Small Cystic Spaces Research Articles

Adenomatoid tumor of ovary – A rare case

Adenomatoid tumors are benign tumors of mesothelium and rare tumors found in male and female genital tract. They are more common in males than females. They account for 30% of all paratesticular neoplasm in males and 1.2% tumors of uterus. There are very few cases reported in ovaries. A 62 year old female presented with complaints of vague abdominal pain. Ultrasonography showed a unilateral tumor with of neoplastic etiology. The diagnosis of adenomatoid tumor of ovary postulated based on the distinct features numerous small vacuoles and cystic spaces of the neoplasm.

A LITERATURE REVIEW OF RADIOLOGICAL FINDINGS TO GUIDE THE DIAGNOSIS OF GALLBLADDER ADENOMYOMATOSIS.

Background: Gallbladder adenomyomatosis (GA) is a benign gallbladder entity discovered as an asymptomatic gallbladder mass. Since gallbladder cancer is in the differential diagnosis for gallbladder masses, the ability to differentiate benign disease avoids a more extensive oncologic resection. This study sought to review imaging modalities used to diagnose GA. Methods: PubMed and SciVerse Scopus were systematically searched using the terms: “gallbladder adenomyomatosis” and “gallbladder imaging” for articles published between January 2000 and January 2015. Results:Atotal of 14 articles were reviewed in this analysis. Contemporary series report the use of ultrasound (US), computed tomography (CT) or magnetic resonance imaging (MRI) in GAimaging. Ultrasound detection of Rokitansky-Aschoff sinuses, visualized as small cystic spaces with associated “comet-tail” or “twinkling” artifact, is pathognomonic for GA. A “Pearl-Necklace” sign of small connected sinuses on MRI or “Rosary” sign on CT are additional characteristics that may assist in establishing a diagnosis. Conclusion: Ultrasound is the most commonly used tool to investigate GA. If not diagnostic, CT or MRI are effective in attempting to differentiate a benign or malignant cholecystic mass. Characteristic signs should lead the surgeon to perform a laparoscopic cholecystectomy in symptomatic patients or manage non-operatively in asymptomatic patients

Artifactual Cystic Spaces in Prostatic Transurethral Resections and Related Specimens: A Potential Diagnostic Confounder.

Aims. Histopathologic benign mimickers of prostate cancer have mostly focused on glandular mimics, with non-glandular mimics mainly limited to inflammatory conditions. While there is a paucity of literature recognizing small cystic (presumably artifactual) spaces in transurethral resection specimens, in some instances they can become florid enough to mimic vascular or epithelial neoplasms. Herein, we detailed histologic, immunophenotypic, and clinicopathologic findings in a large series of specimens showing prominent diagnostically confounding cystic spaces. Methods and Results. Sixty specimens were obtained (50 transurethral resections, 7 aquablations, 3 laser enucleations), from 17 different surgeons. Seven specimens had concurrent genitourinary pathology (4 prostatic adenocarcinoma, 1 solitary fibrous tumor, 1 prostatic atypia, 1 urothelial carcinoma in situ). The extent of cystic change among overall tissue examined ranged from 1 mm-8 mm (mean 3.4 mm), with luminal content of cystic spaces characterized as empty (72%), both empty and fluid-like (17%), and both empty and mucin-like (11%; mucin histochemical stain was negative on all specimens). Notable differences in degree of tissue cautery artifact or inflammation was not found. Immunohistochemistry performed on 30 specimens showed cystic spaces negative for S100, ERG, pankeratin, and CD45. Conclusion. Although artifactual in nature, in some instances small cystic spaces encountered in prostatic transurethral resections and more novel related procedures can become florid enough to warrant recognition as a potential diagnostic confounder of vascular or epithelial neoplasms.

Pulmonary fibrosis as an outcome of COVID-19 pneumonia

In this study, we report three cases of persistent severe respiratory failure and radiological signs of diffuse pulmonary fibrosis in patients after COVID-19 related pneumonia. Chest CT criteria for a diagnosis of pulmonary fibrosis include the presence of traction bronchiectasis and parenchymal bands (linear opacities), as well as numerous small subpleural cystic air spaces (honeycombing). The study found that all cases of fibrosis were associated with such risk factors as male gender, old age, and multicomorbidity. Chest CT of one patient with acute respiratory distress syndrome showed radiographic characteristics of pulmonary fibrosis together with the presence of ground glass opacities (GGO) – the main CT feature of COVID-19 pneumonia. In two other patients, CT features of pulmonary fibrosis appeared in about 2 months after the hospital stay.Thus, pulmonary fibrosis is severe and rapidly progressive complication of COVID-19 pneumonia with a poor prognosis, especially in patients with multiple risk factors.

