A huge prolapsed cervical leiomyoma: A case report.

INTRODUCTION AND IMPORTANCE: Uterine leiomyoma is the most common pelvic tumor in women. Its cervical location is rare and may extend into the vagina in 2.5 % of cases. Treatment of cervical fibroids includes either myomectomy or hysterectomy, depending on the patient's profile and the tumor's characteristics. These fibroids challenge the surgeon because of their proximity to vital pelvic structures and their likelihood of causing surgical complications. CASE PRESENTATION: A 47-year-old woman presented with abdominopelvic pain and a bulky necrotic mass protruding out of her vagina. CT scan showed a large heterogeneous anterior mass of the cervix measuring 30 cm prolapsed in the vagina. She underwent a total hysterectomy with complete resection of the cervical mass. The histopathological report confirmed the diagnosis of a cervical leiomyoma with no signs of malignancy. CLINICAL DISCUSSION: Three types of cervical leiomyoma are known: interstitial, supra-vaginal, and polypoidal. The last one, observed in our case, is the rarest type. When prolapsed in the vagina, cervical leiomyoma can outgrow its blood supply and become necrotic. Several approaches are available for the management of cervical leiomyomas. The approach choice depends on many factors such as the tumor size and location, its extent, and the desire for fertility. CONCLUSION: This report describes the case of a large gangrenous and prolapsed non-pedunculated cervical leiomyoma which remains a rare and disabling complication of this benign tumor for which hysterectomy remains the treatment of choice.

Reclassification of papillary thyroid microcarcinoma (pMCT) according to the "Porto proposal" criteria.

INTRODUCTION: pMCT is defined as a variant of papillary carcinoma that measures≤1 cm in diameter and which is characterized by an excellent prognosis. Recently, a proposal has been advanced to use the designation of papillary mirotumour (pMT) for pMCTs with no risk factors . AIM: In this study, we aimed to reclassify pMCTs according to the Porto proposal(Pp) criteria. METHODS: We have retrospectively collected cases of pMCT diagnosed in our pathology department over a period of 10years(2012-2022). Clinical and pathological parameters have been retrieved from the patient's medical records and pathological reports. We have evaluated all cases following the criteria of Pp. Cases that fulfilled all the criteria have been reclassified as pMT. We have briefly compared the clinical outcomes in both groups. RESULTS: 29 cases of pMCT was found. Mean age of patients was 46,6 years-old (17-67) with a female predominance (sex ratio=0,45). 23 cases of pMCT were incidentally discovered. The tumor was located in the right thyroid lobe in 15cases. The mean size of the tumor was 5,2mm. Multifocality was observed in 5 cases. A total of 17 cases could be classified as pMT according to the Pp. Only one patient developed pulmonary metastasis and local recurrence; however it was related to the papillary carcinoma firstly diagnosed in his contralateral lobe. Clinical outcome was also good in the group of papillary microcarcinoma (pMC) with no recurrence or distant metastasis. CONCLUSION: According to the Pp,>50% of pMCT could be reclassified as pMT which could reduce the psychological impact and overtreatment. Further studies with large sample size and molecular analysis are however needed in order to definitively validate and generalize the use of Porto proposal.

Bone metastatic carcinoma coexisting with plasma cell myeloma: a case report.

OBJECTIVE: Multiple myeloma is a clonal plasma cell proliferation often causing bone lytic lesions. It is sometimes challenging to differentiate these lytic lesions associated with multiple myeloma from bone destruction due to a metastasis. Although coexistence of solid tumors and plasma cell myeloma in one patient has been described, synchronous skeletal metastases from both neoplasms occurring in the same bone lesion is exceptional. Indeed, only one case has been reported in the literature. CASE PRESENTATION: Herein, we report a case involving a 68-year-old Caucasian male patient admitted to our department for coronavirus disease 2019 infection with incidental finding of multiple lytic bone lesions during hospitalization. Laboratory tests revealed an increased immunoglobulin G kappa M protein and high levels of carbohydrate antigen 19-9. Bone marrow aspiration showed increased atypical plasma cells consistent with multiple myeloma. Percutaneous image-guided biopsy of one of the osteolytic lesions was performed. Pathological examination identified both plasma cell neoplasm and poorly differentiated metastatic carcinoma within the same bone lytic lesions. CONCLUSION: The present case raises awareness among clinicians and pathologists that clinical and radiologic suspicion of multiple myeloma may be within the spectrum of second primary malignancies.