Cases reported "Uterine Neoplasms"

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1/271. Malignant mixed Mullerian tumor with rhabdoid features: a report of two cases and a review of the literature.

    Rhabdoid tumors were originally described as a type of pediatric renal neoplasm that contains cells resembling rhabdomyoblasts but lacking muscle differentiation. Extrarenal rhabdoid tumors have since been reported in multiple anatomic sites in the pediatric and adult population. These tumors are characterized by an aggressive clinical course, resistance to treatment, and a rapidly fatal outcome. Eight cases of uterine neoplasms with rhabdoid differentiation have been previously reported. In the three cases where clinical follow-up was available, the patients died of disease within 3 to 17 months after the diagnosis was established. We report two cases of uterine malignant mixed Mullerian tumor (carcinosarcoma) with rhabdoid differentiation. The findings and clinical outcome confirm the aggressive nature of uterine tumors with rhabdoid differentiation. One of the patients died of disease 3 months after initial operative treatment while the other patient's tumor recurred in 1 month and she died within 10 weeks. The poor prognosis of these neoplasms makes their histopathologic recognition important.
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2/271. Vision disturbances after operative hysteroscopy.

    Vision disturbance after transurethral resection of the prostate using glycine (1.5% aminoacetic acid) as the irrigating fluid is well known (TURP syndrome). Not so commonly seen or reported is transient blindness after operative hysteroscopy with glycine. It occurred in a 38-year-old woman who underwent hysteroscopic myomectomy and endometrial resection in which the distention medium was glycine. (J Am Assoc Gynecol Laparosc 6(2):213-215, 1999)
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3/271. Exaggerated placental site erroneously diagnosed as non-metastatic trophoblastic disease. A case report.

    BACKGROUND: Exaggerated placental site (EPS) is classified as a non-neoplastic trophoblastic lesion, and histologically it consists of endometrial and myometrial invasion of intermediate trophoblasts and syncytiotrophoblasts and it differs morphologically from placental site trophoblastic tumors and placental nodules. The purpose of this report is to increase physicians' awareness of this lesion. CASE: A 48-year-old woman with post-molar rising betahCG titers and a clinical diagnosis of non-metastatic trophoblastic disease underwent hysterectomy. Final histopathology showed exaggerated placental site--a lesion often unfamiliar to clinicians. CONCLUSION: It is suggested that operative hysteroscopy may be useful in the diagnosis and management of EPS.
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4/271. Cytopathological observations in a 27-year-old female patient with endometrioid adenocarcinoma arising in the lower uterine segment of the uterus.

    The determination of the malignancy of an endometrioid adenocarcinoma arising in the lower uterine segment (LUS) is difficult because of the high degree of differentiation of adenocarcinoma. The cytopathological and immunohistochemical features of endometrioid adenocarcinoma arising in the LUS of a young adult female are presented. The preoperative cytopathological examination of a 27-yr-old female could not enable an accurate diagnosis of malignancy. hysterectomy specimens revealed the presence of an endometrioid-type adenocarcinoma with minimal atypia and myometrial invasion, which was located in the LUS. This tumor was consistent with a histological diagnosis of endometrioid minimal-deviation adenocarcinoma (MDA). Immunohistochemically, the tumor's glands were p53-, proliferating cell nuclear antigen-, and carcinoembryonic antigen-positive, and estrogen receptor-, progesterone receptor-,and vimentin-negative. The cytological and surgical specimens showed a remarkable association of squamous metaplasia. Although cytopathological difficulties in determining malignancy of MDA endometrioid adenocarcinoma arising in the LUS are well-known, the following features worth noting include: 1) squamous metaplasia on cytological and histological slides; 2) epithelial cells incorporating polymorphic nuclear neutrophils on cytological slides; and 3) positive immunohistochemistry of p53 protein. Diagn. Cytopathol. 1999;21:117-121.
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5/271. Pulmonary leiomyomatosis in women after hysterectomy for uterine myoma. Benign metastasizing leiomyoma?

    INTRODUCTION: Leiomyomas, which usually occur multilocular in uterus, can develop even if rarely in other organs with smooth muscle cells. The tumour is considered benign; 2 case reports supports the hypothesis that uterus myoma could metastasize, and in the metastasis sites grow invasively. methods: 2 female patients 44 y. and 29 y. old were admitted to our clinic for MPL. Due to increasing tumor size respectively dypnea, they were operated on. Multiple nodules of the left lung in one case, and a mediastinal tumour in the other were resected; resected tumour was histologically examined. RESULTS: In both cases it was a matter of well-differentiated leiomyosarcoma. The mediastinal tumour has already invade the N. phrenicus. Postoperatively there were no complications. patients discharged in well-doing state, medical control one year later revealed no new growth. CONCLUSION: Multiple pulmonary leiomyomas are rare, they occur in sexually mature women in coincidence with uterus myoma. Even though many authors assume that MPL is a lung metastasis of benign tumours, the pathogenesis is still hypothetical. Supporting this thesis is the hormone dependence of both the uterine and the pulmonary tumours; against it, is that extrapulmonary locations are too rarely observed. The still open pathogenetical question has no therapeutical consequence. Whenever technically possible, a radical, parenchyma-saving surgical therapy should be the first choice. Otherwise hormon-ablation is a good alternative.
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6/271. Sonographic evaluation of a leiomyoma of the broad ligament of the uterus.

