Clear cell carcinoma of the pelvic side wall arising from endometriosis.

Endometriosis is a condition wherein an ectopic layer of endometrial tissue arises in an extra-uterine location, often effecting significant pelvic pain and infertility. While very uncommon, there have been reported cases of endometriosis undergoing malignant transformation, frequently involving the ovaries and seldom in extra-gonadal regions. We recount a case depicting a 63 year-old woman who presented with an apparent inguinal hernia in 2017; she was ultimately diagnosed with a pelvic side wall clear cell carcinoma and attendant metastatic disease to the medial groin, which emanated from endometriosis. Malignant transformation of endometriosis identified in the pelvic side wall is a very rare finding. Nevertheless, oncologists should maintain a high index of suspicion in patients with a history of endometriosis or pelvic surgery.

A very rare case of synchronous carcinomas of the endometrium and ovary with peritoneal keratin granulomatous involvement.

► Peritoneal keratin granulomas infrequently manifest themselves in conjunction with gynecologic cancer. ► We report on a patient with synchronous ovarian and uterine cancers that contained extensive keratin granulomas. ► Comprehensive pathologic sampling may be essential to conferring optimal patient management.

Multidisciplinary treatment of pelvic and cardiac intravenous leiomyosarcomatosis.

•Intravenous leiomyosarcomatosis is a rare condition in which malignant myometrial tissue metastasizes to the heart.•We discuss the complicated diagnosis and treatment of a patient afflicted with intravenous leiomyosarcomatosis.•To ensure a favorable prognosis, therapy should comprise comprehensive and multi-disciplinary treatment.

A rare case of primary retroperitoneal mucinous adenocarcinoma: a case report.

BACKGROUND: Primary retroperitoneal mucinous adenocarcinomas are very rare tumors that resemble ovarian mucinous cystadenocarcinomas. CASE: A 39-year-old woman presented with a 20-cm cystic lesion. Following surgery final pathology revealed mucinous adenocarcinoma consistent with a primary retroperitoneal process. The patient responded favorably to 6 cycles of paclitaxel and carboplatin chemotherapy and currently has no evidence of disease. CONCLUSION: During surgical resection of a primary retroperitoneal mucinous adenocarcinoma, ensuring that the lesion remains intact has clinically significant implications.

Primary small cell neuroendocrine carcinoma of the endometrium.

BACKGROUND: Small cell neuroendocrine carcinoma is very rarely encountered within the endometrium. CASE STUDY: A patient underwent a hysterectomy and salpingo-oophorectomy for a suspicious gynecologic condition. Pathology revealed invasive small cell neuroendocrine carcinoma of the endometrium; the neoplasm exhibited positive immunoreactivity for synaptophysin, pancytokeratin and CD56 but was negative for CD3 and CD20. Prior to chemotherapy, a completion lymphadenectomy was indicated to determine the presence of nodal metastases. CONCLUSION: The prognosis of small cell neuroendocrine carcinoma of the endometrium is unfavorable but prompt detection with surgery and adjuvant therapy may confer a better clinical outcome.

Complex retrieval of embedded IVC filters: alternative techniques and histologic tissue analysis.

