1/14. Unusual recurrence of cervical adenosquamous carcinoma after conservative surgery.The use of less radical procedures for the treatment of early cervical cancers is gaining interest among physicians and young patients. Some authors have described surgical procedures aimed at reducing the surgical aggressiveness but the safety of such procedures remains debated. After a polypectomy, a young patient had a diagnosis of stage Ia(2) cervical adenosquamous carcinoma in 1995. As she wished to preserve her fertility, she underwent a cone biopsy and pelvic lymphadenectomy, without evidence of tumor spread. In 1998, at the 13th week of gestation, she had a diagnosis of a pelvic mass. The mass was a recurrence of carcinoma involving the myometrium, just underneath the peritoneum. She underwent a radical hysterectomy with bilateral oophorectomy. An ovarian metastasis was also detected at pathological exam. She received chemotherapy postoperatively and remains alive without evidence of disease. The recurrence of cervical cancer is traditionally regarded as an issue concerning the cervix, the parametria, or the lymph nodes. When the uterus is preserved we must also consider the possibility of a recurrence involving the corpus. With wider acceptance of limited therapeutic approaches we must be prepared for the detection of previously unknown patterns of recurrence and the follow-up modalities must be consequently adapted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/14. colon cancer in pregnancy: report of a case and review of the literature.Most colon cancer cases occur in patients over 50 years of age, although about 3% of colorectal cancer patients are younger than 40. During pregnancy the incidence of this neoplasm is estimated to be 0.002%. To date only 32 cases of colonic cancer arising above the peritoneal reflection during pregnancy have been described in the literature. We report another such case, stressing the need for constant alertness on the part of physicians in the presence of abdominal pain and/or distension, a palpable abdominal mass, rectal bleeding and/or weight loss during pregnancy. In fact, the reportedly poorer prognosis of this cancer in pregnant patients is mainly due to the fact that the initial symptoms of the malignancy are usually attributed by the patient, but also by physicians, to normal pregnancy.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/14. Focus on primary care: from nevus to neoplasm: myths of melanoma in pregnancy.Malignant melanoma is one of the few malignancies that regularly affect women during their childbearing years. Additionally, the incidence of melanoma has been increasing over the last several decades. early diagnosis of stage I disease may lead to curative therapy; thus it is important for physicians and midwives to do a full examination of the skin. However, the myth that nevi may naturally grow or change during pregnancy has been shown not to be true and should not delay a diagnostic evaluation of a suspicious nevus. Older studies had theorized a worse outcome for pregnant women with melanoma. However, multiple controlled series and investigations have found that stage for stage this cancer is not affected adversely by pregnancy. prognosis, recurrence, and incidence of melanoma seemed to be unaffected. Estrogen-containing oral contraceptives, as well as hormone replacement therapy, have no adverse affect on the disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/14. Paroxysmal hypertension, pheochromocytoma, and pregnancy.BACKGROUND: hypertension is the most common medical complication of pregnancy. pheochromocytoma in pregnancy is rare, and if unrecognized, can cause serious perinatal morbidity and mortality. methods: A patient with severe hypertension, postpartum pulmonary edema, and a recognized pheochromocytoma is described. RESULTS: Abdominal palpation after vaginal childbirth reproduced the diagnostic triad of hypertension, headaches, and palpitations. magnetic resonance imaging established the correct diagnosis before biochemical confirmation of excess catecholamine production. The patient responded to alpha-adrenergic receptor blockade with control of her severe hypertension and clearing of pulmonary edema. The best time to diagnose a pheochromocytoma is before delivery because vaginal childbirth stimulates the release of lethal amounts of catecholamines. CONCLUSIONS: The physician who delivers babies must distinguish between labile hypertension and paroxysmal hypertension. Most experts believe that a spontaneous vaginal delivery is contraindicated when the patient has a pheochromocytoma. Postpartum pulmonary edema associated with a pheochromocytoma is unusual. The profound pressor response elicited by palpation of the postpartum abdomen, the failure of medications usually effective in the treatment of a hypertensive crisis, and the use of magnetic resonance imaging to confirm a functioning adrenal adenoma are the features unique to this case.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/14. Successful infertility treatment in a cancer patient with a significant personal and family history of cancer.BACKGROUND: infertility can be a devastating problem for a couple desperate to conceive. Unfortunately, these same women with infertility also bear the burden of an increased risk of ovarian and breast cancer. We present a case of a woman with infertility who persevered despite a personal and family history of cancer to achieve her goal of having a family. Case: The patient's father had died of breast cancer at an early age. The patient had been unsuccessfully treated for infertility elsewhere before transferring to our institution. A diagnostic laparoscopy revealed an early ovarian cancer treated by oophorectomy only. RESULTS: After a period of observation, infertility treatment was resumed, leading to the successful cesarean