    Leiomyomas of the uterus generally have a characteristic ultrasound appearance. We present a case of leiomyoma of the broad ligament of the uterus. A 46-year-old woman who had previously undergone a hysterectomy had a pelvic mass with a whorled appearance and acoustic shadowing suggestive of a leiomyoma on sonography. Based on the sonographic appearance, a preoperative diagnosis of a leiomyoma was made despite the unusual location. Histologic examination of the excised mass revealed leiomyoma originating from the broad ligament.
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7/271. pancreaticoduodenectomy for metastatic tumors to the periampullary region.

    Although operative resection of metastatic lesions to the liver, lung, and brain has proved to be useful, only recently have there been a few reports of pancreaticoduodenectomies in selected cases of metastases to the periampullary region. In this report we present four cases of proven metastatic disease to the periampullary region in which the lesions were treated by pancreaticoduodenectomy. Metastatic tumors corresponded to a melanoma of unknown primary site, choriocarcinoma, high-grade liposarcoma of the leg, and a small cell cancer of the lung. All four patients survived the operation and had no major complications. Two patients died of recurrence of their tumors, 6 and 63 months, respectively, after operation; the other two patients are alive 21 and 12 months, respectively, after operation. It can be inferred from this small but documented experience, as well as a review of the literature, that pancreaticoduodenectomy for metastatic disease can be considered in selected patients, as long as this operation is performed by experienced surgeons who have achieved minimal or no morbidity and mortality with it.
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8/271. Effectiveness of an inferior vena caval filter as a preventive measure against pulmonary thromboembolism after abdominal surgery.

    In three patients with a previous history of pulmonary thromboembolism, inferior vena caval filters were inserted before elective laparotomies to prevent a recurrent pulmonary thromboembolism. Two patients had colon cancer and underwent colectomies, while the other had myoma uteri, which might have been the cause of deep vein thrombosis, and thus a hysterectomy was performed. In spite of their poor risks, their postoperative courses were fairly good owing to perioperative management including anticoagulant therapy, and no recurrence has been observed since the operation in every case. A pulmonary thromboembolism is a fatal complication which follows deep vein thromboses. In patients with such a previous history, the risk is much higher after a laparotomy because of long-term bed rest, hypercoagulability, and so on. The mortality rate after a recurrence of pulmonary thromboembolism is reported to reach 30% without adequate therapy, whereas it is reduced to 8% with anticoagulant therapy, and to 0.8% with additional inferior vena caval filter placement. Considering the feasibility of insertion and the low incidence of complications, preoperative inferior vena caval filter placement is thus recommended for patients having a previous history of either pulmonary thromboembolism or deep vein thrombosis.
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9/271. Torsion of a functional ovarian cyst in a premenopausal patient receiving tamoxifen.

    We report a case of torsion of an ovarian follicular cyst that developed during treatment with tamoxifen for breast cancer. A 40-year-old Japanese woman was admitted complaining of acute lower abdominal pain. Eight months earlier, she had undergone a partial mastectomy and local irradiation for ductal carcinoma of her left breast, estrogen receptor-positive stage I (T(1a) N(1b) M(0)). The administration of tamoxifen, 20 mg/day, and doxifluridine, 600 mg/day, were started immediately postoperatively. Pelvic examination after admission revealed the left ovarian cyst and enlarged uterus. Transvaginal ultrasonography and computed tomography revealed a multilocular cystic mass in the pelvic cavity. The pathological diagnosis of the tumor after total hysterectomy and bilateral salpingo-oophorectomy was a typical follicular cyst with torsion and uterine leiomyoma. This ovarian cyst was believed to have developed during tamoxifen administration.
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10/271. A novel interventional therapy using the combination of bilateral bronchial stent dilatation and percutaneous cardiopulmonary support for critical airway obstruction due to metastatic carcinomatous carina.

    For an inoperative critical airway obstruction (bilateral bronchial stenoses) from a carcinomatous carina due to the mediastinal lymphnodal metastasis from uterine cancer, we succeeded in improving the patient's severe dyspnea by the combination of bilateral bronchial stent dilatation and a percutaneous cardiopulmonary support (PCPS) system. The imminent airway stenosis with severe dyspnea may have a high risk of asphyxia and contact-flooding during implanting of the stent. By the novel use of PCPS in advance for blood-oxygenation as a respiratory support, we could safely perform the interventional therapy of bronchial expandable metallic stents, and the patient obtained a good quality of life without dyspnea until she died of systemic metastatic cachexia. This technique may possibly be approved as an option for temporary remission therapy of a critical airway obstruction.
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