ABSTRACT
ANTECEDENTES: existe una asociación demostrada entre endometriosis y algunas histologías del carcinoma epitelial de ovario. Por otra parte, se ha observado que hasta un 30% de las neoplasias de ovario se presentan de forma concomitante a neoplasias del endometrio. Para considerar la sincronicidad entre estos tumores, estos deben cumplir criterios anatomopatológicos estrictos como los descritos por scully. OBJETIVO: presentar un caso clínico de carcinoma endometrioide sincrónico de ovario y endometrio sobre focos de endometriosis, así como su diagnóstico y manejo. CASO CLÍNICO: paciente de 27 años que consulta por spotting intermenstrual. En la ecografía endocavitaria se observa un pólipo endometrial. Además, se describe un tumor anexial izquierdo de 42mm, trilobulado, con un polo sólido de 17×15mm. Se somete a una polipectomía histeroscópica y quistectomía ovárica laparoscópica. Asimismo, se reseca implante sospechoso en el fondo de saco posterior. El resultado anatomopatológico de las piezas quirúrgicas fue: pólipo endometrial con hiperplasia compleja con atipias y focos de adenocarcinoma endometrioide grado I; el tumor quístico ovárico izquierdo consistente con quiste endometriósico con focos de adenocarcinoma endometrioide. La lesión peritoneal corresponde a un implante de adenocarcinoma endometrioide grado I. El estudio de las características anatomopatológicas y la presencia del implante peritoneal sugieren el diagnóstico de un carcinoma endometrioide ovárico con origen en una lesión endometriósica sincrónico con un carcinoma endometrioide endometrial. CONCLUSIÓN: el diagnóstico diferencial entre la sincronicidad o diseminación de los tumores de ovario y endometrio de estirpe endometrioide supone un reto para el clínico y es fundamental para el correcto manejo de estas neoplasias.
BACKGROUND: there is a demonstrated association between endometriosis and some epithelial ovarian carcinoma histologies. On the other hand, it has been observed that up to 30% of ovarian neoplasms present concomitantly with endometrial neoplasms. To consider synchronicity between these neoplasms, they must meet strict pathological criteria such as those described by scully. OBJECTIVE: to introduce a case of an ovarian and endometrial synchronous endometrioid carcinoma implanted on endometriosis sites, as well as its diagnosis and management. CLINICAL CASE: a 27-year-old patient who consulted because of an intermenstrual spotting. The ultrasound image showed an endometrial polyp. Furthermore, a 42 mm left adnexal trilobal tumor with a 17×15mm solid pole was described. She underwent a hysteroscopic polypectomy and laparoscopic ovarian cystectomy. Likewise, resection of a suspicious implant in the posterior vaginal fornix was done. The pathological result of the surgical pieces was: endometrial polyp with complex hyperplasia with atypia and focal points of grade I endometrioid adenocarcinoma; the left ovarian cystectomy: endometriotic cyst with focal points of endometrioid adenocarcinoma. The peritoneal lesion corresponded to a grade I endometrioid adenocarcinoma implant. The study of the pathological characteristics and the presence of the peritoneal implant suggest the diagnosis of endometrioid ovarian carcinoma originated in a synchronous endometriotic lesion with endometrial endometrioid carcinoma. CONCLUSION: differential diagnosis between the synchronicity or spread of ovarian and endometrial endometrioid cell line carcinomas, is a great challenge and it is essential for the correct management of these neoplasms
Subject(s)
Humans , Female , Adult , Ovarian Neoplasms/diagnosis , Endometrial Neoplasms/diagnosis , Carcinoma, Endometrioid/diagnosis , Neoplasms, Multiple Primary/diagnosis , Ovarian Neoplasms/surgery , Ovarian Neoplasms/pathology , Endometrial Neoplasms/surgery , Endometrial Neoplasms/pathology , Carcinoma, Endometrioid/surgery , Carcinoma, Endometrioid/pathology , Diagnosis, Differential , Neoplasms, Multiple Primary/surgery , Neoplasms, Multiple Primary/pathologyABSTRACT
Inflammatory myofibroblastic tumor or inflammatory pseudotumor was first described by Brunn in 1932. Umiker et al. named it so in 1954 for its ability to mimic malignancy clinically and radiologically [Med Pediatr Oncol 2000; 35(5): 484-7]. This tumor, characterized by its rareness, affects mainly the lung and the orbit. Histologically, the tumor is characterized by the presence of fibroblasts, myofibroblasts, polymorphs, lymphocytes, and neutrophils. This case report and review of literature present a male patient, 37 years old, with a bulky mediastinal lesion at the topography of the 4th rib. Histopathology reveals Hodgkin's Lymphoma (HL) concomitant with inflammatory myofibroblastic tumor (IMT). This report aims to emphasize the relevance of differential diagnoses to a better medical assistance. To the best of our knowledge, a case with this characteristic has never been seen before.
