Malignant acanthosis nigricans, tripe palms and the sign of Leser-Tre'lat, a hint to the diagnosis of early stage ovarian cancer: a case report and review of the literature

BACKGROUND: Malignant acanthosis nigricans is a mucocutaneous eruption associated with internal malignancies. Tripe palms refers to a characteristic velvety thickening of the palms, with exaggeration of normal skin markings. The sign of Leser-Tre'lat is the presence of multiple seborrheic keratoses and scattered skin tags caused by a malignancy. We are reporting the first case of ovarian cancer in association with three coexisting cutaneous paraneoplastic dermatosis. CASE: A 52-year-old female presented with skin manifestation consistent with MAN, TP and the sign of Leser-Tre'lat. Patient underwent extensive work up and was discovered to have stage I, high grade adenocarcinoma of the ovary. Skin manifestations gradually recovered after initiation of chemotherapy. CONCLUSION: The presence of acanthosis nigricans in conjunction with tripe palms and the sign of Leser-Tre'lat are highly suggestive of an internal malignancy and necessitate an extensive investigation in order to discover the underlying malignancy.     

Uterine Malignant Mixed Mullerian Tumor in a Patient on Long-Term Tamoxifen Therapy for Breast Cancer

A case of malignant mixed mullerian tumor of the uterus, heterologous type, in an 83-year-old woman on tamoxifen (TAM) therapy for 9 years for breast cancer is presented. Benign endometrial polyps were diagnosed on endometrial curettings for postmenopausal bleeding after the patient had been on TAM for 5 years. Recurrent postmenopausal bleeding developed 4 years later. Endometrial curettings and hysterectomy revealed a 10-cm polypoid malignant mixed mullerian tumor (MMMT) and endometrial polyps. There was no invasion of the myometrium or endocervix and no evidence of metastatic tumor in 13 pelvic lymph nodes, peritoneal washings, or omentum. TAM has been associated with the development of endometrial polyps, hyperplasia, and adenocarcinoma possibly mediated through its agonistic estrogenic properties. Only one other case of MMMT arising in patients on TAM therapy has been previously reported, but may also be a consequence of the estrogenic effects of TAM therapy.     

Incisional skin metastasis of a squamous cell cervical carcinoma 3.5 years after radical treatment—a case report

Metastatic carcinoma in an abdominal wall incision from internal malignant neoplasm is an uncommon and often a preterminal event. Most commonly metastatic skin incisional cancers have been reported with cancers of colon, kidney, and bladder. Incisional metastasis from postoperative case of carcinoma cervix is very rare. It has been reported in few patients with adenocarcinoma and poorly differentiated histopathology, more so at drain site postoperatively. We report a postoperative case of squamous cell carcinoma cervix FIGO stage IIA in a patient who after 3.5 years of completion of radical treatment (postoperative external and intravaginal radiation therapy) developed incisional skin metastasis followed by extensive subcutaneous metastasis in the vulval region. She received salvage chemotherapy; however, she did not show any response and finally succumbed to the disease. The outcome of patients with incisional skin metastasis is usually poor as they are often associated with locoregional recurrence. The intent of treatment remains palliation either by radiation/chemotherapy/surgery alone or in combinations. As far as we know, this is the first case of squamous cell carcinoma cervix stage IIA having incisional scar recurrence 3.5 years after postoperative radiotherapy.     

Bone metastasis as a presenting feature of endometrial adenocarcinoma: case report and literature review

A rare case of endometrial adenocarcinoma that presented with symptoms of bone metastasis in the right ischium is described. The patient had no signs or symptoms of gynecological malignancy and the diagnostic work up did not reveal the primary disease. The bone metastasis was treated successfully by radiotherapy, but three years later the patient noted vaginal bleeding, which led to the diagnosis and treatment of the primary endometrial cancer. Another 20 cases of endometrial carcinoma with bone metastasis have been found in literature, but only five of them presented with the feature of bone metastasis. Bone metastasis should be considered in patients with endometrial adenocarcinoma.     

Solitary metastatic endometrial carcinoma of the spleen

Carcinomatous metastatic involvement of the spleen usually indicates widespread malignant disease. Solitary metastatic lesions in this organ are exceedingly rare and the literature reveals fewer than 15 cases. We have observed a poorly differentiated adenocarcinoma of the body of the uterus (adenoacanthoma) with an unusual route of metastasis in a 59-year-old patient. Only one case with the same pattern of spread from an endometrial carcinoma has been reported earlier.     

