Serous papillary cystadenofibroma of vulva: A histopathological surprise

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We report a case of a 45-year old female with a history of swelling in the genital region for the last 3 years.

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Local examination revealed a pedunculated swelling, soft in consistency, arising from the right genital fold – vulva.

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Ultrasonogram showed an encapsulated heterogenous complex cyst, with septations and internal echoes.

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MRI on T2W image showed characteristic low signal, well defined multiloculated cystic swelling.

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After wide local excision, the histopathology was suggestive of serous papillary cystadenofibroma (SPCAF) of vulva, with no previous cases being reported.

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SPCAFs are uncommon tumours with high degree of heterogeneity which becomes a major challenge.

Introduction

Serous Papillary Cystadenofibromas (SPCAFs) of the vulva is rare.

Case report

We report a case of a 45-year-old female who presented with a painless slow growing mass in the genital region. Examination revealed a 10 × 8 cm swelling from the vulva. USG was suggestive of a complex cystic lesion and MRI showed a low signal intensity lesion on T2W image. She underwent wide local excision and the histopathology was suggestive of a SPCAF.

Discussion

Vulval tumors rare- account for 4 % of female genital tract tumors. Mainstay of treatment in cases of SPCAF is wide local excision. Histopathology confirms the diagnosis and is used to rule out malignant transformation.

Conclusion

These represent uncommon tumors with high degree of heterogeneity which becomes a major challenge and systematic evaluation is crucial for clinical decision-making and patient management.

An uncommon diagnosis of a common presentation of mass per rectum

Introduction - In adults, protrusion of intussuscepted sigmoid growth through the anal canal is exceedingly rare, with only 9 cases being reported till date. Case Report - A 52-year old man presented to emergency department with what appeared to be an episode of rectal prolapse following straining while defaecating. On examination, he had a prolapsed 8 × 8 cm bowel, with a 2 × 2 cm friable villous growth as the lead point, with space between the mass and the perianal skin. Computed Tomography of the abdomen was done which was suggestive of telescoping of the sigmoid into the rectum protruding out through the anal canal with features of intestinal obstruction. He underwent exploratory laparotomy with sigmoidectomy with Hartman's Procedure. Post-operative period was uneventful. Histopathology was suggestive of moderately differentiated carcinoma. Discussion - In colo-anal intussusception, as was in our patient, the preferred approach is to reduce the intussusception before resection, to perform a sphincter saving operation as compared to an Abdominoperineal Resection (APR) otherwise. Conclusion -A high index of suspicion is important to diagnose and treat such cases early to avoid lethal outcomes by misdiagnosing it as simple rectal prolapse.

Does Quality of Life Among Modified Radical Mastectomy and Breast Conservation Surgery Patients Differ? A 5-Year Comparative Study

Breast cancer is the most common cancer among females worldwide, of whom more than 80% survive for more than 5 years. Hence, ensuring a good quality of life (QOL) is essential to achieve holistic approach in treating patients. A cross-sectional study was conducted to compare the QOL in women who underwent modified radical mastectomy (MRM) and breast conservation surgery (BCS) for breast cancer in the last 5 years. QOL was evaluated based on the long-term quality of life-breast cancer (LTQOL-BC) questionnaire. A greater percentage of women who underwent MRM complained of difficulty in completing their house work compared with the BCS group (50% compared with 31%). Twenty-five percent (6) of the women who had undergone MRM reported feeling of being incomplete as women, along with a lack of femininity. However, more than 80% of the women in both groups said that they felt stronger as survivors and derived strength from their experience. There were significant differences in the quality of life of women from both groups in terms of physical function and body image, with the BCS group appearing to have a better QOL.

HATRICK-Synchronous Triple Primary Tumors of Thyroid

Multiple primary cancer (MPC) has an incidence of 1.8% and is defined as having two or more cancers in a single patient. Synchronous tumors are defined as ≥ 2 primary tumors occurring within 6 months of diagnosis of the first primary tumor. We present a case of a 27-year-old female patient who presented with a painless, gradually progressive right-sided neck swelling for the last 1 year with no systemic complaints. Examination revealed a 4 × 3-cm, firm, smooth surfaced swelling on right lobe of thyroid. USG neck showed a hypoechoic solid nodule on the right lobe and the left lobe was normal. FNAC showed features of adenomatous colloid nodule, Bethesda II. Right hemithyroidectomy specimen revealed evidence of triple tumors-not otherwise-specified (NOS) tumor, papillary carcinoma thyroid, and medullary carcinoma thyroid, which was confirmed with positivity on IHC with synaptophysin, CEA, and chromogranin. Concurrent appearance of NOS, PTC, and medullary carcinoma thyroid in the very same patient is extremely rare and has not been previously reported in the English literature.