Perianal endometrioma presented as perianal abscess: report of two cases.

Perianal endometriosis is a rare clinical presentation of the extrauterine appearance of endometrium reported in <1% of the cases. The condition is accompanied by perianal cyclic pain and a palpable mass. If diagnosed by physical examination only, the condition may be easily misinterpreted as a perianal abscess and treated improperly with incision, thus resulting in "abscess recurrence." Additional diagnostic imaging such as endoanal ultrasonography and magnetic resonance imaging should be mandatory to provide an accurate diagnosis and proper treatment resulting in low recurrence rates. We present two cases of perianal endometriomas initially diagnosed and treated as perianal abscesses.

Small intestine metastasis from endometrial carcinoma initially presented as enterocutaneous fistula: a case report and literature review.

Although endometrial cancer is the fourth most common malignancy among women, it rarely metastasizes to the small intestine. Cases of endometrial recurrence to the intestine clinically present with secondary anemia, melena, abdominal cramps, and epigastric pain. Only a dozen cases are reported in the literature, but none presented with an enterocutaneous fistula. In this report, we present a case of an 88-year-old female patient previously treated for endometrial adenocarcinoma with surgery and adjuvant radiotherapy. Fourteen months after the surgery, the patient presented with an enterocutaneous fistula on the anterior abdominal wall, which was confirmed to be a metastasis from the primary tumor. To our knowledge, this is the first case of endometrial cancer metastasizing to the small intestine with involvement of the anterior abdominal wall and the occurrence of an enterocutaneous fistula, which was treated with radical surgery.

Adenoid cystic/basal-cell carcinoma of the prostate following high-grade urothelial bladder cancer: a case report.

Adenoid cystic/Basal-cell carcinoma (ACC/BCC) of the prostate is a rare histological type exhibiting various morphological characteristics and an optimal treatment has not yet been established. We report the case of a 63-year-old patient who complained of incomplete bladder emptying and recurrent urinary infection six months after transurethral resection of a high-grade urothelial bladder tumor. The clinical features, digital rectal examination, serum PSA levels, and multiparametric MRI did not refer to any suspicious prostatic lesions and cystoscopy revealed bladder neck hypertrophy, and yellowish zones in the prostatic urethra. Transurethral resection was performed due to these findings and histopathological analysis showed poorly differentiated ACC/BCC of the prostate. Even though there is no proven mutual correlation between ACC/BCC and urothelial bladder cancer, the appearance of obstructive urinary symptoms, bladder-neck hypertrophy, and macroscopic changes in prostatic urethra should be reconsidered for transurethral resection biopsy considering the possibility of ACC/BCC.

Laparoscopic fenestration and omentopexy as treatment for large splenic pseudocyst: Case report.

INTRODUCTION AND IMPORTANCE: Pseudocysts of the spleen are rare entities with cystic lesions of the spleen being uncommon in general. It is estimated that splenic cysts occur in about 0, 07% of the population1. In general, splenic cystic lesions are discovered incidentally or by mass effect. In the literature, only a limited number of splenic cysts are reported. We report a case of splenic pseudocyst with mass effect where we used laparoscopic fenestration of the pseudocyst with omentopexy as a treatment of choice. CASE PRESENTATION: The patient is a 62-year-old male with no previous history of trauma. He visited his GP for abdominal pain with flaring towards the left shoulder accompanied by early satiety, occasional obstipation, and breathing difficulties. He was referred to our hospital after enhanced computed tomography showed a 15 × 13 cm splenic cyst with displaced stomach and pancreatic tail medially and left kidney downward. Management options were discussed with the patient and he opted for a laparoscopic approach. In this case, we performed laparoscopic fenestration of the pseudocyst with omentopexy. CLINICAL DISCUSSION: Until recently splenectomy was the surgical treatment of choice for all large or symptomatic cystic lesions of the spleen2, however with growing knowledge about the protective role of the spleen an approach with spleen protection is advocated. CONCLUSION: There are many advantages to the laparoscopic approach of splenic cystic lesions and it may be the treatment of choice for this uncommon surgical problem.

Signet ring cell carcinoma of rectum metastasizing to synchronous renal cell carcinoma: a case report.

BACKGROUND: Rectal signet ring cell carcinoma is a rare type of colorectal adenocarcinoma characterized by an aggressive biological behavior and poor prognosis. The co-occurrence of colorectal carcinoma and renal cell carcinoma (RCC) has found in many hundreds of patients, many of whom also have additional malignancies. Cancer to cancer metastasis is rare and an uncommon phenomenon in malignancy, especially at the time of initial diagnosis, suggesting a genetic susceptibility. CASE PRESENTATION: We present the case of a 66-year-old Macedonian man with synchronous rectal signet ring cell carcinoma and RCC with tumor to tumor metastasis feature. He underwent a left nephrectomy and anterior rectal resection after complaining of constipation for 3-4 months and the appearance of synchronous tumors on the imaging studies. Morphology and immunohistochemical analysis of specimens from the RCC revealed signet ring cells identical to the rectal signet ring cell carcinoma. The next-generation sequencing study revealed mutations in TP53 and ERBB2, and microsatellite stable signet ring cell carcinoma was determined by deoxyribonucleic acid (DNA) sequencing. CONCLUSIONS: Cancer to cancer metastasis, although rare, needs to be considered in synchronous tumors. RCC, when diagnosed in multiple synchronous tumors, should be examined carefully. The paucity of reported cases indicates the need for advanced research in imaging methods for metastasis and new therapeutic approaches.

Correlation of Immunohistochemistry and Fluorescence in Situ Hybridization for HER-2 Assessment in Breast Cancer Patients: Single Centre Experience.

BACKGROUND: Accurate assessment of HER-2 is imperative in selecting patients for targeted therapy. Most commonly used test methods for HER-2 are immunohistochemistry (IHC) and fluorescence in situ hybridisation (FISH). We evaluated the concordance between FISH and IHC for HER-2 in breast cancer samples using Food and Drug Administration approved tests. MATERIAL AND METHODS: Archived paraffin tissue blocks from 73 breast cancer patients were used. HER-2 immunostaining was performed using Ventana anti-HER-2 monoclonal antibody. The FISH assay was performed using PathVysion™ HER-2 DNA Probe Kit. RESULTS: Of the 73 cases 68.5% were IHC 0/1+, 15.07% were IHC 2+ and 16.44% were IHC 3+. Successful hybridisation was achieved in 72 cases. HER-2 FISH amplification was determined in 16.67% cases. Ten IHC 3+ and two IHC 2+ cases were FISH positive. Two of the IHC 3+ cases were FISH negative. Concordance rate was 100%, 18.18% and 83.33% for IHC 0/1+, 2+ and 3+ group, respectively. Total concordance was 84.72%, kappa 0.598 (p < 0.0001). The sensitivity of IHC in detecting IHC 2+ and IHC 3+ cases was 16.7% and 83.3%, and the specificity was 85% and 96.67%, respectively. CONCLUSION: The consistency between the methods was highest for IHC negative and lowest for IHC equivocal cases. The immunohistochemistry showed high sensitivity for IHC 2+/3+ cases and high specificity for IHC 3+ cases. Our results support the view that false-positive rather than false-negative IHC results are a problem with HER-2/IHC testing, and that IHC should be used as an initial screening test, but IHC 2+/ 3+ results should be confirmed by FISH.