An enormous pelvic tumor in a 46-year-old woman with an elevated serum CA 125 level, what lies beneath it? Investigation of uterine tumors in postmenopausal women

Survival and prognostic factors among different types of liposarcomas based on SEER database

The aim of this study is to elucidate the disparities in survival and risk factors among different subtypes of liposarcoma, through analysis of epidemiological and prognostic data. The study cohort consisted of 12,822 patients diagnosed with liposarcoma in the United States between 2000 and 2021, whose data were retrieved from the Surveillance, Epidemiology, and End Results (SEER) program. The prognosis for different subtypes of liposarcoma and the associated factors such as age, tumor stage, intervention, gender, tumor grade, location, size, chemotherapy and radiotherapy, were retrieved from the database. Well-differentiated liposarcoma demonstrated the most favorable prognosis, with 5-year and 10-year survival rates of 82% and 68%, respectively, followed by myxoid liposarcoma, pleomorphic liposarcoma and dedifferentiated liposarcoma, which exhibited the poorest prognosis. Advanced age, higher tumor stage, and the absence of surgical intervention were associated with inferior survival outcomes across all subtypes. Male gender, higher pathological grade, and primary tumor sites outside the extremities were identified as risk factors for the prognosis of subtypes other than pleomorphic liposarcoma. Larger tumor size was an indicator of a worse prognosis in subtypes other than well-differentiated liposarcoma. Chemotherapy was a risk factor for the prognosis of well-differentiated and myxoid liposarcomas but had no significant correlation with the prognosis of pleomorphic and dedifferentiated liposarcomas. Radiotherapy served as a protective factor for the prognosis of subtypes other than well-differentiated liposarcoma. Survival and prognostic factors vary among the major subtypes of liposarcoma, necessitating individualized analysis for each subtype. Poorer outcomes can be anticipated in the dedifferentiated and pleomorphic subtypes, while well-differentiated and myxoid liposarcomas exhibit relatively favorable prognoses.

Small bowel obstruction secondary to uterine fibroids: a case presentation

Small bowel obstruction (SBO) is a serious condition with distinct symptoms such as constipation, vomiting, and abdominal distension. It is commonly caused by well-recognised factors. Recent advancements in imaging techniques and minimally invasive procedures have significantly improved our ability to accurately select patients for surgical intervention and promptly identify common SBO causes. Nonetheless, it is crucial to recognise that diagnosing rare SBO causes remains a challenge. We present a rare case of mechanical bowel obstruction caused by massive uterine fibroids in a 44-year-old woman. Large uterine fibroids can cause mechanical small intestine obstruction, although this is not a common cause. Diagnostic imaging, particularly computed tomography, plays a crucial role in diagnosing and determining appropriate management plans. Accurate monitoring and imaging can lead to improved patient outcomes by avoiding unnecessary surgical intervention and reducing morbidity and mortality rates. Treatment options include both medical and surgical methods. Both approaches have proven effective, with surgical procedures being the last resort if medical treatments are unsuccessful. The accuracy and efficacy of these surgical methods have shown promising results and significant prognostic benefits. It is critical to identify and report rare causes of bowel obstruction to improve future recognition and enhance patient outcomes.

Extraosseous Plasmacytomas: A Radiologist's Perspective-A Narrative Review of the Literature

Extraosseous plasmacytomas (EPs) are rare neoplasms originating from plasma cells, often associated with multiple myeloma. EPs are classified into three subtypes: extramedullary myeloma, solitary extramedullary plasmacytoma (SEP), and multiple solitary plasmacytomas. They can manifest in various anatomical sites, including the lung, mediastinum, breast, liver, pancreas, stomach, mesentery, kidney, small and large bowel, testis, and soft tissue. Despite their rarity, EPs present a diagnostic challenge due to their non-specific imaging appearances, which can mimic other neoplastic and inflammatory conditions. This review aims to describe the radiographic features of EPs in the chest, abdomen, and pelvis based on a thorough analysis of the existing literature. While imaging plays a crucial role in the detection and characterization of EPs, histological confirmation is necessary to differentiate them from other neoplastic entities. The review underscores the importance of considering EPs in the differential diagnosis, particularly in patients with a history of multiple myeloma. Understanding the imaging characteristics of EPs is essential for accurate diagnosis and appropriate management. Early imaging is crucial in these patients to exclude the possibility of EP, as timely diagnosis can significantly impact patient outcomes.

Follicular Thyroid Carcinoma Arising from the Struma Ovarii Coexisting with Papillary Thyroid Carcinoma, Hashimoto's Thyroiditis and Polycystic Ovarian Syndrome-a Case Report and Literature Review

Purpose

Struma ovarii is a highly specialized teratoma consisting primarily of mature thyroid tissue. However, malignant struma ovarii coexisting with thyroid carcinoma, not to mention autoimmune disease, is uncommon. Malignant struma ovarii complicated with papillary thyroid carcinoma, Hashimoto's thyroiditis and polycystic ovarian syndrome has never been reported in literature.