Pre-operative classification of molar pregnancy: How good is ultrasound?

Histopathology is the reference standard for diagnosing hydatidiform molar pregnancy (HMP). To assess the performance of pre-operative transvaginal ultrasound (TVS) to predict HMP. A retrospective diagnostic accuracy study was performed on women who had both TVS and histopathological examination of uterine curettings between January 2011-February 2017. TVS diagnosis of partial MP (PMP) included assessment of fetal parts and/or empty gestational sac with small cystic spaces adjacent to gestational sac. TVS diagnosis of complete MP (CMP) included assessment of complex, echogenic intra-uterine mass(es) containing multiple small cystic areas. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (PLR/NLR) for TVS were reported. Reference standard was histology. There were 4917 consecutive women who underwent TVS; 1636 underwent surgical curettage for miscarriage. Forty out of 4917 (0.6%) had HMP histologically; 25/40 (62.5%) had suspected HMP and 15/40 (37.5%) did not; 24/40 (60.0%) had CMP of which 19/24 (79.1%) were suspected on TVS and 5/24 (20.8%) were not; 16/40 (40.0%) had PMP of which 6/16 (37.5%) were suspected on TVS and 10/16 (62.6%) were not. The sensitivity, specificity, PPV, NPV, PLR and NLR of pre-operative TVS to predict HMP were: 60.0, 99.1, 63.2, 99.0% 68.4, 0.4; for CMP: 79.2, 99.8, 86.3, 99.6%, 421.7, 0.2; for PMP: 37.5, 99.3, 35.3, 99.4%, 54.3, 0.6. Histology remains the gold standard for diagnosing HMP. TVS is an acceptable diagnostic tool for HMP. When there are no ultrasound features of HMP, almost all these women will not have an underlying HMP.

Benign multicystic peritoneal mesothelioma: literature review and update

ABSTRACTBenign multicystic peritoneal mesothelioma (BMPM) is a rare peritoneal tumor diagnosed predominantly in pre-menopausal women. Associated risk factors include endometriosis and pelvic inflammatory disease in women, and prior abdominal surgery in both genders. To date, the pathogenesis of this disease remains controversial with possible etiologies, including a neoplastic versus a reactive process. Given the risk factors, some authors believe that this disease is secondary to a reactive process. However, because some studies describe cases where there is no prior surgical history or inflammatory milieu present, and because of this entity’s predilection for recurrence, some authors believe the origin to be neoplastic. Some genetic and familial associations have also been reported. Malignant transformation is extremely rare, with only two cases reported in the literature, despite the recurrence potential. Like the etiology, the name of this entity is also controversial. Some authors prefer the term “peritoneal inclusion cyst (PCM)” instead of “benign cystic mesothelioma” and argue that the term mesothelioma should only be used when there is evidence of atypia. Most cases of BMPM are discovered incidentally. Others reflect sequela of tumor mass effect. It appears intra-operatively as large, multi-focal, cystic lesions in the peritoneal and pelvic cavity. Diagnosis is achieved through surgical sampling with histopathological examination. Immunobiologically, BMPM exhibits multiple small cystic spaces with flattened lining containing calretinin positive cells without atypical features, mitotic figures, or tissue invasion. Treatment includes cytoreductive surgery. Here we present a case of BMPM in a 60-year-old male – a rare disease in an uncommon patient population.

MAMMARY ANALOG SECRETORY CARCINOMA OF SALIVARY GLANDS:A CASE REPORT.

Objective Mammary analog secretory carcinoma(MASC), is a distinctive low-grade malignant salivary cancer. Microscopically, most cases of MASC consist of a circumscribed mass divided by thin fibrous septa into lobules composed of microcystic, tubular, and solid structures. Due to the scarcity of reported cases, however, little information exists regarding this lesion in the salivary gland. Here, we report a case of MASC occurring in the parotid gland. Clinical Presentation Our patient is a 28-yer-old male who presented with a 3.0 × 2.5 × 2.0cm in the right parotid gland, referred slowly growing, painless approximately one year duration. The tumor is rubbery, with a white-tan to gray cut surface. On the cut surface of the mass, many small cystic spaces may be seen, containing yellow to whitish fluid. The borders of the tumor is circumscribed but not encapsulated. Conclusion Most cases of MASCs were diagnosed as AciCC or adenocarcinoma not otherwise specified. Many MASC were found to harbor an ETV6-NTRK3 fusion gene because of a t(12;15) (p13,q25) translocation, a finding identical to secretory carcinoma of the breast. The most recent version of the World Health Organization (WHO) Classification of Head and Neck Tumours utilizes the terminology of “secretory carcinoma” for consistency. In addition to the case report, we review the past and current cases enrolled of MASC. Awareness of such a clinical presentation is important for the clinician.

