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Sealey AJ, Balasooriya J. Perforated appendicitis with endosalpingiosis. J Surg Case Rep 2024; 2024:rjae091. [PMID: 38426183 PMCID: PMC10902260 DOI: 10.1093/jscr/rjae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/04/2024] [Indexed: 03/02/2024] Open
Abstract
Endosalpingiosis a condition of ectopic glandular epithelium diagnosed histologically, most commonly on pelvic and abdominal peritoneum, that can be associated with abdominal pain mimicking appendicitis. There is evidence emerging that endosalpingiosis may be associated with serous ovarian malignancies. Here we describe a case of perforated appendicitis with concurrent endosalpingiosis. Further research is required to better elucidate the association between endosalpingiosis and malignancy, and the implications of a concurrent presentation with a hollow viscus perforation.
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Affiliation(s)
- Andrew J Sealey
- General Surgery, Canberra Health Services, Yamba Drive, Acton 2605, Australia
| | - Janaka Balasooriya
- General Surgery, Canberra Health Services, Yamba Drive, Acton 2605, Australia
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2
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Zhan H, Zhang H, Sun J, Wang W, Zhu J, Huang X. Refractory florid cystic endosalpingiosis: A case report with 5 years follow up and literature review. Int J Gynaecol Obstet 2023; 163:44-50. [PMID: 37014527 DOI: 10.1002/ijgo.14764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/13/2023] [Indexed: 04/05/2023]
Abstract
Endosalpingiosis is characterized by the presence of ectopic, benign glands with a fallopian tube-like ciliated epithelium. Florid cystic endosalpingiosis (FCE) is a rare type of endosalpingiosis and presents with tumor-like lesions. In general, FCE has no specific clinical features. In this case, extensive pelvic multiple Müllerian cysts were first observed and removed during the patient's second cesarean section. Lesions relapsed after a year. Therefore, the patient underwent total hysterectomy and bilateral salpingectomy; pathology revealed that the patient had FCE. According to imaging studies during the follow up, recurrent and progressive multiple pelvic and extra-pelvic cysts were observed. The patient had no obvious symptoms, and the results of her laboratory tests were within normal limits. Ultrasound-guided aspiration and lauromacrogol sclerotherapy were performed, and in the past year, the cysts have stabilized without progression. This is the first reported case of recurrent FCE after total hysterectomy and bilateral salpingectomy with a 5-year follow up. A literature review and novel ideas for diagnosing and managing FCE based on this case are also presented.
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Affiliation(s)
- Hong Zhan
- Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Obstetrics and Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongyun Zhang
- Department of Ultrasound, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jin Sun
- Department of Radiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenwen Wang
- Department of Pathology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiang Zhu
- Department of Ultrasound, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiufeng Huang
- Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Obstetrics and Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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3
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Otsuka I. Primary Retroperitoneal Carcinomas: New Insights into Pathogenesis and Clinical Management in Comparison with Ovarian Carcinomas and Carcinoma of Unknown Primary. Cancers (Basel) 2023; 15:4614. [PMID: 37760583 PMCID: PMC10526425 DOI: 10.3390/cancers15184614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/07/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
Primary retroperitoneal carcinomas are very rare tumors. Their pathogenesis remains unknown but may be associated with that of ovarian carcinomas, considering the similarity in morphology and gender preference. Although metaplasia of coelomic epithelium is the most widely accepted theory, the pathogenesis of retroperitoneal carcinomas may differ by histologic subtype, like ovarian carcinomas. Mucinous carcinoma, which develops in both women and men, may originate in both primordial germ cells and Walthard cell nests that may be derived from the fallopian tube. Serous carcinomas may be associated with endosalpingiosis, the presence of fallopian tube-like epithelium outside the fallopian tube, and a remnant Müllerian tract. Endometrioid and clear cell carcinomas appear to be associated with extraovarian endometriosis. Additionally, both carcinomas in the retroperitoneal lymph nodes may be metastatic diseases from endometrial and/or renal cell cancer that regress spontaneously (carcinoma of unknown primary). Retroperitoneal carcinomas are difficult to diagnose, as they have no characteristic symptoms and signs. Surgery is the cornerstone of treatment, but the necessity of chemotherapy may depend on histological subtype. Further studies are necessary, in particular studies on endosalpingiosis, as endosalpingiosis is a poorly understood condition, although it is associated with the development of both serous and mucinous carcinomas.
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Affiliation(s)
- Isao Otsuka
- Department of Obstetrics and Gynecology, Kameda Medical Center, Kamogawa 296-8602, Japan
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Dan C, Sahai A, Suri P, Singh J, Trehan RS. Mixed Epithelial Stromal Tumor of the Kidney With a Mesenteric Lymph Node: A Case Report and Literature Review. Cureus 2023; 15:e46058. [PMID: 37900393 PMCID: PMC10605561 DOI: 10.7759/cureus.46058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Mixed epithelial and stromal tumor (MEST) of the kidney belongs to the broad spectrum of renal neoplasms, distinguished by their varying composition of stromal to epithelial components. The histopathological display of the biphasic growth pattern of mesenchymal and epithelial elements, often with estrogen and progesterone receptor positivity, clinches the diagnosis. It is typically benign, with low recurrence rates and excellent prognosis after surgical resection. MEST constitutes a rare and unique subset, with limited research and understanding, requiring differentiation from other renal tumors. Our patient's presentation of a morphologically benign renal MEST with an imaging-positive inferior mesenteric lymph node renders this case exceptionally rare.
