Journal
Diagnostic challenges of androgen secreting tumor by sclerosing stromal tumor: A case report
Innovative laparoscopic technique for the resection of a giant abdominal cyst in a young female: A case report
Management challenges of ovarian adult-type granulosa cell tumors at a tertiary facility in resource-limited setting: A case series of three patients and review of the current literature
Acute abdominopelvic pain and distension in a 21-year-old woman revealing a mixed germ cell tumor: A case report
Incidental appendiceal mucocele discovery: A case series and literature review
ABSTRACT Introduction: Low-grade appendiceal mucinous neoplasms (LAMNs) are rare entities that can present significant challenges when discovered incidentally by general surgeons during surgery or through postoperative pathology. These lesions may mimic common abdominal conditions and are often not suspected preoperatively. Methods: We present a case series of five patients in whom appendiceal mucoceles were incidentally identified either intraoperatively or on postoperative pathological examination. The patients ranged from 36 to 79 years old and presented with symptoms such as right lower quadrant pain, initially attributed to appendicitis, ovarian torsion, or other gynecological conditions. Intraoperative findings varied from dilated appendices with mucinous content to large cystic masses involving adjacent structures. Results: In each case, the general surgeon had to make immediate decisions regarding management. Surgical interventions included laparoscopic appendectomy and open right hemicolectomy, with an emphasis on careful handling to prevent rupture and spillage of mucin. Postoperative pathology confirmed LAMNs, with tumor stages ranging from pTis to pT4a. Some patients required additional procedures, such as cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), due to the presence of acellular mucin or peritoneal involvement. The discussion focuses on practical guidance for general surgeons when faced with an incidental appendiceal mucocele. Key recommendations include avoiding intraoperative rupture by gentle handling, assessing the need for extended resection based on intraoperative findings, and ensuring thorough communication with pathology for accurate staging. Postoperative management should involve reviewing pathology reports carefully, considering referral to a multidisciplinary team for higher-stage tumors, and implementing long-term surveillance protocols due to the risk of recurrence. Conclusion: General surgeons play a critical role in the initial management of incidentally discovered appendiceal mucoceles. Prompt recognition and appropriate intraoperative decision-making are essential to optimize patient outcomes. By adhering to careful surgical techniques and collaborating with multidisciplinary teams, surgeons can effectively manage these unexpected findings and mitigate potential complications associated with LAMNs. Highlights
Brenner tumor associated with mucinous cyst and endometriosis: a case report
Background: Brenner tumors are rare ovarian neoplasms that often coexist with other epithelial tumors, most commonly mucinous cystic neoplasms. The association of Brenner tumors with endometriosis is unusual and not well-documented in the literature. Case presentation: We describe the case of a 64-year-old postmenopausal woman presenting with abnormal uterine bleeding and a left adnexal mass. Histopathologic examination revealed the synchronous presence of a benign Brenner tumor, mucinous cystadenoma, and a microscopic focus of endometriosis, all within the same ovary. Discussion: The simultaneous occurrence of these three lesions is highly unusual. A potential shared histogenetic origin has been proposed for Brenner and mucinous tumors, while the coexistence of endometriosis raises further questions regarding hormonal or microenvironmental influences. Thorough histopathologic and immunohistochemical evaluation is essential in such complex presentations. Conclusion: This case underscores the importance of comprehensive pathologic assessment in ovarian masses, especially when multiple histologic components are present. Recognition of rare associations can prevent misdiagnosis and guide appropriate clinical management.
