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1/312. Small cell neuroendocrine carcinoma of the cervix with involvement of multiple pelvic nodes--A successfully treated case by multimodal approach.

    Small cell neuroendocrine carcinoma of the cervix is very rare and is usually associated with dismal prognosis if treated by conventional surgery and radiotherapy even in early stage disease. This tumor is characterized by early lymphatic and hematogenous spread. Only one successfully treated case of small cell neuroendocrine carcinoma of the cervix with dissemination to the pelvic nodes had been reported before in the literature. We are reporting a case of small cell neuroendocrine carcinoma of the cervix with multiple pelvic nodal metastases including the common iliac nodes, which had been successfully treated with a multimodal approach including radical hysterectomy, pelvic/para-aortic lymphadenectomy, and postoperative chemotherapy using cisplatin-etoposide combinations and pelvic irradiation.
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ranking = 1
keywords = radiation
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2/312. The use of fluconazole as a local irrigant for nephrostomy tubes.

    OBJECTIVES: Few data exist concerning the combined use of fluconazole systemically and as an irrigant for nephrostomy tubes in a patient with renal candidiasis. The patient described here presented with renal fungal balls obstructing the drainage of urine from her nephrostomy tubes. methods: Twelve months after chemoradiation for a stage IIB squamous cell carcinoma of the uterine cervix, a 35-year-old woman presented with renal obstruction necessitating insertion of ureteral stents. After 6 months of chemotherapy, the patient developed uremia. After nephrostomy tubes were placed, renal candidiasis was noted, and fluconazole was begun systemically. When the renal candidiasis failed to clear, nephrostomy tube irrigations were begun. RESULTS: Fourteen days of therapy with fluconazole resulted in the resolution of the uremia. The patient died 6 months later with her nephrostomy tubes in situ and without evidence of candidiasis in her urinary tract. CONCLUSIONS: The patient described was successfully treated without having to remove her nephrostomy tubes. Two other authors have reported the successful use of fluconazole irrigation to treat candidiasis in nephrostomy tubes that was unresponsive to systemic fluconazole. Before the appearance of these reports, the best results were obtained with removal of the catheter in renal candidiasis.
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keywords = radiation
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3/312. Rapid progression of squamous cell carcinoma of the cervix after hyperbaric oxygenation.

    The role of hyperbaric oxygenation in the treatment of radiation-induced sequelae and chronic ulcer is well established. On the contrary, a possible cancer-causing or growth-enhancing effect by hyperbaric oxygenation was highly controversial. Herein, we present a 55-year-old Chinese woman with recurrent squamous cell carcinoma of the cervix on her left inguinal area. She received concurrent chemoradiation therapy followed by radical inguinal lymphadenectomy due to persistent tumor mass. The patient was complicated with severe radiation fibrosis and unhealed wounds, so she was treated with hyperbaric oxygenation (HBO). However, the patient died of complications of the disease after completing HBO therapy I month later and autopsy of the patient showed carcinomatosis of the abdominal cavity and lower abdominal wall. Because previous studies have been inconclusive regarding the effect of HBO on tumor cells, we reviewed the possible relation between the HBO and tumor cells.
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ranking = 3
keywords = radiation
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4/312. Intra-abdominal angiosarcomatosis after radiotherapy.

    BACKGROUND: We report a case of a 61-year-old Japanese woman who developed intra-abdominal angiosarcomatosis 20 years after receiving radiotherapy for squamous cell carcinoma of the cervix. methods AND RESULTS: The surgically resected portion of the ileum showed diffuse proliferating angiosarcoma, with irregular channels lined by atypical vascular endothelial cells. Immunohistochemical studies showed that the tumour cells were positive for factor viii-related antigen and ulex europaeus agglutinin 1. At autopsy, the tumour had disseminated to the peritoneum and invaded into the right thoracic cavity. CONCLUSIONS: These findings were compatible with radiation-induced angiosarcomatosis.
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keywords = radiation
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5/312. rhabdomyosarcoma (RMS) of the uterine cervix in two Ethiopian patients: case report.

    Most rhabdomyosarcomas (RMS) of the female genital tract occur in infants and young children as sarcoma botryoides. To our knowledge, RMS of the cervix has never been reported in ethiopia. Two patients with RMS of cervix in their second and third decades of life were seen in a short period of time span at Tikur Anbessa Hospital in the first half of 1996. Difficulties were encountered in reaching a diagnosis and appropriately managing the patients which necessitated the revision of previous biopsy result especially in the first patient. Both presented clinically with bloody vaginal discharge and cervical mass. RMS of the cervix deserves attention in a young patient with cervical mass and bloody vaginal discharge. The excised tissue should be subjected to histopathologic study. Treatment with polychemotherapy and/or radiation in addition to aggressive surgical approach should be made available to obtain good results.
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ranking = 1
keywords = radiation
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6/312. Carcinoma of the uterine cervix metastatic to behind the zygomatic arch: a case report.

