Intra-abdominal hemangiopericytoma: an unexpected finging during laparotomy

Two cases of intraabdominal hemangiopericytoma are reported. 1. A 32-year-old patient underwent laparotomy because of a tumor arising from the greater omentum. Histological examination showed benign hemangiopericytoma. 2. In a 57-year-old women laparotomy revealed a tumor attached to the Omentum maius. Histological examination confirmed the diagnosis of malignant hemangiopericytoma. In spite of radical operation the patient died 9 months later. Until now only a few case reports exist about the occasional finding of hemangiopericytoma when gynecological disease was suspected. If the tumor is malignant prognosis does not seem to be improved by the additional radio- or chemotherapy.     

Congenital hemangiopericytoma in a neonate.

Hemangiopericytoma is a rare malignant vascular tumor that usually occurs in adults. The occurrence of these tumors in infants, known as congenital or infantile hemangiopericytoma, is even rarer and their behavior may be more benign than the adult type. We describe a 1-day-old female neonate with congenital hemangiopericytoma, presenting with a right inguinal mass at birth. At the time of surgery, lymphangioma was suspected because of its appearance, fluid-filled multicystic content, and the high incidence of this disease in pediatric patients. Tumor excision was performed and hemangiopericytoma was diagnosed by histology. There was no tumor recurrence during 12 months of follow-up.     

Malignant cervical schwannoma: An unusual pelvic tumor

BACKGROUND: Primary malignant cervical schwannomas (malignant peripheral nerve sheath tumors) are extremely rare tumors that grossly may resemble many other more common lesions. The diagnosis, management, and follow-up of a malignant cervical schwannoma are presented with a review of the literature. CASE: A 51-year-old female presented with a 3-year history of perimenopausal vaginal bleeding. A 3 x 3 cm friable, spongy lesion was noted on the posterior aspect of the cervix. Frozen-section analysis could not rule out a malignant smooth muscle tumor. The patient underwent an exploratory laparotomy, total abdominal hysterectomy, and bilateral salpingo-oophorectomy. Immunohistochemistry and electron microscopy aided in the final diagnosis of a malignant cervical schwannoma. The patient is alive and well 1 year from her definitive surgery. Another patient with the same tumor received the same surgical management. This patient is now 10 years from her surgery and is alive with no evidence of disease. CONCLUSION: Immunohistochemistry and electron microscopy are useful in the diagnosis of a malignant cervical schwannoma. This case and long-term follow-up from another case provide evidence that simple hysterectomy may be sufficient therapy for this uncommon lesion.     

Malignant female adnexal tumors of probable Wolffian origin.

Female adnexal tumors of probable Wolffian origin are rare. Although the histological features of the benign tumors are recognized, features of malignancy are not well defined in published work because these tumors are particularly rare. In this study, we report an 81-year-old woman presenting with a 6-month history of postmenopausal bleeding. A pelvic transvaginal ultrasound scan demonstrated a midline, highly vascular, predominantly solid pelvic mass, approximately 14 cm, posterior to the uterus. CA-125 was moderately raised. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy. Immunohistochemical staining and electron microscopy supported the diagnosis of female adnexal tumor of probable Wolffian origin. There was significant and widespread nuclear pleomorphism with increased mitotic activity endorsing the diagnosis of a malignant tumor. Seven months after initial surgery, follow-up magnetic resonance imaging showed a mass with a maximum diameter of 7 cm in the region of the right adnexa consistent with a recurrence. The patient declined further treatment.     

Primary malignant schwannoma in peritoneum of pelvis minoris: a case report

There are reports of rare cases of malignant schwannoma of the small bowel, ovary or urinary bladder. We report a case of malignant schwannoma found in peritoneum without any other localisation in 66-year-old woman. The first diagnosis was tumor of right ovary. Laparotomy was performed and a big, solid tumor of urinary bladder involving the small bowel was found. There were some small tumors in peritoneum and parametrium. All the tumors were removed. The histological changes of the small lesions were described as malignant schwannoma. The mass in urinary bladder and small bowel was found to be of an inflammatory origin. The cases described by other authors suggest, that the diagnosis of malignant schwannoma in pelvis minoris is very difficult. Surgery is an adequate way of final diagnosis and management.     

