1/55. Successful treatment of malignant placental site trophoblastic tumor with combined cytostatic-surgical approach: case report and review of literature.OBJECTIVE: Although rare among gestational trophoblastic diseases, the clinical relevance of malignant placental site trophoblastic tumor (PSTT) derives from its potential malignancy associated with early systemic tumor cell dissemination and manifestation of fatal metastases. Because of the low number of cases reported so far worldwide, several treatment strategies have been under consideration, which will be debated following this case report. METHOD: We present the case of a 33-year-old female with PSTT and metastases to the vagina and lung. A 9-month delay in accurate diagnosis was caused by a misinterpretation of her symptoms as signs of a spontaneous abortion. Specialized pathological examination finally led to the diagnosis of PSTT. Primary surgical treatment consisting of abdominal hysterectomy and unilateral salpingo-oophorectomy was followed by multiple resections of recurrent vaginal disease. After the completion of six cycles of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) chemotherapy, hCG titers stayed within the normal range. The patient is without evidence of disease 39 months after primary diagnosis. RESULT: This is the third case of documented long-term remission (>1 year) in metastatic PSTT after combined cryostatic-surgical treatment. CONCLUSION: Since the few previously reported cases with prolonged remission have been treated with the described combined cytostatic-surgical approach consisting of cytoreductive surgery and adjuvant chemotherapy, this approach may be recommended for metastatic PSTT.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
2/55. Prolonged remission of recurrent, metastatic placental site trophoblastic tumor after chemotherapy.BACKGROUND: Placental site trophoblastic tumor (PSTT) is a form of gestational trophoblastic neoplasm that is frequently resistant to chemotherapy. In most cases disease is confined to the uterus and can be cured by curettage or simple hysterectomy. patients with metastases, however, frequently have progression of disease and die despite aggressive multiagent chemotherapy. CASE: A 31-year-old woman was found on review of uterine curettings to have a PSTT. Imaging studies revealed multiple lung lesions, a liver lesion, and an enlarged irregular uterus. hysterectomy and staging surgery revealed a large tumor in the endometrial cavity and multiple metastases. She was treated with etoposide-methotrexate-dactinomycin and cyclophosphamide-vincristine and had a complete clinical remission. Six months later, however, she had a recurrence. She was then treated with six cycles of etoposide-methotrexate-dactinomycin and etoposide-cisplatin. Three years after completion of the second regimen she is without evidence of disease. CONCLUSION: Treatment with multiagent chemotherapy can produce long-term remission, even in patients with recurrent, metastatic PSTT. Addition of platinum may be helpful in patients who have recurred or progressed after treatment with non-platinum-containing regimens.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
3/55. Management of uterine Mullerian adenosarcoma with extrauterine metastatic deposits.OBJECTIVE: The aim of this study was to provide the management and outcome of three patients who presented with uterine Mullerian adenosarcoma associated with extrauterine metastases. methods: A retrospective study of three patients who were referred to our hospital was performed. One patient was referred because of vaginal metastatic deposits that were noted during investigations for primary infertility. The other two were referred because of abnormal vaginal bleeding; one of these had a large polyp protruding through her cervix into the vagina. RESULTS: In two patients the preoperative diagnosis and extent of their disease were known while in the third patient the diagnosis was only made postoperatively. All patients had a type II radical abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Two patients were given three cycles of neoadjuvant chemotherapy and pelvic irradiation over 12 weeks. Both of these patients had their diagnosis made preoperatively and the chemotherapy consisted of 240 mg/m(2) carboplatin and 80 mg/m(2) farmorubicin per cycle. The pelvic irradiation consisted of daily fractions of 1.8-Gy irradiation to a total of 45 Gy over the first 6 weeks. The other patient was given the same regime postoperatively. All patients are still alive and free of disease between 34 and 56 months. CONCLUSION: Radical surgery, chemotherapy, and irradiation provide a management option with seemingly favorable outcome for patients with uterine Mullerian adenosarcoma associated with extrauterine metastases.- - - - - - - - - - ranking = 2keywords = cycle (Clic here for more details about this article) |
