1/8. Hemorrhagic pyelitis, ureteritis, and cystitis secondary to cyclophosphamide: case report and review of the literature.OBJECTIVE: Hemorrhagic cystitis is a well-known complication of cyclophosphamide therapy but extensive involvement of the entire urinary tract is far less common. We report here a patient who developed severe hemorrhagic pyelitis, ureteritis, and cystitis after one cycle of cyclophosphamide-containing combination chemotherapy. METHOD: A patient with synchronous carcinoma of the ovary and the uterus developed severe hemorrhagic pyelitis, ureteritis, and cystitis leading to bilateral hydronephroses and acute renal failure after one cycle of combination chemotherapy containing cyclophosphamide. The blood clots in the upper urinary tract were aspirated endoscopically and bilateral internal ureteric stents were inserted. RESULT: She underwent a prolonged diuretic phase with several episodes of hypokalemia, hypomagnesemia, and hypocalcemia and required intensive fluid and electrolytes replacement. Subsequently, she recovered fully with the ureteric stents removed 26 days later. CONCLUSION: In contrast to previous reports, where 2.8 g of cyclophosphamide was estimated to be the minimum cumulative dose required to cause hemorrhagic cystitis, this case illustrates that severe hemorrhagic complication can occur even after a low dose of cyclophosphamide (600 mg/m(2), total dose of 846 mg). Prompt diagnosis and intervention may be life-saving.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
2/8. Ovarian yolk sac tumor associated with endometrioid carcinoma and mucinous cystadenoma of the ovary.The clinicopathologic and immunohistochemical findings of an unusual case of ovarian yolk sac tumor associated with endometrioid carcinoma and mucinous cystadenoma of the ovary are reported. The tumor was detected in a 51-year-old postmenopausal woman who presented with abdominal swelling and a pelvic mass. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy. The tumor was confined to the right ovary and measured 16.0 cm in greatest dimension. Microscopic examination revealed that the tumor had a yolk sac component associated with an endometrioid carcinoma, grade I, and a mucinous cystadenoma. A background of atypical endometriosis was noted. Immunoperoxidase studies showed that the yolk sac component stained diffusely with a cytokeratin cocktail and was focally positive for alpha-fetoprotein. It was negative for keratin 7. In contrast, the endometrioid carcinoma stained positive for keratin 7 in addition to the cytokeratin cocktail, but was negative for alpha-fetoprotein. After surgery, the patient received three cycles of chemotherapy. However, the disease progressed and the patient died 10 months after the diagnosis of the ovarian tumor.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |
3/8. Chronic administration of single weekly paclitaxel in heavily pretreated ovarian cancer patients.Ovarian cancer patients with paclitaxel-resistance have been reported to respond to a weekly schedule of the same drug. In this report, two cases with long progression free interval by weekly paclitaxel (T) are presented. Case 1. A 41-year-old Japanese woman, gravida 2, para 0, was referred to our hospital in September 16, 1998, because of abdominal mass accompanying large amount of ascites with elevated CA125 (8400 U/ml) and CA19-9 (770 U/ml). Exploratory laparotomy (tumor biopsy plus partial omentectomy) was performed September 21, 1998. After the surgery, the tumor was diagnosed as serous cystadenocarcinoma of the ovary (stage IV) and 6 cycles of treatment consisting of cyclophosphamide, adriamycin and cisplatin (CAP) were performed. The CA 125 level (8400 U/ml) rapidly declined to 150 U/ml by this CAP therapy. After second cytoreductive surgery (SRS) (total hysterectomy and bilateral salpingo-oophorectomy), residual tumor was less than 2 cm. Although 7 cycles of CAP was added, ascites and elevation of CA 125 (5100 U/ml) were observed. Therefore, treatment with single weekly T was performed and CA 125 levels remained between 70-90 U/ml during 13 cycles of this therapy (progression free interval; more than 1 year). Thereafter, she is alive with disease and followed-up. Case 2. A 48-year-old Japanese woman, gravida 3, para 2, was referred to our hospital in July 22, 1998, because of abdominal swelling and pain. Computing tomography (CT) and magnetic resonance imaging (MRI) revealed large amount of ascite and pelvic mass (9 x 7 x 7 cm), and low density area (3 x 3 cm) suggesting metastasis in right lobe of liver. serum CA 125 level elevated to 5100 U/ml. Bilateral salpingo-oophorectomy and infracolic omentectomy were performed on August 5, 1998. The tumor was diagnosed as endometrioid adenocarcinoma of the ovary, stage IV and chemotherapy with CAP was initiated on September 5, 1998. After 6 cycles of CAP, SRS was performed. After SRS, 3 cycles of CAP were added and changed to weekly T because of damage of renal function. The CA 125 level returned within normal range during weekly T. Total 13 cycles of weekly T were performed and progression free interval was about 18 months. Thereafter, she received treatments with gamma knife and CAP for brain metastasis. She is alive without disease and followed-up. Side effects by weekly T were mild and tolerable despite of long term treatment. In addition, weekly T can be safely used in outpatient setting and even in patients with poor performance status (PS), and warrant long time to progression.- - - - - - - - - - ranking = 3keywords = cycle (Clic here for more details about this article) |
