Primary retroperitoneal mucinous carcinoma is an extremely rare malignancy, posing diagnostic and therapeutic challenges due to its nonspecific clinical presentation and lack of established management guidelines. The present article reports the case of a 39-year-old woman with progressive abdominal bloating and ascites, initially evaluated for a suspected ovarian mass. Imaging studies revealed a large mass with cystic and solid components mimicking an ovarian origin. However, surgical exploration revealed a retroperitoneal mass. Subsequent pathological analysis confirmed the diagnosis of mucinous Mullerian carcinoma. Molecular analysis revealed several mutations, including BRAF (V600E). Surgical resection was successful in treating the mass and the patient was in full remission at two-year follow-up. Despite its rarity, mucinous carcinoma should always be considered in the differential diagnosis of retroperitoneal masses. This case report discusses the anatomopathological features of primary retroperitoneal mucinous carcinoma and highlights the need for further research to elucidate the optimal management strategies and prognostic factors for this rare malignancy.

Borderline ovarian Brenner tumors are rare malignancies mainly diagnosed after menopause. A first pregnancy after fertility-sparing surgery by laparoscopic unilateral salpingo-oophorectomy was reported in a previous article. We now report the first baby birth after unilateral salpingo-oophorectomy for a borderline ovarian Brenner tumor and a review of the literature.

We report the case of a 79-year-old woman with a large pelvic mass and postmenopausal bleeding, associated with hyperestrogenism. A pelvic MRI shows the presence of a large mass of 12.6 cm originating from the right ovary without signs of metastasis. A total abdominal hysterectomy with unilateral salpingooophorectomy was performed, knowing the patient underwent a left salpingooophorectomy decades ago. The pathological findings showed an ovarian clear cell carcinoma (pT1A) with associated endometrial intraepithelial neoplasia. There is convincing evidence that the production of estrogen is located in the activated ovarian stroma. This supports the view that functioning stroma of ovarian cancer can lead to hyperestrogenism and eventually endometrial cancer.

Objectives: To assess the feasibility and the safety of treating female stress urinary incontinence (SUI) with suburethral implantation of a mixture of the stromal vascular fraction from adipose tissue and leukocyte-and platelet-rich-fibrin.Methods: Patients with SUI were treated with a mixture of stromal vascular fraction and leukocyte-and platelet -rich fibrin. The stromal vascular fraction was obtained from enzymatic digestion of autologous adipose-tissue and added to an leukocyte-and platelet-rich-fibrin membrane. The mixture was transvaginally implanted into the suburethral area. A fraction of the Stromal vascular fraction sample was used for cellular characterization. Patients were followed for 9 months. Every 3 months, the patients were clinically evaluated with a cough-stress test and a validated-questionnaire. An MRI was performed preoperatively and 3 months after the procedure to assess tissue changes.Results: Ten patients received the surgical procedure. The validated-questionnaire revealed a subjective SUI improvement in nine patients 3 months after the operation and in seven patients 9 months after the operation. Eight, six, and four patients achieved a negative cough-stress test 3, 6 and 9 months post-injection, respectively. Flow cytometric analysis of stromal vascular fraction cell phenotypes revealed predominantly mesenchymal and endothelial cell heterogeneity. In total, we injected 0,18 x 106 to 13,6 x 106 cells. No adverse events were observed peri- or postoperatively.Conclusion: These preliminary results suggest that the suburethral implantation of a combination of SVF and L- PRF is a feasible and safe modality for treating female SUI. However, evidence is lacking and further research are needed to clarify the respective roles of SVF and L-PRF in female SUI treatment.

Intracystic papillary carcinoma (IPC) is a rare tumor with good prognosis that occurs in only 5% to 7.5% of male breast cancer. We report a case of a 46-year-old man who presented a brown nipple discharge a few months ago. He had a bilateral IPC and an invasive ductal carcinoma on the right breast. A double mastectomy was then performed with a bilateral sentinel lymph node biopsy, and he received chemotherapy, radiotherapy, and hormonotherapy. Two years after the diagnosis, the patient recovered and was free of recurrence. Considering the scarcity of this tumor type, we conducted a systematic literature review on the PubMed of all the cases of IPC in men. The clinical presentation, imaging, and treatment of the 43 case reports from the 41 articles selected were described. Furthermore, no clear guidelines for IPC management are available. Conservative surgery should also be preferred, and a sentinel lymph node biopsy should be performed systematically. Moreover, radiotherapy should be proposed in the case of conservative surgery, and hormone therapy could be proposed in the case of invasive IPC or IPC associated with a ductal carcinoma in situ.

