Cases reported "Genital Neoplasms, Female"

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1/9. Primary adenocarcinoma of the female urethra.

    Three cases of primary adenocarcinoma of the female urethra are presented. The tumour in the first case was associated with urethritis glandularis and is thought to arise from previous glandular metaplasia of the urethral mucosa. The tumour in the second case resembled the clear-cell carcinomas of the lower female genital tract and is thought to be of embryonic rest origin. The tumour in the third case is thought to arise from the paraurethral glands.
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2/9. Malignant mesonephric tumors of the female genital tract: a clinicopathologic study of 9 cases.

    Nine malignant mesonephric tumors were obtained from the consultation files of one of the authors (J.P.) over a 13-year period (1988-2001). There were 4 adenocarcinomas (ACs) and 5 malignant mixed mesonephric tumors (MMMTs). The ACs were found in the cervix (3) and vagina (1). The MMMTs involved the uterus (1), cervix (3), and vagina (1). Most patients presented with abnormal vaginal bleeding. The 4 patients with mesonephric AC ranged in age from 24 to 54 years (mean, 41 years). The tumors measured 2 to 6 cm (mean, 3.7 cm). Two ACs were stage I and two were stage II. Two of the three patients with follow-up information were alive without clinical evidence of disease at 3 and 11.5 years, and the other was alive with recurrent tumor 8.5 years postoperatively. The 5 patients with MMMTs ranged in age from 37 to 62 years (mean, 49 years). The mean size of four tumors was 5.2 cm (range, 3.5-8 cm). The uterine MMMT infiltrated the entire myometrial wall extending to the endometrial cavity where it resembled an endometrial polyp. Although the most common histologic pattern in the current series was the glandular (ductal) pattern, retiform, tubular, and solid growth patterns were also encountered. Among the MMMT subgroup, the sarcomatous component was homologous in 3 cases (endometrial stromal or spindle cell) and heterologous in the other 2 cases (skeletal muscle and cartilage). Of the 4 patients with follow-up information available, 1 (stage II) died of disease 7 months after surgery, another (stage IV) was alive with bone metastases at 3.3 years, and the other 2 patients (stages IB and IC) had no clinical evidence of disease at 1 and 3.7 years, respectively. Evidence of mesonephric hyperplasia was found in 5 (42%) cases. The MMMT that arose in the corpus presented as an endometrial polyp. In this case, histologic differential diagnosis includes serous carcinoma, endometrial stromal sarcoma, and uterine tumor resembling ovarian sex cord-stromal tumor. Immunostainings are not helpful. Mesonephric ACs often present in early stage and have better prognosis than their mullerian counterparts. Surgery alone appears to be the treatment of choice. In contrast, MMMTs may present in advanced stage and are aggressive tumors, similar to malignant mixed mullerian tumors.
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3/9. Endometrioid carcinoma of the fallopian tube resembling an adnexal tumor of probable wolffian origin: a report of six cases.

    Six adenocarcinomas of the fallopian tube that resembled the female adnexal tumor of probable wolffian origin are described. The tumors, which occurred in patients from 38 to 66 (average 55) years of age, typically formed intraluminal masses. One was an incidental finding on microscopic examination. On microscopic examination, the tumors were characterized by a predominant pattern of small, closely packed cells punctured by numerous glandular spaces, which were typically small but occasionally were cystically dilated. Many of the glands contained a dense colloid-like secretion that was positive with the periodic acid-Schiff stain. Small amounts of intracellular mucin were present in all cases. In the solid areas of three cases, spindle cells that focally formed concentric whorls were present. In all cases, small numbers of tubular glands typical of endometrioid adenocarcinoma were identified. The cytologic atypia and mitotic activity of the tumors were variable, but they exceeded that usually seen in wolffian duct tumors. The evidence indicates that this neoplasm represents an unusual form of endometrioid adenocarcinoma. It is important that it is distinguished from a tumor of wolffian duct origin.
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4/9. Papillary tumor of the broad ligament.

    A 43-year-old woman received a hysterectomy with bilateral adnexectomy for a cystic tumor of the right broad ligament. The tumor, measuring 10 cm in diameter, was apart from the ovaries, oviducts, or uterus. The cyst wall had well-developed smooth muscle layers. Cells lining the cyst were benign-looking, relatively low columnar type, and were compatible with those of mesonephric origin. From the inner surface of the cyst numerous cauliflower-like structures projected into the lumen. These were predominantly papillary architecture covered by epithelial cells with occasional solid or glandular growth. Although structural and cellular atypism may suggest its malignant nature, the validity for frank malignancy of the present tumor could not be gained because of the absence of capsular invasion and metastasis. So, the diagnosis of papillary tumor of borderline malignancy was made. It may be safely assumed that the papillary tumor arose in a preexisting parovarian cyst of mesonephric origin.
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5/9. Aggressive angiomyxoma of the female pelvis and perineum. Report of nine cases of a distinctive type of gynecologic soft-tissue neoplasm.

