Lung adenocarcinoma with EGFR gene mutation metastatic to the uterine cervix: A case report

INTRODUCTION

The cervix is a rare site of metastasis from advanced lung adenocarcinoma. Driven gene detection is particularly important for the treatment of advanced lung adenocarcinoma.

PATIENT CONCERNS

A 49-year-old Chinese female was sent to our hospital because of lumbago and sacroiliac joint pain; she was unable to walk and had vaginal bleeding. The following examinations were performed: imaging, colposcopy, bronchoscopy, immunohistochemistry and next-generation sequencing.

DIAGNOSIS

According to the clinical manifestations and the examination results, the diagnosis was lung adenocarcinoma with cervical, brain, adrenal gland and bone metastases. More importantly, EGFR gene mutations (del19) were detected in both the primary lung lesion and uterine cervical biopsy specimen.

INTERVENTIONS

Osimertinib was chosen as the first-line treatment.

OUTCOMES

Lumbago and sacroiliac joint pain were significantly relieved. The levels of tumor markers decreased. Primary injuries and metastatic sites were significantly reduced.

CONCLUSION

Physicians should be alert to the signals of vaginal bleeding and consider that primary lung adenocarcinoma may metastasize to the uterine cervix.

[A Case of Uterine Body Metastasis from Sigmoid Colon Adenocarcinoma]

We report a case of metastatic carcinoma to the uterine body from a colorectal adenocarcinoma. A 73-year-old woman underwent laparoscopic sigmoidectomy for sigmoid colon carcinoma 2 years before. In the following study, her serum carcinoembryonic antigen level was elevated, and a uterine body tumor invading the rectal wall was detected via enhanced computed tomography. Colonoscopic examination revealed an elevated lesion at the rectum, which was diagnosed as an adenocarcinoma. Based on these results, we diagnosed the uterine tumor as metastatic tumor from the colon carcinoma. Immunostaining was negative for CK7, but positive for CK20. Thus, we confirmed metastasis of the sigmoid colon cancer to the uterus. Metastasis to the female genital tract from extragenital malignancies are rare, and the prognosis is extremely poor. However, some patients attain long-term survival by surgical intervention even in such cases.

p40 in metastatic pulmonary trophoblastic tumour: potential diagnostic pitfall on histopathology

p40, one of the two isomers of p63, is nowadays widely used for diagnosis of squamous cell carcinoma, especially in subtyping non-small cell carcinoma on lung biopsies. We describe a case in which lung tumour was misdiagnosed as squamous cell carcinoma due to p40 immunopositivity. A 36-year-old lady presented with cough and left sided chest pain of 2 months duration. Chest imaging revealed a lesion in left lower lobe of the lung and biopsy was suggestive of squamous cell carcinoma. However, past history revealed amputation of great toe for non-healing discharging ulcer which on histopathology was diagnosed as choriocarcinoma. She also had a history of hysterectomy five years ago, details of which were not available. Post-amputation β-hCG levels were high and she had been treated with multimodality chemotherapy for choriocarcinoma. She had good response to chemotherapy initially, however became resistant later on. Review of the lung biopsy in the light of the past history along with extensive literature review led to the final diagnosis of metastatic trophoblastic tumour to lung. Hence, awareness that p40 immunopositivity can be seen in trophoblastic tumours is essential to avoid misdiagnosis, especially in sites like the lung where squamous cell carcinoma is common.

[A Hematogenous Metastasis from Scirrhous Gastric Cancer to the Uterus]

A 46-year-old woman was referred to our hospital because of nausea. Endoscopy revealed scirrhous gastric cancer, and abdominalcomputed tomography revealed peritonealdissemination. She was diagnosed with Stage IV gastric cancer and treated with S-1 plus CDDP combination chemotherapy. After 4 courses of chemotherapy, the primary tumor and peritoneal dissemination were considered clinically stable, but the uterus grew rapidly. She was diagnosed as having uterine metastasis based on cervicaland endometrialsmear class V cytology. As the chemotherapy was not effective for the uterine lesions, totalhysterectomy and bilateralsal pingo-oophorectomy were performed. Histological findings showed a poorly differentiated cancer with vascular emboli. Uterine metastases are an important consideration in women with scirrhous gastric cancer, and we recommend palliative hysterectomy for chemotherapy-resistant metastases if the primary tumor and other metastases are controlled.

