1/16. Endometrial adenocarcinoma in pregnancy.OBJECTIVE: The coexistence of endometrial adenocarcinoma and pregnancy is rare. Most cases are discovered in the first trimester due to irregular bleeding or spontaneous abortion. CASE: A 44-year-old woman, gravida 3, para 2, was admitted due to abnormal vaginal bleeding. After complete history, physical examination, and laboratory evaluation, she was diagnosed with spontaneous abortion and underwent a suction curettage. Pathological examination of the tissue included chorionic villi and an area of atypical hyperplasia and endometrial cancer. CONCLUSION: Recent association between first-trimester spontaneous abortions and subsequent endometrial cancer makes these rare cases of concurrent endometrial cancer and first trimester of pregnancy attractive in that they may disclose insights into the pathophysiology of hormone-dependent cancers.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/16. Hepatic hemangioendothelioma: prenatal sonographic findings and evolution of the lesion.We describe a case of hepatic hemangioendothelioma that was first suspected based on prenatal sonographic findings at 19 weeks' menstrual age. At 16 weeks, the patient presented with a markedly elevated maternal serum alpha-fetoprotein level. Serial sonographic examinations revealed that the fetus had cardiomegaly, hepatomegaly with a hepatic mass and dilated intrahepatic vessels, a single umbilical artery, and a placental chorioangioma. Arteriovenous shunting within the hepatic mass was seen using color Doppler and pulsed Doppler sonography. An enlarged artery arising from the abdominal aorta supplying the mass was demonstrated. Postnatal physical examination and radiologic studies supported the diagnosis of hepatic hemangioendothelioma. The evolution in the sonographic appearance of this hepatic lesion in utero over a 17-week period is described.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/16. Metastatic breast cancer in pregnancy: first case of chemotherapy with docetaxel.The focus of this paper is a case study of a woman in the first trimester of pregnancy who presented with metastatic breast cancer. The bony spread of the metastases was rapid and it was necessary to treat the patient as soon as possible after the period of organogenesis (days 18-60 of human gestation). This stage is the phase of greatest sensitivity of teratogens and the malformations are observed most often. Yet, the choice of third-line chemotherapy was difficult because of anthracycline-resistant metastatic breast cancer. The world literature reported cytotoxic combinated regimens as the standard of care for the management of the metastases. The development of new antitumoral strategies with less toxicity and their encouraging results led us to the approval of docetaxel for the treatment of the patient even though it had never been tested in pregnancy. Docetaxel is a potent inhibitor of microtubule depolymerization and has a unique ability to alter certain classes of microtubules. The monochemotherapy was administered once every 3 weeks for a total of three cycles until 30 weeks of gestation. During the 32nd week of pregnancy the patient delivered a female infant whose birthweight and apgar score were normal. The infant did not have any anomalies. The woman finished her treatment in puerperium and she received three cycles of docetaxel. The patient has been receiving vinorelbine (one cycle every 2 weeks) for 2 years; her last follow-up was good and showed that the progression of the metastases had stopped. The daughter's psychophysical development was normal.- - - - - - - - - - ranking = 0.13624506342329keywords = physical (Clic here for more details about this article) |
4/16. Sclerosing stromal tumor of the ovary in pregnancy: clinical, ultrasonography, and magnetic resonance imaging findings.We report a case of sclerosing stromal tumor of the ovary in a 30-year-old pregnant patient presenting with pelvic pain, dysuria, and metrorrhagia. Very few reports of sclerosing stromal tumor of the ovary during pregnancy have been presented. The purpose of our work is to present the findings at physical examination, ultrasonography, magnetic resonance imaging, and histopathology, to review the literature regarding this uncommon neoplasm, and to show the usefulness of magnetic resonance imaging in the assessment of pelvic masses during pregnancy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/16. Fetal dose reduction in head and neck radiotherapy of a pregnant woman.BACKGROUND AND PURPOSE: A pregnant woman was referred for post-operative radiotherapy of a malignant schwannoma in the head and neck region. A best-treatment plan was devised in order to minimize the fetal dose. MATERIAL AND methods: The fetal dose resulting from radiological examinations was determined according to international protocols, that resulting from radiotherapy was calculated according to Recommendation 36 of the American association of Physicists in medicine (AAPM) Task Group. Pre-treatment dosimetry was performed with an anthropomorphic phantom. Several alternative treatment plans were evaluated. The use of a multileaf collimator (MLC) and a virtual wedge (VW) was compared to cerrobend blocks (CB) and physical wedge (PW). In-vivo dosimetry was performed using a vaginal probe containing thermoluminescent dosimeters (TLD). RESULTS: The total fetal dose resulting from diagnostic and radiotherapy procedures was estimated to be 36 mGy. The technique based on MLC and VW was elected for patient treatment. Measurements for this configuration resulted in afetal dose reduction of 82%. The shielding of the patient's abdomen further reduced the fetal dose by 42%. CONCLUSION: The use of VW and MLC for the treatment of a pregnant woman is highly recommended. Each case should be individually studied with pre-treatment and in-vivo dosimetry.- - - - - - - - - - ranking = 0.13624506342329keywords = physical (Clic here for more details about this article) |
6/16. Neonatal effects of breast cancer chemotherapy administered during pregnancy.A human fetus is most susceptible to teratogenic agents during the first trimester of pregnancy. cyclophosphamide and doxorubicin are pregnancy category D agents; however, potential benefits may warrant treatment with these agents during pregnancy under special circumstances. During her first trimester of pregnancy, a 37-year-old Caucasian woman was diagnosed with stage IIB infiltrating ductal carcinoma in situ (breast cancer) that was estrogen and progesterone receptor negative and human epidermal growth factor receptor-2 positive. The patient was treated with doxorubicin and cyclophosphamide in the second and third trimesters and delivered a premature baby boy at 31 weeks' gestation. The neonate was intubated on delivery because of respiratory distress and failure; however, no physical anomalies were observed. He had neutropenia and anemia, quite possibly as a result of his mother's chemotherapy 1 week before delivery. He was prophylactically treated for sepsis, but all cultures were negative. The infant grew and developed normally during his first year of life and remained in good health. An objective causality assessment revealed that it was probable that the infant's adverse events (prematurity, neutropenia, and anemia) were related to his mother's doxorubicin and cyclophosphamide therapy; however, these were the only adverse events potentially linked to in utero exposure to chemotherapy during the second and third trimesters. Due to the special considerations of both mother and infant, optimal treatment for patients with pregnancy-associated breast cancer requires the expert opinion of a multidisciplinary care team.- - - - - - - - - - ranking = 0.13624506342329keywords = physical (Clic here for more details about this article) |
7/16. Spontaneous hemothorax caused by intrathoracic synovial sarcoma.Synovial sarcoma, which is a soft tissue malignancy, primarily affects the extremities in the para-articular regions in adolescents and young adults. Synovial sarcoma of the pleural cavity is extremely uncommon, and there have been only a few reports in the literature. We report here an unusual case of left-sided spontaneous hemothorax as a presenting manifestation of intrathoracic synovial sarcoma in a 33-year-old pregnant woman. Spontaneous hemothorax, unrelated to trauma, is a very unusual clinical presentation, but we must consider entities with a physical risk assessment promptly because of the possible need for urgent management based on the hemodynamic condition of the patient. We should always be aware of possible causes of spontaneous hemothorax.- - - - - - - - - - ranking = 0.13624506342329keywords = physical (Clic here for more details about this article) |
8/16. Metastatic pheochromocytoma in pregnancy and fetal biophysical assessment after maternal administration of alpha-adrenergic, beta-adrenergic, and dopamine antagonists.Metastatic pheochromocytoma, a rare complication of pregnancy, was managed from 30 weeks' gestation until delivery three weeks later with a combination of alpha-adrenergic blockade (Minipres) beta-adrenergic blockade (timolol), and dopamine synthesis inhibition (Demser). The biophysical parameters of fetal heart rate (FHR) baseline, variability, and reactivity, as well as fetal breathing movements, body movements, tone, and amniotic fluid volume were followed sequentially during this period. A 1450-g growth-retarded infant, who subsequently did well, was delivered by cesarean section; the mother received combined surgical and medical therapy for her metastatic disease in the postpartum period. The initial fetal biophysical alteration observed was a reduction in mean FHR baseline rate; further biophysical test abnormalities appeared only after overt fetal compromise was evident. Sequential multiple parameter biophysical testing in such circumstances appears to be a valid and valuable approach to antepartum management.- - - - - - - - - - ranking = 1.0899605073864keywords = physical (Clic here for more details about this article) |
9/16. Acute polyhydramnios associated with fetal hepatoblastoma.A 28-yr-old gravida II mother presented at 29 wk gestation with acute polyhydramnios. The most common causes for polyhydramnios were excluded and onset of preterm labor at 31 wk prevented further studies. tocolysis failed and a severely asphyxiated boy was born. He had a very distended abdomen with a 7 cm hepatomegaly and was in shock. No other physical abnormalities were found. The child died 15 min after birth. At post mortem examination a fetal type hepatoblastoma was detected. duodenal obstruction due to the liver tumor might have caused the polyhydramnios.- - - - - - - - - - ranking = 0.13624506342329keywords = physical (Clic here for more details about this article) |
10/16. Early gastric cancer and a concomitant pregnancy.Gastric cancer associated with pregnancy is most often associated with a poor prognosis because the cancer stage is usually advanced at the time of diagnosis. The symptoms are frequently masked by factors related to the normal pregnancy and diagnostic approaches are restricted by physical and psychological clinical events. The authors treated a 30-year-old woman at 35 weeks of gestation. She had episodes of hematemesis and a prompt diagnosis of early gastric cancer was made following observations using a gastroduodenal fiberscope. A living normal child was delivered following oxytocin-induced labor and, 18 days later, curative resection for the gastric cancer was done. The patient has been doing well for over 16 months at this writing, with no evidence of recurrence. Based on the author's experience and a review of the literature, they conclude that early gastric cancer detected during pregnancy has a satisfactory prognosis and that use of the gastrofiberscope facilitates an early diagnosis in a pregnant subject with untoward symptoms of the GI tract.- - - - - - - - - - ranking = 0.13624506342329keywords = physical (Clic here for more details about this article) |
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