Rapidly growing bilateral ovarian cystadenoma in a 6-year-old girl: case report and literature review

Locally advanced cervical rhabdomyosarcoma in adults: A case report

BACKGROUND

Rhabdomyosarcoma is a soft tissue tumor of primitive mesenchymal cells origin, occurring predominantly in children and adolescents, but extremely rare in adults and the data regarding its treatment are sparse. Here, we would like to share our experience in the treatment of a locally advanced primary embryonal rhabdomyosarcoma of cervix in a 39-year-old female.

CASE SUMMARY

The patient was admitted with symptoms of intermenstrual bleeding and postcoital bleeding for six months. Physical examination revealed a friable, polyp-like mass (5 cm × 5 cm) in her cervix protruding into the vagina, while the uterus was mobile and normal-sized. Colposcopy-directed biopsy was performed, and a pathological diagnosis of embryonal rhabdomyosarcoma was made. Magnetic resonance imaging of the pelvis showed that the cervical volume was significantly increased, with a hypointense and hyperintense soft tissue mass on the right side, invading the cervical stroma; the mass was 5 cm × 5 cm with a clear boundary and confined to the cervix; there were no obvious findings indicating tumor invasion in the vaginal wall, parametrium, or pelvic wall; no enlarged lymph nodes were observed in the pelvic cavity. Based on our findings, the tumor was classified as stage IA according to the intergroup rhabdomyosarcoma studies criteria and IB3 stage according to The International Federation of Gynecology and Obstetrics 2018. The patient underwent two courses of neoadjuvant chemotherapy and a partial remission was achieved. Subsequently, she underwent laparoscopic radical hysterectomy, bilateral salpingo-oophrectomy and pelvic lymph node dissection and there were no risk factors revealed by postoperative pathological examination. Adjuvant chemotherapy was performed after surgery. The patient was disease-free until the last follow-up, 49 mo after completing the entire treatment.

CONCLUSION

Our experience suggests that neoadjuvant vincristine, dactinomycin, and cyclophosphamide chemotherapy followed by radical surgery and adjuvant chemotherapy might be reasonable therapeutic option for bulky cervical rhabdomyosarcoma in adults without fertility desire. Since large-scale studies on such rare conditions are rather impossible, further case reports and systematic reviews could help optimize the treatment of primary, bulky cervical rhabdomyosarcoma in adults.

Ovarian borderline tumors in pre-menarche girls

By reason of a new case of an ovarian mucinous borderline tumor (BOT) in a pre-menarche girl, a research of current literature was implemented. Low-grade malignant epithelial tumors are extremely rare in young children and, as far as we know, only a few case reports exist. The patients presented with vomiting, pain, and a swollen lower abdomen. Pre-operative diagnosis primarily consists of imaging techniques. At Stage Ia, the tumor is confined to the ovary without penetration of the capsule, no malignant ascites or peritoneal implants. Treatment consists of removal of the tumor combined with concurrent salpingo oophorectomy, appendectomy, omentectomy, and peritoneal lavage. Although the treatment recommendations are not uniform, basically, preservation of fertility is the main objective. The prognosis is very good, but recurrence is possible even after 10 years.

Recurrent bilateral serous cystadenomas in a premenarchal girl: a case report and literature review

BACKGROUND

Ovarian serous cystadenomas are rare in children. No case of recurrence after surgical resection in a premenarchal girl has been published.

CASE

An 8-year-old presented with abdominal pain and ultrasound showed bilateral ovarian cystic masses with normal clinical and laboratory exam. Cystectomies were performed revealing serous cystadenomas. Ten months later, her pain returned and ultrasound showed new cysts. Persistence of cysts and symptoms required repeat surgery with the same pathology.

SUMMARY AND CONCLUSION

Premenarchal girls with ovarian cystic masses require surgical intervention in cases of persistent symptoms, uncertain diagnosis, or concern for ovarian torsion. With reassuring imaging and tumor markers, conservation of the ovary can be achieved with cystectomy alone. Ultrasound follow-up is recommended after surgical resection until bimanual exam can be performed.

Bilateral ovarian serous borderline tumor with a giant non-invasive peritoneal implant in a four-year-old girl

Epithelial ovarian tumors are uncommon before 20 years of age and rarely occur before puberty. The vast majority of these tumors are benign, and few cases of malignant and borderline tumors are described. We report a case of a 4-year-old premenarchal girl, previously healthy, who presented with two abdominal masses. Laboratory analysis of blood showed elevation of the serum level of the CA-125. Ultrasonographic examination disclosed bilateral cystic ovarian masses. Laparoscopic exploration revealed bilateral ovarian multicystic masses with retro-uterine peritoneal implant. Bilateral salpingo-oophorectomy with implant resection was performed. Histologic findings were consistent with a serous borderline tumors of both ovaries and the peritoneal implant was of the non-invasive type. There is no evidence of recurrence at 3-year follow-up. To our knowledge, there are only four cases of ovarian borderline tumors in premenarchal girls reported in the English literature: three of the mucinous type and only one of the serous type.