1/21. Abnormal uterine bleeding as a presenting sign of metastases to the uterine corpus, cervix and vagina in a breast cancer patient on tamoxifen therapy.Metastases to the female genital tract from extragenital cancers are uncommon. The ovaries are most often affected with the breast and gastrointestinal tract being the most common sites of the primary malignancy. Metastases to the uterus from extragenital cancers are significantly rarer than metastases to the ovaries and in the majority of cases the ovaries are also involved. A case of metastases restricted to the uterine corpus, cervix and vagina from breast carcinoma, without involvement of the ovaries, is described. The patient who had been on tamoxifen therapy presented with postmenopausal bleeding. The diagnosis of uterine metastases was established during endometrial ablation and confirmed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. This case illustrates that abnormal uterine bleeding in a breast cancer patient, regardless of whether she is receiving or not receiving tamoxifen, should always alert the physician to consider the possibility of uterine metastases from breast carcinoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/21. Carcinoma of the uterine cervix metastatic to behind the zygomatic arch: a case report.PURPOSE: We propose to present a novel case of a genital malignancy metastatic to the head and neck. Carcinoma of the uterine cervix is the third most frequent malignancy of the female genital tract. Early detection and improved radiation and surgical techniques have resulted in better control of the pelvic tumor and a greater incidence of distant metastasis. Metastases to the soft tissue of the head and neck region have not been reported. methods: We present the first known case of a 35-year-old woman with cancer of the uterine cervix who presented with metastasis to the soft tissue behind the zygomatic arch. RESULTS: The patient received radiation therapy to the zygomatic region and cisplatin therapy with a near-complete remission. CONCLUSION: This case shows that not all squamous cell cancers detected above the clavicles are from a thoracic or a head and neck primary tumor. The atypical location should alert the physician to suspect distant metastasis, rather than locoregional disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/21. 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) |
4/21. Asymptomatic vasculitis of the uterine cervix in presence of cervical intraepithelial neoplasia grade III.CASE REPORT: A 34-year-old woman was diagnosed to have a high-grade cervical intraepithelial neoplasia and was treated by large loop excision of the transformation zone. histology of the excised cone confirmed the diagnosis but also showed evidence of vasculitis of medium-sized vessels of the cervix. The woman was referred to a physician to rule out underlying systemic disease. Extensive laboratory and clinical screening was negative. DISCUSSION: The clinical significance and management of asymptomatic isolated vasculitis of the uterine cervix are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/21. Small bowel perforation after radiotherapy for cervical carcinoma.radiotherapy is the treatment of choice for carcinoma of the uterine cervix. We report on a 62-year-old Chinese woman with cervical carcinoma, in whom a small bowel perforation developed 5 months after radiotherapy. Ten centimetres of small bowel, including the perforation site, were resected. No bowel adhesion was detected during the operation. The postoperative course was uneventful, and the patient was discharged home 7 days after surgery. Histological examination confirmed post-irradiation injury. The presenting complaints of patients with bowel perforation following radiotherapy vary, and signs of peritonitis may be absent. Emergency physicians must be alert for these complications in patients who have been treated with radiotherapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/21. A young woman with clear cell adenocarcinoma of the uterine cervix.In May 1999, an 18-year-old woman visited a physician because of vaginal bleeding and the excretion of large clots from the vagina. A vaginal tumor was discovered and the patient was referred to our outpatient department. Vaginal examination showed a bleeding, tumor, approximately 6 cm in size, protruding from the cervical os and filling the vagina. The cytological finding of the uterine cervix was class V, and the histological diagnosis by punch biopsy was clear cell adenocarcinoma (CCAC) of the uterine cervix. The patient initially received neoadjuvant chemotherapy (NAC) with intraarterial injections of 8 mg/m(2) of mitomycin, 270 mg/m(2) of etoposide, and 380 mg/m(2) of carboplatin. Although the NAC reduced the size of the tumor, it failed to produce favorable pathological changes and was therefore deemed ineffective. A radical abdominal hysterectomy and pelvic lymphadenectomy were performed on October 12. Macroscopic findings showed a tumor, 6 cm in diameter, growing from the right side of the uterine cervix, with a fragile, necrotic surface. Pathological diagnosis was CCAC of the cervix (pT2a, N0, M0). The patient was discharged from our hospital without any postoperative chemotherapy or radiation therapy. No signs of recurrence have been detected since. We reviewed the literature on CCAC patients in japan up to the present and compared the data with the data reported in a review of CCAC in the netherlands. While there were similarities between the patients in the two countries in the patients' pattern of growth and the poor prognosis of the tumors, there was a significant difference between the countries in the patients' history of diethylstilbestrol (DES) exposure. These results suggest that menarche and menopause may play roles in promoting carcinogenesis, or alternatively, that a subpopulation of women are subject to genetic or exogenous risk factors other than DES.