Synchronous occurrence of HPV-associated cervical squamous cell carcinoma (FIGO IIA) in prolapsed uterus and adenocarcinoma of the anal canal cT1N0M0: Case report.

RATIONALE: Guidelines of rare synchronous tumours treatment are often unavailable due to lack of wide prospective studies. Additionally, their management is not just a simple sum of coexisting tumours management and has to regard many circumstances like symptoms, age, comorbidities, advancement. PATIENT CONCERNS: Herein, we report a case of an 81-year-old woman who presented with bleeding from the prolapsed uterus. DIAGNOSES: Based on physical examination, that is, speculum examination, bimanual, and per rectum, followed by rectoscopy and histopathology, the diagnosis of cervical squamous cell carcinoma FIGO IIA2 in prolapsed uterus with anal canal adenocarcinoma cT1N0M0 was made. INTERVENTIONS: Dominating complaint of bleeding from prolapsed cervix was managed with radical vaginal hysterectomy in conjunction with wide colpectomy preceded by laparoscopic pelvic and paraaortic lymphadenectomy. Due to the lack of consent for removal of the anus, only radiotherapy was applied instead. OUTCOMES: The patient underwent magnetic resonance image follow-up. No recurrence was found at 18 months. LESSONS: Imaging is useful method of synchronous cancers diagnostics. These cancers may vary in aetiology and stage. Cervical cancer may be co-existing with another anogenital cancer. Therapy of synchronous cancers should be individualized taking into account patient's consent, age, physical condition, and comorbidities.

The Diagnosis of Perineural Invasion: A Crucial Factor in Novel Algorithm of Coexistence of Conventional and Nerve-Sparing Radical Hysterectomy.

Nerve-sparing radical hysterectomy (NSRH) was introduced to mitigate adverse effects associated with conventional radical hysterectomy (CRH) in cervical cancer. However, the introduction of NSRH was compromised by possible existence of perineural invasion (PNI). Additionally, the coexistence of NSRH and CRH is currently the fact. The aim of the study was to review the literature and attempt to construct a novel and preliminary PNI diagnostic algorithm that would establish the coexistence of NSRH and CRH in one system of early-stage cervical cancer (ESCC) surgical treatment. This algorithm takes into account the PNI risk factors and current and future diagnostic methods such as imaging and biopsy.

Transformation of a glandular odontogenic cyst into mucoepidermoid carcinoma of the mandible: A case report.

The glandular odontogenic cyst (GOC) is a rare pathology of odontogenic origin, which can behave unpredictably. It is problematic in clinical, radiographic and histological diagnostics. Intraosseous mucoepidermoid carcinoma (MEC) is a rare tumor which affects the jaws, typically found in the mandible. This malignancy, which usually originates from the salivary glands, can also be caused by a transformation of the mucous cells found in odontogenic cysts. This article presents a rare case of GOC transforming into MEC of the mandible, which was reported during the treatment of a 52-year-old male patient. The aim of this work was to present some of the therapeutic and clinical difficulties encountered when GOC transforms into mucoepidermoid cancer in the mandible, considering the pathomorphological and histological differentiations. The differentiation between MEC and GOC might be difficult through microscopic examination and requires the cooperation of a clinician ­ a maxillofacial surgeon ­ and a histopathologist.

Natural history of leiomyomas beyond the uterus.

RATIONALE: Most leiomyomas are located in the uterus. Leiomyomas are rarely found outside the uterus and classified as leiomyoma beyond the uterus (LBU). This group consists of disseminated peritoneal leiomyomatosis, benign metastasizing leiomyoma, intravenous leiomyomatosis, parasite leiomyoma located in the broad ligament and retroperitoneal space. The descriptions of the patients who suffer from these types of leiomyomas are presented mainly in case reports. PATIENT CONCERNS: A 34-year-old multiparous woman was operated on multiple recurrent uterine leiomyoma in parametrium. At one time, 32 leiomyomas were removed. Thirteen months following it, in next laparotomy, 132 leiomyomas were excised. Histologically, both were intravenous leiomyomas (IVLs). DIAGNOSIS AND INTERVENTIONS: In follow-up, computed tomography (CT) and magnetic resonance imaging scans were performed to look for next recurrent leiomyoma. Accidentally, the mass was found in inferior vena cava which was diagnosed as intravenous vena cava leiomyoma. The mass was removed and the final diagnosis of intravenous myoma was confirmed in histopathology. OUTCOMES: CT scan performed 3 months after the surgery for leiomyoma in vena cava revealed no pathology. Next 10 months' follow-up was uneventful. LESSONS: The recurrent multiple uterine leiomyoma precede LBU. The uterine leiomyoma spreads intravenously route to parametria as parasite leiomyoma, then to vena cava. It has to be taken into account in follow-up.