4/55. Kinetics of plasma platinum in a hemodialysis patient receiving repeated doses of cisplatin.The pharmacokinetics of cisplatin were studied in a 46-year-old hemodialysis patient treated for uterine cancer with weekly cisplatin. Hemodialysis was performed immediately before, one-hour after, and two-hours after cisplatin administration for two consecutive cycles each. The concentrations of total and free platinum were measured. The decay curve of both total platinum and free platinum showed a biphasic pattern characterized by an alpha-phase and a beta-phase, the same as in non-hemodialysis patients. There were no differences between the individual cycles in the peak platinum concentration or the decay pattern. The plasma platinum concentration decreased to below detection limit 3 months after the final dose.- - - - - - - - - - ranking = 2keywords = cycle (Clic here for more details about this article) |
5/55. Transient ovarian failure: a complication of uterine artery embolization.OBJECTIVE: To report a case of transient ovarian failure shortly after arterial embolization for treatment of uterine fibroids, followed by recovery of ovarian function. DESIGN: Case report. SETTING: A university-based hospital. PATIENT: A 49-year-old woman with menorrhagia and anemia secondary to uterine fibroids and refractory to medical management. The follicle-stimulating hormone (FSH) level on cycle day 3 before the procedure was 8.2 mIU/mL. INTERVENTION(S): Bilateral uterine artery embolization for treatment of menorrhagia. MAIN OUTCOME MEASURE(S): serum FSH level. RESULT(S): The patient developed amenorrhea and hot flashes 3 months after uterine artery embolization. Her serum FSH level at that time was 140.1 mIU/mL. Four months later, uterine bleeding resumed; her serum FSH level was 2.1 mIU/mL. CONCLUSION(S): uterine artery embolization may hasten ovarian failure. This procedure should be reserved for women who have completed their child-bearing or are poor candidates for myomectomy. patients should be counseled appropriately about the risk of possible ovarian failure.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
6/55. adenosarcoma of the uterine body in a 19-year-old woman--three year survival: case report.BACKGROUND: Uterine adenosarcoma is a rarely by occurring tumor. It is composed of a benign adenoid structure and a sarcomatous stromal component. The average age of patients with a diagnosis of uterine adenosarcoma is about 70 years. CASE: We present a case of a 19-year-old woman with a rarely occurring uterine adenosarcoma manifesting itself by irregular bleeding and producing fragile polypous matter which was spreading into the vagina. The final diagnosis was made only by repeated biopsies. Abdominal hysterectomy with bilateral salpingo-oophorectomy, appendectomy and revision of iliac lymph nodes were performed. Teleradiotherapy was applied from 4 fields in 25 fractions to a total exposure of 50 Gy. It was followed by six cycles of chemotherapy containing 50 mg/m2 doxorubicin and 5 g/m2 ifosfamid administered in 21-day dose intervals. CONCLUSION: This case should demonstrate the difficulty of making the right diagnosis. Since the end of therapy the patient has been regularly seen in our onco-gynecologic department. Now, 40 months after the end of chemotherapy and 46 months after making the diagnosis, there are no signs of relapse.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
7/55. Is lack of response to single-agent chemotherapy in gestational trophoblastic disease associated with dose scheduling or chemotherapy resistance?OBJECTIVE: The aim of this study was to determine whether in the management of low-risk gestational trophoblastic neoplasia (GTN) the administration of 5-day courses of 12 microg/kg actinomycin D is effective following the failure of 1.25 mg/m(2) "pulsed" actinomycin D. methods: patients with low-risk GTN who failed to respond to 1.25 mg/m(2) pulsed actinomycin were switched to the 5-day course of 12 microg/kg actinomycin. RESULTS: patients with low-risk GTN who failed to respond to pulsed actinomycin were changed to the same chemotherapy agent, actinomycin D, given as a 5-day course at 12 microg/kg. Four of the five responded and one required methotrexate to achieve remission. CONCLUSIONS: Pulsed biweekly actinomycin and pulsed weekly methotrexate have been shown to have a higher failure rate than the 5-day regimens of the same medications. This study demonstrates that failure of pulsed actinomycin may be successfully treated by a 5-day course of the same medication. It appears that with the pulsed regimens cytotoxic exposure of trophoblastic cells to the medication is too brief and the 5-day course permits more cells to be in cycle. It is suggested that, following failure of a pulsed regimen, the patient is given the same chemotherapy as a 5-day course, rather than switching from actinomycin to methotrexate or vice versa. This conserves options for chemotherapy in GTN.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
