Pure large cell neuroendocrine carcinoma of ovary: A rare clinical entity.

OBJECTIVE: Large cell neuroendocrine carcinoma (LCNEC) of the ovary is a rare tumour. Its pure form without any associated surface epithelial stromal or germ cell component is more rarely seen. Its prognosis is generally very poor even when the diagnosis is made at an early stage. We report a case of pure large cell neuroendocrine tumour of ovary. The patient was a 73-year-old woman with symptom of pelvic pain. Ultrasonography detected an abdominal tumour larger than 10 cm. She underwent an exploratory laparotomy with resection of the pelvic mass. After the surgery six cycles of chemotherapy (Etoposide and Cisplatin) were administered to the woman. She is still healthy after the last chemotherapy. Due to the rarity of the disease, few number of reported cases and the lack of systematic population based studies or registry data, we reported this case.

A randomized controlled experimental study of the efficacy of platelet-rich plasma and hyaluronic acid for the prevention of adhesion formation in a rat uterine horn model.

PURPOSE: Platelet-rich plasma (PRP) has been known to possess an efficacy in tissue regeneration. The aim of this study was to determine the role of PRP on post-operative adhesion formation in an experimental rat study. METHODS: Thirty Sprague-Dawley rats were randomly divided into control, hyaluronic acid, and PRP treatment groups and operated on for uterine horn adhesion modeling. Blood was collected to produce a PRP with platelet counts of 688 × 10(3)/µL, and 1 ml of either hyaluronic acid gel or PRP was administered over the standard lesions, while the control group received no medication. The evaluation of post-operative adhesions was done on the 30th post-operative day. The location, extent, type, and tenacity of adhesions as well as total adhesion scores, tissue inflammation, fibrosis and transforming growth factor-1beta (TGF-1ß) expressions were evaluated. RESULTS: The total adhesion score was significantly lower in the PRP group (3.2 ± 1.5) compared with the hyaluronic acid (5.0 ± 1.3) and control (8.1 ± 1.7) groups. The extent of the adhesions was significantly lower in the PRP group. There was no significant difference in the type and tenacity of adhesions between the hyaluronic acid and the PRP group. The level of inflammation was significantly higher in the control group than the others, while there was no difference between the PRP and hyaluronic acid groups. TGF-1ß expression was significantly lesser in the PRP group than the control and hyaluronic acid groups. CONCLUSIONS: PRP is more effective than hyaluronic acid treatment in preventing post-operative adhesion formation in an experimental rat uterine horn adhesion model.

Krukenberg carcinoma metastasized from stomach resembling mucinous cystadenocarcinoma of the ovary.

The ovaries are common site of metastasis in a variety of primary neoplasms. Multiple tumors such as breast, lung, and pancreas have been reported to metastasize to the ovary, however; the colon and stomach are the most common primary cancer sites that of ovarian metastasis. An ovarian mass mostly originates from its self-tissue, but sometimes it can be a metastasis of a gastrointestinal system tumor. Such cases are often misdiagnosed as primary ovarian cancers. A 42-year-old woman was admitted to our hospital with pelvic pain. She had a history of her complaints for two months. Bilateral large ovarian mass was detected in transvaginal ultrasound. Laparotomy was performed, the pathologist suggested inspection of the stomach after the frozen section analysis; therefore, an irregular mass on the stomach was detected. The general surgeon was attended to the operation, and an inoperative stomach tumor was reported by the general surgeon. After that due to the partial obstruction of jejunum, a gastrojejunostomy was performed. It is in fact difficult to distinguish between metastatic mucinous carcinomas and primary mucinous carcinomas of the ovary, due to the similar appearance of as cystic tumors on gross examination. The clinicians should be aware of the likely concomitant gastrointestinal system tumor when a large and bilaterally mass was detected on physical examination. This case also reminds that a systemic examination is necessary even if the large ovarian tumors suspicious of primary malignancy were noticed.

Is mucinous adenocarcinoma of the endometrium a risk factor for lymph node involvement? A multicenter case-control study.

