Ultrasonographic predictors of thyroid cancer in Bethesda III and IV thyroid nodules.

Background: Bethesda III and IV thyroid nodules continue to be difficult to manage. Although molecular testing may assist in decision-making, it is expensive, not widely available, and not without pitfalls. The objective of this study is to assess whether certain thyroid ultrasonographic features may predict the risk of thyroid cancer in patients with Bethesda III and IV thyroid nodules and be used as additional decision-making tools to complement cytopathological results in deciding on diagnostic thyroidectomy. Methods: We retrospectively evaluated the ultrasonographic features of Bethesda categories III and IV thyroid nodules in patients who underwent subsequent thyroidectomy. We used the final histopathological examination of the surgical specimens as the gold-standard test and analyzed individual preoperative ultrasonographic features as predictors of malignancy. Results: Of the 278 patients who were diagnosed with Bethesda III and IV thyroid nodules on fine needle aspiration cytology (FNAC), 111 (39.9%) had thyroid cancer, and 167 (59.9%) exhibited benign nodules. The malignancy rate was higher in patients with Bethesda IV nodules (28/50, 56%) than those with Bethesda III nodules (83/228, 36.4%; p=0.016). In univariate analysis, hypoechogenicity (55.6% in malignant vs. 35.3% in benign, p=0.006) and calcifications (54.5 in malignant vs. 35.4% in benign, p=0.008) were significantly different between the benign and malignant pathology groups, whereas the size of the dominant nodule, number of nodules, irregular borders, taller-than-wide shape, and the presence of lymph nodes were comparable between the two groups. These two ultrasonographic features (hypoechogenicity and calcifications) remained significantly associated with the risk of malignancy in multivariate logistic regression analysis (for hypoechogenicity, p=0.014, odds ratio: 2.1, 95% CI:1.0-3.7 and for calcifications, p=0.019, odds ratio: 1.98, 95% CI:1.12-3.50). The sensitivity, specificity, positive and negative predictive values, and accuracy were 31.5%, 83%, 55.6%,64.7%, and 62.6%, for hypoechogenicity, respectively and 32.4%, 82%, 54.5%, 67.8%, and 62%, for calcification, respectively. Conclusions: Hypoechogenicity and calcifications in Bethesda III and IV thyroid nodules are strong predictors of thyroid cancer and associated with a two-fold increased risk of malignancy.

Psychiatry Residents' Attitudes towards Spirituality in Psychiatric Practice in Saudi Arabia.

OBJECTIVES: This study examined residents' attitudes and practices regarding the relevance of spirituality in psychiatry within Saudi residency training programs; their experiences and comfort levels in addressing patients' spiritual concerns; and their interest and past learning experiences in this area of training and practice. METHODS: This cross-sectional study targeted trainees and recent graduates of residency programs across Saudi Arabia. The study materials consisted of an electronic questionnaire that was adapted with permission. RESULTS: The total number of respondents was 71 out of 180 potential participants (39.44%). Most residents (64.8%) felt that it was appropriate to inquire about the spiritual aspects of patients' lives and that it was essential to address spiritual problems or needs that patients may have within the clinical setting (71.8%). Many participants (40.80%) described themselves as being both religious and spiritual. Most respondents (94.4%) did not receive any training on spirituality and psychiatry, and 80.3% said they would like to learn more about the subject. CONCLUSIONS: Our findings indicate that residents have an overall high level of personal spirituality and that they feel it is relevant in clinical practice. However, they have not had much training in this area and are interested in learning more. Educational initiatives would be beneficial for improving the effectiveness of residents and patient care in this untapped area of spirituality in psychiatry.

Eyelid Soft Tissue Chondroma: A Case Report.

Soft tissue chondromas are rare benign tumors that occur in extraosseous and extra-synovial locations. We report herein a rare presentation of eyelid soft tissue chondroma in a 45-year-old male presented with a 2-year history of a slowly enlarging subcutaneous firm mass on the left upper eyelid, and complete excision of the lesion followed by histopathological examination rendered the diagnosis of soft tissue chondroma.

