A rare case report of a myxoid liposarcoma arising from the broad ligament.

Myxoid liposarcoma (MLPS) is the second most prevalent subtype of liposarcoma. It is usually found in the deep tissues of the lower limbs and rarely in gynecologic tract. Herein we present the second case in the English literature of a primary MLPS arising from the broad ligament which was thought to be a borderline ovarian tumor. The aim is to discuss its clinical and pathological characteristics. A 42-year-old woman presented with pelvic pain for the last 6 months. Magnetic resonance imaging was not specific. She underwent a surgical resection of the tumor mass, and pathological examination confirmed the diagnosis of MLPS deriving from the broad ligament. She received radiotherapy and the patient is doing well at 3 months follow-up. The clinical aspects, pathological diagnosis, prognosis, and therapy approach of broad ligament MLPS are all poorly understood. Complete surgical resection with or without radiotherapy is the mainstay of treatment in located MLPS.

Aggressive Behavior of Warty Squamous Cell Carcinoma of the Vagina Associated with Uterine Prolapsed: Unusual Report.

Warty squamous cell carcinoma (WSCC), is a rare variant of squamous cell carcinoma that occurs mostly in younger women, but can occur in old women. It is due to human papillomavirus (HPV) infection. This rare entity has been described in several organs such as vulva, cervix, and penis. To the best of our knowledge WSCC of vagina associated with the third-degree of uterine prolapse has never been reported in the literature. We present an exceptional case of WSCC of vagina occurred in a 77-year-old woman with long disease duration. The physical exam found a large ulcer-budding lesion of the middle and lower third of the vagina that depends on the left vaginal wall. The full work-up concluded to stage IVA of FIGO classification, due to the bladder involvement. The patient underwent a hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic node dissection, left partial cystectomy with left ureteral reimplantation and total vaginectomy, followed by adjuvant radiotherapy. The patient had no recurrence during 8 years of regular follow-up. WSCC can express locally aggressive behavior, such we reported; despite it appears to be less aggressive than the typical well-differentiated squamous cell carcinoma. That leads to individualize WSCC from other verruciform neoplasms.

An Aggressive Presentation of Merkel Cell Carcinoma: A Case Report.

Merkel cell carcinoma (MCC) is a rare malignant neuroendocrine tumor more common in immunosuppressed old patients. It is characterized by a high frequency of local recurrence, regional nodal metastasis, distant metastasis, and low survival rate. The diagnosis of MCC is challenging due to its rarity and can be clinically mistaken for other skin cancer. We report a case of locally advanced MCC of the left groin with aggressive behavior that was finally controlled with a combined treatment and we collected data from the literature to discuss the appropriate therapeutic algorithm for the management of this uncommon skin tumor.

Prognostic factors and the role of pelvic lymphadenectomy in uterine leiomyosarcomas.

OBJECTIVES: Leiomyosarcomas are relatively rare uterine smooth muscle tumors. Surgery is the most common therapy choice for uterine leiomyosarcomas. However, controversy exists over the appropriate initial surgical management, especially about the role of lymph node sampling. The aim of our study is to analyze the prognostic factors and the role of lymphadenectomy in overall survival and in disease-free survival. METHODS: We analyzed retrospectively 31 patients suffering from uterine leiomyosarcomas at Institute of Salah Azaiez during 2000-2014. Demographic and clinical features such as age, menopausal status, stage, tumor size, and management options were examined, and pathological characteristics such as mitotic count, lymphovascular space invasion, and tumor necrosis were evaluated. RESULTS: Out of 31 patients treated for uterine leiomyosarcomas, pelvic lymphadenectomy was done for 18 patients. No para-aortic lymphadenectomy was performed. Median number of resected lymph nodes was 13 ± 7 (range: 3-27). Lymphatic metastasis was observed in 2 out of 18 patients with clinical stage IA and IIIB. The distribution of different variables (age, International Federation of Gynecology and Obstetrics stage, tumor size, mitotic count, and adjuvant treatment) between the group of patients, who had or had not lymphadenectomy done, had no significant difference. The 5-year overall survival and disease-free survival were 61% and 50%, respectively. Clinical stage, presence of lymphovascular space invasion, and lymph nodal dissection were found to be relevant for disease-free survival on univariate analysis. Only age and menopausal status were found to be a prognostic factor for overall survival. CONCLUSION: Hence, routine lymph node dissection was not generally recommended. Our study demonstrates that lymphadenectomy has a statistically significant effect on disease-free survival but not on overall survival.