Patients and Methods

A 32-year-old female was admitted to our hospital due to a history of abdominal distension and menolipsis over the past half a year. Physical examination touched a 6 × 6 cm mass with a clear boundary, normal movement, and no pressing pain in the right adnexal area, Imaging revealed a cystic solid mass of 6 × 7 cm in the right ovary and the level of tumor markers including CA125, CA199, CA153, CEA, AFP were normal, but with low TSH and increased TPOAb, TGAb, TRAb. Laparoscopic right ovary tumor resection was performed, followed by comprehensive staging surgery, as well as thyroidectomy after pathologic diagnosis. The patient was diagnosed with a combination of follicular thyroid cancer from struma ovarii, papillary thyroid carcinoma and Hashimoto's thyroiditis, along with polycystic ovarian syndrome. Immunohistochemical staining showed positivity for Ag, CK-pan, CK7, PAX8 and TTF-1 in the right ovarian mass, and the left thyroid was positive for the BRAF V600E mutation.

Results

The patient underwent thyroxine suppression therapy and radioactive iodine 131I therapy after operation. Serum thyroglobulin was undetectable, and no signs of recurrence or metastasis were detected in the imaging examination at the 2-year follow-up.

Conclusion

Malignant struma ovarii coexisting with thyroid carcinoma is rare. No report has been identified in literature review on the rare malignant struma ovarii coexisting with thyroid carcinoma, Hashimoto's thyroiditis and polycystic ovarian syndrome. Our case can offer experience of diagnosis and treatment to some extent for such rare case. Therefore, it is essential to consider the association between ovarian tumors and the endocrine system. This case is valuable in understanding the diagnosis and management of such an unusual complicated disease.

Clinical aspects and therapeutic strategy in a case of urinary bladder endocervicosis

The diagnostic complexities posed by lesions within the urinary bladder underscore the need for personalised management approaches. Endocervicosis, a rare condition stemming from Müllerian tissue, is characterised by the benign infiltration of endocervical glands, predominantly affecting the urinary bladder. Despite the absence of definitive symptoms, meticulous preoperative assessment is imperative to ensure precise diagnosis and optimal surgical intervention. While typically benign, recent cases have hinted at a potential association with adenocarcinoma, underscoring the necessity for meticulous management. The management of endocervicosis lacks consensus, with suggested surgical modalities including transurethral resection or partial cystectomy. In this case, a 47-year-old woman presented to our department with chronic pelvic pain following hysterectomy for adenomyosis. Imaging tests revealed a solid lesion situated at the dome of the urinary bladder. Consequently, a segmental cystectomy with circular tumour-only excision, with minimal free surgical margins, was undertaken to preserve bladder integrity. Histopathological analysis confirmed the diagnosis of endocervicosis. While the reported cases of urinary bladder endocervicosis remain limited, this instance contributes valuable insights into its understanding and management. It underscores the pivotal role of accurate diagnosis and tailored surgical intervention in optimising patient outcomes and mitigating postoperative complications, with tumour-only excision emerging as a promising and feasible approach.

Multiple benign metastasizing leiomyoma in the abdominal wall: a case report and literature review

Benign metastasizing leiomyoma (BML) is a rare disease that results from metastasis of uterine leiomyoma to distant sites with benign pathologic features. The lung is the most common metastatic site for BML. This report describes the case of a 49-year-old woman who presented with a mass in the abdominal wall with a surgical history of uterine myomectomy. Ultrasound and Magnetic resonance imaging (MRI) revealed multiple mass lesions. The histopathology of the mass specimen indicated BML. The imaging and clinical features of BML are discussed based on the characteristics of this case and related literature reports.

A rare case of squamous cell carcinoma associated with a huge ovarian dermoid cyst in a postmenopausal woman

Malignant transformation of mature cystic teratoma (MCT) is a well-known but uncommon phenomenon seen mostly in postmenopause women. We report a case of a 65-year-old postmenopausal woman with a malignant transformation of MCT and with a low-grade squamous intraepithelial lesion in her cervix. She was treated surgically by total abdominal hysterectomy with bilateral salpingo-oophorectomy with a preoperative diagnosis of right ovarian teratoma. Her postoperative period was uneventful. On follow-up, the histopathology report revealed a right ovarian dermoid cyst with well-differentiated squamous cell carcinoma; there was no evidence of malignancy elsewhere, including the cervix. Ascitic fluid was also free of malignant cells, and the disease was at stage Ia. The patient did not receive any adjuvant chemotherapy and was followed up with clinical examination postoperatively for 1 year, and there was no evidence of any relapse clinically. Preoperative diagnosis of malignant transformation of squamous cell carcinoma (SCC) is difficult, as there is no specific screening marker and no consensus or standard guidelines available regarding the optimum management of this relatively poorly known entity. Here we emphasize the need for a high index of suspicion of malignant transformation with the presence of factors such as elderly age, the huge size of the tumor, and large solid components in the tumor. Considering the scarcity of case reports and studies about SCC arising from MCT, every experience with malignant transformation of MCT should be reported for a better understanding of the disease presentation and management.

