Malignant fibrous primary histiocytoma of the recto-vaginal septum

Considering the different localizations of malignant fibrous histiocytomas (MFH), that of the recto-vaginal septum is extremely rare. The present report describes a case, probably the first in literature, characterized by a storiform-pleomorphic histological type, treated with posterior exenteration and adjuvant chemotherapy. The Authors stress the still controversial histogenetic problem, as well as those related to a correct therapeutic approach.     

A case of calcified ovarian fibroma with ossification

From a review of the available literature over the past 22 years it is concluded that calcification of ovarian fibromas is relatively rare. Of the articles reviewed not one mentioned the presence of concomitant ossification. A case of calcified ovarian fibroma with ossification in a 21-year-old patient is presented.     

A rare case of extrauterine adenosarcoma arising in endometriosis of the rectovaginal septum

OBJECTIVE: To present a rare case of endometrial stromal sarcoma arising in endometriosis of the rectovaginal septum. DESIGN: Case report. SETTING: Academic tertiary referral center for endometriosis treatment. PATIENT(S): A 50-year-old woman with a history of endometriosis presented with catamenial rectal pain and deep dyspareunia. Imaging findings suggested new endometriotic lesions in the rectovaginal space. INTERVENTION(S): Total hysterectomy, salpingo-oophorectomy, and excision of the lesion in the rectovaginal septum were performed. Although extemporary pathology confirmed endometriosis, the final histologic diagnosis was extrauterine adenosarcoma in the rectovaginal septum. Two years later, recurrence of the malignancy occurred and was treated by resecting the new perirectal mass. Subsequent radiotherapy and chemotherapy were administered. MAIN OUTCOME MEASURE(S): Imaging findings at follow-up evaluation. RESULT(S): The patient was in good health for 2 years after the initial surgery, when she developed a new lesion at the site of the previous resection. The histologic appearance of the lesion was consistent with recurrence of the tumor. After postoperative therapy, the patient is now without evidence of disease. CONCLUSION(S): Malignant transformation of endometriosis should be considered in the differential diagnosis of a new pelvic lesion in a patient with a history of endometriosis.     

Diagnostic problems in a case of fibroma ovarii

Fibroma ovarii is a solid benign tumor which consists of fibrous tissue. It is usually hard, but there may be small cystic spaces due to degenerative changes. The incidence of fibroma ovarii is about 8 to 10%. The authors present a case of this tumor with difficulties in diagnosis before operation.     

Post-menopausal ovarian fibroma associated with steroid hormone synthesis: A case report

ObjectiveOvarian fibromas are benign, sex cord-stromal tumors occurring in both peri- and post-menopausal women. Generally, these tumors are non-functional and do not produce hormones. However, this case report proves the first case of steroid hormone synthesis in an ovarian fibroma by immunohistochemistry.Case reportA 77-year-old post-menopausal woman presented with a left ovarian tumor, abnormal endometrial thickness, and high levels of estradiol (E2). The tumor was found to be a fibroma, which was positive for alpha-inhibin. We examined estrogen-producing enzymes using immunohistochemistry. The tumor was positive for estrogen receptor, progesterone receptor, 17β-hydroxysteroid dehydrogenase (HSD)-1, adrenal 4 binding protein/steroidogenic factor 1, 17β-HSD-5, steroid sulfatase, and P450c17.ConclusionThis case study shows that E2 can be locally produced from circulating inactive steroids, by estrogen-producing enzymes. This is the first report of steroid hormone synthesis in an ovarian fibroma.     

Pregnancy in a woman with a uterine septum. A case report.

A term pregnancy occurred in the presence of a significant uterine septum. The changes in the anatomic appearance of the septum were documented sonographically throughout the gestation. A complete workup for other causes of pregnancy loss and attention to obstetric detail are central to the management of such patients.     

Septate uterus with double cervix and longitudinal vaginal septum. A case report.

BACKGROUND: Congenital uterine anomalies in the general population are estimated to have an incidence of 0.001-10%. The septate uterus, the most common form of structural uterine anomaly, has the highest reproductive failure rate. A rare developmental variant is a septate uterus with cervical duplication and a complete longitudinal vaginal septum. The existence of this anomaly challenges classical müllerian developmental theory. Traditional transabdominal metroplasty has been replaced by operative hysteroscopy in the surgical correction of a septate uterus, with laparoscopy aiding in the diagnosis and contributing to the safety and efficiency of the procedure. CASE: A 28-year-old, nulliparous woman with a septate uterus with cervical duplication and complete longitudinal vaginal septum was diagnosed by combined laparoscopy and hysteroscopy. Excision of the complete longitudinal vaginal septum followed by hysteroscopic partial resection of a thick uterine septum with laparoscopic assistance was performed. However, because of the septum's broad base and the rigidity of the operative resectoscope, we opted to proceed with transabdominal metroplasty. CONCLUSION: Only six cases of septate uterus with cervical duplication and complete longitudinal vaginal septum have been reported. Although its counterpart, the septate uterus, has effects on preterm labor, fetal presentation, infertility and spontaneous abortion, its reproductive outcome has not been assessed. Review of the literature suggests that surgical correction in the setting of poor reproductive outcome has been beneficial. Laparoscopically assisted hysteroscopic resection of the uterine septum is a safe, effective surgical technique of uterine reunification and is preferable to transabdominal methods. However, in certain cases, conventional transabdominal metroplasty may still be required.     

The diagnosis and management of infiltrating nodular recto-vaginal endometriosis

This paper reviews the history of infiltrating recto-vaginal endometriosis, its clinical and histological diagnosis, together with discussion of treatment options available. Important new work demonstrates significant serious symptomatology which patients suffer, and the relief that can be obtained by radical surgical excision. However this treatment is only available in certain specialist centres. The appropriate methods of management are yet to be subject to a proper randomized control trial, and results of treatment can only be assessed by meticulous recording of patient signs and symptomatology pre- and post-operation associated with histological confirmation of the disease.     

Primary adenocarcinoma of the rectovaginal septum: a case report and literature review

The authors report the third case of primary adenocarcinoma of the rectovaginal septum without associated endometriosis and discuss the pathogenesis of this tumour. Some of the tumour cells were stained with OC 125 antibody which recognises epithelium of coelomic origin; adenocarcinoma of the rectovaginal septum may arise directly from embryological Müllerian remnants.     

Primary adenocarcinoma arising from endometriosis of the rectovaginal septum: a case report

Adenocarcinomas developing in endometriotic lesions have been reported, most commonly in the ovary. The rectovaginal septum is a rare location of this neoplastic transformation. We report a case of primary adenocarcinoma arising from endometriosis of the rectovaginal septum in a 25-year-old woman presenting with lower abdominal pain and dyspareunia. Diagnostic and treatment modalities were discussed. Immunohistochemical studies of different keratin subtypes and CA125 expression of the tumor cells are of interest for the diagnosis. Preoperative radiation therapy promotes clinical symptoms relief, tumor volume reduction, and better radical surgical approach.     

Metastatic hepatocellular carcinoma in the nasal septum: report of a case.

Metastatic hepatocellular carcinoma (HCC) in the sinonasal region is rare. We report the case of a 45-year-old male hepatitis B carrier who had metastatic HCC 2 years after resection of the primary tumor. The patient died of terminal hepatic failure 6 weeks after the discovery of nasal septal metastasis. The clinical and histopathologic characteristics of the primary and metastatic hepatocellular tumors are described. This is the first reported case of nasal septal metastasis from HCC.