[A Case of a Patient with Metastatic Rectal-Uterine Cancer from the Ascending Colon Who Underwent NOSE]

An 80-year-old woman had undergone a right hemicolectomy for ascending colon cancer 9 months prior to the current presentation. CT and PET-CT showed a solitary tumor measuring 55mm in diameter at the uterus and rectum. Three 5mm ports and two 12mm two ports were placed. The sigmoid colon was mobilized using a medial approach as usual in laparoscopic surgery. The rectum and uterus were mobilized and were resected. We inserted the End-catchTM in from the vagina and removed the specimen. The patient had no abdominal pain and was discharged from the hospital 9 days after the operation.

Detection of circulating tumour cells may add value in endometrial cancer management

OBJECTIVE

To evaluate the role of circulating tumour cells (CTCs) in patients with endometrial cancer (EC).

STUDY DESIGN

This study included 40 patients with a pre-operative diagnosis of high-risk EC between April 2015 and May 2016. Patients were further divided into high-risk (grade 3, non-endometrioid, myometrial invasion ≥1/2 and stage III-IV) and high-intermediate-risk (grade 2-3, endometrioid, myometrial invasion <1/2 and stage I-II) groups according to postoperative pathological results. CTCs were detected using the CellSearch system, and CTC results were correlated with standard clinicopathological characteristics and serum tumour marker CA125/HE4 status using Chi-squared test, continuity correction or Fisher's exact test. The pharmacodynamic effect was detected after the first cycle of adjuvant therapy. Patients were followed up for 13 months to assess outcomes.

RESULTS

Fifteen percent of patients had one or more CTCs. The presence of CTCs was found to be significantly associated with cervical involvement (83.33% vs 11.76%, p=0.00). No significant difference in CTC-positive rates was detected between the high-risk and high-intermediate-risk groups, and no significant correlation was found between CTCs and serum CA125/HE4, either by positive rates or exact serum levels of the conventional tumour markers. No more CTCs were detected after the first cycle of standard chemotherapy in this study, and no distant metastases or recurrence were found in the CTC-positive patients during the follow-up period.

CONCLUSION

The presence of CTCs was correlated with cervical involvement. Early-stage EC patients with CTCs may benefit from additional adjuvant therapies. Assessment of CTCs may be useful in the management of high-risk EC patients.

A case report of benign metastasizing leiomyoma of the lung: FDG-PET-CT findings and the utility of uterine needle biopsy

Benign metastasizing leiomyoma (BML) is a rare condition that affects other organs out of the uterus. Recently, a few case reports in which 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) has been used to distinguish the malignancy have been published. Here, the authors present a case of BML with metabolic activity on PET, in which needle biopsy of the uterus was efficient to make diagnosis.

[Metastasizing Leiomyoma of the Lung Detected on Chest X-ray after Surgery for Breast Cancer；Report of a Case]

A 60-year-old postmenopausal woman presented with a lung nodule, which was detected on a chest X-ray 2 years after surgery for breast cancer. Pulmonary metastasis from the breast cancer was suspected and surgical resection was performed. On histopathological examination, the lung nodule showed a smooth muscle cell tumor, and immunohistochemical staining was positive for estrogen and progesterone receptors. As a mass in the uterine was detected by computed tomography images before surgical resection, benign metastasizing leiomyoma of the lung was suspected. Subsequently, the patient underwent hysterectomy and bilateral salpingo-oophorectomy. The pathological findings revealed that the mass in the uterine was atypical leiomyoma, which was consistent with the primary lesion of the lung metastasis. Atypical leiomyoma is classified as a benign tumor, but in this case, careful follow-up is required because of its clinical course and histological features.

