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We report a recently observed case of primary umbilical endometriosis without previous pelvic surgery. A 41-year-old Japanese woman complained of umbilical nodular tumor. Histopathology revealed endometriosis of an approximate 10 mm resected mass. The stromal cells in endometriosis were immunohistochemically positive for CD10. Two months later the first umbilical surgery, she underwent a left salpingo-oophorectomy and release of adhesion around the left adnexa under a laparoscope. She was treated with dienogest (2 mg/day) for six months after four injections of GnRH analogue for four months. After three years of the follow-up, there were no signs of local relapse and no clinical and ultrasonographic abnormalities due to endometriosis.

Ovarian carcinosarcoma composed of high-grade carcinoma and sarcoma is an extremely rare neoplasm and typically occurs in postmenopausal women aged over 60 years. A 73-year-old female, gravida three para three, presented to our hospital with right lower abdominal pain. Right pelvic solid tumor with ascites was detected on pelvic ultrasound examination. She underwent hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy, but the tumor had invaded to the right ureter, and some fragile tumor could not be taken (sub-optimal surgery). On the imprint and ascitic cytology specimens during operation, atypical cells suggestive of adenocarcinoma and spindle atypical cells with immunocytochemically vimentin positive were found. The resected tumor was histopathologically carcinosarcoma consisted of serous adenocarcinoma, chondrosarcoma and fibrosarcoma. Immunohistochemical analysis revealed that adenocarcinoma cells were positive for AE1/AE3 and fibrosarcoma cells stained with vimentin. The final diagnosis was the right ovarian carcinosarcoma (stage pT3CNxMx). Microsatellite instability was stable and BRCA1/2 mutations could not be found in the carcinosarcoma cells. The patient was given four cycles of chemotherapy with paclitaxel, carboplatin and bevacizumab regimen, and thereafter she was treated with the ifosfamide and cisplatin because of slight elevation of serum CA125.

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Background: Primary fallopian tube cancer is an extremely rare gynecological malignancy. Aim: To discuss, through a case report, the diagnostic process by means of cytology immunohistochemistry. Case Presentation: A 47-year-old Japanese woman, who also had lung cancer, presented with enlarged para-aortic lymph node without any symptoms. Based on the vaginal cytology report suggestive of gynecologic malignant tumor (possibly fallopian tube adenocarcinoma), primary surgery comprised of total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. Histopathology and immunohistochemistry examinations revealed primary fallopian tube carcinoma with metastasis of para-aortic lymph node. She is free from recurrence and metastases 9 months after the surgery and chemotherapy. Conclusion: Although primary fallopian tube cancer is a rare gynecologic malignancy, vaginal cytology may be useful for detecting fallopian tube carcinoma.

Granulosa cell tumors (GCTs), adult type, are the most common type of ovarian sex cord tumors. Menstrual irregularity, even secondary amenorrhea is frequently observed in premenopausal women bearing GCTs with hormonal activity. We present here in an extremely rare case of adult GCT in a patient presenting with secondary amenorrhea and serum testosterone (Test) and luteinizing hormone (LH) elevations, and decreased estradiol (E 2). A 32-year-old woman visited our hospital complaining of secondary amenorrhea two years after second delivery. Signs of virilisatoin, such as increased pubic hair and clitoromegaly were present. A pelvic ultrasound scan revealed a right adnexal solid mass measuring 2.9x3.9 cm. Under the working diagnosis of sexcord tumor, the woman underwent a laparoscopic surgery of a right salpingo-oophorectomy and the tumor was collected from the Douglas' pouch. The tumor was diagnosed as an adult-type GCT stage IA. Spontaneous menstruation occurred and serum levels of Test, LH, FSH and E 2 showed normal ranges one month after surgery. The patient is now healthy without evidence of a recurrence 30 months after the surgery. Although s-Test and LH elevations in patients with GCT is rare and its mechanism is not clearly understood, monitoring of s-Test and LH may provide an additional tumor marker after conservative surgery in such patients.

Anisakiasis can involve any part of the digestive tract, but most cases reported have involved the stomach; few reports have described colonic anisakiasis. Furthermore, asymptomatic colonic anisakiasis has been reported to be very rare. A 58-year-old Japanese male asymptomatically received colonoscopy due to a fecal occult blood testing positive, and an Anisakis larva was removed in the ascending colon. After colonoscopy, an detailed questionings concerning eating raw fish revealed that the patient ate the liver of raw filefish 21 days before the colonoscopy. Thus, questionings concerning eating the raw fish were very important and helpful for correct diagnosis. This case report demonstrated that colonic anisakiasis can be diagnosed by colonoscopy before severe complications (intestinal obstruction, perforation, and cancer development) occur. Also, biopsy forceps could be used to remove the Anisakis worms, demonstrating that diagnosis and treatment can be simultaneously performed.

We experienced a case of serous tubal intraepithelial carcinoma (STIC), which is the earliest morphologically recognizable precursor of pelvic high grade serous carcinoma, diagnosed by cytology during the operation. A 48-year-old Japanese woman visited to our department because of abnormal cytological result and the left adnexal mass on female cancer screening. Pre-operatively, she was diagnosed as cervical intraepithelial neoplasia (CIN) 3, adenomyosis, and the left adnexal cystic lesion with papillary growth. At laparotomy, the left adnexal tumor turned out to be cystic fallopian tube with small papillary growth on the inner surface, but abnormal findings were not present on bilateral ovaries. The cytology of the imprint smears from the papillary projection and ascitic fluid showed positive, suggesting serous adenocarcinoma. Histopathological examination of the lesion revealed the left fallopian tube lesion was STIC with immunohistochemically positive reactivity against p53. No metastases including disseminated lesions were noted. The patient received four courses of systemic chemotherapy, and had no recurrent signs 10 months after the operation.