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Difficulties in the differential diagnosis of tumors in the female reproductive system

https://doi.org/10.17749/2313-7347.2019.13.4.369-383

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Abstract

Introduction. Most pelvic tumors originate from reproductive organs. Even using the up-to-date imaging techniques, radiologists experience difficulties in determining the source of the lesion since a wide range of tumors look similar to each other on the distorted backdrop of pelvic anatomy, large invasive formations, and an active inflammatory reaction of the pelvic peritoneum.

Aim: to evaluate “pitfalls” in the preoperative noninvasive diagnosis of female pelvic tumors by applying the clinical diagnostic tools.

Materials and methods. Four rare clinical cases were analyzed; all of them posed difficulties in interpreting the diagnostic examination due to their atypical characteristics. There were 2 cases of ovarian cancer, initially identified by an experienced team of radiologists as benign pelvic pathology. Also, there were fibroids with degeneration, marked proliferative activity, and a massive inflammatory reaction of the peritoneum – that was diagnosed as a malignant ovarian tumor. Tumor biopsies were examined using morphological and immunohistochemical methods (with the р16, Ki-67, p53, CD 117, S 100, CD 34 markers). Immunohistochemical (IHC) studies were performed with formalin-fixed paraffin materials using the avidin-biotin-peroxidase method. Antibodies to estrogen receptor (ER), progesterone receptor (PR), cytokeratin 7 (CK7), cytokeratin 20 (CK20) and Wilms tumor protein 1 (WT1) were also used.

Results. A thorough analysis of the clinical picture and a joint multidisciplinary discussion (gynecologist, oncologist, radiologist, etc.) made it possible to avoid diagnostic errors.

Conclusion. These observations demonstrate the difficulties of differential diagnosis between ovarian metastases of uterine cancer and primary multiple ovarian and uterine cancer, as well between leiomyosarcoma and uterine myoma with high mitotic activity. Obviously, the change in diagnosis calls for a change in the treatment strategy.

About the Authors

Ju. V. Nosova
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Health Ministry of Russian Federation
Russian Federation

Julia V. Nosova – Postgraduate Student, Department of Innovative Oncology and Gynecology

4 Akademika Oparina St., Moscow 117997, Russia.



A. E. Solopova
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Health Ministry of Russian Federation
Russian Federation

Alina E. Solopova – MD, PhD, Leading Researcher, Department of Radiology

4 Akademika Oparina St., Moscow 117997, Russia

Scopus Author ID: 57194196522. Researcher ID: P-8659-2015.



G. N. Khabas
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Health Ministry of Russian Federation
Russian Federation

Grigorii N. Khabas – PhD, Head of Department of Innovative Oncology and Gynecology

4 Akademika Oparina St., Moscow 117997, Russia.



A. V. Asaturova
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Health Ministry of Russian Federation
Russian Federation

Aleksandra V. Asaturova – PhD, Senior Researcher, Department of Pathology

4 Akademika Oparina St., Moscow 117997, Russia.

Scopus Author ID: 57190118907.



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For citation:


Nosova J.V., Solopova A.E., Khabas G.N., Asaturova A.V. Difficulties in the differential diagnosis of tumors in the female reproductive system. Obstetrics, Gynecology and Reproduction. 2019;13(4):369-383. (In Russ.) https://doi.org/10.17749/2313-7347.2019.13.4.369-383

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ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)