Cases reported "Uterine Neoplasms"

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1/152. sciatic neuropathy secondary to a uterine fibroid: a case report.

    Lesions of the sciatic nerve outside the pelvis have been well described. Lesions within the pelvis, however, are far less common. We report the case of a 55-yr-old woman with a history of chronic low back pain who presented with progressive right buttock and posterolateral right lower limb pain associated with right foot numbness and tingling. She denied any associated low back or left lower limb pain. The patient was initially treated for a probable right lumbosacral radiculopathy, without improvement. A subsequent magnetic resonance image of the lumbosacral spine revealed multilevel disc degeneration at L3-4 through L5-S1, without disc herniation or canal stenosis. A magnetic resonance image of the pelvis revealed a markedly enlarged uterus, with a large pedunculated myoma impinging on the right sciatic foramen. The patient underwent a subtotal abdominal hysterectomy, with resolution of her right lower limb pain. This case illustrates the importance of considering intrapelvic causes of sciatic neuropathy. To our knowledge, this is the first reported case of sciatic neuropathy secondary to a uterine fibroid.
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2/152. Sigmoid colon carcinoma metastatic to the myometrium.

    Metastases to the uterus from extragenital cancers are significantly rarer than metastases to the ovaries. Of the approximately 200 cases of metastases to the uterus from extragenital cancers that have been reported in the literature, more than half are cases of metastases from breast carcinoma and only 16 are cases of metastases from colorectal carcinoma. A case of isolated metastases restricted to the myometrium of the right uterine comu from sigmoid colon carcinoma, without involvement of the ovaries, is described. The patient who six months previously had surgery for sigmoid colon carcinoma presented with right lower abdominal pain and a palpable mass in the region of the right uterine cornu. The diagnosis of isolated metastases restricted to the myometrium of the right uterine cornu was confirmed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. This case illustrates that a growing uterine mass in a patient with a history of primary extragenital cancer, regardless of whether abnormal uterine bleeding is present or absent, should alert the physician to consider the possibility of uterine metastases.
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3/152. Metastatic salivary duct carcinoma to the uterus: report of a case diagnosed by cervical smear.

    Metastasis to the uterus from extragenital sites is uncommon. We report on a rare case of salivary duct carcinoma (SDC) of the parotid gland with metastasis to the uterus, diagnosed by cervical smear. To the best of our knowledge, this is the first case reported in the literature. A 61-yr-old woman with a prior diagnosis of SDC was admitted to hospital with a fractured left humerus, back pain, and vaginal bleeding. A cervical smear and an endometrial aspiration were performed. The cervical smear showed numerous fragments and many isolated tumor cells in a clean background. The tumor cells were large and had abundant, granular/vacuolated cytoplasm. The nuclei were slightly pleomorphic, with fine chromatin and 1-2 small nucleoli. The malignant cells were morphologically identical to the primary tumor and correlated with the tumor in the endometrial aspiration. A diagnosis of metastatic salivary duct carcinoma was made. Although metastatic SDC to the uterus is rare, this possibility should be considered in the differential diagnosis of a positive cervical smear. This case also illustrates the importance of appropriate clinical history, including the knowledge of a primary tumor which may prevent unnecessary clinical investigations. Diagn. Cytopathol. 1999;21:271-275.
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4/152. Torsion of a functional ovarian cyst in a premenopausal patient receiving tamoxifen.

    We report a case of torsion of an ovarian follicular cyst that developed during treatment with tamoxifen for breast cancer. A 40-year-old Japanese woman was admitted complaining of acute lower abdominal pain. Eight months earlier, she had undergone a partial mastectomy and local irradiation for ductal carcinoma of her left breast, estrogen receptor-positive stage I (T(1a) N(1b) M(0)). The administration of tamoxifen, 20 mg/day, and doxifluridine, 600 mg/day, were started immediately postoperatively. Pelvic examination after admission revealed the left ovarian cyst and enlarged uterus. Transvaginal ultrasonography and computed tomography revealed a multilocular cystic mass in the pelvic cavity. The pathological diagnosis of the tumor after total hysterectomy and bilateral salpingo-oophorectomy was a typical follicular cyst with torsion and uterine leiomyoma. This ovarian cyst was believed to have developed during tamoxifen administration.
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5/152. Serosal complications of single-agent low-dose methotrexate used in gestational trophoblastic diseases: first reported case of methotrexate-induced peritonitis.

    methotrexate (MTX) is a folate antagonist widely used both as an anticancer drug and as an immunosupressant. Administration of an 8-day methotrexate and folinic acid regime may be associated with pleuritic chest pain and pneumonitis. We have reviewed the toxicity seen in 168 consecutive patients treated with low-dose MTX for persistent trophoblastic disease. Twenty-five per cent of patients developed serosal symptoms, pleurisy was the commonest complaint. The majority of patients had mild to moderate symptoms which were controlled with simple analgesia and did not necessitate a change in treatment; 11.9% had severe symptoms which necessitated a change in treatment. One patient developed a pericardial effusion and a second patient developed severe reversible peritoneal irritation. The possible aetiology and pathophysiology of methotrexate-induced serosal toxicity is discussed.
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6/152. A huge 6.2 kilogram uterine myoma coinciding with omental leiomyosarcoma: case report.