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Affiliation(s)
- Chitramalya Dan
- Hematology and Oncology, Greater Washington Oncology Associates, Silver Spring, USA
| | - Akshat Sahai
- Hematology and Oncology, Greater Washington Oncology Associates, Silver Spring, USA
| | - Priyasha Suri
- Hematology and Oncology, Greater Washington Oncology Associates, Silver Spring, USA
| | - Jaideep Singh
- Hematology and Oncology, Greater Washington Oncology Associates, Silver Spring, USA
| | - Ram S Trehan
- Hematology and Oncology, Greater Washington Oncology Associates, Silver Spring, USA
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Shapiro S, Abdulhak A, Lenczowski J, Sayeed S, Mochel M. Cutaneous endosalpingiosis arising from C-section scar: A case report with review of literature. J Cutan Pathol 2023; 50:310-315. [PMID: 36169222 DOI: 10.1111/cup.14335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 11/28/2022]
Abstract
Endosalpingiosis is a pathologic phenomenon in which non-neoplastic fallopian tube epithelium implants in ectopic locations. It is an uncommon and poorly understood condition, with most cases occurring within the abdominopelvic cavity. Cutaneous presentations of endosalpingiosis are even more rare, with only six cases described in international literature to-date. This report describes an additional case of cutaneous endosalpingiosis. The lesion arose within the scar tissue of a Pfannenstiel incision from 4 years prior in a 24-year old, previously healthy African American female. Punch biopsy of the lesion revealed a cystic mass lined by PAX8+ ciliated columnar cells and a surrounding fibrotic stroma with focal CD10-positivity, consistent with a histopathologic diagnosis of endosalpingiosis. In addition, this report provides a comprehensive review of the other documented cases of cutaneous endosalpingiosis, as well as the proposed pathogenesis, histopathologic and clinical features, and potential treatment avenues for this unique clinical entity.
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Affiliation(s)
- Sarah Shapiro
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Abraham Abdulhak
- Department of Dermatology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Joi Lenczowski
- Department of Dermatology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sadia Sayeed
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mark Mochel
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, USA
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Burla L, Kalaitzopoulos DR, Mrozek A, Eberhard M, Samartzis N. Intraoperative Appearance of Endosalpingiosis: A Single-Center Experience of Laparoscopic Findings and Systematic Review of Literature. J Clin Med 2022; 11. [PMID: 36498581 DOI: 10.3390/jcm11237006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Endosalpingiosis is assumed to be the second most common benign peritoneal pathology after endometriosis in women. Although recent studies indicate a significant association with gynecologic malignancies, many underlying principles remain unclear. This work aimed to systematically describe the intraoperative appearance of endosalpingiosis. Methods: Data and intraoperative videos of patients with histologically verified endosalpingiosis were retrospectively reviewed. The main outcome measures were macroscopic phenotype and anatomical distribution. Additionally, a systematic review searching PubMed (Medline) and Embase was conducted. Results: In the study population (n = 77, mean age 40.2 years (SD 16.4)), the mean size of lesions was 3.6 mm and the main visual pattern was vesicular (62%). The most frequent localization was the sacrouterine ligaments (24.7%). In the systematic review population (n = 1174 (210 included studies overall), mean age 45.7 years (SD 14.4)), there were 99 patients in 90 different studies with adequate data to assess the appearance of the lesions. The mean size of the lesions was 48.5 mm, mainly with a cystic visual pattern (49.5%). The majority of the lesions affected the ovaries (23.2%), fallopian tubes (20.4%), or lymph nodes (18.5%). Comparing this study to the literature population, the main differences concerned the size (p < 0.001) and main visual patterns (p < 0.001) of lesions. Conclusions: The usual intraoperative findings of endosalpingiosis appeared less impressive than described in the literature. In our study population, lesions of a few millimeters in size with a vesicular appearance were mostly seen, most frequently in the sacrouterine ligament area. Intraoperative recognition by the gynecologic surgeon and histologic diagnosis should play an important role in further understanding this entity, scientifically and clinically.