A diagnostic challenge of primary serous borderline tumor involving the peritoneum: A case report
ABSTRACT Introduction and importance: Primary peritoneal serous borderline tumor (PPSBT) is a rare epithelial tumor that is identical to non-invasive peritoneal implants in patients with ovarian serous borderline tumors. Case presentation: A 51-year-old woman presented with abdominal swelling. Radiological findings revealed a large, well-defined cystic lesion within the right abdominopelvic cavity, measuring 19 × 14 × 10 cm, without any connection to both ovaries. Given the imaging characteristics, the differential diagnosis primarily included benign cystic neoplasms, mesenteric or peritoneal cysts, and other cystic lesions of gastrointestinal or embryological origin. Laparoscopic excision of the cyst was done. The gross examination showed the smooth outer surface with an intact capsule. The inner surface showed firm yellow-white papillary outgrowths. Microscopic examination revealed numerous irregular papillae with fibro-myxoid cores and a hierarchical branching pattern. The component cells have large hyperchromatic nuclei and a moderate degree of cellular atypia. By immunohistochemical staining, the tumor cells showed a positive reaction for PAX8 and WT1, while calretinin was negative. The diagnosis was reported as a primary peritoneal serous borderline tumor. Clinical discussion: The clinical presentation of PPSBT is often misleading. Thorough radiological and laparoscopic examinations are very important to exclude any secondary involvement from ovarian tumors. Microscopic examination and immunohistochemical staining are crucial for establishing the diagnosis of PPSBT and exclusion of other differential diagnoses. Complete surgical excision of the cyst is the standard treatment with follow-up of the patient. Conclusion: PPSBT is a rare and challenging diagnosis. It requires accurate clinical, radiological, histopathological, and immunohistochemical examination. Highlights
Cystadenofibroma case report: The chameleon of cancer
ABSTRACT Introduction: Ovarian cystadenofibroma is a rare benign tumor of the ovary that presents unique diagnostic challenges for clinicians due to its resemblance to malignant neoplasms. Presentation: We present the case of a 36-year-old female who presented with acute abdominal pain and imaging findings suggestive of a cystic ovarian neoplasm, later histopathologically confirmed as a cystadenofibroma. Discussion: Ovarian cystadenofibroma may demonstrate lesser magnetic resonance imaging (MRI) T2 signal enhancement than cystadenocarcinofibromas ((CACFs), their malignant counterparts) aiding clinicians in their diagnosis. This case demonstrates the importance of considering benign ovarian neoplasms, such as ovarian cystadenofibroma, in the differential diagnosis of complex ovarian masses - despite radiological and clinical features suggestive of malignancy. Conclusion: Accurate preoperative diagnosis is essential for guiding appropriate surgical management. Highlights
Sertoli-Leydig cell tumor: An unusual pathological presentation raising a therapeutic dilemma, a case report
ABSTRACT Introduction: Sertoli–Leydig cell tumors (SLCTs) are rare, with a challenging diagnosis and management. Herein is our case. Case report: We report the case of a 14-year-old female patient who presented with secondary amenorrhea with clinical signs of virilization. A pelvic MRI showed a solid-cystic intraperitoneal mass. The patient underwent surgery. A left adnexectomy, along with an omentectomy, peritoneal biopsy, and peritoneal cytology sampling, was performed. The histopathological examination confirmed a Sertoli-Leydig cell tumor of the left ovary. While the majority of the tumor cells were well-differentiated, a focal area contained poorly differentiated cells with high mitotic activity and sarcoma-like features. The case was presented at a multidisciplinary tumor board meeting to assess the potential benefit of adjuvant chemotherapy, given the presence of a poorly differentiated component. However, adjuvant chemotherapy was not recommended. Discussion: SLCTs are rare ovarian neoplasms that predominantly affect individuals of reproductive age. Virilization occurs in up to 60 % of cases. Serum tumor markers can aid in the detection of SLCTs. According to the latest WHO classification, SLCTs are categorized as well-differentiated, moderately differentiated, or poorly differentiated. Surgical resection remains the gold standard treatment, while postoperative chemotherapy is recommended for patients with poor prognostic factors. However, managing SLCTs remains challenging due to the lack of standardized treatment guidelines. Prognosis is primarily determined by tumor stage and degree of differentiation. Conclusion: Managing SLCTs remains complex, and further studies are needed to better define treatment guidelines. Highlights
