Retroperitoneal mucinous adenocarcinoma occuring during pregnancy in a supernumerary ovary

Primary Retroperitoneal Carcinomas: New Insights into Pathogenesis and Clinical Management in Comparison with Ovarian Carcinomas and Carcinoma of Unknown Primary

Primary retroperitoneal carcinomas are very rare tumors. Their pathogenesis remains unknown but may be associated with that of ovarian carcinomas, considering the similarity in morphology and gender preference. Although metaplasia of coelomic epithelium is the most widely accepted theory, the pathogenesis of retroperitoneal carcinomas may differ by histologic subtype, like ovarian carcinomas. Mucinous carcinoma, which develops in both women and men, may originate in both primordial germ cells and Walthard cell nests that may be derived from the fallopian tube. Serous carcinomas may be associated with endosalpingiosis, the presence of fallopian tube-like epithelium outside the fallopian tube, and a remnant Müllerian tract. Endometrioid and clear cell carcinomas appear to be associated with extraovarian endometriosis. Additionally, both carcinomas in the retroperitoneal lymph nodes may be metastatic diseases from endometrial and/or renal cell cancer that regress spontaneously (carcinoma of unknown primary). Retroperitoneal carcinomas are difficult to diagnose, as they have no characteristic symptoms and signs. Surgery is the cornerstone of treatment, but the necessity of chemotherapy may depend on histological subtype. Further studies are necessary, in particular studies on endosalpingiosis, as endosalpingiosis is a poorly understood condition, although it is associated with the development of both serous and mucinous carcinomas.

Primary retroperitoneal tumor during pregnancy: Case report and review of the literature

OBJECTIVE

To report the case of a pregnant patient diagnosed with a primary retroperitoneal tumor and to conduct a review of the literature pertaining to the diagnosis, treatment and maternal-fetal prognosis of this disease condition during pregnancy.

METHODS

A 19-year-old patient who presented with a retroperitoneal tumor identified on ultrasound. The results of the percutaneous biopsy showed a benign tumor. A healthy neonate was delivered by cesarean section. Surgical resection was performed four months later, and histopathology showed a mature cystic teratoma. A search was conduced in the Medline via PubMed, Lilacs, SciELO and ScienceDirect databases using the terms "pregnancy," "neoplasms," and "retroperitoneal neoplasms," including case reports and case series of retroperitoneal tumors during pregnancy. Diagnosis, treatment and maternal-fetal prognosis were identified.

RESULTS

Overall, 1658 titles were identified. Of these, 34 case reports and 1 case series met the inclusion criteria. Of the cases, 62.9 % were benign. Diagnosis was made as an incidental finding in 63 % of cases, and 77 % of the masses were identified on ultrasound. Percutaneous biopsy was used in 8 % of cases, including the case reported here. Surgical treatment was used in 88 % of cases usually after delivery. Maternal mortality occurred in 8.5 % of cases. Fetal prognosis was good in 65 % of the pregnancies.

CONCLUSIONS

Despite being frequently benign, retroperitoneal tumors during gestation have a reserved maternal and fetal prognosis in a substantial number of cases. There is a need to assess the risks and benefits of percutaneous biopsy.

Primary Retroperitoneal Mucinous Tumours Diagnosed in Pregnancy: A Case Report and Literature Review

We present the case of a pregnant patient who was found to have a primary retroperitoneal mucinous tumour (PMRT). An abdominal mass measuring 11.5 × 9.8 × 8.8cm, initially thought to be of ovarian origin, was found incidentally on ultrasound in a 36-year-old patient at 20 weeks’ gestation. Tumour markers were normal. She underwent an elective Caesarean section at 34 weeks, but the uterus, fallopian tubes and ovaries were normal. The mass was found to be retroperitoneal. A clinical decision was made to avoid further surgical exploration at the time. Following further surgical planning, the patient underwent open resection of the retroperitoneal mass, 6 weeks after her Caesarean section. Histology confirmed a moderately differentiated adenocarcinoma suggestive of a primary retroperitoneal mucinous adenocarcinoma. A literature review following this identified five case reports of PMRT in pregnancy in the last decade. In all cases, the patients underwent tumour resection without adverse pregnancy outcomes. While our patient had an uncomplicated pregnancy, she developed a 2cm lesion suggestive of disease recurrence 15 months post-operatively. A plan was made for surgical resection. PMRT are rare, but can occur in pregnant patients and patients of childbearing age. Tumour resection should be carried out, but where there is no concrete evidence of tumour invasion, the uterus and ovaries should be spared to avoid infertility and menopause. We would recommend early tumour resection, given its potentially aggressive nature.

