Sebaceous Carcinoma Arising in Ovarian Teratoma: First Report Associated With Germline Mismatch Repair Gene Mutation.

Sebaceous carcinoma is an uncommon primary cutaneous neoplasm which may be associated with mismatch repair (MMR) abnormalities and sometimes with Muir-Torré syndrome. These neoplasms rarely arise in the ovary within a teratoma/ dermoid cyst. We report a sebaceous carcinoma arising in an ovarian teratoma in a 49-yr old (the 14th case reported in the literature) which exhibited loss of expression of MMR proteins MSH2 and MSH6. A germline mutation c.1102C>T was present in exon 7 of the MSH2 gene, the first report of a germline mutation associated with this tumor type. In reporting this case, we review prior reports of primary ovarian sebaceous carcinoma. We recommend that all sebaceous carcinomas of the ovary undergo immunohistochemistry for MMR proteins for investigation of possible Lynch syndrome.

A prospective study of the use of the Myosure resectoscope to manage endometrial polyps in an outpatient setting.

BACKGROUND: The Myosure resectoscope has been in use since 2009. Our unit is the first in Australia to describe the use of the Myosure device in the outpatient setting to resect endometrial polyps. AIM: To compare patient satisfaction and pain scores of pre- and postmenopausal women undergoing outpatient removal of endometrial polyps using the Myosure device. MATERIAL AND METHODS: Public hospital based prospective study. Patients (n=42) who opted to have resection of endometrial polyps under local anaethesia were recruited. Procedures were performed using a 6.25-mm hysteroscope with a MyoSure Lite device. Patient experiences were collected using a questionnaire immediately postprocedure. Pain level was assessed using 100-mm visual analogue score (VAS). Resection times and untoward events were recorded. RESULTS: Mean endometrial polyp size was 13 mm and the mean resection time was 39.4s. Complete resection was achieved in 95.2% of cases. The median VAS was 2.7 (range 0.7-7.5). The pain scores did not differ significantly between nulliparous or parous women who only had a caesarean section delivery and those who have delivered vaginally. However, VAS was statistically less in postmenopausal women in comparison with premenopausal women (2.5 vs 3.2, respectively; (P = 0.047)). Overall, women were very satisfied; 97.6% would recommend the procedure to a friend and 95.2% happy to consider a repeat procedure in the future if required. The complication rate was 4.8%, and all were minor in nature. CONCLUSION: Operative hysteroscopic procedures can be performed successfully in the outpatient setting using the Myosure Lite device with a high level of patient satisfaction.

Multifocal FIGO stage 1A1 cervical squamous carcinomas have an extremely good prognosis equivalent to unifocal lesions.

Early invasive squamous carcinomas of the cervix are sometimes multifocal. There are few guidelines regarding how to measure multifocal carcinomas and options include measuring from the edge of 1 invasive focus to the edge of the furthest invasive focus, adding the maximum horizontal dimension of each invasive focus together or regarding multiple foci as representing distinct small areas of invasion and if clearly separate measure them individually. For tumors with a shallow depth of invasion (<3 mm), this has implications for staging and management because if the maximum horizontal dimension is taken from the edge of 1 invasive focus to the edge of the furthest invasive focus, this could represent a International Federation of Gynaecology and Obstetrics (FIGO) 1B1 carcinoma, whereas alternatively these could be regarded as separate foci of 1A1 disease. It has been our practice to regard such lesions as representing multiple foci of invasion (multifocal FIGO 1A1 carcinomas) if clearly separate, arbitrarily defined by us as a minimum of 2 mm between each separate focus of invasion. In this study, we have obtained follow-up in a series of "multifocal 1A1 cervical squamous carcinomas" treated by local excisional methods (large loop excision of transformation zone or cone biopsy) with margins clear of premalignant and malignant disease. The study included 22 cases, 11 of which (50%) would have been regarded as FIGO stage 1B1 if the horizontal dimension had been measured from the edge of 1 invasive focus to the edge of the furthest invasive focus. In none of the cases was there evidence of recurrence of premalignant or malignant disease during follow-up (9-91 mo; mean and median 48 and 45.5 mo, respectively). Although limited by a relatively small number of cases, our results support the hypothesis that with regard to tumor staging and management, it is best to consider multifocal lesions as representing separate individual foci of invasion, to measure each focus separately, and to determine the FIGO stage on the basis of the highest FIGO stage of an individual focus.