Jamshid Abdul-Ghafar

Small cell carcinoma of the ovary, hypercalcemic type complicated by enterocutaneous fistula: a case report

Small cell carcinoma of the ovary, hypercalcemic type, is a rare, highly aggressive malignancy that predominantly affects young women and is associated with poor prognosis and limited treatment options. We report the first documented case of small cell carcinoma of the ovary, hypercalcemic type, in a 30-year-old Pakistani woman who presented with abdominal pain, vomiting, weight loss, and biochemical evidence of hypercalcemia. Imaging revealed a large left adnexal mass measuring 9.3 cm × 10.7 cm × 9.7 cm. Subsequent histopathological and immunohistochemical analysis demonstrated characteristic features of small cell carcinoma of the ovary, hypercalcemic type with complete loss of SMARCA4 (BRG1) expression, confirming the diagnosis. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection, followed by multi-agent chemotherapy. Despite her initial response, she developed widespread metastatic disease with tumor infiltration of the abdominal wall and encasement of ileal loops. This ultimately resulted in a contained ileal perforation and the formation of an enterocutaneous fistula-an uncommon and previously unreported complication of small cell carcinoma of the ovary, hypercalcemic type. This case highlights the diagnostic and therapeutic challenges associated with small cell carcinoma of the ovary, hypercalcemic type, and underscores the critical role of SMARCA4 immunohistochemistry in confirming the diagnosis, particularly in resource-limited settings where molecular testing may not be widely accessible.

Ovarian Cancer Detection in Ascites Cytology with Weakly Supervised Model on Nationwide Data Set

Conventional ascitic fluid cytology for detecting ovarian cancer is limited by its low sensitivity. To address this issue, this multicenter study developed patch image (PI)-based fully supervised convolutional neural network (CNN) models and clustering-constrained attention multiple-instance learning (CLAM) algorithms for detecting ovarian cancer using ascitic fluid cytology. Whole-slide images (WSIs), 356 benign and 147 cancer, were collected, from which 14,699 benign and 8025 cancer PIs were extracted. Additionally, 131 WSIs (44 benign and 87 cancer) were used for external validation. Six CNN algorithms were developed for cancer detection using PIs. Subsequently, two CLAM algorithms, single branch (CLAM-SB) and multiple branch (CLAM-MB), were developed. ResNet50 demonstrated the best performance, achieving an accuracy of 0.973. The performance when interpreting internal WSIs was an area under the curve (AUC) of 0.982. CLAM-SB outperformed CLAM-MB with an AUC of 0.944 for internal WSIs. Notably, in the external test, CLAM-SB exhibited superior performance with an AUC of 0.866 compared with ResNet50's AUC of 0.804. Analysis of the heatmap revealed that cases frequently misinterpreted by AI were easily interpreted by humans, and vice versa. Because AI and humans were found to function complementarily, implementing computer-aided diagnosis is expected to significantly enhance diagnostic accuracy and reproducibility. Furthermore, the WSI-based learning in CLAM, eliminating the need for patch-by-patch annotation, offers an advantage over the CNN model.

A rare ovarian hilus cell tumour accompanying bilateral serous cystadenomas: report of a case

Abstract Background Hilus cell tumours is considered an uncommon branch of androgen producing neoplasms that accounts for < 5% of all ovarian tumours. They are mostly benign and have characteristic gross and microscopic features. Here we present the first case of a hilus cell tumour in association with bilateral serous cystadenomas. Case presentation A 65-year-old lady with no symptoms of virilization, presented with postmenopausal dysfunctional uterine bleeding and radiological investigations revealing bilateral ovarian cysts that required a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Gross and microscopic evaluation confirmed the diagnosis of hilus cell tumour associated with bilateral serous cystadenomas. Conclusions This was the first case of hilus cell tumour in association with bilateral serous cystadenomas of the ovaries. Although, majority of hilus cell tumours that have been reported in the literature were benign, further studies are required to determine the behavior of the disease.

Ovarian seromucinous tumors: clinicopathological features of 10 cases with a detailed review of the literature

Abstract Background The 2014 WHO Classification of ovarian neoplasms introduced a new entity of seromucinous tumors associated with endometriosis. These tumors encompassed a spectrum from benign to malignant and included seromucinous cystadenoma/ cystadenofibroma, seromucinous borderline tumor/atypical proliferative seromucinous tumor and seromucinous carcinoma. However, the 2020 WHO Classification of Female Genital Tumours removed seromucinous carcinomas as a distinct entity and recategorized them as Endometrioid carcinomas with mucinous differentiation. Here we describe clinico-morphologic features of seromucinous tumors recategorizing cases originally diagnosed as seromucinous carcinoma in light of 2020 WHO classification and present detailed review of literature. Methods Slides of seromucinous tumors were reviewed. Special emphasis was given to evaluation of stromal invasion. Follow-up was obtained. Results Ten cases were diagnosed. Mean age was 40 years. Four cases were bilateral. Mean size was 19 cm. Grossly; luminal papillary projections were seen in 6 cases. Tumors demonstrated a papillary architecture with papillae lined by stratified seromucinous epithelium showing nuclear atypia. Stromal invasion was seen in 4 cases. Six cases were reported as borderline seromucinous tumors and 4 cases originally diagnosed as seromucinous carcinoma were recategorized as endometrioid carcinoma with mucinous differentiation on review. Endometriosis was seen in 4 cases. CK7, PAX8 and ER were positive in 7/7 cases. Two cases showed extra-ovarian involvement. Follow up was available in 7 cases. Six patients were alive and well at follow up ranging from 8 to 46 months. Six patients received chemotherapy postoperatively. One patient with carcinoma died of disease 18 months postoperatively. Conclusion In our series, 4 cases were originally diagnosed as seromucinous carcinomas. However, these were recategorized in light of the 2020 WHO Classification of Female Genital tumors as endometrioid carcinomas with mucinous differentiation. Six cases were diagnosed as seromucinous borderline tumors. Thus, majority of cases were borderline in agreement with published literature.

Giant hamartomatous polyp of the uterine cervix with heterologous mesenchymal tissue in a child: a case report

Abstract Background Polyps of the uterine cervix are one of the most common benign hyperplastic lesions occurring in the female genital tract that usually arise from the endocervical canal and are believed to be the result of reactive changes due to long-standing chronic inflammation, multiparty, and foreign bodies. Cervical polyps are usually small in size (less than 4 cm) that are commonly found in adult women; however, a few cases of giant polyps and the rare occurrence of these lesions in children have also been reported. Heterotopias and malignant transformation in cervical polyps are considered to be very rare. Case presentation We present the case of a 10-year-old Afghan girl with a giant pedunculated mass protruding out of the uterine cervix that was accompanied by abdominal pain and mass sensation. The mass was completely excised by surgical intervention and the specimen was submitted for histopathological evaluation. Upon gross and microscopic examination, the characteristic findings of a hamartomatous polyp with heterologous mesenchymal tissue in the form of mature cartilage were seen. To the best of our knowledge, this is the first case of a giant (17.5 cm) hamartomatous polyp of the uterine cervix in this age group. Conclusion Giant hamartomatous cervical polyps rarely occur in patients below 10 years of age. The majority of these lesions are benign; however, a few cases with malignant transformation are also reported, which demands elaborate investigations into the etiopathogenesis and nature of the lesions.