The development of papillary serous carcinoma of the peritoneum subsequent to endometrial carcinoma: a case report and review of the literature.

Metachronous papillary serous carcinoma of the peritoneum (PSCP) after endometrial carcinoma (EC) is an extremely rare condition. Only three patients have been reported in the English literature. We present the fourth patient who had a more aggressive and fatal clinical course. A 79-year-old multiparous woman complained of progressive abdominal pain and distension after 5 years, subsequent to total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometrioid type EC. Serum CA-125 level being followed routinely rose above 500 IU/mL. Abdominal and pelvic computed tomography demonstrated ascites, omental thickening, and nodularity. Paracentesis showed malignant cells resembling papillary adenocarcinoma. Omentectomy and bilateral pelvic lymphadenectomy were performed as cytoreductive surgery. The histologic slides of the totally sampled ovaries obtained from the first operation were reexamined and the corresponding paraffin blocks were re-sectioned but no tumor was detected. The microscopic appearance of the tumor in the omentum differed from that of the previous EC. Immunohistochemically, while the tumor showed reactivity for low and high molecular weight cytokeratin (CK) cocktail, epithelial membrane antigen, CK7, CA-125, and Ber-EP4, the immunostains for calretinin, monoclonal carcinoembryonic antigen, and CK20 were negative. On the basis of these results and the criteria proposed by the Gynecologic Oncology Group, the tumor was diagnosed as metachronous PSCP developed after EC, which corresponded to stage IIIC according to FIGO criteria for ovarian carcinoma. The patient received two cycles of carboplatin and paclitaxel and died 2 months after the cytoreductive surgery.

The diagnostic value of on-site cytopathological evaluation and cell block preparation in fine-needle aspiration cytology of liver masses.

OBJECTIVE: The aims of this study were to evaluate the typing accuracy of conventional smear (CS), cell block (CB) preparations and combined use of both procedures (CS + CB) for the diagnosis of hepatic malignancies and to determine whether immediate on-site cytopathological evaluation improves the diagnostic yield of liver fine-needle aspiration cytology (FNAC). METHODS: Ultrasound-guided FNABs were performed on 323 consecutive cases with liver masses between December 2002 and December 2004. Histologically and/or clinically correlated 167 cases were included in the study. Preliminary FNAB results, results of CS, CB, and combined use of CS and CB were compared regarding diagnostic sensitivity, specificity, and accuracy for the diagnosis of malignancy. Subtyping accuracies of different methods were also compared. RESULTS: The sensitivity of on-site cytopathological examination and CS were both 92.8%. The sensitivity of CS + CB was slightly better than that of CB (93.5% versus 84.8%). Specificity of all procedures was achieved 100%. Diagnostic accuracy of on-site cytopathological evaluation, CS, CB, and CS + CB were 93.9%, 93.9%, 87.2%, and 94.5%, respectively. A specific subtype diagnosis of malignant tumours could be rendered accurately on the basis of preliminary diagnosis in 71%, CS in 75.4%, CB in 78.3% and combined approach in 92% of cases. In terms of typing accuracy, 87.5% of HCCs, 93.2% of adenocarcinomas, 92.3% of neuroendocrine carcinomas, 100% of lymphomas and 100% of other malignant tumours were correctly subclassified in the final cytopathological diagnosis. The agreement between preliminary diagnosis and final cytopathological diagnosis was 77.2%. CONCLUSION: With use of on-site cytopathological evaluation and combined use of CS and CB, the diagnostic accuracy of liver tumours approaches 100% and also significantly improve diagnostic and subtyping accuracy of liver malignancies.

A calcifying fibroma of the meninges report of a case and review of the literature.

We report an unusual tumor related to the meninges designated as a calcifying fibroma of the meninges. Our patient was a 44-year-old man.The tumor was located in the right frontotemporoparietal region and was excised totally via a right frontotemporoparietal craniotomy. The patient had recovered completely, and no recurrence was observed in a follow-up period of three years. Histopathologically, we noted scattered spindle cells among the hyalinized collagenous stroma, dystrophicpsammomatous calcifications, abundant perivascular hyalinization and cartilagenous metaplasia. Immunohistochemically, the tumor cells showed actin, smooth muscle and vimentin immunreactivities. Ultrastructurally, spindle cells showed fibroblastic features. The lesion is a true tumor and it should be kept in mind in the differential diagnoss of meningeal calcifying lesions.

The importance of lifelong follow-up for patients with pheochromocytoma: report of a case.

We report herein the case of a patient who developed a malignant recurrence of pheochromocytoma 13 years after undergoing complete resection of a histologically benign, unilateral, sporadic tumor. A discussion on the importance of lifelong follow-up for patients undergoing surgery for pheochromocytoma follows this case report.