Cases reported "Uterine Neoplasms"

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11/97. choriocarcinoma and human immunodeficiency virus (hiv) infection: a case report.

    The appropriate management of gynecological malignancies in human immunodeficiency virus (hiv)-infected patients is uncertain. gestational trophoblastic disease is highly curable and occurs predominantly among young females. However, such patients are often immunocompromised and cytotoxic agents may further compromise immunity. This case report demonstrates the successful management of choriocarcinoma in a hiv-infected patient.
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12/97. Metastatic uterine papillary serous carcinoma to the pericardium.

    BACKGROUND: Uterine papillary serous carcinoma is an aggressive tumor with a high propensity for distant spread. Metastases to the heart or pericardium are rare in gynecologic malignancies and usually fatal. CASE: A 64-year-old African American woman was diagnosed with recurrent uterine papillary serous carcinoma metastatic to the pericardium. Her case at presentation was significant for an elevated serum CA-125, evidence of metastatic disease to the liver, and massive cardiomegaly. Cytologic analysis of fluid obtained by pericardiocentesis confirmed recurrence. Despite treatment with paclitaxel and a pleuropericardial window, the patient succumbed to her disease. CONCLUSION: The prognosis for patients whose recurrent uterine papillary serous carcinoma has metastasized to the heart or pericardium is extremely poor. Effective adjuvant and salvage therapies are essential.
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13/97. Uterine angiomyolipoma: case report and review of the literature.

    Extrarenal angiomyolipomas (AML) have been reported at various anatomical sites, but infrequently in the gynecological region. In the uterus, only a few cases have been described. We describe a uterine angiomyolipoma occurring in a 40-year-old woman without evidence of tuberous sclerosis. The tumor arose on the right wall of the uterine body and was partially cystic, and it was associated with marked degeneration. It was composed of mature adipose tissue, anomalous blood vessels and non-vascular smooth muscle cells. immunohistochemistry revealed that non- vascular smooth muscle cells were positive for alpha-smooth muscle actin (alpha-SMA), desmin, vimentin, antihuman muscle actin (HHF35) and progesterone receptor (PR), and negative for cytokeratin, antihuman melanoma (HMB45), CD34, S-100 and estrogen receptor (ER). It is of particular interest that non-vascular smooth muscle cells were negative for HMB45, in contrast to renal and other extrarenal AML in which HMB45 immunoreactivity has been demonstrated in these cells.
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14/97. Ischemic uterine rupture and hysterectomy 3 months after uterine artery embolization.

    The exact frequency and extent of complications after uterine artery embolization (UAE) have yet to be documented in the literature. Ischemic necrosis and rupture of the uterus is a theoretical concern of this procedure. Rupture of the uterus from any cause is a very serious gynecologic complication requiring immediate surgical intervention to prevent death. Ischemic necrosis and rupture of the uterus can occur months after UAE. In our patient they occurred 3 months after UAE for treatment of symptomatic uterine myomas, and required hysterectomy. To our knowledge, this is the first report of ischemic uterine rupture after UAE in the united states.
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15/97. Intravenous leiomyomatosis of the uterus.

    BACKGROUND: Intravenous leiomyomatosis is a rare uterine tumor defined as an intraluminal growth of benign smooth muscle cells in either venous or lymphatic vessels outside the confines of, or even in absence of leiomyomas. We report a case of intravenous leiomyomatosis of the uterus managed at our institution. CASE REPORT: The patient, a 47-year-old woman; gravida 2 para 2, presented without complaints for a routine gynecological examination. An irregular-shaped enlarged uterus with a nodular pelvic mass extending into the broad ligament was found laparotomy revealed a large retroperitoneal, moderately firm tumor which demonstrated fingerlike projections into the pelvic veins. Due to great blood loss, surgery had to be discontinued with substantial residual disease and our patient was set on a regimen of the GnRH analogue leuprolide, which was applied over 5 months. This led to a reduction of the tumor which facilitated successful surgery. The primary tumor as well as the residual disease were classified as a leiomyoma with intravenous extension consisting of uniform, spindle-shaped smooth muscle cells in a whorled arrangement. Mitotic activity was low and pleomorphism was missing. Areas with degenerative changes were found, as well as prominent vascularity. At the right parametrium, the lumina of the dilated veins were filled with tumor. Immunhistochemically, the intravascular parts of the tumor revealed a positive staining reaction for vimentin, desmin and alpha-smooth muscle actin. The tumor also reacted for antibodies against estrogen- and progesterone-receptors. CONCLUSION: knowledge about this rare uterine tumor is important for adequate treatment and exact differential diagnosis. Though intravenous leiomyomatosis imitates a malignant neoplasm regarding its pattern of growth and extension, it must be differentiated histologically from malignant tumors to prevent overtreatment. Since intravenous leiomyomatosis demonstrates a tendency to recur, long-term follow-up of the patient is recommended.
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16/97. tamoxifen-related uterine carcinosarcomas occur under/after prolonged treatment: report of five cases and review of the literature.

