A case of a mucin-producing bile duct tumor diagnosed over the course of 6 years.

We report a case of a mucin-producing intraductal papillary neoplasm of the intrahepatic bile duct (M-IPNB) diagnosed over a period of 6 years. A 64-year-old man underwent follow-up evaluations for an abdominal aortic aneurysm at our hospital. In 2009, a computed tomography (CT) scan revealed a simple hepatic cyst in segment 3 of the liver. Annual CT scans initially showed almost no change in the size or shape of the cyst. The cystic lesion, which measured 5 cm in 2014, had increased to 11 cm by 2015, and a solid component was detected within the cyst. A biliary cystic tumor was suspected and we performed a left lateral hepatectomy. Pathological examination showed that the papillary lesion in the cyst included adenocarcinoma and adenoma components. We diagnosed M-IPNB in 2015. Identification of the solid component of the cyst, as well as an increase in cyst diameter in the image analyses, was critical for diagnosis of M-IPNB.

[ULTRASOUND CRITERIA OR THE OPERABILITY AND EFFICACY OF THE TREATMENT OF THE MALIGNANT EPITHELIAL OVARIAN TUMOURS].

In order to isolate the main sonographic criteria of ovarian cancer operability the dynamical U.S. examination was performed on 65 women with epithelial tumors of II-III stages before and during 5 years after treatment beginning, which included (in different combinations) cytoreductive surgery and neoadjuvant chemotherapy. Only total 14 (21.5%) relapses were revealed. The U.S. prognostic criteria of the ovarian cancer treatment efficacy with and without neoadjuvant chemotherapy were defined.

A case of bilateral ovarian synchronous tumors (left ovarian serous papillary adenocarcinoma and right ovarian malignant mixed Müllerian tumor).

Synchronous bilateral ovarian cancer is extremely rare and there is no established guideline for management. A case of a 58-year-old multiparous woman with bilateral ovarian synchronous malignant tumors is presented. The clinical consideration and treatment of related cases are discussed.

Cyst growth rate predicts malignancy in patients with branch duct intraductal papillary mucinous neoplasms.

BACKGROUND & AIMS: Little information is available about the clinico-pathologic characteristics of pancreatic branch duct intraductal papillary mucinous neoplasm (Br-intraductal papillary mucinous neoplasm [IPMN]) because of difficulties in diagnosis based on radiologic and tissue information. We investigated the natural history of Br-IPMN using imaging and surgical pathology data from patients. METHODS: Data were collected from patients admitted to a single tertiary referral institution from January 2000 to March 2009 (median follow up of 27.9 months); 201 patients were diagnosed with Br-IPMN with an initial cyst less than 30 mm without main pancreatic duct dilatation or mural nodules. The patients were followed for more than 3 months and examined by computed tomography (CT) at least twice. RESULTS: The mean size of the patients' initial cysts was 14.7 mm; the mean cyst growth rate was 1.1 mm/year. Thirty-five patients received surgery during follow up and 8 were confirmed to have malignant cysts. The malignant cysts were greater in final size than nonmalignant cysts (24.3 mm vs 16.9 mm; P = .003); they also grew by a greater percentage (69.8% vs 19.4%; P = .046) and at a greater rate (4.1 mm vs 1.0 mm/year; P = .001). The actuarial 5-year risk of malignancy was 41.6% in the group that received surgery and 10.9% for all patients. Cysts that grew more than 2 mm/year had a higher risk of malignancy (5-year risk = 45.5% vs 1.8%; P < .001). CONCLUSIONS: In combination with cyst size and the presence of mural nodules, cyst growth rate could be used to predict malignancy in patients with Br-IPMN.

Normal-sized ovarian papillary serous carcinoma: a case report.

A normal-sized ovarian papillary serous carcinoma is rare. We present the case of a 46-year-old woman with progressive abdominal fullness of one week's duration. The medical evaluation revealed abdominal carcinomatosis with normal-sized ovaries and an elevated serum CA-125 level of 147,365.8 U/ml. Cytoreductive surgery (hysterectomy, bilateral salpingo-oophorectomy, omentectomy, lymphadenectomy, infracolic omentectomy, peritoneal biopsy, washing cytology, and appendectomy) was performed. The histologic examination revealed an ovarian serous papillary carcinoma. Adjuvant chemotherapy was administered. The serum CA-125 level decreased after completion of treatment. Normal-sized ovarian serous surface papillary carcinomas should be kept in mind as an origin of disease in patients who have peritoneal carcinomatosis, which sometimes is a diagnostic dilemma of the disease source. We report this case to emphasize the clinical symptoms and importance of the early and accurate diagnosis of a normal-sized ovarian papillary serous carcinoma.

A large cystic tumor with bile duct communication originating around the hepatic hilum.

