1/10. Postmenopausal intravenous leiomyomatosis with high levels of estradiol and estrogen receptor.BACKGROUND: Intravenous leiomyomatosis is a rare variant of leiomyoma. CASE: The patient was a 49-year-old gravida 3, para 3 woman with menopause at age 46. She presented with a history of syncope. Vaginal examination revealed an enlarged and elastic-soft mass of the uterus. A pelvic ultrasound, computed tomography scan, and magnetic resonance imaging showed a heterogeneous, irregularly shaped 8- to 10-cm tumor. In addition, the inferior vena cava was almost completely occluded. Cardiac ultrasound demonstrated a mobile mass in the right atrium. The serum estradiol was 208 pg/mL (normal 0-59). Intravenous leiomyomatosis with cardiac extension was diagnosed preoperatively. A resection of the intracardiac and intracaval mass and a subtotal hysterectomy with bilateral salpingo-oophorectomy were performed. The uterine tumor weighed 600 g, and the cordlike intravascular tumor extending from the internal iliac vein into the right ventricle was 40 cm long and weighed 60 g. Pathologic examination confirmed intravenous leiomyomatosis with no evidence of atypia. The level of estrogen receptor in the tissue was 140 fmol/mg protein. The postoperative course was uneventful, and she has been in good health for 17 months after the operation. CONCLUSION: We report a case of intravenous leiomyomatosis extending into the right ventricle treated with a one-stage operation. It is possible that a high concentration of serum estradiol and high level of tissue estrogen receptor are related to the intravenous leiomyomatosis.- - - - - - - - - - ranking = 1keywords = menopause (Clic here for more details about this article) |
2/10. Coil embolization of a tuboovarian anastomosis before uterine artery embolization to prevent nontarget particle embolization of the ovary.uterine artery embolization (UAE) is being used more frequently as a primary treatment for uterine leiomyoma. Performing UAE in women who desire future fertility is controversial because of the risks of premature menopause and the undetermined effects on pregnancy. The etiology of ovarian failure after UAE is not yet clearly defined, but one of the leading possibilities is nontarget embolization of the ovaries. In this case report, the authors describe a technique of selective coil embolization of a uterine artery-to-ovarian artery communication before UAE performed specifically to protect the ovary from nontarget embolization.- - - - - - - - - - ranking = 1keywords = menopause (Clic here for more details about this article) |
3/10. Contrast-enhanced sonography during uterine artery embolization for the treatment of leiomyomas.uterine artery embolization (UAE) is a successful and safe treatment for symptomatic leiomyomas. However, rare complications such as premature menopause and uterine necrosis can arise because of embolization of non-target tissues. We studied the feasibility of using contrast-enhanced sonography with intravenous SonoVue just before, during and after complete occlusion of both uterine arteries. In a patient with multiple, large, symptomatic leiomyomas, contrast-enhanced imaging established that the UAE was technically successful and that myometrial vascularity was not reduced. Our case suggests that ultrasound contrast agents may have a role in monitoring UAE and thus may help prevent ischemic complications. Further studies are required to confirm this.- - - - - - - - - - ranking = 1keywords = menopause (Clic here for more details about this article) |
4/10. Postmenopausal bleeding resulting from placental site trophoblastic tumor of the uterus: a case report.BACKGROUND: Placental site trophoblastic tumor (PSTT) is the least common form of gestational trophoblastic disease. Occurrence of PSTT after menopause is extremely rare. CASE: A 53-year-old woman complained of postmenopausal bleeding 6 years after cessation of her menstrual periods. On dilatation and curettage and on hysterectomy and bilateral salpingo-oophorectomy later, PSTT was found in the uterus with myometrial invasion and no metastasis. serum human chorionic gonadotropin levels before and after the operation were 15 and < 1 IU/mL, respectively. hysterectomy was performed. CONCLUSION: Because of PSTT's rarity, limited information is known about its natural history, and there is no reliable means to predict clinical outcome. Thus, patients must be evaluated on a case-by-case basis.- - - - - - - - - - ranking = 1keywords = menopause (Clic here for more details about this article) |
5/10. Rapidly growing leiomyoma in a postmenopausal woman.We present here a case of a rapidly growing leiomyoma occurring after menopause. The tumor weighed 4329 g, suggesting the rapid accumulation of 'hyaline fibrosis'. A small amount of proliferative activity was detected as evidenced by ki-67 antigen immunoreactivity.- - - - - - - - - - ranking = 1keywords = menopause (Clic here for more details about this article) |
