Superficial Angiomyxoma of the Vulva: A Case Report

Superficial angiomyxoma is a rare benign mesenchymal tumor that mainly occurs in the genital region. We report the case of a 51-year-old woman with a painless vulvar mass, well circumscribed on ultrasound. On gross finding, it was a polypoid and bilobed mass, partially encapsulated. On histological examination, it was a proliferation of non-atypical spindle cells with an abundant, myxoid stroma and numerous medium-sized blood vessels. The diagnosis was superficial angiomyxoma. The clinical features do not often lead to the diagnosis of superficial vulvar angiomyxoma. It is based on histological examination and immunohistochemistry is helpful to differentiate it from other myxoid tumors.

Refractory Ascites Revealing an Ovarian Yolk Sac Tumor with Intraperitoneal Rupture

Yolk sac tumors of the ovary are rare entities that account for 2% - 5% of all ovarian tumors. They represent the second most common histological variant of malignant germ cell tumors of the ovary after dysgerminomas. Yolk sac tumors are most commonly encountered in women in the second and third decades. Microscopically, they are highly polymorphic and can present in a pure form or associated with another contingent of germ cell tumor. We report the case of a 26-year-old woman, who underwent surgery for a large right ovarian tumor rupturing into the peritoneal cavity. The ovarian tumor was revealed by ascites of great abundance and abdomino-pelvic pain. On histological examination, the diagnosis of yolk sac tumor in its pure and polyvesicular vitelline pattern was made. Through this observation, we propose to discuss the anatomoclinical particularities of these tumors by emphasizing the importance of histology for the diagnosis as well as the need of an early and appropriate management.

Invasive Mole of the Uterus: A Case Report

Invasive mole is a rare subgroup of gestational trophoblastic disease characterized by the invasion of molar tissue into the myometrium or uterine vasculature. In this paper, we report the third case of invasive mole described in the Malagasy literature. A 33-year-old woman was referred to the Soavinandriana Hospital, her complaint was persistent vaginal bleeding during 2 months, occurring at 3 months of pregnancy with biological anemia without hemodynamic repercussions. The human chorionic gonadotropin (HCG) level was 385,931 mIU/ml. A haemostasis hysterectomy was performed. Histological examination showed an enlarged uterus and endometrial cavity containing edematous chorionic villi with trophoblastic proliferation invading the myometrium. The diagnosis was an invasive mole, stage I, FIGO score 6. Chemotherapy was prescribed but was not honored. After 45 days of follow-up, the serum βHCG level decreased to 1803 mIU/ml, without clinical symptoms. The patient then lost sight. Persistent vaginal bleeding after pregnancy may be the only clinical symptom of an invasive mole and should raise suspicion. Histological examination establishes the diagnosis. As this is an unusual cause of vaginal bleeding, our case should remind physicians that when faced with this symptom, the possibility of an invasive mole should be considered in order to make an early diagnosis for less aggressive treatment.

Mesenchymal Tumors in Gastrointestinal Tract

Mesenchymal neoplasms arising in the digestive tract are rare compared to adenomas and carcinomas [1]. They include several entities with histomorphological similarity and immunohistochemistry helps to confirm the diagnosis [2]. Our goals are to study the epidemiological aspect of mesenchymal tumors, and to compare the histological diagnoses before and after the use of immunochemistry. This is a retrospective, descriptive, single-center study performed on all cases of mesenchymal tumors in gastrointestinal tract, diagnosed at the laboratory of Pathological Anatomy Unit of Joseph Ravoahangy Andrianavalona University Hospital from January 1, 2007 to December 31, 2018. We included 29 cases. The mean age was 43.28 years. The sex ratio was 1.07. After immunohistochemical examination, 24.14% of tumors changed diagnosis to GISTs which are the most common mesenchymal tumor involving the gastrointestinal tract. In all cases of mesenchymal tumors of the gastrointestinal tract GIST should first be ruled out before making other diagnoses. Histologic and immunophenotypic features are thereby essential. According to the literature review, if c-Kit and DOG-1 are negative, molecular biology must be used.

