Malignant transformation of mature cystic teratoma of the ovary.

Mature cystic teratoma is the most common ovarian germ cell neoplasm. Malignant transformation is a rare occurrence, accounting for 1.5%-2% of cases. Malignant changes can arise from any constituent tissue of a teratoma; however, squamous cell carcinoma is the most common histologic type seen, followed by adenocarcinoma and sarcoma respectively. Tumor marker concentration levels, age, and the tumor maximum diameter are predictive indicators for malignant transformation. Proper diagnosis includes recognizing the possibility of malignant transformation versus excluding other differential options, such as metastasis. Primary cytoreductive surgery, adjuvant chemotherapy, and radiotherapy are the current treatment methods. The aim of the review is to discuss the clinical and pathologic features of malignant transformation within mature cystic teratomas, while reviewing the reported malignant types, differential diagnoses, and treatment options. Data sources include review of pertinent peer-reviewed literature on malignant transformation of mature cystic teratoma and cases seen in authors' institutional practice. Mature cystic teratomas are a commonly encountered benign ovarian tumor. However, the possibility of malignant transformation should remain in consideration, especially with given clinical or pathologic features: increased patient age, tumor size, or tumor marker levels. Thorough sampling of solid tumor foci can help identify malignant components. Awareness and proper diagnosis, along with early detection and clinical management, shows improved patient outcomes.

Polymorphous low-grade neuroepithelial tumor of the young: Rare tumor and review of the literature.

Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a recently described low-grade neuroepithelial tumor with an infiltrative growth pattern and oligodendrocyte-like cells that are CD34 immunopositive. Correlating histology and results from molecular testing is critical to correctly diagnosing PLNTY, as its histologic appearance is similar to oligodendrogliomas and shares genetic abnormalities common to other low-grade epilepsy associated tumors (LEATs). In this case report, we describe a 31-year-old female with intractable epilepsy found to have a temporal mass and diagnosed with PLNTY after histopathologic and molecular testing. We describe the radiographic, histologic, and genetic features in relation to the epileptic and oncologic outcomes for this patient. Then, we compare these features and outcomes to other cases of PLNTY described in the literature.

Small Cell Carcinoma of the Ovary, Hypercalcemic Type, in a 12-Month-Old Girl.

Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a highly aggressive malignant tumor affecting predominantly young adults and adolescents with an average age of 23.9 at time of diagnosis. Up to two thirds of patients have paraneoplastic hypercalcemia. The molecular signature of these tumors is SMARCA4 mutations, with somatic and germline pathogenic variants previously described. We report a case of a previously healthy one-year-old girl who was noticed to have mild anemia and an abdominal mass during a well-child visit. Further laboratory testing revealed hypercalcemia. A computerized tomography scan showed a left-sided ovarian mass (9.3 x 7.3 x 7 cm). The resection specimen showed a large ovarian tumor with solid tan-yellow cut surfaces and small foci of necrosis. Microscopically, the tumor was composed of sheets of small, hyperchromatic epithelioid cells with focal rhabdoid large cell morphology. The tumor cells were strongly and diffusely positive for WT1 (N-terminal antibodies) with focal EMA and Pan-keratin positivity. Absent SMARCA4 (BRG1) protein expression by immunohistochemistry ultimately established the diagnosis of small cell carcinoma of the ovary, hypercalcemic type. To our knowledge, this is the youngest patient reported in the literature.

Turquoise Discoloration of Organs on Autopsy Secondary to Treatment of Septic Shock With Methylene Blue.

Septic shock can result from the dissemination of infections and can lead to hypoperfusion secondary to vasodilation. Methylene blue can help stabilize blood pressure refractory to other measures in shock. We report a case of a 58-year-old male who died of septic shock due to Pseudomonas aeroginosa bacteremia secondary to acute folliculitis and epididymo-orchitis. He was given methylene blue for reversal of septic shock but he did not respond and expired. Autopsy findings were significant for bluish-green discoloration of organs, especially the heart, lungs, and brain during prosection secondary to methylene blue treatment. It is important to recognize artifacts of treatment and to discern them from changes due to putrefaction or the classic green pigmentation associated with Pseudomonas aeruginosa infection, such as chloronychia. The case report illustrates that circulating methylene blue and its metabolites can accumulate in the organs in a dose-related fashion, imparting an interesting turquoise to dark blue-green pigment during the autopsy. Additional studies are warranted to enable pathologists to differentiate among the pigmentation associated with Pseudomonas aeruginosa bacteremia, putrefaction, and methylene blue treatment.

Decidualized Stroma in Pelvic Lymph Nodes in a Pregnant Patient With Cervical Squamous Cell Carcinoma: A Case Report.

Decidualized endometrial stroma is an uncommon finding in lymph nodes but is typically found in the setting of endometriosis where endometrial glands give a hint toward the diagnosis. On the other hand, endometrial stroma with no identifiable endometrial glands can be challenging to differentiate from metastatic squamous cell carcinoma. We report a case of a 22-year-old female who presented to our medical center as a known case of cervical squamous cell carcinoma. The patient desired future fertility and became pregnant. She was treated during her second trimester and underwent a radical cesarean hysterectomy at 37 weeks' gestation with bilateral pelvic lymph node dissection. Resection showed residual moderately differentiated squamous cell carcinoma of the cervix with lymphovascular invasion. Two pelvic lymph nodes were found to have decidualized stroma. Immunohistochemistry was done to rule out metastasis and no metastatic carcinoma was identified in any of the lymph nodes. It is necessary to be aware of the possibility of decidualized stromal changes in pelvic lymph nodes to avoid misdiagnosis.