[A Case of Sigmoid Colon Cancer with Metastasis to the Uterus]

A 65-year-old woman complaining of fetor ex vagina was diagnosed with endometrial adenocarcinoma of the uterus based on the pathological findings of an endometrial biopsy. Sigmoid colon cancer was found on a pre-operative CT scan. Diagnosis of double cancer was made and we performed sigmoidectomy and panhysterectomy with associated resection of both adnexa. Histopathological examination found that the tumor accounted for almost all of the uterine mucosa and over half of the muscular layer. Immunostaining showed CK7 (-), CK20 (+), CDX2 (+), ER (-), and PgR (-), and we diagnosed it as a metastasis to the uterus of the sigmoid colon cancer. The pathological diagnosis was a moderately differentiated adenocarcinoma, pT4b (SI: urinary bladder), pN0 (0/12), H0, P1,M1a (uterus), pStage Ⅳ. As adjuvant chemotherapy, she was administered XELOX for 6 months. Although colorectal cancer rarely metastasizes to the uterus, due to the increase in the prevalence of colorectal cancer, it may be also increase. To choose the best treatment course, it is necessary to diagnose whether it is a primary uterine cancer or a metastatic uterine cancer.

Incidental Finding of Metastatic Cutaneous Malignant Melanoma at Uterine Leiomyoma, A Thai University Hospital Experience: A Case Report

BACKGROUND

Metastatic malignant melanomas to the uterus are extremely rare; to our knowledge, no more than 13 cases have been reported to date.

CASE REPORT

A 44-years-old multigravida woman presented with a black and irregular surface mass at medial aspect of left thigh. There was also an enlarged left groin node. Wide excision with lymph node dissection revealed malignant melanoma. Further examination found a huge pelvic mass with left deep vein thrombosis consequent by pressure effect. Chest and complete abdominal computed tomography revealed an enlarged, fibroid uterus with pressure effect at left common iliac vein. A total abdominal hysterectomy and bilateral adnexectomy were performed. Intra-operative finding was scattered hyperpigment spots at surface of the uterus and its tumor Histopathological report showed metastatic malignant melanoma involving myometrium and uterine serosa. Diagnosis of stage IV malignant melanoma (uterine metastasis) was achieved. The patient was counseled about her diagnosis, stage, prognosis and further treatment.

CONCLUSION

Uterine metastatic malignant melanoma was a rare condition. This report represents the first case of a cutaneous malignant melanoma involving a uterine leiomyoma in Thailand.

Pelvic synovial sarcoma of unknown primary origin: case report and literature review

A case report of a 26-year-old woman with pelvic pain for one-month duration is presented. The physical exam was unremarkable, but a right pelvic mass was found on ultrasound. Computed tomography (CT) of the abdomen/pelvis confirmed a heterogeneous 6 x 4.4 cm mass within the right pelvis adjacent to the superior-lateral aspect of the uterus. Laparoscopy was performed, and the mass was found to be friable and necrotic. The origin of the mass was not able to be determined due to the collapse of the mass upon instrumentation. Histology revealed spindle cells. Further studies, including immunochemical staining, revealed a synovial sarcoma. Patient underwent laparotomy for staging and in hopes of obtaining clear tumor margins. Surgery revealed subsequent tumors involving the mesentery of the small intestine and the peritoneal wall. Biopsies taken at surgery did not reveal the primary origin of the original pelvic tumor.

Rare case of uterine PEC-oma (perivascular epithelioid cell tumor) recurrence. Case report and literature review

Perivascular epithelioid cell tumor (PEC-oma) is a rare mesenchymal neoplasm. Literature reports more than 100 cases of PEC-oma, a third of which is of uterine or uterine retroperitoneum origin. The case of a 59-year-old woman presented here is, to the best of our knowledge, the first described fast uterine PEC-oma recurrence of the tumor of the gastrointestinal tract origin. In this text the authors also present literature review concerning this rare female tumor

Micro-metastases into the uterine leiomyoma from invasive ductal breast cancer under adjuvant tamoxifen therapy: case report

Metastasis of breast cancer to the uterus is extremely rare. However, breast cancer is the leading tumor metastasizing from extragenital organs to the uterus. The most common signs of uterine metastasis are bleeding and mass effect. Tamoxifen use is known to increase risk of endometrial cancer. Immunohistochemical staining with GCDFP can be useful in differentiating primary uterine tumors from breast cancer metastasis. Metastasis to the uterus has been reported to worsen the prognosis. Although hysterectomy has been effective on survival, treatment modality to be used in the presence of other systemic metastases is not clear. Locoregional treatments can be used in oligometastatic cases. In addition, removal of solitary organ metastasis together with bone metastasis provides improvement in survival.