Unilateral acquired blepharoptosis due to orbital metastatic disease as an initial presentation of an overlooked breast carcinoma - A case report.

INTRODUCTION AND IMPORTANCE: Orbital metastasis from breast cancer may be infrequently noted after the management of the primary lesion. It is rare in such cases to present with unilateral mechanical blepharoptosis without ophthalmoplegia. CASE PRESENTATION: We present a case of unilateral acquired blepharoptosis of the left upper eyelid without ophthalmoplegia or exophthalmos three years after the onset of a suspicious breast mass. The patient did not disclose a history of breast cancer nor any positive family history to the ophthalmologist and anesthesiologist. The radiology images revealed an ill-defined enhanced lesion at the superior medial aspect of the left orbit. The orbital biopsy of the lesion showed poorly differentiated carcinoma as per the initial histopathology report. Vigilant history-taking enabled us to get information about a previous breast lesion and to correlate this with specific histopathological findings. DISCUSSION: Management of orbital lesions might be challenging, and the approach should include detailed history and assessment. Biopsy and radio imaging are further needed to aid in providing the proper diagnosis. The clinicopathological correlation in our case has led to the final diagnosis of orbital metastatic breast cancer. CONCLUSION: Ophthalmologists should be aware of variable ocular presentations of malignancy and adopt a team approach to obtain a carefully detailed history from patients presenting with orbital diseases and communicate adequately with the ocular pathologists who are handling the biopsy. Long-term follow-up and enhancement of patients' awareness of possible late orbital metastasis are recommended in all patients with breast masses.

Detection of Increased Expression of Claudin-1 in Triple-Negative Breast Cancer: Analysis and Clinical-Pathological Correlation.

Background Triple-negative breast cancer (TNBC) is a highly aggressive disease that lacks therapeutic targets and prognostic biomarkers. Claudin-1 is a well-described tight junction protein with prognostic value in many human cancers. Aims The need for the discovery of biomarkers of TNBC disease was a major reason for this study. Claudin-1 is a tight junction protein that has shown promising results in the prognosis and management of cancer in general. In the breast, claudin-1 expression and significance have shown variable results, especially in TNBC patients. Our study assessed expression of claudin-1 in a group of TNBC patients, and correlated this expression with clinical-pathological parameters, and with the expression of ß-catenin. Materials and methods Tissues from a group of 52 TNBC patients were retrieved from the archives of the community hospital. All related information including demographical, pathologic and clinical data were retrieved. Immunohistochemistry assays of a rabbit polyclonal antibody anti-human claudin-1 were applied using the avidin-biotin peroxidase methodology. Results A statistically significant majority of TNBC cases positively expressed claudin-1 (81%, χ2=13.705; p<0.001). Most TNBC cases had grade 2 ß-catenin expression (77.5%; p<0.001), and positive expression for claudin-1 correlated with that of ß-catenin (χ2= 23.757; p<0.001). Claudin-1 and ß-catenin expressions within tumour cells shared several features including absent or weakness of membranous expression, and redistribution of both proteins to the cytoplasm of tumour cells, and in some cases to the nuclei of these cells. Claudin-1 expression also correlates with adverse survival outcomes, where only four of 20 claudin-1-positive patients who received neo-adjuvant chemotherapy (NAC) achieved pathological complete response (pCR). Conclusions The above presents a complex role of claudin-1 in TNBC patients. In this study, claudin-1 expression was associated with poor prognostic features including invasion, metastases and adverse clinical outcomes. Claudin-1 expression in TNBC correlated with the expression of ß-catenin, an important oncogene and a major contributor to the epithelial mesenchymal transition (EMT) phenomenon. Overall, the above results may serve as an impetus for further mechanistic studies to assess the exact role of claudin-1 in TNBC and its possible use in the management of this subset of breast cancer.

