Cases reported "Vaginal Neoplasms"

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11/38. Malignant extragastrointestinal stromal tumor presenting as a vaginal mass: report of an unusual case with literature review.

    The clinical and pathologic features of a malignant extragastrointestinal stromal tumor presenting as a vaginal mass are discussed. A 66-year-old female presented with copious vaginal bleeding and spontaneous passage of tumoral tissue per vagina. Histologic assessment showed a mitotically active spindle cell neoplasm. Immunohistochemical analysis demonstrated the neoplasm to be positive for CD117 (transmembrane tyrosine kinase) and CD34, consistent with a malignant extragastrointestinal stromal tumor. Subsequent clinical examination revealed an 8-cm posterior vaginal wall mass, with probable origin from the rectovaginal septum. This case is unique based on the primacy of presenting gynecologic complaints, and the unusual anatomic location of the lesion. A literature review of the pathologic features of extragastrointestinal stromal tumors and factors predictive of biologic behavior are discussed. Correct tumor diagnosis is emphasized given the effective treatment possible with imatinib for patients with unresectable tumors.
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ranking = 1
keywords = gynecologic
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12/38. Extragastrointestinal stromal tumors presenting as vulvovaginal/rectovaginal septal masses: a diagnostic pitfall.

    Gastrointestinal stromal tumor (GIST) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Most GISTs arise in the stomach and small bowel, whereas a small number occur elsewhere in the GI tract. Rare cases are identified outside the GI tract and are collectively known as extragastrointestinal stromal tumors (EGISTs). Because of their malignant potential and recent advances in the management of GISTs with imatinib mesylate (Gleevec, Glivec), it is imperative that these tumors are correctly diagnosed. In this study, we reviewed the clinical and pathologic characteristics of 3 cases of EGIST presenting as vulvovaginal/rectovaginal septal masses that were originally misdiagnosed, presumably due to their unusual anatomic locations. The original diagnoses were leiomyoma in one case and leiomyosarcoma in 2 cases. The lesions were localized to the rectovaginal septum () or vagina () and ranged from 4 to 8 cm in diameter. All 3 lesions had a spindle cell morphology that mimicked a smooth muscle tumor. Mitotic figures numbered from 12/50 to 16/50 high power fields (HPFs; median 15). immunohistochemistry revealed that all 3 cases were strongly positive for KIT (CD117) and CD34 and negative for smooth muscle actin, desmin, pan-cytokeratin, and estrogen receptor. KIT sequence analysis revealed oncogenic mutations in all 3 cases. The first tumor recurred at 2 years and the second tumor recurred at 10 years; the third case is too recent for meaningful follow-up. EGISTs that present as gynecologic masses are rare but may be more common than is currently recognized. Misdiagnosis may lead to inappropriate therapy because conventional chemotherapy and radiotherapy are not effective in the treatment of GISTs, whereas imatinib mesylate (Gleevec, Glivec) has a proven role in managing these tumors. Thus, it is imperative to consider EGISTs in the differential diagnosis of mesenchymal neoplasms in the vulvovaginal/rectovaginal septum.
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ranking = 1
keywords = gynecologic
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13/38. Small-cell carcinoma of the vagina. A clinicopathologic study.

    We report a case of small-cell carcinoma of the vagina in a women whose entire uterus, cervix, both fallopian tubes, and both ovaries had been removed 22 years previously. She presented with diffuse submucosal disease of the distal vagina with a possible soft-tissue component extending beyond the end of the vaginal vault. Extensive microscopic and immunohistochemical assessment established the diagnosis; treatment was initiated with chemotherapy, followed by local radiotherapy. To our knowledge, this is the first fully characterized case of its kind. We discuss the aggressive local behavior and the characteristics of gynecologic small-cell tumors in general.
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ranking = 1
keywords = gynecologic
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14/38. Correction of incontinent ileocolic urostomy with Kock's nipple valve.

    Continent urostomy procedures may be replacing the incontinent ileal or colon conduit as the preferred method of urinary diversion in gynecologic cancer patients. One method of continent urinary diversion utilizes the detubularized ascending and transverse colon as a reservoir with a tapered segment of distal ileum as the stoma through which the patient catheterizes the pouch (Miami pouch). Failures of this procedure have been reported. A case report of such a failure is presented. This patient was managed by replacing the tapered ileal stoma with a Kock intussuscepted nipple valve made from proximal ileum. The patient is now continent. This technique warrants further investigation as a method of treating patients with continent urostomies of various types (Kock, indiana, Miami, Mainz) that become partially or completely incontinent.
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ranking = 1
keywords = gynecologic
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15/38. Complications of laser therapy in the gynecological patient: a review of four patients.

    Complications of gynecological laser treatment for perineal disease have been seen with increasing frequency. This may be the result of more women undergoing therapy with this method. Four women presenting with unstable perineal scarring are discussed.
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ranking = 5
keywords = gynecologic
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16/38. Postirradiation angiosarcoma of the vaginal vault.

    We describe a unique case of an angiosarcoma arising in the vaginal vault 21 years after hysterectomy and radiotherapy for stage I carcinoma of the cervix. We also review the literature regarding angiosarcomas arising after previous radiation therapy for gynecologic malignancies.
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ranking = 1
keywords = gynecologic
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17/38. Solitary metastasis of renal adenocarcinoma to the vagina. A case report.

    Solitary metastases are not unusual in renal adenocarcinomas. Vaginal metastases occur but rarely and are the cause of presentation in most patients. Because of the tumor's similarity to other primary gynecologic tumors, the patients present difficult diagnostic and management problems, as shown by the case reported here.
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ranking = 1
keywords = gynecologic
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18/38. Use of Cavitron Ultrasonic Surgical Aspirator (CUSA) for palliative resection of recurrent gynecologic malignancies involving the vagina.

    Three patients with recurrent ovarian and/or endometrial cancer involving the vagina underwent successful palliative surgical debulking with the Cavitron Ultrasonic Surgical Aspirator (CUSA). Its use minimized bleeding and accomplished temporary control of the tumor.
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ranking = 4
keywords = gynecologic
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19/38. bleomycin, vincristine, mitomycin-C, and cisplatin in the management of gynecological squamous cell carcinomas.

    Twenty-one patients with squamous carcinoma of the genital tract were treated with bleomycin, Oncovin, mitomycin-C, and cisplatin (BOMP). Six patients received BOMP as primary therapy. Five of six responded with one patient having an autopsy-proven complete response after treatment for a disseminated adenosquamous carcinoma. Eight patients were treated for early recurrence, none responded. Seven patients were treated for late recurrences and one responded. We believe that BOMP has significant potential for primary treatment, but not for early or late recurrent disease.
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ranking = 4
keywords = gynecologic
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20/38. Vaginal and bladder angiosarcoma after therapeutic irradiation.

    Angiosarcoma involving the female genitourinary tract is a rare soft tissue malignancy of vascular origin. We have described probably the first reported case of postirradiation angiosarcoma involving the vagina and bladder, and have reviewed the existing literature on the subject of angiosarcoma resulting from previous therapeutic irradiation for gynecologic malignancy.
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ranking = 1
keywords = gynecologic
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