Journal of Mid-life Health

Primary Ovarian Leiomyoma: A Common Tumor at an Uncommon Site

ABSTRACT Primary ovarian leiomyoma is a very rare benign tumor accounting for 0.5%–1% of all the benign ovarian neoplasms. The most common presentation is unilateral, small masses discovered incidentally on radiology, predominantly occurring in premenopausal women of age group 20–65 years. A 49-year-old woman presented with pain in the abdomen and abnormal uterine bleeding. Ultrasonography showed a heterogeneous, hypoechoic solid mass of size 10.4 cm × 6.4 cm × 7.7 cm arising from fundus. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histological examination revealed a leiomyoma arising primarily in the right ovary. The diagnosis was confirmed immunohistochemically. Ovarian leiomyoma, a rare tumor of the ovary, should be considered in the differential diagnosis of solid ovarian masses, which display gross anatomical and histological similarities. An immunohistochemical analysis is essential for definitive diagnosis. Herein, we report a case of unilateral ovarian leiomyoma in a premenopausal woman.

Uterine Serous Cystadenoma or Endosalpingiosis?: A Case Report with a Review of Literature

ABSTRACT Endosalpingiosis is a nonneoplastic lesion defined by the presence of tubal epithelium at ectopic sites such as the peritoneum, bladder, appendix, and even uterus. They may be asymptomatic and detected incidentally on ultrasonography. However, cystic endosalpingiosis is also known to be a mimicker of ovarian neoplasms. It is crucial for both the clinician and the pathologist to be aware of this benign lesion so that overdiagnosis and overtreatment can be avoided. We report a case of endosalpingiosis of the uterine serosa in a 45-year-old woman which was misdiagnosed as an adnexal cyst on radiological investigations.

Primary Ovarian Leiomyoma with Torsion in a Postmenopausal Woman: A Rare Case with Progesterone Receptor Positivity

A BSTRACT Ovarian leiomyomas are rare benign smooth muscle tumors, accounting for <1% of all ovarian neoplasms. While most commonly found in premenopausal women, their occurrence in postmenopausal women is rare and often raises concerns about malignancy. We report a unique case of ovarian leiomyoma torsion in a 73-year-old postmenopausal woman who presented with postmenopausal bleeding and acute pelvic pain. Imaging studies initially suggested an ovarian mass and surgical exploration revealed a twisted mass, which was histologically confirmed as a leiomyoma. Immunohistochemical analysis of the tumor demonstrated strong positivity for progesterone receptors, suggesting a potential role for progesterone in the tumor’s growth, even in a postmenopausal setting. This case highlights the diagnostic challenge of ovarian leiomyomas in older women and underscores the importance of histopathological examination, including immunohistochemistry, to guide management and provide insights into the potential hormonal influence on tumor development.

The Odd Couple: An Extremely Rare Coexistence of Ovarian Serous Carcinoma and Low-grade Appendiceal Mucinous Neoplasm

A BSTRACT Serous neoplasms are the most frequently encountered tumors of the ovary, typically arising as primary lesions. In contrast, mucinous tumors of the appendix are well-documented for their association with mucinous ovarian tumors and pseudomyxoma peritonei. To date, only one case has been reported in the literature describing the synchronous occurrence of a serous ovarian neoplasm and an appendiceal mucinous tumor. We present the second documented case of a low-grade appendiceal mucinous neoplasm (LAMN) occurring concurrently with a serous carcinoma of the ovary. A 68-year-old postmenopausal female presented with abnormal vaginal bleeding and was found to have a pelvic mass on imaging, raising suspicion for an ovarian malignancy. She underwent radical hysterectomy with a prophylactic appendectomy. Histopathological analysis confirmed a diagnosis of low-grade serous carcinoma in the left ovary, with an incidental finding of LAMN noted in the appendix. This rare coexistence highlights the importance of recognizing such rare association, as the distinction between serous and mucinous ovarian tumors is clinically significant due to their differing biological behaviors and treatment strategies. This case also provides detailed histopathological and immunohistochemical insights supporting the distinct diagnoses of these two neoplasms.

Clinicopathological Characteristics of Multiple Primary Malignancies Involving Female Genital Tract at a Tertiary Cancer Institute of Northeast India

ABSTRACT Background: The term “Multiple Primary Malignant Neoplasms (MPMNs)” refers to two or more unrelated primary malignant neoplasms that originate from single or different organs and occur in one patient. MPMNs have been divided into synchronous and metachronous based on time duration after first malignancy. Materials and Methods: This was a hospital-based retrospective study conducted at a tertiary cancer institute in Northeast India. Clinicopathological factors of patients with multiple primary malignancies with at least one female genital tract malignancy attending the gynecological oncology outpatient department were observed. Those with ambiguous status of primary malignancy and incomplete treatment of first primary malignancy were excluded from the study. Results: A total of 57 patients with MPMN, including one case of triple primary malignancy, were included in the study. 59.18% of cases had metachronous, and 40.81% had synchronous malignancies. The median time to the development of second primary malignancy was 60 months. Among the first diagnosed malignancies, cervix was the most common site (26.5%), followed by endometrium (20.4%) and ovary (14.28%), whereas ovarian malignancy was more commonly diagnosed second malignancy (38.77%), followed by endometrium (14.28%) and cervix (10.2%). In an analysis of synchronous malignancies, the most common genital tract involvement was seen with endometrium and ovary, with a predominance of low-grade endometrioid histology in 75% of cases. Conclusions: As the cancer survivor population continues to increase in future, these patients must be comprehensively evaluated on follow-up, and a cognizance of prior treatment taken should be kept. In addition, it is vital that the clinicians keep a lookout for high-risk population in which genetic testing may be beneficial.