Possible vertical transmission of corona virus disease 19 (COVID-19) from infected pregnant mothers to neonates: a multicenter study.

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly contagious with various possible routes of transmission, resulting in high mortality globally. Controversy exists regarding the vertical transmission of the SARS-CoV-2 infection to fetuses of COVID-19-infected women. The aim of this study was to investigate the possibility of the vertical transmission of SARS-CoV-2 from COVID-19-infected mothers to their neonates. MATERIALS AND METHODS: We prospectively collected demographical and clinical characteristics of 31 COVID-19 positive pregnant women and their neonates. All mothers and neonates were tested for SARS-CoV-2 infection using the real-time polymerase chain reaction on nasopharyngeal swabs and breast milk samples. Antenatal and placental abnormalities were ultrasonically and histopathologically examined. In cord blood samples, the immunoglobins (Ig) M and IgG were estimated qualitatively. RESULTS: The women's mean age and gestational age were 31 years and 38 weeks, respectively, with 58% undergoing an elective cesarean section. Gestational diabetes was reported in 29% of cases, 64.5% of women were medically free and only 16.12% were symptomatic. A normal antenatal ultrasound was observed in 77.42% of cases. Nine cord blood samples were positive for IgG. Villous infarction (24%), villous agglutination, and chorangiosis (51%), accelerated villous maturation (21%) and reduced and hypercoiling were reported for 6.97% of the umbilical cords. Three newborns had possible vertical transmission of SARS-CoV-2 infection, of which, two were preterm and IUFD. The third neonate was born full-term, admitted to NICU and later discharged in good health. CONCLUSION: Our findings support the possibility of the direct vertical transmission of the SARS-CoV-2 infection to neonates from infected mothers. Further studies with a larger sample size are required to validate the current findings.

The Many Faces of Serous Neoplasms and Related Lesions of the Female Pelvis: A Review.

Ovarian serous tumors and related lesions are one of the most common conditions of the female genital tract. While ovarian high-grade serous carcinoma carries high mortality and adverse prognosis, most other serous lesions have better clinical behavior. In recent years, significant progress has been made in understanding the nature and histogenesis of these lesions that has contributed to better and more precise clinical management. Most of the high-grade serous carcinomas involve the ovaries and/or peritoneum, although in most cases, their origin seems to be in the fallopian tube. This view is supported by the recognition of precursor lesions in the fallopian tube, such as p53 signature and serous tubular in situ carcinoma. This paper presents salient morphologic, immunohistochemical, and molecular data related to serous tumors and related lesions of the female pelvis and discusses the histogenetic interrelationship among these lesions in light of current knowledge.

A 46-Year-Old Woman with Primary Infertility and a Diagnosis of Microcystic Stromal Tumor of the Ovary Confirmed by Histology and Gene Sequencing: A Case Report and Review of the Literature.

BACKGROUND Microcystic stromal tumor (MCST) of the ovary is a rare entity with distinct pathological and molecular features. However, a lack of awareness of ovarian MCST can lead to delayed diagnosis or misdiagnosis. We present a case of ovarian MCST and review all previously reported cases and discuss their clinical and pathological characteristics. CASE REPORT A 46-year-old woman with primary infertility due to polycystic ovary syndrome presented with bleeding and pain. Radiological images showed a complex solid and cystic adnexal mass. Microscopically, the tumor was lobulated with cellular regions separated by fibrous plaques and small anastomosing cysts, consistent with an ovarian MCST. The tumor cells showed positive staining for vimentin, CAM 5.2, CD10, ß-Catenin, CD99, and cyclin D1. Genetic sequencing showed a point mutation in the CTNNB1 gene, with no mutations in the APC, BRCA1, and BRCA2 genes. The patient underwent surgery and was disease-free at 24 months after her initial diagnosis. CONCLUSIONS The diagnosis of ovarian MCST should consider the differential diagnosis of cystic tumors of the ovary. Further research is encouraged to elucidate the various molecular pathways involved in the pathogenesis of this tumor and to determine its optimal treatment and long-term prognosis.

