Small cell carcinoma of the ovary: a rapidly lethal tumor occurring in the young

Two patients with metastatic small cell carcinoma of the ovary managed by the Clinical Gynecologic Oncology Service at Roswell Park Memorial Institute are presented. Despite intensive multimodal therapy after extensive cytoreductive surgery, both patients expired from this rare tumor within 6 months of diagnosis. Neither tumor was associated with hypercalcemia, previously reported in the only existing review of the tumor in the world literature. Because of the highly aggressive nature of this cancer, effective combination chemotherapy must be found if the natural history of this tumor is to be altered.     

Sister Joseph's nodule: Seven cases of umbilical metastases from gynecologic malignancies

Seven cases of patients with gynecologic cancer and Sister Joseph's nodule, umbilical metastases from intraabdominal malignancy, are presented, making a total of 44 such cases in the literature. One such case, uterine leiomyosarcoma with umbilical metastases, is the first such lesion reported. Although the prognosis is generally poor, a few long-term survivors have been reported, and aggressive therapy may be warranted, particularly in patients with ovarian malignancy.     

Primary transitional cell carcinoma of the fallopian tube associated with primary carcinomas of the ovary and endometrium

A patient with primary transitional cell carcinoma of the fallopian tube, primary endometrial adenocarcinoma, and primary endometrioid carcinoma of the ovary is reported. The clinical picture was similar to that of adenocarcinoma of the fallopian tube, but the mode of spread was somewhat different and more aggressive. The patient was treated with surgery and a combination of internal and external radiotherapy.     

Placental-site trophoblastic tumor (trophoblastic pseudotumor): case report demonstrating failure of chemotherapy, surgery, and radiotherapy to control metastatic disease

A case of metastatic placental-site trophoblastic tumor (trophoblastic pseudotumor) is presented and compared to four previously reported cases. Chemotherapy with MAC (methotrexate, dactinomycin, cyclophosphamide), aggressive surgical debulking, and radiotherapy were ineffective in producing disease regression. Only two of the four similar cases in the literature showed short responses (4-7 months) to several different aggressive multiagent chemotherapy regimens. Optimal therapeutic outcome is likely to result from an early diagnosis and aggressive surgical treatment of localized tumor.     

Basaloid squamous cell carcinoma of the vagina metastasizing to the lung. A case report

BACKGROUND: While observed on the vulva, basaloid squamous cell carcinoma (BC) of the vagina is extremely rare, with no reported cases. CASE: A 54-year-old, African American woman presented with carcinoma metastatic to both lungs, morphologically similar to her BC of the vagina four years previously. She was treated initially in 1995 with local excision. Reexcision and radiation therapy were given for a recurrence in 1996. CONCLUSION: BC of the vagina is an extremely rare and aggressive tumor, which can recur and metastasize.     

Cervical adenoid cystic carcinoma associated with ascites

Two new cases of cervical adenoid cystic carcinoma are reported. The addition of these two cases brings the total number of reported cases in the literature to 88 making this the most common gynecologic site of occurrence for this unusual tumor. Ascites developed in both of these cases after primary radiation therapy. The significance of this unique association is discussed.     

Adenoid cystic carcinoma of the Cervix. Report of 9 cases and a reappraisal.

The clinical and pathologic findings of 9 patients with adenoid cystic carcinoma of the cervix are presented. A review of the literature identified an additional 29 cases. The tumor was usually associated with adenocarcinoma or squamous cell carcinoma of the cervix. Adenoid cystic carcinoma of the cervix appears to be an aggressive type of tumor; of the 38 cases reported in the literature lung metastases have occurred in 18 (47.4%), and of these, 14 patients are known to have died of the cancer.     

Metastatic carcinoma of the cervix uteri from the gastrointestinal tract

Six cases of metastatic carcinoma of the uterine cervix are reported. Of these, five originated from the stomach and one from the colon. The histopathologic features of metastatic carcinoma of the cervix uteri are presented and the route of the metastasis is discussed.     