    Nine case of a distinctive soft tissue tumor of the female pelvis and perineum are described. They were characterized by their occurrence in young women (ages 21-38), large size (up to 60 X 20 cm), locally infiltrative nature, and grossly gelatinous appearance. The initial clinical impression was usually that of a Bartholin gland cyst. The microscopic appearance was that of spindle or stellate cells widely separated by a loose myxoid stroma focally rich in collagen fibrils, a prominent vascular component, including many large thick-walled vessels without an arborizing pattern, and foci of proliferating glandular elements in two cases. Mitotic activity was exceedingly low. Ultrastructural study of the spindle cells showed features consistent with myofibroblastic differentiation. Four patients developed large local recurrences; one tumor recurred twice, 14 and 15 years after initial excision. No distant metastases have been documented to date, and all patients are alive and well. The differential diagnosis of this unusual tumor includes myxoma, myxoid liposarcoma, sarcoma botryoides, myxoid variant of malignant fibrous histiocytoma, nerve sheath myxoma, and other soft tissue tumors with secondary myxoid changes. We have chosen the term "aggressive angiomyxoma" for this neoplasm to emphasize the neoplastic nature of the blood vessels and its locally infiltrative and recurrent nature.
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6/9. Benign glandular elements and decidual reaction in retroperitoneal lymph nodes.

    Among 70 patients with gynecologic malignancies who underwent surgical staging and pelvic and periaortic lymphadenectomy, five were found to have benign glandular and/or stromal elements in the retroperitoneal lymph nodes. In three instances, these were originally diagnosed as metastatic cancer. The literature on this subject is reviewed and its significance is discussed.
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7/9. Adenoid cystic carcinoma of Bartholin's gland--a review of the literature and report of a patient.

    A case of adenoid cystic carcinoma of the Bartholin's gland, a rare vulval tumor, is reviewed with respect to clinical and pathological characteristics. Histological transition from normal Bartholin gland to adenoid cystic carcinoma was evident in this case. Local recurrences are common and often precede distant metastases. The recommended primary treatment is vulvectomy, obtaining clear margins and bilateral inguinofemoral node dissection.
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8/9. Rare case of transitional cell carcinoma originating in Bartholin's gland duct.

    We report a rare case of papillary invasive transitional cell carcinoma (TCC) that originated in Bartholin's gland duct. It resulted in differentiation into low-grade dysplasia and grade-III invasive TCC. Because invasive lesions within the lamina propria developed from flat dysplasia, the invasive TCC had presumably progressed from low-grade dysplasia. To our knowledge, 6 cases of TCC originating in Bartholin's gland have been reported previously, but our report is the first to describe TCC associated with dysplasia. The progressive course of this rare carcinoma is discussed.
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9/9. Adenoid cystic ovarian carcinoma compared with other adenoid cystic carcinomas of the female genital tract.

    Adenoid cystic carcinoma (ACC) of the ovary is an extremely rare neoplasm referred to infrequently in the literature. A new case of a pure, primary, ovarian ACC is reported. The patient was a 45-year-old white woman who had a stage IA, well-circumscribed, unilateral, ovarian mass. Histologically, the tumor was composed of small, uniform, and basaloid cells exhibiting predominantly a tubular pattern, as well as demonstrating cribriform and focal solid areas. There was no necrosis and minimal nuclear pleomorphism; the mitotic rate was fewer than three cells per 10 high-power fields. Immunohistochemical examination showed that the tumor cells were strongly positive for cytokeratins CAM 5.2 and AE1/3 and carcinoembryonic antigen. The cells at the periphery of the epithelial aggregates in the cribriform and tubular areas were positive for muscle-specific actin and, occasionally, for S100 protein. Electron microscopic examination revealed that these cells had convoluted nuclei and filamentous structures associated with dense bodies. These findings support a myoepithelial component. A characteristic feature was the production of periodic acid-Schiff stain-positive basement membrane material, which appeared as reduplicated basal lamina by electron microscopic examination. The patient is currently alive, without evidence of recurrence or persistent tumor 7 years after surgical excision. The tumor demonstrated immunohistochemical and ultrastructural findings similar to those of ACCs of salivary gland origin and to other ACCs of the female genital tract. The histogenesis of most ovarian ACCs is through metaplasia of the celomic epithelium, but pure cases might also be of teratomatous origin.
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