    The risk of tamoxifen-related endometrial adenocarcinoma is well established with daily dose and treatment duration of adjuvant tamoxifen as risk factors. There have also been in the past years, a few descriptions of uterine nonepithelial malignancies occurring after tamoxifen. We describe five recent cases of uterine carcinosarcomas occurring under/after tamoxifen administered in an adjuvant setting. None of these patients had received prior pelvic radiation therapy. Their median age at the diagnosis of breast cancer was 58 years (41-68), and 69 years (50-84) at the diagnosis of uterine carcinosarcoma. The median length of exposure to tamoxifen was 9 years (5-20), and the median time from the initiation of tamoxifen to the diagnosis of the uterine malignancy (latency period) 9 years (7-20). All patients presented with an advanced stage (IIA-IVA). Our data, together with those of the literature, plead for a causal role of a prolonged exposure to tamoxifen on the subsequent development of uterine carcinosarcoma. The long latency period observed even in patients receiving only 5 years of treatment leads us also to consider a prolonged gynecologic follow-up of the patients.
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17/97. Primary uterine tumors and multiple endocrine adenomatosis, type I.

    Multiple endocrine adenomatosis, Type I was initially diagnosed in a 35-year-old woman with primary chief cell hyperplasia of the parathyroids. Approximately 5 years later, vaginal bleeding developed and a well-differentiated endometrial adenocarcinoma was recognized. An adenomatoid tumor of the uterus was discovered in addition to a nonfunctional islet cell tumor of the pancreas. Multiple endocrine adenomatosis is reviewed in relation to possible gynecologic neoplasms.
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18/97. Uterine papillary serous carcinoma after pelvic radiation therapy for cancer of the cervix.

    The carcinogenic effect of ionising radiation in humans has well documented in both atomic bomb survivors and patients exposed to therapeutic radiation. patients irradiated for cancer of cervix have frequently been studied for the later development of secondary malignancies because treatment is relatively successful and many patients survive long enough to be at risk for late complications of radiotherapy. Most investigations have revealed an increased incidence of uterine sarcoma following pelvic radiation therapy for a variety of gynecologic disorders (Norris and Taylor, 1965; Fehr and Prem, 1974). Wagoner, in a review of over 1800 women treated with ionising radiation for invasive cervical cancer, reported a fourfold increase in risk for the later development of uterine sarcoma (Wagoner, 1984). In this paper we report the case of uterine papillary serous carcinoma 16 years after pelvic x-ray therapy for cervical cancer.
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19/97. Acquired hypertrichosis lanuginosa associated with endometrial malignancy.

    A 46-year-old nulligravida complained of the recent development of an erythematous skin eruption and fine blond hair over her face. These complaints appeared to be symptoms of acquired hypertrichosis lanuginosa, which may be associated with malignancy. The patient was found to have an endometrial adenocarcinoma with nodal metastases and was treated with hysterectomy and irradiation. Eighteen months later there was no evidence of the cancer, and the lanugo hairs had vanished. This is the first known instance of hypertrichosis lanuginosa associated with a gynecologic cancer and the first ever observed in which the lanugo hairs disappeared after cancer therapy.
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20/97. Successful use of anti-retroviral therapy in combination with cytotoxic chemotherapy for persistent molar pregnancy: a case report.

    Due to the hiv pandemic, the chances of finding gynecological malignancies in hiv-infected women are increased. This poses management and ethical dilemmas as the treatment for such malignancies are likely to further decrease their immunity. gestational trophoblastic disease occurs predominantly among young women and has excellent response to chemotherapy. However, such therapy is not possible if their immunity (CD4 counts) is markedly depressed. The patient described presented with persistent molar pregnancy and had low CD4 count. She was given antiretroviral therapy and once the CD4 count had risen to acceptable levels cytotoxic chemotherapy was administered. She received a total of 13 cycles of chemotherapy with no significant untoward effects. After a 6-month follow-up period the patient was well with a negative serum betaHCG level and CD4 count above 200. We conclude that hiv-infected women with gestational trophoblastic disease may be safely treated with cytotoxic chemotherapy provided anti-retroviral therapy is concurrently administered to boost immunity.
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