Recto-vaginal septum cystadenocarcinoma: a case report and review of the literature.

BACKGROUND: Carcinoma of the recto-vaginal septum is a quite rare location and related to peritoneal and primary ovarian carcinomas. There are only few reports in the literature with a very poor prognosis. CASE PRESENTATION: Here we report the case of a 63 years old woman with past medical history of left oophorectomy presenting with a pelvic pain. The magnetic resonance imaging (MRI) demonstrated a 10 cm mass located in the recto-vaginal septum. A block resection was performed allowing the retrieval of a 10 cm solid tumor of the recto-vaginal septum. Peritoneal biopsies and the right ovary were normal the final diagnosis was cystadenocarcinoma of the recto-vaginal septum. The patient received adjuvant chemotherapy and displays no sign of recurrence 36 months after diagnosis. CONCLUSION: The management of recto-vaginal septum carcinoma with en bloc resection should be performed to avoid peritoneal spread and improve prognosis.

Surgical management of biliary cystadenoma and cystadenocarcinoma of the liver.

Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are rare biliary duct neoplasms. This study investigated reasonable management strategies of cystic neoplasms in the liver. Charts of 39 BCA/BCAC patients (9 males, 30 female; median age 53.74 ± 14.50 years) who underwent surgery from January 1999 to December 2009 were reviewed retrospectively. Cyst fluid samples of 32 BCA/BCAC patients and 40 simple hepatic cyst patients were examined for the tumor markers carbohydrate associated antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA). The most frequent symptoms were abdominal pain (N = 10), abdominal mass (N = 7), abdominal distension (N = 4), jaundice (N = 2), and fever (N = 3); the remaining patients showed no clinical symptoms. Liver resection (N = 17) or enucleation (N = 22) was performed in the 39 patients. Ultimately, 35 patients were diagnosed with intrahepatic BCA and four patients were diagnosed with BCAC. The median CA19-9 level was significantly higher in BCA/BCAC patients than in simple hepatic cyst patients. The median CEA levels in BCA/BCAC patients and controls were 6.83 ± 2.43 and 4.21 ± 2.91 mg/L, respectively. All symptoms were resolved after surgery, and only one BCAC patient showed recurrence. The incidence of intrahepatic cystic lesions was 1.7%. Increased CA19-9 levels in the cyst fluid is a helpful marker for distinguishing BCA/BCAC from common simple cysts. The presence of coarse calcifications is suggestive of BCAC. Complete surgical removal of these lesions yielded satisfying long-term outcomes with a very low recurrence rate.

Inferior vena cava obstruction and collateral circulation as unusual manifestations of hepatobiliary cystadenocarcinoma.

BACKGROUND: Hepatobiliary cystadenocarcinoma represents a rare epithelial malignant tumor derived from the intrahepatic bile duct. METHODS: A 71-year-old woman, who had undergone laparoscopic drainage of a cystic lesion of the right hepatic lobe, was misdiagnosed as having hepatic echinococcal disease, and received intracystic infusion of 95% ethanol four years ago. She was admitted to our hospital for further treatment. RESULTS: Physical examination revealed dilated superficial veins across the right abdominal wall. After mapping the direction of blood flow in these vessels, we assumed that this was a sign of inferior vena cava obstruction. Abdominal ultrasound, computed tomography, magnetic resonance imaging combined with magnetic resonance angiography showed a large cystic mass in the right upper quadrant and epigastrium, displacing the adjacent structures, adherent to the inferior vena cava, which was not patent, resulting in dilation of superficial epigastric veins. The patient underwent an exploratory laparotomy. Total excision of the huge mass measuring 16X15 cm was possible under selective vascular exclusion of the liver. Removal of the tumor resulted in immediate restoration of flow in the inferior vena cava. On the basis of the pathology and findings of immunohistochemical analysis, a hepatobiliary cystadenocarcinoma was diagnosed. CONCLUSIONS: In the present case, hepatobiliary cystadenocarcinoma was accompanied by dilated superficial venous collaterals due to inferior vena cava obstruction. Selective vascular exclusion of the liver allowed a safe oncological resection of the tumor.

Cystic "feminine" pancreatic neoplasms in men. Do any clinical alterations correlate with these uncommon entities?

INTRODUCTION: Mucinous cystic neoplasm (MCN) and solid pseudopapillary neoplasm (SPN) of the pancreas are uncommon hormone-related pancreatic tumors (HRPTs) with a clear predominance in young women. This trial aims to investigate the possible association between HRPTs development in males and phenotypic and sex hormone alterations. METHODS: We performed a retrospective analysis of our database between February 1990 and February 2012. Risk factors for sexual dysfunction were considered exclusion criteria. We investigated secondary sexual characteristics development, sex hormone level and overall sexual dysfunction degree according with the International Index of Erectile Function Questionnaire (IIEF). RESULTS: We initially identified 25 patients [(MCN: n = 16 (64%); SPN: n = 9 (36%)]. At follow-up, 5 patients were lost, 8 resulted dead and 3 were excluded according to exclusion criteria. We finally enrolled 9 patients (MCN: n = 5; SPN: n = 4). Puberty occurred within physiological age for 7 patients, whereas it was delayed in 2 cases. Three patients revealed mild to moderate sexual dysfunction, along with low testosterone level in two cases. One patient presented hormonal alteration with a normal IIEF score. DISCUSSION: In this study, the first in literature with similar aim, hormonal and/or sexual dysfunction was present in 4 out of 9 patients affected by HRPT. The rarity of these lesions makes further trials to be needed for reliable conclusions.