A 37-year-old woman presented with a right labium majus thickening with no palpable mass, which had been evolving for a few months. A partial right labium majus ablation was performed at the request of the patient for esthetic reasons. The lesion was most histologically similar to CALME (childhood asymmetric labium majus enlargement). The lesion was benign, but several other differential diagnoses were considered. Two years after the surgery, there had been no recurrence. To our best knowledge, this is the first such case reported in an adult.

Objective Extended field chemoradiation is recommended for patients with locally advanced cervical cancer (LACC) and para-aortic lymph node (PALN) metastases. The radiation planning may be based on PET/CT while others recommend to rely on surgical staging. We report the rate of patients for whom the radiation field defined on PET/CT was modified by the histological PALN status. Methods Between March 2010 and December 2016, 168 consecutive patients with LACC underwent a pre-therapeutic PET/CT and PALN dissection. The data were reviewed retrospectively. The diagnostic performance of the PET/CT for definition of PALN status was calculated. We determined the percentage of patients for whom PALN dissection altered the external beam radiotherapy (EBRT) field defined on the PET/CT basis. Results Of 151 patients with negative PALNs on PET/CT, 26 had histological PALN metastases. Of 17 patients with positive PALNs on PET/CT, 9 were negative on histology of which 7 were located in the common iliac region. Sensitivity, specificity, positive and negative predictive value of PET/CT were 23.5, 93.3, 47.1 and 82.8% respectively. In total, 35 out of 168 patients underwent EBRT - field adaptation (pelvic vs extended field). The rate of radiation field modification (27,7%) was particularly high in the subgroup of patients with metastatic pelvic lymph nodes (PLNs) on PET/CT. Conclusion Para-aortic surgical staging contributes significantly to individualize the radiation treatment of patients with LACC, particularly for those with positive PLNs at PET/CT. Indication of surgical staging deserves particular attention when the PET/CT suggests positive LNs in the common iliac region.

"Conservative surgical treatment of a borderline ovarian Brenner tumour in a pre-menopausal woman with subsequent pregnancy: case report of a rare entity." Journal of Obstetrics and Gynaecology, 40(4), pp. 578–579

Uterine leiomyoma is the most common benign smooth muscle tumour that originates from the myometrium. Ovarian sex steroids are responsible for the growth of such tumours, though estrogen and progesterone are not the only modulators involved in the tumourigenesis and growth of leiomyomata. The activation of glucocorticoid receptor (GR) can induce the expression and activity of estrogen sulfotransferase, an enzyme that generally inactivates estrogen, because of the effects of sulfonated estrogen fails to activate the estrogen receptor, it is of interest to know whether GR is present or not in leiomyomata and in the normal myometrium. The aim of this study is to analyse the expression of GR in leiemyoma and myometrium. Method: The immunohistochemistry of 47 patients was tested to find the expression status of estrogen receptor (ER), progesterone receptor (PR) and GR in leiemyoma and normal myometrium. Results: GR, ER and PR were expressed in both normal myometrium and in leiomyoma. There was a significant difference in the expression of GR found in normal myometrium compared with those expressed in leiomyoma (Allred Score, 256±29 versus 91 ±23). The GR expressed was significantly lower than the ER and PR expressed in leiomyoma. Conclusion: This presence of GR in the normal myometrium and in myomas is interesting and could be used for therapeutic action. But, first, the roles of G on myomas have to be understand. Journal of Gynecology & Reproductive Medicine Frederic Buxant1*, Sven Saussez2 and Jean Christophe Noël3 *Corresponding author Dr Frederic Buxant. Department of Gynecology. Iris South Hospital. Brussels. Belgium. Rue Jean Paquot 63. 1050 Bruxelles. AD Andorra. E-mail: fbuxant@his-izz.be. Submitted: 27 Sep 2017; Accepted: 07 Oct 2017; Published: 15 Oct 2017

