1/18. Primary pelvic non-Hodgkin's lymphoma.OBJECTIVE: To describe five cases of primary pelvic non-Hodgkin's lymphoma, a rare gynecologic malignancy. methods: The charts of five women with primary pelvic non-Hodgkin's lymphoma were reviewed. Histologic classification was based on the Working Formulation, and staging was based on the Ann Arbor system. disease status was monitored with physical examination and imaging studies. RESULTS: During a 10-month period, five women were diagnosed with primary pelvic non-Hodgkin's lymphoma, including one parasacral, one uterine, one vaginal, and two ovarian tumors. Presentations included abdominal and pelvic pain, abdominal and pelvic mass, and abnormal vaginal bleeding. Treatment included combination chemotherapy, with or without radiation. Four patients were alive and disease free 20--33 months after therapy. CONCLUSION: Primary pelvic non-Hodgkin's lymphoma may present like other more common gynecologic cancers. It should be considered in the differential diagnosis of gynecologic malignancy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/18. An unusual cause of pelvic mass.BACKGROUND: pelvic pain with an associated pelvic mass is a common problem in the emergency room (ER) or physician's office. Concerns about ectopic pregnancy, infection, or malignancy usually dominate the diagnostic evaluation. At the same time, domestic violence as the cause of a pelvic mass is seldom suspected by physicians. CASE: A 38-year-old woman came to the ER with left lower quadrant pain and a left pelvic mass. After four hospital days and multiple diagnostic imaging studies, the diagnosis of hematoma caused by physical trauma to the abdomen was elucidated. CONCLUSION: Proper diagnosis of the cause of the pelvic mass could have been made earlier by careful attention to the social history and by recognizing the high incidence of domestic violence as opposed to the relative infrequency of some other diagnostic entities for which the patient was tested.- - - - - - - - - - ranking = 0.1192632314045keywords = physical (Clic here for more details about this article) |
3/18. Penile metastasis from primary transitional cell carcinoma of the renal pelvis: first manifestation of systemic spread.BACKGROUND: Almost one-third of all penile metastases are detected at the same time as a primary tumor, whereas the remaining two-thirds are detected a mean of 18 months after the discovery of the primary tumor. Cutaneous metastasis of transitional cell carcinoma (TCC) is extremely rare and generally accepted as the late manifestation of a systemic spread. CASE PRESENTATION: We report the first case of simultaneous penile and lung metastases from a primary TCC of the renal pelvis in a 76-year-old man, that occurred 8 years after a left nephroureterectomy. CONCLUSIONS: This case report underscores the importance of physical examinations of the skin of patients who undergo surgical procedures for TCC from bladder as well as from the upper urinary tract, including those seemingly without metastatic disease, because of the possibility of skin and penile metastatic spread.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/18. Phase I/II study, combination of radiotherapy and hyperthermia in patients with deep-seated malignant tumors: report of a pilot study by the radiation Therapy Oncology Group.This is a report of a Phase I/II study activated in March 1984 and completed in October 1988 by the radiation Therapy Oncology Group on the feasibility/toxicity of hyperthermia in patients with deep-seated malignant tumors. The main objective of this study was to evaluate the morbidity of regional hyperthermia (systemic and regional, acute and late effects); a secondary objective was to evaluate tumor response to combined irradiation and regional hyperthermia. A total of 54 patients with locally advanced abdominal or pelvic malignancy were accrued to this study; 42% were male and 58% female. Seventy-five of the patients had pelvic tumors and 25% abdominal tumors. Acute toxicities included grade 4 in three patients (1 cutaneous, 1 infection and 1 chemical peritonitis) one grade 3 (skin), and 12 grade 2 toxicities (6 skin and 6 gastrointestinal). With regard to late toxicities, grade 4 was noted in one patient (skin), grade 3 (GI) in one, and grade 2 (skin, peripheral neuropathy) in six patients. The prescribed course of hyperthermia was completed in 17 (32%) of patients. In 36 patients (68%) the course of hyperthermia was terminated, primarily because of patient discomfort. Tumor response was assessed by physical examination or radiological studies. Of 44 patients evaluable for response, there were 17 (39%) complete responses and 6 (14%) partial responders. Significant technical problems in heat delivery and thermometry remain.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/18. Ectopic splenomegaly in Felty's syndrome.A 50-year-old woman with Felty's syndrome, who presented with "menopausal" symptoms, was found to have a large pelvic mass on physical exam. Computed tomography of the pelvis led to an incorrect diagnosis of malignancy, while radionuclide imaging using Tc-99m sulfur colloid confirmed the diagnosis of ectopic splenomegaly.- - - - - - - - - - ranking = 0.1192632314045keywords = physical (Clic here for more details about this article) |
6/18. Aggressive angiomyxoma first diagnosed as levator hernia.When a 32-year-old woman was first seen, physical findings suggested she had a large levator hernia, but at the time of surgical resection an aggressive angiomyxoma was found.- - - - - - - - - - ranking = 0.1192632314045keywords = physical (Clic here for more details about this article) |
7/18. Imaging the effects of an ectopic spleen on the urinary tract.A 75-year-old woman with chronic lymphocytic leukemia who presented clinically with urinary frequency was found on physical examination to have a pelvic mass. Ultrasound and computed tomography showed it to be due to a large ectopic spleen lying in the pelvis behind the bladder and compressing it anteriorly. The spleen became smaller and the symptoms regressed with chemotherapy. We review the features of an ectopic spleen as seen on diagnostic imaging studies.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/18. Misdiagnoses in obstetric and gynecologic ultrasound examinations: causes and possible solutions.Two small series of cases documenting ultrasound misdiagnoses are presented. The first concerns obstetric ultrasound misdiagnoses originating in the private offices of physicians. The second concerns gynecologic ultrasound misdiagnoses originating in a level II medical center. A dichotomy exists in the use of diagnostic ultrasound examination in the practice of obstetrics and gynecology. The dichotomy is a serious defect in our specialty that needs urgent addressing. The institutional problem can be partially resolved by furnishing the sonographer with the referred patient's history and physical findings. The problem of the ultrasound machine in the office of a private physician is much more complex. It may require government intervention and strict licensing measures for resolution.- - - - - - - - - - ranking = 0.1192632314045keywords = physical (Clic here for more details about this article) |
9/18. Extraovarian pelvic yolk sac tumors.The clinical and pathologic features of four extraovarian pelvic yolk sac tumors (YST) are described. The women, 17 to 39 years of age, were found to have a pelvic mass on physical examination, or in one case, at cesarean section. The tumors were bulky and arose within, or in close proximity to, the uterus. One tumor involved the endometrial cavity and myometrium extensively, another was attached to the anterior uterine serosa, another was in the cul-de-sac, and one lay between the lower uterine segment and urinary bladder. The ovaries were grossly unremarkable in all cases. Peritoneal metastases were present at the time of operation in two patients and were documented on histologic examination in a third. The serum alpha fetoprotein (AFP) level was elevated postoperatively in the three patients in whom it was determined. Three of the YST were pure and had a typical histologic appearance, whereas the fourth had an endometrioid-like glandular pattern and was associated with a teratoma. Immunohistochemical stains performed in three cases all showed AFP and alpha-1-antitrypsin (AAT). All patients received postoperative combination chemotherapy. Two of them died of tumor 14 and 24 months, respectively, postoperatively and two were disease-free 6 and 8.5 years, respectively, postoperatively.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/18. Deviation of the prostatic urethra in pelvic masses.A cystourethrogram in the anteroposterior view can be useful for the diagnosis of a mass in the true pelvis in males, particularly when rectal examination is not possible. The technique is simple and rapid and has the same morbidity as simple urethral catheterization. This maneuver should be used whenever a pelvic mass is suspected in a male and physical findings fail to confirm its presence.- - - - - - - - - - ranking = 0.1192632314045keywords = physical (Clic here for more details about this article) |
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