1/11. Hemorrhagic pyelitis, ureteritis, and cystitis secondary to cyclophosphamide: case report and review of the literature.OBJECTIVE: Hemorrhagic cystitis is a well-known complication of cyclophosphamide therapy but extensive involvement of the entire urinary tract is far less common. We report here a patient who developed severe hemorrhagic pyelitis, ureteritis, and cystitis after one cycle of cyclophosphamide-containing combination chemotherapy. METHOD: A patient with synchronous carcinoma of the ovary and the uterus developed severe hemorrhagic pyelitis, ureteritis, and cystitis leading to bilateral hydronephroses and acute renal failure after one cycle of combination chemotherapy containing cyclophosphamide. The blood clots in the upper urinary tract were aspirated endoscopically and bilateral internal ureteric stents were inserted. RESULT: She underwent a prolonged diuretic phase with several episodes of hypokalemia, hypomagnesemia, and hypocalcemia and required intensive fluid and electrolytes replacement. Subsequently, she recovered fully with the ureteric stents removed 26 days later. CONCLUSION: In contrast to previous reports, where 2.8 g of cyclophosphamide was estimated to be the minimum cumulative dose required to cause hemorrhagic cystitis, this case illustrates that severe hemorrhagic complication can occur even after a low dose of cyclophosphamide (600 mg/m(2), total dose of 846 mg). Prompt diagnosis and intervention may be life-saving.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
2/11. carcinosarcoma of the uterus associated with a nongestational choriocarcinoma.choriocarcinoma has been reported in association with endometrial carcinoma and as a metaplastic change in multiple carcinomas, including liver, urinary bladder, lung, and the gastrointestinal tract. We report choriocarcinoma in conjunction with a carcinosarcoma (also called malignant mullerian mixed tumor) in a 71-year-old woman whose hysterectomy specimen revealed two polypoid lesions of the endometrium, one arising from the anterior endometrium and one arising from the posterior endometrium. Histologic examination revealed three histologic patterns. The anterior endometrial lesion showed a FIGO grade 2 endometrioid endometrial adenocarcinoma. The posterior endometrial lesion showed a carcinosarcoma composed of a high-grade adenocarcinoma and scant homologous stromal sarcoma. In addition, a choriocarcinoma was identified intermixed with the adenocarcinoma. The syncytiocytotrophoblasts and cytotrophoblasts stained strongly with 0 human chorionic gonadotropin (beta-hCG) and human placental lactogen (hPL). The patient's beta-hCG levels on postoperative days 14, 27, and 42 were 283, 32, and 7 mIU/mL, respectively. This unusual case suggests the importance of identifying the choriocarcinomatous component, since the serum beta-hCG can serve as a marker of tumor recurrence postoperatively.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
3/11. Transitional cell carcinoma of the endometrium associated with a benign ovarian brenner tumor: a case report.Transitional cell carcinomas (TCCs) of the endometrium are rare, and only 10 cases have been described to date. We report the case of a 46-year-old woman who developed both a TCC of the endometrium and a benign ovarian brenner tumor. Such an association has not yet been reported in the literature. Immunohistochemical studies of the uterine tumor showed cytokeratin 7 positivity and cytokeratin 20 negative staining, which was consistent with a Mullerian derivation. Human papilloma virus (HPV) immunostaining as well as polymerase chain reaction (PCR) analysis using primers for HPV types 6, 11, 16, and 18 failed to detect viral dna. The coexistence of a TCC of the endometrium and an ovarian brenner tumor might be coincidental but raises the possibility of a field effect, as seen with multifocal endometrioid tumors or multiple urinary tract TCCs.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
4/11. vesicovaginal fistula treated with fibrin glue.We report here a case of vesicovaginal fistula, following radiation therapy and intensive local chemotherapy for recurrent endometrial cancer of the vaginal stump, which was ameliorated with fibrin glue. The procedure temporarily postponed urinary diversion until the recurrence of irreparable fistula more than 4 years after the development of the first vesicovaginal fistula.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
5/11. Invasive micropapillary carcinoma of the breast metastatic to the urinary bladder and endometrium: diagnostic pitfalls and review of the literature of tumors with micropapillary features.Carcinomas with micropapillary features have been described in the breast, urinary bladder, lung, and ovary. They are characterized by the presence of micropapillary tufts in clear spaces. Unequivocal vascular invasion is usually present at the periphery of the tumor. Consequently, these tumors have a high propensity for lymph node metastases and high-stage disease. The metastatic carcinoma can consist exclusively of the micropapillary component, which may elicit an erroneous diagnosis if located in the bladder or lung, as in the patient presented herein. We present a case of a 59-year-old woman with a history of bilateral breast carcinoma status post-bilateral mastectomy, chemotherapy, and tamoxifen therapy. She presented with urinary frequency, and a pelvic mass was noted. A biopsy of the endometrium revealed a poorly differentiated carcinoma. urinary bladder biopsies showed a carcinoma with micropapillary features diagnosed as micropapillary transitional cell carcinoma. She presented to M.D. Anderson Cancer Center (Houston, TX) for further treatment recommendations. The urinary bladder and endometrial biopsies both contained carcinomas with micropapillary features. The mastectomy specimen showed an invasive ductal carcinoma with a significant micropapillary component. The tumor cells from the breast, endometrium, and urinary bladder were positive for cytokeratin (CK) 7 and estrogen receptor and negative for CK20. In view of the morphologic and immunohistochemical profile, the carcinoma in the endometrium and urinary bladder were interpreted as metastatic lesions from the breast primary. Carcinomas with a micropapillary component are morphologically identical in the breast, urinary bladder, and lung. However, micropapillary serous carcinoma has a different appearance more akin to borderline tumors of the ovary. Immunohistochemical stains are useful in distinguishing these lesions in that thyroid transcription factor-1 positivity suggests a lung primary, CK7 and estrogen receptor suggest a breast primary, and both CK7 and CK20 positivity suggest a urinary bladder primary. It is important to exclude metastatic carcinomas with micropapillary features before making a definite diagnosis of a primary tumor. Carcinomas with micropapillary features have a propensity for lymph node metastases and advanced stage disease. This article discusses the differential diagnosis of carcinomas with micropapillary features in different organs.