Case Of Serous Cystadenocarcinoma Research Articles

Clinicopathological Profile of Ampulla of Vater and Pancreas Malignancies at Cipto Mangunkusumo Hospital in 2015-2019

Background
 Malignancies of ampulla of vater and pancreas are often difficult to distinguish. Malignancies in ampulla of vater include malignancies in major duodenal papilla, distal common bile duct and pancreatic duct opening (Wirsung). The origin of the primary tumor, histopathological diagnosis and staging play a role in therapy and prognosis. WHO Classification of tumors of the digestive system, 2019 made changes in tumor staging following the system of the American Joint Committee on Cancer (AJCC), 8th edition. This study was conducted to determine types of pancreatic and ampullary malignancies, demographic distribution, location, profile, histomorphology and tumor staging changes in the 7th edition of the AJCC to 8th edition of the AJCC in the WHO Classification of tumors of the digestive system, 2019. The aim to determine clinicopathological profile of malignancies of ampulla of vater and pancreas as well as tumor staging changes based on AJCC edition 8.
 Methods
 Observational descriptive study on pancreatic and ampulla vater malignancy resection preparations at Department of Anatomic Pathology FKUI/RSCM, period January 2015 to December 2019 that met the inclusion criteria. Demographic evaluation, tumor location, histopathological profile and patient staging changes were carried out based on the 8th edition of AJCC.
 Results
 There were 27 cases of adenocarcinoma in ampulla of vater, 10 cases of pancreatic ductal adenocarcinoma, 1 case of mucinous cystic neoplasm with adenocarcinoma focus, 1 case of serous cystadenocarcinoma, 7 cases of PanNET, 2 cases of PanNEC, 3 cases of SPN, 1 case of MiNEN. Changes in pT were present in 29 cases. Changes in pN were present in 6 cases.
 Conclusion
 The diagnosis and pathological staging are in accordance with the 2019 WHO digestive system tumor classification. Tumor differentiation, presence or absence of lymphovascular invasion, perineural invasion and lymph node metastases and incision margin status are important histopathological parameters.

A rare case of serous cyst adenocarcinoma of pancreas with splenic tuberculosis and neuro endocrine deposits in omentum of a young female

Cystic tumours of pancreas with malignant potential are very rare including serous cystic tumour, although mucinous cystic neoplasms of pancreas possess more frequent ability to transmute into mucinous cystadenocarcinoma. Neuroendocrine Tumors (NETs) are rare tumors comprising approximately 2% of all malignancies. The most common sites are gastrointestinal tract and the lung. Most of these tumors are well-differentiated and have an indolent course therefore an incidental finding.

Comparative Study of Ultrasound and Magnetic Resonance Imaging of Adnexal Masses

Background: Current study aimed to assess the role of ultrasound and MRI in the evaluation of adnexal mass lesions and comparison with clinical outcomes. Subjects & Methods: A total of 30 suspected adnexal mass detected on ultrasonography was performed MRI, and accuracy of both USG and MRI were compared with histopathology. Results: Abdominal pain was predominantly confined to the lower abdomen in13 of 30 cases (43.3%). On USG total number of benign lesions was 19, and the total number of malignancies was 11. However, on MRI, 21 cases were mild, and 9 cases were malignant. six cases were diagnosed as malignant in ultrasound. In these six cases, two cases were serous cystadenocarcinoma, two were mucinous cystadenocarcinoma, one was serious papillary cystadenocarcinoma of the fallopian tube, and one was a malignant tubo-ovarian mass. MRI accurately diagnosed 4 indeterminate cases that correlated with the histopathology report. 9 malignant lesions were diagnosed as malignant by MRI were 3 cases of serous cystadenocarcinoma, 2 cases of mucinous cystadenocarcinoma, 1 case of malignant tubo-ovarian mass, 1 case of endometrioid carcinoma, 1 case of serous papillary cystadenocarcinoma of the fallopian tube and 2 cases of malignant sex cord-stromal neoplasms. Both the cases of serous cystadenomas were correctly diagnosed as benign lesions on both ultrasound and MRI. There were 2 cases of mucinous cystadenocarcinoma, which were accurately diagnosed as malignant on both USG and MRI due to the presence of solid components, mural thickening. The sensitivity, specificity, and accuracy of USG were 36.6%, 94% and 55% respectively. The sensitivity, specificity, and accuracy of MRI were 81.80%, 94.7%, and 65.7%, respectively. Conclusion: The best agreement was observed between MR findings and diagnosis in origin, tissue content, and tissue characteristics. Sonography had a weak correlation in context to the definitive diagnosis for the origin and tissue content of a mass.

