Primary leiomyoma of the fallopian tube: preoperative ultrasound findings.

Leiomyoma of the fallopian tube is extremely rare. Most cases are asymptomatic and found incidentally at autopsy or unrelated operation. These leiomyomas tend to be singular, small, and unilateral, with a resultant rare preoperative diagnosis. They are often managed with laparotomy, as seen in the literature review. Therefore, preoperative imaging is never reported. We describe a case of leiomyoma of the fallopian tube, which was suspected before operation and treated by laparoscopic approach. Transvaginal ultrasound clearly showed a hypoechoic solid mass separate from the left ovary and uterus in a 44-year-old woman. Color Doppler ultrasound detected low impedance flow in this mass. Diagnostic laparoscopy and the follow-up laparoscopic salpingoectomy revealed a primary leiomyoma of the fallopian tube. We conclude that powerful ultrasound could be helpful in diagnosing rare gynecologic disorders but laparoscopy can be used for definite diagnosis and management of such disorders.

Recurrent breast cancer presents as a single solid ovarian mass and ascites.

OBJECTIVE: Ovarian malignancy is highly suspected when patients present with an ovarian cystic mass lesion accompanied with ascites. However, aside from the primary origin, a metastatic lesion should be considered, since the ovary is frequently metastasized from cancers of other organs, such as the genital tract, gastrointestinal tract, and breast. Herein, we report the case of a patient with a left adnexal mass and ascites to emphasize consideration of metastatic ovarian tumors from non-gynecologic organs. CASE REPORT: A 47-year-old woman with a history of right breast infiltrating lobular carcinoma, T3N0M0, grade 3, was treated with modified radical mastectomy and axillary lymph-node dissection in July 2001. Tumor recurrence was noted in December 2003. Therefore, she underwent palliative radiotherapy and various kinds of chemotherapy. In March 2006, she experienced poor appetite and abdominal fullness, and was found to have a 12-cm adnexal mass accompanied with ascites. Ovarian cancer was suspected, and exploratory laparotomy was performed. However, metastatic carcinoma of the ovary of breast origin was finally diagnosed. CONCLUSION: In cases of pelvic tumors in patients who have a history of other primary cancers, metastasis should be suspected initially. Although the prognoses of these patients seem to be worse, intensive cytoreductive surgery would improve quality of life and offer a chance of better survival in highly selected patients.

Poor prognosis of intraoperative rupture of mature cystic teratoma with malignant transformation.

OBJECTIVE: To present the phenomenon of the postoperative rapid progression of mature cystic teratoma (MCT) with malignant transformation (MT) when intraoperative spillage occurs during operation. CASE REPORTS: Two patients with MCT were treated, one with total hysterectomy plus bilateral salpingo-oophorectomy in an exploratory laparotomy, and the other with cystectomy with laparoscopy, respectively. Tumor spillage occurred during both operations. The postoperative pathology showed MCT with MT (squamous cell carcinoma type). Both patients were referred to our hospital and underwent treatment (3 months and 8 days, respectively, after the initial operation). At the secondary laparotomy for staging surgery, tumor dissemination was observed in both patients. CONCLUSION: Whether or not tumor dissemination is correlated with tumor rupture during operation, we emphasize that any patient with a preoperative diagnosis of MCT should have it removed intact to avoid the possibly catastrophic event of tumor dissemination.