PURPOSE:Glucocorticoids (GCs) are often administered prior to any chemotherapeutics to prevent the secondary effects of anticancer agents. Glucocorticoid receptors (GRs) are expressed in several types of cancer cells, particularly in several histological types of breast cancer. Activation of GRs is not associated with any specific cellular response. Both proapoptotic and antiapoptotic responses have been observed, depending on the study or the type of breast cancer cells. Therefore, it is of relevance to investigate the possible modulation of apoptotic effect of chemotherapeutic agents when cancerous cells have previously been exposed to GCs.METHODS:In vitro cell growth was assayed by counting MCF-7 cells upon exposure to epirubicin (25 nM), 5-fluorouracil (5-FU) (15 µM), and paclitaxel (15 nM), either with or without prior exposure to the GC dexamethasone (Dex) (100 nM).RESULTS:Following preexposure to Dex, the antiapoptotic activity of paclitaxel was significantly reduced by 8.5% (p<0.05), but the activities of epirubicin and 5-FU remained unaltered.CONCLUSION:In light of the finding that the response of MCF-7 cells pretreated with Dex was significantly reduced, we recommend that the function of GCs should be defined more precisely if they are to be used in conjunction with chemotherapy.

Cancer- associated fibroblasts (CAFs) are actively involved in breast carcinoma. Our previous study demonstrated that the majority of these CAFs were smooth muscle actin (SMA) positive and were therefore termed peritumoral myofibroblast (PMY). Glucocorticoid, linked or not with its receptor (GR), has been postulated to serve a major role in normal breast and breast carcinoma; however, their role in CAFs remains poorly understood. The aim of the present study was to assess the presence of GR in breast CAFs and particularly in PMY in 56 cases of invasive breast carcinoma in correlation with clinicopathological parameters, by immunohistochemistry. GR was observed in CAFs in 51 cases (91%) and were more frequent in luminal A subtype (19/19 cases; 100%). The stromal expression was statistically correlated with the tumor grade (P=0.03), the Ki-67 index (P=0.003) and the presence of GR in the epithelial component (P=0.01). The demonstration of a frequent expression of GR in breast CAFs may serve as an interesting target for future therapeutics for the regulation of the tumoral breast microenvironment.

Glucocorticoids (GCs) are used in the treatment of cancer to induce programmed cell death in the transformed cells of the hematopoietic system and to reduce side effects. Additionally, GCs are described as an inhibitor of certain chemotherapy or radiation‑induced apoptosis and also an inhibitor of cancer progression by downregulating or upregulating the expression of several genes. The present study used immunofluorescence to investigate the presence of the glucocorticoid receptor (GR) in MCF‑7 cells, and the cell culture growth was determined by cell counting the number of cells following exposure to GC and/or dexamethasone (Dex). The presence and immunoreactivity of the GR were confirmed, and treatment with Dex (10(-8)‑10(-7) M) caused an inhibitory effect (30‑35%) on the proliferative activity of the MCF‑7 cells. This growth inhibitory effect was possibly produced by the pro‑apopotic effect of Dex. Since Dex is administered systematically prior to breast cancer chemotherapy, the possible interactions between these drugs require further investigation.

Les infections génitales hautes représentent une pathologie très fréquente. L’imagerie joue un rôle important en réalisant un bilan non invasif des lésions infectieuses et en orientant la prise en charge thérapeutique. L’échographie Doppler sus-pubienne et endo-vaginale est l’examen de choix en première intention. L’IRM est une excellente technique complémentaire à l’échographie pour la caractérisation des lésions. Les atteintes infectieuses pouvant être visualisées en imagerie sont l’endométrite, la cervicite, la salpingite, le pyosalpinx, l’ovarite, l’abcès tubo-ovarien et la pelvipéritonite. Le but de cet article est de mettre l’emphase sur les signes radiologiques de la PID au stade initial de sa prise en charge.

Introduction: Extraovarian granulosa cell tumor (GCT) is a very uncommon tumor, assumed to arise from the ectopic gonadal tissue along the embryonal route of the genital ridge. Case report: We report the case of a 25 year-old woman who was presented at the emergency unit with a severe abdominal pain focused on the left iliac fossa. The patient had delivered normally 2 months before. An ovarian mass of 79 × 67 × 89 mm was shown in vaginal ultrasound as well as at the abdominal scan. Exploratory laparoscopy was performed and a torsion of the fallopian tube and an hemato-salpinges was visualized. Re-vascularisation was not achieved and a left salpingectomy took place. The immuno-histopathology report revealed an extra-ovarian GCT deriving from the fimbriae of the tube. Follow-up surgery was discussed. The case is presented for its rarity.