PURPOSE: The purpose of this multicenter case-control study was to compare the demographic and clinical characteristics of patients with mucinous adenocarcinoma of the endometrium (MAE) and endometrioid endometrial carcinoma (EEC). METHODS: A retrospective review of two cancer registry databases in Turkey was conducted to identify patients diagnosed with MAE between January 1996 and December 2012. Each patient was matched with a control EEC patient by age and tumor grade. Cases and controls were compared in terms of known risk factors for lymph node metastasis, disease-free survival (DFS), and overall survival (OS). RESULTS: The analysis included 112 patients with MAE and 112 with EEC. No significant difference in baseline characteristics was evident between the two groups. Lymphovascular space invasion, deep myometrial invasion, cervical involvement, and tumor diameter did not differ significantly between the mucinous and endometrioid cases. Multivariate analysis confirmed that only mucinous histology (OR 2.2, 95 % CI 1.1-4.5; P = 0.02) was an independent predictor of lymph node involvement. Although the median DFS and OS tended to be better in the endometrioid group, the differences were not statistically significant. Routine appendectomy was performed in 52 (46.2 %) patients with MAE. No mucinous tumor of the appendix was identified. CONCLUSION: Routine appendectomy is not necessary when the appendix is grossly normal at the time of surgery for MAE. Although the DFS and OS of EEC and MAE patients were similar, the risk of nodal metastasis in MAE patients was greater than that in ECC patients, and we thus suggest to perform retroperitoneal lymphadenectomy (both pelvic and para-aortic) for patients with MAE during the initial operation.

Report of a pregnant woman underwent radical hysterectomy for cervical cancer.

Cervical cancer during pregnancy has an incidence of about 1 to 10 in 10.000 individuals and is one of the most common malignancies occurring during pregnancy. In this report, we aimed to evaluate a pregnant women with cervical cancer underwent radical hysterectomy and pelvic and paraaortic lymphadenectomy at our clinic. A 47 years of pregnant woman (G8, P7) with an intrauterine pregnancy of 4 weeks 6 days of gestation admitted to our high risk pregnancy department with vaginal bleeding complaint. On vaginal examination, we detected a 4 cm of lesion protruding from the cervix. Biopsy of the lesion was proved as microinvasive squamous carcinoma of the cervix. Subsequently radical hysterectomy and pelvic and paraaortic lymphadenectomy was performed. Postoperative pathology was large cell keratinizing squamous cell carcinoma of the cervix. In conclusion, although its rarity, clinicians should suspect of cervical cancer in a pregnant woman complaining of vaginal bleeding.

Unusual form of superficial spreading squamous cell carcinoma of cervix involving the endometrium, bilateral tubes and ovaries: a case report with literature review.

OBJECTIVE: Although the majority of metastatic ovarian tumors arise within the female genital tract, squamous cell carcinoma of the cervix is a rare form of metastases to the bilateral ovaries by endometrial and transtubal spreading. CASE: A 53-year-old woman was referred to the oncology clinic with postmenopausal bleeding. On vaginal examination, a 3 cm tumor arising from the cervix was inspected. Multiple cervical biopsies and endocervical curettage revealed large cell, non-keratinized squamous cell cervix carcinoma. Radical hysterectomy and bilateral salpingo-oophorectomy were performed. Bilateral pelvic and para-aortic lymph nodes were also removed. The final pathology report revealed endometrial, focal myometrial, bilateral tubal mucosal, fimbrial and bilateral ovarian squamous cell carcinoma involvement. Pelvic and para-aortic nodes were free from metastases. CONCLUSION: Although the incidence of ovarian metastases of adenocarcinoma of the cervix is significantly higher, squamous cell carcinoma may also metastasize to the ovaries by endometrial and transtubal spreading in the absence of lymph node involvement. Especially in young patients for whom preservation of the ovaries is supposed, gross intraoperative inspection of the radical hysterectomy specimen and endometrium should be done and ovaries should be evaluated carefully.

Malign mural nodules associated with serous ovarian tumor of borderline malignancy: a case report and literature review.