Rare metastases of pancreatic tail carcinoma in female genital organs

A case is presented of pancreatic tail carcinoma metastasizing to the uterus, right ovary and right sacrouterine ligament 2.5 years after the primary tumor had been detected and treated. During explorative laparotomy, performed after 3D color Doppler ultrasonographic visualization of a suspected finding in the right adnexal region, metastatic deposits in the uterus, right ovary, right sacrouterine ligament and right ureter originating from the primary adenocarcinoma of the tail of the pancreas were detected and surgically removed.

Primary gynaecological tumours mistaken for metastases: report of two cases with review of literature

We describe two neoplasms of rare occurrence, one of ovarian and the other of uterine origin that were sent for consultation. Both lesions were diagnosed as metastatic carcinomas by pathologists with special interest in gynaecological pathology. The cases were referred for a second opinion because of subsequent failure to identify the primary source. We discuss the differential diagnoses, the need for generous sampling particularly in ovarian mucinous neoplasms and the value of including particular antibodies in the panel to aid the diagnostic process. Metastatic tumours mimicking primary tumours are always challenging. These two cases illustrate the need to be vigilant against the reverse scenario as well.

Lobular carcinoma of the breast metastasizing to leiomyoma in a patient under letrozole treatment

Metastasis of extragenital neoplasms to the uterus is extremely rare. Lobular breast cancers metastasize to the uterus more than ductal carcinomas, but they metastasize as tiny nodules that can be missed with the standard diagnostic workup. Uterine involvement by a metastatic tumor is usually a manifestation of end-stage disease; patients are reported to die within weeks to months. Therefore surgery is not recommended. Here we report a case of lobular breast cancer metastasizing to a leiomyoma in a patient using letrozole. Our patient was submitted to surgery because the leiomyoma had grown to the level of the xiphoid process. She is alive one year after the operation. In conclusion growth of leiomyomas under aromatase inhibitors should be considered as a sign of metastases and surgery can be planned in selected cases.

A conservative approach in persistent low-level elevation of serum beta-human chorionic gonadotropin following chemotherapy for gestational trophoblastic neoplasia

OBJECTIVE

To question whether patients with persistent low-level elevation of beta-human chorionic gonadotropin (beta-hCG) following chemotherapy for gestational trophoblastic neoplasia can be managed conservatively.

STUDY DESIGN

A retrospective study of all patients requiring chemotherapy for gestational trophoblastic neoplasia (GTN), treated in Sheffield from 1994 to 2007, evaluating those for whom a clinical decision was made to stop chemotherapy when the serum beta-hCG level remained elevated.

RESULTS

Of the 350 patients requiring chemotherapy, 17 had persistently elevated beta-hCG at the time chemotherapy was stopped. The range of elevation was 4-43 IU/L (mean, 7.5) and duration 3-32 weeks (mean, 10.7). In 16 patients, beta-hCG became undetectable and further treatment was not required; in only 1 patient did the level suddenly become elevated (from 12 to 77 IU/L after 3 months), requiring further and curative chemotherapy.

CONCLUSION

These results suggest that a conservative but watchful approach can be taken for persistent low-level elevation (up to 40 IU/L) of serum beta-hCG following chemotherapy.

Does OPTIMOX strategy ("stop-and-go" approach) also work in treatment of pancreatic cancer with oxaliplatin-based regimens?

A recent pooled analysis and a meta-analysis suggested a survival benefit of gemcitabine-platinum doublets when compared with single agent gemcitabine. Sensory neurotoxicity is a potentially limiting toxicity associated with oxaliplatin therapy. Because neuromodulatory agents have shown rather disappointing activity in the prevention of oxaliplatin-induced neurotoxicity, the so-called OPTIMOX (stop and go) approach offers a reasonable strategy when oxaliplatin-based therapy is used in the palliative setting. This strategy seems to be successful when used as a first-line approach, rather than being held in reserve until chemotherapy based on another agent fails in patients with metastatic colorectal cancer. However, no data exists to support OPTIMOX strategy in pancreatic cancer. We here describe the first report of a patient with metastatic pancreatic cancer in whom OPTIMOX strategy allows her to manage the toxicity as well as achieve long-term disease control.

