Mature cystic teratoma with co-existent mucinous cystadenocarcinoma: describing a diagnostic challenge-a case report.

BACKGROUND: Mature cystic teratoma co-existing with a mucinous cystadenocarcinoma is a rare tumor that few cases have been reported until now. In these cases, either a benign teratoma is malignantly transformed into adenocarcinoma or a collision tumor is formed between a mature cystic teratoma and a mucinous tumor, which is either primarily originated from epithelial-stromal surface of the ovary, or secondary to a primary gastrointestinal tract tumor. The significance of individualizing the two tumors has a remarkable effect on further therapeutic management. CASE PRESENTATION: In this case, a mature cystic teratoma is co-existed with a mucinous cystadenocarcinoma in the same ovary in a 33-year-old Iranian female. Computed Tomography (CT) Scan with additional contrast of the left ovarian mass suggested a teratoma, whereas examination of resected ovarian mass reported an adenocarcinoma with a cystic teratoma. A dermoid cyst with another multi-septate cystic lesion including mucoid material was revealed in the gross examination of the surgical specimen. Histopathological examination revealed a mature cystic teratoma in association with a well-differentiated mucinous cystadenocarcinoma. The latter showed a CK7-/CK20 + immune profile. Due to the lack of clinical, radiological, and biochemical discoveries attributed to a primary lower gastrointestinal tract tumor, the immune profile proposed the chance of adenocarcinomatous transformation of a benign teratoma. CONCLUSIONS: This case shows the significance of large sampling, precise recording of the gross aspects, histopathological examination, immunohistochemical analysis, and the help of radiological and clinical results to correctly diagnose uncommon tumors.

Primary Retroperitoneal Mucinous Cystadenocarcinoma during Long-term Administration of Infliximab for the Treatment of Crohn's Disease.

We herein report a rare case of primary retroperitoneal mucinous cystadenocarcinoma (PRMC) in a 60-year-old man. The patient, who had been treated with infliximab for Crohn's disease of the colon for 13 years, was referred to our hospital for lower back pain. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging revealed multiple cystic lesions in the right retroperitoneum, the calcification of the cyst, and bone lesions. Bone and CT-assisted biopsies of the retroperitoneal lesions revealed poorly differentiated adenocarcinoma. The patient was diagnosed with PRMC with bone metastases using immunohistochemical staining and positron emission tomography/CT.

Primary retroperitoneal mucinous cystadenocarcinoma in pregnancy - case report.

INTRODUCTION: Primary retroperitoneal mucinous cystadenoma (PRMC) and its malignant variant - cystadenocarcinoma are extremely rare tumors known only from case studies and reviews. PRMC is a cystic tumor of the retroperitoneum, which remains asymptomatic for a long time and can reach significant proportions. It occurs mainly in women. CASE REPORT: We present the case of a 38-year-old healthy woman with diagnosed resistance in the right mesogastrium during a c-section. The delivery was terminated without a surgical intervention. The above mentioned resistance was examined further by ultrasound, computed tomography and magnetic resonance imaging. All imaging examinations showed a solid - cystic bilocular expansion, which looked like a mesenteric cyst in the right paracolic area. The patient was asymptomatic at all times, with only a palpable resistance of the abdominal wall. In November 2020, the patient underwent an elective surgery - extirpation of the cystic tumor and prophylactic appendectomy. The operation was performed classically, via midline laparotomy without perioperative perforation of the cystic tumor and without complications in the postoperative period. The histopathological examination showed a malignant variant of PRMC. So far, the patient remains free of any problems and is followed at the department of oncology. CONCLUSION: The goal of treatment is to achieve complete surgical removal of the tumor without its perioperative perforation. Due to the rare occurrence of the disease, there are no guidelines for the diagnosis and treatment of PRMC. Precisely because PRMC is a rare tumor, it should be part of the differential diagnosis of cystic tumors of the retroperitoneum, especially when young women are concerned.

Mucinous cystadenocarcinoma in the renal pelvis: primary or secondary? Case report and literature review.