KI-67 LI Expression in Triple-Negative Breast Cancer Patients and Its Significance.

PURPOSE: Triple-negative breast cancer (TNBC) is a subset of breast cancer which is known to carry a poor prognosis because of lack of targets for hormonal therapy. Research efforts have focused in recent years on discovering biomarkers of management in TNBCs. KI-67 Labelling Index (LI) is a nuclear protein which has proven to play diagnostic and prognostic roles in many cancers. MATERIALS AND METHODS: We analysed the expression of KI-67 LI by immunohistochemistry in TNBC cases from the University hospital. This expression was cross-checked against clinical-pathological criteria of TNBC patients and against Vimentin expression in TNBC patients with significant KI-67 expression. RESULTS: KI-67 LI was significantly expressed in the majority of TNBC cases. This expression was significantly correlated with lymph node metastases, tumour invasion, high tumour nuclear grade, clinical stage, adverse survival outcome, and failure to achieve pathological complete response. TNBCs' KI-67 LI expression was also correlated with Vimentin expression, the mesenchymal chief marker of the EMT phenomenon. CONCLUSION: Collectively, our study presents a strong argument for the use of KI-67 LI as a biomarker of aggressive, metastatic TNBC disease with poor outcome. This study, along with mounting evidence in the scientific literature, presents a case for the use of this nuclear protein in diagnosis, prognosis, and follow-up of patients with this difficult diagnosis.

Case Report: Neonatal Multi-System Inflammatory Syndrome Associated With SARS-CoV-2 Exposure in Two Cases From Saudi Arabia.

Background: Vertical transmission of SARS-CoV-2 is under investigation. A few reports suggest the possibility of SARS-CoV-2 transmission from mothers to their neonates. Most neonates have mild symptoms, but some develop multisystem involvement and shock. Case Presentation: We report two cases of possible SARS-CoV-2 vertical transmission from mothers to their neonates. The first case shows maternal infection with SARS-CoV-2 in the second trimester followed by recurrent infection in the third trimester right before the delivery. The infant demonstrated respiratory distress soon after delivery along with myocardial dysfunction and multi-organ system involvement. The second case shows maternal infection with SARS-COV-2 at the time of delivery with preterm labor secondary to placental abruption, with that delivery resulting in the preterm neonate requiring non-invasive ventilation with multisystem involvement in the context of persistently positive SARS-COV-2 PCR in the neonate. Both neonates were treated with IVIG along with steroids. Both neonates recovered fully and were discharged and allowed to go home. Conclusion: In neonates, COVID-19 usually presents as an asymptomatic or mild illness; some may develop a more severe course. Our two cases, however, demonstrate that multisystem involvement, although rare, is possible. This report also supports the current evidence of possible vertical transmission from mothers to their neonates. This multisystem involvement might be underreported and should be considered in neonates with respiratory distress when born to mothers suffering of COVID-19. Clinical Trial Registration: [KSUMC], identifier [No#98763298].

A Giant Leiomyoma with Massive Cystic Hydropic Degeneration Mimicking an Aggressive Neoplasm: A Challenging Case with a Literature Review.