delivery of triplets. Although recurrent ovarian cancer was diagnosed at delivery, the patient remains disease free, with three healthy children, 4 years after optimal tumor reductive surgery for stage IC low malignant potential ovarian cancer. CONCLUSIONS: infertility patients with significant cancer issues may achieve a term delivery and remain disease free for a meaningful length of time with the assistance of their physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/14. Successful pregnancy and delivery in a patient with chronic myelogenous leukemia (CML), and management of CML with leukapheresis during pregnancy: a case report and review of the literature.Although infrequently seen, the management of cancer during pregnancy can be difficult for patients, their families and physicians. The concomitant occurrence of pregnancy and chronic myelogenous leukemia is uncommon. We describe the successful management of a 26-year-old woman in the first trimester of her pregnancy with chronic myelogenous leukemia (CML) in chronic phase by using only leukapheresis. She was treated with leukapheresis until her delivery at 36 weeks of gestation. The procedure was without significant adverse effects on the patient or fetus. We applied a total of 15 leukapheresis treatments throughout the pregnancy. The patient gave birth vaginally to a healthy 2800 g boy at 36 weeks of gestation. We conclude that leukapheresis may provide an alternative treatment to chemotherapy, alpha-interferon or imatinib in pregnant patients with CML, particularly with concern over their potential teratogenic and other adverse effects.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/14. Cystic degeneration of a leiomyoma masquerading as a postoperative abscess.Leiomyomas are common tumors that usually have a typical sonographic appearance. With degeneration, however, the sonographic findings may be completely uncharacteristic. We report a case of a multicystic anterior uterine wall mass detected at antenatal sonography in an asymptomatic patient. Differential diagnosis included myoma, varicosity, hematoma, abscess, uterine anomaly, and pelvic neoplasm. At cesarean section, the mass was confirmed to be a myoma. Postoperatively, an ultrasound was performed by the radiology service during evaluation of suspected endometritis and the mass was interpreted as an endometrial abscess. This case illustrates that myomas can present with sonographic features consistent with a number of pathologic disorders. This variable pattern of echogenicity may sometimes create difficulty in establishing a correct diagnosis. The case also demonstrates the importance of communication between services and the need for not only antenatal but also postpartum and gynecologic ultrasound studies to be performed by physicians trained in sonographic findings of the abnormal uterus.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/14. Successful pregnancy following continuous treatment with combination chemotherapy before conception and throughout pregnancy.A 21-year-old woman with diffuse histiocytic lymphoma received combination chemotherapy continuously for 16 months before conception and throughout pregnancy. procarbazine and BCNU were given for 5 months before conception and throughout the first and second trimesters, and streptozotocin was given throughout the third trimester. A male infant who was phenotypically and genotypically normal was delivered. The authors reviewed the literature regarding chemotherapeutic agents given during the first trimester of pregnancy. Although most chemotherapeutic agents are teratogenic in the animal model, the incidence of teratogenicity of chemotherapeutic agents given to humans in the first trimester of pregnancy is 12.7%. This represents a fivefold increase in teratogenicity. As yet the administration of chemotherapeutic agents in the second and third trimesters has not resulted in teratogenicity. This information may help the physician when deciding whether to treat pregnant patients with chemotherapeutic agents during the first trimester or whether to continue treatment when the patient has become pregnant while receiving these agents.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/14. colon carcinoma in pregnancy. Case report and review of literature.The Authors report on a case of colon carcinoma occurred in a pregnant woman. As complaints for digestive tract disfunctions are common during pregnancy, the diagnosis of the malignancy was delayed. The Authors suggest the treating physician be alert to avoid under estimation of symptomatology.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/14. Pregnant woman with a neck mass.None of the consultants was comfortable with the idea of proceeding with the biopsy of a neck mass in an outpatient clinic setting. All warned about the possible relationship of the mass with important anatomic structures. With regard to needing further information, physicians requested an imaging study of the neck, thoracic cavity, and mediastinum (Dr. Cummings); pelvic examination, breast examination with mammography, chest x-ray, and CBC (Dr. Weymuller); flexible endoscopy, chest x-ray, CBC, and MRI (Dr. Woodson). All three experts advised her to put IVF on hold. After the work-up, they would proceed with a biopsy of the mass and send the tissue to the pathologist in saline. In addition, tissue should be examined for fungus and AFB (Drs. Weymuller and Woodson). Because the patient proceeded with IVF and became pregnant, two experts advised her to abort and proceed with treatment for her Hodgkin's disease (Drs. Cummings and Woodson). The other option was for her to continue her pregnancy and proceed with radiotherapy to her neck, with shielding of the abdomen (Dr. Weymuller).- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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