Right heart masses in a patient with endometrial stromal sarcoma.

We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.

Endometrial stromal sarcoma in a 20-year-old woman.

Endometrial stromal sarcoma (ESS) is an uncommon and challenging condition comprising 10% of all uterine sarcomas and found in women 42-58 years of age. ESS is difficult to diagnose in young women as it masquerades as a leiomyoma. We report this tumour in a 20-year-old woman presenting with heavy and prolonged menses and urinary retention. She was not sexually active and did not give consent for pelvic examination. A preoperative diagnosis of a submucous leiomyoma with an adnexal mass was made. At laparotomy, the leiomyoma was found to be wedged between the cervix and the vagina, and was removed vaginally. A 5-6 cm retroperitoneal mass was adherent to the right pelvic wall, which was also removed. Histopathology of both specimens revealed ESS. The final diagnosis according to the International Federation of Gynaecology and Obstetrics classification was stage IV ESS. After oncology consult, she was referred for chemotherapy. She is now on follow-up.

Humoral Hypercalcemia in Uterine Cancers: A Case Report and Literature Review.

BACKGROUND Paraneoplastic hypercalcemia is a well-described complication associated with a variety of malignancies. However, its incidence in gynecological malignancies is low. CASE REPORT A 53-year-old woman presented with progressive abdominal distention and irregular vaginal bleeding of several weeks' duration. A contrast CT abdomen and pelvis was significant for a mass in the lower uterine/cervical region, multiple peritoneal and omental masses, enlarged pelvic and paraaortic lymph nodes, and large-volume ascites. A pelvic exam revealed a fungating vaginal mass, with biopsy showing a high-grade tumor with immunohistochemical staining positive for vimentin, CD10, and cyclin D1, consistent with endometrial stromal sarcoma. During her hospitalization, the patient became increasingly lethargic. Workup showed severe hypercalcemia and evidence of acute kidney injury. The patient did not have evidence of bony metastatic disease on imaging studies. Further laboratory evaluation revealed an elevated PTHrP of 301 pg/mL (nl 14-27), a depressed PTH level of 3 pg/mL (nl 15-65), and a depressed 25-OH vitamin D level of 16 ng/mL (nl 30-100), consistent with humoral hypercalcemia of malignancy. The patient was treated with pamidronate, calcitonin, and intravenous fluids. She eventually required temporary hemodialysis and denosumab for refractory hypercalcemia, which improved her electrolyte abnormalities and clinical status. CONCLUSIONS Uterine malignancies of various histologies are increasingly recognized as a cause of humoral hypercalcemia. They are an important differential diagnosis in a woman with hypercalcemia and abnormal vaginal bleeding or abdominal symptoms.

Afectación ganglionar en endometriosis rectal aislada / Lymph node involvement in isolated rectal endometriosis

No disponible

Low-grade Endometrial Stromal Sarcoma Primarily Arising in the Vagina: A Case Report.

BACKGROUND: Endometrial stromal sarcoma (ESS) is a rareform of endometrial cancer, comprising < 0.2% of all uterine malignancies and 10% of all uterine sarcomas. To date, the English-language literature contains 6 reports of extrauterine ESS arising primarily in the vagina. We describe the seventh such case, and the first case in which the origin is at the introitus of the vagina. CASE: A 43-year-old, nulligravid, Caucasian woman presented for an annual gynecologic examination and was found to have an asymptomatic 5 x 5-mm, rubbery, soft tissue mass at the 5 o'clock position of the vaginal introitus. As has been reported in several cases of low-grade ESS, this case originated at a site of endometriosis. CONCLUSION: Based on our experience as well as a thorough review of the literature, it appears that early stage low-grade ESS arising in the vagina can be treated effectively with surgical resection followed by close observation for recurrence.

The utility of the 3D imaging software in the macroscopic rendering of complex gynecologic specimens / 부인종양

No abstract available.

Dramatic recurrence of cancer in a patient who underwent kidney transplantation--case report.