BACKGROUND: Cystic tumors of ovary, whether benign, borderline, or malignant may be associated with mural nodule of various types, including sarcomas, sarcoma-like mural nodules (SLMN), and foci of anaplastic carcinoma. Cases of serous borderline ovarian tumor with mural nodules of mixed type are very rare. CASE: A 54-year-old woman referred with abdominal swelling. Imaging studies revealed a huge mass localized in pelvis and lower abdomen and grade 1-2 left renal hydronephrosis. Preoperative Ca-125 was 798 U/ml. In exploratory laparotomy there was a 16 cm mass adherent to lateral abdominal wall and intestines. Adhesiolysis and de-bulking surgery were performed including bilateral pelvic, para-aortic lymphadenectomy, appendectomy and omentectomy. Left ureter was found to be dilated because of the infiltration of distal part by the tumor, so distal ureteral resection and neoureterocystostomy were performed. Final pathology revealed borderline serous ovarian tumor with mural nodules which were consisted of SLMNs, multiple and sharply demarcated from the adjacent tumor, and sarcomatous nodules showing infiltrative appearance in metastatic regions. Mural nodules showed a positive reaction for vimentin and SMA but were negative for cytokeratin and also necrosis, hemorrhage, and 10-15 mitoses in 10 high power fields were noted. She had postoperative chemotherapy and follow-up is going on without metastases in her first year. CONCLUSION: The existence of sarcomatous nodules combined with the SLMN necessitates a careful histologic analysis for treatment and the determination of prognosis. However, too few cases of mixed type mural nodules have been published to warrant a conclusion regarding their prognosis.

Laparoscopic conservative approach to ovarian pregnancies: two cases.

Primary ovarian ectopic pregnancy occurs quite rarely. Primary ovarian ectopic pregnancies usually occur in young, highly fertile, multiparous women using IUD. Two cases, we presented were middle aged, infertility and did not use IUD. The treatment of choice for ovarian pregnancy is usually ovarian wedge resection or oophorectomy, also there is a place for medical treatment of carefully selected patients. In this report, we aimed to present the laparoscopic conservative treatment of spontaneous ovarian ectopic pregnancy in two patients who had primary infertility.

Successful treatment of ligneous conjunctivitis with topical fresh frozen plasma in an infant.

A 6-month-old female infant presented to our clinic with bilateral eyelid swelling, yellowish-white membranes under both lids, and mucoid ocular discharge. Her aunt had similar ocular problems that were undiagnosed. The conjunctival membranes were excised and histopathological investigation of these membranes showed ligneous conjunctivitis. Further, laboratory examination revealed plasminogen deficiency. A good response was observed to topical fresh frozen plasma (FFP) treatment without systemic therapy, and the membranes did not recur during the treatment. Topical FFP treatment may facilitate rapid rehabilitation and prevent recurrence in patients with ligneous conjunctivitis.

Rectus abdominalis muscle metastasis from uterine leiomyosarcoma: An unusual case and review of the literature.

Uterine leiomyosarcoma is an aggressive malignancy. Spread to the lung, thyroid, liver, brain, pancreas, heart, duodenum, breast, vagina, submandibular gland, and bone has been reported. We describe a case of metastatic uterine leiomyosarcoma to the rectus abdominalis muscle as the first case in the literature. A 39-year-old nulligravid woman presented with a history of pelvic pain. Physical examination discovered about a 6-cm mass in the suprapubic region. She had previously undergone a hysterectomy for uterine leiomyosarcoma. Operative findings had revealed a mass measuring 4×5×6 cm located in the rectus abdominalis muscle. Abnormal mitotic figures and necrosis were evident, and uterine leiomyosarcoma was diagnosed. Uterine leiomyosarcomas are malignancies of the smooth muscle arising from the myometrium. Skeletal muscle is an uncommon site of metastasis by hematogenous spread. In conclusion, we have described a case of skeletal muscle metastasis (first case of rectus abdominalis muscle metastasis) secondary to uterine leiomyosarcoma.

Clinical significance of atypical squamous cells of undetermined significance in detecting preinvasive cervical lesions in post- menopausal Turkish women.

