Bhagirath Majmudar

The Sister (Mary) Joseph nodule: Its significance in gynecology

Twenty-five cases of metastatic carcinoma of the umbilicus in women diagnosed and treated at Emory University Hospitals from 1973 to 1989 were reviewed, as were all previously reported cases in the English language literature. In our series, overall survival was greatest in patients treated with aggressive surgery and chemotherapy, compared with patients receiving no therapy or those treated with either surgery or adjunctive therapy alone. Individual survival was enhanced when the primary tumor site was of ovarian origin.

Pelvic colonization with Actinomyces in women using intrauterine contraceptive devices

Recent reports suggest a relationship between intrauterine contraceptive device (IUD) use and colonization or infection of the genital tract with Actinomyces species. This prospective, case-controlled study was designed to determine the incidence of colonization or infection with Actinomyces in IUD users. None of 50 control patients and four of 50 study patients (8%) had Actinomyces identified. None of the patients with positive results had symptomatic pelvic infection. Cervical cytology was effective in detecting each of the four study patients with positive results. It appears that the presence of any type of IUD is a major predisposing factor to colonization with Actinomyces.

Granular cell tumors of the vulva

Granular cell tumor (GCT), although nearly ubiquitous, is seen infrequently in the vulva. A review of the surgical pathology files from Grady Memorial Hospital, Atlanta, Georgia, from 1983 through 1987 identified eight cases of vulvar GCT. Five of the eight patients had more than one skin and soft tissue lesion. Two of the five had biopsy-proven multicentric GCT with a unique clinical course. One of the patients was a 32-year-old woman with multiple vulvar, lingual, laryngeal, bronchial and pulmonary GCT, necessitating multiple excisions and ultimately pneumonectomy. The second patient had multiple GCTs in the vulva and inguinal area and finally in both lungs, resulting in her death at age 39. No dependable microscopic features could be identified to distinguish benign GCT from its more aggressive variant. However, Feulgen DNA histomorphometry demonstrated aneuploidy in the patient with apparent lung metastases, whereas the tumors from patients with a benign course as well as from the patient with multiorgan involvement were diploid. In three of five patients who could be interviewed there was a history of soft tissue tumors in members of the family. The multifocal nature and possible familial component of GCT need to be explored further.

Ovarian hemangioma—report of three cases and review of the literature

IntroductionOvarian hemangiomas are rare tumors, with less than 50 reported cases in the English literature. This is a low incidence, considering the rich vascular supply of the ovary.DiscussionWe have encountered three cases of ovarian hemangiomas found incidentally at the time of surgery. Ovarian hemangioma should be considered when a hemorrhagic ovarian tumor is encountered. Although often an incidental finding at surgery, these lesions may rarely be associated with systemic manifestations.

Teratoma of the umbilical cord

A case of teratoma of the umbilical cord is described. Four previous reports of this entity are briefly reviewed, and a detailed description of the current case is presented. The histogenesis of teratomas at this unusual site is discussed. The features that distinguish teratomas of the umbilical cord and placenta from acardius fetus are enumerated.

Leiomyomatosis peritonealis disseminata: Clinicopathologic analysis of five cases

Leiomyomatosis peritonealis disseminata (LPD) is an exceedingly rare, usually benign condition that clinically simulates a disseminated malignancy. It occurs predominantly in women of childbearing age. Approximately 50 cases of LPD have been described in the literature with 2 cases reported to have progressed into aggressive leiomyosarcomas. Excessive hormonal stimulation appears to correlate with LPD development since it is commonly associated with pregnancy. Conservative treatment with long-term follow-up is recommended because of LPDs generally indolent clinical course. We report 5 cases of LPD with a review of the literature.

Respiratory obstruction caused by a multicentric granular cell tumor of the laryngotracheobronchial tree

An unusual case of acute respiratory obstruction caused by multicentric granular cell tumors of the laryngotracheobronchial tree is presented. The patient also had granular cell tumors in the tongue, vulva, and chest wall. Multiplicity of the lesions in the left lung and recurrent episodes of intercurrent pulmonary infections necessitated left pneumonectomy. The extreme rarity of such a clinical circumstance is illustrated by a review of the literature. Salient clinical and pathological features of the tumor are briefly discussed.

Serous tumor of low malignant potential of the fallopian tube.

Although serous tumors of low malignant potential (STLMP) of the ovary are relatively common, similar tumors of the fallopian tube are exceedingly rare. We report the case of an STLMP of the fallopian tube in a 31-year-old woman and review the literature.

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.

Ovarian Myxoma: Ultrastructural and Immunohistochemical Findings

The ultrastructural and immunohistochemical findings are reported in two ovarian myxomas, one of which was also associated with a sclerosing stromal tumor of the same ovary. Both neoplasms showed a myxoid, moderately cellular proliferation of spindle and stellate cells interspersed with areas of fibrosis and hemorrhage as well as delicate vascular spaces. Ultrastructurally, stellate neoplastic cells with irregular nuclei and occasional nucleoli were embedded in a mucinous and loose collagen matrix. Their cytoplasm showed abundant intracytoplasmic thin filaments that rarely condensed into poorly formed dense bodies. These thin filaments correlated with immunoreactivity for muscle-specific actin and vimentin. The neoplastic cells showed no immunoreactivity with antibodies to desmin, S-100 protein, cytokeratin AE1:AE3, factor VIII-related protein, or placental alkaline phosphatase. These ultrastructural and immunohistochemical findings are consistent with myofibroblastic differentiation. These ancillary studies exclude important, clinically more aggressive differential considerations such as myxoid rhabdomyosarcoma, myxoid liposarcoma, myxoid neural tumors, mucinous adenocarcinoma showing pseudomyxomatous change, and myxoid-appearing endodermal sinus (yolk sac) tumor.