Metastatic Adenocarcinoma of right supraclavicular lymph nodes from primary ovarian cancer: a rare presentation

Background: Lymph-node metastases to the right supraclavicular lymph nodes (RSCLNs) in ovarian malignancies are very rare occurrences. The majority of RSCLN metastases normally originate from primary neck, lung, and esophagus malignancies. A literature review revealed that only 2 cases of ovarian metastases to the RSCLNs have been reported. Case: A 28-year-old, single nulliparous woman presented to a local tertiary hospital with a 2-month history of progressive abdominal distension. This was associated with a loss of appetite and a marked weight loss. She had no significant medical illnesses or family history of malignancies. Examination revealed a nontender palpable lymph node in the right supraclavicular region, measuring 4 × 3 cm. No other lymph nodes were palpable at the left supraclavicular or cervical areas. There was also gross ascites. Other examination results were unremarkable. A computed tomography (CT) scan showed an RSCLN mass and complex solid-cystic masses arising from the pelvis. Fine-needle aspiration (FNA) biopsy of the RSCLN was performed, revealing a metastatic adenocarcinoma with features compatible with serous adenocarcinoma of the ovary. Results: This patient was treated successfully with neoadjuvant chemotherapy that was followed by a total abdominal hysterectomy, and bilateral salpingo-oophorectomy, omentectomy, and appendectomy. She was alive with no recurrences at a 1-year regular follow-up. Conclusions: The rarity of RSCLN metastases in ovarian cancer might incline clinicians to neglect the presence of RSCLN enlargement during examinations. Thus, clinicians should examine both left and right SCLNs thoroughly in women suspected of having gynecologic malignancies

Upregulation and hypomethylation of EGFR in Formalin-fixed Paraffin Embedded FFPE tissues of colon adenocarcinoma

Introduction: Colorectal cancer (CRC) is the third most common cancer worldwide. Even though many cancer therapies have been developed, considerable proportions of patients respond poorly to therapy and the number of resistance cases increases. CRC emerges as a result of genetic and/or epigenetic modifications of epidermal growth factor receptor (EGFR) in colonic epithelial cells during tumourigenesis. Determination of DNA methylation status of EGFR is very crucial to further understand the role of this gene in carcinogenesis. However, the applicability of formalin-fixed paraffin embedded (FFPE) tissues in molecular studies is still limited due to high degradation of the nucleic acids. Hence, this study aimed to determine the gene expression and DNA methylation status of EGFR in FFPE CRC samples. Methods: Fifty-nine of archival FFPE CRC cases with the adjacent normal colon tissues were retrieved. Manual micro-dissection was performed prior to RNA and DNA extraction. EGFR expression and DNA methylation status was evaluated by qPCR and methylation specific PCR (MSP) techniques respectively. Results: EGFR was overexpressed in 54.2% (p-value=0.021) of CRC cases. Hypomethylation of EGFR was discovered in 81.4% and 79.7% of FFPE CRC tissues and normal adjacent tissues respectively. No significant association was found between DNA methylation and mRNA levels of EGFR. Conclusion: Determination of gene expression and DNA methylation in FFPE tissues were successfully carried out. The overexpression and hypomethylation of EGFR strongly suggest its important role in CRC tumourigenesis. Hypomethylation in normal tissue adjacent to the tumours indicates this epigenetic change occurs at the early step in carcinogenesis

Vulvovaginal angiomyofibroblastoma: an uncommon benign mesenchymal tumour

The female genital tract angiomyofibroblastoma (AMFB) is a rare benign mesenchymal tumour that mostly affects premenopausal women. Although it is most commonly seen in the vulvovaginal region, it has also been documented in the inguinosacral region, pelvis, and retroperitoneum (1,2). Patients usually present with indolent, painless swell- ing in the vulvovaginal region, or a pedunculated lesion on rare occasions. Those that appeared in the vulva were frequently misdiagnosed as Bartholin cysts. Leiomyoma is a differential in the vaginal area. AMFB must be recognised from aggressive angiomyxoma (AA) due to the latter’s potential for recurrence with typical infiltrative boundaries. We discuss a case of a 46-year-old woman who had a slow-growing paravaginal swelling incidentally discovered during a total hysterectomy for leiomyoma five years prior

Nasopharyngeal Carcinoma with Cystic Cervical Metastasis Masquerading as Branchial Cleft Cyst: A Potential Pitfall in Diagnosis and Management

Introduction:Most metastatic lymph nodes from head and neck malignancy are solid. Cystic nodes are found in 33% - 61% of carcinomas arise from Waldeyer’s ring, of which only 1.8% - 8% originate are from the nasopharynx. Some cystic cervical metastases were initially presumed to be branchial cleft cyst. This case report aims to highlight the unusual presentation of cystic cervical metastasis secondary to nasopharyngeal carcinoma in a young adult. The histopathology, radiological features and management strategy were discussed. Case Report:A 36-year-old man presented with a solitary cystic cervical swelling, initially diagnosed as branchial cleft cyst. Fine needle aspiration yielded 18 ml of straw-coloured fluid. During cytological examination no atypical cells were observed. Computed tomography of the neck showed a heterogeneous mass with multiseptation medial to the sternocleidomastoid muscle. Histopathological examination of the mass, post excision, revealed a metastatic lymph node. A suspicious mucosal lesion at the nasopharynx was detected after repeated thorough head and neck examinations and the biopsy result confirmed undifferentiated nasopharyngeal carcinoma. Conclusion:Cystic cervical metastasis may occur in young patients under 40 years. The primary tumour may not be obvious during initial presentation because it mimicks benign branchial cleft cyst clinically. Retrospective review of the computed tomography images revealed features that were not characteristic of simple branchial cleft cyst. The inadequacy of assessment and interpretation had lead to the error in diagnosis and subsequent management. Metastatic head and neck lesion must be considered in a young adult with a cystic neck mass

Kimura disease: a case series presenting as orbital mass

Introduction: Kimura disease (KD) is a chronic inflammatory process that can occur within the head and neck region involving deep subcutaneous tissue. Tumour-like nodules were the usual presentations. Albeit rare, there have been reports on orbital KD occurrence in recent years. Case series: We reported seven cases of orbital KD of patients aged 12 to 67 years old from a tertiary referral center in Malaysia. Painless orbital swelling was the most common presentation. The duration of presentation ranges from 2 months up to 6 years. Peripheral blood investigations demonstrated eosinophilia (>5% of white blood cells) and elevated serum immunoglobulin E (IgE) level. The orbital mass measures from 1cm to 5cm in dimension. Differentials include Hodgkin lymphoma, haemangioma, angiolymphoid hyperplasia with eosinophilia (ALHE) or a pseudotumour. In all cases, surgical excision was performed. Histopathological examination showed various degrees of lymphoid hyperplasia with germinal centres, eosinophilic infiltrates, hyalinized vascular proliferation and fibrosis. Diagnoses of KD were made. There were no recurrences seen on available follow up data of 2 cases. Conclusion: Albeit rare, orbital KD alerts to its common existence within the head and neck region. It mimics ALHE microscopically and malignant neoplasm clinically and radiologically. Thus, awareness for this entity, its histological characteristics with clinical and radiological correlations are essential in achieving a correct diagnosis. As there is no consensus on its optimal treatment, and its unpredictable response to the therapeutic interventions, the choice and extent of treatments also varied according to individual response and disease recurrence