Fetal sacrococcygeal immature teratoma - report of two cases and review of the literature.

Sacrococcygeal teratomas (SCTs) are rare congenital tumors. With the improvement of diagnostic imaging methods and follow-up protocols in pregnancies, in utero detection of these tumors has increased. Despite these progresses, SCTs may present difficulties in establishing in utero diagnosis and subsequent management. We present two cases of SCT in 18 weeks, respectively 22 weeks pregnancy, diagnosed using ultrasound imaging and pathologically confirmed. Also, the article aims to recapitulate clinicopathological aspects and prognosis of these lesions, following the review of the literature.

Clinical and morphological correlations in early diagnosis of endometrial cancer.

The prevalence of endometrial cancer among asymptomatic women is rather reduced also due to the absence of a cost-efficient test, as there are no ideal screening examinations for endometrial cancer. Several methods were proposed in medical practice to discover endometrial neoplasia at an early stage, among which: endometrial biopsy, endovaginal ultrasound, targeted biopsy hysteroscopy. This study was made on a group of 38 patients monitored for metrorrhagia in the interval between July 1, 2014-July 1, 2016. All patients were monitored clinically and by ultrasound, endometrium samples were taken by biopsied uterine curettage, and a histopathological examination was performed, completed by immunomarking, whenever necessary. The clinical and paraclinical methods allowed for the creation of a protocol by which patients were monitored. This protocol allowed for the modulation and effectiveness of the treatment, establishing the best therapeutic conduct and the remote supervision.

Fat-forming Solitary Fibrous Tumor of the Kidney - A Case Report and Literature Review.

Fat-forming solitary fibrous tumors arising from the kidney are extremely rare, with only few cases reported so far. We report the case of a 49-year-old patient investigated for lumbar pain and diagnosed preoperatively with a large retroperitoneal tumor destroying the right kidney. The patient was submitted to surgery, the tumor being resected en bloc with right nephrectomy. The histopathological studies demonstrated the presence of a hemangiopericytoma-like tumor with adipocytary component; the immunohistochemical studies demonstrated the presence of cluster of differentiation 34 (CD34), while human melanoma black (HMB45) staining was negative. Therefore, the diagnostic of fat-forming solitary fibrous tumor of the kidney was established. The postoperative outcome was uneventful, the patient being discharged on the sixth postoperative day. In conclusion, although fat-forming solitary fibrous tumor of the kidney is a very rare entity, this diagnosis should be taken into consideration whenever a large retroperitoneal mass with high adipose content and renal invasion is described at the preoperative studies.

Difficulties of clinical and histopathological diagnosis in advanced vulvar clear cell carcinoma.

Clear cell carcinoma (CCC) of the female genital tract usually arises in the ovary, endometrium, cervix and vagina. A rare site for CCC is the vulva, and moreover even rarer are the cases involving the Bartholin gland. A 54-year-old female was admitted for a 1.5×2 cm tumor at the level of the right Bartholin gland. The magnetic resonance imaging (MRI) exam revealed enlarged inguinal, pelvic and para-aortic lymph nodes but no other primary tumor. Microscopic examination revealed CCC. The tumor was positive for cytokeratin 7 (CK7), paired-box 8 (Pax8), napsin A and vimentin, negative for estrogen receptor (ER), progesterone receptor (PR), calretinin, cluster of differentiation 10 (CD10), carcinoembryonic antigen (CEA), p16 and p63. Also, p53 was expressed in 30-40% and Ki67 in 70% of the malignant cells. Given the clinical, imagistic, histological and immunohistochemical features of the tumor, we concluded that the tumor is a CCC of the Bartholin gland. Aim of the study is to signal a rare case of CCC of Bartholin gland. Since there are only two other cases reported in literature, the natural history and prognosis of the disease is not known, also there are no therapeutic guidelines regarding this rare tumor so appropriate treatment is uncertain. Therefore, it is important that new cases are reported for a better understanding of this rare condition. Bartholin gland carcinoma is a pathology quite rarely encountered in practice. The positive diagnosis is eminently histological and immunohistochemistry. Bartholin gland CCC is an extremely rare diagnosis with, to our knowledge, only two other cases reported in literature, but with a potential aggressive clinical behavior and poor outcome.

