either vulval dystrophy or nonspecific inflammation. Unexpectantly the diagnosis of syringoma was made on pathological examination of biopsy specimens. This unusual case is presented as the presenting symptoms and macroscopic appearance was atypical for syringoma.     

Skull metastasis in primary vulvar adenocarcinoma of the Bartholin's gland: a case report

BACKGROUND: Metastatic bone involvement in vulvar squamous carcinoma is very rare. Here, we present a case of primary adenocarcinoma of the Bartholin's gland giving rise to isolated skull metastasis. CASE: A 74-year-old woman was referred with a diagnosis of primary vulvar adenocarcinoma of the right labium minus. A right hemivulvectomy was performed with ipsilateral inguinofemoral lymphadenectomy, revealing a primary adenocarcinoma of the Bartholin's gland and metastatic involvement in 6 out of 13 lymphnodes. During chemotherapy administration, the patient started complaining of a worsening of right hypoacousis. CT scan and MRI of the brain showed the presence of a metastatic lesion on the right side of the skullbone. The diagnosis was metastatic poorly differentiated adenocarcinoma. CONCLUSION: In adenocarcinoma of the Bartholin's gland at an advanced stage of disease, a bone scan or survey in the preoperative as well as follow up staging procedures could be useful.     

Mesonephric adenocarcinoma of the vagina with a 3-year follow-up

BACKGROUND: Mesonephric adenocarcinoma of the vagina is exceedingly rare, with only one well-documented case in the literature. Little is known regarding clinical presentation, pathological characteristics, therapy, or prognosis of the vaginal mesonephric adenocarcinoma. CASE: A 55-year-old woman presented with a polypoid mass at the right vaginal apex, extending to the right paravaginal tissue. The tumor was an adenocarcinoma with ductal and tubular pattern arising in a background of mesonephric remnants. Tumor cells showed immunoreactivity for pankeratin, epithelial membrane antigen (EMA), and calretinin. The right fallopian tube and one paravaginal lymph node were positive for metastases. The patient is disease-free 3 years after surgery, radiation therapy, and chemotherapy. CONCLUSION: We report the second case of mesonephric adenocarcinoma of the vagina with metastasis to the right fallopian tube and to one paravaginal lymph node.     

Synchronous diagnosis of multiple tumours in a postmenopausal woman

We report an unusual case of a postmenopausal woman that was diagnosed with multiple tumours derived from different embryogenic tissues. She presented with postmenopausal vaginal bleeding. Clinical examination revealed a large pelvic mass, tender on palpation. Serum CA-125 level was elevated at 8,985 kU/l (normal range 0–35). A CT scan showed a malignant-appearing right ovarian mass with a peritoneal nodule, small amount of free fluid in the pelvis and evidence of a colonic intussusception. The patient underwent total abdominal hysterectomy, bilateral salpingo-ophorectomy, partial omentectomy and right hemicolectomy with side-to-side anastomosis. Histopathology showed a Grade 3 endometrial adenocarcinoma. Both ovaries were completely replaced by partially necrotic poorly differentiated endometrioid adenocarcinoma. Small deposits of metastatic adenocarcinoma were seen within the omentum. Sections from the retroperitoneal mass showed a low-grade liposarcoma. A large polypoid tumour within the right colon was a tubulo-villous adenoma.     

Gastric cancer diagnosed by biopsy of the uterine cervix

Biopsy of the uterine cervix from a 46-year-old woman who suffered from epigastric pain and weight loss showed metastatic adenocarcinoma. The primary site of the tumor was the stomach. At laparotomy, disseminated adenocarcinoma on the peritoneum and Krukenberg's tumor in the right ovary were found. A palliative partial gastrectomy, resection of the right ovary, and postoperative chemotherapy were performed. The possible mechanism of metastasis of extragenital cancer to the uterus is discussed.     