The long-term survival in primary retroperitoneal mucinous cystadenocarcinoma: a case report

Background

Primary retroperitoneal mucinous cystadenocarcinoma (PRMC) is extremely rare, and its biological behavior, pathogenesis, optimum treatments, and prognosis remain to be elucidated. We herein report a case of PRMC with an 80-month follow-up.

Case presentation

A 29-year-old woman was diagnosed with unknown retroperitoneal tumor with benign right ovarian cyst and uterine fibroids, and she underwent laparotomy. The tumor was completely resected with a subsequent histopathological diagnosis of primary retroperitoneal mucinous cystadenocarcinoma (PRMC). Eighty months after surgery, she remains recurrence-free.

Conclusion

PRMC is an extremely rare tumor. Only around 60 cases have so far been published in the literature. The preoperative diagnosis of PRMC is difficult, and a definitive diagnosis can usually only be made based on the findings of histopathological examinations after surgery. Presently, only radical resection is useful for both diagnostic and therapeutic purposes. The optimal long-term management after surgery is still not well established. Further studies on PRMC are therefore needed to elucidate the etiology and establish effective treatments.

Cystic Endometrioma with Coexisting Fibroma Originating in a Supernumerary Ovary in the Rectovaginal Pouch

A supernumerary ovary is an exceedingly rare disorder, in which the structure containing ovarian tissue is located at some distance from the normally placed ovary. 16 cases of endometriosis or tumors originating in a supernumerary ovary have been published in the English literature, but no case of coexisting endometriosis and a tumor has been published. We present the case of a 40-year-old female with cystic endometrioma with coexisting fibroma originating in a supernumerary ovary in the rectovaginal pouch. The present case is the first to be reported with coexisting endometriosis and a tumor originating in a supernumerary ovary. Our experience with this case and the results of our previous studies of rectovaginal endometriosis indicated that the possibility of originating in a supernumerary ovary shall be examined in cases of cystic endometrioma in the rectovaginal pouch.

Uterine cervical adenocarcinoma metastasizing concurrently to eutopic and ectopic ovaries: A case report

Ectopic ovary, a designation that includes supernumerary ovaries and accessory ovaries, is a rare gonadal anomaly. We encountered a patient with a metastasis to such an anomaly and herein provide a review of the published work. A 43-year-old woman was diagnosed with stage IIb cervical adenocarcinoma with suspicion for a right ovarian malignancy. She underwent laparotomy after completing three cycles of neoadjuvant chemotherapy. Intraoperative inspection revealed two normal ovaries, but an ovary-like structure was identified attached to the fimbriae of the left fallopian tube. A cystic tumor, 12 cm in diameter, developed from this structure, which was not connected to the infundibulopelvic ligament. The mass was pulled and elevated into the right pelvis by omental adhesions. Pathological examination revealed uterine cervical endometrioid adenocarcinoma with deep stromal invasion, vaginal invasion, and pelvic lymph-node metastases. Both the left eutopic ovary and the ovary-like structure contained endometrioid adenocarcinoma metastases. The ovary-like structure contained spindle-shaped theca cells, which were positive for inhibin α; therefore, this structure was defined as ovarian tissue. The final diagnosis was well-differentiated uterine cervical endometrioid adenocarcinoma with metastases to the pelvic lymph nodes and to the left eutopic and ectopic ovaries (pT2a2N1M0). To the best of our knowledge, there have been no previous descriptions in the English-language published work of uterine cervical adenocarcinoma metastasizing concurrently to unilateral eutopic and ectopic ovaries. © 2016 Japan Society of Obstetrics and Gynecology.

Mature Teratoma in a Supernumerary Ovary in a Child: Report of the First Case

BACKGROUND

Supernumerary ovary (ie, ovarian ectopia having no anatomic connection with the normally placed ovaries) is a rare gynecologic condition. To the best of our knowledge, only 1 pediatric case of supernumerary ovary has been reported to date in the English literature.

CASE

A 4-year-old girl was assessed for foul-smelling vestibular discharge and was found to have a fistulous tract with opening near the vaginal orifice. Fistuloscopy revealed hair in the lumen of the tract. Computed tomography scan showed a retroperitoneal mass in continuation of the tract. Excision of the mass revealed a mature teratoma in a retroperitoneal supernumerary ovary.