Coexistence of ovarian epithelial tumor of borderline malignancy with pregnancy: a case report]

OBJECTIVES: Ovarian tumors during pregnancy are a rare event. In most cases the tumors are detected accidentally during routine examination, ultrasound or a caesarean section at term. Histologic subtypes and prognosis do not differ from tumors not associated with pregnancy, it seems however, that there are more lesions of borderline malignancy and of low grade. STUDY DESIGN: The patient age 26 during 16 week of pregnancy was operated in Department of Gynecology & Obstetrics in Hospital of S?upsk. RESULTS: During laparotomy ovarian epithelial tumor of borderline malignancy stage I A has been diagnosed and unilateral cystectomy after meticulous surgical exploration was done. A successful spontaneous delivery occurred subsequently when the patient was in 38 week of pregnancy. The patient is followed for disease status every three month and her health is good. CONCLUSIONS: Serous low malignant potential ovarian tumors during pregnancy have microscopic and clinical features suggesting aggressive behavior, however, these features appear to regress at the termination of pregnancy. Limited resection, after meticulous surgical exploration is adequate therapy for women of reproductive age.     

Primary peritoneal psammocarcinoma: A case presenting with an upper abdominal mass and elevated CA-125.

Primary peritoneal serous adenocarcinoma with predominating psammoma bodies, psammocarcinoma, is a very rare tumor with only seven cases documented in the English literature. Pathological classification of this entity was established in 1990 and clinical behavior of this tumor is uncertain. Based on limited data these tumors appear to behave similarly to low malignant potential tumors of the ovary. This case describes a 59-year-old woman who underwent exploratory laparotomy for a large upper abdominal cystic mass. Findings included a large tumor mass involving the gastrocolic omentum and dense small bowel adhesions. The patient had normal ovaries and was debulked to no macroscopic disease. Final pathologic diagnosis confirmed a stage IIIC primary peritoneal psammocarcinoma. The patient has received no adjunctive therapy and is without evidence of disease 2 years after surgery. Primary peritoneal psammocarcinoma is a neoplasm which can mimic serous adenocarcinoma of the ovary. In contrast, primary peritoneal psammocarcinoma appears to behave in an indolent fashion. Primary surgical debulking should be attempted, while the utility of postoperative chemotherapy remains unknown.     

Primary retroperitoneal mucinous cystadenoma

Primary retroperitoneal mucinous cystic tumors are extremely rare, and although their histopathogenesis is still uncertain, several theories have been proposed. Traditionally, transabdominal laparotomy and enucleation of the cyst is the treatment of choice. The anatomopathological examination of the mass is imperative in the fact to eliminate malignant lesions. We report the case of a 43-year-old woman, with primary retroperitoneal mucinous cystic tumor, revealed by an abdomino-pelvic mass. During laparotomy, a totality of the tumor was removed. The anatomopathologic study permitted the diagnosis.     

Jejunal adenocarcinoma presenting as a primary ovarian carcinoma

OBJECTIVE: The aim of this case report was to evaluate the impact of immunohistochemical markers in diagnosing the primary site of adenocarcinoma in the abdominopelvic region. METHODS: Surgicopathologic data were obtained from laparotomy and necropsy. Paraffin-embedded tissue from the ovary and jejunum was stained with hematoxylin and eosin, as well as with immunohistochemical stains for cytokeratin 20 and cytokeratin 7. RESULTS: A 53-year-old African American woman underwent an emergency laparotomy due to small bowel obstruction. During the operation, in addition to a complex adnexal mass as the cause of obstruction, a small solid jejunal tumor was also identified. Pathologic evaluation of the two sites demonstrated an infiltrating moderately to poorly differentiated adenocarcinoma with mucinous features. The malignant cells from both intestinal and ovarian sites showed immunoreactivity for cytokeratin 20 and revealed negative staining for cytokeratin 7. These results confirmed the diagnosis of intestinal primary with ovarian metastasis, which was initially misdiagnosed as an ovarian primary. CONCLUSION: Given the potential difficulty in determining the primary site of these tumors, immunohistochemistry proved to be a useful tool in reaching the correct diagnosis.     

Uterine tumor resembling an ovarian sex cord tumor associated with metastasis.

Uterine tumors resembling ovarian sex-cord tumors (UTROSCT) are very rare, usually benign uterine tumors, and are probably derived from uterine mesenchymal stem cells. In this case report, a unique case of a malignant UTROSCT is described. Four years after a diagnosis of UTROSCT of the uterine corpus, the patient developed obstructive ileus due to a large infiltrating tumor within the small bowel with the same morphology and expression pattern as the previously diagnosed UTROSCT. In addition, 2 benign gastrointestinal stromal tumors were detected in the same patient. This case indicates that although the majority of UTROSCT are benign tumors, some of them might undergo malignant transformation and have a metastatic potency.     

