1/4. Endometrial stromal sarcoma of the uterus: MR and US findings.We describe the MRI and US features of two patients with endometrial stromal sarcoma of the uterus. Both lesions appeared as voluminous polypoid masses within an expanded endometrial cavity on both US and MRI. They had mixed echo-texture and heterogenous signal intensity on both T1- and T2-weighted sequences. T2-weighted images were most helpful in detecting the endometrial nature of the disease and its relationships with surrounding myometrium.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/4. Placenta percreta with bladder invasion as a cause of life threatening hemorrhage.PURPOSE: Abnormal placental penetration through the myometrium with bladder invasion is a rare obstetric complication with potential for massive blood loss. Urologists are usually consulted after a life threatening emergency has already arisen. Their familiarity with this condition is crucial for effective management. We describe 2 cases of placenta percreta with bladder invasion to highlight the catastrophic nature of this clinical entity, and review the literature on current diagnostic and management strategies. MATERIALS AND methods: Between 1986 and 1998, 250 cases of adherent placenta (0.9%) were identified in 25,254 births at our institution, including 2 (0.008%) of placenta percreta with bladder invasion. We treated these 2 multiparous women who were 33 and 30 years old, respectively. Each had undergone 2 previous cesarean sections. RESULTS: Presenting symptoms were severe hematuria in 1 patient and prepartum hemorrhage with shock in the other. Ultrasound showed complete placenta previa in each with evidence of bladder invasion in 1 patient. hysterectomy, bladder wall resection and repair, and bilateral internal iliac artery ligation were required to control massive intraoperative hemorrhage. The patients received 22 and 15 units of packed red blood cells, respectively. fetal death occurred in each case. convalescence was complicated by disseminated intravascular coagulation in patient 1 but subsequent recovery was uneventful. CONCLUSIONS: A high index of suspicion for placenta percreta with bladder invasion is required when evaluating pregnant women with a history of cesarean delivery and placenta previa who present with hematuria and lower urinary tract symptoms. ultrasonography and magnetic resonance imaging may assist in establishing the diagnosis preoperatively. With proper planning and a multidisciplinary approach fetal and maternal morbidity and mortality may be decreased.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/4. Large cell neuroendocrine carcinoma of the uterine cervix: a clinicopathological study of six cases.Six cases of cervical large cell neuroendocrine carcinomas (LCNEC) were found among 972 patients (0.6%) with invasive cervical carcinoma. The patients, who were from 27 to 51 (mean 38) years of age, presented with vaginal bleeding or an abnormal Papanicolaou smear. Five tumors were stage Ib and one was IIa. All patients underwent radical hysterectomy and received adjuvant chemotherapy and pelvic radiotherapy. Four patients died of tumor 6 to 19 months (mean 14 months) postoperatively. On histologic examination, the tumor cells were arranged in an organoid growth pattern and were larger than those of typical small cell carcinoma. Glandular differentiation was present in one case. Mitotic figures ranged from 15 to 45 (mean 29) per 10 high-power fields. Prominent vascular invasion and necrosis was seen in all of the tumors. Each tumor was immunoreactive for chromogranin a and/or synaptophysin. The results of this study confirm the aggressive nature of cervical LCNECs. The recognition of LCNECs is necessary to establish the most effective treatment for these aggressive tumors.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/4. Angiographic-guided embolization of metastatic invasive mole.BACKGROUND: The friable and hypervascular nature of a metastatic invasive mole places the patient at risk for significant hemorrhage. Bleeding is the chief cause of morbidity and mortality in patients with a histopathological diagnosis of invasive mole. Bleeding from vaginal metastatic lesions can be controlled by packing the vagina and local excision if necessary. Often the results are less than satisfactory. CASE: This case describes a 43-year-old Hispanic female with metastatic invasive mole to the vagina. Following chemotherapy, she underwent life-threatening hemorrhage requiring hospitalization and multiple transfusions. The metastatic lesions were successfully embolized with gelfoam by selective angiography. The patient required minimal additional chemotherapy and is currently without evidence of disease. CONCLUSIONS: The technique of angiographic embolization is emerging as a successful and minimally invasive procedure as illustrated in this presentation. Prophylactic embolization with or prior to the administration of chemotherapy in the management of metastatic invasive mole is discussed and may play a role in the primary therapy of this condition.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |