Padrão histopatológico e incidência de carcinomatose peritoneal ao diagnóstico em mulheres com câncer de ovário / Histopathological pattern and incidence of peritoneal carcinomatosis at diagnosis in women with ovarian cancer

Objetivo: Descrever o padrão histopatológico e identificar a incidência de carcinomatose peritoneal no momento do diagnóstico de mulheres diagnosticadas com neoplasia de ovário. Métodos: Trata-se de um estudo transversal e descritivo, baseado na análise secundária de dados correspondentes aos prontuários de mulheres adultas com diagnóstico de neoplasia de ovário de um serviço de referência em oncologia clínica. Foram analisados 40 prontuários entre janeiro de 2007 e janeiro de 2017. Resultados: Ao estadiamento segundo o sistema da International Federation of Gynecology and Obstetrics, três mulheres (7,5%) apresentavam estadiamento clínico (EC) II, três (77,5%) estágio ECIII com carcinomatose peritoneal/invasão da pelve e seis (15%) estágio ECIV com metástases à distância, especialmente para pulmão e fígado. Em relação ao padrão histopatológico, 20 mulheres apresentaram adenocarcinoma seroso papilífero de alto grau (50%), 4 (10%) adenocarcinoma seroso papilífero de baixo grau, 3 (7,5%) adenocarcinoma endometrioide, 3 (7,5%) tumor de teca/granulosa, 3 (7,5%) carcinoma de células claras, 3 (7,5%) tumores não classificados, 2 (5%) disgerminoma e 2 (5%) com cistoadenocarcinoma mucinosos. Conclusão: É nítida a necessidade de mais estudos envolvendo essa patologia, de modo a favorecer o diagnóstico e a intervenção em estágios mais precoces e reduzir desfechos desfavoráveis. (AU)

Objective: To describe the histopathological pattern, and to identify the incidence of peritoneal carcinomatosis at the time of the diagnosis of women diagnosed with ovarian neoplasm. Methods: This is a cross-sectional and descriptive study, based on the secondary analysis of data corresponding to the medical records of adult women diagnosed with ovarian neoplasm in a reference service of clinical oncology. A total of 40 medical records were analyzed between January 2007 and January 2017. Results: At the staging (FIGO system) of the International Federation of Gynecology and Obstetrics, three women (7.5%) had clinical staging (EC) II staging, 31 (77.5%) were in the ECIII stage, with peritoneal carcinomatosis/pelvic invasion, six (15%) were in the ECIV stage, with metastases at a distance, especially to lung and liver. Regarding the histopathological pattern, twenty women had high-grade papillary serous adenocarcinoma (50%), 4 (10%) with low-grade papillary serous adenocarcinoma, 3 (7.5%) with endometrioid adenocarcinoma, 3 (7.5%) with granulosa-theca tumor, 3 (7.5%) with clear cell carcinoma, 3 (7.5%) with unclassified tumors, 2 (5%) with dysgerminoma, two (5%) with mucinous cystadenocarcinoma. Conclusions: There is a clear need for further studies involving this pathology, in order to favor diagnosis and intervention at earlier stages and to reduce unfavorable outcomes. (AU)

¹⁸F-FDG PET/CT Imaging of Pulmonary Mucinous Cystadenocarcinoma with Signet Ring Cells / 대한핵의학회잡지

A 63-year-old male with a recently diagnosed right lung lesion was referred for staging. F-FDG PET/CT scan revealed a hypodense, cystic-like mass in the right upper lung lobe, which demonstrated low, diffuse ¹⁸F-FDG uptake, likely due to the presence of mucus, as well as intensely hypermetabolic right hilar and right paratracheal lymph nodes. Transbronchial biopsy revealed a primary pulmonary mucinous cystadenocarcinoma with the presence of signet ring cell carcinoma, a co-existence of two rare variants of lung adenocarcinoma. This case report demonstrates the metabolic phenotype along with the radiographic characteristics of this rare tumor and its metastases.

Ovarian needle aspiration in the diagnosis and management of ovarian masses / 부인종양

OBJECTIVE: Ovarian needle aspiration and biopsy (ONAB) may be employed for pretreatment diagnosis of ovarian malignancies or intraoperatively to facilitate removal of ovarian masses. However, there is reluctance to utilize this procedure due to potential cyst rupture or seeding of malignant cells. The objective of this study was to examine the efficacy of ONAB over a 13-year period at our institution. METHODS: Between 2000 and 2013, all ONAB specimens were identified from the Queen's Medical Center Pathology Department database. All cytologic specimens were reviewed and correlated with histopathologic findings. A retrospective chart review was conducted to retrieve data on clinical course and treatment. RESULTS: This study identified 144 cases of ovarian masses sampled by aspiration or needle biopsy between 2000 and 2013. Ninety-two (64%) cases had corresponding histopathology, 84 (91%) of which were obtained concomitantly. On histology, 12 (13%) cases were malignant and 80 (87%) benign. Three false negative cases were noted; 2 serous borderline tumors and 1 mucinous cystadenocarcinoma. These were sampling errors; no diagnostic tumor cells were present in the aspirates. Sensitivity and specificity of ONAB in the detection of malignancy were 75% and 100%, respectively. The positive and negative predictive values were 100% and 96%, respectively. CONCLUSION: ONAB represents a valuable tool in the diagnosis of malignancy and treatment of ovarian masses. In our study, it was highly specific, with excellent positive and negative predictive value.

Mucinous cystadenocarcinoma of ovary with metastasis in 14-year-old girl

Ovarian mucinous tumors in <15 years old are rare with <50 cases reported till date in the literature. Majority of them are benign or borderline epithelial ovarian tumors with only 12 cases of cystadenocarcinomas reported at a young age. We report a case of mucinous cystadenocarcinoma in 14-year-old girl with metastasis to omentum at the time of presentation. Management of such cases is tricky as conservative approach sparing fertility of the patient is adopted. This case is presented for its rarity and unique presentation. To the best of our knowledge, this is the thirteenth case of ovarian cystadenocarcinoma being reported at a very young age and the first case being reported from Indian subcontinent. Extensive review of the previously published cases in the literature has been done in this study.

Cistoadenocarcinoma mucinoso de apéndice cecal / Mucinous cystoadenocarcinoma of the appendix

Objetivo Exposición de 3 casos tratados quirúrgicamente en nuestra clínica. Casos clínicos Caso 1: paciente mujer de 78 años con diagnóstico de quiste complejo de ovario derecho, se realizó la cirugía y se evidencia tumoración de apéndice cecal. Caso 2: paciente varón de 38 años con dolor abdominal crónico. Presenta marcador tumoral antígeno carcinoembrionario elevado, laparoscopia exploratoria evidencia líquido mucinoso peritoneal y tumoración apendicular. Caso 3: paciente mujer de 42 años con dolor crónico en fosa iliaca derecha con marcadores tumorales normales. Laparoscopia exploratoria evidencia tumoración dependiente del apéndice cecal con localización retrocecal ascendente. Discusión Se debe considerar a los mucoceles apendiculares dentro del diagnóstico diferencial de dolor en cuadrante inferior derecho del abdomen. Es preferible realizar una hemicolectomia radical para lesiones grandes y/o perforadas por el riesgo de existir cistoadenocarcinoma. El abordaje laparoscópico es una buena alternativa de manejo.

Objective We present three surgically treated cases in our hospital Case Reports Case 1: A 78 years old woman with a diagnosis of complex ovarian cyst. During surgery, an appendicular tumor was found. Case 2: A 38 years old male with chronic abdominal pain with high levels of carcinoembryonic antigen. During exploratory laparoscopy an appendicular tumor and mucinous peritoneal fluid were found. Case 3: A 42 years old woman with chronic pain in the right lower abdomen, negative tumor markers. During exploratory laparoscopy a retrocecal appendicular tumor was found. Discussion Appendiceal mucoceles should be considered in the differential diagnosis of right lower abdominal pain. If the lesions are big or perforated, a radical hemicolectomy should be performed due to the risk of a cystadenocarcinoma. Laparoscopic approach is a good alternative for management.

