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1.
Background Sarcomatoid carcinoma of the cervix is a rare entity. To date, less than 20 cases have been reported in the English literature. Case We present a case of a 75-year-old multigravida woman who was treated with radiation therapy. Conclusion It is an aggressive tumour and primary treatment with radiation in early stage disease offers an effective form of therapy.  相似文献   

2.
BACKGROUND: Carcinosarcomas are rare neoplasms of the female genital tract. They tend to be highly aggressive and are generally associated with a poor prognosis. Carcinosarcomas of the uterine cervix are extremely rare, with only approximately 35 cases previously reported in English. CASE: A 68-year-old woman presented with cervical carcinosarcoma. She remained without evidence of recurrent disease for 18 months after surgical resection and pelvic radiation treatment. CONCLUSION: In a review of all cases reported in the literature, it appears that cervical carcinosarcomas tend to present at an earlier stage than carcinosarcomas of the uterine corpus, therefore allowing early diagnosis and treatment. They may therefore be associated with a better overall prognosis than their counterparts in the corpus. Some studies have shown improved survival of patients of carcinosarcoma of the uterine corpus whose treatment included postoperative radiation and chemotherapy. Due to the better prognosis of cervical carcinosarcomas, we suggest studies to evaluate the role of aggressive, multimodal therapy, with the intent of obtaining a cure of cervical carcinosarcomas.  相似文献   

3.
Objective: Small cell carcinoma of the cervix is a very rare and aggressive tumor. Most gynecologic oncology centers have little experience with this tumor. The purpose of the study was to evaluate the University of Kansas’ experience with this tumor and compare findings with those found in current literature.Methods: Fifteen patients with small cell carcinoma of the cervix were treated at or in association with Kansas University Medical Center between 1977 and 1997. Clinical data including age of patient, pregnancy history, stage of tumor, recurrence, type of therapy, presenting symptoms, location of metastases, and overall survival were studied.Results: Age at diagnosis ranged from 20 to 83 years with a mean of 47. Two patients were nulliparous, 2 were primiparous, and 11 were multiparous. Five patients (33%) were stage I, 3 (20%) were stage II, 1 (7%) was stage III, and 6 (40%) were stage IV at diagnosis. Four patients (27%) had progressive courses without good response to treatment, 7 (47%) recurred at an average of 15 months. The patients were treated with surgery, radiation, chemotherapy, or a combination thereof. Extrapelvic metastases developed in 5 of 8 patients with stage I or stage II disease with distant nodes, liver, lung, and brain being common sites. Three patients (20%) developed brain metastases. Tumor lysis syndrome was encountered in one patient. One patient was alive and well 80 months after diagnosis and one patient was lost to follow-up. The remaining 13 died of their disease. Mean survival was 22.3 months for stage Ib, 40 months for stage II, 27 months for stage IIb, 8 months for stage III, and 19.2 months for stage IV.Conclusions: Small cell carcinoma of the cervix is a rare and aggressive variant of cervical cancer. Our experience with this tumor raises the question of increased incidence of central nervous system metastases with small cell carcinoma. Present therapy has not significantly improved outcome with this tumor. There is conflicting evidence regarding the etiologic role of an infectious agent. Tumor lysis syndrome is a possible risk when treating these patients.  相似文献   

4.
BACKGROUND: The treatment regimen indicated for most advanced stage vulvar, vaginal, and cervical cancer usually involves adjuvant chemoradiation therapy. Although the risk of complications is low, there have been reported cases of radiation necrosis and osteomyelitis following treatment for vulvar, vaginal, and cervical cancer. CASES: We present a vulvar cancer patient and a cervical cancer patient, both of whom were treated with radical surgery and postoperative chemoradiation. Following therapy, they were afflicted with pelvic radiation necrosis and osteomyelitis. The patients underwent surgery to resect the necrotic bone tissue and long-term antibiotic therapy to treat their osteomyelitis. They have since recovered and are followed closely by their gynecologic oncology and infectious disease physicians. CONCLUSION: The radiotherapy utilized to treat advanced stage gynecologic cancer can cause intestinal, vaginal, and urologic complications from micro-vascular damage to the organs. Pelvic bone osteonecrosis is a rare but disabling complication of pelvic radiation. Fortunately, with aggressive therapy, these patients may do well clinically.  相似文献   