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Ortiz Requena D, Goiburu MB, Velez-Torres J, Ronquillo N, Livingstone AS, Rosenberg AE. Retroperitoneal Cystic Adenopecoma with Genetic Analysis: A Rare Neoplasm. Int J Surg Pathol 2022; 31:332-337. [PMID: 35815865 DOI: 10.1177/10668969221105616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lymphangiomyomatosis is a member of the PEComa family, and usually involves the pulmonary parenchyma of middle-aged females. Infrequently, it may involve abdominal and retroperitoneal lymph nodes, and rarely it has been described to be associated with fallopian tube-type ciliated epithelium co-existing in one neoplasm. To increase our understanding of this unusual tumor, we describe the morphology and genetics of one case and review the literature. We present the case of a 50-year-old female found to have 12.5 and 7.7 cm cystic retroperitoneal masses, describe its unique pathological features and review the literature on the previously reported cases. Based on its unique morphological, immunohistochemical, and molecular features we propose the term adenoPEComa to represent this entity. This case represents a rare example of adenoPEComa with lymphangiomyomatosis of the lymph nodes. It is the first example that has undergone next-generation sequencing revealing a mutation in TSC2 making it a confirmed member of the PEComa family of tumors.
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Affiliation(s)
- Domenika Ortiz Requena
- 23215Jackson Memorial Hospital/University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, Florida, USA
| | - Maria Belen Goiburu
- 23215Jackson Memorial Hospital/University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, Florida, USA
| | - Jaylou Velez-Torres
- 12235University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, Florida, USA
| | - Nemencio Ronquillo
- 12235University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, Florida, USA
| | - Alan S Livingstone
- 12235University of Miami Miller School of Medicine, Department of Surgery, Miami, Florida, USA
| | - Andrew E Rosenberg
- 12235University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, Florida, USA
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Rajha A, Piso P, Halmy L, Panczel I, Nedelcut DS, Herold Z, Szasz AM, Acs M. Rare Histologies and Infrequent Indications for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Anticancer Res 2022; 42:3681-3692. [PMID: 35790287 DOI: 10.21873/anticanres.15857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022]
Abstract
AIM This single-centre study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with rare histologies and uncommon tumour origins. PATIENTS AND METHODS Prospectively collected data from the data registry of a single institution was retrospectively investigated. We present a series of selected patients who underwent CRS and HIPEC between 2011 and 2021 for peritoneal metastases arising from infrequent tumour entities. RESULTS The study included 76 patients. From the wide range of histologies, seven groups were formed: Cancer of unknown primary, uncommon ovarian cancer types, other gynaecological tumours (endosalpingiosis, endometrial and cervical cancer), small bowel carcinoma, recurrent peritoneal mesothelioma, desmoplastic small round-cell tumour, and other rare malignancies. The median peritoneal cancer index was 8. Fifty-five patients with primary and 22 patients with recurrent disease were examined. Complete macroscopic tumour resection was achieved in 84% of cases. The median survival was 68.53 months considering the entire cohort, whilst the longest survival rate was registered in the group with rare ovarian cancer, and the shortest in the group of patients with small round-cell tumour, at 112.3 and 11.4 months, respectively (small round-cell tumour versus rare ovarian cancer, hazard ratio=15.6817; 95% confidence interval=2.6585-92.5030; p=0.0024). CONCLUSION Based on the encouraging results in some test groups, especially in rare ovarian cancer, CUP, small bowel cancer and recurrent mesothelioma, multicenter prospective studies examining such rare tumour histologies are needed to reach a higher number of cases and, thus, explore the impact of multimodal therapy on these patients.
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Affiliation(s)
- Alaedin Rajha
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Pompiliu Piso
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Laszlo Halmy
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Ivan Panczel
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Dan-Sebastian Nedelcut
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Zoltan Herold
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Attila Marcell Szasz
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Miklos Acs
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany;
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Muirhead FC, Lee HL, Singh R. Ovarian endosalpingiosis mimicking hydrosalpinges. Unexpected intraoperative findings and a diagnostic rollercoaster. J Surg Case Rep 2021; 2021:rjab264. [PMID: 34211694 PMCID: PMC8241478 DOI: 10.1093/jscr/rjab264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/23/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022] Open
Abstract
Over 80 % of ovarian cancer diagnoses are in women aged over 50 years. Post-menopausal women are at significantly increased risk compared with other age groups. Tumour biomarkers and ultrasound assist with diagnostics. A post-menopausal woman was referred with a possible left adnexal cyst on ultrasound. A tertiary gynaecological ultrasound suggested bilateral hydrosalpinges without cysts. Tumour markers were negative. Unexpectedly, while undergoing a laparoscopy, the tubes were normal in appearance; however, multiple cystic deposits suspicious for malignancy were noted on the ovaries. A laparoscopic bilateral salpingo-oophorectomy was performed without spillage and pelvic washings obtained. On histopathology, the ovaries contained multiple, benign epithelial cysts and pelvic washings were negative. This case demonstrates an unanticipated peri-operative diagnostic dilemma. It highlights the surgical management decisions required to balance duty of care and consent compliance within the scope of general gynaecology. It emphasizes the importance of histopathological examination to confirm diagnoses.