BACKGROUND: Besides cardiovascular diseases and infections, cancers are the main cause of death in patients after transplantation of a vascularized organ. After transplantation, usually de novo cancers develop. Recurrences of cancers that had been diagnosed and treated before transplantation are much rarer. In exceptional cases, cancer is transferred with the donor's organ. The epidemiology and the course of post-transplantation de novo neoplasia is relatively well known. However, the issue of recurrence of pre-transplantation cancer, which is significantly rarer and its course more individualized and difficult to predict, poses a challenge to contemporary transplantation. CASE REPORT: This paper presents an unexpectedly rapid recurrence of rare cancer-endometrial stromal sarcoma-that occurred shortly after transplantation of a kidney from a deceased donor to a patient who had undergone cancer treatment 7 years earlier. The dramatic course of the disease, complicated with recurrent massive thrombosis of the inferior vena cava and the right cardiac cavities, as well as pulmonary embolism and serious infectious complications, illustrates the difficulties related to qualifying patients with a history of malignancy for transplantation. CONCLUSIONS: Based on this case report, we attempt to find an answer to the question about the risk of cancer recurrence in patients receiving immunosuppressive therapy and find out how it can be minimized. Answering these questions is particularly important if the recurrent cancer is substantially more aggressive, cancer treatment options are limited, and the prognosis is poor due to lack of immunocompetence.

Sarcoma del estroma endometrial de grado alto / High degree endometrial stromal sarcoma

El sarcoma del estroma endometrial es un tumor infrecuente, que comprende menos del 1 por ciento de los tumores malignos ginecológicos. Presentamos el caso de una adolescente de 16 años con hemorragia uterina anormal a la que se le realizó histerectomía subtotal. Microscópicamente, la neoplasia estaba constituida por una proliferación maligna de células estromales del endometrio. El estudio inmuno-histoquímico mostró positividad para vimentina, desmina, CD10, CD117.El CD10 es un marcador inmuno-histoquímico del estroma endometrial normal y de los tumores del estroma endometrial, y es útil para el diagnóstico diferencial entre el sarcoma del estroma endometrial y el leiomioma celular o el leiomiosarcoma uterino. Las mejores opciones de tratamiento se obtienen con un enfoque multidisciplinario y en centros especializados(AU)

Endometrial stromal sarcoma is a rare tumor comprising less than 1 percent of gynecological malignancies. We report the case of a 16 year-old adolescent with abnormal uterine bleeding who underwent hysterectomy subtotal. At microscopy the neoplasm was composed of malignant proliferation of endometrial stromal cells. Immunohistochemical studies were positive for vimentin, desmin, CD10 and CD117. CD10 is an immunohistochemical marker of normal endometrial stroma and of endometrial stromal neoplasms. This marker is useful in the differential diagnosis of endometrial stromal sarcoma versus uterine cellular leiomyoma or uterine leiomyosarcoma. The best treatment options are obtained with a focus multidisciplinary, in specialized centers(AU)

Primary extrauterine endometrial stromal sarcoma: Located in pelvic and abdominal tissue and arising in endometriosis.

Primary extrauterine endometrial stromal sarcoma is a rare tumor and it is infrequently associated with endometriosis. We are reporting a case of this unusual tumor in a 42-year-old female who presented with multiple nodules of tumor in the abdomen and pelvis and with metastases in para-aortic lymph nodes. The right parametrium, in addition, had a focus of endometriosis, which was contiguous with the tumor, confirming its origin.

Fertility-sparing management combined with photodynamic therapy for endometrial stromal sarcoma: a case report.

BACKGROUND AND OBJECTIVES: Low-grade endometrial sarcoma (LGESS) has a favorable prognosis after standard surgical treatment. The conservative fertility-sparing treatments in young patients with LGESS have been reported; however, the role of conservative therapy is not well defined. STUDY DESIGN/PATIENT AND METHODS: A 31-year-old nulliparous woman was diagnosed with LGESS after resection of a cervical polyp with resection margin positive for malignancy. She underwent fertility-sparing surgery including laparoscopic pelvic lymph node dissection, hysteroscopic endometrial polypectomy, endocervical curettage, and photodynamic therapy (PDT) on the endometrium and uterine cervix. And she had received adjuvant therapy with a non-steroidal aromatase inhibitor. RESULTS: She conceived by in vitro fertilization and delivered twins at 32+2 weeks gestation by Cesarean section 32 months after conservative treatment. She has no evidence of recurrence after 99 months of follow-up. CONCLUSION: Conservative management of LGESS may be attempted in selected patients who want to preserve fertility. Conservative surgery combined with PDT has shown effective results in long-term follow-up.