TUMOR MARKERS

Object: Analysis of serum tumor markers CA-125, CEA, AFP, & ß-HCG in patientswith ovarian malignant tumors and correlation of their serum levels with histological types. StudyDesign: Institution based descriptive and prospective study. Place & Duration: Department ofPathology, Liaquat University of Medical & Health Sciences, Jamshoro from January 2009 toJune 2011. Material & Methods: One hundred cases, diagnosed as ovarian malignant tumor onH&E staining were selected for study & measurement of serum CA-125, CEA, AFP, & ß-HCGpreoperatively and postoperatively in each case. Results: Out of 100 ovarian cancers diagnosedon H&E stain 33 were serous cystadenocarcinoma, 29 mucinous adenocarcinoma, 19 germ celltumors and 15 sex-cord stromal tumors, 1 endometroid carcinoma, 1 brenner tumor, 1 clear cellcarcinoma and 1 case of NHL. Increased level of CA-125 was seen preoperatively in 33/33 casesof serous cystadenocarcinoma and 24/29 cases of mucinous adenocarcinoma. Surprisinglyincreased levels were also seen in 10/19 germ cell tumor and 8/15 in sex-cord stromal tumors.CEA is raised in mucinous tumors. AFP & ß-HCG were raised in germ cell tumors & sex cordstromaltumors. Serum tumor marker levels were declined following appropriate therapy of thetumors. Conclusions: Serum tumor markers are useful and important for the detection of ovariantumors. They may also help in assessment of response to specific treatment, prognosis & followup of patient.

Pediatric ovarian tumors in a tertiary care hospital of Kolkata: An experience of last 5 years with its clinicopathological correlation

Background: Pediatric ovarian tumors are rare with an approximate incidence of 2.6 per 100,000 girls per year. Aims and Objectives: This study was done to delineate the clinicopathological profile of pediatric ovarian masses encountered in a tertiary care hospital over 5 years. Materials and Methods: A retrospective study was conducted for a period of 5 years during which all patients whose age did not exceed 20 years and underwent surgical resection of ovarian masses, were included. History, operative notes, gross findings, and microscopic features of each case were noted. Results: A total of 76 cases were included in the study. The age of patients ranged between 2 and 20 years with a mean of 17 ± 2.5 years. Of the 76 cases, 53 (69.7%) were benign and 23 (30.3%) malignant tumors. The benign tumors included 16 cases each of teratoma (21.1%) and serous cystadenoma (21.1%), and 21 cases of mucinous cystadenoma (27.6%). Germ cell tumors were the commonest malignant tumors in patients up to 15 years of age and they included four cases of dysgerminoma (5.3%) and one case of immature teratoma (1.3%). Between 16 and 20 years, 8 cases of serous cystadenocarcinoma were found (10.5%), in addition to seven malignant germ cell tumors (9.2%). One case (1.3%) each of granulosa cell tumor and sertoli leydig cell tumor was also found in the same age group. Conclusion: Pediatric ovarian tumors require early attention and institution of appropriate treatment since they bear important implications on the future lives of young females.