BACKGROUND Leiomyomas are the most frequent benign tumors of the uterus. They often exhibit degenerative changes (hyaline, myxoid, hemorrhagic, hydropic, and cystic), which lead to varying and sometimes challenging clinical, radiological, and histopathological features. We present this case to highlight the importance of recognizing these variants and their differential diagnosis since they resemble forms of uterine sarcomas with a potential for misdiagnosis. CASE REPORT A 32-year-old single woman presented with large pelviabdominal masses mimicking, clinically and radiologically, an aggressive uterine or ovarian tumor. The masses collectively measured 33×24×15 cm, and a definite intraoperative diagnosis could not be made. Resection showed a giant leiomyoma with massive cystic hydropic degeneration. The patient underwent myomectomies with transposition of the ovaries into the lateral abdominal wall. Although the surgery was complicated by a massive hemorrhage with an approximate blood loss of 6 liters requiring blood transfusion and bilateral internal iliac artery ligation, the patient was discharged home on the fourth day after surgery, with an uneventful 16-month follow-up. CONCLUSIONS Few leiomyomas showing this marked degree of hydropic degeneration have been reported in the literature. The differential diagnosis includes uncommon variants of leiomyomas (eg, intravenous leiomyomatosis), as well as uterine sarcomas (eg, low-grade endometrial stromal sarcoma) and ovarian carcinomas. Therefore, appropriate evaluation of the clinicopathological features is vital to ensure appropriate management and not to erroneously diagnose a benign leiomyoma as a more aggressive type of tumor.

Massive Retinal Gliosis in an Infant Microphthalmic Globe: A Case Report.

BACKGROUND Massive retinal gliosis (MRG) is a rare benign intraocular tumor that results from the proliferation of well-differentiated glial cells in response to long-standing pathological processes, including glaucoma, trauma, chronic inflammation, vascular disorders, and congenital anomalies. This lesion is considered to be nonneoplastic and occurs ≥10 years after the predisposing insult. It usually affects children and can mimic other conditions, including uveal melanomas, vasoproliferative tumors of the retina, astrocytic hamartomas, and retinal hemangioblastomas. CASE REPORT We present a case of infant MRG with severe left eye microphthalmia. An 11-month-old boy was presented by his parents in the Oculoplastic Unit of a teaching university hospital with bilateral incomplete cryptophthalmos and small globes. An enucleation of the left globe was carried out to stimulate orbital bone growth and to improve the cosmetic outcome. The histopathological examination revealed a microphthalmic globe with sclerocornea and disorganized intraocular anterior segment structures. The retina was dysplastic with proliferating spindle-shaped glial cells showing fibrillar eosinophilic cytoplasm and filled most of the vitreous cavity. The glial origin of the cells was confirmed by the immunohistochemical markers (glial fibrillary acidic protein and synaptophysin), supporting the diagnosis of MRG. The optic nerve was markedly hypoplastic. CONCLUSIONS MRG is a rare intraocular tumor that is clinically difficult to diagnose. A definite diagnosis can be made only on the basis of a histopathological examination and immunohistochemical markers.

Good Outcome of Early-Stage Rectal Cancer Diagnosed During Pregnancy.

BACKGROUND Colorectal cancer (CRC) in pregnancy is very rare. It is often associated with poor prognosis which is contributed to delayed diagnosis due to the overlapping symptoms of CRC and pregnancy. The purpose of this case report is to highlight the importance of early diagnosis and treatment of CRC in a young pregnant patient with good maternal and fetal outcomes. CASE REPORT A 30-year-old patient, gravida 3, presented at 9-week gestation with a history of sudden painless, fresh, rectal bleeding with no aggravating factors such as constipation or hemorrhoids. Sigmoidoscopy showed a small fungating, intramural mass, 40 cm from the anal verge, which easily bled upon touch. The rest of the colon up to the terminal ilium was normal. The mass was completely removed during the sigmoidoscopy procedure, and the histopathological diagnosis was a tubulovillous adenoma with focal intramucosal carcinoma. After the polypectomy procedure, the patient had an uneventful, bleeding-free pregnancy and delivered a healthy baby at full term. The sigmoidoscopy procedure was considered to be both diagnostic and therapeutic since the entire mass was completely removed. CONCLUSIONS Early diagnosis and intervention are critical in improving the overall outcome of CRC in pregnancy and requires a high index of clinical suspicion. Taking a detailed patient history, exercising attentiveness, and conducting thorough investigations of all symptomatic pregnant women are recommended. Treatment options should involve a multidisciplinary team with consideration to the patient's own choices.

Laparoscopic resection of retroperitoneal intra-psoas muscle schwannoma: A case report and extensive literature review.