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Affiliation(s)
- Fleur C Muirhead
- Obstetrics and Gynaecology, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Hong L Lee
- Obstetrics and Gynaecology, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Rajeev Singh
- Obstetrics and Gynaecology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Fujii S, Inoue C, Mukuda N, Murakami A, Yamaji D, Yunaga H, Nosaka K. Magnetic resonance imaging findings of endosalpingiosis: a case report. Acta Radiol Open 2021; 10:20584601211022504. [PMID: 34178378 PMCID: PMC8202271 DOI: 10.1177/20584601211022504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/15/2021] [Indexed: 11/15/2022] Open
Abstract
Endosalpingiosis is characterized by the presence of glands lined by benign tubal-type epithelium outside the fallopian tube. It is usually an incidental finding and rarely occurs as a tumor-like mass lesion. Here, we describe the magnetic resonance imaging findings of endosalpingiosis that presented as a paraovarian multicystic lesion. It exhibited iso to low intensity on T1-weighted images and inhomogeneous high intensity on T2-weighted images. The septa presented relatively iso to slight high intensity on T2-weighted images and strong contrast enhancement on dynamic contrast-enhanced imaging. Endosalpingiosis should be considered as a differential diagnosis in cases of paraovarian multicystic lesions along the uterine serosa.
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Affiliation(s)
- Shinya Fujii
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
- Shinya Fujii, Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, Tottori 683-8504, Japan.
| | - Chie Inoue
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Naoko Mukuda
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Atsushi Murakami
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Daisuke Yamaji
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiroto Yunaga
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kanae Nosaka
- Department of Pathology, Faculty of Medicine, Tottori University, Yonago, Japan
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Lee HL, Farrell R, Kamath V, Ho-Shon I, Yap F. Concordant PET/CT and ICG positive lymph nodes in endometrial cancer: a case of mistaken identity. J Surg Case Rep 2020; 2020:rjz377. [PMID: 31976060 PMCID: PMC6963166 DOI: 10.1093/jscr/rjz377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/02/2019] [Indexed: 11/12/2022] Open
Abstract
Endometrial carcinoma is the most common gynecological malignancy in developed countries. In early stage endometrial cancer, routine systemic pelvic lymphadenectomy showed no survival benefits and results in increased morbidity. The role of PET/CT imaging for the pre-operative detection of lymph node metastases in endometrial cancer is unclear. Sentinel lymph node (SLN) mapping may reduce the surgical staging morbidity while maintaining prognostic information of the lymph node status. Recently, indocyanine green (ICG) SLN mapping has been utilized to detect nodal metastasis in endometrial cancer. Endosalpingiosis is defined as the presence of tubal-like epithelium outside of the fallopian tube and can sometimes be misinterpreted as cancer metastasis. Here, we discuss a patient with newly diagnosed endometrial cancer who had pelvic and para-aortic lymph nodes with high glucose avidity on PET/CT, and ICG positivity on SLN mapping, suspected clinically to be metastatic adenocarcinoma, but with the pathological finding of endosalpingiosis only.
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Affiliation(s)
- Hong L Lee
- Department of Gynaecology, Joondalup Health Campus, Joondalup, WA, Australia
| | - Rhonda Farrell
- Department of Gynaecological Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Vasanth Kamath
- Department of Pathology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Ivan Ho-Shon
- Department of Nuclear Medicine and PET, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Francis Yap
- PathWest, Department of Health, Perth,WA, Australia
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Chui MH, Shih IM. Oncogenic BRAF and KRAS mutations in endosalpingiosis. J Pathol 2019; 250:148-158. [PMID: 31576556 DOI: 10.1002/path.5353] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/07/2019] [Accepted: 09/26/2019] [Indexed: 11/08/2022]
Abstract
Endosalpingiosis, a microscopic lesion composed of ectopic Fallopian tube epithelium, frequently involves the peritoneum and lymph nodes in patients with ovarian serous borderline tumour or low-grade serous carcinoma, but its pathogenic significance remains unclear. Using laser-capture microdissection and droplet digital PCR, we investigated whether endosalpingiosis harbours the driver mutations in BRAF and KRAS that characterise ovarian low-grade serous neoplasms. Somatic mutations were detected in 14 (33%) of 43 endosalpingiotic lesions analysed. Of 21 women with endosalpingiosis associated with a synchronous or metachronous ovarian low-grade serous tumour, mutations were identified in endosalpingiotic lesions from 11 (52%) women, with most cases (10/11, 91%) demonstrating identical mutations in both tumour and endosalpingiosis. In contrast, of 13 cases of endosalpingiosis not associated with an ovarian tumour, only one harboured a KRAS mutation. The proliferative activity as assessed by Ki-67 immunohistochemistry was lower in endosalpingiosis than in low-grade serous tumours, and endosalpingiosis with either a BRAF or KRAS mutation had a significantly lower Ki-67 index than those without. Ectopic expression of KRASG12V in Fallopian tube epithelial cells led to ERK phosphorylation, p21 induction, growth arrest and cellular senescence. In conclusion, we demonstrate that endosalpingiosis represents an interesting example of cancer driver mutations in deceptively normal-appearing cells, which may be prone to neoplastic transformation upon bypass of endogenous oncosuppressive mechanisms. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Michael Herman Chui
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ie-Ming Shih
