Immunohistochemical analysis using cell block technique leads accurate diagnosis of ovarian malignant lymphoma: A case report.

INTRODUCTION: Ovarian malignant lymphoma is a rare gynecologic disease and some patients show marked ascites, similar to that observed in advanced ovarian cancer. Although radical surgery improves prognosis of ovarian cancer, treatment of lymphoma is based on chemotherapy, therefore, differential diagnosis is crucial. PRESENTATION OF CASE: A 65-year-old woman presented with a 1-month history of abdominal distention. Pelvic ultrasonography showed an 11-cm solid mass in the pelvis. Computed tomography and magnetic resonance imaging revealed bilateral (mainly left) ovarian masses in the pelvis and multiple metastases. Laboratory examination revealed that serum CA125 levels were elevated, suggesting the existence of advanced ovarian cancer. To confirm the diagnosis, the ascites was removed via abdominocentesis. Although no malignant epithelial cells were observed, atypical lymphoid cells dispersed in the ascites were detected in the cytological analyses. Thus, for accurate diagnosis, we performed re-abdominocentesis and immunohistochemical (IHC) analysis using cell block technique. Cell block analysis showed negative staining for CD3 and positive staining for CD20 in large atypical lymphoid cells, suggesting the existence of large B-cell lymphoma. Repeat blood examination showed that the serum sIL-2R level was elevated. We decided to perform biopsy to make the final treatment decision. Histologically, the tumor demonstrated diffuse proliferation of large atypical lymphoid cells. IHC analysis showed CD3(-), CD5(+), and CD20(+). In addition, IHC analysis also showed CD79a(+), CD10(-), bcl-2(+), and cyclin D1(-). The final diagnosis was diffuse large B-cell lymphoma. DISCUSSION AND CONCLUSION: Here, we present the case of a patient with ovarian malignant lymphoma that was diagnosed using cell block analysis.

Unexpected Tubal Pregnancy at 13 Weeks' Gestation that Was Treated with Laparoscopic Surgery Under Massive Hemoperitoneum.

An advanced second trimester tubal pregnancy is rarely encountered because almost all ecopic pregnancy are diagnosed at an early stage. Transvaginal sonography is simple and useful for diagnosing ectopic pregnancy. However, diagnosing the site of ectopic pregnancy and gestational age is sometimes difficult. We experienced a case of an unexpected 13-week tubal pregnancy that was not able to be diagnosed with an accurate pregnancy site and gestational age by transvaginal sonography before surgery. Under massive hemoperitoneum, forceps penetrated the area of pregnancy, which led to further massive bleeding. However, laparoscopic surgery was able to be performed. The findings in our case suggest the importance of examining with transabdominal sonography, especially in an emergency and in advanced tubal pregnancy. In addition, careful manipulation of forceps is required when the ectopic pregnancy mass is large.

Transumbilical extraction of 151-300-g myomas without morcellator versus conventional laparoscopic myomectomy with power morcellator.

STUDY OBJECTIVE: The aim of this study was to compare the surgical outcomes, particularly the specimen retrieval time, between two methods of laparoscopic myomectomy: transumbilical retrieval of the myoma without a morcellator and conventional retrieval of the myoma using a power morcellator via the left lower quadrant. DESIGN: Retrospective study. SETTING: Public hospital. PATIENTS: Seventy-four women undergoing laparoscopic myomectomy. INTERVENTIONS: Laparoscopic myomectomy followed by myoma retrieval via transumbilical extraction or electric motorized morcellator extraction. MEASUREMENTS AND MAIN RESULTS: Seventy-four patients undergoing laparoscopic myomectomy followed by myoma retrieval via transumbilical extraction or electric motorized morcellator extraction were studied. Significant differences were observed in the average weight of the retrieved myomas between the transumbilical and morcellator groups (141.0 vs. 262.8 g, respectively; p < 0.001). Therefore, we chose 27 patients whose total specimen weight was 151-300 g; 13 patients were in the transumbilical extraction group and 14 were in the electric motorized morcellator group. No significant differences were observed in patient characteristics between the two groups. The operative time, blood loss volume, and myoma retrieval time were similar between the two groups. CONCLUSION: Laparoscopic myomectomy with transumbilical extraction for myoma retrieval is a feasible method for specimens weighing up to 300 g.

Endometrial adenocarcinoma arising in a Turner's syndrome patient with spontaneous menstruation: a case report.

BACKGROUND: Women with Turner's syndrome exhibit anovulation, and the majority do not spontaneously menstruate. We present an unusual case of endometrial adenocarcinoma developing in a Turner's syndrome patient who was exhibiting spontaneous menstruation while not receiving regular hormone therapy. CASE: The patient's karyotype from blood lymphocytes was a mosaic of 45,XO/ 46,XX. Menarche and sexual development were normal. Her menstrual cycle had been regular for one year, but then became noticeably irregular. At age 26 she was referred to our hospital after bleeding for almost 1 year. An endometrial adenocarcinoma was detected during performance of diagnostic endometrial curettage. A total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy was conducted. The final histological diagnosis was endometrial adenocarcinoma, Grade 1, pT1a N0 M0. Fluorescence in situ hybridization analysis of the right and left ovaries revealed a mosaic karyotype of 45,XO/ CONCLUSION: Previous reports regarding Turner's syndrome detected spontaneous menstruation in only 16% of patients; however, spontaneous menstruation was observed in 8 of 10 (80%) Turner's syndrome cases that developed endometrial carcinoma without receiving regular hormone therapy (p < 0.0001). Hormone therapy may be indicated for an irregular menstrual cycle in Turner's syndrome patients.

[A case of metastatic rectal cancer from serous adenocarcinoma of the ovary].

A 51-year-old woman was hospitalized with constipation and bloody feces. Under diagnosis of a primary rectal cancer with peritonitis, an ileostomy was scheduled. Since peritoneal dissemination was found, histologically she was diagnosed as metastatic rectal cancer from serous adenocarcinoma of the ovary. Chemotherapy with paclitaxel and carboplatin was performed, and complete disappearance on assessable examination was seen. Eight months after the first operation, she underwent total hysterectomy, oophorectomy and low anterior resection of rectum. No viable cancer tissue could be found. After the second operation, she has been doing well without any recurrence for 1 year and half.