Calcifying Epithelial Odontogenic Tumour. Review of the literature and own experience.

The present paper discusses the case of a patient who was surgically treated for a rare calcifying epithelial odontogenic tumour (Pindborg tumour) at the Department of Maxillofacial Surgery, F. Chopin Clinical Voivodeship Hospital in Rzeszow. Calcifying Epithelial Odontogenic Tumour (CEOT) is a benign odontogenic tumour arising from the remnants of the dental lamina epithelium. The first three cases of this tumour were recognized by the Danish pathologist J.J. Pindborg in 1955. Since then Calcifying Epithelial Odontogenic Tumour has been commonly referred to as the Pindborg tumour. This type of neoplasm is relatively rare, since it occurs in approximately 0.4% of all odontogenic tumour cases. Due to a fairly common tendency of recurrence, estimated to be approximately 14% of all cases, the preferred o choice of treatment is radical surgical procedure and postoperative follow-up. Appropriate clinical and histopathological diagnosis is very important before applying the most suitable surgical treatment. Based on the case reviewed and the available literature, we can confirm the suitability of the therapeutic procedure course aligned with contemporary views, guidelines and established standards.

The prognostic significance of tumour infiltrating lymphocytes in oral squamous cell carcinoma.

Currently there is being conducted an extensive search to find new prognostic factors in oral squamous cell carcinoma which would assist in better patient management. One of the most promising prognostic markers is the density of tumour infiltrating lymphocytes. 100 cases of patients with oral squamous cell carcinoma that underwent surgical resection between 2006 and June 2016 at our institution were included in this study. From each case the most representative HE stained slide was identified and the density of tumour infiltrating lymphocytes were classified as non-brisk or brisk, which was included in the survival analysis. Upon analysis there was a strong correlation between non-brisk (n = 28) and brisk (n = 72) tumour infiltrating lymphocytes and the primary clinical outcomes: overall survival (p = 0.0472) and local recurrence-free survival (p = 0.00037). Univariate and multivariate Cox regression model confirmed the high prognostic value of tumour infiltrating lymphocytes as the independent prognostic indicator of better survival, being even superior, in our study, to the traditional pTNM system. This study provides robust evidence that the density of tumour infiltrating lymphocytes demonstrates a high prognostic significance in oral squamous cell carcinoma.

Benign metastasizing leiomyoma: A review of current literature in respect to the time and type of previous gynecological surgery.

INTRODUCTION: Benign metastasizing leiomyoma (BML) is a rare disorder that affects women with a history of uterine leiomyoma, which is found to metastasise within extrauterine sites. The aetiology of BML remains unexplained. Because BML is rare, and most publications contain descriptions of single cases, no statistically determined time relations were found between the primary and secondary surgeries, which may have aetiological implications. OBJECTIVES: To determine age before BML surgery, age during diagnosis of BML, type of prior surgery, and location of metastasis based on the literature. METHODS: A systematic review of four databases (Medline/PubMed, Embase, Web of Science, and Cochrane) covering articles published from 1 January 1965 to 10 April 2016. The inclusion criteria were full-text articles in English and articles containing case reports. Articles in languages other than English (39), articles containing incomplete data (14), i.e. no information regarding the time of surgery and/or the site of metastasis, articles bereft of case studies (25), and articles with access only to summaries, without access to the complete text (10) were excluded. Of 321 titles identified, only 126 articles met the aforementioned criteria. RESULTS AND CONCLUSIONS: The mean age during primary surgery and BML diagnosis was 38.5 years and 47.3 years, respectively. The most common surgery was total hysterectomy. The most frequent site of metastasis was the lungs; other organs were affected less frequently.The site of metastases and their number were not related to the longer time span between the patient's initial surgery and occurrence of metastasis. The analysed data, such as the age during primary surgery, age during BML diagnosis, site and type of metastasis, do not provide us a clear answer. Thus, BML pathogenesis is most probably complex in nature and requires further multidirectional research.

