Carcinosarcoma arising from high-grade serous carcinoma of the ovary without estrogen receptor, WT-1, and PAX8 immunoreactivity.

OBJECTIVE: We encountered a case of high-grade serous carcinoma (HGSC) of the ovary which recurred as carcinosarcoma of the sigmoid colon. Tumor cells of both the primary carcinoma and the secondary carcinosarcoma were negative for estrogen receptor (ER), WT-1, and PAX8. It is well known that most ovarian carcinomas arising from the Müllerian duct are immunoreactive for these biologic parameters. To our knowledge, this is the first case report that provides the results of immunohistochemical analysis of WT-1 and PAX8 for a primary carcinoma and recurrent carcinosarcoma. CASE REPORT: A 61-year-old woman had an advanced right ovarian HGSC. After a primary debulking surgery (hysterectomy, bilateral salpingo-oophorectomy and omentectomy) and adjuvant chemotherapy, complete remission was achieved. However, four and a half years later, a tumor arising beside the sigmoid colon was detected. A tumorectomy was performed through combined partial resection of the ileum and sigmoid colon. Microscopically, the tumor was diagnosed as carcinosarcoma of the sigmoid colon, which had originated from HGSC of the ovary. Interestingly, the malignant cells of the primary carcinoma and epithelial components of the recurrent carcinosarcoma were negative for ER, WT-1, and PAX8. These immunohistochemical features were unusual. Three cycles of chemotherapy with the previously used regimen and three additional cycles of doxorubicin and ifosfamide combination chemotherapy were administered. Currently, 3 years after the final chemotherapy was administered, the patient remains healthy. CONCLUSION: HGSC of the ovary can recur as carcinosarcoma. Tumor cells of the primary HGSC without ER, WT-1, and PAX8 expression may have dedifferentiated and recurred as carcinosarcoma.

Carcinomatosis peritoneal secundaria a cáncer de mama ductal infiltrante sincrónico a adenocarcinoma de sigma. Revisión bibliográfica a propósito de un caso tratado en nuestro hospital / Peritoneal carcinomatosis secondary to invasive ductal carcinoma synchronous to sigmoid adenocarcinoma. Literature review and report of a case treated in our hospital

OBJETIVO: Revisión bibliográfica del diagnóstico, tratamiento y supervivencia del carcinoma de mama metastásico que cursa con carcinomatosis peritoneal. PACIENTES Y MÉTODOS: Presentamos el caso de una paciente en tratamiento en nuestro hospital comentándose los aspectos clínicos, diagnósticos y terapéuticos de interés. CONCLUSIÓN: Las metástasis del tracto gastrointestinal extra-hepáticas secundarias a tumor de mama son poco comunes (8-10%). La carcinomatosis peritoneal presenta una baja incidencia, habiéndose descrito pocos casos en la literatura, siendo la mayoría de tipo lobulillar infiltrante. Nuestro caso tratado de carcinomatosis peritoneal de origen mamario ductal infiltrante lo hace aún más infrecuente

AIM: We provide a literature review of the diagnosis, treatment and survival of metastatic breast cancer with peritoneal carcinomatosis. PATIENTS AND METHODS: We present a case treated in our institution and discuss relevant clinical, diagnostic, and therapeutic features. CONCLUSION: Extra-hepatic gastrointestinal metastasis from breast cancer is infrequent (8%-10%). The incidence of peritoneal carcinomatosis is low, with few cases reported in the literature, mostly from invasive lobular carcinoma. Our case of invasive ductal carcinoma is even less frequent

Unusual Pattern of Invasive Lobular Carcinoma Metastasis: A Case Report.