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Richard W. TeLinde Gynecologic Pathology Research Program, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jarrell JF, Vilos GA, Allaire C, Burgess S, Fortin C, Gerwin R, Lapensee L, Lea RH, Leyland NA, Martyn P, Shenassa H, Taenzer P. No. 164-Consensus Guidelines for the Management of Chronic Pelvic Pain. J Obstet Gynaecol Can 2019; 40:e747-e787. [PMID: 30473127 DOI: 10.1016/j.jogc.2018.08.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-based guidelines of value to primary care health professionals, general obstetricians and gynaecologists, and those who specialize in chronic pain. BURDEN OF SUFFERING CPP is a common, debilitating condition affecting women. It accounts for substantial personal suffering and health care expenditure for interventions, including multiple consultations and medical and surgical therapies. Because the underlying pathophysiology of this complex condition is poorly understood, these treatments have met with variable success rates. OUTCOMES Effectiveness of diagnostic and therapeutic options, including assessment of myofascial dysfunction, multidisciplinary care, a rehabilitation model that emphasizes achieving higher function with some pain rather than a cure, and appropriate use of opiates for the chronic pain state. EVIDENCE Medline and the Cochrane Database from 1982 to 2004 were searched for articles in English on subjects related to CPP, including acute care management, myofascial dysfunction, and medical and surgical therapeutic options. The committee reviewed the literature and available data from a needs assessment of subjects with CPP, using a consensus approach to develop recommendations. VALUES The quality of the evidence was rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice were ranked according to the method described in that report (Table 1). RECOMMENDATIONS The recommendations are directed to the following areas: (a) an understanding of the needs of women with CPP; (b) general clinical assessment; (c) practical assessment of pain levels; (d) myofascial pain; (e) medications and surgical procedures; (d) principles of opiate management; (f) increased use of magnetic resonance imaging (MRI); (g) documentation of the surgically observed extent of disease; (h) alternative therapies; (i) access to multidisciplinary care models that have components of physical therapy (such as exercise and posture) and psychology (such as cognitive-behavioural therapy), along with other medical disciplines, such as gynaecology and anesthesia; G) increased attention to CPP in the training of health care professionals; and (k) increased attention to CPP in formal, high-calibre research. The committee recommends that provincial ministries of health pursue the creation of multidisciplinary teams to manage the condition.
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Wang Y, Sessine MS, Zhai Y, Tipton C, McCool K, Kuick R, Connolly DC, Fearon ER, Cho KR. Lineage tracing suggests that ovarian endosalpingiosis does not result from escape of oviductal epithelium. J Pathol 2019; 249:206-214. [PMID: 31131879 DOI: 10.1002/path.5308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/07/2019] [Accepted: 05/23/2019] [Indexed: 12/19/2022]
Abstract
Most high-grade serous carcinomas are thought to arise from Fallopian tube epithelium (FTE), but some likely arise outside of the tube, perhaps from ectopic tubal-type epithelium known as endosalpingiosis. Importantly, the origin of endosalpingiosis is poorly understood. The proximity of the tubal fimbriae to the ovaries has led to the proposal that disruptions in the ovarian surface that occur during ovulation may allow detached FTE to implant in the ovary and form tubal-type glands and cysts. An alternative model suggests that cells present in ectopic locations outside the Müllerian tract retain the capacity for multi-lineage differentiation and can form glands with tubal-type epithelium. We used double transgenic Ovgp1-iCreERT2 ;R26RLSL-eYFP mice, which express an eYFP reporter protein in OVGP1-positive tissues following transient tamoxifen (TAM) treatment, to track the fate of oviductal epithelial cells. Cohorts of adult mice were given TAM to activate eYFP expression in oviductal epithelium, and ovaries were examined at time points ranging from 2 days to 12 months post-TAM. To test whether superovulation might increase acquisition of endosalpingiosis, additional cohorts of TAM-treated mice underwent up to five cycles of superovulation and ovaries were examined at 1, 6, and 12 months post-TAM. Ovaries were sectioned in their entirety to identify endosalpingiosis. Immunohistochemical staining for PAX8, tubulin, OVGP1, and eYFP was employed to study endosalpingiosis lesions. Ovarian endosalpingiosis was identified in 14.2% of TAM-treated adult mice. The endosalpingiotic inclusion glands and cysts were lined by secretory and ciliated cells and expressed PAX8, tubulin, OVGP1, and eYFP. Neither age nor superovulation was associated with a significant increase in endosalpingiosis. Endosalpingiosis was also occasionally present in the ovaries of pre-pubertal mice. The findings imply that ovarian endosalpingiosis in the mouse does not likely arise as a consequence of detachment and implantation of tubal epithelium and other mechanisms may be relevant. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Yisheng Wang
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.,Obstetrics & Gynecology Hospital of Fudan University, Shanghai, PR China
| | - Michael S Sessine
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yali Zhai
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Courtney Tipton
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kevin McCool
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Rork Kuick
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Eric R Fearon
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kathleen R Cho
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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15
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Hattori Y, Sentani K, Matsuoka N, Nakayama H, Hattori T, Kudo Y, Yasui W. Intramural florid cystic endosalpingiosis of the uterus after menopause. POL J PATHOL 2018; 69:321-4. [PMID: 30509061 DOI: 10.5114/pjp.2018.79554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Endosalpingiosis is a benign condition characterized by the presence of tubal epithelium outside the fallopian tube and the absence of endometrial stroma. Florid cystic endosalpingiosis is a very rare form of endosalpingiosis that presents as a tumor-like lesion. We report the case of a 67-year-old woman who presented with a cystic lesion of the uterus. Macroscopically, a cut section revealed a multicystic, whitish mass in the myometrium of the fundus. Histologically, the lesion consisted of numerous variably sized glands that were lined with a single or stratified layer of ciliated columnar cells similar to tubal epithelium.
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16
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Abstract
INTRODUCTION AND HYPOTHESIS We reviewed reported cases of endocervicosis, endosalpingiosis, and müllerianosis of the bladder or ureters in women in order to highlight these conditions as distinct from endometriosis or adenomyosis. METHODS Medline and Scopus searches of all cases published till the October 1, 2017. All retrieved references were searched manually to identify relevant articles. RESULTS Twenty-six articles reported endocervicosis. These included 37 cases described by the authors as endocervicosis of the bladder. We identified 7 case reports of bladder endosalpingiosis. There were 26 publications including 27 cases of müllerianosis of the bladder and 3 cases affecting the lower ureter. Literature descriptions are limited but available accounts do not point to features that uniquely distinguished these conditions. Affected women tended to be older, and in many cases, there was a possible relation to past surgery and particularly to hysterectomy and caesarean sections. Many cases were reported in postmenopausal women. Local excision was sufficient in most cases. CONCLUSION The etiology of these conditions remains speculative, but case reports raise a possible link to pelvic surgery. There is a need for more detailed accounts of these lesions, which should be considered in the differential diagnosis of pre- and postmenopausal women with pelvic pain, dyspareunia, lower abdominal pain or discomfort, dysuria, frequency, or hematuria.
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Affiliation(s)
- Marwan Habiba
- 1 Department of Health Sciences, University of Leicester, Women and Perinatal Services, University Hospitals of Leicester, Leicester, United Kingdom
| | - Ivo Brosens
- 2 Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Giuseppe Benagiano
- 3 Department of Gynecology, Obstetrics and Urology, Sapienza University of Rome, Rome, Italy
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17
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Abstract
Bladder endocervicosis is a benign disease, characterized by the presence of ectopic endocervical tissue in the bladder wall, with few cases described in the literature. A case of bladder endocervicosis in a 35-year-old female, with the previous history of cesarean section, subtotal hysterectomy, and right oophorectomy is reported here. The patient was asymptomatic and the bladder lesion was detected on pelvic ultrasonography. Transurethral bladder resection was performed and the histopathological analysis revealed bladder endocervicosis. 12 months of follow-up have passed without evidence of clinical or radiological recurrence. Clinical presentation, pathological features, and treatment are discussed.
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Affiliation(s)
- Sofia Santos-Lopes
- Department of Urology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Ana Cebola
- Department of Urology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Ana Afonso
- Department of Pathology, CUF Descobertas Hospital, Lisbon, Portugal
| | - Fernando Ferrito
- Department of Urology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.,Department of Urology, CUF Infante Santo Hospital, Lisbon, Portugal
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18
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Im S, Park HS, Cho U, Yoo C, Jung JH, Yoo J, Choi HJ. Florid cystic endosalpingiosis associated with a retroperitoneal leiomyoma mimicking malignancy: a case report. Int J Clin Exp Pathol 2017; 10:10112-10116. [PMID: 31966902 PMCID: PMC6965923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/08/2017] [Indexed: 06/10/2023]
Abstract
Florid cystic endosalpingiosis (FCE) is a rare type of endosalpingiosis that presents as a mass-like lesion. Here we report an unusual case of FCE associated with a retroperitoneal leiomyoma. A 46-year old female presented with a palpable abdominal mass. A pelvic CT revealed a 23.5×16.3×9.4 cm sized multilocular cystic and solid mass in the retroperitoneum. Surgical excision of the mass was performed. Microscopically, the cystic spaces were lined by a single layer of ciliated tubal epithelium. The solid areas consisted of thick bundles of spindle cells. There were no cytologic atypia, mitosis or necrosis. The spindle cells were positive for actin and desmin, and were negative for c-kit, CD34, S100 and HMB-45, confirming the diagnosis of FCE associated with retroperitoneal leiomyoma.
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Affiliation(s)
- Soyoung Im
- Department of Hospital Pathology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea Suwon, Republic of Korea
| | - Hong Sik Park
- Department of Hospital Pathology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea Suwon, Republic of Korea
| | - Uiju Cho
- Department of Hospital Pathology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea Suwon, Republic of Korea
| | - Changyoung Yoo
- Department of Hospital Pathology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea Suwon, Republic of Korea
| | - Ji-Han Jung
- Department of Hospital Pathology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea Suwon, Republic of Korea
| | - Jinyoung Yoo
- Department of Hospital Pathology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea Suwon, Republic of Korea
| | - Hyun Joo Choi
- Department of Hospital Pathology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea Suwon, Republic of Korea
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19
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Im S, Jung JH, Choi HJ, Kang CS. Intramural florid cystic endosalpingiosis of the uterus: a case report and review of the literature. Taiwan J Obstet Gynecol 2015; 54:75-7. [PMID: 25675925 DOI: 10.1016/j.tjog.2014.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE We report a case of intramural florid cystic endosalpingiosis in the lower uterine segment of the uterus. CASE REPORT A 43-year-old female presented with vaginal bleeding. Abdominal computed tomography suggested a leiomyoma with cystic degeneration. A total hysterectomy revealed a 4.0 cm × 3.8 cm cystic mass in the lower uterine segment. The cystic space microscopically was lined with a single layer or stratified layer of ciliated columnar cells that resembled tubal epithelium without cytologic atypia. The glandular spaces were surrounded by normal myometrium with no evidence of periglandular endometrial stroma, which was consistent with the diagnosis of florid cystic endosalpingiosis. CONCLUSION Florid cystic endosalpingiosis involving the uterus is a rare and clinically unexpected finding; however, it should be considered in the differential diagnosis of a uterine mass.
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Affiliation(s)
- Soyoung Im
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Han Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Hyun Joo Choi
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Suk Kang
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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20
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Maeda K, Kojima F, Ishida M, Iwai M, Kagotani A, Kawauchi A. Müllerianosis and endosalpingiosis of the urinary bladder: report of two cases with review of the literature. Int J Clin Exp Pathol 2014; 7:4408-4414. [PMID: 25120826 PMCID: PMC4129061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 06/23/2014] [Indexed: 06/03/2023]
Abstract
Müllerianosis of the urinary bladder is an extremely rare benign condition, characterized by the presence of a mixture of at least two müllerian-derived components, and endosalpingiosis is also an extremely rare condition, characterized by the presence of tubal-type epithelium. In this report, we describe the 17(th) case of müllerianosis and 5(th) case of endosalpingiosis of the urinary bladder. A 39-year-old Japanese female presented with menstrual hematuria and was found to have a polypoid lesion in the posterior wall of the urinary bladder. Histopathological study demonstrated variably-sized dilated tubular glands in the lamina propria and muscularis propria. These dilated glands were covered by ciliated cuboidal cells, and some of them were covered by columnar cells with intracytoplasmic mucin. Moreover, a tiny focus of endometrial tissues was also present. Immunohistochemically, these glandular cells were positive for estrogen receptor. Accordingly, a diagnosis of müllerianosis was made. The second case was a 37-year-old Japanese female, who was found to have a polypoid lesion in the posterior wall of the bladder. Dilated tubular glands were covered by ciliated cells in the lamina propria and muscularis propria. Neither endocervical nor endometrial tissues were observed. Immunohistochemically, these ciliated cells were positive for estrogen receptor. Accordingly, a diagnosis of endosalpingiosis was made. Our analysis revealed that these two conditions mainly affect premenopausal females and occur exclusively in the posterior wall. Although the pathogenesis remains completely unresolved, a metaplastic theory is favored. The recognition of these two conditions is important because they can mimic invasive adenocarcinoma.
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Affiliation(s)
- Koki Maeda
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
- Department of Urology, Shiga University of Medical ScienceShiga, Japan
| | - Fumiyoshi Kojima
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Mitsuaki Ishida
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Muneo Iwai
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Akiko Kagotani
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Akihiro Kawauchi
- Department of Urology, Shiga University of Medical ScienceShiga, Japan
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21
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Lui MW, Ngu SF, Cheung VYT. Mullerian cyst of the uterus misdiagnosed as ovarian cyst on pelvic sonography. J Clin Ultrasound 2014; 42:183-184. [PMID: 23949900 DOI: 10.1002/jcu.22081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 06/28/2013] [Indexed: 06/02/2023]
Abstract
Mullerian cyst of the uterus, also known as endosalpingiosis, is rare and often can be misdiagnosed as adnexal cyst on pelvic sonography. A 47-year-old woman was referred for an incidental finding of a right adnexal mass on pelvic sonography, suspected to be an ovarian cyst. During laparoscopy, a pedunculated cystic mass arising from the right anterior uterine wall was seen. The mass was resected laparoscopically and histologic examination showed a benign Mullerian cyst of the uterus. Diagnosis of Mullerian cyst of the uterus can be challenging. However, with increased awareness, preoperative diagnosis of this condition should be possible sonographically.
