Mesodermal Tumors Research Articles

Primary Retroperitoneal Tumors: A Report of 08 Cases at the General Surgery Department of The Mohamed VI University Hospital in Marrakech

Primary retroperitoneal tumors are a rare and heterogeneous group of neoplasms arising within the retroperitoneal space, excluding the kidneys, urinary tract, adrenal glands, major blood vessels, and adjacent viscera. Treatment involves surgical resection, often requiring sacrifices of adjacent organs, with adjuvant chemotherapy considered in some cases. Histologically, mesodermal tumors were most common, with myxoid liposarcomas being predominant. Long-term outcomes vary, with some cases showing favorable evolution but others experiencing recurrence or mortality post-surgery. This study aims to provide insights into the clinical presentation, diagnostic approach, treatment modalities, and long-term outcomes of primary retroperitoneal tumors based on a retrospective analysis of cases treated at the general surgery department of the Mohamed VI University Hospital in Marrakech. By elucidating the characteristics and management of these tumors, this study seeks to contribute to the understanding of primary retroperitoneal tumors and guide future diagnostic and therapeutic strategies to improve patient outcomes.

Recurrent cervical adenofibroma progressing to adenosarcoma: a rare case report.

Cervical adenofibroma is a rare form of mixed mesodermal tumor that can present as cervical polyps with a tendency for local recurrence and progression. Few cases progressing to adenosarcoma have previously been reported. We report a case of cervical adenofibroma progressing to adenosarcoma, and we seek to remind clinicians of the method and importance of the differential diagnosis of this disease. A fertile woman was admitted in our department for the eighth recurrence of a cervical polypoidal mass which for the past 10 years. Recurrence of cervical adenofibroma was confirmed by ultrasound and MRI. A wide local excision under hysteroscopy was performed due to her strong desire to preserve the uterus. Surgical pathology and immunohistochemical interpretation revealed cervical adenosarcoma. A hysterectomy with conservation of the ovaries was recommended, with regular follow-ups for evidence of disease recurrence. Differential diagnoses of cervical adenofibroma are hard to prove. Adenosarcoma should be ruled out, especially in women presenting with recurrent cervical polypoidal masses. A combined histological/immunohistochemical investigation is mandatory.

NKX3.1 immunohistochemistry and methylome profiling in mesenchymal chondrosarcoma: additional diagnostic value for a well-defined disease?

Mesenchymal chondrosarcoma (MCS) is a rare and highly aggressive tumour of soft tissue and bone that is defined by an underlying and highly specific fusion transcript involving HEY1 and NCOA2. Histologically, the tumours show a biphasic appearance consisting of an undifferentiated blue and round cell component as well as islands of highly differentiated cartilage. Particularly in core needle biopsies, the chondromatous component can be missed and the non-specific morphology and immunophenotype of the round cell component can cause diagnostic challenges. We applied NKX3.1 immunohistochemistry which was recently reported as a highly specific marker as well as methylome and copy number profiling to a set of 45 well characterised MCS cases to evaluate their potential diagnostic value. Methylome profiling revealed a highly distinct cluster for MCS. Notably, the findings were reproducible also when analysing the round cell and cartilaginous component separately. Furthermore, four outliers were identified by methylome profiling for which the diagnosis had to be revised. NKX3.1 immunohistochemistry showed positivity in 36% of tumours, the majority of which was rather focal and weak. Taken together, NKX3.1 expression showed a low sensitivity but a high specificity in our analysis. Methylome profiling on the other hand represents a sensitive, specific and reliable tool to support the diagnosis of MCS, particularly if only the round cell component is obtained in a biopsy and the diagnosis is not suspected. Furthermore, it can aid in confirming the diagnosis in case RNA sequencing for the HEY1::NCOA2 fusion transcript is not available.

Merger and Consolidation-Carcinosarcoma-Uterine Cervix

Carcinosarcoma of uterine cervix is an exceptionally encountered, high grade neoplasm composed of malignant epithelial and mesenchymal elements. Additionally designated as malignant mixed mesodermal tumour, homologous neoplasms of uterine cervix are denominated as carcinosarcoma.