INTRODUCTION: Soft tissue tumors of Schwann cells in either the peripheral or cranial nerves are known as schwannomas or also as neurilemmomas. Limited data exists regarding psoas muscle schwannoma in the literature. Therefore, we have done an extensive literature review and found a total number of 46 cases of intra-psoas schwannoma including our case, which are summarized in this article along with reporting our new case. PRESENTATION OF CASE: We report a very rare case of primary left intra-psoas muscle schwannoma in a 39-year-old Saudi gentleman, smoker with an unremarkable medical and surgical history. The patient presented to the emergency department with exacerbated chronic lower abdominal pain since almost 2 years. After conforming the diagnosis, the patient was admitted electively and underwent uneventful laparoscopic hand-assisted resection. DISCUSSION: Schwannomas are neurogenic tumors which known to be solitary, benign, well circumscribed, encapsulated, and slow-growing tumors. Multiple imaging modalities are used to detect such a tumor. Although there is no consensus on the best surgical approach, endoscopic mini-laparotomy, laparoscopy (anterior [as in our case] or lateral), and robotic resection were reported with good outcomes. CONCLUSION: Retroperitoneal schwannoma and intra-psoas muscle variant are a rare entity, with slow growing rate and risk of malignant transformation. Therefore, high index of suspicion, good follow-up, and large-cohort studies are encouraged.

Papillon-Lefèvre Syndrome and Basal Cell Carcinoma: A Case Study.

Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive disorder characterized by palmoplantar keratoderma and early-onset periodontitis. It was first described by Papillon and Lefèvre in 1924. PLS is caused by mutations in the cathepsin-C (CTSC) gene. The development of malignant skin neoplasms in PLS patients is extremely rare. To date, there have been two cases of malignant melanoma (MM) in PLS patients reported in international journals. Further, only one case of squamous cell carcinoma (SCC) has been reported in PLS patients. To the best of our knowledge, no cases with basal cell carcinoma in PLS patients have been reported in literature. Thus, we report a case of a 55-year-old male from Arabic Saudi with PLS and basal cell carcinoma. The patient was homozygous for a G-to-C substitution at the nucleotide position 815 (CTSC, c.815G>Cp.(Arg272Pro), which is a pathogenic variant. Since this is not the first case of skin cancer in PLS patients, we are supporting the possibility that cathepsin-C play a role in cancer development.

Malignant Mixed Germ Cell Tumor Overgrowing a Gonadoblastoma in a Female With a 46, XX Karyotype: A Case Report.

Gonadoblastoma is an uncommon ovarian tumor arising primarily in females with gonadal dysgenesis and a 46, XY karyotype. Germ cell tumors arising within and/or overgrowing a gonadoblastoma have been reported. We report a rare case of a malignant mixed germ cell tumor (yolk sac tumor and choriocarcinoma) arising in a gonadoblastoma of the left ovary in a 19-year-old female with a 46, XX karyotype. The patient's initial α-fetoprotein level was 20 000 KIU/L. The patient underwent a laparoscopic unilateral salpingo-oophorectomy with omentectomy and peritoneal washing followed by adjuvant chemotherapy.

Radiological tests versus pathological diagnostics: Complimentary or antagonistic relationship? The experience of a tertiary hospital.