Cardiac Metastasis from Carcinoma of the Cervix: Report of Two Cases

Background.The presence of cardiac metastasis from cervical carcinoma is extremely rare. The diagnosis is made almost exclusively postmortem. There are few cases of premortem diagnosis, and it is believed that when cardiac metastasis are foundin vivo,the prognosis is extremely poor. Due to the rarity of this condition it is very difficult to standardize care for these patients. Considering the evidence provided by the cases in this report, it is possible that aggressive therapy may lengthen patients survival and quality of life.Case.We present two cases of cervical carcinoma with metastasis to the heart. Both patients presented with symptomatology of cardiac tamponade. Both patients had invasion of the myocardium from presumed endomyocardial metastasis where the prognosis is even worse. We took an aggressive therapeutic approach to our patients and had excellent results in one. Our report includes the longest survival reported for a patient to date with premortem diagnosis of intramyocardial metastasis from cervical carcinoma.Conclusion.We concluded that the prognosis for cardiac metastasis from cervical carcinoma is extremely poor. The stage of the disease at initial presentation does not predict the future development of cardiac metastasis. Taking an aggressive therapeutic approach, including thoracentesis, chemotherapy, and radiation therapy to the heart, survival and quality of life can be improved.     

Lymphoma of the ovary: Report of twenty new cases and update of previous series

Ovarian lymphoma is a rare entity. This review of 55 cases, including 35 that were previously reported, updates and reclassifies the cases from the Ovarian Tumor Registry and the Gynecologic Pathology Laboratory. The problems of differential diagnoses are stressed.     

Adenocarcinoma of the endometrium: Analysis of 256 cases with carcinoma limited to the uterine corpus: Pathology review and analysis of prognostic variables

Histologic specimens of all patients undergoing hysterectomy for clinical Stage I adenocarcinoma of the endometrium at Stanford University Hospital between 1959 and 1975 were reexamined. From this group 256 acceptable cases of adenocarcinoma confined to the uterine corpus (Pathologic Stage I) were identified. In patients treated with initial surgery, relapse rate was highly correlated with depth of myometrial invasion (P = 0.0001) and also with the histologic grade of the uterine adenocarcinoma (P = 0.008). Twenty-six patients (10%) had lesions with papillary architecture and anaplastic cytology similar to papillary serous carcinoma of the ovary. These women with uterine papillary serous carcinoma (UPSC) had a 50% relapse rate and accounted for one-half the treatment failures ( ) in the entire study group. Six of the seven upper abdominal relapses in this study were in patients with UPSC, suggesting that this histologic variant may behave more like ovarian serous carcinoma than the usual endometrial adenocarcinoma. Twenty-one patients (9%) had endometrial carcinomas with extensive mucinous differentiation (mucinous carcinoma), while 38% of all the cases of endometrial carcinoma showed at least some focal mucin production. Twenty percent showed focal squamous differentiation. Neither mucinous nor squamous differentiation, as we have applied these designations, were significantly correlated with relapse rate. Among the patients undergoing hysterectomy for clinical Stage I adenocarcinoma, 99 patients were found on review to have lesions which fell short of our current criteria for diagnosis of carcinoma in the uterine corpus and were reinterpreted as metaplasia and/or hyperplasia. None of these patients subsequently developed clinical relapse. The results of this study suggest a need for modification in the FIGO grading system for endometrial cancer and also support a definition of well-differentiated endometrial carcinoma more restrictive than that commonly employed.     

Extrauterine Müllerian adenosarcoma; a clinicopathologic report of a case with distant metastases and review of the literature.

This is a report of a Müllerian adenosarcoma of homologous type which arose from the right pelvic sidewall and presented as a pelvic hematoma in a 46-year-old woman. The tumor was locally aggressive and histologically similar to cases arising in the uterus reported earlier by Clement and Scully. Following her death from B. fragilis septicemia, the autopsy revealed widespread, occult hematogenous metastases composed entirely of the sarcomatous element of the tumor. The problems in diagnosis and management of a pelvic sidewall neoplasm are presented, and the methods of therapy of the homologous and heterologous forms of this new entity are reviewed and discussed in relation to their biologic behavior.     

