Peritoneal mesotheliomas mimicking adnexal tumors. Clinicopathological characteristics of four cases and a short literature review

Three cases of peritoneal benign cystic mesotheliomas in women 32-34 years of age and one case of peritoneal malignant mesothelioma in a 47-year-old woman are reported. All cases presented with abdominal discomfort and/or pain and the physical and radiological diagnostic methods showed adnexal tumors. The cystic mesotheliomas developed in the cul-de-sac and the right pelvic sidewall, presented as multiple small cysts or large multilocular cystic mass. The malignant mesothelioma showed extensive infiltration of the omentum the intestinal loops and the surface of the uterus and adnexa, with bilateral hydrosalpinx and ascites. All cases presented histological and immunohistochemical characteristics consistent with tumors of mesothelial origin. No history of asbestos exposure was reported. The correct diagnostic and therapeutic approaches to these neoplasms are discussed.

A rare ovarian Leydig cell tumor (hilar type) causing virilization in a postmenopausal woman

All patients with virilization signs, increased levels of androgen hormones and rapidly progressive hirsutism should be evaluated for an androgen-producing tumor. The ovarian origin of virilization can be suspected by the presence of elevated levels of circulating androgens, with normal levels of cortisol metabolites and a negative dexamethasone suppression test. A case report of a 50-year-old postmenopausal patient with rapidly progressive hirsutism is presented. After an extensive preoperative investigation a right oophorectomy was performed and a Leydig-hilus cell tumor was diagnosed.

Virilizing ovarian Krukenberg tumor in a 27-year-old pregnant woman. A case report and literature review

A case is reported of a 27-year-old pregnant woman with ovarian tumors, measuring 12 cm and 11.5 cm in the greatest diameter, discovered during investigation for virilization symptoms. Termination of the pregnancy at the 22nd week of gestation and tumorectomy with both adnexa were performed, with the provisional diagnosis of arrhenoblastoma. Pathological examination of the tumors showed typical Krukenberg neoplasms and subsequent upper GI tract endoscopy revealed a gastric cancer that was excised. The pathological examination revealed a diffuse type gastric adenocarcinoma with signet ring morphology, similar to ovarian tumors. In any case of ovarian tumor with unusual hormonal manifestations, in addition to hormonally active sex cord-stromal neoplasms, metastatic ovarian tumors must be considered as well, especially in cases of bilateral tumors.

Extraovarian mature cystic teratoma of the mesentery. A case report and literature review

A case is reported of a 60-year old woman who had intermittent abdominal pain due to a mesenteric teratoma which was misdiagnosed by the standard methods of abdominal tumor diagnosis as an ovarian tumor. The neoplasm measured 9 x 8 x 8 cm, was filled by hair and sebum, and histologically presented the typical features of a mature cystic teratoma. The mesentery and overlying small intestine showed an extensive inflammatory granulomatous reaction. The uterus and adnexa were free of neoplasmatic disease. This case of extra ovarian mature cystic teratoma which developed in the mesentery is unique among > 2000 ovarian tumors examined during a 30-year period at Aretaieion Hospital Pathology Laboratory.

Monodermal teratomas (struma ovarii). Clinicopathological characteristics of 11 cases and literature review

During the last 15 years in the Pathology Laboratory of Aretaieion University Hospital, 256 cases of teratomas were examined and 11 cases (4.3%) presented characteristics of struma ovarii. Eight patients aged 19-34 years and four 41-74 years (median 41 years). One 74-year-old patient presented with virilization signs but pain and a pelvic mass were the most frequent symptoms. The tumors were unilateral in 9/11 cases, the size ranged from 5-17 cm, and they were compact or microcystic in 10/11 cases and cystic in one case. Histological pattern was microfollicular in 5/11 cases, solid in 3/11 cases, pseudoglandular in 2/11 cases, with focal clear and oxyphil cell changes, and infiltration of the fibrous wall in one case. Tumorectomy was performed in 9/11 cases and total hysterectomy with adnexa in two cases with large tumors (16-17 cm in diameter). Immunohistochemistry is useful in the recognition of struma in atypical cases. No malignant struma ovarii was observed in our cases. Tumorectomy is the appropriate therapeutic approach because of the benign nature of these tumors despite atypical histological features and the young age of the patients.