1/34. A staff dialogue on a socially distanced patient: psychosocial issues faced by patients, their families, and caregivers.Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The following case of an hiv-positive woman who was diagnosed with cervical cancer during a twin pregnancy was discussed at the May, 1999 Schwartz Center Rounds. The patient was in drug rehabilitation having been dependent on crack cocaine, with a past history of syphilis and gonorrhea. She was single and her other children were in foster care. Initially she was suspicious and non-compliant. A plan was negotiated to biopsy the cervical lesion after cesarean section and with confirmation of malignancy she underwent radical surgery and subsequently radiotherapy. Despite the almost insurmountable social and educational distance between her and her caregivers, they managed to bond and facilitate care. Although there were compromises with which staff were uncomfortable, the relationship was maintained and continues.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
2/34. Cytology of polypoid adenomyomas: a report of two cases.Uterine polypoid adenomyomas, both typical and atypical variants, often arise in the lower uterine segment or endocervical canal as pedunculated polypoid masses that may be accessible for cytologic sampling. However, their cytologic findings have rarely been described in the literature. Two women in their reproductive age presented with abnormal vaginal bleeding. The cervicovaginal smear of the first patient contained sheets and strips of reactive endocervical cells in an inflammatory background. In addition, loose aggregates of spindle-shaped smooth muscle cells were also noted. The findings were consistent with those of a typical polypoid adenomyoma. The cervicovaginal smears of the second patient consisted of tightly packed, crowded clusters of glandular cells which were initially interpreted as atypical glandular cells, suspicious of adenocarcinoma. In retrospect, loose aggregates of smooth muscle stromal cells were noted. Subsequent curettage revealed an atypical polypoid adenomyoma. The cytologic findings of typical polypoid adenomyoma were nonspecific except for the presence of loose aggregates of smooth muscle cells. The cytologic features of an atypical polypoid adenomyoma may mimic that of a neoplastic glandular process. The findings of tightly packed clusters of glandular cells and loose aggregate of bland-appearing smooth muscle cells in premenopausal patients may suggest the diagnosis of atypical polypoid adenomyoma. Diagn. Cytopathol. 2000;22:176-180.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
3/34. Endocervicosis involving the uterine cervix: a report of four cases of a benign process that may be confused with deeply invasive endocervical adenocarcinoma.Four cases of endocervicosis that involved the outer cervical wall and paracervical connective tissue are reported; in one case there was also transmural involvement of the urinary bladder. A diagnosis of cervical adenocarcinoma was an initial concern of the referring pathologist in three cases. The patients were from 29 to 45 years of age; there was a history of cesarean section in two cases. Two patients presented with pelvic pain, one with dysmenorrhea, and one with symptoms related to an ovarian tumor. In three cases, a gross abnormality of the outer aspect of the cervix was noted at the time of hysterectomy and in the fourth at the time of macroscopic pathologic examination. The anterior wall of the cervix in each case was involved by a firm rubbery mass, 1 to 2.5 cm in maximal dimension, with cysts seen on sectioning in two. Microscopic examination disclosed a dominant population of glands of variable size and shape, including cystically dilated glands, lined by mucinous endocervical-type epithelium that ranged from columnar to flattened. All the glands had lining cells with bland cytologic features with absent to rare mitotic figures. A periglandular stromal reaction, present in two cases, was related to mucin extravasation. A cuff of endometriotic stroma was present around rare glands in one case. The appearance of the lesion was similar to that of endocervicosis of the urinary bladder, and as in that site, raised concern for adenocarcinoma, specifically for the minimal deviation (adenoma malignum) type of cervical adenocarcinoma. awareness of the distinctive features of endocervicosis in this site, including its dominant location in the outer portion of the cervix and paracervical connective tissue and the typical presence of an uninvolved zone of cervical wall between the endocervicosis and the eutopic endocervical glands, facilitate the correct diagnosis.- - - - - - - - - - ranking = 4keywords = process (Clic here for more details about this article) |
4/34. Bronchorrhea revealing cervix adenocarcinoma metastastic to the lung.Copious bronchorrhea can be related to bronchioloalveolar carcinoma, but reports of bronchorrhea related to lung metastasis are rare. We report the case of a woman presenting lung metastases of a cervical adenocarcinoma revealed by bronchorrhea, eventually identified as ectopic cervical mucus. Treatment included anticancer drugs and erythromycin, the latter in order to reduce the bronchorrhea, with eventually poor efficacy. This observation illustrates the importance of respiratory signs in the post-therapeutic follow up of cancer, especially cough and bronchorrhea in adenocarcinoma.- - - - - - - - - - ranking = 225.97020663661keywords = alveolar (Clic here for more details about this article) |
