Double Trouble: A case of synchronous high-grade serous carcinoma of the fallopian tube and borderline mucinous tumor of the ovary / Philippine Journal of Obstetrics and Gynecology

@#A 55‑year‑old, Gravida 2 Para 2 (2002), presented with postmenopausal vaginal bleeding. Workups pointed toward ovarian malignancy with distant metastasis (pleural effusion). Exploratory laparotomy, bilateral salpingo‑oophorectomy, surgical staging, and appendectomy were performed. On histopathological examination, synchronous high‑grade serous carcinoma of the right fallopian tube and borderline mucinous tumor of the left ovary were diagnosed. Primary fallopian tube carcinomas are very uncommon, while synchronous tumors of the female genital tract are extremely rare. Furthermore, there is a paucity of literature discussing the occurrence of synchronous primary malignancies arising from the fallopian tube and the ovary. It is crucial to differentiate primary malignancies from metastatic cancers to determine accurate staging and prognosis, as well as to assign appropriate treatment strategies. Immunohistochemistry and molecular testing play vital roles as adjunctive diagnostic tools to histologic examination in determining the origins of these tumors and distinguishing primary tumors from metastasis.

Cistoadenoma mucinoso gigante de ovario de bajo grado de malignidad / Giant mucinous ovarian cystadenoma of low malignancy

El cistoadenoma mucinoso de ovario representa aproximadamente 15 por ciento de las lesiones neoplásicas benignas de ovario y en 5 por ciento de los casos pueden ser bilaterales. Suele manifestarse en edades medias de la vida y son poco frecuentes en la edad pediátrica y en la adolescencia. El objetivo del trabajo es profundizar en el diagnóstico y la conducta terapéutica de esta enfermedad. Se realizó una revisión del tema y se presentó un caso relevante por las dimensiones del quiste. Se presenta una adolescente de 16 años de edad que presentó un cuadro de distensión abdominal y dolor en hemiabdomen derecho de un mes de evolución. Se le realizó cirugía y se encontró un tumor gigante de ovario izquierdo con 10 kilogramos de peso, se corroboró el diagnóstico histológico de cistoadenoma mucinoso de ovario. La paciente evolucionó satisfactoriamente(AU)

Ovarian mucinous cystadenoma accounts for approximately 15 percent of benign ovarian neoplastic lesions and in 5 percent of cases may be bilateral. It usually manifests in middle ages of life and they are rare in pediatric age and adolescence. The objective of this paper work is to deepen on the diagnosis and therapeutic state of this disease. A review of the topic was made and a case was presented because of the significant dimensions of the cyst. We present a 16-year-old girl who presented abdominal distension and pain in the right hemiabdomen for a month of evolution. Surgery was performed and a giant tumor on the left ovary was found. It weighed 10 kilograms, corroborating the histological diagnosis of mucinous ovarian cystadenoma. The patient evolved satisfactorily(AU)

Diagnosis and treatment of mucinous tumor of the bile duct: our experience on 11 patients / 中华肝胆外科杂志

Objective To study the diagnosis,treatment and therapeutic results of 11 patients who suffered from mucinous tumor of the bile duct.Methods Eleven patients who were diagnosed to suffer from mucinous tumor of the bile duct were retrospectively studied.Three patients who presented with obstructive jaundice were diagnosed on ERCP,and 8 patients who had extra-and intrahepatic cholangiolithiasis were diagnosed by biopsy during choledochoscopy.Results One of the 3 patients who underwent ERCP died from obstructive jaundice after failed drainage of bile using endoscopic nasobiliary drainage (ENBD).The remaining two patients underwent laparoscopic common bile duct exploration and T tube drainage.The eight patients who had extra-and intrahepatic cholangiolithiasis were diagnosed by biopsy during choledochoscopy.Conclusions The clinical presentation of mucinous tumor of bile duct is non-specific and the preoperative misdiagnosis rate is high.Common bile duct exploration,T tube drainage and long-term T tube drainage is a good way to treat mucinous tumor of the bile duct.