PURPOSE: We evaluated the safety and effectiveness of alternative endovascular methods to retrieve embedded optional and permanent filters in order to manage or reduce risk of long-term complications from implantation. Histologic tissue analysis was performed to elucidate the pathologic effects of chronic filter implantation. METHODS: We studied the safety and effectiveness of alternative endovascular methods for removing embedded inferior vena cava (IVC) filters in 10 consecutive patients over 12 months. Indications for retrieval were symptomatic chronic IVC occlusion, caval and aortic perforation, and/or acute PE (pulmonary embolism) from filter-related thrombus. Retrieval was also performed to reduce risk of complications from long-term filter implantation and to eliminate the need for lifelong anticoagulation. All retrieved specimens were sent for histologic analysis. RESULTS: Retrieval was successful in all 10 patients. Filter types and implantation times were as follows: one Venatech (1,495 days), one Simon-Nitinol (1,485 days), one Optease (300 days), one G2 (416 days), five Günther-Tulip (GTF; mean 606 days, range 154-1,010 days), and one Celect (124 days). There were no procedural complications or adverse events at a mean follow-up of 304 days after removal (range 196-529 days). Histology revealed scant native intima surrounded by a predominance of neointimal hyperplasia and dense fibrosis in all specimens. Histologic evidence of photothermal tissue ablation was confirmed in three laser-treated specimens. CONCLUSION: Complex retrieval methods can now be used in select patients to safely remove embedded optional and permanent IVC filters previously considered irretrievable. Neointimal hyperplasia and dense fibrosis are the major components that must be separated to achieve successful retrieval of chronic filter implants.

Recurrent lymphatic ascites in a patient cured of cervical carcinoma.

► Lymphatic ascites is a rare complication attributed to abdominal or thoracic trauma. ► We report on a patient who developed two prolonged bouts of recurrent lymphatic ascites. ► The patient's lymphatic ascites occurring 20 years later is very unusual.

The excimer laser sheath technique for embedded inferior vena cava filter removal.

An inferior vena cava (IVC) filter became embedded within the IVC of a 45-year-old man after prolonged implantation. Because of incorporation of the filter legs within the caval endothelium, the filter was densely adherent and could not be sheathed using standard retrieval methods. In this patient, the authors performed percutaneous filter retrieval using an excimer laser sheath technique for circumferential ablation of dense fibrotic tissue between the filter and IVC. Endovascular laser ablation allowed facile separation of the filter from the IVC, without tearing of the tissues, and the filter was removed successfully without complication.

Chromosomal aberrations in a case of synchronous extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type and bronchogenic adenocarcinoma.

We present the chromosomal aberrations in a case of synchronous extranodal marginal zone B-cell lymphoma and bronchogenic adenocarcinoma with bronchioloalveolar features. Using fluorescence in situ hybridization, we identified deletion of the immunoglobulin heavy chain gene in the lymphomatous component, but not the carcinomatous component. The presence of differing genetic compositions suggests a biclonal environment composed of 2 distinct neoplastic processes.

Translocation and expression of CSF1 in pigmented villonodular synovitis, tenosynovial giant cell tumor, rheumatoid arthritis and other reactive synovitides.

We recently demonstrated that CSF1, the ligand of the tyrosine kinase receptor, CSF1R, can be translocated in pigmented villonodular synovitis (PVNS) and tenosynovial giant cell tumor (TGCT). In this study, we evaluated the staining characteristics of PVNS/TGCT and reactive synovitides for CSF1 and CSF1R by in situ hybridization and immunohistochemistry on tissue microarrays and correlated these findings with the recently described translocation. We collected specimens of TGCT/PVNS from 60 patients and of rheumatoid arthritis and other reactive synovitides from 74 patients. We identify 2 groups of PVNS and TGCT cases by the presence of CSF1 translocation and CSF1 expression. The first group (35 of 57 cases; 61%) had both the CSF1 translocation and high expression of CSF1 RNA, confirming our previous findings. Interestingly, a second group (22 of 57 cases; 39%) was identified that showed high expression of CSF1 RNA or CSF1 protein but did not have the translocation. The rheumatoid arthritis and reactive synovitis specimens showed localization of CSF1 RNA and protein to the synovial lining cells, implying a possible role for CSF1 in the pathogenesis of these lesions. As the CSF1 translocation is postulated to play an important role in the biology of PVNS/TGCT, the consistent presence of CSF1 expression in translocation-negative cases implies that other mechanisms can lead to CSF1 up-regulation. The consistent presence of CSF1 overexpression in all cases of PVNS/TGCT and reactive synovitides suggests both an important role for CSF1 in the spectrum of synovial pathologies and the possibility of targeting the CSF1/CSF1R interaction therapeutically.