Retrorectal epidermoid cyst with unusually elevated serum SCC level, initially diagnosed as an ovarian tumor

Retrorectal epidermoid cyst is one of the developmental cysts which arise from remnants of embryonic tissues. We report a rare case of retrorectal epidermoid cyst, initially diagnosed as an ovarian tumor. Serum SCC value as tumor marker was elevated to the high level. Laparoscopy revealed ovaries, uterus and other pelvic organs were all normal. This tumor existed in the retroperitoneal cavity and compressed the rectum. Later, complete tumor resection was performed by laparotomy. Histological study revealed the epithelium of this tumor consisted of only squamous cells without atypia, and the diagnosis of this tumor was retrorectal epidermoid cyst. Retrorectal epidermoid cyst is very rare, and difficult to diagnose before surgery. However, if we have-knowledge of developmental cysts, and by careful digital examination and image diagnosis, a differential diagnosis can be made

HPV カンセン ジョウキョウ ト シキュウ ケイガン ケンシン ニオケル サイボウ シン ト HPV ケンサ ヘイヨウ ノ イギ

Human papillomavirus (HPV) 中高リスク型の感染が,子宮頸部の前癌病変や子宮頸癌の発症に関与していることが明らかにされた.HPV 感染の一部は持続感染し,子宮頸癌のリスクとなる.そこでHPV 感染状況と子宮頸癌検診における細胞診とHPV 検査併用の意義について検討した.対象は3 年以上経過観察可能であった細胞診正常81 例と細胞診異常で組織診を施行した80 例である.HPV 検出にはHybrid Capture AssayII®( HC-II®) 法を用いた.細胞診正常11 例,細胞診異常61 例でHPV が検出され,細胞診異常の程度が進むほどHPV 検出率は上昇した.組織診でも病変が進行するほどHPV 検出率は高くなった.細胞診正常ではHPV陽性持続で病変の進行を認めた.組織診別では,慢性子宮頸管炎(Chronic Cervicitis:CC) ではHPV 陽性持続1 例と陽性化1 例に,子宮頸部上皮内病変(Cervical Intraepithelial Neoplasia:CIN) IではHPV 陽性持続2 例に,CIN IIでは陽性持続3 例と陽性化した1 例に,CIN IIIでは陽性持続2 例に病変の進行が認められた.HPV 感染が認められなかった例では病変の進行を認めない結果から,細胞診とHPV 検査を併用することにより,細胞診正常でHPV 検査陰性であれば検診間隔を3 年に延ばすことが可能であると示唆された.またHPV持続感染が病変進行の原因となると考えられ,HPV 検査の導入は子宮頸癌の早期発見,早期治療に有用である.Persistent infection with intermediate or high risk subtypesof human papillomavirus (HPV) is associated withuterine cervical neoplasia and cervical cancer. Over a3-year period, we followed up 161 patients with normal( 81cases) and abnormal (80 cases) results of cytologicalscreening tests to determine the status of persistent HPVinfection and the significance of combined uterine cervicalcancer cytological screenings and HPV tests. The hybridcapture assay II® method was used to test for intermediateor high risk of HPV infection. HPV infection was detectedin 11 patients with normal results and 61 patients with abnormalresults of cytological screening tests. The positiverate of HPV infection was associated with the status of cytologicaland pathological lesion progression. Lesions of 2patients with persistent HPV infection who had normal resultsin cytological screening tests had been diagnosed withprogressive lesions. Lesions of patients in whom HPV infectionwas negative or negative conversion were determinedto be non-progressive. Disease progression was seen in theform of chronic cervicitis in 1 patient with persistent HPVinfection and 1 patient with HPV positive conversion;inthe form of cervical intraepithelial neoplasia (CIN) I in 2patients with persistent HPV infection;in the form of CINII in 3 patients with persistent HPV infection and 1 patientwith HPV positive conversion;and in the form of CIN IIIin 2 patients with persistent HPV infection. In conclusion,combined cytological screening and HPV tests will increasethe precision of uterine cervical cancer screening and willbe valuable for the early detection and a rapid treatment ofuterine cervical cancer. Moreover, the interval between 2consecutive uterine cervical cancer screenings can be extendedto at least 3 years in patients who have normal resultsof cytology and no HPV infection