ABSTRACT
Se presenta el caso de un paciente masculino de 73 años de edad operado por adenocarcinoma del antro gástrico. Se practicó gastrectomía subtotal distal más linfadenectomía D2. Durante el examen anatomopatológico de la pieza quirúrgica se encontró otro tumor pequeño en el espesor de la pared del antro cubierto por mucosa normal, separado del adenocarcinoma. El análisis histológico confirmó otra neoplasia incidental sincrónica, un tumor del estroma gastrointestinal de tipo fusiforme, positivo para el marcador tumoral CD117. El objetivo del trabajo es presentar esta asociación tumoral sincrónica, revisar sus características y las teorías etiopatogénicas actuales de esta condición sincrónica según la literatura especializada(AU)
A case is presented of a 73-year-old male patient who was operated for a gastric adenocarcinoma of the antrum. A distal subtotal gastrectomy plus D2 lymphadenectomy were practiced. During the anatomic and pathologic examination of the surgical piece, a second tiny tumor was found in the wall of the antrum and that was covered with a normal mucosa separated from the adenocarcinoma. The histologic examination confirmed another synchronous incidental neoplasm, a spindle-cell gastrointestinal stromal tumor, positive for the tumor marker CD117. This paper is aimed at presenting synchronous tumor entity, to review its characteristics and the current etiologic and pathogenic theories of this synchronic condition according to the specialized literature(AU)
Subject(s)
Humans , Male , Aged , Adenocarcinoma , Gastrointestinal Neoplasms/etiology , Gastrointestinal Stromal Tumors/surgery , Gastrectomy/adverse effectsABSTRACT
Se presenta el caso de un paciente masculino de 73 años de edad operado por adenocarcinoma del antro gástrico. Se practicó gastrectomía subtotal distal más linfadenectomía D2. Durante el examen anatomopatológico de la pieza quirúrgica se encontró otro tumor pequeño en el espesor de la pared del antro cubierto por mucosa normal, separado del adenocarcinoma. El análisis histológico confirmó otra neoplasia incidental sincrónica, un tumor del estroma gastrointestinal de tipo fusiforme, positivo para el marcador tumoral CD117. El objetivo del trabajo es presentar esta asociación tumoral sincrónica, revisar sus características y las teorías etiopatogénicas actuales de esta condición sincrónica según la literatura especializada(AU)
A case is presented of a 73-year-old male patient who was operated for a gastric adenocarcinoma of the antrum. A distal subtotal gastrectomy plus D2 lymphadenectomy were practiced. During the anatomic and pathologic examination of the surgical piece, a second tiny tumor was found in the wall of the antrum and that was covered with a normal mucosa separated from the adenocarcinoma. The histologic examination confirmed another synchronous incidental neoplasm, a spindle-cell gastrointestinal stromal tumor, positive for the tumor marker CD117. This paper is aimed at presenting synchronous tumor entity, to review its characteristics and the current etiologic and pathogenic theories of this synchronic condition according to the specialized literature(AU)
Subject(s)
Humans , Male , Aged , Adenocarcinoma/diagnostic imaging , Gastrointestinal Neoplasms/etiology , Gastrointestinal Stromal Tumors/surgery , Gastrectomy/adverse effectsABSTRACT
Los tumores malignos sincrónicos primarios de ovario y endometrio son raros y se reportan en alrededor de un 5 por ciento y pueden tener muy buen pronóstico cuando son detectados tempranamente. El objetivo del presente trabajo es dar a conocer a la comunidad científica el caso de un paciente con tumores malignos concurrentes de ovario y endometrio poco frecuentes. Se presenta una paciente femenina de 67 años de edad, multípara, de color de piel blanca, a la cual se le diagnosticó un adenocarcinoma de endometrio y en el curso de la cirugía se encontró un tumor sólido de ovario y el diagnóstico histopatológico arrojó un tumor de las células de la granulosa. Los tumores sincrónicos de ovario y endometrio parecen tener mejor pronóstico y sobrevida cuando son de bajo grado y diagnosticados en etapas tempranas(AU)
The primary synchronous malignant ovarian and endometrial tumors are rare and they are reported in around 5 percent. They can have very good prognosis when they are early detected. The aim of this paper is to inform the scientific community the case of a patient with concurrent malignant tumors of ovarian and endometrial infrequent. We present a 67 year old female patient, multiparous, white skin color, who was diagnosed with an endometrial adenocarcinoma. In the course of surgery, a solid ovarian tumor was found. Her histopathologic diagnosis yielded a granulose-cell tumor. Synchronous ovarian and endometrial tumors appear to have a better prognosis and survival when they are low grade and diagnosed at early stages(AU)