INTRODUCTION: Cystic lesions in the renal pelvis may cause a diagnostic dilemma. These lesions may be benign or (pre)malignant and primary of secondary. CASE REPORT: A 65-year-old woman presents with a complex cystic mass in the lower pole of the left kidney measuring approximately 16 cm in size and classified as Bosniak type 2F with minimally thickened septa and thick calcifications on non-contrast-enhanced computed tomography. The histopathological findings are consistent with a mucinous cystadenocarcinoma in the renal pelvis. Given the absence of a primary focus and based on clinical and radiological examination, the diagnosis of a primary renal neoplasm is preferred. DISCUSSION: A review of the literature is performed to evaluate the histological differential diagnosis and confirm the diagnosis. Epidemiology with an overview of available similar cases since 2009, as well as etiological factors, treatment and prognosis was reviewed. CONCLUSION: Primary renal mucinous cystadenocarcinoma is an exceedingly rare tumor. Histopathology still remains the gold standard for the diagnosis of this tumor. Because of the rarity, secondary involvement from more common sites, such as ovary and gastrointestinal tract, should be thoroughly excluded.

18F-FDG PET/CT Findings in a Patient With Primary Mucinous Cystadenocarcinoma of the Breast.

A 50-year-old woman presented with a mass in the upper outer quadrant of her left breast, which proved to be a mucinous cystadenocarcinoma by biopsy. An F-FDG PET/CT was performed for staging, which showed that the breast tumor was the only lesion with abnormal F-FDG avidity. Breast-conserving surgery was performed following a negative sentinel lymph node biopsy of the left axilla, and primary mucinous cystadenocarcinoma of the breast was finally diagnosed.

Etiologic Distribution of Pancreatic Cystic Lesions Identified on Computed Tomography/Magnetic Resonance Imaging.

OBJECTIVES: This study aimed to determine the distribution of etiology of pancreatic cysts using established criteria/markers from cyst fluid analysis and cytology that have been reported to have high specificity in published literature. METHODS: A retrospective study of pancreatic cysts using an endoscopic database from March 2002 and May 2013 was conducted. Pancreatic cysts <10 mm and cysts with a history of pancreatic cancer were excluded. RESULTS: In our cohort of 758 patients with pancreatic cyst(s), the cyst etiology was as follows: mucinous cyst/side-branch intraductal papillary mucinous neoplasms (SB-IPMNs)/mucinous cystic neoplasms (MCN; 48.2%), pseudocyst (27.6%), serous cystadenoma (11%), simple cysts (6.4%), mucinous cystadenocarcinoma (5.1%), and other (1%). Approximately 41% (n = 310) of the cysts were ≥3 cm in size and included the following: pseudocyst (39.7%), mucinous cysts/SB-IPMN/MCN (28.1%), serous cystadenoma (16.7%), mucinous cyst adenocarcinoma (9.7%), and simple cyst (4.8%). In 118 patients with a known history of acute pancreatitis, the cyst diagnoses included pseudocyst (68.7%), mucinous cyst/SB-IPMN/MCN (18.6%), benign/simple cyst (7.6%), and mucinous cystadenocarcinoma (2.5%). CONCLUSIONS: In patients with cystic pancreatic lesion noted on cross-sectional imaging, approximately half of the patients have lesions without malignancy or malignant potential and therefore not requiring surveillance. Endoscopic ultrasound/endoscopic ultrasound-guided fine-needle aspiration evaluation of the pancreatic cysts can help optimize their further management.

Urachal Mucinous Cystadenocarcinoma.

A 57-year-old man presented with a 6-month history of pelvic fullness. He had no lower urinary tract symptoms or altered bowel habits. On examination, there was a non-tender pelvic mass which extended from the pubic symphysis to the level of the umbilicus. CT scan of the abdomen demonstrated a 22×11×11 cm cystic mass arising from the pelvis extending into the midline and superiorly to the umbilicus. Other than raised carcinoembryonic antigen of 7.6 ng/mL (<5.0), the remainder of his blood test were unremarkable. Flexible cystoscopy demonstrated a convex deformity of the bladder wall in keeping with the compression and displacement as seen on the CT. The patient underwent an open excision of the cystic structure (urachal remnant), partial cystectomy, partial excision of anterior abdominal wall and pelvic lymphadenectomy. A check cystogram performed 12 days following the initial operation was unremarkable.