Role of ultrasound in the diagnosis and management of gestational trophoblastic disease in Rwanda Rural health facilities- A case report

Introduction Gestational trophoblastic disease (GTD) is a rare kind of proliferative disorder of trophoblastic cells which develops from the placenta in early pregnancy and the complete hydatidiform mole (CHM) sub-type which limited to endometrium is most common. It has excellent prognosis if early appropriate diagnosis and management are done. A well performed ultrasound(US) play a primordial role in the diagnosis of maternal health disorders during routine prenatal care. This helps in avoiding complications and consequently aids in achieving the objectives of the Millennium Development Goals (MDGs) in Rwanda. Aim To understand the definition of Gestational trophoblastic disease(GTD); To recognize key diagnostic findings of complete molar pregnancy on ultrasound and appropriate management in maternal follow up and To review the differential diagnosis for ultrasound findings seen with GTD. Methods The case has been referred in ultrasound unit for scan from outpatient department and follow up US was ordered and done during management period while the patient lies on a bed while operator moves the 3,5 MHz lubricated transducer of frequency with gel on the abdomino- pelvic region with full urinary bladder and Mindray ultrasound Machine has been used. Results There was a large moderately hyperechogenic mass completely filling the endometrial cavity with numerous small cystic spaces of different size. Post 5 days under treatment, anechoic area within endometrial cavity and myometrium well outlined was discharged and in 3rd medical visit after 2 weeks, US were normal. Conclusion Ultrasound is the first modality to be used in all rural health facilities for diagnosis of suspected Gestational trophoblastic disease (GTD) for better results. It is available and free of radiation. Recommendation -The US is the baseline modalities to be used in 1st trimester in pregnancy women with GTD suspicion bleeding. -All rural health facilities should have empowered and capable trained Medical imaging practitioners for appropriate carrying out the ultrasonographic investigation for better care service delivery on GTD(Medical imaging practitioners Role extension project after formal training by Prof. Kawooya).

PP - ORAL CYSTADENOMA

Cystadenoma is a salivary gland epithelial tumor characterized by predominantly multicystic growth. It is a rare benign lesion in which the epithelium demonstrates adenomatous proliferation. The tumor is composed of cystic spaces of variable number and size. It occurs predominantly in women aged 57 years on average. Most tumors are located in minor salivary glands; only approximately 45% of all cases of cystadenoma arise in the parotid gland. This report presents the study case of a 52-year-old Brazilian female that was admitted in our clinic presenting a slow-enlarging painful mass located on the mandibular gingiva for approximately 6 months. lntraoral examination showed a single, firm to the touch, smooth-surfaced with marked borders nodule located on the lingual gingiva between dental elements 41 and 42. Pathological examination revealed multiple small cystic spaces with lumens often containing eosinophilic material with scattered epithelial, inflammatory cells and a cuboidal lining epithelium. A diagnosis of major salivary gland cystadenoma was made. The patient has been under follow-up for one year, and no recurrence was observed. Keywords: gland, salivary. neoplasia, benign. Cystadenoma.

Pancreatic serous cystadenoma – A case report

Microcystic serous cystadenoma is a benign tumor of pancreas, also termed as Clear cell or Glycogen rich adenoma. It occurs at any site in pancreas and composed of small cystic spaces lined by small cuboidal cells with clear cytoplasm, glycogen. There is an association with von Hippel Lindau syndrome in few cases. Clinical symptoms are variable. Excision is almost curative.We report a case of 70 year old male who presented to the OPD with vague complaints of local discomfort. Ultrasound showed a mass in the pancreas. Pancreatectomy was done and diagnosed as microcystic serous cystadenoma of pancreas on histopathology.

