1/3. Abnormal uterine bleeding as a presenting sign of metastasis to the endometrium in a patient with a history of cutaneous malignant melanoma.BACKGROUND: Metastatic melanomas to the uterus are very rare; to our knowledge, only 11 cases have been reported to date. CASE: A 39-year-old multigravid woman with a history of cutaneous malignant melanoma presented with abnormal uterine bleeding. Histopathologic study of the endometrial biopsy showed neoplastic cells containing brown granular pigment among the endometrial glands suggesting melanoma. Immunohistochemical studies demonstrated intense reactivity of tumor cells for S-100 protein and HMB-45 confirming the diagnosis of endometrial metastatic malignant melanoma. A complete clinical workup ruled out metastatic spread to the brain, lungs, skeleton, or abdomen. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node sampling were performed. Final pathology examination revealed malignant melanoma limited to the endometrium. CONCLUSIONS: Abnormal uterine bleeding in patients with a history of malignancy should always alert the physician to consider the diagnosis of metastatic spread to the genital tract.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. Carcinoma of the endometrium in patients treated with tibolone.BACKGROUND: Tibolone is a synthetic steroid with estrogenic, androgenic and progestogenic properties, which has been used as an alternative to estrogen replacement therapy in several countries. One of its outstanding features is that it does not stimulate endometrial proliferation. CASES: We report four cases of histologically diagnosed adenocarcinoma of the endometrium in women using tibolone. CONCLUSIONS: Although we do not suggest causality between the use of tibolone and the development of endometrial malignancy, the association described should alert physicians to thorough investigation in patients presenting with vaginal bleeding while on tibolone, despite the absence of endometrial thickness by sonogram.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/3. Well-differentiated endometrial adenocarcinoma in an infertility patient with later conception. A case report.BACKGROUND: The incidence of well-differentiated endometrial adenocarcinoma in reproductive-age women is approximately 5%. When the women desires to retain her future fertility in light of this diagnosis, choices of surgery vs. medical therapy may present a dilemma for both the physician and patient. CASE: A young infertility patient with well-differentiated endometrial adenocarcinoma conceived by ovulation induction and intrauterine insemination after medical therapy. She subsequently delivered vaginally, and follow-up dilatation and curettage revealed no evidence of recurrent carcinoma. CONCLUSION: This case illustrates that with close observation by endometrial sampling for histologic diagnosis and follow-up, medical therapy can be an option for treating this condition to allow future fertility. The patient must be extensively counseled, however, concerning the nearly 33% chance of progression or recurrence of disease. One must also stress the importance of frequent evaluation of symptoms and endometrial pathology postpartum, with endometrial sampling as indicated and discussion of definitive surgical therapy once fertility is no longer desired.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |