Cases reported "Genital Neoplasms, Female"

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1/62. skin metastases of gynecologic adenocarcinomas affect serum levels of hCGbeta but not those of SCC antigen.

    Squamous cell carcinoma antigen (SCC-Ag) has been shown to be elevated in patients with epidermoid carcinoma of the cervix but also in patients with benign tumors of epithelial origin and in benign skin disorders. Elevated serum levels of the free beta subunit of human chorionic gonadotropin (hCGbeta) have been observed in patients with cancer of different types, and cancer aggressiveness is related to hCGbeta expression. Therefore, we expected that extensive metastatic skin dissemination of gynecologic malignancies would cause a rise in the serum levels of SCC-Ag and hCGbeta. The serum levels of SCC-Ag, hCGbeta and CA 125 were monitored in 2 patients with extensive skin dissemination of ovarian and endometrial adenocarcinoma. skin metastases had no effect on serum levels of SCC-Ag but they caused an increase in serum levels of hCGbeta. SCC-Ag is not a marker for metastatic skin lesions of gynecologic carcinomas of nonepidermoid origin. hCGbeta expression is associated with aggressiveness of cancer and may be a useful marker indicating therapy resistance.
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2/62. Malignant peritoneal mesothelioma treated by continuous hyperthermic peritoneal perfusion chemotherapy.

    Malignant mesothelioma of the peritoneum is a rare tumour for which the therapeutic approach has not yet been standardized. The efficacy of the current regimes is limited. Effective locoregional therapy is crucial, since this tumour is most often confined to the peritoneal cavity at the time of the initial diagnosis and remains there for much of its clinical course. If and when haematogenous metastases occur, they rarely contribute to the death of the patient, which is often caused by the overgrowth of the primary tumour and its local complications. A case of diffuse malignant peritoneal mesothelioma treated by cytoreductive surgery and continuous hyperthermic peritoneal perfusion with cisplatin is reported. The patient received systemic combination chemotherapy postoperatively. She is in good condition and free of disease 28 months after her treatment. Continuous hyperthermic peritoneal perfusion chemotherapy has recently been used in patients with secondary peritoneal carcinomatosis from digestive and gynecological malignancies with promising results. It is also possible that the same treatment alone or in combination with systemic chemotherapy may be effective in the treatment of primary peritoneal malignancies, as in the case of diffuse peritoneal mesothelioma.
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keywords = gynecologic
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3/62. Abnormal genital tract bleeding.

    The etiology of abnormal genital tract bleeding encompasses a wide range of disorders that can be secondary to anatomic changes of the female genital tract, infection, endocrinologic disorders, malignancies, and systemic illness. Appropriate workup is guided by age-related differential diagnoses for abnormal bleeding. Modern diagnostic tools can quickly focus the evaluation and allow timely intervention. Most abnormal genital tract bleeding is uterine bleeding, which is one of the most common gynecologic problems that health care providers will face. It accounts for approximately 15% of office visits and 25% of gynecologic operations. Abnormal uterine bleeding in reproductive-age women is defined as bleeding at abnormal or unexpected times or by excessive flow at the time of an expected menses. The average menstrual cycle length and duration of flow is 28 days and 4 days, respectively, with an average blood loss of 35 cc (1). Any bleeding should be considered abnormal in premenarchal girls and in post-menopausal women except for those with predictable withdrawal bleeding taking hormone replacement therapy. This article will review the categories of abnormal genital tract bleeding and the diagnostic tools needed to establish the correct diagnosis. Common clinical cases will be presented to illustrate the presenting symptoms, differential diagnoses, workup, treatment, and long-term follow-up.
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4/62. Chronic administration of single-agent paclitaxel in gynecologic malignancies.

    OBJECTIVE: There are currently limited published data available on the safety and feasibility of the prolonged administration of paclitaxel. The goal of this study was to review the cumulative toxicity associated with the continuous long-term administration of this agent to women with gynecologic cancers. methods: Eleven patients with gynecologic malignancies of varying histologic subtypes who received >15 consecutive courses of paclitaxel were identified in a retrospective review of individuals treated between 1994 and 1999 in the Gynecologic Oncology Program of the Cleveland Clinic Taussig Cancer Center. The analysis excluded paclitaxel delivered as a component of an initial chemotherapy regimen for the cancer. paclitaxel was administered at doses ranging from 80 to 175 mg/m(2) every 3-4 weeks as a 3-h infusion. RESULTS: In general, the patients included in this report were heavily pretreated and were continued on therapy either as a result of documentation of an objective response or with evidence of stabilization of disease (e.g., physical examination, radiographic evaluation, ca-125 antigen level) and the maintenance of a satisfactory quality of life. In the 11 patients, the median duration of therapy was 20 cycles (range: 16-36 cycles). alopecia was observed in all patients. A single patient experienced grade 3 anemia and grade 4 neutropenia. Of note, there was 1 case of grade 2 and no cases of grade 3 peripheral neuropathy in this population. CONCLUSION: Prolonged delivery of paclitaxel for >15 consecutive cycles can be safely administered to carefully selected patients with persistent or recurrent advanced gynecologic cancers.
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keywords = gynecologic
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5/62. Hereditary nonpolyposis colorectal cancer with gynecologic malignancies: report of two families in taiwan.

    Hereditary nonpolyposis colon cancer (HNPCC), also known as Lynch syndrome, is characterized by germline and somatic mutations of dna mismatch repair genes with dominant inheritance of site-specific colorectal cancer or colorectal cancer plus cancers of extracolonic sites. We describe two Taiwanese HNPCC families with members who had predominantly gynecologic malignancies. In one family, the 53-year-old proband was found to have five synchronous and metachronous tumors of the genitourinary system, which included endometrial adenocarcinoma, cervical squamous cell carcinoma, ureteral and bladder transitional cell carcinoma, and ovarian teratoma. Fourteen of her first- and second-degree relatives were victims of genitourinary and gastrointestinal malignancies. The other family was characterized by four sisters who developed endometrial adenocarcinomas at young ages (36-42 yr). Their father died of both stomach cancer and colon cancer at age 47. The diagnosis of HNPCC was confirmed in this family by genetic analysis. A heterozygous germline mutation (G5 to G6 frame-shift at 183-187) of the hMSH2 (human MutS homolog 2) gene was identified in white blood cells of all the affected family members. The frequent presentation of genitourinary cancers in HNPCC highlights the importance of family-history taking in patients with gynecologic cancers and a genetic diagnosis of HNPCC.
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6/62. disseminated intravascular coagulation in gynecologic cancer.

    Disturbances in the blood coagulation mechanism are seen by the obstetrician and gynecologist as rare complications of abruptio placentae, retained dead fetus syndrome, amniotic fluid embolism, toxemia, saline amnioinfusion, and septic abortion. Two cases of disseminated intravascular coagulation complicating gynecologic malignancy are presented. Laboratory studies showed thrombocytopenia, hypofibrinogenemia, and increased fibrin degradation products. Derangements of hemostasis in patients with malignancy are discussed from a clinical viewpoint.
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keywords = gynecologic
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7/62. Synchronous renal cell carcinoma and gynecologic malignancies.

    BACKGROUND: Synchronicity of renal cell carcinoma and gynecologic malignancies is a rare condition and standardized treatment does not exist. CASES: Three cases of synchronous renal cell carcinoma and gynecologic malignancies are described. All three cases underwent optimal cytoreductive surgery for the gynecologic malignancy and a radical nephrectomy for the renal cell carcinoma. Adjuvant treatment, after surgery, was individualized in each case. Estrogen and progesterone receptors were positive in all the gynecologic tumors but negative in the renal cell tumors. CONCLUSIONS: This is apparently the largest report of synchronous renal cell carcinoma and gynecologic malignancies. Despite this rare condition, surgery should still be considered as primary treatment for these patients.
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keywords = gynecologic
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8/62. Primary myeloid sarcoma of the gynecologic tract: a report of two cases progressing to acute myeloid leukemia.

    Primary gynecologic myeloid sarcomas are rare, and their diagnosis is often difficult. Differential diagnosis includes lymphomas and carcinomas of the gynecologic tract. We report the clinical, morphological, immunohistochemical and cytogenetic features of two cases of chloromas of the female genital tract, which progressed to acute myeloid leukemia in spite of aggressive therapy.
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keywords = gynecologic
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9/62. Clinical importance of molecular determinations in gynecologic patients with multiple tumors.

    BACKGROUND: The prognosis and treatment of patients with multiple tumors may depend on the correlation between tumors: multiple primary tumors, or recurrent tumors, and metastatic disease. The authors investigated whether the detection of molecular aberrations in multiple gynecologic tumors in individual patients provided clinically useful information on the correlation between the tumors. methods: Between 1999 and 2001, molecular analyses were performed on tissue from 15 gynecologic patients, all with multiple tumors. The molecular analyses included loss of heterozygosity determinations at eight DNA loci and mutation analyses of p53 exons 5-8 using the single-strand conformation polymorphism method. Previously, it was not possible to use routine diagnostic histopathology to determine accurately the correlation between multiple lesions in patients with gynecologic malignancies, information that may have an impact on clinical decision-making and prognosis. RESULTS: Molecular results were obtained from all tumors from each of the 15 patients. The DNA alterations detected provided evidence that two patients had second primary tumors, nine patients had a single tumor with metastases, and four patients had two independent primary tumors as well as metastatic disease. The results provided additional diagnostic information and contributed to clinical decision-making. CONCLUSIONS: The authors demonstrated that, by comparing DNA alterations in multiple tumors within an individual patient, evidence about correlations between the tumors can be obtained. These investigations can be performed on routinely processed tissues, and the results may be of clinical importance in helping to determine the management or prognosis of patients with gynecologic malignancies.
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keywords = gynecologic
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10/62. carboplatin-based chemotherapy in patients with gynecological malignancies on long-term hemodialysis.

    We report on three cases of long-term dialysis patients with gynecological malignancies who were successfully treated with chemotherapy. Two epithelial ovarian carcinoma patients were treated with a single agent, carboplatin (100-200 mg/m2). One recurrent endometrial carcinoma patient was treated with carboplatin (200 mg/m2) and paclitaxel (135 mg/m2). Hemodialysis was started 2 h after the carboplatin infusion and lasted 4 h in all three cases. All patients tolerated these therapies without significant myelosuppression or severe side-effects. Our findings suggest these regimens are feasible, and the combination of paclitaxel and carboplatin is effective chemotherapy when administered to long-term hemodialysis patients with recurrent endometrial carcinoma.
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keywords = gynecologic
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