Clear cell carcinoma arising in extraovarian endometriosis: report of three cases and review of the literature

The literature on malignancy arising in extraovarian endometriosis comprises only three cases of clear cell carcinoma. We wish to report the clinical features and pathologic findings of an additional three cases. The first concerns a 39-year-old oriental pregnant woman who presented with a large intraluminal obstructing lesion of the sigmoid colon, the second case deals with an abdominal wall mass that appeared in a cesarean section scar of a 45-year-old black woman, and the third case describes an ulcerating lesion of the perineum and the buttock in a 43-year-old white woman with a long history of endometriosis in an episiotomy scar. Our observations support the notion that clear cell carcinoma arising in extraovarian endometriosis behaves differently from its counterpart in ovarian endometriosis, but more in line with clear cell carcinoma of the endometrium.     

Penile strangulation: two case reports and review of the literature

IntroductionEntrapment or strangulation of the penis is a rare emergency situation that can lead to a wide range of vascular and mechanical injuries.AimThe aim of this article is to present our experience dealing with penile strangulation. A review of the literature is also summarized in this report. Current treatment options and outcomes are also evaluated.MethodsWe performed a computerized MEDLINE search followed by a manual bibliographic review of cross-references. These reports were analyzed and the important findings summarized.ResultsPenile strangulation has been first time reported in 1755. Since that time, sporadic reports have appeared in the literature describing a variety of foreign bodies on the penis that have in common only the property of circularity. We noted motives, types of objects, types of strangulation, symptomatology, trauma grades, diagnoses, including psychological involvement, as well as possible treatment options. Furthermore, two cases of penile strangulation from our clinical practice are presented involving different degrees of vascular insult leading to different pathogenesis, clinical presentation, and surgical approach.ConclusionPenile strangulation is an unusual clinical condition and the consequences can be severe. Penile strangulation could lead to different degrees of vascular obstruction. Consequently, several clinical syndromes can occur: from mild nonsignificant vascular obstruction that resolves after decompression to severe gangrene of the penis accompanied with impaired renal function. The most common motive associated with foreign bodies on the penis is sexual or erotic in nature. The choice of method for removal depends upon type, size, incarceration time, trauma grade, and availability of the equipment. Prompt diagnosis and early treatment are essential to avoid the potential complications of ischemic necrosis and autoamputation. Ivanovski O, Stankov O, Kuzmanoski M, Saidi S, Banev S, Filipovski V, Lekovski L, and Popov Z. Penile strangulation: Two case reports and review of the literature.     

Parasitic leiomyomas: two case reports and review of literature

Fibroids or leiomyomas are common tumours of the uterus. Very rarely, a subserous fibroid may detach from the uterus and attach itself to other structures. Such fibroids are called parasitic fibroids. We present two such rare cases of parasitic fibroids attached to the sigmoid colon and urethra, respectively.     

Clear cell carcinoma of the ovary: a review of the literature

Objective

Different histologic types of epithelial ovarian cancer may represent different diseases with unique clinical and molecular characteristics. Clear cell carcinoma (CCC) of the ovary has been reported as having a worse prognosis than high grade serous epithelial ovarian cancer (EOC). This article critically reviews the literature pertinent to the pathology, pathogenesis, diagnosis, management, and outcome of patients with ovarian CCC.

Methods

MEDLINE was searched for all research articles published in English between January 01, 1977 and January 30, 2012 which reported on patients diagnosed with ovarian CCC. Given the rarity of this tumor, studies were not limited by design or number of reported patients.

Results

Ovarian CCC tumors represent 5-25% of ovarian cancers. Its histologic diagnosis can be challenging, resulting often times in misclassification of these tumors. Ovarian CCC tends to present at earlier stages and has been associated with endometriosis, ARID1A and PIK3CA mutations. When compared to stage-matched controls, patients with early-stage ovarian CCCs may have a better prognosis than patients with high-grade serous tumors. For those with advanced stage disease, high-grade serous histology confers a better prognosis than ovarian CCC. Patients with Stage IC-IV have a relatively poor prognosis and efforts should center in discovery of more effective treatment strategies.

Conclusions

Ovarian CCC is a biologically distinct entity, different from high-grade serous EOC. Future studies should explore the role of targeted therapies in the management of ovarian CCC.     

