Second surgery performed after CT scan: resection of anterior abdominal wall and space of Retzius mass, subtotal hysterectomy and oophorectomy. All macroscopic disease removed.
(1) Retroperitoneal mass: Four pieces of tissue, the largest one is a multilobulated mass partially opened. On sectioning the tissue has a whorled appearance.
(2) Subtotal hysterectomy and bilateral oophorectomy: An opened uterus without cervix and both attached adnexa. The myometrium reveals small white lesions probably small fibroids. Corpus luteum present on sectioning of the right ovary.
(3) Rectus sheath: The specimen consists of two irregular fragments of brown tissue.
(4) Peritoneal nodule: A single fragment of white tissue.
(5) Aortic lymph node: A fragment of white tissue, well circumscribed.
(6) Left ileal artery lymph node: A small fragment of white tissue.
(1) Microscopic examination reveals fascicles of smooth muscle cells with focal hypercellularity. Atypia however not apparent. Mitotic activity is not abundant. Immunohistochemistry reveals the following: DOG.1 - Focal positivity within tumour cells; CD117 - Completely negative; SMA - Strong positivity within tumour cells. These findings are thus in keeping with those of a benign leiomyomata without overt evidence of atypia or necrosis.
(2) Microscopic examination reveals endometrial tissue with proliferative activity. There is no evidence of endometritis, endometrial polyps or malignancy. The myometriumn reveals adenomyosis as well as benign leiomyomata. The right fallopian tube reveals paratubal cysts. The ovary shows cystic follicles as well as a corpus luteum. The left fallopian tube is within normal limits and the left ovary reveals similar features to the right ovary. There is no overt evidence of malignancy. There is also evidence of thrombus formation in a blood vessel with organization.
(3) Microscopic examination reveals fibromuscular tissue within which a proliferation of nodules of smooth muscle cells can be identified with a vesicular appearance. Immunohistochemistry revealed the following: SMA - Strong positivity within tumour cells; DOG.1 and CD117 - Negative. These findings are in keeping with benign leioomyomata.
(4) Microscopic examination reveals fibrofatty tissue with a focus of fat necrosis and surrounding fibrosis. No smooth muscle cell proliferation can be identified.
(5) Microscopic examination reveals fibrofatty tissue within which there is evidence of fat necrosis. There is no evidence of malignancy. No lymphoid tissue could be identified.
(6) Microscopic examination reveals a lymph node with sinus histiocytosis. There is no evidence of metastatic malignancy.
(1) Retroperitoneal mass - BENIGN LEIOMYOMAS
(2) Subtotal hysterectomy: Endometrium - PROLIFERATIVE myometrium - ADENOMYOSIS - BENIGN LEIOMYOMATA; Right fallopian tube - PARATUBAL CYST; left fallopian tube - WITHIN NORMAL LIMITS; Ovaries - CORPORA ALBICANTEA - CYSTIC FOLLICLES; serosa - WITHIN NORMAL LIMITS
(3) Rectus sheath nodule - BENIGN LEIOMYOMAS
(4) Peritoneal biopsy - FAT NECROSIS
(5) Left iliac artery lymph node - FAT NECROSIS - NO LYMPHOID TISSUE IDENTIFIED
(6) Para-aortic lymph node - SINUS HISTIOCYTOSIS - NO EVIDENCE OF METASTATIC MALIGNANCY