Low malignant potential tumors of the ovary: a study of 76 cases

This study analyzes the clinical and pathological features of 76 patients who were diagnosed as having ovarian low malignant potential tumor over a 20-year period: 39 (51.3%) of the tumors were mucinous, 29 (38.2%) serous, three (3.9%) endometrioid, and five (6.6%) mixed. Patients with serous tumors were significantly younger (mean age 40 years) than those with mucinous tumors (mean age 50.5 years). Serous tumors were more frequently bilateral (48.3%) than mucinous tumors (12.8%). The extent of tumor (FIGO stage) at the primary laparotomy was related to the prognosis: the survival of 14 patients with stage III and six patients with stage II tumor was significantly inferior to that of the 56 patients with stage I tumors (P less than .01). Patients with stage III mucinous low malignant potential tumors and pseudomyxoma peritoneii fared badly. Four patients with stage II and 13 patients with stage III tumors had residual tumor after primary surgery. Five of these patients received no subsequent treatment of whom four are alive and well from 5.5 to 19 years after diagnosis. Three patients received pelvic radiotherapy. Eleven patients were treated with chemotherapy for residual or recurrent tumor but only one (9.1%) had an unequivocal response.     

Ruptured ovarian granulosa cell tumors as a cause of the acute abdomen

A rare case of acute abdomen syndrome due to a ruptured ovarian tumor and a penetrated fallopian tube is described. Based on the intraoperative finding and patient’s age, a right-sided salpingo-oophorectomy, appendectomy and peritoneal washings were performed. After a histological diagnosis of malignant granulosa cell tumors and FIGO IIA clinical classification, the patient returned 1 month after the procedure. A relaparotomy with a hysterectomy, left-sided salpingo-oophorectomy and omentectomy were then performed. No spread was found during the laparotomy, and the histologic diagnosis pointed to adenomyosis and chronic cervicitis. The patient regularly presents for control examination, and has now been free for 11 years since the surgery from clinical, biochemical or ultrasonographic signs of a relapse of the disease. Received: 3 August 2001 / Accepted: 8 October 2001 Correspondence to D. Habek     

Primary malignant mesothelioma of the peritoneum: a clinical and immunohistochemical study

BACKGROUND: Primary peritoneal mesothelioma is regarded as a fatal disease that presents with progressive ascites at a relatively late stage of its natural history. Differential diagnosis between this rare tumor and both serous papillary carcinoma of the peritoneum and ovary can be problematic. CASE: A 54-year-old woman presented to our institution with a 4-month history of dull epigastric pain and increased abdominal girth. Exploratory laparotomy revealed the presence of extensive intraperitoneal dissemination of a malignant neoplasm without a recognizable primary site. Suboptimal cytoreduction was carried out, and histological diagnosis was that of a malignant epithelioid mesothelioma. This was confirmed with a panel of immunohistochemical markers. The patient despite having a complete response after adjuvant chemotherapy died 18 months after primary surgery. CONCLUSION: No single immunohistochemical stain is pathognomonic of peritoneal primary malignant mesothelioma (PMM), and the results of a panel of antibodies should be interpreted to set the diagnosis.     

Wolffian duct tumors: case reports and review of the literature

BACKGROUND: Female adnexal tumors of probable wolffian origin are a distinctive epithelial neoplasm arising from the remnants of the mesonephric duct. Although generally considered a tumor of low malignant potential, these tumors can recur. Two cases are reported here. CASES: (1) A 38-year-old G(6)P(6) Latin American woman presented with lower abdominal pain and a pelvic mass. She had a history of a total abdominal hysterectomy and bilateral salpingo-oophorectomy with a paratubal nodule found incidentally 3 years prior. The pathologic findings were consistent with a female adnexal tumor of probable wolffian origin. Imaging studies revealed significant metastatic disease throughout her abdomen and pelvis. The recurrence was confirmed at laparotomy and tumor debulking was performed. Four months later the patient suffered a second recurrence and is currently undergoing treatment with systemic therapy. (2) A 71-year-old Caucasian woman who had undergone exploratory laparotomy and tumor reductive surgery for a female adnexal tumor of probable wolffian duct origin was seen for routine evaluation 1 year after her surgery. Her computed tomography scan revealed possible evidence of recurrence. CONCLUSION: Most female adnexal tumors of wolffian origin behave in a benign fashion. However, there is a potential risk of recurrence. Surgical excision by total abdominal hysterectomy and bilateral salpingo-oophorectomy at the time of diagnosis may be the best recommended mode of therapy. The role of adjuvant radiation therapy or chemotherapy remains questionable.     

Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management.

OBJECTIVE: Our purpose was to determine maternal and fetal outcome in patients undergoing surgery for pelvic mass in pregnancy. STUDY DESIGN: Maternal and fetal records of 130 cases of adnexal masses associated with intrauterine pregnancy that required laparotomy or aspiration or that were diagnosed incidentally at the time of cesarean section were reviewed. The chi(2) and Fisher's exact tests were used for statistical analysis. A P value of 相似文献   

Desmoplastic small round cell tumor with primary ovarian involvement: case report and review

BACKGROUND: Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive, malignant neoplasm that has recently been characterized. It has not been associated with a primary visceral organ. In women, cases are even more rare and often have some ovarian involvement. CASE: An 11-year-old girl presented with abdominal pain, nausea, and vomiting. A CT scan revealed a large heterogeneous pelvic mass with cystic components and an 8-cm midabdominal mass. During exploratory laparotomy, the patient was found to have a pelvic mass measuring 12. 9 cm replacing normal ovarian tissue. The midabdominal mass was also removed. Pathology, cytology, and immunohistochemistry confirmed a desmoplastic small round cell tumor. Even with aggressive surgical and medical intervention, the patient died 11 months after initial diagnosis. CONCLUSION: We present a rare small cell tumor that is associated with ovarian involvement. The prognosis in these patients is extremely poor and very few survivals have been reported.     

卵巢原发性弥漫大B细胞淋巴瘤一例并文献复习

卵巢弥漫大B细胞淋巴瘤（diffuse large B cell lymphoma,DLBCL）是一种临床少见的发生于卵巢的恶性肿瘤,其发病机制尚不清晰,临床表现及辅助检查无明显特异性,术前诊断困难,确诊只能依靠组织病理结果及免疫组织化学结果,极易与卵巢其他恶性肿瘤相混淆,错过最佳治疗时机会延误病情。报道我院收治的1例卵巢DLBCL病例,患者以腹胀为主诉就诊,无其他不适,影像学检查不典型,入院初步诊断为盆腔肿物,通过行剖腹探查术得以明确诊断,给予手术及化学药物治疗。回顾性分析该患者的临床资料,复习相关文献,旨在加深临床医生对该病的认识,切实提高临床诊治能力。     

Malignant hemangiopericytoma of the breast: a case report with a review of the literature

Introduction A hemangiopericytoma of the breast is uncommon, and a hemangiopericytoma of the breast is even rarer. Only a few cases of hemangiopericytoma of the breast have been reported in literature. Case report Here, we report a case of a 66-year-old woman who presented with a mass in her left breast. The patient had trauma to her left breast 2 years ago with consecutive hematoma. An ultrasound-guided core biopsy indicated a malignant vascular tumor. Its morphology and immunohistochemical marker profile was characteristic for a malignant hemangiopericytoma. Thus, she underwent a mastectomy and an axilla sampling. Discussion The mammogram and the ultrasound findings of 2004 are presented in relation to those of 2006. Hemangiopericytoma of the breast is infrequent, so that the characteristics of this lesion are discussed in addition to the review of the previous literature on this unusual neoplasm.     

Gliomatosis peritonei and teratomatous implant with carcinomatous transformation presenting 54 years following oophorectomy for dermoid cyst

BACKGROUND: Gliomatosis peritonei is a rare condition associated with ovarian teratomas in which benign glial implants are identified on the peritoneal surfaces of the abdomen. The implants have been identified at initial surgery and at second-look laparotomy. CASE: Here, we present a case of an 82-year-old female who was diagnosed with gliomatosis peritonei 54 years after her initial surgery for an ovarian dermoid tumor. A separate teratomatous implant containing focally invasive adenocarcinoma was also present. CONCLUSION: This is by far the longest interval between initial diagnosis and identification of glial implants reported. Additionally, the presence of a separate malignant teratomatous implant suggests that teratomatous implants may retain malignant potential, in contrast to implants composed of purely benign glial tissue.     

Sclerosing stromal tumor of the ovary associated with Meigs' syndrome: a case report

Sclerosing stromal tumors of the ovary are distinct, but rare benign neoplasms. These tumors appear solid and are very vascular giving the impression of malignant tumors. They occur mostly in young women. Morphologically they have distinct characteristics which differentiate them from other stromal tumors. Benign ovarian tumors associated with Meigs' syndrome are rare. In this article a case of ovarian sclerosing stromal tumor associated with Meigs' syndrome in a 17-year-old women is described and the differential diagnosis is also discussed.