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1/41. Primary peritoneal psammocarcinoma: A case presenting with an upper abdominal mass and elevated CA-125.

    Primary peritoneal serous adenocarcinoma with predominating psammoma bodies, psammocarcinoma, is a very rare tumor with only seven cases documented in the English literature. Pathological classification of this entity was established in 1990 and clinical behavior of this tumor is uncertain. Based on limited data these tumors appear to behave similarly to low malignant potential tumors of the ovary. This case describes a 59-year-old woman who underwent exploratory laparotomy for a large upper abdominal cystic mass. Findings included a large tumor mass involving the gastrocolic omentum and dense small bowel adhesions. The patient had normal ovaries and was debulked to no macroscopic disease. Final pathologic diagnosis confirmed a stage IIIC primary peritoneal psammocarcinoma. The patient has received no adjunctive therapy and is without evidence of disease 2 years after surgery. Primary peritoneal psammocarcinoma is a neoplasm which can mimic serous adenocarcinoma of the ovary. In contrast, primary peritoneal psammocarcinoma appears to behave in an indolent fashion. Primary surgical debulking should be attempted, while the utility of postoperative chemotherapy remains unknown.
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2/41. Long-term consequences following conservative management of epithelial ovarian cancer in an infertile patient.

    A 35-year-old woman with primary infertility underwent an ovarian cystectomy for a 5 x 4 cm left adnexal mass. There was no macroscopic evidence of metastatic disease. The final pathology report revealed a poorly differentiated serous cystadenocarcinoma. Because the patient desired to retain child-bearing capacity, she refused a surgical staging of her ovarian cancer. She elected to receive combination chemotherapy. This was then followed by a negative reassessment laparotomy. The patient was diagnosed with recurrent, metastatic ovarian carcinoma 10 years later.
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3/41. Low-grade ovarian cancer in an adolescent patient.

    BACKGROUND: Ovarian tumors in the pediatric population are most likely to be of germ cell origin. However, serous tumors have also been reported in adolescent patients. CASE: A 14-year-old girl was diagnosed with stage IIIc low-grade ovarian cancer. Her serum CA-125 was elevated preoperatively and was a marker for recurrence of disease. Five months after completing standard chemotherapy, she developed recurrent disease, which progressed despite hormonal therapy. She then developed toxicity on liposomal doxorubicin (Doxil) and is now receiving hospice care. CONCLUSION: Low-grade serous adenocarcinoma of the ovary can present as advanced disease and should be considered in the differential diagnosis of an ovarian mass in an adolescent patient.
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4/41. Intramedullary spinal cord metastasis from ovarian carcinoma.

    BACKGROUND: Intramedullary spinal cord involvement by ovarian carcinoma is extremely rare. CASE: A patient with stage IV serous cystadenocarcinoma of the ovary presented with neurologic complaints 16 months after primary treatment. magnetic resonance imaging demonstrated a metastatic lesion in the intramedullary area of the spinal cord. No other site of metastatic disease was observed. The patient received three cycles of carboplatin with complete resolution of the neurologic symptoms and a remarkable reduction of the lesion. Following chemotherapy she was given radiotherapy on the spinal cord, but died 10 months later for disseminated abdominal disease, without neurologic symptoms. CONCLUSION: spinal cord involvement is unusual in ovarian carcinoma; multidisciplinary treatment, including chemotherapy and radiotherapy, may offer good palliation of the symptomatology.
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5/41. Papillary serous carcinoma of peritoneum: case study and review of the literature on the differential diagnosis of malignant peritoneal tumors.

    The distinction between malignant mesothelioma and other malignant neoplasms diffusely involving the peritoneum is important for proper patient treatment. The extra-ovarian peritoneal serous papillary carcinoma is a rare, primary, multicentric peritoneal tumor that is morphologically identical to ovarian serous carcinoma of equivalent grade, but can spare or minimally involve the ovaries. We report such a tumor in a 65-year-old female who had abdominal swelling, ascites with positive cytology and a high grade of nuclear atypia in malignant cells as well as elevated serum CA125. Exploratory laparotomy findings of intrabdominal carcinomatosis were not accompanied by any evident primary site; so the diagnosis of a primary papillary serous neoplasia of the peritoneum was strongly considered. Since the amount of residual disease may be an important prognostic determining factor in primary papillary serous carcinoma of the peritoneum, the patient was debulked to no macroscopic disease and was then given platin-based chemotherapy. The tumor's differential diagnosis from malignant mesothelioma was based, apart from morphologic criteria, on the tumor's immunoreactivity to MOC-31, Ber-EP4 and TAG-72, as well as on the lack of immunostaining for keratin 5/6 and calretinin. Differential diagnosis from ovarian cancer was possible only after the pathological examination of the surgically resected ovaries; the tumor showed minimal superficial invasion of the ovarian cortex.
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6/41. Serous adenocarcinoma of the inguinal region arising from endometriosis followed by a successful pregnancy.