Ultrasound-Guided Diagnosis of Multiple Uterine Fibroids in a Patient With Polycystic Ovaries and Treatment With Relugolix, Estradiol, and Norethisterone Acetate

Uterine fibroids and ovarian cysts are common gynecological conditions that, while benign, when present simultaneously with bacterial vaginosis, can present a more complicated course of management. Symptoms of uterine fibroids include menorrhagia and dysmenorrhea, while ovarian cysts may present with pelvic pain and an adnexal mass. Each condition is typically managed separately; however, they can coexist in some patients, leading to a more complex presentation. This case report presents a 35-year-old African American female patient with the simultaneous occurrence of uterine fibroids and ovarian cysts, complicated by recurrent vaginitis, along with the treatment approach. The treatment choice, relugolix, estradiol, and norethisterone (norethindrone) acetate, is the first once-daily U.S. Food and Drug Administration (FDA) combination hormonal medication approved for menorrhagia due to fibroids. This case is unique in that although the diagnoses are common, their coexistence makes for a more complex presentation, and the course of management presents a newly approved fixed-dose combination hormonal medication. This report discusses the incidence, pathophysiology, diagnosis, and management of uterine fibroids and ovarian cysts. Factors that may contribute to the concurrence of these conditions, such as genetic, hormonal, and environmental risks, are also explored. Diagnostic modalities and ultrasound techniques are reviewed, and treatment options, such as surgery and medical management, are discussed. The importance of a patient-centered approach in the treatment of multi-symptom gynecological disorders and the need to consider conservative management are emphasized.

Anatomic Distribution of Benign Ovarian Tumors in Perimenopausal and Postmenopausal Women

Introduction We aim to report the histotypes and reassess the anatomic distribution of benign ovarian tumors in perimenopausal and postmenopausal women. Methods Medical and pathology reports of women with histologically confirmed benign ovarian pathology were investigated. Data were collected, retrospectively between 2000 and 2020, and analyzed from perimenopausal and postmenopausal women with benign ovarian tumors, after bilateral salpingo-oophorectomy (BSO) with or without total abdominal hysterectomy (TAH). The ovarian masses histology and the distribution of locations were further evaluated. Results The total sample consisted of 1,355 women with benign ovarian tumors; 929 (68.6%) of the perimenopausal and 426 (31.4%) of the postmenopausal age. A dermoid cyst was prominent in the right ovary (52.8%), compared to the left side (41%) (p<0.01). Conversely, in patients with endometriomas and cysts of Morgagni, the observed proportion was more prominent in the left-sided ovary (61.8% vs 27%; p<0.001 and 52.3% vs 36.4%; p<0.01, respectively). Moreover, in the perimenopausal women, we mostly detected endometrioma (18.3%), dermoid cyst (15.5%) and cyst of Morgagni (4%) compared to postmenopausal women, where serous cysts (29.8%) and ovarian fibroids (8%) were the most common tumors. Conclusions Benign ovarian tumors are frequently seen in perimenopausal women and most histotypes present anatomical differences between the left and right ovaries. Serous cysts, followed by paraovarian, dermoid cysts and endometrioma present the commonest ovarian benign masses. Gynecologists should pay special attention to adnexal tumors in the postmenopausal period to choose the right operating setting for women at risk for ovarian cancer.

Gastric-type Mucinous Carcinoma with an Abnormal Increase of CA199: A Case Report and Literature Review

Objective

Gastric-type mucinous carcinoma (GAS), as a rare subtype of mucinous adenocarcinoma, accounts for approximately 1%–3% of cervical adenocarcinoma. It was considered as a new type of cervical mucinous adenocarcinoma by the World Health Organization (WHO) in 2014. GAS represents more aggressive disease than does usual type endocervical adenocarcinoma (UEA).

Case report

A case of cervical adenocarcinoma with an abnormal increase of CA199 in a 50-year-old Chinese woman was reported. Our patient presented with abnormal vaginal discharge and combined with elevated Ca199 at the value of 2,729 U/mL. Imaging examinations showed no abnormalities. Diagnostic conical resection suggested cervical adenocarcinoma in situ. Post-operative pathology confirmed mucinous cervical adenocarcinoma (considering gastric type), infiltrating cervical interstitial >2/3, involving the deep myometrium, accompanied by vascular carcinoma infiltration and lymph node metastasis.

The patients received an extensive hysterectomy and post-operative adjuvant chemoradiotherapy. The chemotherapy regimen was paclitaxel, combined with platinum. After 20 months of follow-up, the patient showed no signs of recurrence.

Conclusion

Preoperative diagnosis of cervical adenocarcinoma is insidious and can be easily misdiagnosed. For patients with high preoperative Ca199, the possibility of GAS should be kept open.