Impact of menopausal status on the behavior of pancreatic cystic neoplasms in women.

PURPOSE: Pancreatic cystic neoplasms have predilections for occurring in young women, for containing "ovarian-like" stroma, and for expressing estrogen and progesterone receptors; these factors suggest a potentially important influence of the hormonal milieu on the biology of these tumors. Therefore, we examined the impact of menopausal status on the clinical features of pancreatic cystic neoplasms in women. METHODS: Seventy-six women with pancreatic cystic neoplasms treated at our institution from 1992 to 2003 were classified into 2 groups according to menopausal status based on the U.S. average menopausal age of 51 years: group I (premenopausal, ages 22-50; n = 36) and group II (postmenopausal, ages 51-80; n = 40). Chi-square and the 2-tailed t-tests compared categorical and continuous variables, respectively. Kaplan-Meier survival estimates were determined and compared with the log rank test. RESULTS: Abdominal pain at presentation occurred more commonly among group I than among group II patients (78% vs 48%, p < 0.05). Solid pseudopapillary tumors were more prevalent among group I than among group II patients (21% vs 3%, p = 0.02). CONCLUSIONS: The clinicopathologic features of pancreatic cystic neoplasms in premenopausal women are not significantly different from those in postmenopausal women. Menopausal status should not bias diagnostic and treatment algorithms for women with these neoplasms.

Transforming growth factor-alpha promotes tumor markers secretion from human ovarian cancers in vitro.

BACKGROUND: The regulatory mechanism of tumor markers secretion has not been well clarified. METHODS: Serum levels of CA 125 and tissue polypeptide antigen (TPA) from 17 patients with Stage III serous cystadenocarcinoma were measured prior to an initial surgical treatment. Epidermal growth factor receptor (EGFR) status was examined by an 125I-EGF binding assay in a human serous cystadenocarcinoma cell (SHIN-3) and in the 17 primary carcinomas. SHIN-3 cell and the EGFR-expressing primary cancer cells (n = 4) were cultured with or without various concentrations of transforming growth factor (TGF-alpha), a ligand for EGFR, and the CA 125 and TPA concentrations in the conditioned media were measured. RESULTS: EGFR was expressed in 12 primary carcinomas and in the SHIN-3 cell, and it was absent in the remaining 5 carcinomas. Pre-therapeutic serum CA 125 and TPA levels were significantly greater (P < 0.05) in patients with EGFR-expressing carcinomas (n = 5). These data suggest a possible involvement of EGFR in regulating these tumor markers secretion. TGF-alpha increased the CA 125 and TPA secretion from SHIN-3 cell. It also promoted the CA 125 secretion in 2 of 4 EGFR-expressing primary ovarian carcinoma specimens. CONCLUSIONS: These results suggest that a signal through the EGFR may be involved in regulating the CA 125 and TPA secretion from human ovarian carcinomas.

Ascitic fluid from human ovarian cancer patients contains growth factors necessary for intraperitoneal growth of human ovarian adenocarcinoma cells.

Human ovarian cancer, the leading cause of death from gynecologic malignancy, tends to remain localized to the peritoneal cavity until late in the disease. In established disease, ascitic fluid accumulates in the peritoneal cavity. We have previously demonstrated that this ascitic fluid is a potent source of in vitro mitogenic activity including at least one unique growth factor. We now report that the human ovarian adenocarcinoma line, HEY, can be induced to grow intraperitoneally in immunodeficient nude mice in the presence (23/28 mice), but not absence (0/21 mice) of ascitic fluid from ovarian cancer patients. Ascitic fluid from patients with benign disease did not have similar effects on intraperitoneal growth of HEY cells (1/15 mice). Once tumors were established by injections of exogenous ascitic fluid, they could progress in the absence of additional injections of ascitic fluid. The mice eventually developed ascitic fluid which contained potent growth factor activity, suggesting that the tumors eventually produced autologous growth factors. This nude mouse model provides a system to study the action of ovarian cancer growth factors on tumor growth in vivo and to evaluate preclinically, therapeutic approaches designed to counteract the activity of these growth factors.

Human Ile-Ser-bradykinin, identical with rat T-kinin, is a major permeability factor in ovarian carcinoma ascites.