Adenosarcoma mülleriano de útero: un tumor infrecuente de difícil diagnóstico / Uterine müllerian adenosarcoma: report of a case and review of the literature

El adenosarcoma de útero es una neoplasia rara y representa aproximadamente el 8% de todos los sarcomas uterinos. Está relacionado con antecedentes de tratamiento con tamoxifeno y con radiación pélvica. La clínica más característica es la de una lesión polipoide recidivante, siendo habitual que la paciente ya haya tenido algunas biopsias previas por ese mismo motivo, en las cuales no haya podido llegarse a un diagnóstico acertado y definitivo. Incluso puede haber llegado a darse un diagnóstico erróneo, de los cuales el más frecuente es el de un pólipo cervical. La lesión consta de un componente glandular benigno creciendo inmerso en un estroma sarcomatoso. Presentamos el caso de una mujer de 53 años con una lesión polipoide uterina. Tras los estudios macroscópico, microscópico e inmunohistoquímico se llegó al diagnóstico de adenosarcoma mülleriano de útero. Se trata de una neoplasia de bajo grado y buen pronóstico, pero que recidiva en un alto porcentaje de casos (25-40%). El tratamiento es la histerectomía total simple con doble anexectomía, seguida o no de radioterapia postoperatoria, aunque en pacientes jóvenes, que no tienen el deseo genésico cumplido, al ser una neoplasia de bajo grado, se han descrito casos en los que se ha optado por un tratamiento conservador. De todas formas, no hay que olvidar que se trata de un tumor maligno y que también se han descrito casos de fallecimiento por esta entidad a causa de metástasis abdominales o de otro tipo, por lo que somos de la opinión de que la mejor y más segura opción terapéutica es la histerectomía (AU)

Uterine adenosarcoma is a rare neoplasm constituting only around 8% of all uterine sarcomas. This tumor is associated with tamoxifen therapy and pelvic radiation. The most characteristic clinical feature is a recurrent cervical polypoid lesion. Patients have often had previous biopsies for the same reason, but without an accurate diagnosis. Furthermore, a mistaken diagnosis may have been made, the most common being cervical polyp. Uterine adenosarcoma consists of neoplastic glands with a benign appearance and a sarcomatous stroma. We report the case of a 53-year-old woman with a uterine polypoid lesion. After macroscopic, microscopic and immunohistochemical studies, the diagnosis was a uterine Müllerian adenosarcoma, which is a low-grade neoplasm with good prognosis, but with a high percentage of recurrences (25%-40%). Treatment is simple hysterectomy with double adnexectomy, with the option of subsequent postoperative radiotherapy. However, because this tumor is a low-grade neoplasm, a more conservative approach has sometimes been adopted in some young patients without children. This tumor is malignant, however, and mortality from abdominal or other types of metastases has been reported. Therefore, we believe that the most appropriate and safest therapeutic option is hysterectomy(AU)

Úlcera eosinofílica lingual: un reto diagnóstico de patogénesis controvertida / Eosinophilic ulcer tongue: a diagnostic challenge controversial pathogenesis

La úlcera eosinofílica, también conocida como granuloma ulcerativo traumático con eosinofilia estromal, es una infrecuente y benigna lesión ulcerativa de la mucosa oral que presenta una evolución persistente, planteando a menudo diferentes diagnósticos clínicos diferenciales. Su diagnóstico se establece solo a partir del estudio histopatológico, si bien su morfología presenta a menudo características que pueden sugerir al patólogo la existencia de un proceso linfoproliferativo, traduciendo una patogénesis lesional controvertida todavía no bien aclarada. Comunicamos una observación clínico-patológica de úlcera eosinofílica afectando a una mujer de 76 años de edad. La lesión, de 2,5 cm de diámetro, afectaba al borde lateral lingual, siendo biopsiada en dos ocasiones, presentando tras un seguimiento clínico de 5 meses una evolución cicatricial, programándose actualmente un seguimiento clínico prologando de 24 meses. Se presentan las características morfológicas e inmunohistoquímicas del estudio biópsico, discutiendo las hipótesis patogéneticas que esta infrecuente lesión ulcerativa plantea(AU)

Eosinophilic ulcer, also know as traumatic ulcerative granuloma with stromal eosinophilia, is a rare and benign ulcerative lesion of oral mucosa that has a persistent progression, often requiring a differential clinical diagnosis. The diagnosis is only established from histopathological studies, which frequently show morphological features that may be suggestive of a lymphoproliferative process, resulting in a controversial pathogenesis that is still not clarified today. We report the clinical and pathological observations of an eosinophilic ulcer affecting a woman 76 year-old woman. A biopsy was performed twice on a 2.5 cm diameter ulcer affecting the lingual edge. After a clinical follow-up of 5 months, a self-limiting course with the production of a scar was verified. She has currently been scheduled for an extended 24-month clinical follow-up. The morphological and immunohistochemical features found in the biopsy study are presented, and the pathogenesis hypothesis of this uncommon ulcerative lesion is discussed(AU)