BACKGROUND: To evaluate the clinical significance of atypical squamous cells of undetermined significance (ASCUS) in PAP test in post-menopausal women and compare with reproductive age women. MATERIALS AND METHODS: A total of 367 patients who referred to our gynecologic oncology clinic were included to the study between September 2012 and August 2013. Data for 164 post-menopausal (group 1) and 203 pre-menopausal (group 2) women with ASCUS cytology were evaluated retrospectively. Immediate colposcopy and endocervical curettage was performed for both groups and conization for all women with a result suggestive of CIN2-3. Histopathological results and demographic features of patients were compared between the two groups. RESULTS: Mean age of the patients was 54.6±6.5 years in group 1 and 38±6.6 years in group 2. Some 14 (8.5%) of post- menopausal women and 36 (17.7%) of pre-menopausal women were current smokers (p=011). Totals of 38 (23.2%) post-menopausal and 64 (31.5%) pre-menopausal women were assessed for HPV-DNA. High risk HPV was detected in 7 (4.3%) and 21 (10.3%), respectively (p=0.029). Final histopathological results recorded were normal cervix, low grade cervical intra-epithelial neoplasia (CIN 1), and high grade cervical intra-epithelial neoplasia (CIN2-3). In group 1 results were 84.8%, 12.2% and 1.8%, respectively, and in group 2 were 71.9%, 23.2% and 4.9%. There were no cases of micro invasive or invasive cervical carcinoma in either group. Two cases were detected as endometrial carcinoma in the menopausal group (1.2%). CONCLUSIONS: In current study we found that preinvasive lesions were statistically significantly higher in pre-menopausal women than post- menopausal women with ASCUS. Cervicitis was more common in menopausal women. Therefore, we think that in case of ASCUS in a post-menopausal woman there is no need for radical management.

Successful treatment of ligneous conjunctivitis with topical fresh frozen plasma in an infant / Sucesso do tratamento da conjuntivite lenhosa com uso tópico de plasma fresco congelado em uma criança

ABSTRACTA 6-month-old female infant presented to our clinic with bilateral eyelid swelling, yellowish-white membranes under both lids, and mucoid ocular discharge. Her aunt had similar ocular problems that were undiagnosed. The conjunctival membranes were excised and histopathological investigation of these membranes showed ligneous conjunctivitis. Further, laboratory examination revealed plasminogen deficiency. A good response was observed to topical fresh frozen plasma (FFP) treatment without systemic therapy, and the membranes did not recur during the treatment. Topical FFP treatment may facilitate rapid rehabilitation and prevent recurrence in patients with ligneous conjunctivitis.

RESUMOUma criança feminina com seis meses de idade se apresentou à nossa clínica com edema palpebral bilateral, membranas brancas amareladas sob as pálpebras de ambos os olhos e descarga mucosa. Sua tia já havia apresentado problemas oculares semelhantes que não foram diagnosticados. As membranas conjuntivais foram excisadas e a investigação histopatológica das membranas demonstraram conjuntivite lenhosa. O diagnóstico de deficiência de plasminogênio foi obtido a partir de um exame laboratorial. Tratamento tópico com plasma fresco congelado (FFP) sem qualquer terapia sistêmica mostrou boa resposta. Não foram observadas recorrências das membranas. O tratamento tópico com FFP pode ajudar a reabilitação rápida e prevenir a recorrência em pacientes com conjuntivite lenhosa.

The effects of cetrimide-chlorhexidine combination on the hepato-pancreatico-biliary system.

Sclerosing cholangitis is a rare but dreadful complication of liver hydatid surgery. Almost all scolocidal agents are associated clinically or experimentally with this complication. Cetrimide-chlorhexidine combination is the most potent scolocidal agent, and this study was designed to examine its effect on the hepato-pancreatico-biliary system. Forty Wistar-albino rats were divided into two groups. 0.5% cetrimide-0.05% chlorhexidine was injected into the biliary tract of study group animals and 0.9% saline ( NaCl ) into the control group through a 3-mm duodenotomy. The animals were sacrificed after 90 days and histopathological examination of the liver, biliary tract, and pancreas was performed 90 days after the biliary injection. The histopathological examination showed that the lesions ranged from focal necrosis to sclerosing cholangitis to liver cirrhosis. Focal necrosis and eosinophilic inflammation were observed in all rats in the study group. The changes in the liver, biliary tract, and pancreas of the study group animals were significantly more severe than those in the control group (p < 0.05). This experimental study confirms the deleterious effect of another scolocidal agents on the hepato-pancreatico-biliary system. Although it is a very effective scolocidal agent, it should not be used in the presence of a duct biliary-cyst communication.