We report the case of a 61-year old woman presented with a voluminous centro-pelvic mass (22 × 17 cm), hydrothorax and ascites. Serum CA-125 was high (11,000 UI/ml). An explorative laparotomy located the mass between the rectum and the posterior wall of the uterus. The histological examination showed a primitive peritoneal tumor with serous and endometrioid differentiations. There was a left ovarian metastasis and both peritoneal and pleural liquids revealed no sign of malignancy. After the incomplete surgery, the hydrothorax and ascites decreased considerably. This association of Pseudo-Meigs’ syndrome with primitive peritoneal tumor is uncommon. To our knowledge this is the first case described through a Medline search.

Purpose: Circulating Tumor Cells (CTCs) detection and phenotyping are currently evaluated in Breast Cancer (BC). Tumor cell dissemination has been suggested to occur early in BC progression. To interrogate dissemination in BC, we studied CTCs and HER2 expression on CTCs across the spectrum of BC staging.Methods: Spiking experiments with 6 BC cell lines were performed and blood samples from healthy women and women with BC were analyzed for HER2-positive CTCs using the CellSearch (R).Results: Based on BC cell lines experiments, HER2-positive CTCs were defined as CTCs with HER2 immunofluoresence intensity that was at least 2.5 times higher than the background. No HER2-positive CTC was detected in 42 women without BC (95% confidence interval (CI) 0-8.4%) whereas 4.1% (95% CI 1.4-11.4%) of 73 patients with ductal/lobular carcinoma in situ (DCIS/LCIS) had 1 HER2-positive CTC/22.5 mL, 7.9%, (95% CI 4.1-14.9%) of 101 women with non metastatic (M0) BC had >= 1 HER2-positive CTC/22.5 mL (median 1 cell, range 1-3 cells) and 35.9% (95% CI 22.7-51.9%) of 39 patients with metastatic BC had >= 1 HER2-positive CTC/7.5 mL (median 1.5 cells, range 1-42 cells). In CTC-positive women with DCIS/LCIS or M0 BC, HER2-positive CTCs were more commonly detected in HER2-positive (5 of 5 women) than HER2-negative BC (5 of 12 women) (p = 0.03).Conclusion: HER2-positive CTCs were detected in DCIS/LCIS or M0 BC irrespective of the primary tumor HER2 status. Nevertheless, their presence was more common in women with HER2-positive disease. Monitoring of HER2 expression on CTCs might be useful in trials with anti-HER2 therapies.

Breast cancers occurring in women with germline BRCA1 mutations tend to fall into the category of triple-negative or basal-like phenotypes, such as metaplastic carcinoma. Low-grade adenosquamous carcinoma of the breast is a rare variant of metaplastic carcinoma. We present the case of a 49-year-old woman with a past medical history of invasive ductal breast carcinoma 13 years ago, and who was recently diagnosed as having a low-grade adenosquamous carcinoma in the same breast. Genetic analysis of blood DNA revealed a BRCA1 mutation. To our knowledge, BRCA1 mutation in association with a low-grade adenosquamous carcinoma of the breast has not yet been reported. Thus, it may be important to consider the possibility of an association, but supplemental studies are needed.