Endometrial carcinoma in septate uterus detected 6 months after full-term delivery: case report and review of the literature

BACKGROUND: Endometrial carcinoma associated with pregnancy is rare. We present the case of a 39-year-old woman with endometrial carcinoma in the septate uterus detected 6 months after normal delivery. CASE: The patient complained of vaginal bleeding from 32 weeks' gestation, and had a spontaneous vaginal delivery at 37 weeks. The bleeding continued after the delivery, but repeated endometrial cytology and biopsy did not reveal evidence of malignancy. An exploratory laparotomy was performed 6 months postpartum with suspicion of uterine myoma. A histological diagnosis of endometrial carcinoma was made based on examination of frozen sections from the hysterectomy specimen, and bilateral salpingo-oophorectomy and pelvic/para-aortic lymphadenectomy were also performed. Histological examination revealed G3 endometrioid adenocarcinoma with squamous differentiation, which arose in the septum of the uterus and deeply invaded the myometrium. The patient received postoperative chemotherapy and is healthy with no evidence of disease 3 years after the treatment. CONCLUSIONS: Although pregnancy-associated endometrial carcinoma is rare, careful examinations are needed when unexplained vaginal bleeding continued.     

Endometrial carcinoma following estrogen-progestogen therapy in Turner's syndrome: a case report and review of the literature.

A case of Turner's syndrome in which the patient developed a well-differentiated adenocarcinoma of the endometrium after 15 years of sequential estrogen-progestogen therapy and 3 additional years of combined therapy is reported. A survey of the literature revealed 10 other cases of Turner's syndrome in which endometrial carcinoma developed after long-term replacement hormonal therapy and one additonal case without a definitive diagnosis of carcinoma. Including the one described here, four patients developed endometrial carcinoma after either combined or sequential estrogen-progestogen therapy. Seven patients were given estrogen alone as substitution therapy. One patient was given progestogens alone for 19 weeks after 9 years of stilbestrol. It appears that the addition of progestogens to the therapeutic regimen does not always prevent the development of endometrial carcinoma. It is advocated that all patients with Turner's syndrome on replacement therapy with estrogens alone or with sequential or combined estrogen-progestogens be closely followed for the development of endometrial carcinoma.     

Non-puerperal uterine inversion associated with endometrial carcinoma--a case report

BACKGROUND: Non-puerperal uterine inversion is rare, and a case associated with endometrial carcinoma is even rarer. It is difficult to diagnose the condition preoperatively and most cases are diagnosed at surgery. CASE: We describe a case of uterine inversion associated with endometrial carcinoma. Initially, the patient was thought to have a cervical adenocarcinoma and treated with chemotherapy; however, a diagnosis of uterine inversion was made with magnetic resonance imaging (MRI) and ultrasonography during pre-surgical chemotherapy. We performed total abdominal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy. CONCLUSION: MRI and ultrasonography can be extremely useful tools for diagnosing uterine inversion.     

Expression of gonadal steroid receptors in the ovaries of post-menopausal women with malignant or benign endometrial pathology: a pilot study

Abstract

This pilot study aimed to investigate the expression of estrogen (ER) and progesterone receptors (PR), as well as their subtypes [alpha (ERα), beta (ERβ)], in the ovaries of postmenopausal women with benign or malignant endometrial pathology. Twenty postmenopausal women (age 66.2?±?7.4 years) were included, diagnosed with benign (n?=?10) or malignant [(serous/papillary (n?=?4), endometrioid (n?=?6)] endometrial lesions. Higher ERβ and PR ovarian expressions were observed comparing women with endometrioid versus non-endometrioid endometrial carcinoma (p?=?0.022 and p?=?0.029, respectively). Age, age at menarche and presence of hypertension were negatively associated with ERs and PR expression. The expression of ERα and ERβ was inversely correlated with menopausal age, which was not verified for PR. No significant association was observed between ERs or PR expression and benign or malignant endometrial pathology. Higher expression of ERβ and PR in the postmenopausal ovary is associated with the presence of a less aggressive type of endometrial cancer, comparing women with endometrioid versus non-endometrioid lesions. The expression pattern of ovarian receptors did not differ regarding the development of benign or malignant endometrial lesions. Larger observational studies are necessary to confirm the significance of our findings.     