Primary vaginal squamous cell carcinoma with bladder involvement in uterine prolapsed patient: Case report.

RATIONALE: Primary vaginal squamous cell carcinoma (SCC) is a rare disease. Primary SCC in prolapsed vagina is extremely rare. In the presented case additional bladder involvement was found. PATIENTS CONCERNS: Primary vaginal SCC may be misinterpreted as decubitus in prolapsed vagina and it may delay proper diagnosis and treatment. DIAGNOSES: Diagnosis was confirmed by the vaginal ulceration biopsy and cystoscopic biopsy of the involved bladder. INTERVENTIONS: In the case presented percutaneous nephrostomy was the only possible treatment of hydronephrosis. OUTCOMES: In advanced primary SCC (Figo IVA) with nodal involvement palliative treatment is only option. LESSONS: Primary SCC mimicking decubitus which appeared in prolapsed vagina, may be accompanied by bladder involvement.

Benign metastasizing leiomyoma in triple location: lungs, parametria and appendix.

Benign metastasizing leiomyoma (BML) usually are situated in one organ, most often in lungs. BML patients typically have a history of uterine leiomyoma treated with hysterectomy, myomectomy or subtotal hysterectomy. The aim of the study was to present the case of a 53-year-old woman with triple location in the lungs, parametria and appendix. She had undergone a myomectomy 26 years earlier. In 2015, she was admitted to the surgical department because of abdominal pain, whereupon a cholecystectomy was performed. CT scans showed pelvic mass with pulmonary metastasis. Upon discharge the patient was referred to the Gynecology Clinic, where a laparotomy was performed. The intraoperative findings were: 1) uterus with multiple leiomyomas, 2) four tumors in the parametria, 3) tumor connected to the appendix. A subtotal hysterectomy, with a bilateral salpingo-oophorectomy, removal of the tumors from the parametria and appendectomy was performed. Pathology confirmed the diagnosis based on morphology and immunohistochemical staining (strongly positive for estrogen receptors and SMA, while Ki67 was very low, below 1%). Upon postoperative recovery, the patient was referred to the Thoracic Surgery Department. During the thoracotomy, multiple nodes, surrounded by lung parenchyma, were revealed. Wedge resection was performed, for localized pulmonary lesions, and sent for pathological examination. The final pathological diagnosis was benign metastasizing leiomyomatosis. In conclusion, the triple location of BML could possibly be a result of a parallel different metastasizing mechanism, although it is impossible to exclude one mechanism, which may be the cause of the metastases in three locations.

A Rare Case of Breast Malignant Phyllodes Tumor With Metastases to the Kidney: Case Report.

Phyllodes tumors are rare breast neoplasms. Surgery is the treatment of choice. The role of postoperative radiotherapy and chemotherapy is still under dispute, as there are no equivocal prognostic factors. Treatment failure results in the occurrence of distant metastasis-mainly to the lungs, bones, liver, and brain. We have described the case of a woman with a malignant phyllodes tumor of the breast that was surgically treated. She did not receive adjuvant therapy because there is no consensus on the role of postoperative chemotherapy and radiotherapy. One year following the surgery, the patient had left-sided nephrectomy performed because of a rapidly growing tumor of the kidney. Renal cancer was suspected; however, a histopathological examination revealed that it was a metastatic phyllodes tumor. At the same time, the patient was diagnosed as having metastases in the other kidney, the lungs, liver, and bones.Our case report describes not only an unusual localization of the metastases (in the kidneys), but also failure of the chemotherapy and the aggressive course of malignant phyllodes tumor. Identification of patients with high risk for distant metastasis and the introduction of uniform rules for the management of adjuvant chemotherapy and radiotherapy would make planning treatment as efficacious as possible.