5/34. Simultaneous squamous cell carcinomas of the uterine cervix and upper genital tract: loss of heterozygosity analysis demonstrates clonal neoplasms of cervical origin.Five cases of cervical squamous cell carcinoma with synchronous superficial squamous cell carcinoma in the upper genital tract were genetically analyzed to demonstrate the possibility of a clonal neoplastic process. In these cases, the cervical lesions were squamous cell carcinoma in situ (cases 1, 2, and 3) and invasive squamous cell carcinoma (cases 4 and 5). loss of heterozygosity (LOH) analyses with a panel of microsatellite markers revealed a monoclonal process in four of the five cases. Homogeneous LOH throughout the microdissected lesions was most frequently detected on 6p and 6q (3 cases), followed by 11p and 11q (2 cases), loci known to be commonly lost in typical cervical squamous cell carcinoma. In two cases, genetic progression in terms of additional LOH was found in the upper genital tract but not in the cervix. Most of these squamous cell carcinomas were monoclonal neoplasms originating from the cervical mucosa with subsequent superficial migration of the tumor clone to the upper genital mucosa, and in some cases, genetic progression.- - - - - - - - - - ranking = 2keywords = process (Clic here for more details about this article) |
6/34. Local anesthetic switching for intrathecal tachyphylaxis in cancer patients with pain.IMPLICATIONS: Switching from bupivacaine to lidocaine may improve intrathecal morphine analgesia in advanced cancer patients, possibly because of different spinal mechanisms limiting the hyperalgesic processes.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
7/34. Alveolar rhabdomyosarcoma of the cervix.BACKGROUND: Alveolar rhabdomyosarcoma (RMS) has a high risk for local and distal failure. Multimodal management of a patient with alveolar RMS of the cervix uteri is outlined. CASE: A 39-year-old woman suffered from alveolar RMS of the cervix without involvement of uterus and parametrium. She was treated with total hysterectomy and left salpingo-oophorectomy. Systemic chemotherapy and pelvic irradiation were also offered. She remains in clinical remission 3 years after presentation. CONCLUSION: Postoperative chemotherapy and irradiation could be effective treatments for alveolar rhabdomyosarcoma of the cervix in adult patients.- - - - - - - - - - ranking = 677.91061990982keywords = alveolar (Clic here for more details about this article) |
8/34. Post-transplant lymphoproliferative disorder of the cervix.BACKGROUND: Post-transplant lymphoproliferative disorder involving the female genital tract is a rare event. CASE: A 67-year-old female status post orthotopic liver transplant 5 years previously for hepatitis b and sarcoidosis presented with vaginal bleeding. Endometrial biopsy revealed a high-grade malignant tumor with immunologic marker studies consistent with lymphoma. The patient underwent an exploratory laparotomy, modified radical hysterectomy, bilateral salpingo oophorectomy, bilateral selective pelvic and para-aortic lymphadenectomy, and omentectomy. Final pathology confirmed monomorphic B-cell post-transplantation lymphoproliferative disorder consistent with non-Hodgkin's B cell lymphoma confined to the endocervix and lower uterine segment. She remains recurrence free after 4 years with no adjuvant therapy. CONCLUSION: Post-transplant complications can present in the female reproductive organs. Gynecologic oncologists need to be aware of this disease process when treating patients for gynecologic symptoms after transplant surgery.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
9/34. Neuroendocrine carcinomas associated with squamous cell carcinomas of the uterine cervix: light and electron microscopic observations in two cases.Small cell carcinomas are rare in cervical cancers and appear to be a heterogeneous group of tumors. Neuroendocrine carcinoma of the cervix, one subtype of small cell carcinomas of the cervix, can be identified by characteristic light and electron microscopic criteria. Two cases of neuroendocrine carcinomas associated with squamous cell carcinomas of the uterine cervix are reported in which electron microscopic studies were performed. The presence of small dense-core membrane-bound granules (120 to 160 nm) in cytoplasmic process under electron microscopic observation confirmed the diagnosis of neuroendocrine carcinoma of the cervix. The coexistence of electron dense-core membrane-bound granules, abundant tonofibrils, and desmosomes within the cancer cells, suggests that these tumors may have derived from the multipotential precursor cells with neuroendocrine and squamous differentiation. Because neuroendocrine carcinomas appear to have the highest incidence of recurrence and the poorest prognosis, it is necessary to distinguish these neoplasms from squamous cell carcinomas of the cervix. literature about neuroendocrine carcinomas of the cervix is also reviewed.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
10/34. Pulmonary tumor embolism to alveolar septal capillaries. An unusual cause of sudden cor pulmonale.Although metastatic spread of tumor to the lungs is common, subsequent production of cor pulmonale is not. The involvement of pulmonary alveolar capillaries causing sudden cor pulmonale is very rare. We describe a patient who presented with chest pain and sudden shortness of breath. autopsy disclosed diffuse pulmonary microembolism to septal capillaries caused by tumor cells from a squamous cell carcinoma of the cervix. To our knowledge, this is the second report of this kind of pulmonary tumor embolism.- - - - - - - - - - ranking = 1129.851033183keywords = alveolar (Clic here for more details about this article) |
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