5.
BACKGROUND: Pure rhabdomyosarcoma of the uterus is an exceedingly rare tumor. While there are no commonly associated tumor markers, a previously reported case confirmed CA125 production by a pure uterine rhabdomyosarcoma. CASE: We describe a postmenopausal woman who presented with vaginal bleeding and was diagnosed with pleomorphic rhabdomyosarcoma of the uterus. Of particular interest was an elevated serum CA125 level at presentation. Immunohistochemical staining with CA125 antibody, however, showed no activity within the tumor. Despite aggressive therapy, the patient experienced distant nodal metastases and succumbed to the disease within 25 months of diagnosis. CONCLUSION: Our patient illustrates the typical presentation and aggressive behavior of this rare neoplasm. While serum CA125 may be a useful tumor marker in selected patients, elevated levels do not directly reflect tumor burden when associated with negative immunohistochemical staining.  相似文献   

6.
Four main clinicopathologic features of neuroendocrine tumors (NETs) of the cervix may be stressed: primary diagnosis at an advanced stage, early nodal metastasis even for low disease, early failure of appropriate local treatment (surgery and/or radiation therapy) and aggressive clinical treatment. Five patients with NET of the uterine cervix (small cell carcinoma type) are reported (one stage I, two stages II, one stage III and one stage IV). One patient was treated by surgery combined with radiation therapy, one by surgery combined with chemotherapy and one by surgery with radiation therapy and chemotherapy. Two patients received radiation therapy alone. Three early stage patients are alive with no evidence of disease 8, 26 and 41 months after diagnosis. The two patients with advanced stage died of disease, 3 and 12 months respectively, after diagnosis. Combination chemotherapy (cisplatin and etoposide) is warranted in disseminated NETs. Neoadjuvant or adjuvant chemotherapy should be combined with radiation therapy and surgery even in early stages.  相似文献   

7.
Background.The presence of cardiac metastasis from cervical carcinoma is extremely rare. The diagnosis is made almost exclusively postmortem. There are few cases of premortem diagnosis, and it is believed that when cardiac metastasis are foundin vivo,the prognosis is extremely poor. Due to the rarity of this condition it is very difficult to standardize care for these patients. Considering the evidence provided by the cases in this report, it is possible that aggressive therapy may lengthen patients survival and quality of life.Case.We present two cases of cervical carcinoma with metastasis to the heart. Both patients presented with symptomatology of cardiac tamponade. Both patients had invasion of the myocardium from presumed endomyocardial metastasis where the prognosis is even worse. We took an aggressive therapeutic approach to our patients and had excellent results in one. Our report includes the longest survival reported for a patient to date with premortem diagnosis of intramyocardial metastasis from cervical carcinoma.Conclusion.We concluded that the prognosis for cardiac metastasis from cervical carcinoma is extremely poor. The stage of the disease at initial presentation does not predict the future development of cardiac metastasis. Taking an aggressive therapeutic approach, including thoracentesis, chemotherapy, and radiation therapy to the heart, survival and quality of life can be improved.  相似文献   