Biliary cystic tumors are rare neoplasms occurring in the liver and less frequently in the extrahepatic biliary system. Recently, biliary cystic tumors in the liver are thought to be divided into a biliary mucinous cystic neoplasm and intraductal papillary neoplasm of the bile duct. We report a case of a large cystic tumor originating around the hepatic hilum which had luminal communication with the bile duct. A 74 year-old-woman underwent abdominal ultrasonography for a routine checkup. It revealed a large cystic tumor in the liver. CT scan and MRI showed a multilocular cystic tumor about 12 cm in diameter with a mural nodule occupying the medial and anterior segment of the liver. Intraoperative cholangiography showed a communication between the cystic tumor and the bile duct. Central bisegmentectomy of the liver and extrahepatic bile duct resection was performed. A papillary tumor existed in the common hepatic duct and was connected with the cystic tumor in the liver. The tumor was mostly composed of noninvasive papillary adenocarcinoma with adenoma components, and was associated with focal microinvasion of adenocarcinoma. Ovarian-like stroma was not observed. This lesion was diagnosed as a cystic variant of intraductal papillary neoplasm of the bile duct. The patient is alive with no recurrence for 18 months since the surgery.

Acute gastric outlet obstruction secondary to papillary serous adenocarcinoma of the endometrium with peritoneal psammomatous implants: a case report.

Endometrial carcinoma is the most common gynecologic cancer in the United States. Uterine papillary serous carcinoma comprises approximately 5-10% of endometrial carcinomas. This aggressive carcinoma typically occurs in older women, characteristically arising on atrophic endometrium. This frequently is associated with early extrauterine spread and, infrequently, with peritoneal dissemination. We present a case of acute gastric outlet obstruction secondary to papillary serous adenocarcinoma of the endometrium with diffuse peritoneal psammomatous implants.

Ovarian carcinoma metastasis to the breast and imaging features with histopathologic correlation: a case report and review of the literature.

Metastasis to the breast from primary ovarian carcinoma is rare. We describe a case in which the patient developed breast metastasis 3 years after initial treatment of a primary ovarian cancer.

Low-grade papillary cystadenocarcinoma of the parotid gland: presentation of a case with cytological, histopathological, and immunohistochemical features and pertinent literature review.

Cystadenocarcinoma of the salivary glands is a very rare, slow growing, low-grade malignant neoplasm. However, when it occurs, it poses a diagnostic challenge. They are usually well circumscribed and exhibit multicystic appearance. The cytological features of fine-needle aspirates show bland appearing papillary and micropapillary neoplasm with variable cellularity and absence of cytological atypia. The cells are small to medium in size with abundant and occasionally vacuolated cytoplasm. The nuclei are eccentric, bland appearing, round, and at the most part uniform in size without anaplasia or mitotic activity. The background is commonly mucoid. Histologically, the neoplasm is usually well circumscribed and contains variably sized multicystic spaces with papillary structures. Foci of definite stromal invasion by tumor cells have to be present to justify the diagnosis of carcinoma. The remainders of the cytological features are similar to these seen on cytological smears. Typically, they are slow growing and conservative, but complete surgical excision is considered adequate. We present a case in a 57-year-old Saudi man that we believe the first from our region demonstrating the clinical and pathological features.

Recurrent ovarian carcinoma presenting as a solitary metastasis to the kidney.

Unusual sites for recurrent ovarian metastases include extrahepatic solid organs (except the spleen), bone and the abdominal wall. We report a rare renal recurrence of ovarian malignancy and its imaging features.

Detection of recurrent ovarian cancer at MRI: comparison with integrated PET/CT.

OBJECTIVE: To compare the diagnostic performances of magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) for the detection of recurrent ovarian tumor. METHODS: Thirty-six patients who underwent primary cytoreductive surgery for ovarian carcinoma received both MRI and PET/CT for the evaluation of ovarian tumor recurrence. Recurrent ovarian tumors in abdomen and pelvis were classified based on site as follows: (1) local pelvic recurrence, (2) peritoneal lesion, (3) lymph nodal metastasis, and (4) distant metastasis. Patient-based and lesion-based analyses were retrospectively performed with the aim of detecting tumor recurrence. For the detection of recurrent ovarian tumors, we compared patient-based and lesion-based diagnostic accuracies of these 2 modalities using the McNemar test. RESULTS: Histopathologic, clinical, and radiological follow-up findings revealed recurrent ovarian tumors in 35 sites of 22 patients. These 35 sites consisted of local pelvic recurrence (n = 15), peritoneal lesions (n = 14), lymph nodal metastasis (n = 4), and abdominal wall metastasis (n = 2). In detecting recurrent ovarian tumor, patient-based sensitivity and the accuracy of PET/CT and MRI were 73% and 91% (P < 0.05), and 81% and 89% (P > 0.05), respectively. In addition, overall lesion-based sensitivity of PET/CT and MRI were 66% and 86%, respectively (P < 0.05). In detecting peritoneal lesions, overall lesion-based sensitivity and accuracy of PET/CT and MRI for peritoneal lesions were 43% and 86%, and 75% and 94%, respectively (P < 0.05). CONCLUSIONS: Magnetic resonance imaging is more sensitive than PET/CT for detecting local pelvic recurrence and peritoneal lesions of recurrent ovarian tumors.