Malignant extraovarian endometriosis: two case reports and review of the literature

Two cases of adenocarcinoma arising in extraovarian endometriosis 19 and 8 years following abdominal hysterectomy and bilateral salpingo-oophorectomy are described. Both patients presented with hydronephrosis. One had been on chronic estrogen therapy. The literature is reviewed in reference to frequency, tumor type, and sites of occurrence.     

Osteogenesis imperfecta in pregnancy: two case reports and review of literature

Osteogenesis imperfecta (OI) is an inherited disease where basic pathology is of defective maturation of collagen. It is more common in women, and the incidence in pregnancy is 1 in 25,000 to 30,000. A multidisciplinary approach is necessary. Ideally, genetic counseling is sought before conception. Once pregnant, prenatal diagnosis can be established by chorion villous sampling. Serial scans would identify the affected fetus with fractures. A cesarean delivery is advocated if the fetus is affected or if the mother has pelvic fractures. An experienced anesthetist should be involved. Because these women are more likely to have a postpartum hemorrhage due to uterine atony, Syntocinon infusion and close observation in the third stage is indicated.     

Diagnostic difficulty of abdominal wall endometrioma: clinical case and literature review

Abdominal wall endometrioma is a rare clinical condition with which the general surgeon is faced and usually presents a diagnostic challenge due to the similar signs and symptoms that this illness shares with other tumors of the abdominal wall. A clinical case which exemplifies this diagnostic challenge is presented, and a review is made about the physiopathology, diagnosis and treatment of abdominal wall endometriomas, emphasizing on the different diagnoses with which it can be confused.     

Double aneuploidy in spontaneous miscarriages: two case reports and review of the literature

The occurrence of double aneuploidy is a relatively rare phenomenon. The clinical presentations are variable depending on the predominating aneuploidy or a combination effect of both. We report the cytogenetic data on products of conception from miscarriages over a period of 5 years. A total of 403 miscarriages were karyotyped and the tissues were villi in all cases. Of 403 cases, 54 cases with single aneuploidy and 2 cases of first-trimester miscarriages with double trisomies were found. These 2 cases with the karyotypes of 48,XXY,+15 and 48,XX,+5,+7 were cited for the first time in this study.     

Squamous cell carcinoma arising in mature cystic teratoma of the ovary: a case series and review of the literature

OBJECTIVES: Malignant transformation of mature cystic teratomas is rare, with squamous cell carcinoma being the most common type. The prognosis is generally poor when disease has spread beyond the ovary. We conducted this study to review our experience with this disease and describe our current treatment modality. METHODS: During a 22-year period (1983-2005), we identified 17 women treated for squamous cell carcinoma arising in a mature cystic teratoma of the ovary. All pathologic diagnoses were confirmed at our institution. A retrospective chart review and comprehensive review of the literature were conducted. RESULTS: The median age was 55 (mean, 54.8; range, 37-75). Eight cases were stage I, 5 were stage II, and 4 were stage III. Mean tumor size was 14.2 cm. All patients underwent surgery, with positive lymph nodes noted in 0 of 10 cases that included lymph node dissection. Ten patients received adjuvant treatment-6 with chemotherapy and 4 with chemoradiation. Six patients had recurrent disease in the pelvis after adjuvant treatment. Four patients died of disease. The overall 1-year survival rate was 60%. The 4 patients with stages IA-IIB disease treated with adjuvant platinum-based chemotherapy and radiation survived at 12-56 months' follow-up. CONCLUSIONS: Squamous carcinomas arising in mature cystic teratomas are commonly large ovarian tumors that occur in perimenopausal women and often present as an incidental pathologic finding. While the prognosis seems highly dependent on surgical stage, there is a lack of consensus in the literature regarding adjuvant treatment. Platinum-based chemotherapy with pelvic radiation may be a reasonable adjuvant therapy for early-stage disease.     