Prognostic significance of inflammatory parameters and nutritional index in clinical stage IVB endometrial carcinomas

Recently, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) or prognostic nutritional index (PNI) have been investigated as prognostic parameters in various malignancies. Herein, we detail how we have investigated the prognostic significance of NLR, PLR and PNI together with the other clinicopathological factors for International Federation of Gynaecology and Obstetrics stage IVB endometrial carcinoma. Thirty-two patients with clinical stage IVB disease were enrolled. The relationship between clinicopathological factors, NLR, PLR or PNI and overall survival (OS) rates was investigated. The 5-year OS rate was 9.7%, and the median survival time was 9 months. In univariate analysis, PS 0–1, G1–2 endometrioid carcinoma, occurrence of surgery, NLR (below median) and PNI (≥median) were identified as favourable prognostic factors. In multivariate analysis, only a histology (G1–2 endometrioid carcinoma) was identified as an independent favourable prognostic factor. Additional large-scale studies are required to confirm the prognostic significance of NLR, PLR and PNI in clinical stage IVB endometrial carcinoma.Impact Statement What is already known on this subject? Several parameters representing the systemic inflammatory response (e.g. neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR)) or the nutritional condition (e.g. prognostic nutritional index (PNI)) have been investigated as prognostic parameters in various malignancies, whereas they have not been thoroughly investigated in endometrial carcinoma. What the results of this study add? In univariate analysis of various factors for overall survival, the performance status (PS) 0–1, grade 1–2 endometrioid carcinoma, occurrence of surgery, NLR (below median) and PNI (≥median) were identified as favourable prognostic factors. However, in a multivariate analysis, only the histology (grade 1–2 endometrioid carcinoma) was identified as an independent favourable prognostic factor. What the implications are of these findings for clinical practice and/or further research? This retrospective study identified that neither inflammatory parameters nor the nutritional index were revealed to be independent prognostic factors by multivariate analyses. Additional large-scale studies are required to confirm the prognostic significance of NLR, PLR and PNI in clinical stage IVB endometrial carcinoma to improve the poor prognosis of this disease

Liposarcoma of the uterine corpus: A case report and literature review

Liposarcoma of the uterine corpus is extremely rare. We performed a laparotomy on a 55-year-old woman with the complaints of abdominal distension and genital bleeding who was found to have a uterine tumor, 17 × 16 cm in diameter. The preoperative diagnosis was a lipoma or lipoleiomyoma of the uterine corpus. However, pathological examination revealed proliferation of mature adipocytes and lipoblast-like atypical cells with small, weakly pleomorphic nuclei and foamy or vacuolated cytoplasm present within a fibrous septum. Immunohistochemistry showed that the tumor cells were focally positive for mouse double minute 2 homolog (MDM2). The final pathological diagnosis was a well-differentiated liposarcoma of International Federation of Gynecology and Obstetrics (FIGO) stage IB (pT1bNxM0). On magnetic resonance imaging (MRI), T1 -weighted and fat-saturated images showed high and low intensity in the tumor, respectively, suggesting that this tumor contained a fat component. The septum inside the tumor had a contrast enhancement on T1-weighted, gadolinium-enhanced imaging. The septum was nonuniformly thickened and partially nodular. In hindsight, these findings may have suggested a well-differentiated liposarcoma in the uterine corpus rather than a lipoma or lipoleiomyoma. Clinicians should be aware of the possibility of a liposarcoma of the uterine corpus when a neoplasm contains adipose tissue and a nonuniformly thickened or partially nodular septum on MRI. Keywords: Liposarcoma, MDM2, MRI, uterine corpus, well-differentiated typ