Clinicopathological analysis of 3 cases of intraductal tubulopapillary neoplasm of the pancreas and literature review / 中华胰腺病杂志

Objective To analyze the clinical symptoms,pathological features and K-ras mutation alterations of intraductal tubulopapillary neoplasm (ITPN),and to better understand ITPN.Methods We collected the clinical data of 3 cases of ITPNs of Changhai Hospital and 16 cases in literature,and analyzed the morphology,K-ras mutation,immunophenotype of tumor cells by routine H&E staining,immonohistochemistry,and fluorescence PCR.Then it was compared with 81 cases of intraductal papillary mucinous tumor (IPMT).Results All the 3 patients of ITPN were male,with a median age of 43 years.Two lesions were located in pancreatic head and 1 case in pancreatic body and tail.ITPNs presented as intraductal solid masses,and consisted of cells with uniformly median-to-high grade nuclear atypia,and tumor cells were arranged as glandular and cribriform.One case was accompanied with invasive ductal adenocarcinoma and peripancreatic lymph node metastasis.All tumor cells of epithelial marker cytokeratin was positively expressed,and p53 was positively expressed in some tumor cells.However,CHR,NSE,MUC2 and MUC5AC were negatively expressed,and K-ras mutation was not detected.The tumor cells of IPMT were presented as papillary pattern and cribriform structure was observed.The majority of cells were mucous epithelium,or goblet cells (intestinal type),a few were eosinophilic epithelium (eosinophilic cells type) and cuboidal epithelium (pancreatic,biliary duct type),MUC2 and MUC5AC was positively expressed,and K-ras mutation rate was 50％.Conclusions As a new tumor entity of pancreas,ITPNs show distinctive features with IPMTs.

Ovarian Large Cell Neuroendocrine Carcinoma Associated with Endocervical-like Mucinous Borderline Tumor: A Case Report and Literature Review

Ovarian large cell neuroendocrine carcinoma is a rare tumor that is usually associated with surface epithelial tumors. Mucinous tumors are most common surface epithelial component identified in reported cases. Ovarian mucinous tumor associated with large cell neuroendocrine carcinoma is almost always an intestinal type. However, large cell neuroendocrine carcinoma associated with pure mucinous borderline tumor of endocervical-like type has not been described previously. The present case report describes a large cell neuroendocrine carcinoma associated with endocervical-like mucinous borderline tumor of the ovary in a 35-year-old woman. The tumor was confirmed by histopathology and immunohistochemistry. A review of the pertinent literature is included.

Clinical Study of Intraductal Papillary Mucinous Tumor of the Pancreas

PURPOSE: Intraductal papillary mucinous tumor (IPMT) of the pancreas pathologically shows papillary proliferation and its tumor cells display a spectrum of changes ranging from adenoma to infiltrating carcinoma. Because of this variability, there have been many difficulties for making an accurate diagnosis and administering proper treatment. The aim of this study was to determine the treatment strategy and differential diagnosis of benign and malignant IPMT. METHODS: Between January 2000 and June 2007, 24 patients with IPMT of the pancreas underwent surgery. The relationships among the clinopathologic features and tumor locations and subtypes were retrospectively investigated. In addition, the type of surgical procedures and findings, the microscopic finding, the immunohistochemical staining and the clinopathological features were analyzed. RESULTS: There were 17 men and 7 women with a mean age of 65 (range: 45~81). Pathologically, 11 cases were benign, 9 were borderline and 4 were malignant. The tumor was located in the head of the pancreas in 17 patients. 16 cases received Whipple's procedure and pylorus preserving pancreaticoduodenectomy, and the others were received different kinds of operations. Regarding the subtypes of IPMT, 2 cases were the main duct type, 19 were the branched type and 3 were the combined type. There were no statistically significant differences in the clinical manifestations, radiologic findings and immnohistochemical staining between the patients with benign and malignant IPMT. Except two patients who were not followed up, all the patients had no recurrence and they survived. CONCLUSION: It is very difficult to exactly differentiate malignant IPMT from benign IPMT with using the current preoperative evaluations and immunohistochemical staining of the resected specimens. The patients who were operated on and followed in our hospital had no recurrence and they all survived. Therefore, if IPMT is suspected, we think the patients should be operated on and we should continue studying other specific antibodies for immunohistochemical staining.

Low-grade Mucinous Cystic Tumor Associated with Endo-metriosis in the Cecum

We report here on an unusual case of mucinous cystic tumor that was associated with endometriosis in the cecum. A 45-year-old woman was admitted to the hospital due to her 5 day history of right lower quadrant abdominal pain with a mild fever. A laparotomy was performed under the clinical impression of the tubo-ovarian abscess. A relatively well defined a multi-locular cystic mass (8.0x8.0x7.0 cm) filled with white-to-yellow thick mucoid material was found in the wall of the cecum. The right ovary and fallopian tube showed marked fibrous adhesion to the external surface of the cecal mass. A right hemicolectomy and salpingo-oophorectomy were performed. Histologically, the tumor was similar to those of ovarian borderline mucinous tumor, the intestinal type, and the mucinous epithelium of the tumor was merged with the endometriotic epithelium and stroma. On immunostaining, the CK20 positive mucinous epithelium was well demarcated from the CK7 endometriotic epithelium. This is the first case of low-grade mucinous cystic tumor intimately associated with intestinal endometriosis in the cecum.