A Case Report of Partial Nephrectomy of Mucinous Cystadenocarcinoma in Kidney and Its Literature Review / Journal of the Korean Cancer Association, 대한암학회지

Mucinous cystadenocarcinoma (MC) of the kidney is a rare epithelial tumor originating from the renal pelvic urothelium and few study cases have been reported. Because of the rarity of these tumors and their unknown histogenesis, its diagnosis is difficult until surgical exploration. We report here on a 55-year-old man referred to the urology department from the hepatology department because of a cystic renal mass measuring approximately 5 cm in size, which was detected incidentally under ultrasonography during the routine examination of liver. The renal mass was finally diagnosed as MC originating from kidney after partial nephrectomy and the patient still showed no evidence of recurrence until 12 months postoperatively. This is the first report on a case of renal MC in a patient who underwent partial nephrectomy. The aim of this report is to present our unusual case of MC and also review the previous literature on the pathological and radiological aspects of MC of kidney.

Spontaneous Rupture of Pancreatic Mucinous Cystadenocarcinoma: A Case Report and Review of Literature / 대한췌담도학회지

The pancreatic cystic lesions are known to be incidentally found up to 10-15% of patients undergoing cross-sectional imaging. And the prevalence of mucinous cystic neoplasm which has malignant potential is known to be up to 25% of all pancreatic cystic neoplasm in South Korea. The symptoms included abdominal pain, palpable mass, weight loss, loss of appetite, jaundice, asymptomatic and etc. However, spontaneous rupture of pancreatic mucinous cystadenocarcinoma (MCAC) is an extremely rare complication. Here we report a case of spontaneous rupture of pancreatic MCAC in a 72-year-old male with review of the literature. To the best of our knowledge, this is the first ruptured case of pancreatic MCAC in male patient.

Radiologic Findings of Primary Mucinous Cystadenocarcinoma of the Breast: A Report of Two Cases and a Literature Review / 한국유방암학회지

Primary mucinous cystadenocarcinoma (MCA) of the breast is a rare but pathologically distinct breast tumor. There have been some case reports on primary MCA of the breast; however, they have all focused on pathologic findings. Here, we report the radiologic findings of two cases of MCA along with a review of the literature. Breast MCA shows a circumscribed mass with some calcifications on mammography, an intracystic solid mass without increased vascularity or a vascular stalk on ultrasound, and a heterogeneously enhancing mass within a rim-enhancing cyst with intermediate signal intensity on T2-weighted magnetic resonance imaging. These radiologic findings and the presence of mucin in the percutaneous biopsy specimen should suggest the possibility of MCA in the differential diagnosis of a breast tumor.

Extragastroesophageal Malignancy-Associated Secondary Achalasia: A Rare Association of Pancreatic Cancer Rendering Alarm Manifestation

Secondary achalasia or pseudoachalasia is a rare esophageal motor abnormality, which mimics primary achalasia; it is not easily distinguishable from idiopathic achalasia by manometry, radiological examination, or endoscopy. Although the majority of reported pseudoachalasia cases are associated with neoplasms at or near the esophagogastric (EG) junction, other neoplastic processes or even chronic illnesses such as rheumatoid arthritis can lead to the development of pseudoachalasia, for example, mediastinal masses, gastrointestinal (GI) tumors of the liver and biliary tract, and non-GI malignancies. Therefore, even if a patient presents with the typical findings of achalasia, we should be alert to the possibility of other GI malignancies besides EG tumors. For instance, pancreatic cancer was found in the case reported here; only four such cases have been reported in the literature. A 47-year-old man was admitted to our center with a 3-month history of dysphagia. His endoscopic and esophageal manometric findings were compatible with primary achalasia. However, unresponsiveness to diverse conventional achalasia treatments led us to suspect secondary achalasia. An active search led to a diagnosis of pancreatic mucinous cystadenocarcinoma invading the gastric fundus and EG junction. This rare case of pseudoachalasia caused by pancreatic carcinoma emphasizes the need for suspecting GI malignancies other than EG tumors in patients refractory to conventional achalasia treatment.