Imaging modalities in the differentiation of various adnexal lesions

Aim The purpose of this study was to discuss the role of different imaging modalities in the diagnosis and evaluation of adnexal masses. Patients and methods A total of 50 female patients with 60 adnexal lesions were included in his study. After clinical evaluation, ultrasound examination was carried out for all cases. After observing all gray scale features, color Doppler was superimposed on the gray images to assess the site of blood flow and measure the Doppler indexes. Computed tomography was performed in seven suspicious cases, and MRI was performed in eight suspicious cases. The results were correlated with operative and histopathological findings. Results Nine malignant cases had Alcazar score greater than 6, whereas the benign cases (41 cases) had a score less than 6. There were two cases (4%) of hydrosalpinx, five cases (10%) of ectopic pregnancy, three cases (6%) of tuboovarian abscess, four cases (8%) of polycystic ovaries, and four cases of solid masses (8%) (one case of ovarian fibroma, one case of subserous uterine fibroid, one case of broad ligament fibroid, and one case of Krukenberg tumor). There were 24 cases of cystic masses (48%) either unilocular or multilocular within thin septae (seven cases of follicular ovarian cysts, eight cases of hemorrhagic cysts, one case of corpus luteal cyst, two cases of endometrioma, three cases of dermoid cysts, two cases of serous cystadenoma, and one case of paraovarian cyst). There were eight complex masses (16%) (one case of granulosa cell tumor, one case of dysgerminoma, one case of papillary carcinoma, one case of metastasis, two cases of serous cystadenocarcinoma, and two cases of mucinous cystadenocarcinoma). Conclusion Using ultrasound and color Doppler studies with scoring system was found to be useful in differentiating a benign from a malignant adnexal mass. Computed tomography scan has shown to be beneficial in assessing the disease extent and planning for treatment. MRI was beneficial in characterizing adnexal masses in problematic cases.

Magnetic resonance imaging for diagnosis of pelvic lesions associated with female infertility

Abstract Objective To study the mandatory indications and accuracy of magnetic resonance (MR) imaging for diagnosis of pelvic lesions associated with female infertility. Design Prospective cross-sectional study. Main outcome measures Indications and accuracy of MR imaging for diagnosis of pelvic lesions. Uterovaginal lesions were excluded as they were studied in a previous article (under publication). Materials and methods 423 infertile women were investigated by hysterosalpingography (HSG), transabdominal and transvaginal ultrasonography after thorough clinical examination. Hundred and thirty (30.95%) patients were associated with pelvic lesions not conclusively diagnosed by HSG or/and ultrasonography and were examined by MR imaging to confirm the diagnosis. Fifty-four patients (41.53%) had uterovaginal lesions. They were discussed in a previous article. Seventy-six (58.46%) patients had other pelvic lesions. The present study concerned with these lesions. Results The diagnosis by MR imaging was conclusive for 11 cases of pyosalpinx, 3 cases of hematosalpinx, 25 cases of hydrosalpinx, 24 cases of ovarian endometriomas, deep endometriosis of the of rectosigmoid (3 cases), urinary bladder (3 cases), one case of endometriosis of the abdominal wall after repeated cesarean sections and six ovarian tumors, 5 cases of benign cystic teratoma and 1 case of serous cystadenocarcinoma. The diagnosis of these lesions was confirmed by laparoscopy or laparotomy and histopathological examination. Magnetic resonance imaging failed to diagnose peritubal adhesions in 22 out of 39 cases (56.41%) of tubal lesions and peritoneal implants of endometriosis in 12 out of 31cases (38.70%) of pelvic endometriotic lesions. They were discovered during the surgical treatment of the tubal and ovarian lesions through laparoscopy or laparotomy. Conclusion The following pelvic lesions associated with female infertility were not conclusively diagnosed by HSG or/ and US but were precisely diagnosed by MR imaging with 100% accuracy: Pyosalpinx, hydrosalpinx and hematosalpinx, ovarian and deep infiltrating endometriosis and benign and malignant ovarian tumors as benign cystic teratoma and serous cystadenocarcinoma.

