1/16. 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) |
2/16. Exaggerated placental site erroneously diagnosed as non-metastatic trophoblastic disease. A case report.BACKGROUND: Exaggerated placental site (EPS) is classified as a non-neoplastic trophoblastic lesion, and histologically it consists of endometrial and myometrial invasion of intermediate trophoblasts and syncytiotrophoblasts and it differs morphologically from placental site trophoblastic tumors and placental nodules. The purpose of this report is to increase physicians' awareness of this lesion. CASE: A 48-year-old woman with post-molar rising betahCG titers and a clinical diagnosis of non-metastatic trophoblastic disease underwent hysterectomy. Final histopathology showed exaggerated placental site--a lesion often unfamiliar to clinicians. CONCLUSION: It is suggested that operative hysteroscopy may be useful in the diagnosis and management of EPS.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/16. 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.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/16. 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) |
5/16. Cyclical haematuria sequel to uterine myomectomy: a case report.A thirty-year old married nulliparous lady had a difficult myomectomy done by a general practitioner one year prior to presentation. Two months after the operation, she had her menstruation, but with a concurrent total, painless haematuria. This combination continued for nine months before her family physician referred her to the urological clinic. Full urological work-up revealed an iatrogenic vesico-uterine fistula, but the features were not consistent with those of the classical vesico-uterine fistula syndrome. Transabdominal fistulectomy not only controlled the haematuria but also helped the patient to achieve a viable pregnancy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/16. Isolated extramedullary relapse of acute myelogenous leukemia as a uterine granulocytic sarcoma in an allogeneic hematopoietic stem cell transplantation recipient.We report an unusual case of acute myelogenous leukemia in a patient who showed an extramedullary relapse in her uterus, without bone marrow recurrence, two years after an allogeneic bone marrow transplant. She complained of irregular vaginal spotting, and magnetic resonance imaging demonstrated a uterine mass. A biopsy revealed a massive infiltration of immature myeloid cells. A variable number of tandem repeats (VNTR) based on an examination of peripheral blood cells showed full donor chimerism. After receiving chemotherapy, her uterine mass had completely resolved. She has remained in complete remission for more than 6 months. This case suggests that physicians should be aware of the possibility of a uterine relapse in female bone marrow transplant recipients with acute myelogenous leukemia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/16. A uterine cavity-myoma communication after uterine artery embolization: two case reports.OBJECTIVE: To report two cases of uterine cavity-myoma fistula as a medical complication after uterine artery embolization. DESIGN: Case report. SETTING: women's Medical Center/Viscomi Institute, Sao Paulo, brazil. PATIENT(S): Two patients presenting with symptomatic myomatous uterus: a 40-year-old woman with increased abdominal volume and hypermenorrhea, and a 42-year-old woman with pelvic pain and infertility. INTERVENTION(S): uterine artery embolization, hysteroscopic follow-up, and laparoscopic myomectomy. MAIN OUTCOME MEASURE(S): Hysteroscopic follow-up after uterine artery embolization. RESULT(S): The patients underwent uterine artery embolization. In the months that followed, a subsequent surgical hysteroscopic follow-up was performed to eliminate the necrotic material of the degenerated myomas. The two patients presented the same outcome 1 year after the uterine artery embolization had been performed: a communication between the uterine cavity and a degenerated myoma. Laparoscopic correction of the uterine wall defect was performed afterward. CONCLUSION(S): Because embolization is a growing option for the treatment of leiomyoma, it is important that potential complications be reported, especially if the patients want to become pregnant. The natural history of the fistula and its consequences are unknown, and physicians should be aware of these complications. Hysteroscopic follow-up was important in the diagnosis of the two cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/16. 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) |
9/16. A reappraisal on the management of lumbosacral plexopathies in gynecological malignancies: where do the physiatrists stand?Two patients are reported here with gynecological malignancies--an ovarian and a cervical carcinoma--who had suffered from lumbar plexopathies during their follow-up. Their management is discussed with an emphasis on the collaboration of the gynecologists and the rehabilitation physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/16. Sonographic findings of uterine leiomyosarcoma.We describe herein various sonographic features of uterine leiomyosarcoma. Transabdominal scanning (TAS) revealed an image indistinguishable from benign leiomyoma, with evidence of degeneration. Transvaginal scanning (TVS) clearly showed the thinness of the myometrium, and the possibility of deep myometrial invasion was suspected at intraoperative open direct ultrasonography (ODU). A very high peak systolic velocity and a slightly increased diastolic component at the periphery of the tumor were evident with pulsed Doppler ultrasound. Thus, TAS, TVS, ODU and Doppler ultrasound will yield useful information for the physician attempting to evaluate the extent and vascularity of uterine leiomyosarcoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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