Pathobiology of ovarian carcinomas / 癌症

Ovarian tumors comprise a heterogeneous group of lesions, displaying distinct tumor pathology and oncogenic potentiel. These tumors are subdivided into three main categories: epithelial, germ cell, and sex-cord stromal tumors. We report herein the newly described molecular abnormalities in epithelial ovarian cancers (carcinomas). Immunohistochemistry and molecular testing help pathologists to decipher the significant heterogeneity of this disease. Our better understanding of the molecular basis of ovarian carcinomas represents the first step in the development of targeted therapies in the near future.

Adenocarcinoma mucinoso de tipo endocervical e intestinal a partir de un teratoma quístico maduro del ovario / Endocervical and intestinal-type mucinous adenocarcinoma from a Mature Cystic Teratoma

Los tumores derivados de células germinales representan el 20-25% de tumores ováricos, siendo sólo 3% malignos. La degeneración maligna se presenta únicamente en 1-2% de los casos. La edad de presentación promedio de la transformación maligna es a los 50 años, siendo los más frecuentes el carcinoma de células escamosas y el adenocarcinoma (1). Dado que la supervivencia a largo plazo se encuentra en relación con la detección temprana y la completa resección quirúrgica, se hace necesario determinar las características clínico-patológicas que sugieran una posible transformación maligna de estos tumores. A continuación, se presenta el caso de una paciente perimenopáusica, con hallazgos histopatológicos indicativos de transformación maligna de un teratoma quístico maduro a cistoadenocarcinoma mucinoso bien diferenciado de tipo endocervical e intestinal.

The germ cell-derived tumors account for 20-25% of ovarian tumors, with 3% being malignant. The degeneration occurs in 1-2% of cases. The age of presentation is menopause, around the age 50, and the most common malignant histological types in this context are squamous cell carcinoma and adenocarcinoma. It is important to determine the clinical-pathological characteristics of malignant transformation (although currently not well established), as because early detection and complete surgical resection are important for long-term survival. A case is presented on a peri-menopausal woman with histopathological findings of malignant transformation of a mature cystic teratoma to well-differentiated mucinous cystadenocarcinoma endocervical and intestinal type.

Pancreatic pseudocyst or a cystic tumor of the pancreas? / 癌症

Pancreatic pseudocysts are the most common cystic lesions of the pancreas and may complicate acute pancreatitis, chronic pancreatitis, or pancreatic trauma. While the majority of acute pseudocysts resolve spontaneously, few may require drainage. On the other hand, pancreatic cystic tumors, which usually require extirpation, may disguise as pseudocysts. Hence, the distinction between the two entities is crucial for a successful outcome. We conducted this study to highlight the fundamental differences between pancreatic pseudocysts and cystic tumors so that relevant management plans can be devised. We reviewed the data of patients with pancreatic cystic lesions that underwent intervention between June 2007 and December 2010 in our hospital. We identified 9 patients (5 males and 4 females) with a median age of 40 years (range, 30-70 years). Five patients had pseudocysts, 2 had cystic tumors, and 2 had diseases of undetermined pathology. Pancreatic pseudocysts were treated by pseudocystogastrostomy in 2 cases and percutaneous drainage in 3 cases. One case recurred after percutaneous drainage and required pseudocystogastrostomy. The true pancreatic cysts were serous cystadenoma, which was treated by distal pancreatectomy, and mucinous cystadenocarcinoma, which was initially treated by drainage, like a pseudocyst, and then by distal pancreatectomy when its true nature was revealed. We conclude that every effort should be exerted to distinguish between pancreatic pseudocysts and cystic tumors of the pancreas to avoid the serious misjudgement of draining rather than extirpating a pancreatic cystic tumor. Additionally, percutaneous drainage of a pancreatic pseudocyst is a useful adjunct that may substitute for surgical drainage.

Cistadenoma mucinoso del apéndice cecal como causa de gangrena intestinal / Appendiceal mucocele causing large bowel gangrene

Introduction: Appendiceal mucocele are lesions located in the cecum, which are found in 0.2 to 0.3 percent of appendectomies and correspond to 8-10 percent of all appendiceal tumors. Clinical case: We report a 83 years old female consulting for abdominal pain lasting 24 hours. On physical examination, signs of peritoneal irritation were found. The patient was operated, finding an appendiceal tumor that was coiled up in the mesentery with large bowel gangrene. An intestinal resection, terminal ileostomy, appendectomy and surgical lavage were performed. The pathological study of the surgical piece reported a mucinous cystadenoma.