A rare giant fibroepithelial stromal polyp arising from the areola of breast-a case report

Fibro-epithelial stromal polyps (FSP) are benign mesodermal tumors. They are rarely seen in the breast. Most of them arise from the nipple. Other sites of origin are the external auditory canal, the tonsil, the ureter, oropharynx, the nasal vestibule, the eyelid etc. Though the occurrence and the rarity of FSP of nipple have been described previously, a FSP arising from the areola with intact nipple hasn’t been reported in the literature till date.

Paediatric Posterior Urethral Polyp: A Case Report

Urethral polyps also known as fibroepithelial polyps, prostatic urethral polyps (in males) or benign urethral polyps and are very rare. They are most common benign mesodermal tumours of the urinary tract. They present with variety of urinary tract symptoms. Voiding Cystourethrogram (VCUG) is the first investigation requiring careful interpretation. Cysto-urethroscopy is the investigation of choice for final diagnosis and excision of urethral polyps. We report a case of an 8-year-old boy who presented with lower urinary tract symptoms. Radiological investigation revealed bilateral hydroureteronephrosis. We confirmed the diagnosis and excised the urethral polyp endoscopically with Holmium YAG Laser rendering patient completely free of symptoms.

Paediatric Posterior Urethral Polyp: A Case Report

Urethral polyps also known as fibroepithelial polyps, prostatic urethral polyps (in males) or benign urethral polyps and are very rare. They are most common benign mesodermal tumours of the urinary tract. They present with variety of urinary tract symptoms. Voiding Cystourethrogram (VCUG) is the first investigation requiring careful interpretation. Cysto-urethroscopy is the investigation of choice for final diagnosis and excision of urethral polyps. We report a case of an 8-year-old boy who presented with lower urinary tract symptoms. Radiological investigation revealed bilateral hydroureteronephrosis. We confirmed the diagnosis and excised the urethral polyp endoscopically with Holmium YAG Laser rendering patient completely free of symptoms.

ENDOMETRIAL CANCER IN ZARIA, NIGERIA: A TWENTY YEAR HISTOPATHOLOGICAL ANALYSIS (1991 - 2010)

Background: Cancer has become a major global public health problem. There are approximately 150,000 cases of endometrial cancer diagnosed each year, making endometrial carcinoma the fifth most common cancer in women. The predisposing factor was linked to reproductive history with duration and type of oestrogen exposure. Endometrial cancer is often diagnosed early. There has not been a comprehensive clinico-pathological study/ documentation of endometrial cancer in the study center. Materials and Method: This is a retrospective histopathological review of endometrial cancer seen over 20- year period obtained from endometrial curettage and hysterectomy specimens submitted to the Department of pathology. Histology slides were retrieved, reviewed and classified using the WHO classification of tumours of the endometrium. Analysis of the collected data was carried out using SPSS Version 15.0, and data were presented in frequency distribution tables and figures. Result: A total of 1,505 cases were diagnosed as malignant lesions of the female genital tract with the endometrial cancer represent 4.4% of the malignancies. Majority of endometrial cancer were epithelial 69.7 %, 21.7 % were grade I tumours, grade II tumours 50.0 % and grade III 28.3 % of the cases. Stromal sarcoma 19.7% of these 61.5 % were high grade stromal sarcoma, 38.5 %, low grade stromal sarcoma and Malignant Mixed Mesodermal Tumours accounted for 10.6 % cases. The age range was from 24 to 80 years. With peak age of incidence in 5th and 6th decades. Most of the endometrial cancers were diagnosed by endometrial biopsies 63.6% while the rest by total abdominal hysterectomy 36.4 %. Conclusion: Endometrial cancer represented 4.4 % of the female genital tract malignancies within the study period with possible early exposure to the aetiological factors and epithelial tumour are commoner than Malignant Mixed Mesodermal Tumours.