Mucinous appendicular cystadenocarcinoma during pregnancy. A case report

BACKGROUND: Primary appendicular adenocarcinoma is a rare type of appendicular carcinoma. We report mucinous appendicular adenocarcinoma during pregnancy. To our knowledge, this is the third reported case. CASE: A 35-year-old woman at 21 weeks of gestation presented with acute abdominal symptoms for the previous 10 days and underwent appendectomy. Histopathologically, examination of the appendectomy material was reported as "mucinous appendicular cystadenocarcinoma." The pregnancy was terminated by misoprostol induction. A right hemicolectomy and staging procedure were performed on the third postpartum day with relaparotomy. CONCLUSION: Although it rarely coexists with pregnancy, primary appendicular adenocarcinoma should be considered in pregnant women with atypical acute abdominal symptoms of long duration. Primary adenocarcinoma of the appendix should be treated with right hemicolectomy even if it is a secondary procedure. Termination of pregnancy is not essential to the surgical procedure, and the decision on the outcome of the pregnancy should be made with the patient.     

Microscopic endometrioid carcinoma arising in endosalpingeal endometriosis

We present a case of microscopic adenocarcinoma arising in the right fallopian tube, which was incidentally found in 74-year-old woman undergoing total abdominal hysterectomy with salpingo-oophorectomy for uterine myoma, hematometra and bilateral hydrosalpinx. A small focus of endometrioid adenocarcinoma confined within the endosalpingeal mucosa of the right fallopian tube associated with endometriosis was fortuitously found during histological examination. Our case seems to be unique since it shows an evident filiation between the lesions of tubal endometriosis and an adjoining focus of microscopic carcinoma. This is the second case report of a microscopic endometrioid carcinoma associated with endosalpingeal endometriosis.     

Spontaneous occurrence of gangrene due to clostridium septicum in a patient with advanced endometrial carcinoma

Background: We report the first known case of spontaneous, atraumatic Clostridium septicum gangrene occurring in a patient with recurrent endometrial adenocarcinoma.Case: A 63-year-old white female undergoing chemotherapy for recurrent endometrial adenocarcinoma presented with right "arthritis-like" shoulder pain. She denied fever, chills, or shoulder trauma. The patient was afebrile and her blood pressure was 100/50. Her right shoulder and upper extremity were remarkable for an area of dark blue discoloration with crepitus. The white blood cell (WBC) count was 8,200/mul with left shift. Serum creatinine, platelet count, and coagulation studies were normal. Computed tomography revealed gas in the right shoulder tissues. A Gram stain of fluid aspirated from the shoulder demonstrated gram-positive spore-forming rods. She declined surgical intervention and expired within hours of admission. Cultures of the right shoulder eventually grew Clostridium septicum.Conclusion: It is imperative to consider clostridial gangrene in the differential diagnosis for any patient with cancer and a fever of unknown origin.     

Bilateral primary ovarian carcinomas: Case report

A case is presented of a patient with a primary high-grade medullary carcinoma of the left ovary with metastasis to the right ovary and a primary low-grade adenocarcinoma of the right ovary.     

Urachal adenocarcinoma metastatic to the ovaries: case report and literature review.

We report a urachal adenocarcinoma metastatic to both ovaries in a 50-year-old Japanese woman. Pelvic examination and imaging studies revealed a large cystic tumor occupying the pelvis and another cystic tumor between the umbilicus and the urinary bladder. A laparotomy was performed. Histopathological examination revealed a urachal tumor that was a well-differentiated invasive mucinous adenocarcinoma; the overlying urothelium was intact. The right and left ovarian tumors were well-differentiated mucinous adenocarcinomas. The urachal and ovarian tumors were immunoreactive for cytokeratin 20 and carcinoembryonic antigen, but negative for cytokeratin 7. The patient is alive with lymph node and bone metastases 6 months postoperatively. This is the eighth reported case of an adenocarcinoma of the bladder with ovarian metastasis.     

Adenocarcinoma of the appendix in pregnancy: a case report

BACKGROUND: Perforation of an adenocarcinoma of the appendix in a pregnant woman is rare and may present as a pelvic mass and acute appendicitis. CASE: A 30-year-old woman, gravida 3, para 2-0-0-2, presented at 26 weeks' gestation with an acute abdomen, right-sided pelvic mass and uterine contractions. Tocolysis and prompt surgical exploration revealed a perforated appendix. The patient underwent a right hemicolectomy with primary anastomosis, her postoperative course was benign, and she delivered a viable infant at term vaginally. Pathology revealed a perforated adenocarcinoma of the appendix. The patient was free of disease at 36 months. CONCLUSION: Adenocarcinoma of the appendix in pregnancy is rare, may present as an acute abdomen with a mass and is managed with right hemicolectomy.     