Ovarian mass in a patient with invasive breast carcinoma: A case report of an unexpected diagnosis
Challenging diagnoses in a case report: Ovarian fibrothecoma with elevated CA125 levels mimicking malignancy
Xanthomatous salpingo-oophoritis accompanied by hobnail cell and apocrine metaplasia: The first case report in the literature
A non-pregnant woman with elevated beta-HCG
ABSTRACT Introduction: Ovarian seminoma is a rare germ cell tumor that typically affects young women. Early diagnosis of malignant tumors, although difficult due to mild symptoms, is crucial for a better prognosis. Here we report the case of a 15-year-old female patient with a large malignant ovarian dysgerminoma to provide a comprehensive overview of the diagnosis and management of this pathology and to help practitioners make an early diagnosis. Case presentation: A 15-year-old patient with no significant past medical history presented to the Obstetrics and Gynecology emergency D in Tunisia with subacute abdominal pain, fever, and unexplained weight loss. Diagnostic evaluation revealed a large, solid ovarian mass with elevated CA-125 levels, and the patient subsequently underwent right adnexectomy with peritoneal cytology. Histopathological analysis confirmed the diagnosis of dysgerminoma with peritoneal involvement, resulting in a FIGO IC and TNM T1C classification, and the patient received fertility-sparing polychemotherapy with satisfactory progression. Discussion: Ovarian seminoma mainly affects young women and can be associated with a variety of risk factors. Clinical signs are variable and can be difficult to detect at an early stage. Imaging techniques can help with diagnosis. Tumor markers may be elevated, but histological confirmation is needed. Treatment usually consists of a combination of surgery and chemotherapy, with good long-term survival rates. Conclusion: Seminomas are rare tumors and early detection is crucial for a better prognosis. This requires close attention to risk factors and regular gynecological examinations from an early age in patients with these risk factors. Highlights
Ovarian fibrosarcoma
ABSTRACT Introduction: Ovarian fibrosarcoma is a rare cancer. In the literature, there have been very few occurrences of fibrosarcoma with ascites. The presence of ascites complicates the diagnosis further, and is associated with a poor prognosis and has been linked to chemoresistance and metastasis. We present this case of an ovarian fibrosarcoma with ascites to provide a comprehensive overview of the clinical presentation, diagnostic evaluation and management of this pathology, which remains a challenge given the rarity of this entity. Presentation of case: We report the case of a 60-year-old woman who was referred to our unit, because of abdominal bloating, sporadic pelvic pain and abdominal distension. Ultrasound showed a heterogeneous mass over the right adnexa with ascites. Serum tumour markers were within normal limits. During surgery, a total abdominal hysterectomy plus bilateral adnexectomy was performed. The final histopathological findings showed a well-differentiated fibrosarcoma. The patient was followed up regularly and no recurrence was seen 2 years after surgery. Discussion: Ovarian fibrosarcomas are uncommon cancers with no known risk factors. Diagnosis can be difficult, especially in the presence of ascites, and other diagnostic options should be considered. Pathological and immunohistochemistry investigations are required for a clear diagnosis. Early metastases and resistance to adjuvant chemotherapy characterize the prognosis of ovarian fibrosarcoma with ascites. Conclusions: Ovarian fibrosarcoma with ascites is a rare and challenging ovarian disease, highlighting the need for postoperative pathology to make a clear diagnosis, complete cytoreductive surgery and individual consideration of adjuvant radiochemotherapy should be included in the management. Highlights
Synchronous occurrence of primary breast cancer and renal cell carcinoma: A case report and literature review