The power Doppler velocity index, pulsatility index, and resistive index can assist in making a differential diagnosis of primary ovarian carcinoma and Krukenberg tumors: a preliminary study.

OBJECTIVE: The aim of this study was to compare the effectiveness of transvaginal power Doppler sonography with spectral Doppler analysis as an aid in preoperatively distinguishing primary ovarian carcinoma and metastatic carcinoma to the ovary (Krukenberg tumors). METHODS: Fifty women with ovarian disease were preoperatively examined with transvaginal power Doppler sonography. Six basic parameters were measured, including intratumoral peak systolic velocity, end-diastolic velocity, time-averaged maximum velocity, pulsatility index (PI), resistive index (RI), and velocity index (VeI). Blood flow analyses were detectable in all patients. Twelve patients with metastatic carcinoma to the ovary were classified as group 1; 38 patients with primary ovarian carcinoma were classified as group 2. Comparison of intratumoral blood flow analyses between the two groups was performed. RESULTS: The PI, RI, and VeI were significantly lower in patients with metastatic carcinoma to the ovary than those with primary ovarian carcinoma (P < .05). There were no significant differences in the peak systolic velocity (P = .871), end-diastolic velocity (P = .508), and time-averaged maximum velocity (P = .850) between the two groups. CONCLUSIONS: Transvaginal power Doppler sonography with spectral Doppler analysis is an effective method in evaluating intratumoral blood flow of Krukenberg tumors. Low impedance (PI, RI, and VeI) might assist us in making differential diagnoses between primary ovarian carcinoma and Krukenberg tumors according to our preliminary results.

Transvaginal ultrasonography with and without saline infusion in assessment of myometrial invasion of endometrial cancer.

OBJECTIVE: The purpose of this study was to determine the diagnostic accuracy of saline infusion ultrasonography (SIUS) compared with transvaginal ultrasonography (TVUS) in the assessment of myometrial invasion of endometrial cancer. METHODS: A total of 53 patients with endometrial cancer were examined preoperatively with TVUS and SIUS with respect to myometrial invasion. All patients were postmenopausal. Ultrasonographic findings were compared with histopathologic findings of the surgical specimens. RESULTS: The median age of the patients +/- SD was 64 +/- 7 years (range, 51-77 years). In all patients, the procedure was well tolerated. The median thickness of malignant endometria was 17 +/- 9 mm (range, 2-51 mm). The specimens consisted of 40 endometrioid adenocarcinomas, 2 serous papillary carcinomas, 5 clear cell adenocarcinomas, 2 adenosquamous carcinomas, 3 mixed types, and 1 undifferentiated carcinoma. There were 18 grade G1, 24 G2, and 11 G3 cases. On histopathologic examination, superficial myometrial invasion (50% of the myometrium) was present in 28 (52.8%). For superficial myometrial invasion, evaluation by TVUS was accurate in 19 (76.0%) of 25 cases, and evaluation by SIUS was accurate in 18 (72.0%) of 25. For deep myometrial invasion, evaluation by TVUS was accurate in 24 (85.7%) of 28 cases, and evaluation by SIUS was accurate in 27 (96.4%) of 28. CONCLUSIONS: Transvaginal ultrasonography is a reliable method for assessing myometrial invasion of endometrial cancer. Saline infusion ultrasonography showed slightly better accuracy in the assessment of myometrial invasion than TVUS, but the differences were not statistically significant.

Three-dimensional power doppler ultrasound is useful to monitor the response to treatment in a patient with primary papillary serous carcinoma of the peritoneum.

To date, this is the first report to monitor changes of intratumor vascularization and the response to radiation and Cyberknife therapy in a patient with recurrent primary papillary serous carcinoma of the peritoneum by three dimensional (3D) power Doppler ultrasonography (PDUS). Transvaginal 3D PDUS detected a recurrent presacral tumor with abundant intratumor vascularity. Serial examinations of the tumor volume and serum CA-125 level were studied before, during, and 6 mo after therapy. Meanwhile, the intratumor blood flow was measured and expressed as vascularity indices. All of the tumor volume, intratumor vascularity indices and serum CA-125 level decreased progressively following therapy. A remaining lesion with nearly absent intratumor power Doppler signals suggested a scarring lesion posttreatment. Indeed, CT-guided tissue biopsy confirmed fibrotic change. 3D PDUS is useful to monitor the response to treatments and to differentiate residual tumors from lesions of scarring change posttreatment. It provides more accurate posttreatment information than pelvic computed tomography.