A case of mesonephric adenocarcinoma of the vagina with a 1-year follow-up.

Mesonephric adenocarcinoma deriving from remnants of vaginal mesonephric ducts is one of the rarest tumors of the female genital tract with only three cases reported till date in international literature. Differential diagnosis from other aggressive tumors is complex and controversies exist in the literature regarding the biological behavior, prognosis, and optimal management strategies of these tumors. A 58-year-old woman presented with a large mass extending from the right adnexal region to the perineum and labia majora. CA125 was increased. A radical excision of the lesion with pelvic and para-aortic lymphadenectomy was performed. A well-capsulated mesonephric adenocarcinoma in a background of vaginal mesonephric remnants was diagnosed. Tumor cells showed immunoreactivity for pancytokeratin, cytokeratin (CK), CD 10, epithelial membrane antigen, vimentin, and calretinin; indeed they were negative for carcinoembryonic antigen, CK 20, estrogen receptor, and progesterone receptor. No evidence of lymph node involvement or metastatic disease was observed. The patient did not receive any adjuvant therapy and is alive and clinically free of disease at 1-year follow-up. In spite of the aggressive biological behavior attributed in literature to mesonephric carcinomas, which is probably due to the complex differential diagnosis with other müllerian tumors, the favorable course of our patient further supports the hypothesis that malignant mesonephric carcinomas may not behave aggressively and that radical surgery alone may be curative.

[Coexistence of ovarian carcinoma with pregnancy--case report]. / Zlosliwy nowotwór jajnika wspólistniejacy z ciaza.

OBJECTIVE: Ovarian tumors during pregnancy are a rare event. More ovarian tumors are detected accidently during ultrasonography examination or caesarean section at term. STUDY DESIGN: Ovarian tumor was recognized at the 36 years old patient during 21 weeks of pregnancy and was observed and treated during caesarean section. RESULTS: During caesarean section the mesonephroid ovarian carcinoma at IA stage has been diagnosed and unilateral cystectomy after meticulous surgical exploration was done.

Endodermal sinus (yolk sac) tumor of vagina and cervix in an infant.

A case of vaginal and cervical endodermal sinus (yolk sac) tumor in a 6-month-old female infant is reported. The patient presented with an intermittent bloody discharge on her diapers. Pelvic CT showed an irregular soft tissue density mass with heterogeneous enhancement within the vagina and extending to the cervix. The histopathologic features were identical to those of endodermal sinus tumors.

The normal and abnormal scrotum in children: evaluation with color Doppler sonography.

The use of color Doppler sonography to evaluate the symptomatic testes in children with scrotal pain or swelling was prospectively studied with a fourth-generation color sonographic unit with a 7-MHz linear transducer. The 32 patients were 1 day to 18 years old (mean age, 8.6 years). Results were correlated with scintigraphic findings in 23 patients, with the final diagnosis established by surgery in 12 patients, and with clinical follow-up in all patients. Eight cases of testicular torsion, including two of acute torsion and six of late torsion, were correctly detected by color Doppler sonography and confirmed surgically. In the remaining patients, perfusion of the testis was correctly detected by color Doppler examination. The final diagnoses in these patients included torsion of the appendix testis (15 patients), epididymitis (five patients), epididymo-orchitis (one patient), yolk sac tumor of the testis (one patient), hydrocele (one patient), and local reaction to an insect bite (one patient). The ability to detect blood flow in the normal contralateral testis was also evaluated in 28 patients. Blood flow was demonstrated in normal testes larger than 1 cm3. Detection of flow in the very small normal prepubertal testis was often difficult, and no flow was identified in one testis. Flow was identified in central arteries in only six of 13 testes smaller than 1 cm3. We conclude that color Doppler sonography is helpful in the initial evaluation of pediatric testes, providing accurate evaluation of the involved hemi-scrotum in our patients and also providing the benefit of both structural and flow information. Until our sensitivity to low-velocity flow improves, we would not suggest the exclusive use of color Doppler sonography in the evaluation of testicular perfusion in the prepubertal patient. We advocate the addition of testicular scintigraphy to corroborate the presence of testicular perfusion when flow in intratesticular arteries cannot be established with certainty by color Doppler sonography.

Primary endodermal sinus tumor of the liver detected by CT.

We report a case of primary endodermal sinus tumor of the liver. Endodermal sinus tumors are rare neoplasms which usually arise in the testis or ovary. Extragonadal endodermal sinus tumors are uncommon and primary tumors of the liver are very rare. The tumor was detected using CT and the diagnosis was made by percutaneous biopsy.

Ovarian endodermal sinus tumor associated with pregnancy: review of the literature.

Endodermal sinus tumor is the second most common malignant germ cell tumor of the ovary and its reported concurrence with pregnancy is extremely rare. This report is the 10th case of endodermal sinus tumor associated with pregnancy and also reviews the previous literature regarding the subject.

[An endodermal sinus tumor (yolk sac tumor) of the anterior mediastinum]. / Endodermaler Sinustumor (Dottersacktumor) des vorderen Mediastinums.

An own case of a primary mediastinal endodermal sinus tumour (yolk sac tumour) is presented that was transformed under therapy into an AFP-negative process and occurred combined with an arcus aortae dexter. This is followed by a description of the clinical and diagnostic patterns of signs and symptoms and of the treatment of this very rare dysontogenetic tumour.