Cutaneous malignant melanoma metastatic to a uterine leiomyoma: a case report

BACKGROUND

Malignant melanoma is the sixth-most-common cancer in the United States and can spread throughout the body. This report represents the second case of a cutaneous melanoma involving a uterine leiomyoma.

CASE

A 49-year-old woman presented with an inguinal mass; biopsy revealed an undifferentiated neoplasm. Further examination and computed tomography revealed an enlarged, fibroid uterus. The patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy and right inguinal lymphadenectomy. Histologic examination of the inguinal lymph node and the leiomyoma revealed metastatic melanoma.

CONCLUSION

As the incidence of melanoma increases, metastasis to unusual locations, such as uterine fibroids, probably will be encountered more frequently.

Occult metastatic lung carcinoma presenting as locally advanced uterine carcinosarcoma on positron emission tomography/computed tomography imaging

Increasingly, positron emission tomography/computed tomography (PET/CT) is being used as a tumor surveillance modality for multiple tumor types. A 73-year-old postmenopausal female with stage IV nonsmall cell lung cancer presented after a PET/CT demonstrated focal uptake in the superior and lateral aspects of the uterus. The patient reported a history of intermittent postmenopausal bleeding and an endometrial biopsy documented uterine carcinosarcoma. Postoperative pathologic review and immunohistochemical staining with thyroid transcription factor-1 revealed metastatic adenocarcinoma consistent with her lung primary in her uterus and adnexa. Our case represents a rare occurrence in which lung cancer has metastasized to multiple female pelvic organs. Increasing use of PET/CT may lead to the discovery of occult metastases masquerading as a second primary malignancy.

[Only metastasis to uterine corpus from superficial bladder cancer that of no original recurrence]

We report a rare case of uterine corpus metastasis from superficial bladder cancer. A 78-year-old female presented with abnormal vaginal bleeding. She received transurethral resection of bladder tumor (TUR-Bt) two years previously, and the pathological findings were transitional cell carcinoma (TCC) grade 3 pT1. Eight courses of BCG instillation were performed postoperatively. There was no recurrence of bladder cancer when vaginal bleeding occurred. Cytology of vaginal discharge was class V, and transitional cell carcinoma suspected. Pathological finding of transvaginal uterine corpus biopsy was TCC. We diagnosed metastases to uterine corpus from bladder cancer.

Uterine metastasis from hepatocellular carcinoma: a case report

The extrahepatic spread of hepatocellular carcinoma (HCC) is uncommon. Moreover, metastatic uterine tumor from extragenital primaries is rare. We report a 63-year-old woman with uterine metastasis from HCC. She had undergone transcatheter arterial embolization four times and surgery for HCC from 2-4 years before. This time, she underwent resection of a newborn, head-sized uterine tumor that was proven to be metastasis from HCC. This is the first described case of metastatic uterine tumor originated from HCC.

Breast cancer followed by corpus cancer: Is there a higher risk for aggressive histologic subtypes?

OBJECTIVE

To analyze corpus cancer patients with a breast cancer history for risk of developing aggressive uterine histologic types.

METHODS

Corpus cancer patients with a history of breast cancer were identified from the Surveillance Epidemiology and End Results database from 1988 to 2001. Demographics, clinico-pathologic, and survival data were analyzed using Kaplan-Meier and logistic regression analyses.

RESULTS

Of 52,109 women diagnosed with corpus cancer, 1922 had a history of breast cancer. Women with a history of breast cancer had a significantly higher proportion of uterine papillary serous carcinomas (UPSC) and sarcomas compared to those without a breast cancer history (9.4% vs. 6.3% for UPSC and 10.3% vs. 8.4% for sarcoma; P < 0.001). Patients with endometrioid or sarcoma of the uterus after breast cancer had significantly worse 5-year survivals than patients without a breast cancer history (84.4% vs. 90.5%; P < 0.001 and 49.0% vs. 63.6%, P < 0.001, respectively). Older age, advanced stage, lack of surgery and radiation treatment, poor histologic types, and history of breast cancer were independent prognostic factors for poorer survival.

CONCLUSION

In this study, the proportional incidence of UPSC and sarcoma was significantly higher in women with a breast cancer history. These findings highlight the association of breast cancer and high-risk corpus cancer subtypes.