Clinicopathological features of malignant mixed mesodermal tumor: analysis of 50 cases

Objective: To investigate the clinicpathological, immunohistochemical and molecular genetic features of malignant mixed mesodermal tumor (MMMT) in the female reproductive system. Methods: To analyze its histopathological characteristics, we performed a retrospective review of the MMMT cases diagnosed at PLA General Hospital, Beijing, China during 2005-2019 using its surgical and pathological databases. EnVision immunohistochemical staining was used to detect the expression of ER, PR, p16, p53 and MMR proteins. Results: Fifty cases were conformed to the diagnosis, including 29 cases originated in the uterus, 16 cases in ovary, 4 cases of synchronous occurrence in uterus and ovary, 1 case in cervix. The tumor was histologically composed of two components, namely carcinoma and sarcoma ones, with clear borderline or blend mutually. The proportion of cancer component in the whole tumor ranged from 5%-90%. The proportion of carcinoma was more than 50% in 76% of the cases, and less than 50% in 24% of cases, including 2 cases with<10% of carcinoma. In the cases of primary uterine MMMT, the main carcinoma type was high grade endometrioid carcinoma (55%, 16/29). In ovarian MMMT, the main carcinoma type was serous carcinoma (12/16), while that of cervical MMMT was squamous cell carcinoma. The others were clear cell carcinoma or the undifferentiated carcinoma. There was one carcinoma type in most cases, only 7 cases had two carcinoma types. Homologous sarcomas, including stromal sarcoma, leiomyosarcoma and high-grade spindle cell sarcomas, were more commonly found in uterine MMMT (72.4%, 21/29). While heterogenic sarcomas, including chondrosarcoma, osteosarcoma and rhabdomyosarcoma, were more commonly noted in ovarian MMMT (12/16) than MMMT of other sites. There were 10 cases that consisted of two types of sarcomas. The synchronous MMMT of uterus and ovary had similar morphology and the types of carcinoma and sarcoma. The tumor cells that spread or metastasized to lymph node, omentum, intestinal wall or skin were all carcinoma cells, and were morphologically consistent with the original tumors. Immunohistochemically, ER and PR were both negative (23/25 in uterine, 8/10 in ovarian tumors). p16 was strongly positive (11/11 in uterine tumors, and 6/6 in ovarian tumors), with similar expression patterns in the carcinoma and sarcoma components. p53 showed mutant-type staining (64%, 21/33) and expressed synchronously in carcinoma and sarcoma components. p53 mutation was found in 35% cases of endometrial carcinoma and 46.7% cases of non-endometrial carcinoma. p53 mutation was also found in only 31.8% cases of heterogenic sarcomas, but in 50% of non-heterogenic sarcomas. Twenty-eight cases (28/33, 85%) presented intact mismatch repair proteins, while 5 cases (5/33, 15%) presented deficient mismatch repair proteins. Conclusions: MMMT in female reproductive system is a rare high-grade biphasic tumor with complex and diverse morphology. The immunohistochemical features are characterized by negative ER/PR and strongly positive p16, mostly mutant p53 and proficient mismatch repair proteins. The patients with a high FIGO stage have worse prognosis.

Sentinel lymph node mapping detection and recurrence rates in clinical stage I endometrial cancer