Abstract Background: Systemic spread of disseminated tumor cells from the primary site may occur early in breast tumorigenesis. The role of HER2 in breast cancer (BC) dissemination is not well understood. We evaluated the expression of HER2 on peripheral blood Circulating Tumor Cells (CTCs) from women with various stages of breast cancer (BC). Methods: 81 women with preinvasive breast lesions (Atypical Ductal Hyperplasia, Lobular Carcinoma In Situ and Ductal Carcinoma In Situ), 101 women with early invasive BC and 35 women with metastatic BC were included. CTCs were defined as Cytokeratin 8,18,19+/CD45-/DAPI+ cells detected using the CellSearch® technology. Any staining for HER2 on CTCs using the CellSearch® HER2 profiling kit was considered positive. HER2 detection was calibrated through peripheral blood spiking experiments with MCF7 and SKBR3 cells. Results: > 1 CTCs/22.5mL of blood were detected in 6 of 81 (7%) women with preinvasive breast lesions (range 0-3 CTCs) and 15 of 101 (15%) women with early invasive BC (range 0-8 CTCs), whereas > 1 CTCs/7.5mL of blood were detected in 17 of 35 (49%) women with metastatic BC (range 0-1160 CTCs) (p<0.001). HER2 expression on CTCs was not associated with estrogen receptor (ER) and progesterone receptor (PR) expression or the histological grade of the primary tumor. In women with detectable CTCs, the ratio of HER2-positive CTCs/total CTCs was higher in HER2-positive than HER2-negative primary tumors (p=0.023). Despite a higher detection rate of CTCs, the ratio of HER2-positive CTCs/total CTCs was lower in metastatic BC (median 0.15, range 0-1.0) than in preinvasive (median 1.0, range 0-1.0) or early invasive BC (median 1.0, range 0.3-1.0) (p<0.001). Similar results were observed when only HER2-negative primary tumors were considered (p=0.004). Conclusion: This is the first report showing that HER2-positive CTCs can be detected in women with preinvasive breast lesions, further supporting the hypothesis that dissemination occurs early in breast tumorigenesis. HER2 expression on CTCs is more commonly observed in earlier stages of breast cancer, suggesting that HER2 plays an important role in early dissemination. The EORTC 90091-10093 trial will test the hypothesis that trastuzumab can eliminate HER2-positive CTCs in patients with HER2-negative early breast cancer. Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 839.

Objective: To analyze the expression of estrogen (ER) and progesterone (PR) receptors in the smooth muscle component (SMC) of deep infiltrating endometriosis (DIE).Design: A prospective clinical and pathologic study of 60 cases of DIE.Setting: University Hospital Department of Gynacology.Patient(s): Sixty patients with symptomatic DIE (uterosacral endometriosis n = 14; bladder endometriosis n = 10; colonic endometriosis n = 16; rectovaginal endometriosis n = 20).Intervention(s): Laparoscopic surgery.Main Outcome Measure(s): The expression of ER and PR was studied by immunohistochemistry in the SMC directly around endometriotic foci and at distance (at least >1.5 cm) from them in correlation with proliferative and secretory phases of cycle.Results: The ER and PR were present in the SMC of DEI in each location excepting colonic endometriosis where ER were absent. Independently of cycle's phases the PR were more abundant than ER. With the exception of rectovaginal endometriosis, where the ER and PR were more abundant in the proliferative than in the secretory phase, in other locations the ER and PR did not differ significantly with cycle's phases. Last, if ER and PR were more abundant in S MC around endometriotic foci than at a distance from them. However, the difference was not significant.Conclusions: Our data substantially confirm for the first time that in various forms of DIE, ER and PR are present not only in glands and stroma but also in the smooth muscle major histologic component of this disease. (Fertil Steril(R) 2010;93:1774-7. (C) 2010 by American Society for Reproductive Medicine.)

Background. 10% of ovarian fibromatous tumours typically exhibit increased cellularity, mitotic activity, and less frequently nuclear atypia. Therefore, the classification within the group of fibromatous tumours may represent some difficulties, thus, one or several of these features should appear. Case. We introduce the clinical and pathologic features based on one case of recurrence of a mitotically active cellular ovarian fibroma (MACF) in the pararectal fossa. This recurrence took place six years after primary surgery. Macroscopically, the tumour was firm, fibrous, well delimited, yellow-white without gross necrosis. On microscopic examination, it was composed of a densely cellular proliferation of fibrolastic-like cells with bland nuclear features and arranged in a fascicular pattern. There was no sign of significant atypia or necrosis. Conclusion. Recently, this case is the first report of a recurrence of MACF, following primary surgery with no tumoral rupture or surgical difficulty. The clinical outcome of ovarian cellular fibromas (CFs) and MACFs is typically uneventful. This case, however, strongly suggests maintaining a long-term clinical follow-up even though the principal tumour was surgically treated without tumour rupture or in the absence of adherence or any surgical difficulty.