1/10. 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) |
2/10. Advanced gastric cancer with multiple lymph node metastasis successfully treated with etoposide, adriamycin and cisplatin.Gastric cancer usually shows poor sensitivity to chemotherapy, and the presence of lymph node metastases is associated with extremely poor prognosis, especially when the number of such nodes is more than 10. We report here a case of advanced gastric cancer with histopathologically confirmed metastases in 15 regional lymph nodes, in which the recurrent tumor was sensitive to combination chemotherapy. Distal gastrectomy with lymphadenectomy was performed for the primary tumor. A hard (recurrent) tumor was detected in the upper abdomen 5 months postoperatively. Abdominal CT revealed two tumors measuring 3.5 x 1.8 and 3.3 x 2 cm in diameter at the front of the pancreatic head, which suggested recurrence. etoposide, adriamycin and cisplatin (EAP) chemotherapy (20 mg/kg adriamycin, 100 mg/kg etoposide and 50 mg/kg cisplatin (CDDP)) was administered every 6 weeks. The tumors regressed and became undetectable on CT after four cycles. At that stage, CDDP was replaced with 400 mg/kg carboplatin, which was administered every 1 or 2 months. The patient had no recurrence 8 years after surgery. For treatment of advanced gastric cancer with multiple lymph node metastases, a wide resection of the tumor should be performed followed by treatment of the residual tumor cells with a suitable combination chemotherapy taking into consideration the characteristics of the tumor and the condition of the host. We present a patient with gastric cancer and histopathologically confirmed metastases in 15 regional lymph nodes, who was successfully treated by surgery followed by EAP adjuvant chemotherapy. The patient remains alive and well at 8 years after surgery.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |
3/10. Intramedullary spinal cord metastasis from ovarian carcinoma.BACKGROUND: Intramedullary spinal cord involvement by ovarian carcinoma is extremely rare. CASE: A patient with stage IV serous cystadenocarcinoma of the ovary presented with neurologic complaints 16 months after primary treatment. magnetic resonance imaging demonstrated a metastatic lesion in the intramedullary area of the spinal cord. No other site of metastatic disease was observed. The patient received three cycles of carboplatin with complete resolution of the neurologic symptoms and a remarkable reduction of the lesion. Following chemotherapy she was given radiotherapy on the spinal cord, but died 10 months later for disseminated abdominal disease, without neurologic symptoms. CONCLUSION: spinal cord involvement is unusual in ovarian carcinoma; multidisciplinary treatment, including chemotherapy and radiotherapy, may offer good palliation of the symptomatology.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |
4/10. A case of early-stage epithelial ovarian cancer in pregnancy.There are few reports in the literature of platinum-based chemotherapy administered in pregnancy. We present a case of serous adenocarcinoma of the ovary complicating pregnancy. Following laparotomy at 16 weeks of gestation, four cycles of cisplatin were administered prior to confinement at 32 weeks. There were no neonatal sequelae. We believe there is increasing evidence for the safe use of cisplatin in pregnancy.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |
5/10. Hepatic resection of metastatic tumor from serous cystadenocarcinoma of the ovary.Metastatic carcinomas are the largest group of malignant tumors of the liver. But parenchymal liver metastasis from cystic ovarian adenocarcinoma is very rare. We report a case in which the resection of metastatic liver neoplasm from ovarian serous cystadenocarcinoma was done 7 yr after initial treatment. A 48-yr-old oriental housewife complained of easy fatigability and right lower quadrant discomfort. The hepatic mass was detected by ultrasonographic examination. serum albumin, bilirubin, and aspartate aminotransferase/alanine aminotransferase were normal. alkaline phosphatase level was slightly increased at 146 IU/L. A tumor marker study showed alpha-fetoprotein 0.97 IU/mL, carcinoembryonic antigen 0.965 ng/mL, cancer antigen 125 1,267 ng/mL and CA 19-9 106.1 ng/mL. The operation involved cholecystectomy and segmentectomy VI and VII of the liver. The patient recovered from the surgery without any complication. On the 10th postoperative day, the patient received a single-regimen chemotherapy with paclitaxel (Taxol, 155 mg/m(2) BSA) and was discharged. She has been carefully followed-up without any evidence of recurrence after completion of the remaining 5 cycles of chemo-therapy, at intervals of three weeks.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |
6/10. paclitaxel and carboplatin chemotherapy administered during pregnancy for advanced epithelial ovarian cancer.BACKGROUND: Ovarian cancer diagnosed during pregnancy is uncommon. Most chemotherapy use reported has been in combination with cisplatinum. paclitaxel in combination with carboplatin during pregnancy has not yet been reported. CASE: A right adnexal mass was diagnosed during pregnancy at 5 weeks' gestational age in a 30-year-old woman. A laparotomy was performed 2 1/2 weeks later because of the worsening nature of her symptoms and the possibility of ovarian torsion. At surgery, the patient was diagnosed with stage IIIC ovarian papillary serous cystadenocarcinoma. She was treated with six cycles of paclitaxel and carboplatin beginning at 16-17 weeks' gestation. At 35.5 weeks' gestation, a cesarean hysterectomy, left salpingo-oophorectomy, and pelvic and paraaortic nodal sampling with multiple peritoneal biopsies was performed without incident. However, the patient had refractory disease present in the remaining ovary. She was treated with further chemotherapy and is currently doing well. The patient experienced no adverse reactions during her treatment, and the infant has normal growth and development at 15 months of age. CONCLUSION: paclitaxel used in combination with carboplatin for the treatment of ovarian cancer during pregnancy caused no adverse effects in the infant.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |
7/10. Management of advanced-stage primary carcinoma of the fallopian tube: case report and literature review.Primary carcinoma of the fallopian tube is a very unusual gynecologic malignancy that accounts for less than 1% of all malignancies of the female genitalia. A 55-year-old, gravida 7, para 3 woman presented with no gynecologic complaints other than backache. TVS demonstrated a 35 x 25 mm heterogeneous mass that was not clearly separated from the left ovary, and another 31 x 14 mm cystic septated lesion in the left ovary region. Pelvic MRI demonstrated a 35 x 35 x 20 mm left adnexal mass that enhanced with contrast and a neighboring tubular-cystic mass. Upper and lower gastrointestinal endoscopy revealed no malignancy. serum CA 125-level was merkedly elevated at 369 U/ml (normal < 35 U/ml). laparotomy revealed left hydrosalpinx and a papillary-fimbrial mass. Pelvic lymph node metastases were observed. Frozen-section analysis identified the mass as a serous adenocarcinoma. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendectomy, omentectomy, pelvic and para-aortic lymph node dissection, and peritoneal washing were performed. The definitive histopathological diagnosis was primary serous adenocarcinoma of the fallopian tube with six of 25 lymph node biopsies showing metastasis. Six cycles of paclitaxel (175 mg/m2) plus cisplatin (75 mg/m2) combinatin chemotherapy were administered with 3-week intervals between cycles. Second-look laparotomy was performed; there was no evidence of disease. At the time of writing 12 months after the second-look laparotomy, she was still disease-free.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
8/10. 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) |
9/10. 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) |
10/10. Malignant tumors of the ovary or the breast in association with infertility: a report of thirteen cases.BACKGROUND: Many questions have been raised recently about the relationship between infertility, fertility drugs and cancer. This prompted us to evaluate our patients having ovarian or breast cancer with a known history of infertility. methods: We report thirteen women who had been examined and/or treated for infertility before the occurrence of malignant tumors of the ovary or the breast at an age under 50 years in 1990-1995 in our unit. RESULTS: Mean age of the patients was 35 years (s.d. 5.9 years, range 28-47 years). Of the 11 ovarian tumors, one was a malignant teratoma, two were granulosa cell tumors and eight epithelial ovarian cancers. Ten women had received either clomiphene citrate alone or together with gonadotrophins, one had used only gonadotrophins, and in two patients ovarian cancer was detected during an infertility work-up but before any treatment. Four women had used clomiphene for more than twelve cycles. Two patients had ductal breast cancer. CONCLUSIONS: Our patients emphasize the need for follow-up and long-term prospective studies in infertile women who have been evaluated or treated for infertility.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |
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