BACKGROUND Metastasis of breast cancer to the gastrointestinal (GI) tract is not common, however, invasive lobular carcinoma is more likely to metastasize to the GI tract than ductal carcinoma. The simultaneous metastasis of invasive lobular carcinoma to the GI tract and ovaries is an extremely uncommon presentation, which may mimic another rare entity that is peritoneal carcinomatosis secondary to breast cancer. Diagnosis of this entity is difficult as it can masquerade as a primary disease process instead of a secondary one. Treatment is even more difficult due to the sparsity of guidelines regarding this presentation. CASE REPORT A 58-year-old female with a history of invasive lobular carcinoma of the left breast treated 5 years prior to presentation with GI symptoms. Workup revealed a stenosis of the sigmoid colon; however, colonoscopy and biopsy did not show signs of malignancy. The patient was initially diagnosed with diverticulitis and given appropriate treatment which mildly improved her symptoms but did not eradicate them. Continued symptoms and failed attempts at diagnosis prompted the decision to perform an exploratory laparotomy which revealed metastasis of invasive lobular carcinoma to the sigmoid colon, appendix, and ovaries. CONCLUSIONS GI metastasis of breast cancer is a difficult entity to diagnose and treat. Concomitant metastasis to the GI tract and genitourinary system is even more challenging to diagnose and treat. These variable metastasis presentations of breast cancer indicate a need for more specific modalities for follow-up of breast cancer patients especially those with the invasive lobular subtype which tends to metastasize to unusual distant sites and present years after diagnosis and treatment of the primary disease.

Diagnostic flow-chart to identify bowel involvement in patients with stage IIIC-IV ovarian cancer: Can laparoscopy improve the accuracy of CT scan?

OBJECTIVE: This study investigates the diagnostic power of CT scan combined with exploratory laparoscopy (EXL) at identifying large bowel involvement in patients with stage IIIC-IV primary Epithelial Ovarian Cancer (EOC) by comparing with the macroscopic surgical findings at laparotomy. METHODS: All patients with FIGO Stage IIIC-IV EOC who had Visceral Peritoneal Debulking (VPD) were included in the study. Results of CT scan, EXL and laparotomy (LPT) with regards to the bowel involvement were prospectively recorded in an ad hoc study form. Setting LPT findings as the gold standard, positive and negative predictive value (PPV/NPV), sensitivity, specificity and accuracy of CT and EXL were calculated. In addition, the diagnostic power of the combination CT scan + EXL was investigated. RESULTS: Ninety-four out of 177 patients (53.2%) had a bowel resection during VPD. CT-scan alone had sensitivity, specificity, PPV, NPV and accuracy of 56.7%, 72.4%, 70.8%, 58.5% and 63.8% respectively. EXL alone 84.4%, 93.8%, 93.8%, 84.3%, 88.8%. CT combined with EXL detected bowel involvement with a sensitivity, specificity, PPV, NPV and accuracy of 87.5%, 70.4%, 77.8%, 82.6% and 79.6% and respectively. The combined tests showed a statistically significant improvement vs. CT scan alone (p < 0001) in sensitivity, NPV and accuracy, with non-significant difference in specificity and PPV. CONCLUSIONS: CT-scan alone shows a limited diagnostic power at detecting large bowel involvement in patients with stage IIIC-IV EOC. The combination of CT scan with EXL increases the diagnostic power and enables to appropriately plan the bowel resection and consent the patients.

Multiple metastases of bones and sigmoid colon after mastectomy for ductal carcinoma in situ of the breast: a case report.

BACKGROUND: The prognosis of ductal carcinoma in situ (DCIS) is reportedly well. Extremely rare patients with DCIS develop distant breast cancer metastasis without locoregional or contralateral recurrence. This is the first report of multiple bones and sigmoid colon metastases from DCIS after mastectomy. CASE PRESENTATION: A 43-year-old woman was diagnosed with DCIS, and she received mastectomy, followed by endocrine therapy and target therapy. During the following-up, convulsions and pain on the legs were complaint. Therefore, Computed Tomography (CT) on bones and positron emission tomography (PET) for whole body were examined in order. Multiple bones and sigmoid colon were under the suspect of metastases, which were then verified by biopsy in the left ilium and colonoscopy respectively. CONCLUSIONS: This case reveals the heterogeneous behavior and the potential poor outcome of DCIS, regular examination and surveillance are necessary even though the distant metastasis rate in DCIS is low.

Colonic metastases 13 years after the primary ovarian cancer: a case study with a brief review of literature.