Endometriosis-associated epithelial ovarian cancer is a more complicated disease than we suspected before

ObjectiveEndometriosis-associated epithelial ovarian cancer (EOC) often includes clear cell carcinoma and endometrioid-type carcinoma. Due to the low incidence of primary mucinous EOC and absence of association between endometriosis and primary mucinous EOC, we present an unusual endometriosis-associated mixed mucinous and endometrioid adenocarcinoma arising from the same ovary.Case reportA 54-year-old woman had an abdominal palpable mass for months. Medical and surgical history, as well as preoperative surveys was unremarkable, except of presence of a pelvic mass. She underwent an exploration laparotomy, and a 22-cm right ovarian tumor was found. Grossly, right ovarian tumor containing brownish cloudy cystic fluid 2450 ml and an apparent 4 × 4 × 2 cm-sized papillary growth. Microscopically, a confluent glandular and infiltrative pattern presented endometrioid adenocarcinoma, and cells with intracytoplasmic mucin and stratified elongated epithelial cells presented mucinous adenocarcinoma. Surgico-pathological stage was FIGO IIIA due to tumor invading to the peritoneum above the pelvis. Postoperatively, the dose-dense chemotherapy was applied with uneventful outcome.ConclusionThis is a rare case, composed with mixed mucinous and endometrioid adenocarcinoma of the same ovary, suggesting that careful pathological diagnosis of endometriosis-associated EOC is needed.     

Combined positron emission tomography and computed tomography for the detection of recurrent ovarian mucinous adenocarcinoma

BACKGROUND: The role of combined positron emission tomography and computed tomography (PET-CT) in the diagnosis of recurrent ovarian mucinous adenocarcinoma is uncertain because of previous reports that PET has limited sensitivity in the detection of mucinous neoplasms. CASE: A 71-year-old white woman presented with complaints of right lower quadrant pain and a palpable adnexal mass. Physical examination and transvaginal ultrasonography revealed a 12 x 13 cm cystic mass in the left side of the pelvis. Exploratory laparotomy, optimal tumor-reductive surgery, total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendectomy, and omentectomy were performed. The diagnosis was FIGO stage IIIC well-differentiated ovarian mucinous adenocarcinoma. The patient was treated with 6 cycles of carboplatin and paclitaxel. Four months after completing chemotherapy, the patient was noted to have an elevated serum CA125 level (72 U/mL), being otherwise asymptomatic. Findings on abdominal and pelvic CT were compatible with postsurgical changes. PET-CT was performed and revealed increased metabolism along the posterior aspect of the right rectus abdominis muscle and abutting the anterior wall of an adjacent loop of bowel. CONCLUSION: PET-CT may identify clinically occult recurrent ovarian mucinous adenocarcinoma.     

Pelvic sidewall adenocarcinoma after definitive therapy for cervical adenocarcinoma in situ

BACKGROUND: Traditionally, hysterectomy is considered definitive therapy for cervical adenocarcinoma in situ (AIS) in women beyond childbearing. CASE: A 45-year-old gravida 2, para 2 patient presented with cervical dysplasia and on pathology review of the large loop excision procedure cervical adenocarcinoma in situ was diagnosed. She underwent extrafascial hysterectomy and bilateral salpingo-oophorectomy. Final pathology revealed adenocarcinoma in situ with negative margins. Twenty-eight months later, she presented with right lower extremity deep venous thrombosis. A computed tomography (CT) scan of the abdomen and pelvis showed a pelvic sidewall mass. A CT-guided biopsy of the mass was consistent with invasive adenocarcinoma of the endocervical type. She underwent combination therapy with weekly cisplatin and extended field radiation therapy. CONCLUSION: This case depicts another example of the unpredictable nature of cervical AIS. Despite undergoing definitive surgery, a residual focus of disease may remain leading to invasive adenocarcinoma. Close follow-up is required of all patients diagnosed with AIS because the disease is poorly understood.     