Low grade appendiceal mucinous neoplasm mimicking malignant ovarian tumor: A case report
Ovarian torsion of a large mature cystic teratoma complicating early pregnancy: a rare case report
Introduction and Importance: Adnexal torsion complicating early pregnancy is rare but should be suspected in pregnant women presenting with acute lower abdominal pain. Mature cystic teratomas (MCTs) are common benign ovarian tumors in women of reproductive age, but their occurrence during pregnancy complicated by torsion is rare. MCTs comprise 20% of all ovarian neoplasms and are commonly encountered in patients between 20 and 40 years of age. Early diagnosis is challenging due to overlapping symptoms with common pregnancy-related conditions, yet prompt recognition and intervention are crucial to preserve maternal and fetal outcomes. This case report aims to highlight the diagnostic and management challenges of adnexal torsion complicating early pregnancy. Case Presentation: We report the case of a 21-year-old primigravida from Northern Tanzania who presented at gestational age of 11 weeks and 4 days of gestation with a sudden-onset history of left lower abdominal pain for 6 h that progressively worsened over time. Abdominal ultrasonography revealed a large left adnexal cystic mass with internal echoes, thickened walls, and posterior acoustic enhancement, measuring 14.0 × 10.4 × 9.3 cm, consistent with a complex ovarian cyst. The uterus was enlarged and contained a viable intrauterine pregnancy with a crown–rump length of 48.6 mm, corresponding to 11 weeks and 4 days of gestation with active cardiac activity. The patient underwent an emergency laparotomy, which confirmed a viable intrauterine pregnancy alongside a large, twisted left ovarian cystic mass measuring 19.0 × 14.0 × 10.0 cm, with torsion of its pedicle around the mesovarium. Detorsion and left salpingo-oophorectomy were performed successfully. Histopathological examination confirmed the diagnosis of a MCT. Postoperative recovery was uneventful, and follow-up at 23 weeks showed a viable ongoing pregnancy. Clinical Discussion: MCTs are prone to torsion due to their size and mobility. Early surgical management is critical to prevent ischemic necrosis and ensure optimal maternal and fetal outcomes. In this case, a timely laparotomy and removal of the affected adnexa resulted in a favorable recovery and continuation of pregnancy. Conclusion: Ovarian torsion due to a MCT in early pregnancy is a rare but important differential diagnosis for acute abdominal pain. Prompt recognition and surgical intervention are vital to preserving maternal health and supporting pregnancy continuation.
The illusion of malignancy: a rare case of post-hysterectomy gossypiboma misinterpreted as ovarian cancer
Introduction and importance: Gossypiboma, or retained surgical sponge, is a rare iatrogenic complication post-surgery, often mimicking malignancies like ovarian cancer in postmenopausal women. This leads to unnecessary oncologic interventions, patient anxiety, and procedural risks. Incidence ranges from 1:1000 to 1:18 000 procedures, with hysterectomies at higher risk due to human errors in counting. Recognizing imaging features is crucial to prevent misdiagnosis, highlighting the importance of multidisciplinary evaluation and preventive protocols in gynecological surgery. Case presentation: A 56-year-old asymptomatic postmenopausal woman, 9 years post-hysterectomy for fibroids, underwent routine transabdominal ultrasound revealing a 7.23 × 15.63 × 16.30 cm heterogeneous right adnexal mass initially interpreted as malignant ovarian neoplasm by a junior radiologist. Senior review and CT scan showed whorled structure with sterile gas, suggesting gossypiboma. Clinical discussion: Gossypibomas can remain latent for years, presenting as fibrotic masses with gas on imaging, mimicking tumors. Diagnostic pitfalls arise from inexperience, as seen here, but pathognomonic signs like spoke wheel patterns aid differentiation. Complications include obstruction or fistula; management involves surgical removal. Prevention requires standardized counting, radiopaque markers, and education to eliminate never events. Conclusion: This case emphasizes the need for high suspicion of gossypiboma in post-hysterectomy adnexal masses to avoid erroneous cancer diagnoses. Adhering to safety protocols enhances surgical integrity and patient outcomes.
Ovid Technologies (Wolters Kluwer Health)
2210-2612
