BLAUSTEINS PATHOLOGY OF THE FEMALE GENITAL TRACT PDF
Lora Hedrick Ellenson, Brigitte M. Ronnett, Robert A. Soslow, Richard J. Zaino, Robert J. Kurman. Pages PDF · Mesenchymal Tumors of the Uterus. Richard J. Zaino, Stanley J. Robboy, Rex Bentley, Robert J. Kurman. Pages PDF · Anatomy and Histology of the Cervix. Alex Ferenczy, Thomas C. Blaustein's Pathology of the Female Genital Tract DRM-free; Included format: PDF; ebooks can be used on all reading devices; Immediate eBook download.
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Request PDF on ResearchGate | Blaustein's Pathology of the Female Genital Tract | Since the publication of the 1/e in , BLAUSTEIN'S PATHOLOGY OF. Request PDF on ResearchGate | Blaustein's Pathology of the Female Genital Tract | Since the publication of the 1/e in , Blaustein's Pathology of the Female. Request PDF on ResearchGate | Blaustein's Pathology of the Female Genital Tract | The vagina, like other orifices that interface between the external.
The capsule covering the mass was intact and the outer surface was smooth and bosselated. On sectioning, the mass was predominantly multicystic and filled with yellowish mucoid material. The cystic spaces varied in sizes from 0. Solid areas were grey-white and firm.
No areas revealing papillary projections, necrosis, or hemorrhage were identified. Normal ovarian tissue was not identified. The right ovary and right Fallopian tube were unremarkable [Figure 1].
The omentum received separately measured cm and was grossly unremarkable. However, on microscopic examination, multiple sections taken from the ovarian mass revealed a tumor composed of spindle shaped cells with uniform bland nuclei and scant cytoplasm arranged in fascicles.
The tumor showed a variable degree of edema and cystic change. There were no mitotic figures. Tumor cells were vimentin-positive. Multiple sections were evaluated to rule out any focus of epithelial differentiation.
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Histological features were consistent with a fibroma ovary with cystic change [Figure 2]. Sections from the cervix showed chronic cervicitis. The myometrium, both Fallopian tubes, the right ovary and the omentum were unremarkable. Discussion Ovarian fibromas are stromal tumors composed of spindle, oval or round cells producing collagen. Very rarely, fibromas without any atypical features are associated with peritoneal implants.
Unfortunately, it has not proved to be a reliable predictor of ovarian cancer as normal values do not exclude the presence of carcinoma and elevated levels can be associated with a benign diagnosis.
In our case, there was a strong clinical, radiological and serological suspicion of malignancy, so radical surgery was planned. Unlike the guarded prognosis encountered for advanced cases of ovarian carcinoma, the surgical option in this case proved to be curative with an uneventful post-operative course.
The present case report emphasizes the varied presentation and unique gross morphology of ovarian fibroma. It also reinforces the non specificity of CA as a marker of ovarian malignancy. It beckons us to re evaluate the presumption that thorough clinical examinations supported by laboratory investigations and imaging modalities are fool proof in themselves. Its diagnosis can be delayed and its presentation varied. Information on this rare tumor type is predominantly through rare case reports with collective consensus on management lacking.
The gynecologic oncologist must exercise prudence in individualizing treatment regimens for this rare yet aggressive malignancy. Introduction Primary leiomyosarcoma of the vagina is exceedingly rare.
The preponderance of carcinomas of the vagina are secondary, with primary tumors representing a much smaller entity [ 1 ]. Of the various histological types of primary vaginal tumors, squamous cell carcinomas are by far the most common type comprising about Alternatively, primary vaginal sarcomas account for only 3. Of the primary vaginal sarcomas, primary vaginal leiomyosarcomas again represent only a fraction.
This means that if every primary vaginal sarcoma was a primary vaginal leiomyosarcoma, primary vaginal leiomyosarcoma would represent a mere 0.
In actuality, since this is not the case, the incidence is likely yet far smaller. In fact, literature reviews in the year found fewer than 70 cases reported in English literature [ 3 ].
This case report represents one such case. The incidence, diagnosis, and treatment of primary leiomyosarcoma of the vagina will be reviewed in this case report.
Blausteins Pathology Of The Female Genital Tract
Hopefully this case report will add further meaningful insight into this rare malignancy. Case Presentation A year-old gravida 3 para 2 presented with a palpable vaginal mass and complaints of pink vaginal discharge and perineal discomfort when she sat down over the previous three months. Her past medical history was significant for morbid obesity, arthritis, fibromyalgia, hypertension, depression, and anxiety. She had two previous full term vaginal deliveries and one spontaneous miscarriage and underwent menopause at age Family history was significant for a maternal grandmother, paternal grandmother, and maternal aunt with breast cancer all diagnosed in their seventies and eighties.
She denied tobacco, alcohol, or illicit drug use and was retired.
On physical examination there was a palpable mass in the posterior lower one-third of the vagina. Transvaginal ultrasound demonstrated 3. CT scan of the chest did not demonstrate any evidence of metastatic disease and MRI of the abdomen and pelvis demonstrated only a uterine fibroid, which was not concerning for malignancy. Given the unknown origin of the 3 vaginal masses, resection in the operating room was performed.
