1/179. Intramedullary spinal metastasis from carcinoma of the cervix.Intramedullary spinal metastases are rare and prior to the availability of MRI were seldom diagnosed antemortem. lung and breast carcinoma are the most common primary sources. Cervical carcinoma is the least likely source of intramedullary spinal metastases. A case of intramedullary spinal metastases is described in a 29-year-old woman with squamous cell carcinoma of the cervix.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/179. Squamous cell carcinoma of suprapubic cystostomy tract without bladder involvement.This report describes a third case of squamous cell carcinoma of the suprapubic cystostomy tract. The first case reported in 1993 concerned a squamous cell carcinoma arising adjacent to the suprapubic cystostomy site and extending anteriorly to the abdominal wall in a 80-year-old man, 5 years after suprapubic urinary diversion for urethral stricture. A second case published in 1995 described a 50-year-old paraplegic man (T11-T12 spinal cord injury) in whom a suprapubic cystostomy tract squamous cell carcinoma developed after 25 years of urinary diversion. The tumour involved the cystostomy tract primarily with extension into the bladder but did not penetrate the bladder wall muscle. Our patient is in fact the second one to have a suprapubic cystostomy tract squamous carcinoma not involving the bladder.- - - - - - - - - - ranking = 0.14285714285714keywords = spinal (Clic here for more details about this article) |
3/179. Clinical delivery of intensity modulated conformal radiotherapy for relapsed or second-primary head and neck cancer using a multileaf collimator with dynamic control.BACKGROUND AND PURPOSE: Concave dose distributions generated by intensity modulated radiotherapy (IMRT) were applied to re-irradiate three patients with pharyngeal cancer. patients, MATERIALS AND methods: Conventional radiotherapy for oropharyngeal (patients 1 and 3) or nasopharyngeal (patient 2) cancers was followed by relapsing or new tumors in the nasopharynx (patients 1 and 2) and hypopharynx (patient 3). Six non-opposed coplanar intensity modulated beams were generated by combining non-modulated beamparts with intensities (weights) obtained by minimizing a biophysical objective function. Beamparts were delivered by a dynamic MLC (Elekta Oncology Systems, Crawley, UK) forced in step and shoot mode. RESULTS AND CONCLUSIONS: Median PTV-doses (and ranges) for the three patients were 73 (65-78), 67 (59-72) and 63 (48-68) Gy. Maximum point doses to brain stem and spinal cord were, respectively, 67 Gy (60% of volume below 30 Gy) and 32 Gy (97% below 10 Gy) for patient 1; 60 Gy (69% below 30 Gy) and 34 Gy (92% below 10 Gy) for patient 2 and 21 Gy (96% below 10 Gy) at spinal cord for patient 3. Maximum point doses to the mandible were 69 Gy for patient 1 and 64 Gy for patient 2 with, respectively, 66 and 92% of the volume below 20 Gy. A treatment session, using the dynamic MLC, was finished within a 15-min time slot.- - - - - - - - - - ranking = 0.28571428571429keywords = spinal (Clic here for more details about this article) |
4/179. Treatment of grade 3 anal intraepithelial neoplasia by complete anal mucosal excision without fecal diversion: report of a case.PURPOSE: The aim of this study was to remove completely the risk of malignant transformation without permanent or temporary fecal diversion in a patient with extensive anal intraepithelial neoplasia. methods: All anal canal mucosa and the lowest 1.5 cm of rectal mucosa were excised and the adjacent rectal mucosa and submucosa advanced to the anal verge skin. RESULTS: The patient achieved normal continence within a month after the operation. Multiple anal canal biopsies at 12 months after the operation revealed normal rectal mucosa. CONCLUSIONS: Total anal mucosal excision offers a relatively simple means of removing the malignant risk of anal intraepithelial neoplasia without fecal diversion in selected patients.- - - - - - - - - - ranking = 0.74355063916486keywords = canal (Clic here for more details about this article) |
5/179. carcinoma of the penis metastasizing to the dorsal spine. A case report.carcinoma of the penis tends to have a predictable route of spread by direct invasion and by regional lymphatic involvement to the inguinal group of lymph nodes. blood-borne distant spread is rare, last to occur, and is seen in 1-3% of cases. Metastasis to the spine is even rarer. We encountered one such case who presented with spinal metastasis, as documented by the whole body bone scan, and this was later followed by involvement of the inguinal nodes. This case is unique in its site of metastatic presentation as well as its pattern of presentation.- - - - - - - - - - ranking = 0.14285714285714keywords = spinal (Clic here for more details about this article) |
6/179. Pigmented squamous cell carcinoma with dendritic melanocyte colonization in the external auditory canal.A case of pigmented squamous cell carcinoma (SCC) with dendritic melanocyte colonization in the external auditory canal is reported and the previous cases are reviewed. A 65-year-old Japanese female was referred with a 7-year history of otitis. The patient also had a darkly pigmented 9 x 8 mm nodule in the external auditory canal. Microscopically, the tumor was SCC, but in some areas melanin pigments were found in the cytoplasm of the tumor cells. The tumor was thus diagnosed as pigmented SCC. As well as the tumor cells, dendritic-shaped cells colonized the tumor parenchyma and were immunohistochemically defined as melanocytes. The authors believe this is the first case of pigmented SCC with dendritic melanocyte colonization in the external auditory canal.- - - - - - - - - - ranking = 2.602427237077keywords = canal (Clic here for more details about this article) |
