Cases reported "Uterine Neoplasms"

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1/2483. Intrapartum ultrasonographic depiction of fetal malpositioning and mild parietal bone compression in association with large lower segment uterine leiomyoma.

    With normal flexion of the fetal head prior to and during early normal labor, the fetal biparietal diameter becomes engaged in (and subsequently traverses) the anterior posterior aspect of the pelvic inlet. Thus, the biparietal diameter (characterized sonographically by depiction of the falx cerebri, thalami, and cavum septum pellucidum) will be obtainable upon transverse suprapubic placement of the ultrasound transducer during the first stage of labor. Deflexion, or extension, of the fetal head may be demonstrated sonographically at the level of the cervical spine. Recently, during intrapartum ultrasonographic assessment of a nulliparous patient with a known, large, lower-segment, uterine fibroid, exhibiting poor progress of labor, the fetal biparietal diameter was documented upon midsagittal suprapubic placement of the transducer. In addition, mild compression of the distal parietal fetal bone was demonstrated and considered consistent with compression by the leiomyoma. Following abdominal delivery, due to fetal distress and arrest of descent, significant deflexion of the fetal head (not suspected by intrapartum cervical examinations) and mild parietal bone depression, consistent with the ultrasonographic examination, were noted. ( info)

2/2483. Uterine malignant leiomyoblastoma (epithelioid leiomyosarcoma) during pregnancy.

    A case of uterine malignant leiomyoblastoma (UML) which was initially mistaken for uterine leiomyoma on two different occasions is presented. About 20 cases of uterine leiomyoblastoma taking a malignant course have been described in the literature. This case of UML is the first diagnosed during pregnancy. In retrospect, tumor tissue removed from the uterus 4 years earlier already showed histological signs of UML. The large and metastatic tumor showed nuclear atypia, a moderate mitotic index, and tumor cell necrosis, indicating malignancy. Treatment consisted of hysterectomy, bilateral salpingo-oophorectomy, and debulking of most other tumor masses. In the literature, radio- and chemotherapy have not proved to be effective in these tumors. Hormonal therapy has only been used in 2 patients. In this patient, hormonal influence on tumor growth may be substantial. The tumor was progesterone- and estrogen-receptor positive and increased in size rapidly during pregnancy. Since little is known about these tumors further studies are necessary to evaluate hormonal influences both as a causative factor and as a therapeutic possibility. ( info)

3/2483. Coil embolization of coronary supply to a cardiac metastasis.

    Coil embolization of tumor-related coronary arteries was successful in interrupting coronary supply to a cardiac metastasis from uterine leiomyosarcoma. In patients with cardiac metastases of highly malignant tumors this may be a palliative therapeutic approach. ( info)

4/2483. Failure of high-dose chemotherapy with peripheral blood stem cell support for refractory placental site trophoblastic tumor.

    Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease. The metastatic and refractory cases have a very poor prognosis. To our knowledge, this is the first report of the application of high-dose chemotherapy with autologous peripheral blood stem cell transplantation (PBSCT) for the treatment of refractory metastatic PSTT. A 36-year-old woman had a metastatic PSTT refractory to several lines of chemotherapy. She was treated with high dose of carboplatin and etoposide with autologous PBSCT. She showed only a temporary response to high-dose chemotherapy with PBSCT support and died of disease. ( info)

5/2483. leiomyoma of the uterus showing skeletal muscle differentiation: a case report.

    A case of uterine leiomyoma with skeletal muscle differentiation is described. The patient is a 40-year-old woman who underwent abdominal hysterectomy and left salpingo-oophorectomy for fibroids. Evidence of skeletal muscle differentiation was evident at light and electron microscopy in one out of three "ordinary" leiomyomas. This was also shown by positive immunoreactions with antiskeletal muscle actin and myoglobin antisera. To our knowledge, this is the second case reported of the occurrence of skeletal muscle differentiation within a uterine leiomyoma and highlights the divergent differentiating potential of smooth muscle cells. ( info)

6/2483. sciatic neuropathy secondary to a uterine fibroid: a case report.

    Lesions of the sciatic nerve outside the pelvis have been well described. Lesions within the pelvis, however, are far less common. We report the case of a 55-yr-old woman with a history of chronic low back pain who presented with progressive right buttock and posterolateral right lower limb pain associated with right foot numbness and tingling. She denied any associated low back or left lower limb pain. The patient was initially treated for a probable right lumbosacral radiculopathy, without improvement. A subsequent magnetic resonance image of the lumbosacral spine revealed multilevel disc degeneration at L3-4 through L5-S1, without disc herniation or canal stenosis. A magnetic resonance image of the pelvis revealed a markedly enlarged uterus, with a large pedunculated myoma impinging on the right sciatic foramen. The patient underwent a subtotal abdominal hysterectomy, with resolution of her right lower limb pain. This case illustrates the importance of considering intrapelvic causes of sciatic neuropathy. To our knowledge, this is the first reported case of sciatic neuropathy secondary to a uterine fibroid. ( info)

7/2483. Complete clinical responses to neoadjuvant chemotherapy for uterine serous carcinoma.

    Three cases of serous carcinoma of the uterus with radiographically documented widespread metastases are presented. Following confirmation of histopathology, all were treated with a standard regimen of carboplatin and paclitaxel for eight courses with complete resolution of distant metastases on CT scan prior to postchemotherapy surgical exploration. Two patients had gross disease at laparotomy, and one had only microscopic tumor found in the uterine specimen. This experience offers rationale for treatment of patients with widely metastatic uterine serous carcinoma or other relative contraindications to surgery with primary carboplatin and paclitaxel. In addition, we believe this experience supports the hypothesis that this regimen may result in prolonged disease-free survival when employed as postsurgical adjuvant therapy. ( info)

8/2483. 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. ( info)

9/2483. Embolic occlusion of the blood supply to uterine myomas: report of 2 cases.

    Uterine myomas are the most common tumours of the female genital tract and with menorrhagia provide the most common indications for hysterectomy. Whilst myomectomy is a surgical alternative, it is associated with greater morbidity and a higher blood transfusion rate. Arterial embolization of myomas is a nonsurgical treatment option that can be performed as an outpatient procedure, is cheaper than myomectomy, permits preservation of reproductive potential, and may not only be associated with less morbidity than myomectomy but also may not cause adhesions which could compromise fertility. This paper details 2 cases treated by this technique. ( info)

10/2483. carcinosarcoma, endometrial intraepithelial carcinoma and endometriosis after tamoxifen therapy in breast cancer.

    The fourth case of heterologous mesodermal tumour of the uterine corpus, that developed, years following tamoxifen therapy for breast cancer in a postmenopausal woman with no previous pelvic irradiation, is presented with coincidental endometriosis and endometrial intraepithelial carcinoma. This coincidence after tamoxifen treatment appears to be an indication for the possible carcinogenic potency of tamoxifen. ( info)
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