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Introduction/Background Glassy cell carcinoma (GCC) of the uterine cervix is a poorly differentiated subtype of adenosquamous carcinoma. It accounts for 1–2% of cervical carcinomas. It has been associated with high-risk human papillomavirus infection (HPV 16, 18 and 32). We present a case of this rare entity. Methodology A 46-year-old patient was admitted to the gynecology department. She had a previous diagnosis of poorly differentiated carcinoma on cervical biopsy performed due to an abnormal enlargement of the uterine cervix on routine ultrasound examination. Radical hysterectomy with bilateral pelvic lymph node dissection and omentectomy was performed. On gross examination, the cervix was barrel-shaped, occupied by a bulky, white-gray exophytic mass measuring 60 mm in its greatest dimension. Results On microscopic examination, the tumor consisted of solid nests of large, pleiomorphic cells with prominent nucleoli, lacking glandular or squamous differentiation, with ground-glass or finely granular cytoplasm. Several mitoses were identified. Tumor nests were embedded in a heavy inflammatory infiltrate. Immunohistochemically tumor cells showed positive staining for EMA, Vimentin, P16, pCEA and negative for CK7, CK20, P63, ER, PR, and HMB45. The omentum and pelvic lymph nodes were tumor free. Our diagnosis based on morphological and immunohistochemical findings was GCC of the uterine cervix. The patient received adjuvant radiotherapy and chemotherapy. She remains disease-free 9 months post surgery. Conclusion GCC is a clinically aggressive subtype of cervical carcinoma with rapid growth, and early metastases. Treatment consists of surgery followed by radio-chemotherapy or neoadjuvant therapy in cases with advanced disease. Multimodal therapy has improved prognosis in patients with FIGO stage I or II but not in higher stage disease. Disclosure Nothing to disclose.

Introduction/Background Breast cancer (BC), depending on molecular subtype, usually metastasize to the liver, lungs, bone and brain. We report an interesting case of a patient, previously treated for hormone receptor-positive, HER2-negative early BC, who presented 7 years later with HER2-positive metastatic disease. Finally she developed an intramedullary spinal metastasis. Methodology A 61 year-old woman underwent left mastectomy in 2010 for BC hormone receptor-positive, HER2-negative, with lymph node involvement. She also received adjuvant chemotherapy, radiation therapy and hormonal treatment until 2017. In 2017 she received Paclitaxel/Bevacizumab followed by Bevacizumab maintenance for recurrence in the lungs, liver and bones. In February 2018 she underwent rebiopsy in the liver due to progressive disease, which revealed metastasis from hormone receptor-negative, HER2-positive BC. She received Trastuzumab/Pertuzumab/Docetaxel until August 2018. In the meanwhile she receive whole-brain radiation therapy in June 2018 for multiple brain metastases. In August 2018 she started Trastuzumab-Emtansine due to progressive disease. On January 2019 she presented in our department with paraplegia. Results Spine MRI was performed ad revealed an intramedullary lesion on level T12-L1 of 3.6×1.5×1.4 cm with contrast enhancement. Differential diagnosis included metastasis from breast cancer and ependymoma. Blood tests indicated thrombopenia and hepatic disturbances. After discussion with the neurosurgeons and radiation oncologists we did not offer any treatment to our patient, because of the established paralysis of the lower extremities. Conclusion BC can rarely give intramedullary spinal lesions. Their treatment is quite challenging. Disclosure Nothing to disclose.

Introduction/Background Adenoid cystic carcinoma (ACC) is an aggressive slow-growing tumor occurring in women with mean age 49 years. The neoplasm is similar to those of salivary gland, evolving from chromosomal translocation (NFIB) and having no HPV-correlation. ACC accounts for 15% of Bartholin´s gland (BG) malignancies and for 2–7% for vulvar carcinomas, with less than 90 cases described. Treatment remains individualistic as there is no level I evidence available, making the new cases crucial to be reported. Methodology A 46-year-old female, presented after a positive biopsy for ACC-BG. She reported a small swelling in her left posterior labia minor during the last 6 months. She had the BG cyst removed and the pathology showed ACC 3 × 3 cm encapsulated inside the cyst. Another 45-year-old female, presented after an excision of a vulvar mass 3,5 × 2,5 × 2,5 cm of the left labia minor after swelling for the last 2 years which resulted histologically in ACC-BG with positive margins and neural and muscular invasion. Results Supplementary surgery was decided and the first patient underwent radical left hemivulvectomy with ipsilateral inguinofemoral lymph node excision. There was no residual disease and no adjuvant therapy was needed. In the second case we performed imaging control and radical vulvectomy with bilateral inguinofemoral lymph node dissection. The pathology-report described a middle line tumor 2 × 1,25 × 1,2 cm infiltrating the outer third of vagina plus one left lymph node, having negative margins (FIGO stIIIa); she then underwent adjuvant radiotherapy. Both women are disease-free after 16 and 20 months respectively. Conclusion Radical excision with negative margins is beneficial, while adjuvant radiotherapy should be considered for patients with risk factors (tumor size, lymph node status, surgical margins). Lung is the most common site of distant metastasis and several chemotherapeutic agents have been used such as cyclophosphamide, adriomycin, 5-FU, cisplatin and tamoxifen. ACC should always be considered in patients older than 40 years with BG lesions. Disclosure Nothing to disclose

Introduction/Background After evaluating the Argon insufflation (99, 9%) effectiveness on improving the method of cervical tissue excision by loop electrosurgery (leep) in bovine cervical specimens we use it safely in our everyday office practice in many leep cases. (the experiment mentioned was presented in ESGO congress2015). Methodology Argon is a chemical element in group 18 of the periodic table and is a noble gas. It is colorless, odorless, nonflammable and nontoxic as a gas. Argon is chemically inert under most conditions and forms no confirmed stable compounds at room temperature. Argon constitutes a cheap material. It has low thermal conductivity and is sometimes used even for extinguishing fires. Based on the argon characteristics above and our previous experience we herein use the simultaneous argon insufflation in the area before cervix so as there is no oxygen to be burned and provoke smoke or tissue damage during leep. Results We apply a small plastic tube that isufflates argon connected to a 5-litre bottle of argon gas on the diathermy pen. The diminution of the thermal injury of the cone while using this patent is macroscopically obvious and microscopically significant. Especially, the zone of carbonization and coagulation of the entrance, middle and exit margins of the loop is decreased. Conclusion Although argon in Gynecology is mostly known in its liquid form via Cryosurgery procedures or in argon plasma beam electrosurgery the argon gas can also be used as a safe and cheap material. The use of lower watts electrosurgery allows us to excise high quality histological specimens inexpensively by altering the air medium of loop electrosurgical procedure to Argon or cooled-Argon. Disclosure Nothing to disclose

Introduction/Background Undifferentiated pleomorphic sarcoma (UPS) is a malignant mesenchymal neoplasm presenting very rarely as a primary breast tumor. We present a case of UPS of the breast with aggressive clinical behavior. Methodology A 67-year-old patient was admitted to our hospital due to a palpable lump of the right breast. Imaging studies revealed a 7 cm multilobular mass. A lumpectomy was performed. On gross examination, the tumor was solid, white-gray and had a greatest dimension of 7.3 cm. Results On microscopic examination, the tumor consisted of spindle cells with alternating cellularity, high-grade atypia, and brisk mitotic activity. Immunohistochemical stains were positive for CD68, CD163, CD10 and negative for AE1/AE3, EMA, CK7, Ck34bE12, p63, SMA, Desmin, S100, CD31, CD34, and CD56. The diagnosis of UPS of the breast was made. The surgical margins were infiltrated. A month later she underwent a modified radical mastectomy. The surgical margins were infiltrated. The patient received first-line systemic therapy. After having received one cycle of systemic therapy, the tumor recurred locally. A third surgical operation was performed to achieve local control. The patient‘s condition deteriorated very rapidly. A month later she presented with metastatic disease to the lungs. The patient passed away due to respiratory insufficiency. Conclusion Primary breast sarcoma diagnosis may occasionally prove very challenging. Before making the diagnosis other more common entities (malignant phyllodes tumor, metaplastic carcinoma and metastatic sarcoma from another primary site) have to be excluded. Extensive tumor sampling, attention to histological detail paired with the use of the appropriate immunohistochemical markers will usually help in making the diagnosis. Similar to the case we present data found in the literature indicates that breast UPS show an aggressive clinical course and a high incidence of recurrence and metastasis. Disclosure Nothing to disclose.

Introduction/Background Bowel and uterine carcinomas are often related genetically, through hereditary syndromes or as metastasizing sides. Metastasis to the female genital tract from extragenital malignancies are rare, and the prognosis is extremely poor. Methodology We herein report a case of a 62 years old woman with metastatic carcinoma to the uterine body from a colon adenocarcinoma, presenting with vaginal bleeding. 16 months before she had an urgent laparotomy due to obstructive ileus. She underwent right colectomy, right oophorectomy and lymphadenectomy and the histological results reported a colon-cecum adenocarcinoma (pT4aN0 grade2) up to the pericolic fat. The appendix, the right adnexa and the lymph nodes were negative. The imaging showed no metastasis to another organ. She received 9 cycles of chemotherapy with oxaliplatin and capecitabine (Xelox) and was followed up. The diagnostic curettage that followed revealed a moderate adenocarcinoma of the uterus compatible with the colon adenocarcinoma (CK7 (+), CK20 (+), p16 (+), CDX2(+), ER (−), PR (−)). Results Colonoscopy-biopsies were negative for malignancy and PET-CT reported a large uterus with focal disease and suspicious pelvic lymph nodes. The rest body scan was negative. She underwent wide total hysterectomy and left oophorectomy, excision of the mesorectum and parts of peritoneum, omentectomy and pelvic lymphadenectomy. The pathology examination reported the uterine adenocarcinoma infiltrating the serosa and myometrium. The mesorectum and 3/11 left lymph nodes were positive. The endometrium was atrophic and the left adnexa, the omentum and peritoneal parts excluded were negative for disease. The patient received 8 cycles of XELIRI-protocol (Capecitabine plus 3-weekly irinotecan) and is now -14 months after- free of relapse. Conclusion According to our findings the tumor was developed of metastases in tissue continuity. To choose the best treatment, it is necessary to always diagnose whether a uterine bleeding is due to a primary uterine or a metastatic carcinoma. Disclosure Nothing to disclose.

Introduction/Background Invasive lobular carcinoma (ILC) with extracellular mucin production is a recently described new variant of ILC with few reported cases in the English literature. We report another case of this rare entity diagnosed in the pathology department of Saint Savvas hospital. Methodology A 65-year-old patient was admitted to the hospital for a palpable lump of the right breast. Physical examination and imaging studies were consistent with malignancy. Frozen section was positive while sentinel lymph node biopsy was negative for malignancy. A right mastectomy was performed. On gross examination the tumor was soft, pale, grayish blue, gelatin-like and well circumscribed. On microscopic examination the tumor consisted of two foci measuring 13 and 6 mm. It consisted of a non-mucinous ILC component of the classical and solid type. The mucinous area represented about 70% of the tumor. Extracellular mucin production was seen in the form of relatively circumscribed multiple nodular areas. Tumor cells in the mucinous area were arranged in clusters and single cells. Several signet ring cells were identified. Tumor cells showed positive staining for ER and negative for PR, HER-2 and E-Cadherin. Ki-67 stained 25% of tumor nuclei. Results The diagnosis of ILC with extracellular mucin production was made. Adjuvant radiotherapy and hormonal therapy was administered. The patient is alive without evidence of recurrence or metastasis six months after surgery. Conclusion Awareness of this new entity will help us avoid confusion with other mucin-producing neoplasms. Differential diagnosis includes mucinous carcinoma, solid papillary carcinoma with extracellular mucin production and composite mucinous and lobular carcinoma. Correct diagnosis is important because both treatment and prognosis are distinct. Disclosure Nothing to disclose.

Introduction/Background Primary squamous cell carcinoma of the ovary (PSCCO) is a rare entity. Most squamous cell carcinoma cases arise from a cystic teratoma or less frequently are associated with Brenner tumor or endometriosis. We review 36 cases of PSCCO reported in the literature. Methodology Data were collected in November 2018. Twenty-three articles from 1964 to 2018 presenting thirty-six cases of PSCCO are reported in the literature. All reviewed cases were analyzed according to diagnosis, surgical approach, adjuvant therapy and outcome. Results Patients‘ age ranged from 27 to 90 years (mean age: 52.9 years). Tumor size ranged from 1.5 to 26 cm in the greatest axis (mean value: 10.3 cm). The most frequent symptom was abdominal pain. Other symptoms were related to tumor growth, metastasis, local extension or were non specific. Only few patients were asymptomatic. In 10 cases high grade Cervical Intraepithelial Neoplasia was associated. Grossly tumors were either cystic or solid. Microscopically several different morphological patterns were present. All patients were treated surgically, in most cases with hysterectomy and bilateral salpingo-oophorectomy. Adjuvant therapy was administered in twenty-four patients. Information regarding outcome was available in 31 cases. Follow-up time ranged from 9 days to 90 months. Eleven patients were alive with no evidence of disease, three were alive with metastases and seventeen succumbed to disease. Conclusion PSCCO is a rare entity. Treatment includes combination of surgical management with adjuvant therapy when necessary. Its prognosis seems to be poorer compared to other ovarian carcinomas. Further investigations are needed to define optimal treatment and prognosis. Disclosure Nothing to disclose.