    PURPOSE: We propose to present a novel case of a genital malignancy metastatic to the head and neck. Carcinoma of the uterine cervix is the third most frequent malignancy of the female genital tract. Early detection and improved radiation and surgical techniques have resulted in better control of the pelvic tumor and a greater incidence of distant metastasis. Metastases to the soft tissue of the head and neck region have not been reported. methods: We present the first known case of a 35-year-old woman with cancer of the uterine cervix who presented with metastasis to the soft tissue behind the zygomatic arch. RESULTS: The patient received radiation therapy to the zygomatic region and cisplatin therapy with a near-complete remission. CONCLUSION: This case shows that not all squamous cell cancers detected above the clavicles are from a thoracic or a head and neck primary tumor. The atypical location should alert the physician to suspect distant metastasis, rather than locoregional disease.
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ranking = 2
keywords = radiation
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7/312. First case of pregnancy after radical trachelectomy and pelvic irradiation.

    BACKGROUND: Invasive carcinoma of the cervix above stage IA1 is usually treated by radical hysterectomy and/or radiotherapy, leading to definitive sterility. CASE REPORT: We report the case of a young patient with stage IB1 carcinoma of the cervix treated in June 1995 by radical trachelectomy (according to the technique described by Dargent) and adjuvant brachy teletherapy. A hormonal replacement of "menopause" was prescribed. One year later, she became pregnant and at 27 weeks gestation gave birth to a healthy child by cesarean section. CONCLUSION: Radical trachelectomy is one of the most recent therapeutic steps forward in the treatment of early stage invasive cervical carcinoma, which can surely be treated in some cases preserving child-bearing potential.
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ranking = 4
keywords = radiation
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8/312. Intraoperative radiation of the paraaortic nodes in cancer of the uterine cervix.

    Intraoperative electron beam irradiation is being used for the therapeutic and prophylactic treatment of the paraaortic nodes in cancer of the uterine cervix. A Varian 18 meV accelerator is employed at an electron energy setting of 6--18 meV. Special aluminum and lucite collimators allow visualization of treatment area and keep the uninvolved small bowel out of the treatment beam. A one-time dose of 2000 rads is delivered in 4 minutes. The procedure presents no special surgical problems, is well tolerated, and appears as a promising supplement in cases where abdominal exploration for surgical staging of cervical carcinoma is carried out.
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ranking = 5
keywords = radiation
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9/312. radiation-associated rectal cancer: report of four cases.

    BACKGROUND/AIMS: radiation-associated rectal cancer is a remarkable clinical entity. We demonstrate 4 patients (mean age 68 years, range 63-74) who had undergone pelvic radiotherapy for cervical cancer. We indicate some characteristics of radiation-associated rectal cancer. RESULTS: Two patients had received intracavitary and external pelvic radiotherapy, while the remaining 2 had external pelvic radiotherapy following hysterectomy. The mean total radiation dose was 63 Gy, though radiation dose information was not available for 1 patient. Colorectal cancer developed at a mean time of 20.7 years (range 11-30) after radiation therapy. All patients presented with chronic radiation colitis, and 3 demonstrated abnormal tumor markers. colonoscopy revealed an ulcerative, localized well-differentiated adenocarcinoma of the rectosigmoid colon in 1 patient, and diffusely infiltrating cancers of the lower rectum, one signet-ring cell carcinoma and two mucinous carcinomas in the remaining 3. One case was stage I, 2 were stage IIIa, and the remaining case was stage IV. Three patients underwent abdominoperineal resection. The remaining patient was felt to be inoperable. The colorectal wall demonstrated the changes of chronic radiation injury. Two patients died within a short time because of their advanced cancers. CONCLUSION: radiation-associated rectal cancer has a tendency to be diagnosed in the advanced stage and to have a poor prognosis. A literature review and our case report suggest that since there are no reliable clinical or laboratory indicators of the presence of a curable colorectal cancer in the setting of chronic radiation proctocolitis, surveillance with a colonoscope should be done 10 years after irradiation in patients with previous pelvic radiotherapy.
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ranking = 8
keywords = radiation
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10/312. Villoglandular papillary adenocarcinoma of the uterine cervix.

    Villoglandular papillary adenocarcinoma of the uterine cervix was recently (1989) described by three main histological features: exophytic proliferation, papillary architecture and mild to moderate cellular atypicality. The authors report a case of villoglandular papillary adenocarcinoma, clinical stage IB, which was peculiar because of its association with a co-existing and simultaneously discovered invasive squamous cell carcinoma. These two patterns were juxtaposed and not intermingled. The patient was treated with radical hysterectomy followed by vaginal radiation therapy. She remains without evidence of recurrence after 12 months of follow-up. Five main clinicopathological features of the villoglandular papillary adenocarcinoma could be stressed: rare histological variant (72 described cases), young age of patients (25-45 years old), superficial stromal invasion, usual association with other tumoral patterns (in situ or invasive adenocarcinoma as well as in situ or invasive squamous cell carcinoma) and excellent prognosis. For selected cases, a conservative surgical approach (cervical conization) was possible.
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ranking = 1
keywords = radiation
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