Subject(s)
Humans , Female , Aged , Carcinoma, Endometrioid/diagnosis , Granulosa Cell Tumor/diagnosis , Neoplasms, Multiple PrimaryABSTRACT
Los tumores malignos sincrónicos primarios de ovario y endometrio son raros y se reportan en alrededor de un 5 por ciento y pueden tener muy buen pronóstico cuando son detectados tempranamente. El objetivo del presente trabajo es dar a conocer a la comunidad científica el caso de un paciente con tumores malignos concurrentes de ovario y endometrio poco frecuentes. Se presenta una paciente femenina de 67 años de edad, multípara, de color de piel blanca, a la cual se le diagnosticó un adenocarcinoma de endometrio y en el curso de la cirugía se encontró un tumor sólido de ovario y el diagnóstico histopatológico arrojó un tumor de las células de la granulosa. Los tumores sincrónicos de ovario y endometrio parecen tener mejor pronóstico y sobrevida cuando son de bajo grado y diagnosticados en etapas tempranas(AU)
The primary synchronous malignant ovarian and endometrial tumors are rare and they are reported in around 5 percent. They can have very good prognosis when they are early detected. The aim of this paper is to inform the scientific community the case of a patient with concurrent malignant tumors of ovarian and endometrial infrequent. We present a 67 year old female patient, multiparous, white skin color, who was diagnosed with an endometrial adenocarcinoma. In the course of surgery, a solid ovarian tumor was found. Her histopathologic diagnosis yielded a granulose-cell tumor. Synchronous ovarian and endometrial tumors appear to have a better prognosis and survival when they are low grade and diagnosed at early stages(AU)
Subject(s)
Humans , Female , Aged , Carcinoma, Endometrioid/diagnosis , Granulosa Cell Tumor/diagnosis , Neoplasms, Multiple PrimaryABSTRACT
Synchronous endometrial and cervical cancer is a very rare condition. This report describes a case of a 46-year-old woman who presented with a cervical mass that measured 5.6 cm along its longest diameter, whose biopsy analysis revealed an endocervical mucinous adenocarcinoma. She was classified as having an IB2 cervical carcinoma and treated with concurrent chemoradiation plus hysterectomy. Pathological and immunohistochemical analysis of the surgical specimens revealed a synchronous endometrioid grade 2 adenocarcinoma in the endometrium, and a well-differentiated mucinous adenocarcinoma in the cervix. Magnetic resonance imaging (MRI) studies performed prior to treatment were reviewed and apparent diffusion coefficient (ADC) maps were generated. The ADC values demonstrated distinct signal intensity differences between the endometrial and endocervical tumors. In conclusion, diffusion-weighted MRI and ADC maps can help to distinguish the site of origin of synchronous tumors.
ABSTRACT
El desarrollo sincrónico de múltiples tumores en el tracto genital femenino es muy infrecuente, presentándose tan solo en el 1 al 2 por ciento de los cánceres ginecológicos. De estos, el 50 al 70 por ciento lo constituyen el grupo de neoplasias primarias sincrónicas de endometrio y ovario. El objetivo del artículo es exponer un caso diagnosticado histopatológicamente en el Departamento de Patología de la Universidad Industrial de Santander en material procedente de histerectomía abdominal ampliada, salpingooforectomía bilateral, linfadenectomía pélvica y apendicectomía, y hacer una revisión de la literatura de esta entidad, dada la infrecuencia de su diagnóstico y a la escasa información local al respecto.
Synchronous development of multiple tumors in the female genital tract is rare, occurring only in the 1 to 2 percent of gynecologic cancers. Of these, 50 to 70 percent consists of the group of synchronous primary neoplasms of the endometrium and ovary. The aim of this paper is to present a case diagnosed histopathologically at the Department of Pathology of the Universidad Industrial de Santander in a sample for histological study consists of material from enlarged abdominal hysterectomy, bilateral salpingoophorectomy, pelvic lymphadenectomy and appendectomy sent by the Hospital Universitario de Santander in 2010, and a review of the literature of this entity, given the rarity of its diagnosis and the lack of local information about it.