Objectives: The literature suggests that sentinel lymph node biopsy (SLNB) is an acceptable alternative to pelvic and paraaortic lymph node dissection (PPALND) in patients with clinical stage I endometrial cancers. The referenced data is largely published from high-volume specialized institutions and a complete PPALND is still performed by many surgeons at smaller, non-specialized centers. Our aim is to demonstrate that SLNB is feasible, reproducible, and sensitive without affecting cancer-specific outcomes when implemented at a non-specialized center. Methods: A retrospective review of patients with clinical stage I endometrial cancer was performed from September 2016 through February 2020. All patients had undergone either a robot-assisted or laparoscopic hysterectomy with SLNB. Endometrioid, uterine papillary serous (UPSC), malignant mixed mesodermal tumor (MMMT), and clear cell (CC) histologies were included. Indocyanine green was injected into the cervix bilaterally as per a previously described protocol. Paraaortic LND was performed at the discretion of the surgeon. In addition to SLNB, complete PPALND was performed for patients with MMMT, UPSC or CC. Sentinel lymph nodes (SLN) were evaluated using ultra-staging protocols including serial sectioning and cytokeratin staining. The medical record was queried for clinical or radiographic evidence of recurrence. Results: A total of 92 patients were included: 69 stage IA, 12 stage IB, 3 stage II and 8 stage III (2 IIIA, 2 IIIC1, 4 IIIC2). The majority of patients were endometrioid (73%), followed by UPSC (15.0%), MMMT (5.0%) and CC (4%). At least one SLN was detected in 95.4% of cases. The rate of bilateral SLN detection was 74.3% and improved over time from 2017-2019: 70% (2017), 74.4% (2018), 80% (2019). Twenty patients underwent PPALND. Non-SLN were positive in 3 patients, all with high-risk histology. There were no other patients with false-negative SLNB. There have been 3 (3%) recurrences to date; one rectal recurrence, one pelvic side wall and one paraaortic lymph node recurrence. All three patients had detected bilateral SLN which were negative at the time of their initial surgery; all three recurrences were high grade histology. Conclusions: SLNB is a sensitive and specific method for assessing lymph node involvement in patients with clinical stage I endometrial cancers. Our detection and recurrence rates are comparable to the rates reported in the literature and demonstrate that when applied at non-specialized centers this approach is safe and reproducible without affecting cancer-specific outcomes.

Lymphatic mapping and obesity with sentinel lymph node biopsy in endometrial cancer

<h3>Objectives:</h3> Sentinel lymph node biopsy (SLNB) has emerged as an acceptable alternative to complete pelvic and paraaortic lymph node dissection (PPALND) for patients with clinical stage I endometrial cancer. Several factors are associated with high risk of bilateral SLN detection failure. Our aim is to investigate the effect of obesity on bilateral SLN detection rates. <h3>Methods:</h3> Patients with either clinical stage I endometrial cancer or complex atypical hyperplasia were retrospectively reviewed from September 2016 through February 2020. All patients had undergone either a robot-assisted or laparoscopic hysterectomy with SLNB. Endometrioid, uterine papillary serous (UPSC), malignant mixed mesodermal tumor (MMMT), and clear cell (CC) histologies were included. Indocyanine green was injected into the cervix per our protocol. Patients with suboptimal lymph node mapping or nodes suspicious for metastasis underwent a side specific pelvic lymph node dissection (LND). In addition to SLNB, PPALND was performed for patients with UPSC, MMMT, and CC. Sentinel lymph nodes (SLN) were evaluated using ultra-staging protocols including serial sectioning and cytokeratin staining. The medical record was queried for successful bilateral or unilateral sentinel lymph node detection. Patient demographic data was then collected and analyzed with sentinel lymph node detection rate. <h3>Results:</h3> A total of 97 patients were reviewed and included: 92 had diagnosed endometrial cancer while 5 had complex atypical hyperplasia. Stage were as follows: 81 patients had stage I or II disease, and 8 patients had Stage III disease diagnosed at surgery. At least one SLN was detected 95.9% of cases, with an overall bilateral detection rate of 77.7%. In total, 53 patients classified as obese (25 Class I, 15 Class II and 13 Class III), 24 patients were overweight (BMI 25-29.9) and 20 patients had normal BMI. Unilateral and bilateral detection rates were not independently associated with obesity class. Bilateral SLN detection rates were 76% in normal BMI class and 67%, 83% and 73% for Class I, Class II and Class III obesity respectively; while at least one SLN was detected in 94% of normal BMI class and 92%, 96%, 100% and 92% in overweight weight class, Class I, II and II obesity respectively. <h3>Conclusions:</h3> Patient BMI is an important consideration for preoperative planning and success of bilateral sentinel lymph node mapping. Bilateral detection rates among obese patients are comparable to those of non-obese patients in our cohort. Despite previously reported correlation between BMI and successful bilateral mapping, our results do not demonstrate this relationship and obesity does not appear to be a contraindication to SLNB.