Selected Case From the Arkadi M. Rywlin International Pathology Slide Series

Herein, we report a 26-year-old patient with lymphangiomatosis of the spleen associated with multiple lymphatic and venous malformations. This patient underwent excision of a large lymphatic malformation of the left abdominal wall during childhood. A venous malformation of her left lower limb was excised during adolescence. Additional lymphatic malformations were found in the soft tissue of her left thigh at the age of 20. During hospitalization for a huge vulvar hemangioma at the age of 26, she was incidentally found to have asymptomatic splenomegaly, for which she underwent splenectomy. Examination of the spleen revealed diffuse involvement by a lymphatic anomaly predominantly forming small cystic spaces. Lymphangiomatosis of the spleen is rare and is classically separated into an isolated or pure form and a generalized form when it is associated with involvement of other viscera and/or multiple soft-tissue planes. This patient was affected by a borderline form of splenic lymphangiomatosis with limited somatic involvement of the superficial soft tissues and blood vessels. Notably, all the additional vascular malformations in this patient were left sided, and at this time there was no additional involvement of internal organ. No hereditary or known syndrome was identified.

Corpuscular thymoma, case report and review of literature

Aim Hassall corpuscles are concentric arrangement of keratinizing epithelial cells that are restricted to the medulla of the normal thymus. Hassall corpuscles in thymomas are unusual findings and are seen in thymomas WHO type B1-3 with medullary differentiation, but rare cases have been documented. Thymoma with abundant Hassall corpuscles (corpuscular thymoma) must be differentiated from thymic carcinoma, well differentiated keratinizing squamous cell carcinoma type. Case report We report a case of a 73-year-old male patient, presenting with cough for one year. Computed tomography (CT) scan showed a well defined anterior superior mediastinal mass. Surgical excision of the mass was performed. Gross examination revealed a large, oval shaped, well circumscribed, encapsulated, firm brown mass measuring 10 × 6 × 4 cm, and weighing 219 g, with heterogeneous pale white solid, small cystic spaces, and necrotic cut surfaces. Light microscopic examination revealed two alternating components, the first forming a delicate loose network of neoplastic epithelium equally admixed with non-neoplastic lymphocytes, and the second forming vague solid sheets with paucity of lymphocytes. Both components show abundant Hassall corpuscles, extensive areas of coagulative tumor necrosis, small cystic spaces, and cholesterol clefts. Immunohistochemical studies showed that the neoplastic epithelium is strongly and diffusely immunoreactive for HMWCK, panCK, and EMA, and focally positive for CAM5.2, and negative for CD5, and C-KIT immunohistochemical stains. Conclusion Corpuscular thymoma reported in the literature as WHO type B2 or B3. Our presented case is of type B3, Modified Masoaka stage 1. We believe that thymoma with corpuscular differentiation is a rare distinct variant of organotypical thymomas, although it is not mentioned in the 2004 WHO classification. Recognition of this rare variant of thymomas is very important to avoid confusion with thymic carcinoma and squamous cell carcinoma type. Careful microscopic examination and immunohistochemical stains are mandatory to differentiate between these entities.

Serous microcystic adenoma of the pancreas

A new case of serous microcystic adenoma in a 75-year-old man is presented. The tumor sized 55x45x55 mm was located in the body and the tail of the pancreas. It was well-circumscribed and spongy on cross-section, with eccentrically located fibrous scar. At microscopic examination, the lesion was composed of many small cystic spaces lined by one layer of flat or cuboidal cells occasionally with clear cytoplasm. A few papillary structures protruding to the lumina of cysts were also seen. Regardless benign nature of the tumor, the patient has died at early postoperative period due to unrelated conditions.

Multidetector computed tomography diagnosis of adenomyomatosis of the gallbladder

The differentiation of gallbladder adenomyomatosis from gallbladder carcinoma is important as both conditions may present with thickening of the gallbladder wall or as a focal mass. Identification of Rokitansky-Aschoff sinuses is the key feature in making an accurate diagnosis of gallbladder adenomyomatosis on imaging studies. The diagnosis of gallbladder adenomyomatosis can be made with accurately by multidetector computed tomography when the presence of Rokitansky-Aschoff sinuses (small cystic spaces within the thickened gallbladder wall) are noted. Herein we present multidetector computed tomography findings of a 27-year-old patient with gallbladder adenomyomatosis.