- - - - - - - - - - ranking = 5.5keywords = urinary (Clic here for more details about this article) |
6/11. adenocarcinoma of the urinary bladder presenting as locally advanced endometrial carcinoma. Case report and review of the literature.BACKGROUND: Carcinoma of the urinary bladder that occurs after urinary diversion is a rare entity. We report a case of an adenocarcinoma arising in a defunctionalized bladder that presented as locally advanced endometrial carcinoma. CASE: A 77-year-old presented with postmenopausal bleeding and mucous vaginal discharge. She had a prior history of urinary diversion via a Koch pouch. Examination revealed a mass protruding through the cervix and possibly involving the bladder anteriorly. The patient underwent anterior pelvic exenteration for a locally advanced mucinous carcinoma thought to be arising from the uterus and invading into the bladder. Final pathology, however, was consistent with a primary bladder carcinoma. CONCLUSION: Carcinoma developing in the bladder after urinary diversion presents at an advanced stage and has associated poor overall survival.- - - - - - - - - - ranking = 4keywords = urinary (Clic here for more details about this article) |
7/11. Transitional cell carcinoma of the endometrium: a case report and review of the literature.We report a case of primary transitional cell carcinoma of the endometrium and review the literature which reveals only 12 cases described to date. The patient presented with postmenopausal bleeding, and there were no distinctive clinical features. An endometrial sample taken at hysteroscopy was reported as a poorly differentiated, papillary, nonserous carcinoma with probable squamous metaplasia. The tumor removed at hysterectomy and bilateral salpingo-oophorectomy was almost all transitional cell with small areas of endometrioid, glandular differentiation. immunohistochemistry demonstrated a similar immunoprofile to endometrioid carcinoma of the endometrium and different from reported cases of transitional cell carcinoma of the ovary and of the urinary tract.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
8/11. Mucinous adenocarcinoma of the endometrium with intestinal differentiation: a case report.Mucinous differentiation of endocervical type has been well documented in endometrial carcinoma. However, we describe an unusual case of adenocarcinoma of the endometrium showing diffuse histological, immunohistochemical, and ultrastructural evidence of intestinal differentiation. Although intestinal differentiation has been described in mesodermally derived tissues including endocervix, ovary, and urinary tract, it has not been reported in normal endometrium. One previous case has been reported showing this pattern in endometrial carcinoma. Possible histogenetic mechanisms of this pattern are discussed.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
9/11. Asymptomatic endometrial carcinoma after endometrial ablation.Endometrial ablation has been recently introduced as a surgical alternative to hysterectomy for the treatment of dysfunctional uterine bleeding. The procedure itself is reasonably safe. However, if occult endometrial cancer is present before the procedure and is not detected, it may be more difficult to diagnose later. Endometrial cancer may also arise de novo from missed endometrial tissue. Two cases of endometrial cancer following endometrial ablation have been reported, but its overall incidence is unknown. A 58-year-old woman was treated with endometrial ablation for dysfunctional uterine bleeding. Three years later she underwent hysterectomy and Marshall-Marchetti-Krantz procedure for urinary incontinence; incidental, asymptomatic endometrial adenocarcinoma was discovered. The final pathology was grade 1 adenocarcinoma, invading more than 50% of the myometrium (FIGO stage Ic). Endometrial cancer may occur following endometrial ablation and it may be asymptomatic. Careful patient selection and close follow-up are essential.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
10/11. Hepatoid adenocarcinoma of the endometrium associated with alpha-fetoprotein production.A 66-year-old woman was hospitalized with a 2-month history of vaginal bleeding. Computed tomography and magnetic resonance imaging on admission showed a uterine tumor. The serum alpha-fetoprotein (AFP) level was 16,170 ng/ml (normal < 20). A total hysterectomy with bilateral salpingo-oophorectomy and regional lymphadenectomy were performed. A grayish-white tumor with focal necrotic areas was located in the posterior wall of the corpus uteri with smaller nodules in the lateral wall of the cervix. The tumor had two histologic patterns: one was a well-differentiated endometrioid adenocarcinoma and the other consisted of nests of cells resembling hepatocytes. In the hepatoid areas, giant cells and mitotic figures were frequent. Tumor cells in both the hepatoid areas and the glandular areas were immunoreactive for AFP. The tumor was diagnosed as a hepatoid adenocarcinoma of the uterus, the first described in this site, although 23 cases of hepatoid adenocarcinoma arising in the stomach, lung, kidney, ovary, duodenum, and urinary bladder have been reported.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
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