11/338. Endometrial adenocarcinoma with diffused/scattered "intramural" spreads: report of a case and review of the literature.A case is reported of endometrial adenocarcinoma of the uterus in an 85-year-old patient with an unusual spreading pattern. On macroscopic examination, only a tiny exophytic tumor was found in the uterine cavity, while microscopic examination demonstrated a scattered (scirrhous) spread of the carcinoma cells throughout the myometrium. The tumor occupied about half of the upper uterine corpus. The intramural spread of the tumor could not be seen at the time of macroscopic examination of the uterine cut surface. The tumor cells were attached closely to the serosal membrane, and metastasis to the left ovary was found. Intraoperative cytology detected malignant cells in the ascites. We present here this unusual type of endometrial carcinoma and review our previous report which dealt with pure "intramural carcinomas of the uterine corpus".- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
12/338. Transabdominal application of transvaginal transducer enhancing depiction of mature cystic teratoma at 34 weeks' gestation.We present an unusual case in which a 36-year-old patient was referred for consultation due to increasing upper left abdominal pain at 35 weeks' gestation. Transabdominal ultrasonography disclosed an appropriate-for-gestational-age singleton, vertex-presenting fetus with normal anatomy. An unclear, complex, semisolid, semicystic mass was noted in the upper right abdomen. Due to the close proximity of the adnexal mass to the patient's abdominal wall, a high-frequency transvaginal transducer was applied transabdominally. Unlike the unclear images generated at conventional transabdominal ultrasonography, this application depicted a discrete mass with multiple characteristics consisting of calcifications, hair and fatty tissue, considered diagnostic of a mature cystic ovarian teratoma. The patient delivered spontaneously at 39 weeks' gestation. At 6 weeks' postpartum an elective laparotomy left ovarian cystectomy was performed and a mature cystic teratoma confirmed by pathology examination.- - - - - - - - - - ranking = 179.74805531892keywords = abdominal pain, pain, upper (Clic here for more details about this article) |
13/338. ovarian cysts in childhood.This is a review of cases of ovarian cyst encountered in childhood in the Manchester children's hospitals. The patients presented with acute or recurrent abdominal pain or an abdominal or pelvic mass. The commonest cyst found was a teratoma, which was discovered because of its size or because of a complication. All but one of the girls with teratomas had not reached puberty. After puberty the cysts were follicular or luteal in type, although there was one case of cystadenoma. Complications in the form of torsion, rupture which haemoperitoneum or haemorrhage into the cyst were common. Treatment consisted of ovarian cystectomy, oophorectomy or salpingo-oophorectomy, and the results were satisfactory.- - - - - - - - - - ranking = 178.49581016524keywords = abdominal pain, pain, chest (Clic here for more details about this article) |
14/338. Treatment of radiation-induced proctitis with sucralfate enemas.OBJECTIVE: To report a case of radiation-induced proctitis treated with sucralfate enemas. CASE SUMMARY: A 77-year-old white woman was transferred from an acute care institution to our inpatient rehabilitation unit with impaired mobility and reduced activities of daily living. Her condition was secondary to myopathy and peripheral neuropathy associated with postradiation chemotherapy and metastatic ovarian carcinoma. During her stay, she developed hematochezia and pain secondary to a diagnosis of radiation-induced proctitis. Her hemoglobin had reached a nadir of 7.3 g/dL. The patient received blood transfusions and was started on 10% w/v sucralfate retention enemas 2 g/20 mL daily for 12 consecutive days. She was symptom-free at discharge, with a stable hemoglobin of approximately 10 g/dL. DISCUSSION: proctitis is a common adverse effect of radiotherapy to the lower abdomen and pelvic area. sucralfate is an aluminum complex that acts as a local cytoprotective agent against ulceration of the gastrointestinal mucosal lining. Rectal administration of sucralfate, as described in our patient and reported in published case studies, may provide an alternative therapy for patients with radiation-induced proctitis. CONCLUSIONS: sucralfate suspension enemas provide a viable treatment option in patients who are intolerant of, refractory to, or not candidates for standard therapy for radiation-induced proctitis.- - - - - - - - - - ranking = 22.176836119364keywords = pain (Clic here for more details about this article) |
15/338. Recombinant human thyrotropin for the diagnosis and treatment of a highly functional metastatic struma ovarii.The optimal treatment of metastatic thyroid cancer that produces high amounts of thyroid hormone has not been well defined. A 46-yr-old woman presented with a follicular thyroid carcinoma arising from a struma ovarii with hepatic metastases. After the removal of both the struma and the thyroid gland, the liver metastases showed evidence of a high degree of hormonogenesis. brain, chest, abdomen, and bone imaging was negative for additional metastases. Because iodine uptake by most thyroid carcinomas is quite low in the absence of high levels of ambient TSH, we used recombinant human TSH (rhTSH) (Thyrogen) to achieve a concentration of 131I activity in the tumor high enough for a significant cytotoxic effect. After rhTSH administration (0.9 mg im daily for 2 consecutive days), a 131I diagnostic whole body scan confirmed the existence of 17 discrete hepatic foci of 131I uptake. To calculate the amount of 131I that would deliver an absorbed radiation dose that would be optimally cytotoxic to the metastases (>8000 rad/lesion) and not to the normal liver, we performed lesion dosimetry. Analysis of dosimetric data showed that 15 of 17 lesions would receive an adequate radiation dose following the administration of 65 mCi of 131I. Additionally, we performed whole body dosimetry to assure that this dose would not cause bone marrow toxicity. The patient was reevaluated 6 months after therapy; the liver metastases showed significant, but partial, response. In conclusion, we used the combination of rhTSH with lesional and whole body dosimetry for the treatment of highly functional metastases from follicular thyroid carcinoma arising within a struma ovarii. This strategy can be applied to determine a safe and effective dose of 131I for the treatment of any thyroid cancer metastases that produce enough TH to preclude stimulation of endogenous pituitary TSH secretion.- - - - - - - - - - ranking = 0.74775484631945keywords = chest (Clic here for more details about this article) |