7/179. Malignant transformation of an ovarian mature cystic teratoma presenting as a rectal mass.BACKGROUND: Squamous cell carcinoma arising from malignant degeneration of a mature cystic teratoma is rare with a reported incidence of approximately 1-3%. The most common presenting symptoms are lower abdominal pain and increasing abdominal girth of several months' duration. Approximately 50% of the patients present with FIGO stage I while 35-38% present with stage III diseases. CASE: The case described herein represents an unusual presentation and initial diagnostic dilemma of locally aggressive squamous cell carcinoma arising in an ovarian dermoid cyst, with invasion into the distal rectum and anal canal causing rectal bleeding similar to the presentation of anal squamous cell carcinoma. Despite aggressive surgical management with posterior exenteration and optimal tumor debulking followed by 5040-cGy pelvic radiation utilizing 25-MV photons, the patient developed pelvic recurrence at the vaginal cuff 6 weeks after completion of her adjuvant radiotherapy. She subsequently failed cis-platinum single-agent chemotherapy and died 9 months after her initial surgery and diagnosis. CONCLUSION: Squamous cell carcinoma in the anal canal, diagnosed by colonoscopy or proctoscopy, could be an unusual presentation of that arising from malignant degeneration of an ovarian dermoid cyst. This tumor may behave in a locally aggressive manner and be resistant to pelvic radiation or single-agent chemotherapy of cis-platinum. The current experience of adjuvant treatment after comprehensive staging and cytoreductive surgery reported in the world literature is limited, and the optimal management of the malignancy remains unclear.- - - - - - - - - - ranking = 0.74355063916486keywords = canal (Clic here for more details about this article) |
8/179. Squamous cell carcinoma of the external auditory canal: two cases treated with high dose rate 192Ir remote afterloading system (RALS).We report two cases of early-stage external auditory canal cancer treated by intracavitary irradiation with a high dose rate (HDR) 192Ir remote afterloading system (RALS) for preoperative treatment. A 6-Fr catheter for the HDR 192Ir remote afterloader, fixed by a plastic earplug, was inserted into the external auditory canal in two cases (case 1, T2N0M0; case 2, T1N0M0). The total intracavitary radiation dosages were 50 Gy (10 Gy/2 Fr/wk for 5 wks) for case 1, and 42 Gy (15 Gy/5 Fr/wk for 3 wks) for case 2. No external irradiation was given in either case. Surgical resection was performed in both cases, three to four weeks after irradiation. Histopathological examination confirmed the post-irradiation changes of necrosis, hyalinosis, and calcification, although vivid cancer cells remained. In preoperative irradiation of external auditory cancer, this method, although limited to treating early-stage cancers, may be a modality of choice for its efficacy and less severe side effects.- - - - - - - - - - ranking = 2.2306519174946keywords = canal (Clic here for more details about this article) |
9/179. Epidural hematoma following epidural analgesia in a patient receiving unfractionated heparin for thromboprophylaxis.BACKGROUND AND OBJECTIVES: The practice of providing postoperative epidural analgesia for patients receiving deep venous thromboprophylaxis with unfractionated heparin is common. This case report is intended to heighten awareness of comorbid risk factors for epidural hematoma and to bring attention to the new ASRA consensus guidelines on the management of neuraxial anesthesia in the presence of standard heparin. CASE REPORT: A 79-year-old woman with apparently normal coagulation and receiving no antiplatelet agents required an abdominoperineal resection for recurrent squamous cell carcinoma of the anus. Approximately 2 hours after her preoperative dose of 5,000 U unfractionated heparin, an epidural catheter was placed on the third attempt. Subcutaneous heparin was subsequently administered every 12 hours. Her international normalized ratio became slightly elevated during surgery while the partial thromboplastin time and platelet count remained normal. The catheter was removed on postoperative day 3, 6 hours after the last dose of heparin. The patient developed signs of an epidural hematoma requiring surgical evacuation on postoperative day 4. The presence of previously undiagnosed spinal stenosis may have contributed to her symptoms. CONCLUSION: Management of postoperative epidural analgesia in the patient receiving thromboprophylaxis with unfractionated heparin requires appropriate timing of epidural insertion and removal, monitoring of coagulation status and vigilance.- - - - - - - - - - ranking = 0.14285714285714keywords = spinal (Clic here for more details about this article) |
10/179. Recurrent rectoneovaginal fistula caused by an incidental squamous cell carcinoma of the neovagina in Mayer-Rokitansky-Kuster-Hauser syndrome.OBJECTIVE: Mayer-Rokitansky-Kuster-Hauser syndrome is a congenital malformation characterized by an absence of the vagina associated with a variable abnormality of the uterus and the urinary tract but functional ovaries. Surgical correction requires the creation of a neovaginal canal by the performance of a neovaginoplasty and an accurate long-term application of an artificial phallus phantom to avoid secondary shrinkage of the canal. Due to the chronic alteration of the posterior neovaginal wall, ulcers and consecutive fistulae may occur. We report the clinical course of a female who required surgical intervention for a rectoneovaginal fistula and developed a recurrence of the fistula due to one of the extremely rare squamous cell carcinomas of the neovaginal epithelium in order to show potential diagnostic and therapeutic features. METHOD: The systematic report of a case is presented. RESULT: Almost 13 years following the initial construction of a neovagina the patient developed a single-tract rectoneovaginal fistula. After surgical repair she represented with a recurrence due to a vast squamous cell carcinoma of the former operation site. Tumor en bloc resection was performed and currently (follow-up: 4 months) she has no signs of new tumor progression. CONCLUSION: Creation of a neovagina is the standard procedure for treating vaginal atresia or aplasia. Because of the long clinical course postoperatively, complications may occur. This report of a case of a malignant transformation in neovaginal epithelium shows the potential risk of malignancy and underlines the necessity of a close follow-up.- - - - - - - - - - ranking = 0.74355063916486keywords = canal (Clic here for more details about this article) |
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