Recurrent small cell carcinoma of the ovary treated with docetaxel: a case report

Multiagent chemotherapy for small cell carcinoma of the ovary (SCCO) may contribute to the prolonged survival of young women who are suffering from this disease, even in the advanced stage with remaining tumor, although the rarity of SCCO complicates the generalization of chemotherapy agents and operation methods for this disease. A 24-year-old patient with SCCO FIGO stage IIC is alive after recurrences and chemotherapy including cisplatin + etoposide after the first operation and docetaxel for the second recurrence. She is now doing well with no evidence of disease more than 4 years after the first operation and 2 years after docetaxel treatment. This may be the first report describing the use of docetaxel that may be included in multiagent chemotherapy.

[A rare variant of malignant melanoma progression]

Progression of melanoma passed under the "mask" of uterine corpus carcinoma. The rarity of this case is an isolated melanoma metastasis into the endometrium and peculiar clinical manifestation.

Adenocarcinoma of the uterine cervix with choriocarcinomatous metastasis

BACKGROUND

Nongestational choriocarcinoma, in very rare instances, has been described as a component of other malignancies with a tendency for a very poor prognosis.

CASE

A 55 year old woman was diagnosed with adenocarcinoma of the cervix, and incompletely treated with only external beam radiation. Adjuvant radical hysterectomy demonstrated no residual tumor, but the patient developed a tumor metastasis mimicking a pulmonary artery thrombus which by histology and immunohistochemistry was pure choriocarcinoma. While chemotherapy was successful in achieving a complete remission, the patient succumbed to complications of her pulmonary metastasis.

CONCLUSION

Choriocarcinomatous dedifferentiation of cervical adenocarcinoma is extremely rare, with only one other case reported in the literature. While the prognosis for patients with such a tumor is generally poor, aggressive combination chemotherapy may be of benefit in some.

Whole-body positron emission tomography with F-18 fluorodeoxyglucose for the detection of recurrence in uterine sarcomas

We evaluated the usefulness of whole-body positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG-PET) for the detection of recurrence in follow-up patients after primary treatment of uterine sarcoma. Eight patients with pathologically proven uterine sarcoma underwent FDG-PET, computed tomography (CT), and ultrasonography (US). Final diagnoses of recurrence were established in five cases (three carcinosarcomas and two leiomyosarcomas). PET revealed recurrent sites in the intraperitoneum, liver, lung, bone, and retroperitoneal lymph nodes. However, the minimum size of the tumor detected by PET depended on the sites of recurrence. CT and US images showed two false-negative cases of intraperitoneal tumors. PET was able to detect a solitary small intraperitoneal tumor, which was very difficult to detect by CT and US. Positive PET findings did not affect the prognosis in three of the five recurrent patients; however, the remaining two patients consequently underwent the combination therapy consisting of surgery and chemotherapy and survived for more than 1 year after the positive FDG-PET results. Application of PET imaging for the early detection of recurrent sites was useful for the decision of treatment strategy for patients with recurrent uterine sarcoma.

Metastatic extragenital neoplasms to the uterus: a clinicopathologic study of four cases

The aim of this study was to elucidate the clinicopathologic features, the differential diagnostic problems, and the prognostic consequences of patients with metastatic extragenital malignancies to uterus. The patients with metastatic extragenital malignancies to the uterus were evaluated. We considered the metastases in non-genital tract organs at diagnosis of primary neoplasm, the distribution of the metastases in the uterus, and the presence of concomitant metastases in other genital and non-genital tract organs. There were four cases of metastatic extragenital malignancies to the uterus. The breast was the most frequent primary site (two cases: 50%). The other two primary tumors were adenocarcinoma of the cecum and malignant melanoma of the skin. The diagnosis was facilitated by clinical history, revealing the previous primary neoplasm, and by specific immunohistochemical study. Almost all the patients died from disseminated disease. Thus, the prognosis of metastatic extragenital malignancies to the uterus alone or simultaneously to the uterus and other organs of the genital tract is poor. Thus, the metastases to the uterus and to other organs of the genital tract can be considered a preterminal event.

Primary peritoneal carcinoma--Uterine involvement and hysterectomy

OBJECTIVE

To assess the frequency of uterine involvement in primary peritoneal carcinoma (PPC) and to describe selected clinical characteristics in patients with and without hysterectomy.

METHODS

All incident cases of histologically confirmed cancer of the ovary or peritoneum, diagnosed in Israeli Jewish women between March 1 1994 and June 30, 1999, were identified within the framework of a nationwide epidemiological study of these neoplasms. The study population was accrued through an active search of all newly diagnosed patients in all the departments of gynecology in Israel. The data of 81 PPC patients included in the present study were abstracted from medical records.

RESULTS

Hysterectomy was performed in 48 patients. These patients had a lower mean age (62.4 +/- 9.4 vs. 66.9 +/- 10.4; P = 0.05) at diagnosis and a higher rate of < or =2 cm residual disease (54.2% vs.24.2%; P = 0.02). Of those with hysterectomy, microscopic involvement was verified in all those with macroscopic involvement. Overall microscopic involvement was present in 28 (58.3%) of the patients who underwent hysterectomy. In the majority of them, only the serosa was involved. Macroscopic uterine involvement was present in 27 (33.3%) patients but in only 12% it was >2 cm. The median survival in patients with hysterectomy was 36 months and in those without hysterectomy 29 months, this difference was statistically not significant (P = 0.2).

CONCLUSIONS

Our study indicates that in an unselected group of PPC patients 33% have any macroscopic uterine involvement. The therapeutic value of routine hysterectomy at the initial operation for PPC should be further investigated.

Recurrent Colorectal Carcinoma Detected by Routine Cervicovaginal Papanicolaou Smear Testing

BACKGROUND

We present a case of recurrent colon cancer detected by routine, annual Papanicolaou screening.

CASE

A 59-year-old African American woman who had been treated for T2N0M0 (stage II, Dukes A) colon cancer 2 years before to presentation had a Pap smear showing a high-grade squamous intraepithelial lesion with a normal cervical biopsy result. Because of this discrepancy, a loop electrosurgical excision procedure and endocervical curettage were performed and showed atypical glandular cells suspicious for adenocarcinoma. Subsequent colonoscopy showed recurrent adenocarcinoma of the colon. The patient underwent an en-block total abdominal hysterectomy and anterior-perineal resection showing invasion of recurrent colon cancer into the uterus and cervix.

CONCLUSION

In patients with a history of extrauterine adenocarcinoma, abnormal Pap screening may indicate recurrent or metastatic carcinoma.

Establishment and characterization of a human ovarian small cell carcinoma, hypercalcemic type, cell line (OS-1) secreting PTH, PthrP and ACTH--special reference to the susceptibility of anti-cancer drugs

We successfully established a novel cell line (OS-1) derived from human ovarian small cell carcinoma, hypercalcemic type secreted PTH, PTH-rP and ACTH. The OS-1 cell line was established from metastatic focus of uterus. A patient was 25-year-old Japanese woman. The first she received left ovariectomy on April 2002. The histopathological diagnosis was ovarian small cell carcinoma, pT2c, Nx, Mx. Then on June 2003, metastatic focus of uterus was ectomied. A part of the recurrent tumor of uterus was cut into small pieces with razor blades, and dissociated with 0.1% trypsin-0.02% EDTA/ PBS(-) solution at room temperature. The single cells and small cell clusters were seeded into 60mm dishes and cultured in growth medium (GM: DMEM/F12 supplemented with 20% fetal bovine serum and 0.1% non-essential amino acids solution) at 37 degrees C, 4.7% CO2 in humidified air. Medium was exchanged twice a week. The OS-1 cells grew as floating cultures in the dishes. Radioimmunoassay of the conditioned media was revealed that the cultures secreted large amount of PTH, PTHrP and ACTH simultaneously. Susceptibilities of anti-cancer drugs to the OS-1 cells were examined using oxygen electrode meter (Daikin), and the results suggested VLB and TXL were effective, and CDDP, CPT-11, VP-16, VCR, CPA, MMC and CBDCA were not effective. In our knowledge, it is the first report that the cell line secreting PTH, PTHrP and ACTH was successfully established from ovarian small cell carcinoma, hypercalcemic type. We expect that OS-1 cell line contribute to study on the mechanism of ectopic hormone secretion and susceptibility of anti cancer drugs to the small cell carcinoma.

Gastric adenocarcinoma presenting as uterine metastasis—A case report

BACKGROUND

Metastases to the uterus are rare, especially from extrapelvic malignancies.