Colon cancer during pregnancy. A case report

BACKGROUND: The reported incidence of cancer during pregnancy is between 0.07% and 0.1%. The incidence of colorectal carcinoma in pregnancy was 1 per 13,000 liveborn deliveries during 1981-1989. CASE: A 33-year-old woman, gravida 2, para 1, was admitted at 30 weeks' gestational age with a history of rectal bleeding and right upper quadrant pain. Abdominal ultrasound and magnetic resonance imaging revealed a mass located on the posterior part of the right liver and a fetus with vertex presentation. Primary cesarean section and a right hemicolectomy and wedge biopsy from the metastatic lesion on the right side of the liver at 34 weeks' gestation was performed. Histologic examination confirmed serosal and lymph node invasion of moderately differentiated mucous-secreting adenocarcinoma of the cecum and adenocarcinoma metastatic to the liver. The patient received systemic chemotherapy. CONCLUSION: Only 1 of 41 cases of colon cancer during pregnancy above the peritoneal reflection has been reported to be localized to the cecum. Our case is the second such one. Women with colorectal carcinoma during pregnancy usually have a poor prognosis, which may be attributable to younger age and delay in diagnosis since the initial symptoms often are presumed attributed to normal pregnancy, as in this case.     

Colon Carcinoma in Pregnancy

A case of metastatic adenocarcinoma of the colon presenting in pregnancy is described. The initial complaint was of right upper quadrant pain with elevated liver enzymes.     

An unusual presentation of metastatic gastric adenocarcinoma--acute onset of right neck swelling.

Central venous thrombosis is an uncommon problem associated with malignancy. We present here a 53-year-old male who visited the emergency room because of right neck swelling. Fluid accumulation over deep neck space led to the diagnosis of suspected hemorrhage, and central venous thrombosis was found by computed tomography. This patient had no other precipitating cause. Autoimmune disorders, hypercoagulation and malignancy surveys were performed during hospitalization. Elevated serum tissue polypeptide antigen and CA130 were noted, and multiple liver metastases were found by another computed tomography. Subsequently, gastric adenocarcinoma was confirmed after gastroendoscopy. Gastric adenocarcinoma with distal metastases was finally diagnosed. This case reminds us that central venous thrombosis is a sign of many diseases. Malignancy, including gastric adenocarcinoma, is one of the causes that should be considered.     

Rare metastases of pancreatic tail carcinoma in female genital organs

A case is presented of pancreatic tail carcinoma metastasizing to the uterus, right ovary and right sacrouterine ligament 2.5 years after the primary tumor had been detected and treated. During explorative laparotomy, performed after 3D color Doppler ultrasonographic visualization of a suspected finding in the right adnexal region, metastatic deposits in the uterus, right ovary, right sacrouterine ligament and right ureter originating from the primary adenocarcinoma of the tail of the pancreas were detected and surgically removed.     

Villoglandular adenocarcinoma of the vulva

BACKGROUND: Only two previous cases of villoglandular adenocarcinoma of the vulva, an entity morphologically similar to tumors found in the uterine cervix and colorectum, have been reported. This paper communicates the first complete immunohistochemical study in villoglandular adenocarcinoma in order to determine its phenotype and histogenesis. CASE: A 69-year-old woman had a 1.5-cm nodule in the right labium majus. Histologically, it corresponded to a minimally atypical, villoglandular adenocarcinoma with a small microinvasion. Immunohistochemically, it was positive to OC125, CEA, and OC19.9 and coexpressed cytokeratins 7 and 20. Chromogranin, nuclear estrogen, and progesterone receptors were negative. CONCLUSION: Phenotypic expression was more consistent with a papillary mucinous ovarian or cervical neoplasm than of a colonic one. Its behavior was similar to that of its morphologic counterpart in the cervix, since the patient had no recurrence 3 years after a wide local excision.     

Eccrine adenocarcinoma of the vulva producing isolated alpha-subunit of glycoprotein hormones

A rare case of adenocarcinoma of the sweat glands of the vulva producing isolated alpha-subunit of glycoprotein hormones is reported. By an immunohistochemical method, eccrine gland adenocarcinoma tissues obtained from the right vulva and from its metastatic lesion in the right subclavicular lymph nodes were found to react with human chorionic gonadotropin (hCG), alpha-hCG but not beta-hCG. The concentrations of alpha-subunit in the serum and urine were markedly elevated to 6000 ng/mL and 55,000 ng/mL, respectively, just before the death of the patient.