8/55. Case of PSTT treated with chemotherapy followed by open uterine tumor resection to preserve fertility.BACKGROUND: Placental site trophoblastic tumor (PSTT) is a rare variant of gestational trophoblastic malignancy, usually seen in young women with a 20% fatality rate. The hysterectomy is general for PSTT, but hysterectomy is undesirable for patients who wish to remain fertile. Recent advancement of chemotherapy and tumor detection and assessment technologies should allow removal of tumor from the uterus by conservative surgery, without losing fertility, although very few cases have been reported to date. This report describes a young PSTT patient treated by combination chemotherapy and open uterine surgery, which resulted in an early restoration of the menstrual cycle and apparent preservation of fertility. CASE: A 26-year-old secundigravida primipara woman presented with a case of PSTT which was diagnosed 4 months after a spontaneous abortion. The tumor was confined to the uterus. Two courses of EMA/CO chemotherapy resulted in a remarkable reduction of the tumor mass, but low levels of serum beta-hCG persisted. After precise evaluation of the residual tumor by MRI and hysteroscopy, the anterior wall of the uterus was opened to resect the tumor in the posterior myometrium. An argon beam coagulator was used to evaporate the myometrium tissue surrounding the lesion. One week later, the patient had normal menstruation. MRI taken 2 weeks after the operation detected no tumor in the uterus nor uterine deformation. serum beta-hCG was reduced below the level of detection. CONCLUSIONS: Open uterine resection of PSTT tumor following appropriate chemotherapy could achieve long-term remission and save fertility of young patients who wish to avoid hysterectomy for future pregnancy.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
9/55. Intraperitoneal haemorrhage secondary to perforation of uterine fibroid after cystic degeneration. Unusual CT findings resembling malignant pelvic tumor: case report.Intraperitoneal haemorrhage is a rare complication of myomatous uterus. We present a case of a 37-year-old white nullipara who presented in the emergency room with acute, lower-abdominal pain which reportedly started after riding over a bump on a motorcycle. On examination, the abdomen was diffusely tender, with moderate spasm and rebound tenderness in both iliac fossae. pregnancy test was negative. Computed tomography revealed a soft-tissue mass with cystic components and inhomogeneous appearance. Free fluid in the peritoneal cavity suggested ascites. The patient underwent an exploratory laparotomy. A ruptured, actively bleeding, subserosal, nonpedunculated, cystic degenerated uterine fibroid was found, as well as approximately two liters of free, bloodstained peritoneal fluid and clots. Subtotal hysterectomy without salpingo-oophorectomy was performed, followed by evacuation of the fluid and clots. The patient's postoperative course was uneventful. In conclusion, definitive, preoperative diagnosis of a perforated, haemorrhaging, uterine fibroid is difficult; exploratory laparotomy is both diagnostic and therapeutic in this rare, life-threatening condition.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
10/55. Cure of metastatic uterine carcinosarcoma to lungs: a case report.Most patients with advanced or recurrent uterine sarcoma experience disease progression and ultimately die. We present a case of uterine sarcoma with lung metastasis treated with systemic chemotherapy and with no evidence of disease for more than 5 years. A 77-year-old woman underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy for carcinosarcoma of the uterus followed by external pelvic radiotherapy. Ten months later, the tumor recurred in the apex of the vagina and was treated with brachytherapy. After 6 months of remission, she presented with pulmonary metastasis. After four cycles of systemic chemotherapy with cisplatin and ifosfamide, the pulmonary nodules completely disappeared. Currently she is still in complete remission after more than 5 years, but unfortunately she has developed myelodysplastic syndrome. This is the first reported case in the literature of cured metastatic uterine carcinosarcoma to lungs, with long-term survival of 5 years.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
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