Two specimens were sent to pathology both showing a smooth muscle neoplasm with increased mitotic activity and moderate to severe cytologic atypia, consistent with leiomyosarcoma. Sections revealed spindle cell neoplasm with moderate to severe cytologic atypia and increased mitotic activity focally up to 8 per ten high power fields with focal coagulative necrosis. According to current classification criteria, it is recommended that smooth muscle tumors of the vagina that are greater than 3.
Margins were positive in both specimens. Pelvic washings were negative for malignant cells. Surgical resection in sum showed presence of disease in the vagina but not elsewhere, making the final diagnosis leiomyosarcoma of the vagina an exceedingly rare diagnosis.
She was consequently treated with doxycycline in the midst of her first cycle.
After her third cycle the patient had severe fatigue and left lower extremity cellulitis. She was hospitalized for 5 days in the setting of pancytopenia and given IV antibiotics. Consequently, plans were made to take the patient to the OR instead of receiving additional chemotherapy.
She underwent a robotic-assisted hysterectomy, bilateral salpingo-oophorectomy, cystoscopy, and resection of residual vaginal tumor. Surgical pathology showed spindle cell neoplasia from the vaginal tissue consistent with the previous diagnosis of leiomyosarcoma of the vagina.
Her uterus, cervix, fallopian tubes, and ovaries showed leiomyomas, but no malignancy. Her pelvic washings were negative. The patient was then treated with standard field pelvic radiation with vaginal high dose radiation for a total dose of cGy. The patient has remained cancer-free to date, 18 months after surgery. Discussion Leiomyosarcomas are largely considered to be a uterine neoplasm and typically arise de novo from uterine smooth muscle, with a rare few originating from preexisting leiomyomas.
Despite this rare transformation from a leiomyoma to a leiomyosarcoma, it is not uncommon to find both leiomyomas and leiomyosarcomas in the same specimen. For instance, approximately 0. The differentiation of the two can only be made histologically where leiomyosarcomas contain marked atypia, from highly differentiated cells to highly pleomorphic and anaplastic cells [ 6 ].
Nuclear atypia, mitotic index, and zonal necrosis are parameters used in the differentiation from leiomyomas [ 6 ]. It is generally accepted that the presence of 10 or more mitoses per 10 high power fields indicates malignancy [ 6 ].
Cytological atypia and necrosis further bolster the diagnosis [ 6 ]. Further, if either nuclear atypia or epithelioid cells are present, 5 mitoses per 10 high power fields are sufficient for the diagnosis of leiomyosarcoma [ 6 ].
Unlike leiomyomas, leiomyosarcomas have complex and often variable karyotypes [ 6 ]. When arising from the uterus, these smooth muscle tumors are most commonly seen between the ages of 45 and 55 and can be quite devastating with potential early metastases often by hematogenous spread [ 1 , 7 ].
These tumors are known for their very aggressive nature and poor prognosis likely secondary to hematogenous metastasis. For instance, one study of autopsies showed that metastases to distant locations such as the lungs often occurred without lymphatic disease, supporting a hematogenous mode of dissemination [ 8 ]. In fact more than half eventually metastasize hematogenously to distant organs.
Leiomyosarcomas also have racial variations with African American women having twice the incidence of leiomyosarcoma compared to Caucasian women [ 9 ]. Leiomyosarcomas of the vulva and vagina are much rarer entities. Since primary leiomyosarcomas represent only a fraction of primary vaginal sarcomas, primary leiomyosarcomas likely represent much less than 0.
The presentation of this malignancy can vary, but generally patients with this malignancy will present with an asymptomatic vaginal mass [ 10 ]. In other cases, such as in our case, vaginal discharge or bleeding may also be present. Vaginal leiomyosarcomas may originate in any part of the vagina but are predominantly submucosal [ 10 ]. Complicating matters further, when the malignancy occurs in more distal parts of the vagina or vulva a resemblance to Bartholin duct cysts can cause a delay in diagnosis [ 11 ].
There is little literature available on vaginal sarcomas, most of which are case reports [ 10 ]. For instance, a recent review in India found that only about 71 cases have ever been reported in the English literature [ 10 ].
This paucity of literature makes ideal management of these tumors difficult, and most gynecologic oncologists will go through their whole career without seeing a single case. As such, the optimal treatment modalities have not been established.Alternatively, primary vaginal sarcomas account for only 3.
Carter et al. Unlike leiomyomas, leiomyosarcomas have complex and often variable karyotypes [ 6 ]. We do compassionate street agencies. Zaino, M. Leiomyosarcomas of the vulva and vagina are much rarer entities. Benign Diseases of the Vulva.
Leiomyosarcoma of the Vagina: An Exceedingly Rare Diagnosis
Her uterus, cervix, fallopian tubes, and ovaries showed leiomyomas, but no malignancy. There were no mitotic figures.
Zaino, Stanley J.
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