8.
Ovarian sex cord-stromal tumors (OSCST) are rare but characteristic pediatric tumors that develop from the non-germinative component of the ovaries. This review summarizes the experience from 62 patients that were prospectively reported to the German MAKEI studies on non-testicular germ cell tumors and diagnosed and treated according to uniform standards. The event-free and overall survival of all patients is 0.87±0.05 and 0.88±0.05, respectively. Stage according to FIGO and mitotic activity have proven prognostically relevant. All events have occurred in patients stage Ic (with malignant ascites of pre-operative tumor rupture) or stage II–III, and all events occurred in patients with more than 20 mitoses per 120 high power fields. In the rare more advanced tumors stage II–III, adjuvant cisplatin-based chemotherapy has been effective. In conclusion, overall prognosis of children and adolescents with OSCST is favorable, particularly if they are diagnosed at low tumor stage. Patients, in whom an aggressive course of disease has to be expected, can be identified at diagnosis by a standardized clinical and histopathologic assessment and may benefit from adjuvant cisplatin-based chemotherapy. On this basis a prospective therapeutic protocol (MAKEI–SCST 2004) has been designed, which is opening for recruitment in 2004 (http://www.uniklinik-duesseldorf.de/scst).  相似文献   

9.
BACKGROUND: Primary carcinoma of the fallopian tube is a rare and aggressive cancer. Information regarding its epidemiologic, biologic, and prognostic characteristics is limited; consequently, no standard treatment has been developed. We report the case histories of 2 women with transitional cell carcinoma (TCC) of the parafallopian tube treated with aggressive multimodality therapy, and the literature is reviewed. CASES: Two women presented with stage IIB TCC of the parafallopian tube. Both were treated with cytoreductive surgery followed by adjuvant intravenous chemotherapy with cisplatin, gemcitabine, and paclitaxel. Our consolidation treatment consisted of intraperitoneal chemotherapy using the same agents, and 1 patient also received additional hyperthermic chemotherapy with docetaxel. Both patients remain free of disease. CONCLUSION: In these 2 cases, an aggressive, multimodality regimen proved to be feasible and effective in treating TCC of the parafallopian tube.  相似文献   

10.
Endodermal sinus tumors of the ovary have historically carried a dismal prognosis. Recently, reports of survivors receiving the benefit of early, aggressive, combination chemotherapy following surgery have appeared in the literature. Two more survivors, similarly treated at our institutions, are reported in this paper. One of these patients has subsequently had a normal pregnancy. There is reason to believe that this aggressive and rapidly fatal disease of young women can now be controlled in a significant percentage of cases. In a review of 86 reported cases of endodermal sinus tumors treated with surgery followed immediately by multidrug chemotherapy, 58% are surviving from 3 months to several years. In addition, in early stage disease, it appears that fertility may be preserved without sacrificing treatment results.  相似文献   

11.
BACKGROUND: Adenoid cystic carcinoma of the cervix is a rare and aggressive neoplasm for which there are no standardized treatment protocols. CASE: A 38-year-old G3P3 Asian female diagnosed with a stage Ib adenoid cystic carcinoma of the cervix with intermediate risk histologic features received a type III hysterectomy in July 2004. She refused external beam radiotherapy, but agreed to be treated with adjuvant vaginal cuff radiation. She has been closely followed and has no evidence of disease to date. CONCLUSION: Patients with stage Ib adenoid cystic carcinoma of the cervix, especially those with histologic features associated with a higher risk of recurrence, should receive aggressive local therapy, following the guidelines established for similarly staged patients with squamous cell carcinoma of the cervix.  相似文献   

12.
BACKGROUND: Large cell neuroendocrine cervical carcinoma is a rare malignancy. These tumors appear to mimic the aggressive behavior of small cell neuroendocrine tumors. Metastasis and recurrent disease are common. Due to the low incidence of these tumors, optimal therapy has not been delineated. CASES: Two patients presented with large cell neuroendocrine cervical carcinoma, stage IB1 and IIA, at our institution from 1997 to 1999. We describe the clinical course for these two patients and review the relevant literature for the management of large cell cervical carcinoma. CONCLUSION: Unlike squamous cell carcinoma, early-stage large cell neuroendocrine tumors of the cervix are aggressive. Disease recurrences are frequent and distant metastasis is common. Multimodal therapy should be considered at the time of initial diagnosis.  相似文献   