Cancer of the colon during pregnancy: report of a case and review of the literature.

A case of adenocarcinoma of the sigmoid colon during pregnancy is reported. The patient presented with anemia and a painless mass over the left abdomen without gastrointestinal discomfort, making this case different from 25 previously reported cases of colon carcinoma above the peritoneal reflection associated with pregnancy.     

Abnormal cervical cytology leading to the diagnosis of gastric cancer

There have been nine cases reported in the English literature in which the finding of malignant cells on cervical/vaginal cytology led to the diagnosis of primary gastric cancer. We report on a patient with gastric carcinoma, metastatic to the cervix, in which the diagnosis was suspected by the finding of signet ring cells on a Papanicolaou smear of the cervix. Prior to treatment of this patient, concordance of signet ring carcinoma on cervical and ascitic fluid cytology and on cervical and gastric biopsies was documented; this has not been reported previously. Thirty-four additional cases of gastric carcinoma metastatic to the cervix are reviewed. This paper is presented to remind the clinician that, however rare, metastases from the gastrointestinal tract to the uterine cervix do occur.     

Alveolar Rhabdomyosarcoma of the Uterine Cervix

Alveolar rhabdomyosarcoma is an uncommon tumor occurring mostly in extremities of children and adolescents. This type of tumor located in the uterine cervix has not been reported previously. A case of pure alveolar rhabdomyosarcoma arising from the uterine cervix in a 45-year-old patient and having a very aggressive clinical course is described. The patient presented with rapidly progressive cervical tumor, which was originally diagnosed as mesonephroid adenocarcinoma. She was treated with a radical two-stage surgical procedure and postoperative external beam and intracavitary irradiation. Despite treatment, she developed metastatic disease and died 3 months after the surgery. The aggressive course of the disease at this location was consistent with that of the majority of alveolar rhabdomyosarcoma cases of other sites reported in literature. No standard effective treatment is known for this tumor in adult patients.     

Stage I small cell carcinoma of the endometrium: survival and management options

Small cell carcinoma (SCC) of the endometrium is a rare but aggressive disease with early systemic involvement. Patient survival is short. To date, no effective treatment protocol has been established. Surgery, radiotherapy, and chemotherapy have been used either alone or in combination. The case of a patient with stage IB endometrial SCC is presented with an overview based on all reported cases of SCC of the endometrium and its treatment with particular reference to stage I cases.     

Embryonal rhabdomyosarcoma (botryoid type) of the cervix: A case report and review

A case report of embryonal rhabdomyosarcoma originating from the cervix in a 3-year-old girl is presented and a brief review of the literature on this topic given. The histopathology of the tumor is discussed and the effectiveness of a less aggressive surgical approach and chemotherapy is demonstrated in this particular case.     

The occurrence of adenocarcinoma in endometriosis of the rectovaginal septum during progestational therapy.

A patient is presented who developed adenocarcinoma in endometriosis of the rectovaginal septum during a second course of hormonal therapy. Malignant transformation in an area of endometriosis during sex steroid therapy has not been previously reported. The rectovaginal septum is recognized as probably the most common site of malignant transformation in extraovarian foci of endometriosis.     

Anaplastic carcinoma arising in an ovarian mucinous cystadenocarcinoma in a 17-year-old female

BACKGROUND: Anaplastic carcinoma arising within a mucinous ovarian neoplasm is rare, with only about 30 reported cases. Reported cases have given a broad age range, ranging from 17 to 72 years of age, but occurrence in adolescents is exceptional, with only a few cases reported. CASE: We report a case of anaplastic carcinoma arising in a mucinous cystadenocarcinoma in a 17-year-old female who presented with severe abdominal pain, an unusual symptom for an ovarian malignancy in the postmenopausal patient, but not in the adolescent. The patient had widespread metastases at the time of presentation, consistent with the aggressive behavior of this neoplasm. CONCLUSIONS: This case illustrates that, although rare, epithelial ovarian malignancy is in the differential diagnosis of abdominal pain in an adolescent.