Surgical Treatment of Intraductal Papillary Mucinous Tumor of the Pancreas

OBJECTIVE: The clinical features and prognosis of intraductal papillary mucinous tumor (IPMT) of the pancreas are diverse. We reviewed the clinicopathologic features and surgical results of patients who were treated for IMPT. METHODS: WE retrospectively reviewed seven cases that were surgically resected and pathologically diagnosed. RESULTS: The mean patient age was 63.7 years and there were 6 (85.7%) symptomatic patients. The diagnostic accuracy of abdominal CT was 57.1% (n=4) and the was 71.4% (n=5). (Ed note: the last part made no sense. Put in the correct terms.) The final diagnosis was benign IPMT in 4 cases (57.1%), malignancy in 3 cases (42.9%, and borderline malignancy, carcinoma in situ and invasive carcinoma in one case each, respectively). Three cases each of pylorus preserving panreaticoduodectomy (42.9%) and distal pancreatectomy were performed (42.(%), respectively, and 1 pancreatic wedge resection (14.3%) was performed for 1 case. Three patients (42.9%) were found to have associated malignancies. The median follow-up duration was 10 months (range: 3-25). Four patients are still alive and 3 patients have died, but only one patient died of systemic metastasis. CONCLUSION: The clinicopathological features, treatment, and prognosis of IPMT are still unclear, but the significant possibility of malignancy and associated malignancies should always kept in mind and further study is required

Clinicopathological Analysis of Growth Patterns of Malignant Intraductal Papillary Mucinous Tumors of the Pancreas: Unusual Growth Pattern of Fistulous Extension

BACKGROUND: Usually, a malignant intraductal papillary mucinous tumor (IPMT) of the pancreas shows invasive carcinoma. Recently, IPMT with an unusual growth pattern of a fistulous extension was reported. However, little is known about malignant IPMTs with a different growth pattern of invasion and fistulous extension. METHODS: Malignant IPMTs were classified into invasive (colloid or tubular type) carcinomas and the fistulous extension type according to their growth patterns. Their clinicopathological characteristics were compared. RESULTS: Among a total of 68 cases of IPMT, there were 16 cases with malignant IPMT; eight, six and two of the colloid, tubular, and fistulous extension types, respectively. The immunohistochemical (IHC) expression of MUC1 was found in seven out of eight colloid and five out of six tubular types, but there was no IHC expression of MUC1 in the fistulous extension type. The IHC expression of MUC2 was noted in one of the eight colloid, one of the six tubular and in both cases with the fistulous extension type. There was no difference in the tumor recurrence rates bet- ween the different growth patterns. CONCLUSIONS: IPMT with the fistulous extension type has a peculiar extension pattern consisting of multiple fistulous tracts without a mass. Although most of the epithelium in the fistulous tract show moderate to severe dysplasia, only the fistulous extension should be considered to be an unusual growth pattern of malignant IPMT. The clinical significance of this unusual type of IPMT remains to be determined.

Intraductal Papillary Mucinous Cholangiocarcinoma / 대한간학회지

No abstract available.

Surgical Management for Intraductal Papillary Mucinous Tumor (IPMT) of the Pancreas Confined to Branch Duct

PURPOSE: Intraductal papillary mucinous tumor (IPMT) of the branch duct type has been reported that it is associated with less aggressive histologic features than the main duct type. The purpose of this study was to evaluate the clinicopathologic features and the optimal management of branch duct type IPMT. METHODS: From October 1994 to November 2004, 30 cases who underwent operations with branch duct type IPMT were reviewed retrospectively. Clinicopathologic findings and late results of treatment were studied in 20 cases of the benign (adenoma, borderline malignancy) group and in 10 cases of the malignant (carcinoma in situ, invasive carcinoma) group. RESULTS: There were statistically significant difference in the 3 factors (mural nodule (P=0.030), diameter of the main pancreatic duct (P=0.036), main location of the tumor (P= 0.031)). There was no statistically significant difference in th survival analysis between the main duct type IPMT including combined type IPMT and the branch duct type IPMT (P=0.572), but there was significant difference between the benign group and the malignant group of the branch duct type IPMT (P=0.049). CONCLUSION: The long-term follow up result of the branch duct type IPMT is similar to that of the main and combined duct type IPMT. Therefore, it is not safe just to monitor the branch duct type IPMT. Our results suggest that surgery is certainly the gold standard treatment for the branch duct type IPMT. And after operation, close long term follow up with appropriate treatment is necessary due to tumor recurrence.