Cystadenocarcinoma of the abdominal wall following caesarean section: case report and review of the literature

OBJECTIVES: Endometriosis affecting surgical scars is a well-described entity that can complicate surgery involving hysterotomies. Malignant transformation is a rare event that has been reported complicating ovarian endometriosis mainly. CASE: A 60-year-old woman having in the past two uneventful caesarean deliveries presented with a solid lower abdominal mass. A surgical biopsy and then a radical resection of the lower half of the abdominal wall were performed, with a diagnosis of adenocarcinoma of endometrial origin. A diagnostic curettage excluded primary endometrial carcinoma. At 1 year she is NED. CONCLUSIONS: This case report illustrates the carcinomatous transformation of an endometrial implant. Despite the rarity of such a diagnosis, it should be borne in mind when endometriosis in abdominal wall is suspected because an oncological resection is required.     

Serous psammocarcinoma of the ovary and peritoneum: two case reports and review of the literature

Serous psammocarcinoma (SPC) is a rare variant of ovarian carcinoma or peritoneum that may present with features consistent with malignancy, or tumors of low malignant potential. This is two-case reports of a SPC of the ovary and peritoneum and review of the literature. A 41-year-old woman was referred to our clinic for adnexal mass. Ultrasonography revealed endometrioma. Endometriotic cyst excision and sacrouterine biopsy were performed via laparoscopy. Histological examination revealed endometrioma and psammocarcinoma of the peritoneum. Staging laparotomy was performed. She received six courses of chemotherapy. She has no evidence of disease after 6 years from surgical therapy and chemotherapy. A 50-year-old woman presented with pelvic pain and discomfort in the upper abdomen with nausea and emesis. CT scan showed extensive tumor in the lower abdomen, and free fluid in the abdomen and pelvis which appeared to be an ovarian tumor. She underwent a laparotomy and a right and left ovarian tumor measuring about 20 × 15 and 8 × 8 cm, respectively, were seen. Staging procedure was performed. Microscopic examination revealed SPC of the ovary. Chemotherapy was planned. The biologic behavior of this disease remains unresolved. Primary surgical debulking should be attempted, while the utility of postoperative chemotherapy remains unknown.     

Prenatal diagnosis of scrotal-inguinal hernia: two case reports and review of the English literature

We present two cases of a prenatal diagnosis of inguinal hernia and the fetal outcome. Initial differential diagnosis included sacrococcygeal teratoma and testicular termatoma, while the final diagnosis was scrotal-inguinal hernia based on sonographic visualization of bowel loop movement in the scrotal mass.     

Abdominal wall metastasis of ovarian carcinoma after low transverse abdominal incision: report of two cases and review of literature

Abstract.   Rafii A, Ferron G, Lacroix-Triki M, Dalenc F, Gladieff L, Querleu D. Abdominal wall metastasis of ovarian carcinoma after low transverse abdominal incision: report of two cases and review of literature. Int J Gynecol Cancer 2006; 16(Suppl. 1): 334–337.
Occurrence of parietal metastases after surgery for a suspect adnexal mass may worsen the prognosis of the disease. However, it is not clear whether abdominal wall metastases is related to specific biologic features or simply to surgical mismanagement involving small incisions and traumatic extraction of the specimen, resulting in direct seeding of cancer cells. We report two cases with development of parietal dissemination of ovarian carcinomas after Pfannenstiel incision. The two patients needed parietal resection to obtain optimal surgical cytoreduction. Pfannenstiel incisions for exploration of suspicious adnexal masses increase the risk of extensive parietal metastasis in case of malignancy because they require reflection of several sheaths of tissue. The parietal extension of the disease may need major parietal resection that can worsen the functional and general outcome of the patients.     

Primary lymphoma of the uterus and cervix: two case reports and review of the literature

Primary lymphoma of the uterus and cervix is rarely encountered. We present two cases of diffuse large B-cell lymphoma of the cervix and uterus that were treated with R-CHOP chemotherapy followed by pelvic radiotherapy. The women are disease free 20 and 19 months after the diagnosis respectively. Seventy-two cases of primary uterine and cervical lymphoma reported in the English literature in the last 10 years from 2000 to 2010 are reviewed.     

Clear cell carcinoma and endometrioid carcinoma arising in a endometriotic cyst of the ovary

A case of two tumors arising in an endometriotic cyst of the ovary is described. These two tumors are macroscopically polypous and are histologically a clear cell carcinoma and an endometrioid carcinoma, respectively. This is a rare neoplasm and its existence supports the general opinion that clear cell carcinoma and endometrioid carcinoma of the ovary are both müllerian in origin.