Metastatic ovarian malignancy is a known and dreaded complication of ovarian malignancy. Ovarian malignancies primarily disseminate through the peritoneal cavity and are only superficially invasive. They rarely metastasise through the haematogenous route, but that occurs in the presence of heavy peritoneal disease. The involvement of the colon in advanced ovarian malignancy is mostly through the peritoneal seedlings. It is very rare for an ovarian malignancy to invade through the serosa into the submucosa and mucosa of an adjacent colonic segment in the absence of active peritoneal disease. This occurring 13 years after the primary malignancy and after receiving a full course of chemotherapy is very interesting. There is always a possibility of a second primary cancer but in this case immunohistochemistry clearly clinched the diagnosis of an ovarian metastasis to the colon.

Aportación de la PET/TC con 11C-colina en la recidiva bioquímica del cáncer de próstata con antígeno específico prostático sérico inferior a 1 ng/ml / Contribution of 11C-Choline PET/CT in prostate carcinoma biochemical relapse with serum PSA level below 1 ng/ml

Objetivo. La PET/TC con 11C-colina ha mostrado buenos resultados en la reestadificación del cáncer de próstata (CP) con antígeno específico prostático (PSA) elevado. Su uso con niveles bajos es controvertido. Nuestro objetivo fue evaluar la aportación de la 11C-colina PET/TC en pacientes con CP, recidiva bioquímica y PSA <1ng/ml. Material y método. Se evaluaron retrospectivamente 50 pacientes consecutivos (edad: 65,9±5,6 años) con recidiva bioquímica de CP y PSA <1ng/ml (media: 0,4±0,2). La PET/TC fue adquirida a los 20 min de la administración intravenosa de 555-740 MBq de 11C-colina. El seguimiento mínimo fue de 30 meses. Resultados. De los 50 pacientes, 21 (42%) mostraron una 11C-colina PET/TC anormal. En 7 (14%) se confirmó la afectación tumoral (4 en lecho prostático, 4 en ganglios pélvicos, 2 en ganglios mediastínicos y un tumor síncrono sigmoide) y se modificó en todos ellos el tratamiento inicialmente previsto. En 2 pacientes (4%) se confirmó enfermedad benigna (uno con sarcoidosis, otro con secuelas de TBC) y en 3 pacientes (6%) ausencia de enfermedad. En los otros 9 pacientes (18%) los hallazgos no fueron estudiados (7 en ganglios mediastínicos y 4 en pélvicos). La 11C-colina PET/TC fue normal en 29 pacientes (58%). Solo en 2 de ellos se confirmó recidiva a los 30 meses. Conclusión. La 11C-colina PET/TC demostró su utilidad en la recidiva bioquímica de CP y PSA <1 ng/ml en el 14% de los pacientes al mostrar enfermedad tumoral, lo que tuvo implicaciones terapéuticas. En un 4% se detectó enfermedad benigna. Una 11C-colina PET/TC normal se asoció a una tasa de recurrencia muy baja a los 30 meses

Objective. 11C-choline PET/CT has demonstrated good results in the restaging of prostate cancer (PCa) with high serum prostate specific antigen (PSA), but its use in patients with low serum PSA is controversial. Our aim was to evaluate the contribution of 11C-choline PET/CT in patients with PCa, biochemical relapse and PSA <1 ng/ml. Material and method. Fifty consecutive patients (mean age: 65.9±5.6 years) with biochemical relapse of PCa and serum PSA <1ng/ml were evaluated retrospectively. PET/CT was performed 20min after intravenous administration of 555-740 MBq of 11C-choline. Minimum follow up time was 30 months. Results. Twenty-one out of 50 patients (42%) had an abnormal 11C-choline PET/CT. In 7 out of 21 patients (14%) tumor was confirmed (4 in prostatic bed, 4 in pelvic lymph nodes, 2 in mediastinal lymph nodes and one synchronous sigmoid carcinoma), and in all cases the initial therapeutic planning was modified. In 2 patients (4%) subsequent tests diagnosed a benign disease (one sarcoidosis, one tuberculosis sequelae) and in 3 patients (6%) they ruled out pathology. The other 9 patients (18%) had no further assessment (7 mediastinal and 4 pelvic lymph nodes). Twenty-nine out of 50 patients (58%) had a normal PET/CT. At 30 months, follow up recurrence was confirmed only in 2 of these patients. Conclusions. 11C-choline PET/CT proved its usefulness in demonstrating tumor in 14% of patients with BR of PCa and serum PSA <1ng/ml, with therapeutic implications. In 4% of patients a benign condition was detected. A normal 11C-choline PET/CT was associated with a very low rate of recurrence at 30 months

