|
|
 |
  |
 |
|
|
|
|
|
 |
21st European Congress of Pathology
Istanbul, Turkey, September 08-13, 2007
http://www.ecp2007istanbul.org/
Slide Seminar 8, September 12th
Challenging Cases in Gynecologic Pathology
Chairpersons: A. Giatromanolaki, E.Yavuz |
|
|
|
Case 1
Presented by: Jolanta Kupryjańczyk
Clinical History
A 27 y.o. female (gravida 0) was diagnosed with right ovarian tumor. A few months before admission she stopped menstruating; her abdomen was enlarging and she thought she was pregnant. For the last 3 weeks before admission she observed fast enlargement of the abdomen. She was slightly hirsute. The patient underwent unilateral oophorectomy and a section was taken from the left ovary. The peritoneal cavity was unremarkable.
|
|
Diagnosis & discussion |
|
|
|
|
Case 2
Presented by: Esther Oliva
Clinical History
A 28-year-old woman presented with abdominal discomfort and difficulty breathing at 29 weeks of gestation. Physical examination revealed the presence of ascites and on ultrasound a 20 cm mass in the right ovary was identified. The patient underwent right salpingo-oophorectomy accompanied by multiple peritoneal biopsies.
|
|
Diagnosis & discussion |
|
|
|
|
Case 3
Presented by: Lars-Christian Horn
Clinical History
A 61-year-old gravida 3, para 3 with menopausal status since 6 years presented with fluor vaginalis and postmenopausal bleeding without using HRT. The gynaecologic examination at admittance revealed a painless enlargement of the uterus up to 20cm, suggesting FIGO-stage II endometrial carcinoma.
|
|
Diagnosis & discussion |
|
|
|
|
Case 4
Presented by: Ana Félix
Clinical History
A 74 years old patient with post-menopausal bleeding underwent an endometrial biopsy and was submitted to a total abdominal hysterectomy and right salpingo-oophorectomy. In her past history, a left salpingo-oophorectomy was performed two years before for a serous cystoadenoma of the ovary.
Additional history:
In the TAH-RSO specimen a mixed endometrial carcinoma (pT1c) invading the external half of the myometrium was found. The patient received external radiotherapy and is well without evidence of disease 36 months after the hysterectomy was performed.
|
|
Diagnosis & discussion |
|
|
|
|
Case 5
Presented by: Eoghan E. Mooney
Clinical History
A 33 year old woman was investigated for irregular vaginal bleeding. Her past history included conjunctival disease with several operations and recurrent vocal cord polyps, for which she had also had surgery. Cervical smears over many years were noted to be inflammatory, with occasional ones reported as having atypical squamous cells. She had suffered from intermittent vaginal discharge since the age of 20. On examination, the cervix was friable, and the vagina showed areas of epithelial erosion. Cervical biopsy and endometrial curettage were performed.
|
|
Diagnosis & discussion |
|
|
|
|
Case 6
Presented by: Esther Oliva
Clinical History
A 26-year-old female with no relevant past medical history presented with uterine bleeding of 3 weeks duration. An endometrial curettage was interpreted as malignant small round cell tumor. The patient underwent radical hysterectomy with extensive lymph node sampling
|
|
Diagnosis & discussion |
|
|
|
|
Case 7
Presented by: David Hardisson
Clinical History
A 41-year-old woman, gravida 0, para 0, whose last menstrual period occurred two weeks before admission presented with vaginal bleeding. Previous medical history was unremarkable, and there was no history of prior radiation therapy or chemical exposures. Physical examination revealed an enlarged uterine corpus. Pelvic ultrasound showed a 10.1 x 9.2 cm uterine mass involving the posterior myometrial wall. The adnexae were normal. No free pelvic fluid was identified. The patient continued to bleed profusely, requiring surgical intervention. Total hysterectomy with bilateral salpingo-oophorectomy was performed without complication. There was no apparent extrauterine extension of tumor, although the serosal surface of the posterior uterine wall was interrupted by the tumor; lymph nodes were clinically unremarkable. The immediate postoperative course was uneventful. After the diagnosis the patient received chemotherapy and abdominal radiation therapy. Despite treatment, the patient developed multiple intraabdominal nodules consistent with local recurrence of the tumor 8 months following hysterectomy.
|
|
Diagnosis & discussion |
|
|
|
|
Case 8
Presented by: Mojgan Devouassoux-Shisheboran
Clinical History
A 62 year-old woman presented with an abnormal pap smear, showing atypical glandular cells. Colposcopy showed a cervical mass. Multiple cervical biopsies were performed.
|
|
Diagnosis & discussion |
|
|
|
|
Case 9
Presented by: Alexandra Giatromanolaki
Clinical History
A 76-year old woman was presented to Gynaecological Department with abdominal pain and retention of urine. Laboratory investigations revealed a retroperitoneal mass (computed tomography) and bilateral dilatation of the pelvicalyceal system (ultrasound). Exploratory laparotomy showed the presence of a large tumour mass within the leaves of the right broad ligament, extending across the midline and displacing the urinary bladder. The peritoneum was scattered with multiple small tumour nodules. A total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed, but the patient died of disease 4 months later.
|
|
Diagnosis & discussion |
|
|
|
|
Case 10
Presented by: Ekrem Yavuz
Clinical History
The patient was a 39-year-old female who presented with abnormal vaginal bleeding and flank pain of two and six-month duration, respectively. A gynecological examination displayed a cervical polypoid lesion protruding into the left vaginal fornix and fixation of the left parametrial area. An abdominopelvic computerized tomogram showed a uterine cervical mass of 2.5x4 cm extending through parametrial soft tissue and grade 4- left hydronephrosis and hydroureterium. An incisional biopsy was taken from the lateral vaginal fornix. The lesion was considered clinically malignant and a total abdominal hysterectomy with resection of parametrium and left nephrectomy and ureterectomy was done. The operation took almost six hours due to the fact that the lesion showed close proximity to pelvic vascular structures and several vascular injuries occured during the operation. The patient is well two years after the operation.
Slide is being rescanned
|
|
Diagnosis & discussion |
|
|
|
|
|
 |
 |
 |
|