Introducción: Los tumores del Apéndice Cecal corresponden al 0,5 por ciento de las neoplasias gastrointestinales y se encuentran entre el 0,8 por ciento y el 1 por ciento de las apendicectomías. El término Mucocele Apendicular (AM), se refiere a un grupo de lesiones localizados a nivel del ciego cuyo rango de incidencia está entre el 0,2 por ciento y el 0,3 por ciento de todas las apendicectomías, y entre el 8-10 por ciento de todos los tumores apendiculares. Las presentaciones clínicas más frecuentes son: cuadro clínico de apendicitis aguda, como hallazgo incidental como en el caso de esta paciente, o como masa abdominal en fosa ilíaca derecha. Caso clínico: Se presenta un caso de Cistade-noma Mucinoso Apendicular (CAM) encontrado como hallazgo incidental en un abdomen agudo quirúrgico con la particularidad de presentarse con una necrosis intestinal.

MR Imaging of Primary Retroperitoneal Mucinous Cystadenocarcinoma in Pregnant Woman

Primary retroperitoneal mucinous cystadenocarcinoma is a very rare malignancy. To date, 51 cases have been reported, including 3 in pregnant women. Herein, we report magnetic resonance findings of a 31-year-old Korean woman (15 weeks and 3 days pregnant) with primary retroperitoneal mucinous cystadenocarcinoma. On abdominal magnetic resonance imaging (MRI), a mass was identified in the retroperitoneal area with a nodular lesion showing heterogeneous signal intensity and focal wall thickening on T1- and T2-weighted images. Exploratory laparotomy and tumor excision were performed. Histological examination revealed primary retroperitoneal mucinous cystadenocarcinoma. The patient subsequently underwent total hysterectomy, bilateral salpingo-oophorectomy, and omentectomy for metastatic mucinous cystadenocarcinoma of both ovaries 15 months after her initial surgery.

A Case of Sarcomatoid Carcinoma Arising from Mucinous Cystadenocarcinoma of Appendix

Sarcomatoid carcinoma or carcinosarcoma is a very rare biphasic tumor characterized by a combination of malignant epithelial and mesenchymal cells. The pathogenesis of sarcomatoid carcinoma is not fully elucidated and the guideline of treatment has not been established yet. Although the upper aerodigestive tract, lung and female urogenital system are known to be the most frequently affected, this tumor also can occur in various sites, including the digestive tract. Since sarcomatoid carcinoma in colon was firstly reported in 1986, 24 cases have been reported to date. We report a rare case with sarcomatoid carcinoma of appendix. Interesting histologic feature of our case was the presence of mucinous cystadenocarcinoma with morphological "transition" between carcinomatous and sarcomatous tissue. To our knowledge, this is the first case of sarcomatoid carcinoma arising from mucinous cystadenocarcinoma of the appendix.

Pulmonary Mucinous Cystadenocarcinoma: Report a Case and Review of CT Findings

A pulmonary mucinous cystadenocarcinoma is an extremely rare tumor that is considered to be a cystic variant of mucin-producing lung adenocarcinoma. We present a case of pulmonary mucinous cystadenocarcinoma in a 54-year-old woman. Chest CT scans showed a 4.3-cm-sized, lobulated, well-defined, and homogeneous mass in the right middle lobe with peripheral stippled calcifications that demonstrated low-attenuation with no enhancement after contrast administration; 18F-fluorodeoxyglucose (FDG) PET/CT demonstrated mild heterogeneous FDG uptake. The mass was diagnosed as adenocarcinoma with mucin production by transbronchial lung biopsy. Right middle lobectomy was performed, and the pathologic examination disclosed a pulmonary mucinous cystadenocarcinoma.