Solitary Splenic Metastasis After Surgically-treated Cervical Cancer - A Case Report and Literature Review.

BACKGROUND/AIM: Solitary metastases after surgically-treated cervical cancer are a rare entity, with only few cases described so far. PATIENT AND METHODS: We present the case of a 31-year-old patient diagnosed with a tumoral splenic lesion at 18 months after surgically-treated cervical cancer. RESULTS: The patient was submitted to surgery, with a splenectomy being performed. The histopathological studies confirmed the presence of a squamous cell cervical cancer splenic metastasis. At one year follow-up after splenectomy, the patient is free of any recurrent disease. CONCLUSION: Solitary splenic metastases after surgically-treated cervical cancer are rarely seen; however, this diagnostic should not be omitted whenever a medical history of cervical cancer is present.

Clinical and pathological features of splenic metastasis from cervical squamous cell carcinoma.

Isolated splenic metastases from squamous cell carcinoma (SCC) of the cervix are rare, with few cases reported in the literature. We review here the main clinical and pathological findings in these patients, with emphasis on histopathological features. Because they are so rare, complex follow-up protocols for patients diagnosed with cervical SCC should exist because, if detected and treated, solitary splenic metastases seem to have a better prognosis than splenic metastases as part of a disseminated disease.

Large cell neuroendocrine cervical tumor treated by radical surgery and adjuvant chemotherapy: A case report and literature review.

Neuroendocrine carcinomas of the uterine cervix are rare, but extremely aggressive, gynecological malignancies that are associated with an overall poor prognosis. The present study reports the case of a 41-year-old patient diagnosed with large cell neuroendocrine cervical tumor. A radical total hysterectomy with bilateral adnexectomy, pelvic and lymph node dissection was performed. The post-operative course was uneventful, and the patient was discharged on post-operative day 8.

Multiple visceral resection for giant non-secretory adrenocortical carcinoma in an elderly patient: a case report.

Adrenocortical carcinomas are rare tumors in adults. They can be hormonally active and detected by a hormonal excess, or be non-secretory tumors. In the latter case, they become symptomatic after a long period of growth, usually after they have already invaded the surrounding tissues. In these cases, multiple visceral resections are sometimes required in order to obtain a complete R0 resection. We present the case of a 65-year-old patient who was addressed to our service for a giant abdominal tumor with compression phenomena in whom we performed a complete resection en bloc with left nephrectomy and adrenalectomy, distal pancreatectomy, splenectomy, left colectomy and para-aortic lymph node dissection. The early postoperative course was uneventful, the patient was discharged eight days after surgery. The histopathological findings revealed an adrenocortical carcinoma with no lymph node metastases.

Psychotic depression due to giant condyloma Buschke-Löwenstein tumors.

UNLABELLED: A 63-year-old patient, with no psychiatric history, was admitted in the psychiatric department with depressed mood, loss of interest in activities, apathy, insomnia, attention deficit, irritability, social withdrawal, prejudice and abandon delusions. Cerebral computed tomography (CT) scan was normal but the general physical examination revealed a voluminous tumor in the inguino-pubic-ano-genital area measuring 350/80/40 mm, which appeared 15 years ago and grew gradually leading to local rickety hygiene and also to depression, especially in the last time period when the tumor grew faster. The DSM-IV-TR diagnostic was affective disorder due to general medical condition. Surgical exams concluded it was a giant exophytic tumor and was recommended a pre-operative abdominal CT scan, which did not revealed metastatic spread. The treatment consisted in wide radical excision into the tumor-free resection margins. Anatomopathological exam concluded condyloma acuminatum - Buschke-Löwenstein tumor (BLT), a very rare borderline tumor. In post-operative period, progress of depression was spectacular, with the full mental recovery by decreasing the antidepressant and antipsychotic medication, fact that strengthen the initial diagnostic of depression due to a general medical condition. CONCLUSIONS: Patients diagnosed with BLT may develop mental disorders especially with devaluation and low self-esteem, social withdrawal and secondary functional impairment. Due to the malignancy risk in such tumors and also the psychiatric unfavorable recovery prognostic in case of continuous general medical condition, the only effective treatment is tumor resection with surgical, oncological, psychiatric postoperative revaluation.