Ovarian Clear Cell Adenofibroma of Low Malignant Potential Developing Into Clear Cell Adenocarcinoma.

Ovarian clear cell adenofibroma is uncommon, and borderline clear cell adenofibroma (low malignant potential) is extremely rare. Borderline clear cell adenofibromas may represent the precursor lesion of clear cell adenocarcinoma of the ovary, but this has not been established. We present a case of a woman in her mid-50s with a clear cell adenofibroma ranging from benign to borderline to frankly invasive. While some clear cell adenocarcinomas are thought to arise from endometriosis, this range of findings supports the theory that some ovarian clear cell adenocarcinomas originate from borderline tumors.

Contribution of 11C-Choline PET/CT in prostate carcinoma biochemical relapse with serum PSA level below 1 ng/ml. / Aportación de la PET/TC con 11C-colina en la recidiva bioquímica del cáncer de próstata con antígeno específico prostático sérico inferior a 1 ng/ml.

OBJECTIVE: 11C-choline PET/CT has demonstrated good results in the restaging of prostate cancer (PCa) with high serum prostate specific antigen (PSA), but its use in patients with low serum PSA is controversial. Our aim was to evaluate the contribution of 11C-choline PET/CT in patients with PCa, biochemical relapse and PSA <1 ng/ml. MATERIAL AND METHOD: Fifty consecutive patients (mean age: 65.9±5.6 years) with biochemical relapse of PCa and serum PSA <1ng/ml were evaluated retrospectively. PET/CT was performed 20min after intravenous administration of 555-740 MBq of 11C-choline. Minimum follow up time was 30 months. RESULTS: Twenty-one out of 50 patients (42%) had an abnormal 11C-choline PET/CT. In 7 out of 21 patients (14%) tumor was confirmed (4 in prostatic bed, 4 in pelvic lymph nodes, 2 in mediastinal lymph nodes and one synchronous sigmoid carcinoma), and in all cases the initial therapeutic planning was modified. In 2 patients (4%) subsequent tests diagnosed a benign disease (one sarcoidosis, one tuberculosis sequelae) and in 3 patients (6%) they ruled out pathology. The other 9 patients (18%) had no further assessment (7 mediastinal and 4 pelvic lymph nodes). Twenty-nine out of 50 patients (58%) had a normal PET/CT. At 30 months, follow up recurrence was confirmed only in 2 of these patients. CONCLUSIONS: 11C-choline PET/CT proved its usefulness in demonstrating tumor in 14% of patients with BR of PCa and serum PSA <1ng/ml, with therapeutic implications. In 4% of patients a benign condition was detected. A normal 11C-choline PET/CT was associated with a very low rate of recurrence at 30 months.

[CA19-9 Producing Gastric Cancer with Early Recurrence of Multiple Colon Metastases Following Gastrectomy-A Case Report].

A 90-year-old male underwent total gastrectomy for gastric cancer 10 months earlier. The cancer was pathologically diagnosed as Stage ⅢA. Preoperative serum CA19-9 level was as high as 1,326 U/mL, but quickly decreased after surgery. Although the serum CA19-9 level gradually re-increased, CT did not reveal recurrence of the disease. Ten months following surgery, the patient visited our hospital due to vomiting, and ileus was suspected because of finding of sigmoid colon tumors in the abdominalCT. Colonoscopy showed a circumferentialtumor with severe stenosis in the sigmoid colon, which was diagnosed as tubular adenocarcinoma by biopsy. After preoperative diagnosis of multiple colon cancers, sigmoidectomy was performed. A total of 4 tumors were revealed in the resected specimen. Pathological findings showed cancer cells with nuclear atypia in all tumors, which was very similar to findings in the previous gastric cancer. Immunohistochemical staining confirmed high expression of CA19-9 in both gastric and colon tumors. We concluded that the tumors were metastases of the CA19-9 producing gastric cancer.

