MR imaging of endometriosis: Spectrum of disease.

Endometriosis is a common gynecological disorder defined by the presence of endometrial tissue outside the uterus. It is the most common cause of chronic pelvic pain and typically affects the ovaries, uterine ligaments, peritoneum, tubes, rectovaginal septum and bladder. It may, however, be found at various extrapelvic sites, including the perineum, liver, pancreas, lung or even the central nervous system, and in such cases, diagnosis may be quite challenging. Even though definitive diagnosis requires laparoscopy, preoperative identification of endometriosis is important not only to differentiate it from other diseases with similar clinical presentations but also, for accurate presurgical mapping, since complete removal of all endometriotic foci is critical for the effective treatment of the patient's symptoms. Ultrasound is performed initially, but magnetic resonance imaging (MRI) is increasingly being used, particularly when sonographic findings are unclear, when deep pelvic endometriosis is suspected or when surgery is planned, as it provides better contrast resolution and a larger field of view compared to ultrasound. In this article, we will discuss distinctive MRI appearances of endometriotic foci and we will review common and uncommon locations of endometriosis within the body, in an attempt to familiarize radiologists with its wide spectrum of manifestations.

Hepatoid carcinoma of the ovary. A case report and review of the literature.

Hepatoid carcinoma (HCO) is a rare ovarian tumor and is thought to be a different subtype from hepatoid-type yolk sac tumor based on its pathologic features. In contrast to hepatoid yolk sac tumor in which the patients are usually young, patients with HCO are elderly with a peak incidence during the sixth decade of life. None of the patients with HCO have had gonadal dysgenesis or recognizable germ cell components within the tumors. We describe a case of a 42-year-old woman who presented to our hospital complaining of abdominal pain. Physical examination and CT scan revealed a large tumor in the left adnexa. She underwent total hysterectomy and bilateral salpingo-oophorectomy with omentectomy. A left ovarian mass measuring 11 cm in diameter was found. Histological diagnosis was hepatoid carcinoma of the left ovary. Immunohistochemical findings suggest that hepatoid carcinoma of the ovary is probably a most likely variant of a common epithelial carcinoma by a process of neometaplasia or transdifferentiation.

Malignant adenomyoepithelioma of the breast--case report.

Malignant adenomyoepithelioma (MAME) of the breast is a rare tumor characterized on the basis of histologic, immunohistochemical and ultrastructural features by malignant proliferation of the epithelial and myoepithelial cells. We report a case of an 80-year-old woman with malignant adenomyoepithelioma of the breast, one of the oldest patients described up to today. A primary tumor in the left breast grew within a short period of time. A modified mastectomy with sampling of the axillary lymph nodes was performed. The lymph nodes did not include any metastatic lesions. In this case the malignancy was evidenced by the presence of a high mitotic rate, several nuclear atypia, necrosis, and local invasion. The tumor was associated with adenosis and in adjacent positions to the infiltrating portions a circumscribed nodule with histological features of benign adenomyoepithelioma was present. Reviewing the literature MAME has been reported in women aged between 26-76 years. The metastatic potential of this entity is not well studied. It appears to have hematogenous rather than lymphatic spread and usually occurs in primary tumors more than 2 cm in size.

Combined carcinoid and mixed (composite) glandular - endocrine cell carcinoma of the stomach in atrophic gastritis.

We describe a case of gastric carcinoid and inflammatory fibroid polyp concomitant with a composite tumor of the gastric antrum composed of poorly differentiated adenocarcinoma - endocrine carcinoma with immunohistochemical documentation of endocrine and non endocrine differentiation in a 67-year-old man with atrophic gastritis and intestinal metaplasia. When gastrectomy was carried out, two lymph nodes along the greater curvature harbored metastasis from carcinoid. The same occurrence is reported in several cases in the literature, which suggests that the association of gastric carcinoid to adenocarcinoma could point to the malignant nature of carcinoid. Furthermore, the findings in this patient reinforce the concept that the epithelial and neuroendocrine cells of the gastrointestinal tract both result from multidirectional differentiation of a primitive cell.

Glomus tumor of the stomach: a case report.

Glomus tumors are relatively uncommon benign neoplasms, most common in the skin and subcutaneous tissue, but can also occur in the viscera, most often in the stomach. Preoperative diagnosis, when the tumor occurs in the stomach, seems difficult but is important, since glomus tumors of the stomach are essentially benign and amenable to conservative excision, contrary to aggressive gastric neoplasms. We describe the case of a 75-year-old man presented to the emergency department with gastrointestinal bleeding and epigastric pain. Gastroscopy revealed a submucosal mass in the antrum of the stomach in correspondence to the lesser curvature. Biopsies taken from the lesion showed morphological and immunohistochemical [positivity for alphasmooth muscle actin (alpha-SMA) and vimentin, negativity for CD34, CD117, chromogranin, synaptophysin, desmin and S-100 protein] characteristics attributable to glomus tumor. The patient underwent a laparotomic antrotomy incision. Histological examination of the tumor confirmed the diagnosis of gastric glomus tumor.