Submucosal urothelial bladder cancer: A case report.

Bladder tumors can be broadly divided into those of epithelial or mesodermal origin. Furthermore, 90% of bladder tumors arise from the epithelium of the bladder, and most cases of bladder cancer are histologically urothelial carcinomas. Mesodermal tumors are exceptionally rare and often benign. Of the mesenchymal tumors of the bladder, leiomyomas are the most common, and their prognosis depends on their histology. The present report describes a case of submucosal urothelial cancer in a patient with no past history of bladder cancer. To the best of our knowledge, there are no previous reports of urothelial cancer occurring in the submucosa. The present report was the first to document a case of submucosal urothelial cancer, whose diagnosis was made possible only by transurethral resection of bladder tumor. Although the precise pathomechanism of the present case was unclear, two hypotheses were considered. First, the urothelial cancer developed within a diverticulum, then the entrance of the diverticulum closed, sealing in the cancer. Second, the bladder cancer stemmed from aberrant urothelium in the submucosal tissue. If submucosal urothelial bladder carcinoma develops within the diverticular environment, its prognosis can be as poor as that of invasive bladder cancer due to the features of the diverticular environment. Even in a patient with a submucosal bladder tumor but no previous history of bladder cancer, bladder cancer should be considered in the differential diagnosis.

Case Report: Primary Pericardial Mesothelioma

BACKGROUND: Primary pericardial mesothelioma is an extremely rare mesodermal tumor, among oncological diseases, with a very low incidence. About 350 cases have been described around the world, most of them diagnosed post-mortem. The short term prognosis is poor, regardless of the treatment, which is mostly palliative. We present a case report regarding this pathology. CASE REPORT: 69 year old patient hospitalized with dyspnea and severe anemia. Complementary workup showed pleural effusion and pericardial effusion. Histopathology report of the pericardial fluid revealed pericardial mesothelioma. EVOLUTION: Due to recurrence of pericardial effusion, it was decided to perform pericardiectomy and left pleurectomy as palliative treatment, to alleviate the patient’s symptoms. Chemotherapy was planned after the procedure, but the patient’s general condition deteriorated severely leading to his death. CONCLUSION: Primary pericardial mesothelioma is a rare tumor, whose symptoms are characterized by the associated pericardial effusion, making the diagnosis difficult due to it low incidence. The prognosis is poor in short- term, and there isn’t an established protocol for the treatment with results that showed improve in mortality. KEYWORDS: MESOTHELIOMA, PERICARDIAL EFFUSION, PERICARDIECTOMY, PLEUROTOMY.

SOX2 Expression in Canine Neoplasia.

SOX2 is a major transcriptional regulator of stem cell pluripotency and self-renewability. Its expression in cancer stem cells from several different tumor types in humans and rodent models directly implicates SOX2 in tumorigenicity, metastasis, drug resistance, recurrence, and poor survival. Our objective was to investigate the expression of SOX2 in canine neoplasia. Immunohistochemistry for SOX2 was performed in sets of 10 archived formalin-fixed paraffin-embedded tissues from 45 distinct canine neoplasms. Normal expression of SOX2 was evaluated in a canine tissue microarray. Strong and diffuse SOX2 intranuclear immunolabeling was consistently found in the majority of ectodermal (13/15) and endodermal tumors (5/7). Negative, variable, or inconsistent SOX2 intranuclear immunolabeling was detected in the majority of mesodermal tumors (10/16) and in tumors with dual or uncertain origin (5/7). Although further studies are necessary to understand mechanistically how SOX2 contributes to the biology of each tumor type, this study demonstrates the expression of SOX2 in a wide variety of canine cancers. In the future, screening methods based on cellular plasticity and pluripotency biomarkers may provide avenues for the rational design of therapeutic strategies that target vulnerable signals upstream or downstream of SOX2 in different cancers, and possibly offer novel clinical applications for SOX2 as a prognostic indicator.

Primitive Myxoid Mesenchymal Tumour of Nose.

Primitive Myxoid Mesenchymal Tumour of Infancy (P.M.M.T.I.) is a locally aggressive myofibroblastic tumour, occurring mostly in the first year of life. Grossly, it occurs as a non-encapsulated, multi-nodular tumour with focal infiltrative growth with a size ranging from 2 to 15cm. It is composed of primitive spindled cells in a myxoid background. It is a low-grade fibroblastic malignancy with low metastatic potential with a high local recurrence rate. On immunohistochemistry, it stains positive for Vimentin. no reactivity for smooth muscle actin, muscle specific actin, desmin, S-100 protein, or myogenin. Electron microscopy documented a poorly differentiated fibroblastic proliferation. The present case is of a P.M.M.T. occurring in the nose of a 3 ½ years old female child. This is the first case reported from Central India. The child had recurrent nasal growth and the excision biopsy was suggestive of intermediate grade fibroblastic neoplasm. The biopsy, on IHC staining, was positive for Vimentin and CD99 and negative for S-100, CD-34 and Desmin, favouring the diagnosis of P.M.M.T. The child had a total of three recurrence of growth after local excision before diagnosis was established. In the prior two surgeries, the histopathological analysis reported it as a benign nasal polyp. After the third surgery, the specimen was sent for IHC. Immunohistochemical stains helped in differentiating it from congenital infantile fibrosarcomas, a similar type of mesodermal tumour. The present case of Primitive myxoid mesenchymal tumour following IHC stains were positive for Vimentin, CD-99, CD-117 and NESTIN, pointing to the primitive nature of the tumour. It was negative for the neural marker. Since it is chemo resistant, the preferred method of treatment is wide surgical excision.

Clinical characteristics and surgical outcomes of retroperitoneal tumors: a comprehensive data collection from multiple departments.

There are only a limited number of comprehensive reports for retroperitoneal tumors (RPTs). The aim of this study was to perform an interdepartmental data collection for RPTs and to comprehensively clarify the clinical characteristics of this rare disease. All patients who were diagnosed with RPT from January 2005 to July 2018 in a single institution were included. The analyzed factors included demographics, clinical features, treatment methods, pathological diagnosis, and prognosis. A total of 422 patients (215 males and 207 females) with primary RPTs were identified. Biopsy for RPT was performed in 180 patients (43%). Among the 422 patients, 239 (57%) underwent surgery. The most common tissue origin was mesodermal (n = 99, 41%), followed by neurogenic (n = 54, 23%), extragonadal (n = 27, 11%), and metastatic tumors (n = 13, 5%). Among the 99 resected mesodermal tumors, the most common pathological subtypes were liposarcoma (n = 55, 56%) and leiomyosarcoma (n = 16, 16%). The long-term outcomes after surgery were analyzed in patients with intermediate and malignant sarcomas (including liposarcoma, leiomyosarcoma, and others combined, n = 71). The 3- and 5-year disease-free survival rates in the intermediate tumors were 68.2% and 54.2%, respectively, whereas those in the malignant tumors were 48.6% and 28.9%, respectively. The 3- and 5-year overall survival rates in the intermediate tumors were 100% and 94.1%, respectively, whereas those in the malignant tumors were 78.4% and 72.8%, respectively (p = 0.009). The clinical manifestations of RPTs were extremely variable. Recurrence after repeating resection is commonly observed in patients with malignant retroperitoneal sarcoma.