Endometrioid carcinoma of the oviduct

Endometrioid carcinoma is a malignant tumor which microscopically resembles endometrial adenocarcinoma, but arises from extrauterine sites, most commonly the ovary. Although its association with endometriosis has received considerable discussion, it appears that most of the malignant endometrioid tumors arise de novo. We present a case of endometrioid carcinoma which is outstanding for its primary site in the oviduct and for its histologic appearance, which incorporated a close interplay between both stromal and epithelial elements. The neoplasm was found incidentally, when the woman presented with postmenopausal bleeding due to adenomatous hyperplasia of the endometrium. The patient presented with a stage I, grade I tumor which did not invade the wall of the oviduct. Twelve years following a TAH-BSO and postoperative radiation, the tumor recurred, requiring additional surgery and chemotherapy. The patient is currently disease free, 2 years from her recurrence.     

Expression of cyclin D1 in normal,hyperplastic and neoplastic endometrium and its correlation with Ki-67 and clinicopathological variables

Methods We investigated cyclin D1 expression in proliferative endometrium, endometrial hyperplasia and endometrioid adenocarcinoma, and examined the correlation of cyclin D1 expression with Ki67 as a cell proliferation associated marker. Immunohistochemical expression of cyclin D1 and Ki67 were studied in 30 cases with endometrial carcinoma, 14 cases with atypical hyperplasia, 15 cases with simple hyperplasia and 30 cases with proliferative endometrium.Results One out of 30 patients (3.3%) with proliferative endometrium, 1 out of 14 patients (7.1%) with atypical hyperplasia, and 8 out of 30 patients (26.6%) with endometrial carcinoma were found to have immunoreactivity to cyclin D1. All cases of simple hyperplasia had negative staining for cyclin D1. A positive immunoreaction for Ki67 was obtained in all cases. Statistically significant difference was found in cyclin D1 immunoreactivity between both proliferative endometrium and adenocarcinoma, and simple hyperplasia and adenocarcinoma (p<0.05). In patients with adenocarcinoma, cyclin D1 immunoreactive cases had higher mean Ki67 values compared with the non-immunoreactive ones (p<0.05). Ki67 and cyclin D1 immunoreactivity had no impact on overall survival. Univariate analysis revealed a significant relationship between survival and grade and stage (p<0.01). Cyclin D1 expression was not correlated with age, depth of myometrial invasion, lymphovascular space involvement, grade, lymph node metastasis and stage.Conclusion Cyclin D1 expression in endometrial carcinoma is higher than proliferative endometrium and simple hyperplasia. These findings support that cyclin D1 may play a role in endometrial carcinogenesis.     

Rare metastases of carcinoma of uterine cervix

This paper describes a case of cancer of the uterine cervix metastasizing in the spleen two years after the primary carcinoma was diagnosed and treated. After detailed diagnostics, the patient was subjected to surgery. Histopathological examination after splenectomy confirmed a very rare case - presence of metastases of planocellular carcinoma of the uterine cervix. Over the last ten years, references cite isolated cases of metastases of adenocarcinoma of the colon, stomach and breast in the spleen as well as lung carcinoma and malignant skin melanoma. Until now cases of uterine cervix carcinoma metastasizing to the spleen have been published as micrometastases detected in autopsy material.     

Clear cell endometrial adenocarcinoma in a young woman: report of a case detected by cytology.

A clear cell adenocarcinoma of endometrium detected by cytology is described in a 29-year-old woman, and prior reports of endometrial adenocarcinoma in women under 30 years of age are reviewed and tabulated. The youngest patients previously reported with clear cell carcinoma of endometrium were 31 and 34 years old. Unlike them, this patient had never used contraceptive steroids. She was not exposed to stilbestrol in utero, and exhibited no endocrine abnormalities. Of interest, however, the patient's mother had also had endometrial carcinoma though not with the clear cell histologic pattern.     

Uterine pleomorphic rhabdomyosarcoma in a patient receiving tamoxifen therapy

INTRODUCTION: Tamoxifen has been used as adjuvant therapy for the treatment of breast cancer. Its use has been associated with the development of proliferative endometrial lesions such as polyps, hyperplasia, and carcinoma. Mesenchymal tumors including malignant mixed mullerian tumors, endometrial stromal sarcomas, adenosarcomas, and leiomyosarcomas have been more recently described with tamoxifen use. CASE REPORT: This report describes the first case of a pure uterine rhabdomyosarcoma in a patient receiving tamoxifen therapy. DISCUSSION: Although uterine rhabdomyosarcomas are rare tumors and may arise de novo, we discuss the possible role of tamoxifen in the development of these mesenchymal tumors.     