INTRODUCTION: Early detection of breast cancer plays a pivotal role in the outcome of the disease. Diagnostic modalities encompass radiological and pathological findings. The aim of this study is to evaluate the correlation between the results of these two modalities in a tertiary hospital. MATERIALS AND METHODS: From a total of 180 patients, 203 ultrasound-guided breast core needle biopsies (US-CNBs) were included in this study over a period of a year (May 2015 - May 2016). All clinical parameters, the site of the biopsy, the size of the needle, the radiological findings, the pathological diagnoses as well as all available follow-up data were reviewed. The concordance between the radiological and pathological results was studied and a statistical analysis conforms to the Pearson Chi-square test was applied. RESULTS: The majority of our patients were above 40 years of age. A strong and statistically significant association was noted between radiological findings and histopathological results (Pearson's Chi-square test = 186.28, P ≤ 0.0001) with only four discordant cases (1.97%). This discrepancy was not statistically associated with age, site of biopsy, needle size, or number of cores obtained (P = 0.621, P = 0.584, P = 0.786, and P = 0.478, respectively). CONCLUSIONS: US-CNB is an accurate method in the diagnosis of breast lesions. Radiological and pathological correlation is of utmost importance in relation to patient's care and to reduce false rates. Follow-up of concordant benign lesions is essential. In addition, the importance of a multidisciplinary breast conference during which input from all teams caring for the patient is strongly emphasized.

Epithelioid mammary myofibroblastoma mimicking invasive lobular carcinoma.

A case of a 53-year-old woman with the epithelioid variant of mammary myofibroblastoma, which was initially misinterpreted as invasive lobular carcinoma, is presented. A needle core biopsy of the 1.6 cm mass showed interlacing bundles of epithelioid myofibroblasts amid dense fibrous tissue associated with lobular carcinoma in situ of the classical type. Most epithelioid cells showed nuclear atypia, and a few exhibited signet-ring cytology. Immunoreactivity for estrogen and progesterone receptors further compounded the deception, and the neoplasm was misinterpreted as invasive lobular carcinoma. Excisional biopsy showed a circumscribed stromal tumor with foci suspicious for invasive lobular carcinoma. The latter was excluded by cytokeratin negativity throughout the tumor. The overall histopathological appearance and immunostaining pattern was confirmatory of myofibroblastoma. This case report emphasizes the potential for mistaking epithelioid myofibroblastoma for invasive lobular carcinoma--particularly in the setting of limited sampling, hormone-receptor immunoreactivity of the lesional cells, and synchronous lobular carcinoma in situ.

Extrauterine epithelioid trophoblastic tumor arising in the ovary with multiple metastases: a case report.

Epithelioid trophoblastic tumor is a neoplasm of the chorionic-type intermediate trophoblasts. It is considered a rare gestational trophoblastic disease and is frequently misdiagnosed as carcinoma. Extrauterine epithelioid trophoblastic tumor has been reported in multiple anatomical sites. We report a case of a 50-year-old woman who presented with abdominal pain and distension. Her initial ß-human chorionic gonatotropin level was 806.7 IU/L. Imaging showed a large complex ovarian mass with peritoneal and subcapsular hepatic deposits as well as pulmonary nodules. Morphological features of the tumor and its immunohistochemical reactivity to CK8/18, CK7, p63, and CD10 were consistent with the diagnosis of an extrauterine epithelioid trophoblastic tumor arising from the ovary. The differential diagnoses, including other ovarian tumors, were ruled out on the basis of morphology and negative immunostaining to a relatively extended panel of antibodies. A prolonged follow up of these cases and the recognition of such rare tumors in unusual sites are crucial to the diagnosing pathologist and treating physician.

Vulvar extrauterine endometrial stromal sarcoma: A case report and literature review.

Endometrial stromal sarcoma (ESS) is an extremely rare neoplasm accounting for only 0.2% of all uterine malignancies and for 15-26% of primary uterine sarcomas. The annual incidence of ESS is 1-2 per million women. Herein, to the best of our knowledge, we present the first reported case of ESS of the vulva in a 50-year-old female presenting with per vaginal spotting over a period of three months. Her past surgical history included a subtotal hysterectomy and left salpingo-oophorectomy for uterine fibroids ten years previously. On examination, a 3.5×3×2 cm cystic mass was found in the right labia majora. The mass was excised and the diagnosis of endometrial stromal sarcoma was made. Subsequent metastatic workup was negative and the patient was started on megestrol acetate. She has remained disease free with no signs or symptoms of recurrent or advanced disease for 28 months.