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/21. ethics surrounding the impoverished patient.A case is presented in which an uninsured woman sought care at a medical clinic and then an emergency room, where she was ultimately diagnosed with early cervical cancer. Although cervical cancer at this stage carries an excellent prognosis, the patient was unable to pay for the diagnostic testing, surgery, and additional treatment that she needed and was therefore told that she would be treated in an emergency situation only. The ethics of providing care in a health care system that makes no provision for care of the indigent is discussed, with consideration of obligations of individual physicians as well as of institutions to care for the sick. A single-payer system is advocated as a solution to the problem of providing care to the under- and uninsured.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/21. Home Study Course: Fall 2005.OBJECTIVE: The Home Study Course is intended for the practicing colposcopist or practitioner who is seeking to develop or enhance his or her colposcopic skills. The goal of the course is to present colposcopic cases that are unusual or instructive in terms of appearance, presentation, or management, or that demonstrate new and important knowledge in the area of colposcopy or pathology. Participants may benefit from reading and studying the material or from testing their knowledge by answering the questions. ACCME accreditation: The American Society for colposcopy and Cervical pathology (ASCCP) is accredited by the accreditation Council for Continuing Medical education (ACCME) to provide continuing medical education for physicians. The ASCCP designates this continuing medical education activity for 1 hour Category I credit of the ASCCP's Program for Continuing Professional Development and the Physician's Recognition Award of the american medical association. Credit is available for those who choose to apply. The Home Study Course is planned and produced in accordance with the ACCME's Essential Areas and elements. disclosure: faculty must disclose any significant financial interest or relationship with proprietary entities that may have a direct relationship to the subject matter. For this course, the author had no such relationship to report.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/21. Home Study Course: Winter 2006.OBJECTIVE: The Home Study Course is intended for the practicing colposcopist or practitioner who is seeking to develop or enhance his or her colposcopic skills. The goal of the course is to present colposcopic cases that are unusual or instructive in terms of appearance, presentation, or management or that demonstrate new and important knowledge in the area of colposcopy or pathology. Participants may benefit from reading and studying the material or from testing their knowledge by answering the questions. ACCME accreditation: The American Society for colposcopy and Cervical pathology (ASCCP) is accredited by the accreditation Council for Continuing Medical education (ACCME) to provide continuing medical education for physicians. The ASCCP designates this continuing medical education activity for 1 hour Category I credit of the ASCCP's Program for Continuing Professional Development and the Physician's Recognition Award of the american medical association. Credit is available for those who choose to apply. The Home Study Course is planned and produced in accordance with the ACCME's Essential Areas and elements. disclosure: faculty must disclose any significant financial interest or relationship with proprietary entities that may have a direct relationship to the subject matter. For this course, the author had no such relationship to report.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/21. Pelvic radiation necrosis and osteomyelitis following chemoradiation for advanced stage vulvar and cervical carcinoma.BACKGROUND: The treatment regimen indicated for most advanced stage vulvar, vaginal, and cervical cancer usually involves adjuvant chemoradiation therapy. Although the risk of complications is low, there have been reported cases of radiation necrosis and osteomyelitis following treatment for vulvar, vaginal, and cervical cancer. CASES: We present a vulvar cancer patient and a cervical cancer patient, both of whom were treated with radical surgery and postoperative chemoradiation. Following therapy, they were afflicted with pelvic radiation necrosis and osteomyelitis. The patients underwent surgery to resect the necrotic bone tissue and long-term antibiotic therapy to treat their osteomyelitis. They have since recovered and are followed closely by their gynecologic oncology and infectious disease physicians. CONCLUSION: The radiotherapy utilized to treat advanced stage gynecologic cancer can cause intestinal, vaginal, and urologic complications from micro-vascular damage to the organs. Pelvic bone osteonecrosis is a rare but disabling complication of pelvic radiation. Fortunately, with aggressive therapy, these patients may do well clinically.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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