Adenoid Cystic Carcinoma (ACC) of the Bartholin's gland misdiagnosed for three times: a case report

BACKGROUND

Adenoid cystic carcinoma (ACC) in Bartholin's gland is an uncommon malignant tumor. These tumors have a vague clinical feature, so they are diagnosed late and discovered at a high-level stage. Our case presented Three Recurrences and Three times Misdiagnosis of Adenoid Cystic Carcinoma (ACC).

CASE PRESENTATION

We report a case of adenoid cystic carcinoma arising in Bartholin's gland of a 64-year-old female patient that appeared after three previous vulvar tumors were excised. The patient underwent bilateral radiotherapy which was performed on the perineum.

CONCLUSION

ACC of the vulvar sweat glands is prone to misdiagnosis and delay in both diagnosis and treatment. As seen in our case, it was misdiagnosed three times as Chondroid Syringoma. Further studies need to be conducted to better understand the tumor prognosis, and its optimal treatment options.

Benign multicystic peritoneal mesothelioma (BMPM) presenting with ambiguous symptoms: A rare case report

Introduction

Benign multicystic peritoneal mesothelioma (BMPM) represents a very rare clinical entity, with only 130 registered cases in the medical literature, therefore it is usually overlooked from the list of differential diagnoses. The treatment consists of surgery and other authors suggest complementing it with hyperthermic intraperitoneal chemotherapy.

Presentation of case

A 25-year-old multiparous female experienced periodic abdominal discomfort for two weeks. She developed constipation, urinary urgency, and irregular menstruation. Family history was remarkable for endometrial and breast cancer. Abdominal examination revealed a palpable mass. Abdominal ultrasound and computed tomography scan identified the multicystic appearance of the mass. The diagnosis was unclear, therefore exploratory laparotomy was performed, which revealed multiple grape-like clusters of cysts that were excised immediately. BMPM was diagnosed based on the pathology report. Eventually, the follow-up did not reveal any recurrence.

Discussion

Mesothelial tumors include three pathological entities, including Benign multicystic peritoneal mesothelioma (BMPM). BMPM is an uncommon neoplasm and has a high recurrence rate after surgery. BMPM consists of clear cysts that take the shape of a grape-like cluster. Clinically, BMPM resembles a tangible abdominal mass and it is challenging to be diagnosed, due to its numerous differential diagnoses.

Conclusion

The definitive diagnosis of intraperitoneal cystic masses is usually challenging. Therefore, BMPM -although very rare- should always be thought of when dealing with an intraperitoneal cystic mass, especially in women in the reproductive years. In our case cytoreductive surgery solely was sufficient to achieve a disease free follow up, however, further studies regarding treatment and follow-up are required.

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The incidence of Benign multicystic peritoneal mesothelioma (BMPM) is exceptionally rare.

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Pathological evaluation is considered the best technique to diagnose.

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BMPM is most common in women in reproductive age.

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BMPM should be considered as a differential diagnosis for abdominal masses.

HPLC determination of the metabolite 4-chloro-o-toluidine in the urine of workers occupationally exposed to chlordimeform

A reversed phase HPLC method (UV detection) is described or the analysis of 4-chloro-o-toluidine in the urine of workers occupationally exposed to chlordimeform. The procedure involves extracting an alkaline hydrolysate of urine with hexane, evaporating off the solvent, and reconstituting the residue with an aqueous acetonitrile mobile phase.