Heterologous mixed müllerian tumor confined to an endometrial polyp.

Mixed müllerian tumors of the uterus, which have been divided into homologous and heterologous types, are considered neoplasms of high malignant potential. In the heterologous variety, the presence of rhabdomyosarcoma has been associated with an especially poor prognosis. We report the first case of a heterologous, malignant mixed mesodermal tumor (adenocarcinoma, stromal sarcoma, and rhabdomyosarcoma) confined to an endometrial polyp. The patient, treated by surgery only, remains clinically free of disease 11 years later. Mixed müllerian tumors of limited extent may not be associated with the dismal prognosis that usually accompanies such lesions.     

子宫内膜增生性疾病患者内膜细胞凋亡的研究

目的 :研究凋亡在子宫内膜增生性疾病中的作用。方法 :用改良原位末端标记技术检测 15例正常月经周期的增生期、分泌期、月经期子宫内膜 ,11例增殖性子宫内膜 ,12例子宫内膜癌 ,以及术前用孕激素治疗的 13例异常增生子宫内膜中的凋亡细胞 ,并计算其凋亡指数 (AI)。结果 :分泌期、月经期子宫内膜、增殖性子宫内膜、子宫内膜癌AI均比正常增生期子宫内膜AI高 (P <0 .0 1)。增殖症患者内膜不典型增生组AI比单纯增生、复杂增生组AI高 (P <0 .0 5 ) ;内膜癌患者低分化组AI比高分化组、中分化组AI高 (P <0 .0 5 )。结论 :细胞凋亡与正常子宫内膜周期性变化有关 ,而在增殖性和癌变子宫内膜中的异常表达可能与子宫内膜的良恶性病变有关     

Clinical, biochemical, and ovarian morphologic features in women with acanthosis nigricans and masculinization

Nine women with acanthosis nigricans and masculinization, who did not appear to have any of the reported syndromes associated with acanthosis nigricans, were studied to characterize the clinical, biochemical, and ovarian morphologic features of their disorders. These patients had the clinical and biochemical profiles of polycystic ovarian disease. All acanthosis nigricans subjects had significant insulin resistance when insulin binding to both circulating monocytes and erythrocytes was compared to the control subjects. Microscopic examination of the ovaries revealed no evidence of recent normal ovulation, sclerosis of the ovarian cortex, follicle cysts, and stromal hyperthecosis. The authors conclude that ovarian stromal hyperthecosis and insulin resistance are consistent findings in the present type of patient. This study provides further evidence supporting a relationship between insulin resistance and human ovarian function.     

Adenocarcinoma of the endometrium and endometrioid carcinoma of the ovary associated with pregnancy

Nine well-accepted cases of endometrial carcinoma associated with pregnancy have been reported. A 10th patient is added and the cases are briefly summarized. At the time of her definitive surgery 6 weeks postpartum, our patient was also found to have a Stage I endometrioid ovarian carcinoma. Nine of the 10 cases have been well-differentiated adenocarcinoma or adenoacanthoma and the lesions have tended to be focal with minimal or no invasion. Given the small number of patients, conclusions regarding prognosis and treatment are difficult to make. However, in younger patients with noninvasive adenocarcinoma of the endometrium, the adnexa may be spared. Endometrioid adenocarcinoma of the ovary, discovered incidentally in our patient, is associated with a concomitant adenocarcinoma of the endometrium in 5-29% of cases, but the present case in which the lesions coexisted with pregnancy appears to be the first such report in the literature.     

Malignant pericardial effusion in endometrial adenocarcinoma

A case of endometrial adenocarcinoma in a 62-year-old woman with malignant pericardial effusion is presented. The patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic node dissection, and paraaortic node biopsy. Postoperatively, she was placed on a combination chemotherapy regimen of cisplatin, doxorubicin, and cyclophosphamide. The patient developed cardiac tamponade during the course of chemotherapy. Although we first suspected cardiotoxic effect of doxorubicin, cytologic examination revealed adenocarcinoma cells in the pericardial fluid. A review of the literature revealed no other cases of cardiac metastasis from endometrial carcinoma diagnosed during life.