Clinical Features and Radiological Findings of Cystic Tumor of the Pancreas

PURPOSE: Most cystic tumors of the pancreas are composed of serous cystic tumor, mucinous cystic tumor, solid pseudo- papillary epithelial neoplasm (SPEN) and intraductal papillary mucinous tumor (IPMT). With advancements in diagnostic imaging, cystic lesions of the pancreas are being detected with increasing frequency; however, there is still difficulty determining the appropriate diagnostic and therapeutic plan. METHODS: A retrospective review was performed of 15 cases that underwent surgery for pancreatic cystic tumors in our department between July 1995 and August 2005. All 15 cases identified had their records and radiological images reviewed. Radiological findings were characterized and analyzed by one radiologist. RESULTS: The median age was 55.9 years. Six cases were male and nine were female. Common symptoms included: epigastirc pain 6/14 (43%) and palpable mass 2/14 (14%). The accuracy of the preop radiological diagnosis including abdominal CT and US was 12/15 (80%). One case of serous cystic tumor, one of chronic pancreatitis and one SPEN were misdiagnosed; the preoperative diagnosis for these cases was mucinous cystic tumor. Serous cystic tumors were seen with central calcification 2/3 (67%), external lobulation 3/3 (100%); however, the mucinous cystic tumors were seen with peripheral calcification 4/5 (80%), no external lobulation 5/5 (100%) by radiological evaluation. There was no calcification, but external lobulation was common in the IPMT. The SPEN had no specific radiological findings except for peripheral calcification. CONCLUSION: Future multicenter studies with endoscopic sonography and aspiration cytology is needed for improved accuracy of diagnosis.

A Case of Pseudomyxoma Peritonei / 대한산부인과학회잡지

Pseudomyxoma peritonei is a poorly understood condition characterized by gelatinous, mucinous implants, and often massive gelatinous ascites. It is commonly associated with mucinous tumors of the ovary or appendix, and a frequently relapsing and protracted disease. But, there are much confusion about its etiology, clinical manifestation, treatment, and prognosis. We experienced a case of pseudomyxoma peritonei originating from the borderline and microinvasive mucinous tumor of the ovary. So we report this case with a brief review of literatures.

A Case of Pseudomyxoma Peritonei Associated with Borderline Mucinous Tumor of Both Ovaries and Appendix / 대한산부인과학회잡지

Pseudomyxoma peritonei is a rare condition characterized by mucinous ascites associated with peritoneal and omental implants. This is most commonly originated from mucinous tumor of the ovary or appendix. We have experienced a case of pseudomyxoma peritonei associated with borderline mucinous tumor of both ovaries and appendix. We concluded that the appendix is the primary lesion of pseudomyxoma peritonei by various immunohistochemical stains and therefore reporting this case with the brief review of literatures.

Atypical Proliferating Muinous Tumor arising in a Mature Cystic Teratoma / 대한산부인과학회잡지

The borderline tumor is not benign but has low malignant potential, which accounts for 10-15% of all ovarian tumors. The mucinous borderline tumors make up approximately 40% of all borderline tumors. About 5% of mature cystic teratomas of ovary include some with mucinous cystadenoma. The malignant transformation is occurred in about 1-3% of patients who have a mature cystic teratoma. There has been reported frequently about the malignant transformation of a mature cystic teratoma. After the first description of a patient with mucinous borderline tumor associated with a mature cystic teratoma in 1988, the borderline tumorous change of a mature cystic teratoma has been reported rarely. This report presents a patient with atypical proliferating mucinous tumor arising in a mature cystic teratoma.

Fine Needle Aspiration Cytology of the Intraductal Papillary Mucinous Tumor of the Pancreas: A Case Report / 대한세포병리학회지

Intraductal papillary mucinous tumor of the pancreas is characterized by intraductal papillary proliferation of mucin-producing epithelial cells with or without excessive mucin secretion. According to the degree of epithelial dysplasia, intraductal papillary mucinous tumor is classified into adenoma, borderline tumor, and carcinoma. We recently experienced a case of fine needle aspiration cytology of the intraductal papillary mucinous adenoma in a 69-year-old male. The fine needle aspiration cytology yielded flat sheets of columnar, mucin containing epithelial cells in the background of dense mucin containing degenerated cellular material and histiocytes.