Neuroendocrine transdifferentiation of prostate carcinoma cells and its prognostic significance.

Neuroendocrine (NE) cells are a distinct epithelial cell compartment of the normal human prostate gland. Their phenotype and range of endocrine secretion products are similar, but not identical to those of NE-like cells from prostate carcinoma. Neuroendocrine differentiation (NED) is a feature commonly seen in prostate carcinoma and a number of studies pointed out that its extent is associated to hormone therapy refractory and aggressive disease. However, less information is available on the significance of NED in organ-confined prostate cancer, although identification of early predictors of aggressive disease would obviously allow for more adequate therapy. We review here recent advances in understanding the differentiation pathways of normal and malignant neuroendocrine cells as well as current information regarding the prognostic and therapeutic implication of NED assessment.

Pancreatic cancer presenting with paraneoplastic thrombophlebitis--case report.

CONTEXT: The complex of symptoms in pancreatic cancer is vague, which often delays presentation and diagnosis. Thrombophlebitis is an unusual presentation of pancreatic cancer, which appears more frequent in the cancer of the body and tail of the pancreas. CASE REPORT: We present a case of a 52-years-old woman who was admitted to the hospital for a superficial thrombophlebitis. At the abdomen ultrasound screening, multiple liver masses, relatively well defined, with a hypo-echoic center and a hyper-echoic periphery, were identified. The head of the pancreas was normal, the body and the tail could not be seen very well due to flatulence. After computed tomography, the diagnosis was "Pancreatic tumor with multiple hepatic metastases (stage IV)". After the histopathological examination, 1250 mg/m2 of Gemcitabine was started on day 1 and 8 every 28 days, plus 100 mg/day of Erlotinib (Tarceva), every day. At the end of the seventh month of treatment, the patient suffered an irreversible ischemic cardiac event. CONCLUSION: Superficial thrombophlebitis can be the initial manifestation of the pancreatic cancer. Gemcitabine and erlotinib is now a FDA approved regimen for patients with metastatic pancreatic cancer. While the search for the best gemcitabine based backbone for advanced pancreatic cancer continues, studies of anti-angiogenic agents alone or in combination with traditional chemotherapy, should be undertaken, as they may improve overall survival in this group of poor prognosis patients.

Neuroendocrine differentiation in prostate adenocarcinoma biopsies and its correlation to histological grading.

Prostate adenocarcinoma is frequently diagnosed on needle biopsies in early, organ-confined stages. New prognostic factors would help identifying at this stage patients at risk for unfavorable evolution, that would benefit from alternate therapy. This study aims to find correlations between the extent of neurocrine differentiation (NED), a feature commonly seen in prostate carcinoma, and known factors of disease evolution such as histological grade, malignant cell proliferation and serum PSA levels. Immunohistochemistry for choromogranin A and neuron-specific enaolase (NSE) was used to calculate expression scores in order to asses the extent of NED in prostate biopsies. Tumour proliferative activity was estimated by calculating percentages of Ki-67 immunoreactive cell nuclei. Results show that the presence of numerous clusters of chromogranin A positive cells is a feature that differentiate tumours with Gleason score 9 from those with a score of 6. Also, the same extended neuroendocrine differentiation is associated with high tumour proliferative activity. Multinomial regression analysis showed that high Ki indices, serum PSA values and NSE scores are predictive for moderately and poorly differentiated prostatic adenocarcinoma.

Postmenopausal choriocarcinoma: a case report.

Postmenopausal uterine choriocarcinoma is very rare and benefits of curative chemotherapy. We present here the case of 62-year-old women with uterine bleeding. Emergency surgery revealed a uterine tumor and histopathology findings were consistent with choriocarcinoma. Immunohistochemistry tests confirmed betahCG and cytokeratin expression by malignant cells, thus establishing the positive diagnosis.