Renal cell carcinoma with isolated metastasis to sigmoid mesentery: a rare resectable combination.

Renal cell carcinoma accounts for 2%-3% of all malignancies in adults. It spreads via direct extension, lymphatic route as well as haematogenous route. Lymph nodes, lungs, bone, liver and brain are the usual sites for its metastatic spread. In the presence of limited metastatic disease with potentially resectable metastases, surgery offers the best chances of cure. In the present case, we describe a case of renal cell carcinoma with a solitary metastasis to the sigmoid mesentery in a patient with Von Hippel-Lindau syndrome. There was no retroperitoneal lymphadenopathy or tumour thrombus in the renal vein. The patient was managed with laparoscopic radical nephrectomy and excision of the sigmoid mesentery mass. At 6 months of follow-up, there is no evidence of recurrent disease.

Adenocarcinoma in Continent Anal Urinary Diversion: Is a Sigma Rectum Pouch a Surgical Option After Failed Ureterosigmoidostomy?

OBJECTIVE: To report our experience of radical resection of secondary cancers after ureterosigmoidostomy. Ureterosigmoidostomy was the most common continent urinary diversion before the era of continent cutaneous diversion and neobladders, specifically in children. When performed for bladder exstrophy, patients will live with this kind of diversion for quite a long time. As a result, urologists will be confronted with patients presenting with an adenocarcinoma in their ureterosigmoidostomy. In most cases reported in the literature, an ileal conduit was used for urinary conversion. However, nowadays an ileal loop must not be the only solution for patients with a long life expectancy. MATERIALS AND METHODS: Between 2004 and 2015, 6 patients were treated for an adenocarcinoma in their ureterosigmoidostomy. All patients underwent radical resection of the tumor-bearing sigmoid colon. After thorough preoperative informed consent concerning the choice of future urinary diversion, such as conversion to an ileal conduit, construction of a continent catheterizable pouch, or repeat continent anal diversion, 4 patients chose a repeat continent anal urinary diversion. RESULTS: Up to this date, no complications or recurrences were seen after a median follow-up of 35 months. CONCLUSION: In patients with secondary malignancy of the colon, radical resection of the tumor-bearing bowel segment is mandatory. A repeat continent anal urinary diversion appears to be a feasible alternative to secondary urinary diversion after resection of the tumor-bearing sigmoid colon. However, a longer follow-up is required to determine whether the risk of secondary malignancy remains unchanged, and whether the risk is increased or decreased.

Accuracy of ultrasound in prediction of rectosigmoid infiltration in epithelial ovarian cancer.

OBJECTIVE: To examine prospectively the accuracy of ultrasound in predicting rectosigmoid tumor infiltration in patients with epithelial ovarian cancer. METHODS: Patients referred for a suspicious pelvic mass between 2012 and 2014 were examined by ultrasound following the standard protocol for assessment of tumor infiltration. Of the 245 patients examined, 191 had proven ovarian cancer and underwent primary surgery and were included in the analysis. Patients with apparently benign or inoperable disease were excluded. Rectosigmoid infiltration was evaluated by histopathology or according to perioperative findings. Clinical, pathological and laboratory parameters were analyzed as factors potentially affecting the sensitivity and specificity of sonography. RESULTS: The sensitivity of ultrasound in detecting rectosigmoid infiltration in patients with ovarian cancer was 86.3%, with specificity of 95.8%, positive predictive value of 92.6%, negative predictive value of 91.9% and overall accuracy of 92.1%. CONCLUSION: Ultrasound is a highly accurate method for detecting rectosigmoid tumor infiltration in ovarian cancer patients, and thus, can be used for planning adequate management, including patient consultation, surgical team planning, suitable operating time and postoperative care. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.