Diagnostic dilemma in a case of malignant mixed mullerian tumor of the cervix.

BACKGROUND: Malignant mixed mullerian tumors (MMMT) are rare biphasic malignant neoplasm. The commonest site of their occurrence in female genital tract is body of the uterus. MMMT of the cervix is extremely rare. CASE PRESENTATION: We report the clinical, pathological and immunohistochemical profile and diagnostic difficulties in a case of giant MMMT of the cervix in a postmenopausal woman who presented with a large cervical mass. On microscopic examination, initially tumor appeared to be endometrial stromal sarcoma, however, immunohistochemical examination revealed the biphasic nature of the tumor. The malignant epithelial component was basaloid squamous carcinoma with homologous sarcomatous component. The patient was treated with surgery. However, she experienced vaginal vault recurrence four months after the initial treatment, which was successfully treated with pelvic radiotherapy. CONCLUSION: Accurate diagnosis of cervical MMMT is important for appropriate treatment of the patient.

Diagnostic dilemma in an elderly woman with intractable ascites and elevated CA-125 level.

In patients with intractable ascites, careful consideration should be given to the patient's past history with emphasis on cardiac, liver and renal disorders. Ascitic fluid cytology indicating the presence of malignant cells should be unequivocal; cytology should be repeated before embarking on potentially toxic anti-cancer treatment in ambiguous cases. Elevated serum CA-125 levels should not be relied upon to make the diagnosis of ovarian/peritoneal carcinoma. We report a case of tricuspid stenosis with severe ascites in an elderly woman who was initially mis-diagnosed and treated as peritoneal/ovarian carcinoma.

Metastatic clear cell variant of hepatocellular carcinoma with an occult hepatic primary.

Metastatic clear cell carcinomas are commonly seen in the kidney and lung. Clear cell variant of hepatocellular carcinoma is an uncommon tumour. Diagnosis is usually made by correlation of histopathology, tumour markers and immunohistochemistry, especially HepPar 1. In this unusual case of metastatic clear cell carcinoma presenting as Sister Mary Joseph's nodule, no primary evidence was observed radiologically in the liver, but the level of alfa fetoprotein was markedly elevated. Metastatic clear cell carcinoma of the liver with an occult hepatic primary was diagnosed by immunohistochemical profile of the tumour.

Benign cystic teratoma of ovary perforating into small intestine with co-existent typhoid fever.

Intra-peritoneal rupture or perforation into adjacent abdominal viscera is a rare complication of benign cystic teratoma (dermoid cyst) of the ovary. We report a 48-year-old woman in whom an ovarian dermoid cyst perforated into a loop of the small bowel. The patient had co-existing typhoid fever, which probably predisposed to this complication. She recovered on antibiotic therapy and after surgical excision.

Primary carcinoma of the female urethra: single center experience of 18 cases.

BACKGROUND: Primary carcinoma of the urethra is more common in women than in men. Vague symptoms in the early stages delay the diagnosis in most patients. Surgery and radiotherapy are used as treatment modalities for these tumors, either alone or in combination. METHODS: We retrospectively analyzed the records of 18 female patients with urethral cancer presented to our institution. Secondary tumors involving the urethra from adjacent organs like bladder carcinoma and gynecological cancer were excluded. RESULTS: In our review, the overall survival was 74% at 3 years and 33% at 5 years with median overall survival of 51 months. There was a statistically better overall survival in patients with early stage tumors compared with later stage disease (P = 0.03) and patients with distally located tumors had better survival compared with proximal and whole urethral involvement. CONCLUSIONS: The prognosis is poor in advanced stages and in those with proximal or whole urethral involvement, requiring extensive surgical procedures. The aim of treatment in distal urethral carcinomas should be local excision and radiotherapy, thereby preserving the bladder.