Resection of biliary mucinous cystic neoplasms of the liver: a prospective cohort series of 13 consecutive patients.

BACKGROUND: Biliary mucinous cystic neoplasms (BMCNs) are uncommon neoplastic septated intrahepatic cysts which are often incorrectly diagnosed and have the potential for malignant transformation. OBJECTIVE: To assess the outcome of surgical resection of BMCNs. METHOD: A prospective liver surgery database was used to identify patients who underwent surgery at Groote Schuur Hospital Complex for BMCN from 1999 to 2015. Demographic variables including age and gender were documented as well as detailed preoperative imaging, location and size, operative treatment, extent of resection, histology, postoperative complications and outcome. RESULTS: Thirteen female patients (median age 45 years) had surgery. Eleven were diagnosed by imaging for symptoms. Two were jaundiced. One cyst was found during an elective cholecystectomy. Five cysts were located centrally in the liver. Before referral three cysts were treated with percutaneous drainage and two were treated with operative deroofing. Six patients had anatomical liver resections and seven patients had non anatomical liver resections of which two needed ablation of residual cyst wall. One patient needed a biliary-enteric reconstruction to treat a fistula. Median operative time was 183 minutes (range: 130-375). No invasive carcinoma was found. There was no operative mortality. One surgical site infection and one intra-abdominal collection were treated. Two patients developed recurrent BMCN after 24 months. CONCLUSION: BMCNs should be considered in middle aged women who have well encapsulated multilocular liver cysts. Treatment of large central BMCNs adjacent to vascular and biliary structures may require technically complex liver resections and are best managed in a specialised hepato-pancreatico-biliary unit.

Mucinous Cystadenocarcinoma of the Breast: Report of 2 Cases Including One With Long-Term Local Recurrence.

Primary mucinous cystadenocarcinoma (MCA) of breast is an exceedingly rare tumor with histologic resemblance to MCA arising in ovary, pancreas, and gastrointestinal tract. In this article, we present 2 additional cases of MCA of breast, one highlighting the diagnostic challenges of a rare entity that may potentially lead to unnecessary chemotherapy and the second case presenting with recurrence after 8 years of primary surgical excision defying the indolent behavior reported in the literature. To our knowledge, this is the first reported instance of such behavior.

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.

Urachal mucinous adenocarcinoma with pseudomyxoma peritonei: A case report.

RATIONALE: Pseudomyxoma peritonei is an unusual clinical condition, and the appendix and ovaries are reported as the primary sites. PATIENT CONCERNS: A 44-year-old man who was reported a 3-month history of lower abdominal pain and distention, along with increased abdominal girth, was admitted with a palpable tender mass in the central lower abdomen. DIAGNOSIS: Ultrasonography showed a large well-circumscribed cystic-solid mass with lobulated margin, extending from the anterosuperior dome of the urinary bladder to the anterior abdominal wall. A computed tomography (CT) scan revealed a midline heterogeneous, hypodense, irregular polycystic-solid mass adjacent to the anterior wall of the abdomen and anterior to the dome of the urinary bladder. fluorodeoxyglucose positron-emission tomography/CT showed intense fluorodeoxyglucose uptake in the thickened wall of the mass. Intraperitoneal laparoscopic exploration also revealed a midline abdominal mass adjacent to the dome of the urinary bladder. Laparotomy showed that the mass originated from the dome of the urinary bladder and was disconnected with the urinary bladder lumen. The final histopathological diagnosis was urachal mucinous adenocarcinoma associated with high-grade pseudomyxoma peritonei. INTERVENTIONS: The patient underwent surgical cytoreductive procedure and the perioperative intraperitoneal chemotherapy. OUTCOMES: The patient made an uneventful recovery, and 7 months later had no recurrence. LESSONS: The urachus is a tubular structure, which extends medially from the apex of the bladder to the allantoid during fetal development, and it usually obliterates after birth. Urachal remnants can cause urachal carcinoma or bladder cancers. Pseudomyxoma peritonei originating from mucinous neoplasm of the urachus is extremely rare.

Pancreatic Cystic Neoplasms: An Update.

