Ovarian Strumal Carcinoid Tumour: Case Report

BACKGROUND: Ovarian strumal carcinoid is a germ cell tumour characterised by a mixture of thyroid tissue and carcinoid. Ovarian struma is a very rare occurrence with 0.3-1% incidence of all ovarian tumours and 3% of mature teratomas. Primary carcinoid ovarian tumours are still uncommon as a part of mature teratoma or mucinous cystadenoma. There are four major variants of a carcinoid tumour: insular, trabecular, strumal and mucinous. A strumal carcinoid is an unusual form of ovarian teratoma composed of an intimate admixture of thyroid/carcinoid tissues.CASE REPORT: This is a case report of a 59-year old woman with a 5-year clinical history of perimenopausal uterine bleeding and three explorative curettages. Gynaecological and ultrasound examinations revealed ovarian enlargement with a diameter of 50 mm with hypoechoic zones suspected of benign teratoma. The diagnostic test such as Ca-125, AFP, free-T4 and TSH was in normal range. A smooth, solid right ovarian 50 an mm-size tumour, as well as small amount of fluid in the Douglas pouch, was found during the total abdominal hysterectomy, bilateral salpingo-oophorectomy and staging biopsy.  The histopathology revealed teratoma with strumal carcinoid tumour IA stage according to AJCC 2010 of the right ovary and negative cytopathology of the fluid from the Douglas pouch. On the postoperative 2-year control, the patient was tumour free, and Ca-125, free-T4 and TSH were in normal range.CONCLUSION: We would like to point out those specific diagnostic tools, such as ultrasound and Ca-125 have low specificity and sensitivity in detection of this rare ovarian malignancy

Endometrioid Adenocarcinoma Arising in Adenomyoma in a Woman with a Genital Prolapse - Case Report

BACKGROUND: Endometrial cancer is the third-ranked genital malignancy in women and includes 3% of cancer deaths. There is a 2.8% chance of a woman developing endometrial cancer during her lifetime. Low-grade endometrioid adenocarcinomas are often seen along with endometrial hyperplasia, but high-grade endometrioid adenocarcinomas have more solid sheets of less-differentiated tumour cells, which are no longer organised into glands, often associated with surrounded atrophic endometrium.CASE REPORT: We present an unusual case of endometrial adenocarcinoma arising in adenomyoma in 74-year old woman presented with genital prolapse, without other clinical symptoms. Ultrasound evaluation revealed endometrium with 4 mm-thickness and atrophic ovaries. The cervical smear was normal. The patient underwent a total vaginal hysterectomy. The histopathology of the anterior uterine wall revealed an intramural adenomyoma of 4 mm in which some endometrial glands with malignant transformation of well-differentiated endometrioid adenocarcinoma without infiltration in surrounding myometrium and lymphovascular invasion were present. The endometrium lining the uterine cavity was predominantly atrophic, and only one focus of simplex and complex hyperplasia was found, with cell-atypia. According to AJCC/FIGO 2010, the tumour was classified: pTNM = pT1B pNX pMX G1 R0 L0 V0 NG1, Stage I. On dismiss, the near-future oncological consultation was recommended.CONCLUSION: We would like to point out the rare occurrence of such type of malignancy and the importance of meticulous histopathology evaluation, even after reconstructive surgery for genital prolapse

High-risk HPV E6/E7 messenger RNA testing versus HPV DNA testing in women with squamous cell abnormalities of the uterine cervix

Aims The study is performed in order to compare the results of two HPV screening methods: High-risk HPV E6/E7 mRNA and HPV DNA. Method Comparative prospective study, conducted in the period for April 2016 to March 2017 at the University Clinics for Gynecology and Obstetrics and Radiotherapy and Oncology in Skopje and Institute of Public Health of Republic of Macedonia of 98 sexually active women, age groups of 20 to 60 years, with squamous cell abnormalities on the cervical cytology. In all 98 women were done: HPV DNA testing, High-risk HPV E6/E7 mRNA testing and colposcopy and directed biopsy with endocervical curettage for histopathological analysis. Results Histopathologically, there were: 36.7% non-neoplastic lesions, 20.4% LGSIL cases, 29.6% HGSIL cases and 13.3% invasive squamous cell carcinomas. HPV DNA was found 78.6% of the cases; E6 and E7 transcripts were found in 58.2%. The rates of detection of HPV DNA and E6 and E7 transcripts were 83.3% and 22.2% for cases with non-neoplastic finding; 65.0% and 45.0% for cases with LGSIL; 75.9% and 93.1% for cases with HGSIL and 92.3% and 100% for cases with invasive squamous cell carcinoma. High-risk HPV E6/E7 mRNA testing showed a higher sensitivity than the HPV DNA testing (79.0% and 75.8%), higher specificity (77.8% and 16.7%) and a higher positive predictive value for HGSIL ( 93.1% and 75.9%) and invasive squamous cell carcinoma (100% and 92.3%). Conclusion High-risk HPV E6/E7 mRNA testing could be more powerful than HPV DNA testing for screening and investigation of HGSIL and invasive squamous cell carcinoma