Malignant Mixed Mesodermal Tumour (MMMT) of the Ovary: An Unusual Primary Tumour

Ovarian carcinosarcoma (Malignant Mixed Mesodermal Tumour) is rare malignant tumour with a poor prognosis. We here present a case of ovarian carcinosarcoma in a 72-yearswoman suffering from intermittent lower abdominal pain for 5 months with previous history of Total Abdominal Hysterectomy (TAH) with Unilateral Salpingo-Oophorectomy (USO) due to leiomyoma 27 years back. Explanatory laparotomy and right salpingo-oophorectomy with complete surgical staging was done at Dhaka Community Medical College Hospital. Histopathology revealed both sarcomatous and carcinomatous component. Surprisingly the patient had no metastatic foci and consulted with a medical Oncologist, who didn’t recommend any chemotherapy and was cancer free during last one and half years follow up.&#x0D; Bangladesh J Obstet Gynaecol, 2019; Vol. 34(2): 124-126

C-Myb regulates tumorigenic potential of embryonal rhabdomyosarcoma cells

Rhabdomyosarcomas (RMS) are a heterogeneous group of mesodermal tumors, the most common sub-types are embryonal (eRMS) and alveolar (aRMS) rhabdomyosarcoma. Immunohistochemical analysis revealed c-Myb expression in both eRMS and aRMS. c-Myb has been reported to be often associated with malignant human cancers. We therefore investigated the c-Myb role in RMS using cellular models of RMS. Specific suppression of c-Myb by a lentiviral vector expressing doxycycline (Dox)-inducible c-Myb shRNA inhibited proliferation, colony formation, and migration of the eRMS cell line (RD), but not of the aRMS cell line (RH30). Upon c-Myb knockdown in eRMS cells, cells accumulated in G0/G1 phase, the invasive behaviour of cells was repressed, and elevated levels of myosin heavy chain, marker of muscle differentiation, was detected. Next, we used an RD-based xenograft model to investigate the role of c-Myb in eRMS tumorigenesis in vivo. We found that Dox administration did not result in efficient suppression of c-Myb in growing tumors. However, when c-Myb-deficient RD cells were implanted into SCID mice, we observed inefficient tumor grafting and attenuation of tumor growth during the initial stages of tumor expansion. The presented study suggests that c-Myb could be a therapeutic target in embryonal rhabdomyosarcoma assuming that its expression is ablated.

Endometrial adenofibroma, A Case Report

Introduction: Adenofibroma is a type of mixed mesodermal tumor that both epithelial and stromal components are benign, and often originate from endometrium at postmenopausal age. Uterine adenofibroma is an extremely rare tumor and this lesion must be differentiated from some benign or malignant lesions of the uterus, particularly adenosarcoma. Because of the rarity and importance of such histopathology at post-menopausal age, this case is presented. Case Presentation: A 63-year-old woman, parity 9, who was at menopause period with a history of prolonged and severe no bloody vaginal discharge during the past 3 months was referred to our center. Transvaginal ultrasonography revealed a hyperechoic area with the dimensions 65 × 37 × 33 mm inside the endometrial cavity, that was suspicious to severe endometrial hyperplasia or malignancy. Tumor marker tests (BHCC, LDH, αFP, CA125, CA19-9, and CEA) were in normal limit. Endometrial biopsy by pipelle was unsatisfactory for diagnosis. Total abdominal hysterectomy was done, and the result of histopathology confirmed endometrial adenofibroma with the dimensions 70 × 47 × 40 mm. Conclusions: The presence of a hyperechoic area of the endometrium with complain of prolonged vaginal discharge in post menopause subjects could attribute to endometrial adenofibroma.

Association of Types of Epithelial Ovarian Cancer with Stage, Cytoreduction and Progression Free Survival Rate

