Histopathological diagnoses of adnexal masses: which parameters are relevant in preoperative assessment?

Objective: The aim of the study was to assess which clinical, laboratory and ultrasound characteristics of adnexal masses might predict the histopathological nature of the disease. Materials and Methods: The study involved all women treated at the Clinic of Gynecology and Obstetrics Clinical Centre of Serbia for adnexal tumors between July 1, 2010 and December 31, 2011. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan performed and RMI was calculated for all patients. Data were related to histopathological findings and statistically analyzed. Results: The study included 540 women out of which 85 had malignant (seven diagnoses), 435 benign (seven diagnoses) and 20 borderline tumors. All types of malignant and borderline tumors were more frequent in postmenopausal women (p=0.000). Only papillary adenocarcinoma significantly more often produced early metastases (p=0.000). Ascites is a common finding in Krukenberg tumors, granulose cell tumors and papillary adenocarcinomas. There were significant differences between tumor diagnoses regarding the levels of Ca 125 and CEA, erythrocyte sedimentation rate (ESR) and risk of malignancy index (RMI) (p0.05). Conclusions: In the light of our results, patient age, menopausal status, blood levels of Ca 125, CEA and ESR, as well as calculated RMI, can predict the nature of adnexal masses. Unfortunately, none of the examined parameters can accurately determine the exact histopathological diagnosis of the adnexal tumor

Endometrial polyps in infertility patients: The first study of their clinical characteristics

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Vulvar hibernoma

A 35 year old woman presented with 18 months history of a painless, soft, well-circumscribed, vulvar subcutaneous lump which measured approximately 7 cm. The lesion was completely excised and microscopically was consistent with a hibernoma. According to the available literature in English, this is the first reported case of hibernoma of the vulva

Mammary-type myofibroblastoma of soft tissue

A 40-year-old woman presented with a 1 year history of a painless, subcutaneous lump on the right buttock. Clinical examination showed an approximately 6 cm large subcutaneous mass covered by apparently normal-looking skin. No inguinal lymphadenopathy was found. The mass was excised with the clinical diagnosis of fibroma. Histologically, the lesion was consistent with mammary-type myofibroblastoma of soft tissue, a very rare, benign mesenchymal neoplasm with myofibroblastic differentiation. After surgical excision she was free of recurrence over a period of 8 months. This article also challenges the theory that suggests the origin of this tumor to be from the embryonic mammary tissue, adding another case of a site other than the milk lines

Nasal angioma with osseous metaplasia

Nasal angiomas are rare. We report a case showing osseous metaplasia and discuss pathogenesis hypotheses. A 41-year-old woman presented with a right lateronasal firm, immobile mass, and interfering with glass wearing. The computed tomography scan imaging was suggestive of chondroma while the magnetic resonance imaging showed on T1-weighted images nodule isosignal, on T2-weighted images hypersignal, and intense enhancement after contrast substance injection. The lesion was surgically resected. Histological examination revealed a 0.8 cm angioma with multifocal osseous metaplasia. The diagnosis of nasal angiomas with extensive osseous metaplasia is difficult requiring microscopic examination. Conservative surgery is the treatment of choice even at an early stage due to the limited effectiveness of embolization or drugs on the osseous component