4/8. Atypical sigmoid metastasis from a high-grade mixed adenocarcinoma of the ovary.BACKGROUND: Intraperitoneal seeding is the most common form of dissemination of epithelial ovarian cancer. Metastasis to the bowel mucosa can occur by invasion from the serosal surface or infiltration of the submucosal capillary network. Hematogenous dissemination usually occurs in the presence of advanced peritoneal disease. CASE: A 39-year-old gravida 3 para 2 woman was diagnosed in October 2000 with a large pelvic mass. She underwent an exploratory laparotomy and a left salpingo-oophorectomy with multiple abdominal and pelvic biopsies. She was diagnosed with an ovarian tumor of low malignant potential, and no further treatment was recommended. Six months later, she developed abdominal discomfort and constipation. A colonoscopy was performed, and a biopsy showed metastatic carcinoma of ovarian origin. The patient presented to The University of texas M.D. Anderson Cancer Center in September 2001 for consultation. The surgical pathology evaluation from her previous surgery indicated high-grade ovarian carcinoma. The patient underwent a total abdominal hysterectomy, right salpingo-oophorectomy, infracolic omentectomy, right pelvic lymph node sampling, and segmental resection with primary end-to-end sigmoid colon anastomosis. The tumor within the colon was a polypoid mass arising from the mucosa with no involvement of the colonic wall. Microscopically, the tumor was a high-grade ovarian papillary serous carcinoma with areas of endometrioid adenocarcinoma. The colonic tumor was immunohistochemically positive for cytokeratin-7 and negative for cytokeratin-20. The patient was treated with six cycles of carboplatin and paclitaxel. The patient then incidentally developed disseminated sarcoidosis. At the time of this report, the patient had no evidence of recurrent or metastatic disease for 2 years. CONCLUSIONS: Epithelial ovarian carcinomas may recur as intraluminal bowel lesions with serosal sparing even in the absence of peritoneal disease. Immunohistochemical staining using cytokeratins-7 and -20 may prove useful in differentiating such lesions from primary colonic malignancies.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |
5/8. Cutaneous metastasis of endometrial carcinoma with hemorrhagic nodules and papules.BACKGROUND: endometrium cancer is the fourth most frequent malignancy in women. However, skin metastasis from endometrium cancer is a very rare entity. CASE: A 58-year-old multiparous woman postmenopausal for ten years presented with multiple metastatic, nodular, hemorrhagic skin lesions located at the initial surgery and radiotherapy site 14 months after the original diagnosis was made. Combination chemotherapy was instituted, but the patient died after the second cycle of chemotherapy. CONCLUSION: Although endometrial cancer is one of the most frequent malignancies in women, skin metastasis from endometrial cancer is very rare. In reported cases metastasis from endometrial cancer has been most commonly noted at the initial surgery and radiotherapy site. Therefore, the initial surgical and radiotherapy site must be examined carefully for skin metastasis.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |
6/8. Complete remission of an endometrial carcinoma with bilateral multiple pulmonary and extrapelvic metastases treated by surgery and chemotherapy consisting of paclitaxel and carboplatin.Successful management of a patient with endometrioid type, grade 2 endometrial carcinoma with bilateral multiple pulmonary and extrapelvic abdominal metastases has been reported. A 61-year-old woman with the preoperative diagnosis of stage IVB endometrial carcinoma underwent surgery followed by six cycles of chemotherapy consisting of paclitaxel (175 mg/m2) and carboplatin (area under curve 5). After the sixth course, there were no abnormal findings on chest and abdominal computed tomography. She has no evidence of disease recurrence 24 months after the induction of chemotherapy. Tumor markers are within normal limits. Endometrial carcinoma with pulmonary metastases, especially those with bilateral multiple pulmonary metastases associated with additional extrapulmonary spread can be successfully treated by extensive surgery followed by chemotherapy consisting of paclitaxel and carboplatin.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |
7/8. Endometrial carcinoma with laparotomy wound recurrence: complete remission following surgery and chemotherapy consisting of paclitaxel and carboplatin.We present a patient with surgical stage I endometrial cancer who experienced laparotomy wound recurrence 4 years after primary treatment. She was treated successfully by complete surgical resection of recurrent tumors and chemotherapy. A 62-year-old white female with laparotomy wound recurrence of endometrial carcinoma with small-bowel involvement and concomitant subcutaneous metastasis in the abdominal wall underwent complete surgical resection of metastatic tumors followed by six cycles of chemotherapy consisting of paclitaxel (175 mg/m2) and carboplatin (area under the curve 5). Since 24 months after resection of recurrence, she has no evidence of disease recurrence. Endometrial carcinoma with laparotomy wound recurrences, especially those with concomitant metastases, can be successfully treated by complete surgical resection followed by chemotherapy consisting of paclitaxel and carboplatin.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |
8/8. Ovarian endometrioid adenocarcinoma coexistent with benign and borderline endometrioid adenofibroma: a case report.A well-differentiated endometrioid adenocarcinoma coexistent with benign and borderline-malignant endometrioid adenofibroma was found in the ovary of a 64-year-old woman. She had vaginal bleeding caused by simple hyperplasia of the endometrium due to high levels of sex steroid hormones. A FIGO stage Ia solid ovarian tumor was identified. It was composed of irregularly shaped endometriotic glands with benign and borderline malignant cytologic features embedded in abundant fibromatous stroma. Well-differentiated malignant epithelium was adjacent to these areas, but fibromatous stroma was not predominant. She was treated by surgery and three cycles of chemotherapy. This paper describes this unusual tumor and reviews the literature.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |