Parathyroid carcinoma is a rare endocrine malignancy with an indolent course but a high risk of recurrence. Diagnosis remains challenging, requiring integration of clinical, biochemical, radiologic, and histopathologic findings. We report a young patient presenting with primary hyperparathyroidism complicated by multiple pathologic fractures and chronic renal failure. Despite initial surgical and medical management, late aggressive recurrence occurred, resulting in significant systemic complications. This case highlights the need for vigilant long-term surveillance and improved diagnostic and therapeutic strategies.

Human ; Parathyroid Neoplasms ; Hyperparathyroidism ; Fractures, Spontaneous ; Philippines

Introduction: Ovarian lymphoma is rare and often misdiagnosed, as its clinical presentation can be similar to other more frequent tumors. It accounts for <1% of all non-Hodgkin lymphomas, with high-grade B-cell lymphoma being the most frequently implicated subtype. Case Description: A 48-year-old woman presented with bilateral ovarian masses, elevated CA-125, and extensive abdominal and thoracic lymphadenopathy. She was managed as advanced ovarian cancer and underwent TAHBSO. Grossly, both ovaries were enlarged and nodular. Histology showed a round cell neoplasm composed predominantly of medium-sized, cleaved lymphocytes, admixed with scattered larger atypical cells. Initial immunohistochemistry panel demonstrated diffuse CD45 positivity and negativity for AE1/AE3, Inhibin, SALL4, Desmin, and Calretinin. Subsequently, CD20 and PAX5 showed diffuse reactivity. CD10, BCL2, and BCL6 highlighted neoplastic follicles. CD3 was negative. High-grade B-cell lymphoma was considered; however, the Ki-67 proliferative index was 38%, and c-MYC expression was low (5%). A final diagnosis of follicular lymphoma involving both ovaries was rendered. Discussion: The clinical presentation strongly suggested advanced ovarian carcinoma. However, histologic and immunophenotypic evaluation established lymphoma. Although aggressive subtypes are more common in advanced cases, indolent entities such as follicular lymphoma should also be considered, particularly in resource-limited settings where delays in diagnosis occur. Distinguishing lymphoma from carcinoma is critical, as management differs significantly and misclassification may lead to overtreatment. Conclusion Recognition of ovarian lymphoma is critical, as accurate diagnosis alters management and prevents unnecessary radical surgery.
CA-125 Antigen ; Immunohistochemistry ; Lymphoma, Follicular ; Ovarian Neoplasms

Introduction: While uterine leiomyosarcoma, an aggressive smooth muscle malignancy, has a strong propensity for hematogenous spread—most commonly to the lungs and liver—gastric metastasis remains exceedingly rare. When it occurs, it presents as a masquerading lesion that mimics primary gastric tumors, creating a significant diagnostic pitfall for both clinicians and pathologists. Case Description: A 75-year-old female presented with recurrent melena. Esophagogastroduodenoscopy revealed a friable, bell-shaped mass measuring 7 × 6 cm in the gastric fundus, suspicious for GIST. Histopathology showed spindle to epithelioid tumor cells arranged in intersecting fascicles and solid sheets with vesicular nuclei, conspicuous nucleoli, numerous mitosis, and tumor necrosis. IHCs demonstrated strong SMA positivity but negative CD117, raising consideration of undifferentiated GIST. However, subsequent DOG1 staining was negative, arguing strongly against GIST. Additional markers including S100, PanCK, CD3, CD20, CD15, and CD30 were negative. Further IHCs revealed diffuse, desmin and H-caldesmon positivity, supporting smooth muscle differentiation. Review of prior records revealed TAHBSO in 2023 for uterine leiomyosarcoma. Discussion: Metastatic involvement of the stomach is rare and most commonly arises from breast or lung primaries. Gastric metastases are rare and most commonly originate from breast or lung primaries. Metastatic uterine leiomyosarcoma presenting as a solitary gastric mass is exceedingly uncommon and may closely mimic primary gastric tumors such as GIST both endoscopically and histologically, representing an important diagnostic pitfall. Conclusion This case highlights a rare metastatic pattern of uterine leiomyosarcoma presenting as an overt gastric mass with GI bleeding. Awareness of this deceptive presentation and careful clinicopathologic correlation are essential for accurate diagnosis. To our knowledge, this represents one of the few reported cases worldwide and possibly the first documented in the Philippines.
Gastrointestinal Stromal Tumors ; Immunohistochemistry ; Leiomyosarcoma ; Gastrointestinal Hemorrhage

Introduction: Breast carcinoma commonly metastasizes to the lymph nodes, bones, lungs, liver, and brain, and synchronous metastatic involvement of both endometrial polyp and uterine leiomyomas are exceedingly rare occurrence. Case description: A 48-year-old female patient presented with a chief complaint of abnormal uterine bleeding and underwent total hysterectomy. Gross examination of the specimen showed a 6.0 cm pedunculated mass at the posterior endometrium with multiple well-defined, tan-white mass with whorl-like pattern, grossly consistent with endometrial polyp and leiomyomas, respectively. Microscopic sections of both the polyp and leiomyomas demonstrated tumor cells arranged in nests and solid sheets consisting of moderately pleomorphic tumor cells with irregularly round to oval, hyperchromatic to open vesicular chromatin, inconspicuous to visible nucleoli and abundant eosinophilic cytoplasm – features reminiscent of invasive carcinoma of the breast. Review of the patient’s past medical history revealed a diagnosis of breast cancer made three months prior to the onset of gynecologic symptoms. Discussion: Immunohistochemistry studies for Mammaglobin, GATA3 and PAX8 were performed which demonstrated positive staining for Mammaglobin and GATA3. PAX8 negativity excluded a primary gynecologic origin. In the context of the patient’s prior diagnosis of breast carcinoma, along with morphologic features and immunoprofile, this case was signed-out as metastatic breast carcinoma involving an endometrial polyp and uterine leiomyomas. Conclusion Endometrial polyp and uterine leiomyomas are two of the most common benign neoplasms in the gynecologic tract. Metastatic involvement of these lesions is exceedingly rare; to the best of our knowledge, there are only 15 reported cases of endometrial polyp and 24 leiomyoma metastases. Despite its rarity, both clinicians and pathologists alike must be aware of this entity to ensure accurate diagnosis and appropriate management.

This is a case of a 33-year-old, G3P3(3003) female patient with a clinical presentation of vaginal bleeding associated with on and off hypogastric pain. The patient was diagnosed and managed as a case of tubo-ovarian abscess and subsequently underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAHBSO). Microscopic sections of both ovaries, however, showed dual population of tumor cells composed of medium-sized, mononucleated cells admixed with multinucleated giant cells with marked pleomorphism, extensive hemorrhage and necrosis. Immunohistochemistry studies using beta-hCG was diagnostic of ovarian choriocarcinoma, favoring non-gestational in origin. Classification of non-gestational choriocarcinoma (NGOC) was established using diagnostic criteria for NGOC established by Saito et al., and Mangla et al. DNA analysis, however, remains to be the gold-standard for differentiating between gestational (GOC) and non-gestational (NGOC) etiology.

Human ; Female ; Adult: 25-44 Yrs Old ; Choriocarcinoma ; Ovary

Renal cell carcinoma (RCC) is notorious for its propensity to metastasize even after a prolonged period of remission following nephrectomy. The metastatic spread can occur months or even years after initial treatment, which necessitates a heightened level of clinical awareness and vigilance in patients with a history of renal malignancy, particularly who present with new or unexplained nasal symptoms. Although RCC most commonly metastasize to the lungs, bones and liver, its involvement in the nasal cavity is exceedingly rare, posing significant diagnostic challenges due to the non-specific nature of symptoms. We describe a case of metastatic renal cell clear cell carcinoma presenting with recurrent epistaxis and unilateral nasal obstruction. Immunohistochemistry studies play a crucial role in confirming the diagnosis and ruling out potential differential diagnoses, along with a comprehensive clinical history of the patient.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Clear Cell Renal Cell Carcinoma ; Carcinoma, Renal Cell ; Metastasis ; Neoplasm Metastasis ; Nasal Cavity ; Epistaxis

Nephroblastoma is an uncommon renal malignancy primarily observed in the pediatric population, with its occurrence in adults being exceedingly infrequent. We describe an extremely rare case of a malignant embryonal tumor presenting in an adult patient with right renal mass. Final histopathologic diagnosis was nephroblastoma with favorable histology. Use of immunohistochemistry studies is generally unnecessary but its rarity in the adult population raises uncertainty in diagnosing this malignancy by histomorphology alone.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Immunohistochemistry ; Wilms Tumor