Endodermal sinus tumour of the posteroinferior mediastinum resembling dumbbell neuroblastoma in a child.

A male infant presenting with paraplegia due to intraspinal extension of an endodermal sinus tumour in the posteroinferior mediastinum is reported. Dumbbell tumours are usually observed in mediastinal neuroblastomas, and rarely in rhabdomyosarcomas of the chest wall. The present case demonstrates the clinical similarity of endodermal sinus tumours to neuroblastomas with extradural extension. Therefore, endodermal sinus tumours should be considered in the differential diagnosis of posterior mediastinal masses, because of the distinctly different treatment from that for other tumours.

Primary mediastinal endodermal sinus tumors: CT evaluation.

Five patients with primary mediastinal endodermal sinus tumor have been evaluated by computed tomography (CT). The tumors were all located in the anterior mediastinum. Prechemotherapy CT demonstrated large, irregularly enhancing inhomogeneous masses without fat components. Calcification was visualized in two tumors. Some parts of the pleura-lung interface were irregular in four cases. Obliteration of fat planes to pericardium and chest wall was evident in all cases, and there was infiltration of intercostal muscles in four. Postchemotherapy CT in two patients who responded to chemotherapy showed either newly developed cystic lesions or cystic change of the original mediastinal mass. The cystic masses had more regular borders, a homogeneous hypodense center, and a smooth peripheral rim of contrast-enhancing tissue.

CT of pineal tumors and intracranial germ-cell tumors.

We reviewed 59 cases of pineal tumors and intracranial germ-cell tumors. Most pineal tumors occurred in the first three decades of life, with the exception of pineocytomas, which were seen at a mean age of 34. A male preponderance was noted in the various pineal tumors, except for pineocytomas. The most common tumor of the pineal region was germinoma, which usually showed high density with homogeneously intense enhancement after IV administration of contrast medium. An increased prevalence of pineal calcification was also a feature of pineal germinomas. No characteristic CT features could be found to differentiate among pineal choriocarcinoma, germinoma, embryonal carcinoma, yolk-sac tumor, pineocytoma, and pineoblastoma. CT is useful in detecting intracranial tumors, but the definite diagnosis should depend on pathologic examination and detection of tumor markers in the serum and CSF.

Immunoscintigraphy using CA 125 antibodies in the management of ovarian cancer.

Radioimmundetection (RID) using anti-CA 125 antibodies proved to be a valuable tool in the follow-up of metastasizing ovarian cancer. Sensitivity, specificity, and accuracy were high. RID had no clinical side effects. But some patients formed antibodies which interfered a) with the evaluation of the scintigram and b) with further measurement of CA 125 levels. We found 2 cm diameter metastases that were not detected by computed tomography. However, the heterogeneity of tumor metastases limits the sensitivity of this method. CA 125 serum levels, immunohistochemistry, and immunoscintigraphy did not always correlate. Monitoring serum levels of CA 125 was most valuable in clinical management of tumor spread and in the optimal use of RID.

Intraabdominal testis with yolk sac tumor in a 2-year-old child.

A case of a large yolk sac tumor in an undescended testicle in a 2-year-old child is presented. No such similar finding has been reported in a young child. Despite the large size of the primary tumor, the high level of serum alpha-fetoprotein and the relatively late clinical presentation, this was a stage I lesion, and the child responded to surgical resection of the tumor and chemotherapy.

Computed tomographic staging of anterior mediastinal neoplasms.

Sixty patients with anterior mediastinal neoplasms undergoing computed tomography before surgical exploration were entered in a prospective study to assess the value of computed tomography in the preoperative staging of anterior mediastinal tumours. Correct prediction of location, size, and tissue density was obtained in all 60 cases. Correct identification of the nature of the tumours was achieved by computed tomography in 37 of the 54 previously undiagnosed cases. Particular attention was given to the evaluation of the relation of the tumour to adjacent mediastinal structures, to predict the feasibility of radical surgical procedures. Overall sensitivity, specificity, and accuracy in identifying resectability were 46%, 85%, and 64%, with positive and negative predictive indices of 78% and 58%. Capsulated or highly invasive lesions were clearly distinguished, and the presence or absence of infiltration of mediastinal vessels, pericardium, and chest wall was correctly recognised in most cases. It is suggested that the evaluation of anterior mediastinal neoplasms should include computed tomography because of its accuracy in predicting size, location, and tissue density of the neoplasm. Computed tomography may suggest, often with good reliability, the histological type of the tumour and its relation to contiguous mediastinal structures, thus contributing to the choice of the appropriate surgical approach or route for biopsy.

Intracranial endodermal sinus tumour--role for chemotherapy.

Pineal tumours are commonly of germ cell origin. The endodermal sinus tumour is a rare histologic subtype that is highly malignant and radioresistant. A single case is described and compared to six reported intracranial cases in which chemotherapy was used in addition to surgery and/or radiation. Although a beneficial effect of chemotherapy cannot be proven, the probable benefit in non-CNS cases requires that it be strongly considered. A uniform approach to diagnosis, investigation and treatment for intracranial tumours of this type is suggested.