Preoperative easily misdiagnosed telangiectatic osteosarcoma: clinical

Purpose: To describe the clinical, imaging, and pathologic characteristics and diagnostic methods of telangiectatic osteosarcoma (TOS) for improving the diagnostic level. Materials and methods: The authors retrospectively reviewed patient demographics, serum alkaline phosphatase (AKP) levels, preoperative biopsy pathologic reports, pathologic materials, imaging findings, and treatment outcomes from 26 patients with TOS. Patient images from radiography (26 cases) and magnetic resonance (MR) imaging (22 cases) were evaluated by 3 authors in consensus for intrinsic characteristics. There were 15 male and 11 female patients in the study, with an age of 9–32 years (mean age 15.9 years). Results: Eighteen of 26 patients died of lung metastases within 5 years of follow-up. The distal femur was affected more commonly (14 cases, 53.8%). Regarding serum AKP, normal (8 cases) or mildly elevated (18 cases) levels were found before preoperative chemotherapy. Radiographs showed geographic bone lysis without sclerotic margin (26 cases), cortical destruction (26 cases), periosteal new bone formation (24 cases), soft-tissue mass (23 cases), and matrix mineralization (4 cases). The aggressive radiographic features of TOS simulated the appearance of conventional high-grade intramedullary osteosarcoma, though different from aneurysmal bone cyst. MR images demonstrated multiple big (16 cases) or small (6 cases) cystic spaces, fluid-fluid levels (14 cases), soft-tissue mass (22 cases), and thick peripheral and septal enhancement (22 cases). Nine of 26 cases were misdiagnosed as aneurysmal bone cysts by preoperative core-needle biopsy, owing to the absence of viable high-grade sarcomatous cells in the small tissue samples. Conclusion: The aggressive growth pattern with occasional matrix mineralization, and multiple big or small fluid-filled cavities with thick peripheral, septal, and nodular tissue surrounding the fluid-filled cavities are characteristic imaging features of TOS, and these features are helpful in making the correct preoperative diagnosis of TOS.

Primitive myxoid mesenchymal tumor of infancy: Report of two cases and review of the literature

Primitive myxoid mesenchymal tumor of infancy is a recently recognized soft tissue tumor with only a few cases reported. Here, we reported another two cases of the lesion, a 5-month-old boy presenting with a soft tissue mass in the neck region that recurred 2 months later and a 3-day-old girl with a congenital superficial dorsal lumbar mass that extended to the spinal canal 1 month later. They shared similar histological patterns, such as unusual diffuse myxoid background, delicate vascular network, small cystic spaces, low to moderate cellularity, and primitive mesenchymal tumor cells. Immunohistochemically, the tumor cells showed positive for vimentin, CD99, CD117 and nestin, negative for myoid, lipoblastic, histiocytic, and neural markers. In conclusion, primitive myxoid mesenchymal tumor of infancy is a distinctive entity with its own clinical pathological features. Expression of CD99, CD117 and nestin may be consistent with the primitive nature of the tumor and may serve as ancillary markers for differential diagnosis from the other infantile tumors.

Synchronous clear cell renal cell carcinoma and tubulocystic carcinoma: genetic evidence of independent ontogenesis and implications of chromosomal imbalances in tumor progression

Seven percent of renal cell carcinoma (RCC) cases are diagnosed as "unclassified" RCC by morphology. Genetic profiling of RCCs helps define renal tumor subtypes, especially in cases where morphologic diagnosis is inconclusive. This report describes a patient with synchronous clear cell RCC (ccRCC) and a tubulocystic renal carcinoma (TCRC) in the same kidney, and discusses the pathologic features and genetic profile of both tumors. A 67 year-old male underwent CT scans for an unrelated medical event. Two incidental renal lesions were found and ultimately removed by radical nephrectomy. The smaller lesion had multiple small cystic spaces lined by hobnail cells with high nuclear grade separated by fibrous stroma. This morphology and the expression of proximal (CD10, AMACR) and distal tubule cell (CK19) markers by immunohistochemistry supported the diagnosis of TCRC. The larger lesion was a typical ccRCC, with Fuhrman's nuclear grade 3 and confined to the kidney. Molecular characterization of both neoplasms using virtual karyotyping was performed to assess relatedness of these tumors. Low grade areas (Fuhrman grade 2) of the ccRCC showed loss of 3p and gains in chromosomes 5 and 7, whereas oncocytic areas displayed additional gain of 2p and loss of 10q; the high grade areas (Fuhrman grade 3) showed several additional imbalances. In contrast, the TCRC demonstrated a distinct profile with gains of chromosomes 8 and 17 and loss of 9. In conclusion, ccRCC and TCRC show distinct genomic copy number profiles and chromosomal imbalances in TCRC might be implicated in the pathogenesis of this tumor. Second, the presence of a ccRCC with varying degrees of differentiation exemplifies the sequence of chromosomal imbalances acquired during tumor progression.Virtual SlidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/1790525735655283