SUMMARY AND CONCLUSION

Supernumerary ovary, a gynecologic rarity, is even more uncommon in children. Hence, a thorough clinical-radiological-pathological correlation is mandatory to diagnose extragonadal ovarian tumors arising in supernumerary ovaries.

Primary retroperitoneal mucinous cystadenocarcinoma (PRMCa): a systematic review of the literature and meta-analysis

PURPOSE

Primary retroperitoneal mucinous cystadenocarcinoma (PRMCa) is a rare tumour. Prognosis and optimal management are not well established. In view of a case managed in our Centre, we performed a systematic review and meta-analysis.

METHOD

Systematic review of medical electronic databases for published data (1950-12/10/2015). No RCTs identified. Individual patient data detracted from case reports and case series were analysed

RESULTS

In total, 73 female and 5 male cases of PRMCa identified including our case. Median age at diagnosis was 42.0 years (range 18-86 years), with women being significantly younger than men at diagnosis (42.0 years versus 62.2 years, p = 0.005). A palpable abdominal mass and abdominal pain were the most common presentations in 42.9 and 23.8 % of cases, respectively. Twenty-six women were <38 years old. There were 16 women <38 years old that had surgical data reported, of which 14 underwent fertility-sparing surgery with excision of the mass. Adjuvant chemotherapy was given in 24.1 % (13/72) women. Follow-up ranged from 1 to 130 months with a median of 15 months. Of the 57 cases that had follow-up reported, recurrence occurred in 23 cases (40.4 %) within a median of 8 months from diagnosis. Median disease-free survival was 15 months (range 1-130 months). Of the women who recurred, 14 died of their disease giving 1, 2 and 5-year disease-specific survival rates of 85.9, 80.7 and 75.4 %, respectively.

CONCLUSION

PRMCa are rare and potentially aggressive tumours that often occur in young women. Removal of the tumour, adequate staging and adjuvant chemotherapy needs to be considered.

Primary retroperitoneal mucinous cystadenocarcinoma during pregnancy

Primary retroperitoneal mucinous cystadenocarcinoma (PRMC) is an extremely rare tumour. This case report describes the treatment and prognosis of a patient with PRMC during pregnancy. This is the third case of PRMC in a pregnant woman, worldwide. The patient was a 37-year-old woman presenting with a left mid-abdominal and pelvic semisolid, cystic mass at 29 weeks' gestation. At 30 weeks' gestation, she underwent an exploratory laparotomy, which revealed a solid tumour (22 × 13 × 11 cm) with an intact capsule extending from the inferior pole of the left kidney to the pelvic inlet in the left retroperitoneal area. The tumour had adhesions with the surrounding connective tissue and could be excised with its capsule intact. In conclusion, based on the limited information available, a PRMC with no visible dissemination excised with an intact capsule appears to have a good prognosis. Tumour excision may be adequate for treatment of PRMCs in the extragenital space and with no dissemination.

A unique benign mucinous cystadenoma of the retroperitoneum: a case report and review of the literature

Primary retroperitoneal mucinous cysts are rare. Most often malignant, lesions present on a spectrum, fitting the histopathological categories of benign, borderline and malignant. The rarest form is the benign mucinous cystadenoma adenocarcinoma, of which only 20 cases have been reported. We present here the curious case of a 37-year-old woman with two large, fast growing, cystic, benign, primary retroperitoneal mucinous cystadenomas treated definitively by local resection.

Primary retroperitoneal mucinous cystadenocarcinoma associated with pregnancy

Primary retroperitoneal mucinous cystadenocarcinoma (PRMC) is an extremely rare tumor. Only 30 cases have been reported previously in the English literature, and little information is available concerning its treatment and prognosis. The patient was a 28-year-old woman, presenting with a right mid-abdominal tumor at 26 weeks of gestation. At 31 weeks of gestation, she underwent an exploratory laparotomy and was diagnosed with a PRMC. No disseminated tumor was observed, and an excision of only the tumor was performed. She had an uneventful vaginal delivery at 38 weeks of gestation and remains free of disease at 13 months after the operation. This report describes a case of PRMC associated with pregnancy. The optimal management of these retroperitoneal masses during pregnancy is discussed. Based on limited experience and the current literature, a PRMC with an intact capsule and no dissemination appears to have a good prognosis and can be treated by tumor excision alone in patients who wish to preserve fertility