Clinical and imageological features of different pancreatic intraductal papillary Mucinous tumors / 医学研究生学报

Objective: To analyze the experience in the treatment of intraductal papillary Mucinous tumors(IPMT) of the pancreas.Methods: We retrospectively analyzed the clinical and imageological features of 30 IPMT patients,17 males and 13 females,who underwent operations in our department from May 2003 to December 2005.The patients with intraductal papillary mucinous adenoma(IPMA) were included in the benign group,and those with intraductal papillary mucinous borderline tumor(IPMB) and intraductal papillary mucinous carcinoma(IPMC) in the malignant group.Results: There were more males than females in the malignant group(76.5% vs 30.8%,P40 mm,which were considered to be the predictors of malignancy.Conclusion: Clinical and imageological features differ signifcantly between different pathological types of IPMT.The presence or absence of mural nodules,the diameter of the main pancreatic duct and the size of the tumor may help differentiate the malignancy from benignancy of IPMT.

Analysis of Clinical Features and Factors Predictive of Malignancy in Intraductal Papillary Mucinous Tumor of the Pancreas: Multi-center Analysis in Korea / 한국간담췌외과학회지

BACKGROUND/AIMS: Despite of increasing numbers of reports on intraductal papillary mucinous tumor (IPMT), there is still difficulty in its' diagnosis, treatment and prediction of prognosis. The purpose of this multicenter study was to evaluate the clinico-pathological features of IPMT in Korea and suggest the prediction criteria of malignancy in IPMT. METHODS: We retrospectively reviewed the clinico-pathological data of 208 patients who underwent operations with IPMT between 1993 and 2002 at 28 institutes in Korea. RESULTS: Of the 208 patients with a mean age of 60.5+/-9.7 years, 147 were men and 61 were women. 124 patients underwent pancreatoduodenectomy, 42 distal pancreatectomy, 17 total pancreatectomy, 25 limited pancreas resection. Benign cases were 128 (adenoma (n=62), borderline (n=66)) and malignant cases were 80 (non-invasive (n=29), invasive (n=51)). A significant difference in 5-year survival was observed between benign and malignant group (92.6% vs. 65.3%; p=0.006). Of the 6 factors (age, location, duct dilatation, tumor appearance, main duct type, and tumor size) that showed the statistical difference in univariate analysis between benign and malignant group, we found three significant factors (tumor appearance (p=0.009), tumor size (p=0.023), and dilated duct size (p=0.010)) by multivariate analysis. CONCLUSION: Although overall prognosis of IPMT is superior to ordinary pancreatic cancer, more curative surgery is recommended in malignant IPMT. Tumor appearance (papillary), tumor size (> or =30 mm) and dilated duct size (> or = 12 mm) can be used as preoperative indicators of malig-nancy in IPMT.

Prevalence and Clinicopathologic Features of Mucinous Cystic Tumor and Intraductal Papillary Mucinous Tumor of Pancreas in Korea

BACKGROUND: Mucin producing cystic neoplasms, such as mucinous cystic tumor (MCT) and intraductal papillary mucinous tumor (IPMT) of the pancreas, are uncommon but become increasing in their incidences. The pathologic classification and biologic potential of these neoplasmsremain the subject of controversy. METHODS: The Gastrointestinal Pathology Study Group of the Korean Society of Pathologists analyzed the clinicopathologic characteristics of 85 casesof MCT and 72 cases of IPMT and examined the expression patterns of p53, CEA and MUC1. RESULTS: IPMT was located largely in the head, and showed connection with the main pancreatic duct (MPD, 68.1%), no ovarian-like stroma (0/72), and presence of intervening intratumoralnormal or atrophic parenchyma. On the other hand, MCT was located largely in thetail (73%), and showed common ovarian-like stroma (66/80), rare connection with the MPD(7/85) and no intervening pancreatic parenchyma. CEA and p53 immunoexpressions weresignificantly increased from adenoma through borderline to carcinoma, but MUC 1 was expressedonly in the invasive carcinoma among cases of MCT and IPMT. CONCLUSIONS: The tumorlocation, ovarian-like stroma, connection with the MPD and intratumoral intervening nonneoplastictissue were helpful in the differential diagnosis between IPMT and MCT. CEA and p53expressions can be indicators of malignancy, while MUC 1 expression can indicate invasion.

Intraductal Papillary Mucinous Tumor of the Pancreas Still Resectable 5 Years after Diagnosis / 대한소화기내시경학회지

Intraductal papillary mucinous tumor (IPMT) of the pancreas is a spectrum of conditions ranging from benign to malignant. It is known that the biologic behavior of IPMT is slower and less aggressive than that of pancreatic ductal carcinoma. We report a case of IPMT of pancreas resected 5 years after diagnosis. The carcinoma remained localized without evident stromal invasion or lymph node metastasis with the background of adenoma, suggesting a adenomacarcinoma sequence. This is a case report that may be helpful to study the natural history of IPMT, particularly slow progression of IPMT.