16/338. 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 = upper (Clic here for more details about this article) |
17/338. Atypical medullary carcinoma of the breast with cartilaginous metaplasia in a patient with a BRCA1 germline mutation.We examined a 34-year-old premenopausal woman who had noticed a left-breast lump a month previously. She had no past history of malignancies but had a family history of breast and ovarian cancers. Her mother had suffered from ovarian cancer when aged 47 years and had died of the disease at age 52. The younger two of the patient's four aunts had developed breast cancer when they were 37 and 48 years old. A physical examination showed an ill-defined mass, 1.5 cm in diameter, located in the upper outer quadrant of the patient's left breast. mammography revealed diffuse microcalcification in both breasts but ultrasonography revealed an irregular tumorous lesion only in the left breast. Aspiration breast cytology revealed adenocarcinoma of the left breast. Modified radical mastectomy of the left breast and excision of a biopsy specimen from the right breast were carried out simultaneously. Histopathologically the left-breast tumor was an atypical medullary carcinoma with cartilaginous metaplasia, of histological grade 3, and the right-breast specimen showed fibrocystic changes with atypical ductal hyperplasia. Estrogen receptors were positive, but progesterone receptor was not detected on the tumor cells, which were immunopositive for nuclear p53 although c-erbB-2 overexpression was not observed. A nonsense germline mutation of the BRCA1 gene (exon5) was detected. The patient has been well since the operation (10 months). These findings may provide useful information about the carcinogenesis and biological behavior of BRCA1-associated breast cancers.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
18/338. Erosion of an intraperitoneal chemotherapy catheter resulting in an enterovaginal fistula.BACKGROUND: With the pharmacokinetic advantages of intraperitoneal chemotherapy delivery and the increased popularity of immunotherapy and gene therapy, intraperitoneal catheters have moved to the forefront as a delivery system in cancer treatment. This delivery system, however, carries with it an intrinsic morbidity warranting attention in the often prolonged chemotherapy regimens demanded by cancer patients. CASE: In reviewing the literature of intraperitoneal catheter complications, there is no other cited case of a peritoneal catheter erosion into intestine presenting as an enterovaginal fistula. Our patient, diagnosed with persistent ovarian carcinoma, had a peritoneal Tenckoff catheter placed for chemotherapy. Many months after termination of the chemotherapy and 15 months after placement, she presented with bowel contents per vagina. A CT scan revealed an abdominopelvic abscess encompassing the detached catheter which embedded in the rectosigmoid colon, allowing direct communication to the upper vagina. The catheter was removed and the abscess was drained. CONCLUSION: Intraperitoneal catheters have a morbidity that persists after nonuse. Therefore, intraperitoneal catheters should be removed if they are not being used.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
19/338. Ovarian mucinous cystadenocarcinoma as a cause of zollinger-ellison syndrome: report of a case and review of the literature.Gastrin producing ovarian tumor is a rare cause of the zollinger-ellison syndrome. We report the case of an ovarian carcinoma showing increased plasma gastrin concentration. A 60-yr-old woman presented with epigastric pain and diarrhea. physical examination showed a large mass in the lower abdomen. Computed tomography revealed a large multilocular ovarian cyst. Upper gastrointestinal endoscopy examination showed multiple ulcerations of the stomach and duodenum. The plasma gastrin level was 1500 pg/ml. No tumors were found in the pancreas and duodenum, and salpingo-oophorectomy was performed. Histologic examination revealed a mucinous tumor of borderline malignant potential. Immunoperoxidase studies for gastrin showed many gastrin-producing cells within the epithelium of the tumor. There have been 11 cases (including our patient) of gastrin-producing ovarian tumor reported in the literature. We review here the relevant literature. Although ovarian gastrinoma is extremely rare, it should be considered as a possible cause of the zollinger-ellison syndrome in women.- - - - - - - - - - ranking = 22.176836119364keywords = pain (Clic here for more details about this article) |
20/338. The great imitator: miliary peritoneal tuberculosis mimicking stage III ovarian carcinoma.PURPOSE: To report a case of peritoneal tuberculosis initially mistaken at the time of surgery for metastatic ovarian carcinoma. CASE REPORT: A 31-year-old Filipino female was found to have increasing abdominal pain, ascites, early satiety, increasing abdominal girth and bilateral complex masses. Diagnostic laparoscopy revealed the presence of > 4 liters of ascites, a frozen pelvis secondary to what appeared to be bilateral ovarian carcinomas, along with miliary seeding of the entire anterior abdominal wall, omentum, small bowel and small bowel mesentery, right and left diaphragmatic surfaces, and hepatic surface. Frozen section, at the time of laparotomy, revealed necrotizing granulomas most consistent with disseminated tuberculosis that was confirmed at the time of final pathologic review and culture. CONCLUSION: Peritoneal tuberculosis can be mistaken for widely metastatic ovarian carcinoma at time of surgery.- - - - - - - - - - ranking = 177.74805531892keywords = abdominal pain, pain (Clic here for more details about this article) |
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