ABSTRACT
Placental mesenchymal dysplasia (PMD) is a rare, benign developmental anomaly with a reported prevalence of 0.02% (Arizawa and Nakayama, 2002). It is characterized by placentomegaly with multiple cystic lesions of the stem villi and vascular anomalies (Pawoo and Heller, 2014). Early detection of PMD has been described during routine prenatal ultrasound (Vaisbuch et al., 2009). The sonographic characteristics of PMD include increased placental thickness and multiple cystic areas within the placenta with either an absence of blood flow or with low venous Doppler signals (Vaisbuch et al., 2009). The differential diagnosis of multicystic placental lesions with the presence of a live fetus include partial molar pregnancy, multiple hematomas, chorioangioma Beckwith-Wiedemann syndrome and PMD. Chorioangiomas are well circumscribed masses within the placenta and they are characterized by the presence of a single feeding vessel with the same pulse rate as the umbilical cord (Zalel et al., 2002). Invasive prenatal testing is required for the exclusion of partial molar pregnancy and Beckwith-Wiedemann Syndrome (Vaisbuch et al., 2009). Definitive diagnosis of PMD is based on the pathologic examination of the placenta. Histology reveals aneurysm or dilated blood vessels that may be thrombosed. The stem villi are edematous and enlarged with thick-walled vessels, without trophoblastic proliferation (Pawoo and Heller, 2014). This case report highlights the significance of the early detection of PMD, illustrates the pitfalls in differential diagnosis and provides valuable insights regarding PMD management in a clinical setting.
ABSTRACT
Ewing's sarcoma of the cervix is a rare entity and presents with considerable challenges in diagnosis and therapy. Herein, we report a case of a cervical Ewing's sarcoma presenting with FIGO stage Ib, diagnosed during the first trimester of the patient's pregnancy. Imaging with CT scans, MRI of her abdomen and PET-CT verified the locoregional extension of the tumor. The diagnosis was confirmed by immunohistochemistry and molecular analysis. Fluorescence in situ hybridization and RT-PCR detected the pathognomonic EWS/FLI fusion gene. Favorable prognostic factors regarding the stage, clinocopathological and molecular characteristics of the tumor are also described. Due to the rarity of the disease, at present, there is no universal consensus on the optimal therapeutic approach. The literature has been reviewed and the therapeutic schemes and available clinical data have been discussed. The patient presented in this case report was treated aggressively with tri-modality therapy and underwent radical hysterectomy followed by adjuvant chemotherapy with Vincristine-Ifosfamide-Doxorubicin-Etoposide and radiotherapy. The patient remains free of this disease 42 months following the diagnosis of her tumor.
ABSTRACT
BACKGROUND: Struma ovarii (SO) is a specialized monodermal teratoma predominantly composed of mature thyroid tissue, accounting for approximately 5% of all ovarian teratomas. Thyrotoxicosis is seen in about 8% of patients with SO. Most SO cases are benign with only 5-10% being malignant, and malignant SO causing thyrotoxicosis is very uncommon. CASE: A 64-year-old woman had been diagnosed with thyrotoxicosis 2 years previously. The thyroid gland was palpable with a micronodular texture, and the patient was euthyroid under carbimazole. She presented with abdominal pain and progressive enlargement of the abdomen over a 2-month period. An abdominal ultrasonography revealed a pelvic mass and a large fluid collection. Additional imaging confirmed the presence of a complex right ovarian mass measuring 13 cm. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, omentectomy and appendectomy. The histological examination revealed the presence of 'follicular thyroid-type carcinoma arising in an SO of the right ovary, with metastatic infiltration in the tissue fragments from the pouch of Douglas'. Antithyroid treatment was discontinued 1 month after surgery in light of the pathology result. During the 4-year follow-up, the patient remained euthyroid. CONCLUSION: There has been controversy about the management of malignant SO, which is a rare entity. Malignant SO causing thyrotoxicosis is even more uncommon. As clinical signs are nonspecific, other causes of thyrotoxicosis must be considered for a differential diagnosis. Our case is one of the very few cases ever reported.