Ascites from patients with metastatic ovarian carcinoma contains high amounts of an activity that increases vascular permeability, as easily detected by a rat skin test. Ascites was fractionated by gel permeation and reversed-phase high-performance liquid chromatographies. The fractions were analysed for permeability-increasing activity. In this way a peptide was isolated and identified as Ile-Ser-bradykinin by sequence and amino-acid analyses. It is identical with T-kinin which has previously been detected as a product of an acute-phase protein, T-kininogen, in rats but never in human material. The so far identified human kininogens, i.e. high- and low-molecular mass kininogens, can only release Met-Lys-bradykinin or its degradations products, as Ile-Ser-bradykinin is not a part of their structure. However, the present results provide evidence that the permeability factor Ile-Ser-bradykinin under certain conditions can be produced in considerable amounts also by human tissues.

Mucinous cystic neoplasm of the pancreas with latent malignancy.

Mucinous cystic neoplasms of the pancreas are rare. They have traditionally been classified as cystadenoma or cystadenocarcinoma. Over a 5-year period, and three operations, a patient initially diagnosed as having a cystadenoma of the pancreas was subsequently found at the time of definitive total pancreatectomy to have a cystadenocarcinoma. The recent literature suggests that there is not distinction between cystadenoma and cystadenocarcinoma, since these tumors have been shown to contain coexisting areas of malignant and benign epithelium in both types. The authors' experience with this patient demonstrates the necessity for thorough histologic sectioning of these tumors to document the presence of carcinoma, since all of these tumors should be regarded as potentially malignant neoplasms. Surgical therapy for these lesions should be total excision whenever feasible.

Characterization of a cell line derived from the ascites of a patient with papillary serous cystadenocarcinoma of the ovary.

An established cell line derived from the ascites of a patient with serous cystadenocarcinoma of the ovary has been characterized. Features studied included morphology, ultrastructure, clonogenicity in soft agar, population doubling time, karyotype, and chemosensitivity. The results indicated that the cells growing in culture were malignant ovarian tumor cells. These cells retained the ability to form free-floating cysts in culture, which were also present in the original ascitic fluid. The cell line had a chromosome number of 80-92 with no distinct mode and 15 stable markers. At passage 4 the cell line showed resistance to doxorubicin [adriamycin (ADM)], phosphoramide mustard (PM), and cisplatin [cis-dichlorodiammineplatinum(II)] (CIS) but rapidly reverted to CIS sensitivity. At passage 25 the cell line was still resistant to ADM and PM, but by passage 59 sensitivity to these drugs appeared to have increased. Frozen cells from passage 15 onward are available.

[Clinico-morphological characteristics and results of treatment of endometrioid cystadenocarcinoma of the ovary]. / Kliniko-morfologicheskie osobennosti i rezul'taty lecheniia éndometrioidnoi tsistadenokartsinomy iaichnikov.

Clinico-morphological peculiarities of endometrioid cystadenocarcinoma of the ovaries (105 cases) were compared with those of a more frequent serous one. Hyperestrogenism was more frequent in endometrioid cystadenocarcinoma, metastases, ascites and hydrothorax developing less frequently. Immediate and long-term results in endometrioid cystadenocarcinoma were better than in cases of serous one. When hormone-producing, both tumors metastasized less frequently and 5-year survival rates in such cases were relatively higher. Progestin treatment was effective in cases of endometrioid cystadenocarcinoma, particularly, in those of hormone-producing form.

Inhibition of leukocyte migration in agar by soluble extract from a human ovarian carcinoma cell line.

A soluble membrane extract was prepared by a hypotonic extraction method from a cultured cell line, CKS, derived from serous cystadenocarcinoma of the ovary. The leukocyte migration inhibition assay in agar was used to determine the cell-mediated immune response with this extract in patients with ovarian carcinoma in comparison with patients with other benign or malignant tumors and normal healthy subjects. With 100 micrograms protein/ml of the extract, leukocytes from 15/25 patients with ovarian carcinoma showed positive response, whereas 5/30 patients with benign tumors, 2/23 patients with non-ovarian carcinomas, and 0/13 normal healthy controls did so. These findings suggested that the soluble membrane extract from the CKS cells specifically inhibited migration of leukocytes from patients with ovarian carcinoma. There was a tendency that the stage III or IV patients responded to the extract more frequently than the stage I patients irrespective of histological type of ovarian carcinoma. The migration inhibition assay with a basic encephalitogenic protein (100 micrograms protein/ml) from bovine brain was performed simultaneously with the ovarian cancer extract. One of 20 patients with ovarian carcinoma, 1/29 patients with benign tumors, 1/22 patients with non-ovarian carcinomas, and 0/13 normal healthy controls responded positively. Therefore, cross-reactivity between the basic protein and tumor-associated antigens could not be demonstrated in the present study.

[Clinical course of benign epithelial ovarian tumors]. / Klinicheskoe techenie dobrokachestvennykh épitelial'nykh opukholei iaichnikov.

The author reports epidemiological and clinical data on 739 patients with benign epithelial ovarian tumors of various histotypes. Serous cystadenomas were found in 46%, mucinous--in 25.3%, endometroid--in 20%, mixed epithelial--in 6.7%, the Brenner tumor--in 2.02%. Benign ovarian tumors are more frequently observed at the age from 31 to 60. The patients show the tendency to the late menstrual cycle and reduced reproductive function. The clinical picture of the lesion is described.