Application of three-dimensional visualization technology for laparoscopic resection of cystic carcinoma in the pancreatic body and tail / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the application of three-dimensional visualization technology for laparoscopic resection of cystic carcinoma in the pancreatic body and tail.</p><p><b>METHODS</b>Six cases of cystic carcinoma in the pancreatic body and tail treated between Nov, 2009 and Mar, 2011 were retrospectively analyzed. The original image data of 64-slice spiral CT were collected and using adaptive region growing algorithm, the serial CT images were segmented and automatically extracted to obtain the 3-dimensional reconstruction images with customized image manipulation software. The specific surgical approach (the trocar position) and surgical procedure were planned based on the reconstructed mode.</p><p><b>RESULTS</b>The reconstructed 3-dimensional model clearly displayed cystic carcinoma in the pancreatic body and tail and the adjacent organs, showing distinct relationship between the cystoma and the splenic artery and vein. All the patients successfully underwent laparoscopic resection of the pancreatic body and tail without perioperative death. The spleen was preserved in 5 cases and removed in 1 case due to mucinous cystadenocarcinoma. The overall rate of pancreatic fistulae was 33.3% without incidences of postoperative hemorrhage. The average hospital stay of the patients was 12 days.</p><p><b>CONCLUSION</b>Three-dimensional reconstruction based on pancreatic CT data provides valuable assistance for laparoscopic resection of cystic carcinoma in the pancreatic body and tail.</p>

relative frequency and histopathological pattern of ovarian masses

Ovarian tumours are one of the major causes of gynaecological problems in females and present marked variation in their histological types. Relative frequency of these lesions is different for Western and Asian countries. This study was designed to find out frequency of various histological patterns of ovarian tumors in patients attending Pathology Department of a teaching institute in Lahore. A retrospective case - series study was conducted on 212 cases of ovarian masses, reported from January 2007 to December 2010. Mean age of the subjects was 35.6 years, ranging from 4 to 80 years. In a total of 212 cases of ovarian masses, 85 [40.09%] were non-neoplastic and 127 [59.91%] were neoplastic. Among neoplastic lesions, 64.57% [82/127] were benign and 35.43% [45/127] were malignant. The commonest non-neoplastic lesion was luteal cyst [38/85] followed by simple serous cyst [30/85]. The commonest benign tumour was dermoid cyst [31/82] followed by serous cystadenoms [20/82]. The commonest malignant tumour was serous cystadenocarcinoma [11/45] followed by mucinous cystadenocarcinomama [9/45]. Neoplastic lesions were more common than non-neoplastic lesions, while benign tumours outnumbered the malignant ones. The commonest benign tumour was dermoid cyst and malignant was serous cystadenocarcinoma. The commonest non-neoplastic lesion was luteal cyst. Among histological types of ovarian tumours, surface epithelial tumours dominated the other types

Epidermal Cyst-like Skin Metastasis in Ovarian Cancer Patient / 대한피부과학회지

Cutaneous metastasis from the ovarian cancer has been found to be exceedingly rare. We report a case of a metastatic ovarian mucinous cystadenocarcinoma, which clinically manifested as the epidermal cyst-like skin nodule on the right upper quadrant of abdomen.

Primary Mucinous Cystadenocarcinoma of the Breast: Cytologic Finding and Expression of MUC5 Are Different from Mucinous Carcinoma

Mucinous cystadenocarcinoma (MCA) in the breast is a rare neoplasm. There have been 13 cases of primary breast MCA reported. The MCA presents as a large, partially cystic mass in postmenopausal woman with a good prognosis. The microscopic findings resemble those of ovarian, pancreatic, or appendiceal MCA. The aspiration findings showed mucin-containing cell clusters in the background of mucin and necrotic material. The cell clusters had intracytoplasmic mucin displacing atypical nuclei to the periphery. Histologically, the tumor revealed an abundant mucin pool with small floating clusters of mucin-containing tumor cells. There were also small cysts lined by a single layer of tall columnar mucinous cells, resembling those of the uterine endocervix. The cancer cells were positive for mucin (MUC) 5 and negative for MUC2 and MUC6. This mucin profile is different from ordinary mucinous carcinoma and may be a unique characteristic of breast MCA.