Evaluation of OLGA and OLGIM Systems in Madagascar, a Country with Low Economic Resources

Chronic gastritis is a persistent inflammation of the gastric mucosa. The Sydney System is the most widely used classification of this disease but it does not allow a ranking of patients according to the evolutionary potential of the disease, unlike the classifications: “Operative Link On Gastritis Assessment” (OLGA) and “Operative Link on Gastritis Intestinal Metaplasia Assessment” (OLGIM). Our goals are to apply and evaluate the three classifications: the Sydney System, OLGA and OLGIM and to draw possible correlations. This is a retrospective, descriptive, single-center study performed on all cases of chronic gastritis, diagnosed at the laboratory of Pathological Anatomy Unit of Joseph Ravoahangy Andrianavalona University Hospital from January 1, 2013 to December 31, 2017. A review and application of the three main classification systems was performed on each case. We included 298 cases. The mean age was 50.85 years. The sex ratio was 1.48. The high-risk stages according to the “Operative Link On Gastritis Assessment” (OLGA) system and the “Operative Link on Gastritis Intestinal Metaplasia Assessment” (OLGIM) system were 0.67% and 2.68%, respectively. We observed a correlation between the two systems with discordance of 5%. The use of the two new systems allows the assessment of the progressive potential of gastritis in patients at risk of developing gastric cancer. For optimal effectiveness of both classifications, biopsies should be performed according to the Sydney System recommendations.

Primary Bilateral Adenocarcinoma of the Fallopian Tube: A Case Report

Primary fallopian tube carcinoma is an uncommon malignancy that accounts for 0.14% to 1.8% of gynecological cancers. The clinical symptom is not specific and preoperative diagnosis is easy to miss or delay because of a lack of specific symptoms. We reported a case of bilateral adenocarcinoma of the Fallopian tubes, was occurred in a 51-year-old postmenopausal woman and diagnosed with bilateral salpingectomy for suspicious of suppurative salpingitis. The diagnosis is not always suspected preoperatively. They are assimilated to salpingitis in the early stage, or to ovarian tumors in the advanced stage. The diagnosis is made postoperatively, after an anatomopathological examination. Its etiology is still poorly understood.

Undifferentiated Uterine Sarcoma: A Rare Cause of Pelvic Pain in Young Woman

We report a case of undifferentiated uterine sarcoma occurring in a 20-year-old woman presenting as a pelvic pain with a mass discovered at the physical examination. The tumor ruptured into the abdominal cavity. A total hysterectomy was performed. On the pathological examination, the uterine corpus presents a proliferation of markedly atypical spindle cells admixed with round cells and pleomorphic cells. The tumor deeply infiltrated the myometrium. The tumor was very necrotizing. There were more than 50 mitoses per 10 fields at high magnification. The isthmus was invaded by the tumor. The diagnosis of undifferentiated uterine sarcoma was confirmed by immunohistochemistry. The tumor shows negativity for the following markers: CKAE1/AE3, h-caldesmon, α-SMA, progesterone receptors, desmin, CD 10, alpha foeto-protein, CD 3 and CD 20.

Lingual Cystic Lymphangioma: About a Case and Literature Review

Lymphangioma is a rare benign tumor of the lymphatic vessels of hamartomatous nature. We report a case of lingual lymphangioma in a 2-year-old child, revealed by macroglossia. The radiology suspected the lesion. Anatomopathological examination confirmed the diagnosis of cystic lymphangioma, and determined its characteristics.

Endometriosis of the Sigmoid Colon Mimicking Malignant Lesion

Endometriosis is defined as the presence of endometrial tissue outside the uterus. It is a benign pathology involving 15% of women of reproductive age. The sigmoid site represents 7% of endometriosis but it is the most frequent area in the digestive tract. We report two cases of colonic endometriosis in which the initial diagnosis suspected a malignant disease. Respectively, the patients were 31 and 48 years old. The first patient complained about abdominal pain with symptoms of intestinal obstruction and was classified after radiological examination as an intrasigmoid tumor with bladder adhesion. The second patient was undergone for a radiological examination because of a bowel obstruction syndrom and a mass in the sigmoid colon was suspected. In both cases, sigmoid colon resection was performed and histological diagnosis was sigmoid endometriosis. Sigmoid endometriosis is rarely diagnosed before surgical excision. Suspicious bowel obstruction and malignant origin lead to large surgical excision. Histological examination is important to establish the diagnosis.

Primary Breast Tuberculosis Mimicking Carcinomatous Mastitis: A Case Report

The breast is a rare localization of extra-pulmonary tuberculosis, even in highly endemic countries. It is most often primitive. The clinical and radiological features are sometimes misleading. It poses diagnostic problems especially with cancer. We report a case of breast tuberculosis having clinical and radiological presentations as a breast carcinoma. Through this observation and a review of the literature, we provide an update on the epidemiological characteristics and the means of diagnosis of this lesion. It was a 52-year-old woman with inflammatory lump of the left breast, adherent to the skin. Ultrasonography and mammography revealed a homogeneous, poorly demarcated nodule of approximately 4 cm of diameter, classified ACR4. Surgical excision was performed. The histological diagnosis was breast tuberculosis. The diagnosis of tuberculous mastitis is made on bacteriological and pathological examinations. Histological examination helps for diagnostic confirmation while excluding a malignant lesion of the breast.