Intimal sarcoma of the left atrium presenting with transient ischaemic attack - A case report and review of the literature.

A 31-year-old female with a history of polycystic ovary syndrome and two recent miscarriages presented with symptoms of a transient ischemic attack. Echocardiography to assess for possible embolic source identified a 4.8 cm left atrial mass, presumed to be an atrial myxoma. At surgery the tumor was suspicious of malignancy. Histopathology revealed a heterogeneous hyper- and hypo-cellular spindle cell tumor showing mild atypia. Atrial myxoma markers were negative. The Ki67 proliferation factor was 30% and fluorescence in situ hybridization (FISH) analysis showed MDM2 amplification. Expert review confirmed the morphological, immunohistochemical, and FISH features to be of a cardiac intimal sarcoma. Recent improvements in imaging, surgery, and molecular testing have increased diagnoses of primary cardiac intimal sarcomas. Here we discuss the pathological and clinical implications of these rare atrial myxoma mimics. .

Hypertrophic Herpes Simplex With Subsequent Development of Plasma Cell Vulvitis: A Potential Diagnostic Pitfall.

A 37-yr-old patient previously diagnosed with human immunodeficiency virus initially presented with a genital lesion which upon histologic assessment was diagnosed as a pseudotumor associated with herpes simplex virus infection. The pseudotumor responded to initial treatment with Acyclovir, however, the lesion recurred 2 yr later and was diagnosed as plasma cell vulvitis. We discuss the clinical presentation, diagnostic work up and treatment options of such a rare lesion.

Postmenopausal hyperandrogenism: the under-recognized value of inhibins.

We report a 70-year-old female presenting with increased libido and mild but rapid onset virilism. Investigations showed markedly elevated androstenedione and 17 hydroxyprogesterone misdirecting to possible late-onset congenital adrenal hyperplasia. High serum testosterone and oestrogens with suppressed gonadotrophins, however, indicated an androgen-secreting tumour. A normal dehydroepiandrosterone sulphate and elevated inhibins A and B indicated the tumour was ovarian in origin, which was confirmed on pelvic examination and imaging. At laparotomy, a right ovarian sertoliform endometrioid carcinoma was removed, following which the patient developed menopausal vasomotor symptoms and improvement of her virilism. Serum testosterone, oestradiol, inhibins A and B became undetectable, gonadotrophins appropriately increased and 17 hydroxyprogesterone and androstenedione normalized. We propose that inhibins may be of diagnostic value and should be included in investigative algorithms of females with virilization and hyperandrogenaemia, especially if postmenopausal. Androgen-secreting tumours must be excluded before raised 17 hydroxyprogesterone concentrations are used to diagnose late-onset congenital adrenal hyperplasia in females with new-onset virilization.

Widespread psammoma body formation arising in the background of a uterine serous carcinoma.

This report highlights a very rare phenomenon of widespread psammomatous calcification without accompanying epithelium, present in the background of a uterine serous carcinoma. Psammomatous calcification is associated with benign and malignant pathology in different organ systems including the gynaecological tract.

Ovarian hilus cell heterotopia.

The eutopic location of ovarian hilus cells in the hilar stroma of the ovary and in the adjacent mesovarium is widely recognized. Hilus cell heterotopia, that is, the presence of normal hilus cells in an abnormal site, is rare and there are only a few case reports and 1 earlier systematic study of this phenomenon in the literature. Hilus cell heterotopia has been reported in the fimbrial stroma of the fallopian tube, paratubal and parafimbrial cyst walls and usually takes the form of discrete, circumscribed nodules or clusters of hilus cells. We report a series of 6 cases of hilus cell heterotopia, all of which were identified in association with other underlying pelvic pathology and in patients over 40 years of age. We have shown that hilus cell heterotopia is not limited to the fallopian tube but can also involve the subcapsular ovarian cortex and may have an infiltrative (rather than a nested) growth pattern that can resemble metastatic carcinoma, potentially mimicking a metastatic lobular carcinoma of the breast. This is particularly relevant in patients in whom staging procedures are carried out for gynecologic pelvic neoplasms, and for those few patients who also have a history of concurrent carcinoma, particularly of the breast.