Introduction: To assess the clinical impact of the Types of Epithelial ovarian tumour designated as Type I and II according to Immunohistochemistry and Histopathology to study the association of Types of EOC with stage, cytoreductability and progression fr ee survival rate. Methods: This study was conducted in the Department of Gynaecological oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India in year 2017 – 2018 after obtaining the approval of the Institute Ethical Review Board committee. Pa tients were asked to sign an informed written consent after explaining the need for the procedure, their possible outcomes and the significance of the results. No new intervention was required in this study. All patients with Epithelial ovarian cancer that was surgically treated (Both Primary delbulking and interval debulking surgery) in the Dept. of Gynaecological Oncology were recruited in this study. Intraoperative mapping of pattern of distribution of disease was done and the patients were divided into 3 Groups. Group A (Pelvis, nodes), Group B (omentum, peritoneum, hemidiaphragm, surface liver), Group C ( Mesentry, Porta hepatic, Lesser sac). If disease was found to be extensive (Fagotti&gt;8/PCI&gt;17) these patients underwent Neoadjuvant cheomotherapy with P aclitaxil and Carboplatin and then assessed for interval surgery. Residual disease was defined as R0 - no residual macroscopic disease after surgery, R1 - 0.1 - 0.5cm residual disease, R2 - 0.5 - 1cm, R3&gt;1cm Stages are defined according to the FIGO classification WH O 2014 criteria (I – IV), stage I/II is considered early FIGO stage, and stage III/IV, where the tumor has spread beyond the pelvic region, as late FIGO stage. The categories of grade are well - differentiated (Grade 1) moderately differentiated (Grade 2), and poorly differentiated (Grade 3). Grade 1 is considered as low - grade tumors and Grades 2 - 3 as high - grade tumors. Histologic types were defined as serous adenocarcinoma, mucinous adenocarcinoma, endometrioid adenocarcinoma, clear cell neoplasms, carcinosarc oma, transitional/Brenner tumors, mixed tumors, or undifferentiated carcinomas along with their HC markers (p53, WT 1, ER, Napsin) were obtained from their histopathology reports. All pathologic diagnoses were given by our dedicated Onco - pathologists . Kaplan - Meier and logistic/Cox - regression analyses were performed to assess the impact of histological type on surgical outcome and survival. Results : All EOC patients (n=101) reporting to our Dept. of Gynaecological oncology who underwent tumour debulki ng in our institution (09/2016 – 012/2018) were classified into one of two groups: type I tumours (n=36); composed of low - grade serous, low - grade endometrioid, clear cell, mucinous and transitional carcinomas; and Type II tumours (n=65) composed of high - grad e serous, high - grade endometrioid, undifferentiated and malignant mixed - mesodermal tumours. Primary debulking surgery rate (PDS) with complete cytoreduction (R0) was more in Type I EOC, with almost 91.2% vs 67.4% in Type II EOC showing clinically and stati stical significance (p value.0.016). Also R1/R2 (R1 - 0.1 - 0.5cm residual disease, R2 - 0.5 - 1cm residual disease), was more in Type II compared to Type I showing borderline statistical significance (p value.0.566). According to the pattern of distribution, PDS and IDS was assessed in all the 3 Groups in Type I &amp; II EOC. Type I had 94.4% PDS compared with 66.2% Type II in Group A (pelvis, nodes) showing clinically and statistical significance (p value 0.001.). In group B (omentum, peritoneum, hemidiphram, liver) Type I had 88.2% PDS vs 60% in type II showing clinically and statistical significance (p value 0.038). In group C (Porta, mesentry, lesser sac) Type I had 75% PDS vs 63.2% in type II showing clinically and statistical significance(p value 0.0676). Accordi ng to the pattern of distribution, cytoreductability (R0/R1,2) was assessed in all the 3 Groups in type I &amp; II EOC. Type I had 8.8% R1/2 compared with 32.6% Type II in Group A (pelvis, nodes) showing clinically and statistical significance (p value 0.016). In group B (omentum, peritoneum, hemidiphram, liver) Type I had 13.3% R1/2 vs 51.9% in type II showing clinically and statistical significance(p value 0.044). In group C (Porta, mesentry, lesser sac) Type I had 33.3%R1/2 vs 58.3% in type II, not showing s tatistical significance (p value 0.429). Conclusion : Type I EOC patients appear to present at earlier stages with younger age of presentation, their d istribution in group B (Omentum, P eritoneum, Surface Liver, Hemidiaphragm) has a significant p value in r elation to their cytoreductability (R0,R1/2). However, Progression free survival analysis an o verall survival was not significant due to the short follow up interval.