ABSTRACT
Large vaginal cysts during pregnancy are rare and can mislead Obstetricians to a false diagnosis, that of "Protruding membranes". Aspiration of the cyst can be easily performed, resulting in the collapsing of the cyst and an uneventful vaginal delivery can be conducted.
ABSTRACT
INTRODUCTION: We describe a case of extragastrointestinal stromal tumor (EGIST) of the omentum harboring a novel KIT mutation and review the literature on omental EGISTs, emphasizing on molecular genetic data. CASE PRESENTATION: A large EGIST arising from the lesser omentum was incidentally diagnosed in a 68-year-old man during emergency laparotomy for intra-abdominal hemorrhage following a car accident. The tumor was composed of CD117+/CD34+ spindle-shaped cells with low mitotic activity. Analysis of tumor DNA revealed a heterozygous duplication of 30 bp in exon 11 of KIT. Nine months after R0 resection, positron emission tomography showed abnormal uptake in the upper abdomen. The patient was treated with imatinib mesylate and is alive and well 2 years after the operation. DISCUSSION: Omental EGISTs remain silent despite a large tumor size. They are diagnosed at a median age of 65 years and show low proliferative activity in the majority (about 80%) of cases. Although the median follow-up period of published cases is only 20 months, mortality appears to be low after R0 resection and is expected to decrease further following the recent introduction of imatinib therapy for high-risk tumors. Accumulating molecular genetic data may lead to improved prognostic classification and patient management.
Subject(s)
Gastrointestinal Stromal Tumors/genetics , Omentum/pathology , Peritoneal Neoplasms/genetics , Proto-Oncogene Proteins c-kit/genetics , Aged , Antineoplastic Agents/therapeutic use , Base Sequence , Benzamides , Gastrointestinal Stromal Tumors/pathology , Gastrointestinal Stromal Tumors/surgery , Humans , Imatinib Mesylate , Incidental Findings , Male , Molecular Sequence Data , Mutation , Neoplasm Recurrence, Local/drug therapy , Peritoneal Neoplasms/pathology , Peritoneal Neoplasms/surgery , Piperazines/therapeutic use , Pyrimidines/therapeutic useABSTRACT
Thyroid tumors producing colony-stimulating factors associated with neutrophilia and/or eosinophilia are very rare and almost all of them concern anaplastic thyroid cancer. Only one case of papillary thyroid carcinoma associated with neutrophilia and one case of medullary thyroid carcinoma associated with eosinophilia have been reported. In this report a 72-year old male patient with metastatic papillary thyroid carcinoma associated with neutrophilia and eosinophilia is described. While investigating the cause of neutrophilia and eosinophilia, a blind bone marrow biopsy of the posterior iliac crest was performed, which showed infiltration by papillary thyroid carcinoma. High blood levels of granulocyte-macrophage colony-stimulating factor (GM-csF) were found using an enzyme-linked immunosorbent assay. As other causes of neutrophilia and eosinophilia were excluded, we assumed that these were paraneoplastic manifestations induced by GM-csF produced by the thyroid tumor. the disease progressed rapidly, despite appropriate treatment which included thyroidectomy and postoperative radioactive (131)I administration. the patient died 11 months after diagnosis because of extensive lung metastasis. Neutrophilia and eosinophilia were stable findings, while serum thyroglobulin levels remained elevated throughout the follow-up period. to our knowledge, this is the first report of a patient with metastatic papillary thyroid carcinoma in whom neutrophilia and eosinophilia associated with high circulating levels of GM-csF were detected.