    BACKGROUND: Inguinal serous carcinoma arising from endometriosis is an unusual cancer. It is uncertain how patients with these tumors should be managed, especially those patients who desire future fertility. CASE: We present a 34-year-old woman with a right groin mass with cyclical pain. Resection of this mass revealed complex atypical hyperplasia, well-differentiated endometrioid adenocarcinoma, and serous carcinoma within a focus of endometriosis. The patient desired to maintain her fertility and was treated conservatively. She is currently 3 years free of disease after diagnosis. She also had one successful pregnancy. CONCLUSION: This is a rare case of carcinoma arising from endometriosis. The long-term prognosis for this patient remains unclear and the patient will require long-term follow-up.
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7/41. Borderline serous cystadenocarcinoma with coexistent angiosarcoma: an unusual form of ovarian carcinosarcoma.

    A 45-year-old woman presented with a short history of abdominal distension and features of intestinal obstruction. Computed tomography examination of the abdomen revealed a solid and cystic mass in the region of the left ovary, but spread within the abdomen was also noted. The ovarian tumor was removed, and an omentectomy was also performed. Microscopic examination of the ovarian tumor and metastases within the omentum showed a carcinosarcoma composed of borderline serous papillary cystadenocarcinoma and angiosarcoma. The angiosarcomatous component was the dominant tumor within the omentum. This case documents an unusual combination of epithelial and sarcomatous elements in an ovarian carcinosarcoma. The tumor behaved aggressively because of the angiosarcomatous component, and since the patient was assessed as having stage IV disease, no further treatment was offered.
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8/41. Ovarian psammocarcinoma with peritoneal implants.

    A case of ovarian psammocarcinomas with omental and peritoneal implants in a 48-year-old woman was treated with total hysterectomy, bilateral oophorectomy and omentectomy. Two years later there was no sign of recurrent disease.
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9/41. paclitaxel and carboplatin chemotherapy administered during pregnancy for advanced epithelial ovarian cancer.

    BACKGROUND: Ovarian cancer diagnosed during pregnancy is uncommon. Most chemotherapy use reported has been in combination with cisplatinum. paclitaxel in combination with carboplatin during pregnancy has not yet been reported. CASE: A right adnexal mass was diagnosed during pregnancy at 5 weeks' gestational age in a 30-year-old woman. A laparotomy was performed 2 1/2 weeks later because of the worsening nature of her symptoms and the possibility of ovarian torsion. At surgery, the patient was diagnosed with stage IIIC ovarian papillary serous cystadenocarcinoma. She was treated with six cycles of paclitaxel and carboplatin beginning at 16-17 weeks' gestation. At 35.5 weeks' gestation, a cesarean hysterectomy, left salpingo-oophorectomy, and pelvic and paraaortic nodal sampling with multiple peritoneal biopsies was performed without incident. However, the patient had refractory disease present in the remaining ovary. She was treated with further chemotherapy and is currently doing well. The patient experienced no adverse reactions during her treatment, and the infant has normal growth and development at 15 months of age. CONCLUSION: paclitaxel used in combination with carboplatin for the treatment of ovarian cancer during pregnancy caused no adverse effects in the infant.
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10/41. Management of advanced-stage primary carcinoma of the fallopian tube: case report and literature review.

    Primary carcinoma of the fallopian tube is a very unusual gynecologic malignancy that accounts for less than 1% of all malignancies of the female genitalia. A 55-year-old, gravida 7, para 3 woman presented with no gynecologic complaints other than backache. TVS demonstrated a 35 x 25 mm heterogeneous mass that was not clearly separated from the left ovary, and another 31 x 14 mm cystic septated lesion in the left ovary region. Pelvic MRI demonstrated a 35 x 35 x 20 mm left adnexal mass that enhanced with contrast and a neighboring tubular-cystic mass. Upper and lower gastrointestinal endoscopy revealed no malignancy. serum CA 125-level was merkedly elevated at 369 U/ml (normal < 35 U/ml). laparotomy revealed left hydrosalpinx and a papillary-fimbrial mass. Pelvic lymph node metastases were observed. Frozen-section analysis identified the mass as a serous adenocarcinoma. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendectomy, omentectomy, pelvic and para-aortic lymph node dissection, and peritoneal washing were performed. The definitive histopathological diagnosis was primary serous adenocarcinoma of the fallopian tube with six of 25 lymph node biopsies showing metastasis. Six cycles of paclitaxel (175 mg/m2) plus cisplatin (75 mg/m2) combinatin chemotherapy were administered with 3-week intervals between cycles. Second-look laparotomy was performed; there was no evidence of disease. At the time of writing 12 months after the second-look laparotomy, she was still disease-free.
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keywords = fallopian tube, tube, disease
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