OVARIAN CANCER;

Object: 1). To analyze of serum tumor marker CA-125 in patients with ovarian malignant tumors. 2). To correlate betweenthe serum levels of tumor marker with histological types of ovarian malignant tumors. Study Design: Institution based descriptive andprospective study. Place & Duration: Department of Pathology, Liaquat University of Medical & Health Sciences, Jamshoro from January2009 to June 2011. Material & Methods: One hundred cases, diagnosed as ovarian malignant tumor on H&E staining were selected forstudy & measure serum CA-125 preoperatively and postoperatively in each case. Results: Out of 100 cases diagnosed as on H&E stainwere 33 serous cystadenocarcinoma, 24 mucinous adenocarcinoma, 10 germ cell tumors and 08 sex-cord stromal tumors. On serumanalysis increased level of CA-125 was seen preoperatively in 33/33 cases of serous cystadenocarcinoma and 24/29 cases of mucinousadenocarcinoma. Serum tumor marker value was declined following appropriate therapy of the tumors. Conclusions: Serum tumormarkers CA-125 is useful and important for the detection of ovarian tumors. It is most significant for serous cystadenocarcinoma. It mayalso help in prognosis and specific treatment of ovarian malignancies relating to histological type.

Serous cystic neoplasms of the pancreas: a clinicopathologic and immunohistochemical analysis [This article has been retracted

To clarify whether the various subtypes of serous cystic neoplasms (SCNs) of the pancreas can be distinguished from each other by marker profiles. The immunoprofiles of 13 SCNs were defined by using antibodies against cytoskeletal, neuroendocrine, hormone receptor, and mucin markers. In addition, we examined the expression of calrentinin and alpha-inhibin. SCN included 7 cases of serous microcystic adenomas (SMA), 3 cases of serous oligocystic ill-defined adenomas (SOIA), 1 case of solid serous adenoma (SSA), 1 case of von Hippel-Lindau-associated cystic neoplasm (VHL-CN), and 1 case of serous cystadenocarcinoma (SCC). These neoplasms are histologically similar, but differ in their localization, gross appearance, gender distribution, and biological behavior. The various types of SCNs showed a very similar immunoprofile, characterized by positivity for cytokeratins (100%) and negativity for vimentin and synaptophysin. Other markers that were commonly expressed in the SCNs were alpha-inhibin (85%), MUC1 (69%) and MUC6 (77%). The results suggest that, despite their biologic differences, the various types of SCNs have the same (or a very similar) cell type and may therefore have a common direction of differentiation. A centroacinar origin is supported by the finding that a number of SCNs share MUC1 and MUC6 expression with pancreatic centroacinar cells. Alpha-inhibin, and MUC6 may be regarded as new markers for this type of pancreatic tumor.

Serous cystadenocarcinoma of the pancreas

A case of serous cystadenocarcinoma of the pancreas in an 85-year-old woman is reported. The tumor extensively involved the body and tail of the pancreas and contiguously invaded the spleen. The histopathology of the tumor was similar to that of serous cystadenoma, but mild nuclear hyperchromatism and atypism were noted, and the neoplastic invasion of nerve fibers in the stroma was observed. In the spleen neoplastic cells forming microcysts were diffusely insinuated in the red pulp without the fibrous stroma. The patient is in good health without recurrence and metastasis after the operation. The present case is the second example of this kind of neoplasm that showed direct splenic invasion. Because serous cystadenocarcinoma of the pancreas exhibits bland cytological features, diligent search for the invasion of the surrounding tissue or peripheral nerves is needed for the differentiation from its benign counterpart.