    Surgery for massive abdominal tumors is both interesting and challenging. We present a case involving a multiple uterine myoma weighing 6.2 Kg which coincided with omental leiomyosarcoma. To our knowledge, this is the first report of this type of condition in the English literature. A 44-year-old nulliparous woman had suffered from abdominal pain for a long time. A huge abdominal mass was palpated on physical examination. Computed tomography scanning revealed a huge pelvic-abdominal mass with the possibility of small bowel loops invaded by the mass. A 6-cm omental mass was incidentally found during the subsequent hysterectomy procedure. Perforation of the urinary bladder occurred during the dissection of adhesion. Resection of the omental mass, wide wedge resection of the invaded small bowel, primary repair of the bladder, and hysterectomy were performed. The final pathologic diagnosis was uterine leiomyomata with omental leiomyosarcoma. The patient returned home on postoperative day 14 and was well at the 18-month follow-up examination. The challenge of these tumors lies in their proper diagnosis and surgical management. More case reports and follow-up studies are needed to confirm the efficacy of their management.
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keywords = abdominal pain
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7/152. Myomectomy during early pregnancy.

    abdominal pain during early pregnancy may be caused by leiomyoma of the uterus. Inconsistency of uterine size and gestational dates in a pregnant patient with acute abdominal pain may be the first sign of leiomyoma. This 31-year-old primigravida presented with progressively worsening lower abdominal pain at 12 weeks gestational age. ultrasonography and magnetic resonance imaging demonstrated a large fundal heterogeneous mass and an intrauterine gestation compatible with her menstrual dates. Exploratory surgery and myomectomy confirmed a large leiomyoma showing benign degenerative changes. The operative procedure was successful, and the pregnancy progressed normally. An elective cesarean section was performed at 37 weeks gestation after confirming fetal maturity by amniocentesis and serial ultrasonography. abdominal pain in a pregnant patient with leiomyoma uteri may be attributable to degenerative changes in the myoma. Surgical intervention during pregnancy is occasionally necessary in uncommon cases of intractable pain.
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8/152. Protruding urethral leiomyoma obscuring vaginal introitus: case report.

    leiomyoma is quite rare in the female urethra. We report an additional case to 29 reported in the literature. A multiparous woman presented with a complaint of a gradually enlarging mass causing dyspareunia for the last seven months. The mass was originating from the upper part of the distal urethra with a relatively thin stalk covered by squamous epithelia, and immunohistopathological examination confirmed it as leiomyoma.
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9/152. Major hemorrhage in a patient with multiple submucous leiomyomata during the treatment of long-acting gonadotropin-releasing hormone agonist.

    Gonadotropin releasing hormone agonist (GnRH-agonist) therapy has been useful as an adjunct before myomectomy or hysterectomy for uterine myoma but the concealed risk is often overlooked. We report an extremely rare clinical presentation of a patient with multiple submucosal myomata during the treatment of long-acting gonadotropin-releasing hormone agonist (GnRH-agonist) in a 23-year-old, virgin woman. This patient exhibited heavy menstruation and severe anemia for half of a year. Ultrasound demonstrated multiple submucous myomata and intramural myomata. She received a conservative medical treatment by GnRH-agonist. The patient showed marked suppression of serum estradiol concentrations throughout treatment (< 20 pg/ml since first dose injection). The volume of the uterus decreased 21% and the total volume of the uterine myomata decreased 27% at the end of the second dose injection. However, a sudden onset of major hemorrhage occurred at the 65th day without "add-back" hormonal replacement therapy after initial therapy of GnRH-agonist. Hypovolemic shock followed soon and immediately resuscitation was performed. After resuscitation, the patient was treated with hysteroscopic myomectomy, followed by 30 ml balloon Foley catheter placement for compressing the intrauterine rough surface and hormonal replacement therapy. When uterus returned to the normal size at the end of the first week, intrauterine device was positioned and maintained for three months. The patient married four months later and got pregnant soon. Now she has a pregnancy of 22 gestational weeks. The phenomenon suggests presence of concealed and potential risk of GnRH-agonist for managing a patient with multiple submucous myomata, even though GnRH-agonist is a well-documented transient treatment for uterine myomata not only by its effect on tumor shrinkage and decreasing blood loss during the myomectomy but also by providing a time for hematological recovery. This unexpected and unwanted clinical presentation should be alerted.
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10/152. diagnosis of recurrent uterine carcinosarcoma by fine-needle aspiration cytology: report of a case.

    Uterine carcinosarcomas are uncommon, aggressive neoplasms usually afflicting postmenopausal women. Histologically, they are characterized by the presence of both malignant epithelial and stromal cells. The latter may be either homologous or heterologous in nature. The cytologic diagnosis of carcinosarcoma via fine-needle aspiration (FNA) was previously described for primary tumors arising in the parotid gland, breast, lung, and ovary. Although the diagnosis of uterine carcinosarcoma via cervicovaginal, endometrial, and peritoneal fluid cytology has been described, the FNA cytology diagnosis of recurrent uterine carcinosarcoma has only been rarely described. We present a case of recurrent uterine carcinosarcoma in a 59-yr-old woman, diagnosed by ultrasound-guided FNA cytology. Cytologic smears showed a biphasic neoplasm consisting of both malignant columnar epithelial and spindle cells, in a background of tumor diathesis. This case illustrates the diagnostic utility of aspiration cytology in the investigation of recurrent carcinosarcoma in clinically suspicious lesions arising postsurgery.
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