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Affiliation(s)
- Man-Wa Lui
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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22
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Gruessner C, Gruessner A, Glaser K, AbuShahin N, Laughren C, Zheng W, Chambers SK. Biomarkers and endosalpingiosis in the ovarian and tubal microenvironment of women at high-risk for pelvic serous carcinoma. Am J Cancer Res 2014; 4:61-72. [PMID: 24482739 PMCID: PMC3902233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 12/12/2013] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION BRCA mutations increase the risk for development of high-grade pelvic serous carcinomas. Tissue biomarkers distinguishing women at high-risk (HR) for ovarian cancer from those at low-risk (LR) may provide insights into tumor initiation pathways. METHODS A prospective study of 47 HR women (40% BRCA carriers) undergoing risk-reducing salpingo-oophorectomy and 48 LR controls undergoing salpingo-oophorectomy was performed. Ovarian/tubal tissues were harvested. Immunohistochemical analysis of candidate proteins CSF-1, CSF-1R, ErbB4 is presented, with scores separately analyzed in epithelium and stroma, in ampulla, fimbria, ovary, and ovarian endosalpingiosis (ES). Comparison was performed between HR and LR groups. RESULTS Elevated levels of CSF-1 (p=0.005) or ErbB4 (p=0.005) in the ovarian epithelium, or ErbB4 (p=0.005) in the ovarian stroma, were significantly associated with both the HR status and carrying a BRCA mutation, as was nuclear ErbB4 staining. Ovarian ES, an entity which likely derives from the tubal mucosal epithelium, was also associated with HR (p=0.038) and BRCA mutation status (p=0.011). Among the BRCA carriers only, markers also found association when present in the tube as well as in ovarian ES (p < 0.05). ROCs were generated including in the regression model both CSF-1 and ErbB4 expression levels. A model including CSF-1 in ovarian epithelium, ErbB4 in ovarian stroma, and younger age achieves AUC=0.87 (73% sensitivity, 93% specificity) of detection of the HR status. In BRCA carriers, CSF-1 in ovarian epithelium alone achieves AUC=0.85. CONCLUSIONS Our data suggest that elevated levels of CSF-1/ErbB4 in the adnexae correlate with HR/BRCA carrier status. CSF-1/CSF-1R signaling is active in ovarian cancer progression; our data suggests a role in its initiation. ErbB4, in particular nuclear ErbB4, may have a role in tumor initiation as well. Ovarian ES, an entity which may represent a latent precursor to low-grade pelvic serous carcinomas, was surprisingly associated with both HR status and the BRCA carrier cohort. In line with these findings, both ErbB4 and CSF-1R expression in ovarian ES correlated with carrying a BRCA mutation. This analysis, which needs to be validated, indirectly suggests a potential link between ovarian ES and the development of pelvic serous carcinoma in women who are BRCA mutation carriers.
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Affiliation(s)
| | - Angelika Gruessner
- Mel and Enid Zuckerman College of Public Health, University of ArizonaTucson, AZ, USA
| | - Katherine Glaser
- College of Medicine, University of ArizonaTucson, AZ, USA
- Department of Obstetrics and Gynecology, University of ArizonaTucson, AZ, USA
| | - Nisreen AbuShahin
- Department of Pathology, University of JordanAmman, Jordan
- Department of Pathology, University of ArizonaTucson, AZ, USA
| | | | - Wenxin Zheng
- College of Medicine, University of ArizonaTucson, AZ, USA
- University of Arizona Cancer CenterTucson, AZ, USA
- Department of Pathology, University of ArizonaTucson, AZ, USA
| | - Setsuko K Chambers
- College of Medicine, University of ArizonaTucson, AZ, USA
- Department of Obstetrics and Gynecology, University of ArizonaTucson, AZ, USA
- University of Arizona Cancer CenterTucson, AZ, USA
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23
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Abstract
The theory of müllerianosis predicts that embryonic müllerian tissue, misplaced during organogenesis, results in the formation of 4 benign müllerian diseases-developmental adenomyosis, endometriosis, endosalpingiosis, and endocervicosis-(developmental müllerian diseases) that will be identified in human female fetuses, infants, children, adolescents, and adults. Direct evidence is presented to support the existence of developmental adenomyosis, developmental endometriosis, and developmental endocervicosis in human female fetuses along with strong circumstantial evidence supporting the existence of all 4 developmental müllerian diseases in human female infants, children, adolescents, and adults. This evidence throws light upon the pathogenesis of rare müllerian lesions whose pathogenesis remains inexplicable by classical and modern theories. Furthermore, this research has scientific and clinical relevance: scientific relevance because it opens up a new field of comparative research-the 4 developmental müllerian diseases complement the 4 acquired müllerian diseases; clinical relevance because it identifies rare müllerian diseases curable by complete surgical excision.
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Affiliation(s)
- Ronald E Batt
- Department of Gynecology-Obstetrics, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, USA.
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