Advanced papillary adenocarcinoma of unknown origin as tumor previa during late pregnancy

Bilateral Maternal Pelvic Kidneys Presenting as a Tumor Previa: Sonographic Diagnosis and Obstetric Management

Renal ectopia occurs when the kidney fails to ascend normally to the retroperitoneal renal fossa. Bilateral cases have also been reported but are very rare. Pregnancy and labor with maternal renal ectopia provides a unique challenge to the obstetricians attempting to prevent damage to the kidneys during labor and allow safe delivery. We describe a case of congenital bilateral pelvic kidneys assessed and diagnosed by 3D sonography as “tumor previa” and managed accordingly.

Undiagnosed rectal tumour--a rare cause of obstructed labour in the second stage

Colorectal cancer presenting in pregnancy is extremely rare. Here the authors present the case of a 25-year-old woman who was diagnosed with second-stage obstructed labour secondary to a large rectal tumour. Decision for emergency caesarean section was made for labour dystocia. Histology later confirmed villous adenocarcinoma of the rectum. The patient died from metastatic rectal cancer within 2 years of diagnosis.

Retroperitoneal adenocarcinoma of unknown origin presenting as a rare cause of obstructed labor

BACKGROUND

Metastatic retroperitoneal adenocarcinoma presenting as obstructed labor is extremely rare.

CASE

An unbooked 35-year-old multipara came to our casualty in obstructed labor at 38 weeks of pregnancy. A palpable retroperitoneal mass was found behind the gravid uterus and cervix after delivery of a live baby during emergency cesarean section. Needle biopsy was taken from the mass and abdomen was closed due to nonavailability of frozen section facility at night. Post cesarean section CT scan confirmed the pelvic mass, which was subjected to open biopsy. A diagnosis of retroperitoneal adenocarcinoma with an unknown primary was made based on histopathology and a negative workup for the possible primary sites. Patient was treated successfully with chemotherapy and did not show recurrence for last 2 years of follow-up.

CONCLUSION

Surgeons should be aware of this extremely rare entity and it highlights the importance of proper antenatal care to pick up such pathology at an early stage by careful examination and ultrasound to minimize the morbidity and mortality. We also suggest frozen biopsy in a suspected pelvic mass during surgery and early cesarean section to avoid the complications of obstructed labor in such advanced stages of malignant tumor.

Serous surface carcinoma of the peritoneum: a clinicopathologic study of 22 cases

Serous surface carcinoma (SSC) of the peritoneum is defined as a primary tumor histologically indistinguishable from serous carcinoma of the ovary, diffusely involving the peritoneal surface but sparing or only superficially invading the ovaries. In this study of 22 cases of SSC, it was found that the main clinical manifestations of SSC were abdominal pain and enlargement. In most cases, SSC evenly involved the entire mesothelial surface but rarely was predominant in or even limited to the pelvis. It frequently invaded the submesothelium, but deep invasion into abdominal and pelvic organs or local metastasis was rare, and distant metastasis was not seen at presentation. Microscopically, SSC was a high-grade tumor frequently showing high mitotic rate, psammomas bodies, and necrosis. The tumor was usually contiguous with hyperplastic mesothelium on either ovarian surface or other locations. Tumor cells in all cases except one showed cytoplasmic or surface neutral or acidic mucin or both. Tumor cells stained positive for keratin (100% of cases), epithelial membrane antigen (100%), Leu-M1 (45%), B72.3 (85%), vimentin (35%), and carcinoembryonic antigen (25%). Electron microscopic studies of six cases showed epithelial differentiation in each. Seven patients (32%) were alive with no clinical disease at 3 to 31 months, one patient (4%) was alive with extensive local disease at 24 months, 11 patients (50%) died almost exclusively of local recurrence at 1 to 70 months, and three patients (14%) died of operative complications. It is concluded that SSC arises from peritoneal mesothelium but has epithelial phenotype. It can be morphologically differentiated from other conditions with similar laparotomy findings, such as malignant mesothelioma, benign papillary mesothelioma, cystic mesothelioma, and benign or borderline peritoneal serous tumors. The prognosis of SSC is poor, and most patients die of uncontrollable local disease.