6/10. Necrotic leiomyoma and gram-negative sepsis eight weeks after uterine artery embolization.BACKGROUND: uterine artery embolization for symptomatic leiomyomata is generally safe, but rare life-threatening complications, including sepsis, can result. CASE: A 39-year-old woman with primary antiphospholipid syndrome, who was on chronic warfarin therapy, underwent uterine artery embolization for severe menorrhagia and a 12-cm intracavitary leiomyoma. Eight weeks postembolization, the patient, who had been essentially asymptomatic, presented in septic shock from gram-negative anaerobic bacteria. She underwent hysterectomy and bilateral salpingo-oophorectomy for a large infarcted necrotic leiomyoma and partial uterine necrosis. The patient's 8-day hospitalization required extended care in the intensive care unit and blood transfusion and resulted in surgical menopause in a patient who is not a candidate for hormone therapy. CONCLUSION: uterine artery embolization is a procedure not without significant risks. From published case reports, it appears that patients most at risk for severe infection of an infarcted leiomyoma after this procedure are those with a large dominant leiomyoma.- - - - - - - - - - ranking = 1keywords = menopause (Clic here for more details about this article) |
7/10. Malignant mesenchymoma arising from a uterine leiomyoma in the menopause.BACKGROUND: Malignant mesenchymoma is a rare tumor and location in the uterus is even rarer. We describe the first case of malignant mesenchymoma arising from a uterine fibroid in the menopause. CASE REPORT: A 64-year-old woman presented with abdominal pain and underwent surgery for a large "uterine fibroid" with suspicious features on ultrasound scan. The mass had developed after the menopause. histology showed benign leiomyomatous tissue with malignant areas consistent with malignant mesenchymoma. CONCLUSION: We report the first case of malignant mesenchymoma arising from the uterus in menopause. Certain radiological features may be associated with this tumor. Due to its rarity, information on management of uterine malignant mesenchymoma is lacking and management options of uterine leiomyosarcomas are reviewed as a surrogate.- - - - - - - - - - ranking = 7keywords = menopause (Clic here for more details about this article) |
8/10. Uterine choriocarcinoma in a postmenopausal woman.Uterine choriocarcinoma developing in patients beyond reproductive age is a rare occurrence. We report a case of choriocarcinoma of uterine corpus in a 54-yr-old woman after 7 yr of menopause and 25 yr after last child birth. She presented with pain in the abdomen, and on radiological investigation a left uterine adnexal mass of 3.4 x 2.8 cm size was detected. Her serum CA125 level was 40 mIU/mL (normal up to 35 mIU/mL). hysterectomy revealed an intramural growth in left uterine cornu measuring 3.5 x 3.0 x 2.5 cm. Histological features of the tumor were consistent with choriocarcinoma, and immunohistochemistry detected strong reactivity for beta-hCG in the tumor cells. serum beta-hCG level 4 wk after surgery was 1345 mIU/mL. The patient was put on combination chemotherapy (EMACO). She achieved serological remission but showed a rise in serum beta-hCG level 4 wk after completion of chemotherapy. We conclude that a high level of suspicion may help in preoperative diagnosis of uterine choriocarcinoma in the postmenopausal age group. However, the response to chemotherapy in these cases may not be as encouraging as in choriocarcinoma of reproductive age.- - - - - - - - - - ranking = 1keywords = menopause (Clic here for more details about this article) |
9/10. Long-dormant invasive mole associated with multiple malignancies.A 65-year-old previously healthy housewife, gravida 3, para 3, was first diagnosed as Stage Ib carcinoma of the uterine cervix (poorly differentiated squamous cell carcinoma) and admitted. The external radiation of 5400 rad by telecobalt source was performed. No intracavitary radiation was added. After about 7 1/2 years the patient noticed a tumor of fist size on her buttocks, but she did not present in our clinic regularly. Because of enlarging tumor and general malaise she was readmitted a year later. On the fifth hospital day she died with ileus. autopsy revealed osteosarcoma of buttocks in the radiation field, stomach cancer (tubular adenocarcinoma) with perforated peritonitis, and invasive mole of the uterine corpus. The patient's last pregnancy terminated as a full-term delivery at 26 years of age and she was 43 years at her menopause. The dormant period of invasive mole was 47 years after her last pregnancy, 30 years after her menopause, and at least 8 years after pelvic radiation.- - - - - - - - - - ranking = 2keywords = menopause (Clic here for more details about this article) |
10/10. Metastatic choriocarcinoma in a postmenopausal woman.Trophoblastic disease is usually related to pregnancy and occurs in about 1 in 1300 pregnancies in Western countries. Since the advent of methotrexate therapy, trophoblastic tumors have become one of the most curable malignancies. Trophoblastic disease can develop independently of gestation, but this is very rare. We report the unusual case of a 58-year-old woman who had a metastatic choriocarcinoma 6 years after menopause and 29 years after her last pregnancy. The tumor proved to be primarily resistant to monochemotherapy and developed chemoresistance to three different polychemotherapeutic regimens. Eleven months after the diagnosis of uterine choriocarcinoma the patient died from advanced metastatic disease.- - - - - - - - - - ranking = 1keywords = menopause (Clic here for more details about this article) |
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