Characteristic crescentic subpleural lung zones with high ventilation (V)/perfusion (Q) ratios in interstitial pneumonia on V/Q quotient SPECT

Nonspecific interstitial pneumonia (NSIP) and usual IP (UIP) preferentially involve subpleural lung zones (SPLZ), and may result in characteristic regional lung function impairment. The aim of this study was to characterize cross-sectional lung ventilation (V)-perfusion (Q) imbalance in these disorders on automated V/Q quotient single photon emission computed tomography (SPECT). 99mTc-technegas/macroaggregated albumin SPECT-derived V/Q quotient SPECT and V/Q profile were automatically built for assessment of cross-sectional lung V-Q imbalance in 38 patients with NSIP or UIP. The findings of V/Q quotient SPECT were correlated with lung CT morphology. The results were compared with 12 healthy nonsmoker controls and 48 patients with chronic obstructive pulmonary disease. V/Q quotient SPECT showed 81 crescentic SPLZ with high V/Q ratios in 32 patients (84%) with NSIP or UIP, which were not observed in controls and patients with chronic obstructive pulmonary disease. Sixty-three (77.7%) of them were located at high-attenuation areas (reticular and/or ground-glass opacities) with or without small cystic air spaces (honeycombing and/or traction bronchiectasis) on CT, and 12 (14.8%) at normal lung areas. V/Q profile at the lung sections with crescentic SPLZ with high V/Q ratios showed flattened peaks with broadened V/Q ratio distribution compared with controls, and standard deviation of V/Q ratios in the entire lungs was significantly correlated with partial oxygen arterial blood pressure (P = 0.0009) and predicted diffusing capacity of the lungs for carbon monoxide (P = 0.0139). Five of eight patients with NSIP or UIP and with worsening of hypoxemia showed an extension of SPCZ with high V/Q ratios on follow-up V/Q quotient SPECT, without significant changes on CT. A high prevalence of crescentic SPLZ with high V/Q ratios is a characteristic feature of lung V-Q imbalance causing alveolar gas exchange impairment in NSIP and UIP.

Histopathology of a functioning mitomycin-C trabeculectomy

The ideal trabeculectomy bleb is diffuse, normally vascularized and characterized by microcystic change in the overlying conjunctiva. We compare and contrast the histopathology of a normally functioning mitomycin-C trabeculectomy site obtained from an eye enucleated for iris melanoma with abnormal blebs discussed in the literature. Representative sections of the normally functioning bleb were examined under the light microscope. The conjunctiva is composed of a uniform three-layered non-keratinizing stratified squamous epithelium overlying a single layer of oedematous basal cells. The conjunctival stroma consisted of loose connective tissue, traversed by capillaries and scattered small cystic spaces lined by endothelial cells. There were no goblet cells and few inflammatory cells and fibroblasts. The scleral trapdoor was evident as a cleft in the scleral wall in communication with the anterior chamber at the surgically created sclerostomy. Because the histopathological findings in our case correlate well with this clinical appearance, we conclude that whereas augmentation with anti-metabolites, such as mitomycin-C, can be associated with significantly altered conjunctival histopathology and consequent hypotony, but, if used carefully, normal architecture is conserved.

Multiple extragenital adenomatoid tumors in the mesocolon and omentum

Adenomatoid tumors are benign mesothelial neoplasms most commonly found in the male and female genital tracts. Extragenital adenomatoid tumors are rare, most of them being solitary tumors. To our knowledge, only one case of multiple extragenital adenomatoid tumors, involving the liver and peritoneum, has been reported to date. Here we report another case of multiple extragenital adenomatoid tumors involving the mesocolon and omentum. A 47-year-old woman presented with a delayed menstrual period. Ultrasonography revealed a left adnexal mass, and surgical resection was attempted at a local hospital. The patient was transferred to our hospital without resection due to the intraoperative finding of multiple peritoneal tumors. At our hospital, an 8.0x7.5x6.0 cm tumor at the mesocolon of the sigmoid colon and three omental nodules measuring up to 2.5x2.0x1.7 cm were resected. Grossly, they were well circumscribed, gray-tan and elastic with small cystic spaces. Microscopically, they were composed of tubules and anastomosing channels lined by flattened or cuboidal cells with bland nuclei. Immunohistochemically, the tumor cells were positive for pan-cytokeratin AE1/AE3, vimentin, cytokeratin 5/6 and calretinin. The postoperative course was uneventful, and the patient was well 10 months after the operation. Despite their rarity, adenomatoid tumors should be included in the differential diagnosis of multiple intra-abdominal tumors.