1/684. Mandibular metastasis in a patient with endometrial cancer. Gynecologic cancers metastatic to bone are a rare entity, and a metastasis to the mandible at initial presentation is even more infrequently seen. We present a case of a 71-year-old woman with stage IV endometrial cancer with a metastasis to the mandible, with no other sites of distal spread apparent. The endometrial tumor was a FIGO grade III adenocarcinoma. The pathologic evaluation of the mandibular lesion revealed poorly differentiated adenocarcinoma with focal squamous differentiation. She was treated with a total abdominal hysterectomy and bilateral salpingo-oophorectomy, radiation therapy to the mandible, and chemotherapy consisting of Taxol and carboplatin for six cycles. She had a complete response, but 10 months after the original diagnosis developed spinal cord compression and progressive disease in the pelvis. patients in good clinical condition with a single bone metastasis should be treated aggressively, as survival can be extended. ( info) |
2/684. Metastatic endometrial cancer in lung and liver: complete and prolonged response to hormonal therapy with progestins. A double complete and prolonged response of metastatic endometrial carcinoma to medroxyprogesterone is reported. A 61-year-old woman with metastatic endometrial carcinoma in lung and liver achieved a complete clinical response with medroxyprogesterone lasting for 2 years. She discontinued the therapy by herself and developed a pulmonary relapse, which disappeared after retreatment with the same hormonal therapy. At present, she is alive without evidence of disease 6 years after starting progestins for metastatic disease and 14 years after treatment of the primary tumor. Progestin therapy in metastatic endometrial carcinoma is discussed, emphasizing the factors predicting response. ( info) |
3/684. Embolic vascular seeding of endometrial adenocarcinoma, a complication of hysteroscopic endometrial biopsy. OBJECTIVE: A case of embolic vascular seeding of endometrial adenocarcinoma following hysteroscopy is reported. methods: This phenomenon was recognized in the uterus specimen from a hysterectomy performed 1 week after hysteroscopic endometrial biopsy. Tissue processing artifact was excluded. RESULTS: Since the patient was otherwise low risk, treatment was limited to hysterectomy. The patient was not given adjuvant therapy. Two years later she remains alive and well with no evidence of disease. The surgical, morphologic, and clinical features of this case are presented and illustrated. CONCLUSION: Previous reports of peritoneal tumor seeding associated with hysteroscopy are reviewed. Tumor embolization during hysteroscopic endometrial biopsy was not followed by tumor recurrence in this case. ( info) |
| A 61-year-old woman presented to the emergency department after experiencing palpitations, shortness of breath, and syncope while taking a shower. Her husband revived her with mouth-to-mouth resuscitation. She had had a similar episode three days earlier while making her bed and had lost consciousness for about 10 sec. She did not appear to have had a seizure. Five months earlier, while taking a walk, she had experienced dizziness, dyspnea, and chest pressure lasting about an hour. A workup at that time included cardiac catheterization, lung scanning, and esophagogastroduodenoscopy, but no abnormality was found. lower extremity edema was noted. ( info) |
5/684. Multiple endometrial stromal nodules with sparse cysts and glands in the lung--a nodular variation of endometriosis that may mimic metastases of sarcoma. We report an unusual case of a nodular variation of pulmonary endometriosis. To our knowledge, there is no previous report on a morphological investigation of this entity. The etiology of this rare condition is still a matter of discussion. The well-circumscribed nodular mass is composed of cells identical to, or closely resembling, those of endometrial stroma containing sparse cysts and glands. Immunohistochemically, the cells showed an extensive co-expression of cytokeratin AE1/AE3 and vimentin and were highly positive for progesterone receptor (PRICA) and estrogen receptor (ERICA). cells lining the cysts and glands as a monolayer were reactive for Ber-Ep4, cytokeratin Pan and cytokeratin AE1/AE3 and negative to all other markers used including PRICA and ERICA. The differential diagnosis of this entity included fibrous tumor of the pleura and metastatic low-grade-endometrial-stromal-sarcoma. The morphological findings are correlated with immunohistochemical studies and results of cell image analysis. This study details the clinicopathological features of the nodular variation of pulmonary endometriosis. ( info) |
6/684. Ovarian carcinoma, endometrial carcinoma, and pregnancy. A 31-year-old G1 P0 patient with a history of infertility presented with light spotting and cramping at the end of her first trimester. An ultrasonogram at 19 weeks gestation revealed an intrauterine gestation of 21 weeks, a large leiomyoma, and a 8.9 x 6.8 cm complex left ovarian mass. At 35 weeks gestation she had an emergency cesarean section and left salpingo-oophorectomy due to a presumed ruptured ovarian mass. The ovarian mass was diagnosed as a serous cystadenocarcinoma. An exploratory laparotomy with a total abdominal hysterectomy, a right salpingo-oophorectomy, omental biopsy, and periaortic node sampling at 9 weeks postpartum revealed a diagnosis of stage IC ovarian serous cystadenocarcinoma and a stage IA secretory endometrial adenocarcinoma. Adjunctive 32P therapy was successfully administered and at this time the patient has had no recurrence. ( info) |
7/684. Late recurrence of a uterine clear cell adenocarcinoma confined to an endometrial polyp: case report. A patient with an endometrial clear cell adenocarcinoma confined to a polyp developed recurrent disease in the abdomen and pelvis four years following hysterectomy. Treatment issues related to this uncommon clinical situation are discussed. ( info) |
8/684. Uterine reduplication, unilateral ureteral and renal aplasia syndrome associated with endometrial cancer: a case report. Endometrial cancer in malformation of the urogenital system is a rare lesion. A correct diagnosis in these cases may be difficult to make due to urogenital anomalies or the unrecognised presence of a second uterine cavity. Proper diagnosis is very important for corresponding treatment. ( info) |
9/684. Stromal sarcoma arising on endometriosis. A clinicopathological and immunohistochemical study of 4 cases. The development of stromal sarcomas on the foci of endometriosis is extremely rare and the differential diagnosis from other tumors of myogenic, vascular, hemopoietic or epithelial origin may present great diagnostic difficulties. We investigated the clinicopathological and immunohistochemical characteristics of 4 cases of endometrial stromal sarcoma that developed on endometriotic foci of the uterus, vagina and omentum. Thye were classed as high grade (1/4) or low grade (3/4) malignant potential tumors, according to their mitotic activity. Immunohistochemically these tumors gave a positive reaction to vimentin, but were negative to desmin, smooth muscle actin, factor viii, EMA and LCA. These characteristics permit their identification and a proper therapeutic approach. ( info) |
10/684. Conservative treatment of adenocarcinoma of the endometrium in young patients. Is it appropriate? Few reports have suggested that nulliparous young patients with endometrial cancer may be treated conservatively to preserve fertility. We present a young nulliparous woman with a well differentiated adenocarcinoma of the endometrium treated with progestins. Since she did not respond, a definite operation was performed revealing involvement of the uterine isthmus, thus necessitating adjuvant radiotherapy. ( info) |