Three-Dimensional Ultrasound and Power Doppler Improve the Diagnosis of Ovarian Lesions

Objective. The aim of this study was to determine whether three-dimensional power Doppler can improve the ability to differentiate benign from malignant ovarian masses.Methods. Transvaginal color Doppler and three-dimensional power Doppler were performed on 120 patients with ovarian lesions. All patients underwent both ultrasound examinations during the day prior to laparotomy or laparoscopy. Scoring systems combining morphological and Doppler parameters were adopted for two- and three-dimensional ultrasound examinations.Results. In each of 11 ovarian malignancies, preoperative diagnosis by three-dimensional power Doppler was confirmed by histopathology. Transvaginal color Doppler missed 1 case of serous cystadenocarcinoma, while 3 benign lesions were considered false positive. In 1 case of cystadenofibroma both transvaginal color Doppler and three-dimensional power Doppler were falsely positive. Qualitative analysis of the tumor vascularity architecture added to morphological parameters had a sensitivity and specificity of 100 and 99.08%, respectively.Conclusions. Better results achieved by three-dimensional ultrasound can be explained by improved recognition of the ovarian mass anatomy, characterization of the surface features, detection of the tumor infiltration, and precise depiction of the size and volume. Three-dimensional power Doppler imaging can detect structural abnormalities of malignant tumor vessels, such as arteriovenous shunts, microaneurysms, tumoral lakes, disproportional calibration, coiling, and dichotomous branching. Three-dimensional power Doppler can enhance and facilitate the morphologic and functional evaluation of both benign and malignant ovarian masses.

Expression of sex hormone-binding globulin mRNA in human ovarian cancers

To know the role of sex hormone-binding globulin (SHBG) in the intracellular steroidal actions in human ovarian cancers, the expression of SHBG mRNA as a substitute for intracellular SHBG expression was investigated in normal ovarian tissues and ovarian tumors. In the present study, we used competitive reverse transcription-polymerase chain reaction-Southern blot analysis to evaluate SHBG mRNA levels. The expression of SHBG mRNA was detected in all normal ovaries and benign and malignant ovarian tumors analyzed. There were no significant differences in the mean SHBG mRNA levels among the three types of tissue. The expression in normal ovaries was significantly higher (p < 0.01) in premenopause, suggesting the predominance of a sex steroid hormone effect on ovarian SHBG synthesis. Relative overexpression of SHBG mRNA was observed in six out of 22 cases (27%) of ovarian cancer (three cases of endometrioid adenocarcinoma, two cases of serous cystadenocarcinoma and one case of mucinous cystadenocarcinoma) in comparison with normal ovaries and benign ovarian tumors. There was no difference in expression among the clinical stages of ovarian cancers. These data suggest that normal human ovaries and ovarian tumors might synthesize SHBG intracellularly, ovarian cancers might conserve an estrogen-associated property via SHBG and the regulation of intracellular SHBG expression might be changed in some cancers.

皮膚筋炎を合併した，正常大の卵巣しょう液性腺癌の１症例

皮膚筋炎 (Dermatomyositis) が先行合併し, 子宮腔部および子宮腔内細胞診で腫瘍細胞を認めた, 正常大の卵巣に発生した漿液性嚢胞腺癌の症例を経験したので報告する.症例は44歳, 女性, 皮膚筋炎のため当院皮膚科に入院治療していたが, 腫瘍マーカー血清CA125が上昇してきたため当科に婦人科悪性腫瘍の有無の検索が依頼された.内診, 超音波および骨盤CTscanでは異常所見は認められなかったが, 子宮膣部および子宮腔内細胞診で, 腫瘍背景を欠如し, psammoma bodyをともなった腺癌細胞集塊がみられた.ダグラス窩穿刺細胞診でも同様の腺癌細胞を認めたため卵巣腫瘍 (卵巣漿液性嚢胞腺癌) を推定病変として開腹手術を予定したが, 肺炎の合併, その他一般状態の悪化のため中止せざるをえなかった.その後最終的には脳血管障害で死亡し剖検が行われた.Macroscopicには腹腔内に著変はみられなかったが, 両側正常大卵巣に漿液性嚢胞腺癌の病理所見が認められ, また両側卵管に疎通性を認めた.子宮膣部および子宮腔内細胞診上の腫瘍細胞出現機序としては経卵管由来であることが示唆された.