Adenocarcinoma with peritoneal dissemination secondary to multiple mature teratomas of the omentum.

BACKGROUND: Teratomas of the greater omentum are rare. In most cases, they are composed of mature tissue elements and behave clinically in a benign fashion. CASE: A 62-year-old woman with a history of bilateral salpingo-oophorectomy due to ectopic pregnancy was found to have multiple cystic teratomas of the omentum. There was a histologic evidence of a sequential transition from benign through borderline to obviously invasive adenocarcinoma within the lining of the cysts as well as peritoneal dissemination. CONCLUSION: We defined the present case as malignant transformation of a mature teratoma, but have no evidence whatsoever for the origin of multiple mature teratomas. Further detailed analyses with more elaborated procedures on many relevant reports would be required to establish the origin and biologic behavior of teratomas of the omentum.

Localized necrotizing angiitis of the ileum.

A 20-year-old woman was hospitalized repeatedly because of intermittent bouts of intestinal obstruction and the symptoms usually improved with conservative treatments. One year after the first admission the patient was hospitalized in emergency and a laparotomy revealed a circular stricture with a pinhole perforation in the ileum. Histological sections of the stricture showed the characteristic features of microscopic polyangiitis varying from active to resolving stages, which were localized in the ileum. Fibrinoid necrosis, fibroblastic and fibrous proliferation of the intima and fibrous replacement of the media with a variable pan- and perivascular inflammatory cell infiltrate were characteristic in the muscular arteries and arterioles. Vascular occlusion by pale eosinophilic, fibrillar-like materials resembling livedo racemosa of the skin, was noticed in the small arterioles and capillaries. Under no prophylaxis, the postoperative course was uneventful with no recurrence of the illness at an 18-month follow up. The pathological alterations were distributed focally, occasionally segmentally, and haphazardly, and required detailed examination by stepwise sections for the histological diagnosis.