The incidence of pancreatic cystic neoplasms is rising, in part from detection through the increasing use of high-resolution cross-sectional imaging techniques. Initial diagnosis is generally based on imaging characteristics identified on computed tomography and/or MRI. Endoscopic ultrasound provides further imaging characterization and also enables fluid aspiration and analysis to additionally aid differentiation. The general approach to these lesions includes surgical intervention and/or surveillance imaging. Taking into account diverse presentations, varying malignant potential, and the uncertain natural history of some of these lesions, an evidence-based approach is limited. This article discusses recent updates in the diagnosis and management of cystic neoplasms of the pancreas.

Primary mucinous cystadenocarcinoma of the testis: An extremely rare ovarian-type surface epithelial carcinoma.

Primary mucinous epithelial tumors of the testis are extremely rare. Although isolated case reports and small series have been published, these interesting neoplasms are less well-known. We report a case of a primary intratesticular mucinous cystadenoma in an asymptomatic 44-year-old man. Right radical orchiectomy was performed because a malignant testicular tumor was suspected. We discuss the management of this uncommon testicular tumor based on the limited reports.

MRI, enhanced CT, and FDG PET/CT in primary retroperitoneal mucinous cystadenocarcinoma.

Primary retroperitoneal mucinous cystadenocarcinoma (PRMC) is an extremely rare neoplasm. We present a case of PRMC with MRI, enhanced CT, and FDG PET/CT findings. Abdominal MRI showed a cystic lesion in the retroperitoneum with a mural nodule. The mural nodule showed progressive enhancement on enhanced CT and intense FDG uptake on early PET/CT with increased SUVmax on delayed PET/CT. Laparoscopy was performed. Retroperitoneal mucinous cystadenocarcinoma was confirmed histopathologically. Metastasis from gastrointestinal tract or ovary was excluded. This case indicates, although rare, PRMC should be considered when a hypermetabolic retroperitoneal cystic lesion with bilateral normal ovaries is found on FDG PET/CT.

[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.

Differential diagnosis of pancreatic serous oligocystic adenoma and mucinous cystic neoplasm with spectral CT imaging: initial results.

AIM: To investigate the imaging characteristics of pancreatic serous oligocystic adenoma (SOA) and mucinous cystic neoplasms (MCNs) using spectral computed tomography (CT) and to evaluate whether quantitative information derived from spectral imaging can improve the differential diagnosis of these diseases. MATERIALS AND METHODS: From February 2010 to June 2013, 44 patients (24 SOAs and 20 MCNs) who underwent spectral CT imaging were included in the study. Conventional characteristics and quantitative parameters were compared between the two disease groups. Logistic regression was used for multiparametric analysis. The receiver-operating characteristic curve was used to evaluate the diagnostic performance of single parameter and multiparametric analysis. Two radiologists diagnosed the diseases blinded and independently, without and with the information of the statistical analysis. RESULTS: Tumour location, contour, size, and monochromatic CT values at 40 keV to 70 keV, iodine concentration, and effective atomic number (effective-Z) in the late arterial phase were the independent factors correlated with category. Multiparametric analysis with logistic regression showed that tumour size, location, and contour were the most effective variations, and obtained an area under the ROC curve (AUC) of 0.934. With the knowledge of statistical analysis, the accuracy of the first reader increased from 70.5% to 86.4%, and the accuracy of the second reader increased from 81.8% to 90.9%. CONCLUSIONS: Although CT spectral imaging provided additional information and multiparametric analysis obtained better performance than single-parameter analysis in differentiating MCNs from SOAs, multiparametric analysis with the combination of quantitative parameters derived from CT spectral imaging did not improve the diagnostic performance. Tumour size, location, and contour played an important role in differentiating MCNs from SOAs.

Mucinous cystadenocarcinoma of renal pelvis presenting as pyonephrosis.

Mucinous cystadenocarcinoma of renal pelvis is a rare epithelial tumor with poor prognosis. It is postulated to arise from metaplastic glandular mucosa in response to chronic irritation, and comprises less than 0.3% of total renal pelvic tumors. We present this case of a tumor noted in a 45-year-old lady that was diagnosed as mucinous cystadenocarcinoma on histological examination after radical nephrectomy. The patient is remaining well over a follow-up of three months.