CASE

We report a 75-year-old woman who underwent hysterectomy for a FIGO Grade I endometrial carcinoma and was found to have evidence of a second malignant process involving the myometrium. The patient underwent a gastroscopy, which showed nonspecific superficial gastric and duodenal erosions. Random biopsies, however, confirmed a diagnosis of primary gastric adenocarcinoma. CT scan also showed pulmonary metastasis. The patient developed progressive disease despite two cycles of chemotherapy consistent of etoposide, doxorubicin and carboplatin.

CONCLUSION

This case illustrates the presence of two spatially separated tumours found in the uterus. Malignant cells present deep in the lymphovascular spaces have morphological features different from the primary endometrial carcinoma. The microscopic appearances of these cells are similar to that of the gastric biopsy, supporting the diagnosis of metastatic gastric adenocarcinoma.

Metastases of breast carcinoma to the uterus. Report of two cases, one harboring a primary endometrioid carcinoma, with review of the literature

BACKGROUND

Metastases to the uterus are rare, accounting for less than 10% of all cases of metastases to the female genital tract from extragenital cancers. The endometrium is even less frequently affected by metastases. Lobular carcinoma is the most common type of breast cancer that metastasizes to the uterus.

CASES

Two cases of infiltrating lobular carcinoma of the breast metastatic to endometrium and myometrium, one of them harboring an endometrioid adenocarcinoma, are reported. Both patients were on tamoxifen therapy and presented with uterine bleeding.

CONCLUSION

To the best of our knowledge, uterine carcinoma serving as recipient of metastatic carcinoma from the breast has not been previously documented. This possibility should be considered when an unusual bimorphic pattern appears in a tumor until proven otherwise.

Postmenopausal bleeding and vaginal nodules as the first presenting sign of adenocarcinoma of the gallbladder

Vaginal submucosal nodules were observed in a 67-year-old woman, with ultrasonographic features of an advanced uterine neoplasm. On biopsy, light microscopy suggested that the lesions might be metastatic foci from an extragenital cancer, with a prevalent tubular growth pattern. Parallel immunohistochemical reactions revealed a diffuse, strong CA 19-9 positivity in both the cell membrane and cytoplasm. Subsequently, high serum levels of such tumor marker were also found, and an extragenital cancer was suspected of pancreatic or biliary origin. A mass in the gallbladder fossa was then detected by computed tomography and a primary gallbladder adenocarcinoma was confirmed on ultrasound-guided biopsy.

Metastatic disease in the breast from nonmammary neoplasms

Breast cancer is the leading cause of death from cancer in women. The metastatic involvement of the breast from nonmammary neoplasms is a relatively rare condition. Female patients are affected five to six times more frequently than male patients. We present seven patients with metastasis in the breast from extramammary tumors. Females seemed to be more frequently affected (6 women and 1 man) and included a wide range of ages (17-70 years old). All female patients had suspicious-looking abnormalities (B1-RADS 4) or lesions highly suspicious of malignancy (BI-RADS 5) in the mammography, without a confirmative fine needle aspiration cytology. The primary malignancies were equally distributed between non-hematological (1 renal adenocarcinoma, 1 melanoma, 1 leiomyosarcoma) and hematological (1 non-Hodgkin's, 2 Hodgkin's lymphomas and 1 leukemia). Treatment is therefore modified, taking into consideration the treatment and prognosis of the primary disease.

Abnormal uterine bleeding as a presentation of metastatic breast disease in a patient with advanced breast cancer on tamoxifen therapy

INTRODUCTION

Extra pelvic tumours rarely metastasise to the female genital tract. Typically it is the ovaries that are involved and the primary tumours include the breast and the gastrointestinal tract. Metastatic disease involving the uterus is rare.

CASE REPORT

A case of metastatic breast carcinoma involving both the uterine corpus and cervix is described. The patient was known to have advanced breast carcinoma and was on tamoxifen therapy when she presented with postmenopausal bleeding. Histological assessment of the hysterectomy specimen including immunohistochemistry staining confirmed the breast carcinoma as the primary.

CONCLUSION

Unusual uterine bleeding in a patient with breast cancer, should alert the gynaecologist to the possibility of metastatic breast disease regardless of tamoxifen treatment.