13.
Carcinosarcoma is a rare but highly aggressive uterine malignancy. Pathologically, carcinosarcoma is a biphasic neoplasm composed of a mixture of malignant epithelial and mesenchymal components. A comprehensive approach for management is recommended with complete surgical staging to assess tumor dissemination followed by multimodal therapy with combinations of external beam irradiation or vaginal brachytherapy and systematic chemotherapy in patients with both early and advanced stage disease.  相似文献   

14.
Small cell carcinoma (SCC) of the endometrium is a rare but aggressive disease with early systemic involvement. Patient survival is short. To date, no effective treatment protocol has been established. Surgery, radiotherapy, and chemotherapy have been used either alone or in combination. The case of a patient with stage IB endometrial SCC is presented with an overview based on all reported cases of SCC of the endometrium and its treatment with particular reference to stage I cases.  相似文献   

15.
INTRODUCTION: Malignant mixed mullerian tumor (MMMT) of the ovary is an extremely rare gynaecologic neoplasm that represents 1% of the malignances of this organ. Stage I disease is rare because it is asymptomatic in early stage. We describe four cases. CASE REPORTS: In the Department of Obstetrics and Gynecology of the University of Bari four cases of MMMT of the ovary were diagnosed. Three patients were in stage IIIC and one of them was a homologous MMMT; the fourth patient was affected by a heterologous stage IV MMMT. All women were treated with surgery and chemotherapy. Two patients are alive 14 and 12 months after diagnosis. The other two died after 37 months and one month, respectively. CONCLUSIONS: The malignant mixed mullerian tumor (MMMT) of the ovary is a particularly aggressive tumor, especially in advanced stages. The survival rate is very low in spite of surgery, chemotherapy and radiotherapy. The optimal treatment for this neoplasm is unknown because of its rarity. Our experience, when considering survival, seems to confirm the use of cisplatin and ifosfamide and to give new horizons to taxol.  相似文献   

16.
BACKGROUND: Squamous cell carcinoma arising from malignant degeneration of a mature cystic teratoma is rare with a reported incidence of approximately 1-3%. The most common presenting symptoms are lower abdominal pain and increasing abdominal girth of several months' duration. Approximately 50% of the patients present with FIGO stage I while 35-38% present with stage III diseases. CASE: The case described herein represents an unusual presentation and initial diagnostic dilemma of locally aggressive squamous cell carcinoma arising in an ovarian dermoid cyst, with invasion into the distal rectum and anal canal causing rectal bleeding similar to the presentation of anal squamous cell carcinoma. Despite aggressive surgical management with posterior exenteration and optimal tumor debulking followed by 5040-cGy pelvic radiation utilizing 25-MV photons, the patient developed pelvic recurrence at the vaginal cuff 6 weeks after completion of her adjuvant radiotherapy. She subsequently failed cis-platinum single-agent chemotherapy and died 9 months after her initial surgery and diagnosis. CONCLUSION: Squamous cell carcinoma in the anal canal, diagnosed by colonoscopy or proctoscopy, could be an unusual presentation of that arising from malignant degeneration of an ovarian dermoid cyst. This tumor may behave in a locally aggressive manner and be resistant to pelvic radiation or single-agent chemotherapy of cis-platinum. The current experience of adjuvant treatment after comprehensive staging and cytoreductive surgery reported in the world literature is limited, and the optimal management of the malignancy remains unclear.  相似文献   

17.
BACKGROUND: Oral lichen planus (LP) is thought to affect 1% of the population. It is an autoimmune inflammatory disease process with varied clinical manifestations. Glabrous skin scarring is rare, but that of mucosal membranes may be more common than recognized. It has been estimated that 25% of patients with oral lesions also harbor genital lesions. CASE: We report 4 cases of LP with genital involvement treated at various stages of development. Severe mucosal scarring occurred, and vulvovaginal scarring commonly resulted in significant dyspareunia. CONCLUSION: Early and aggressive diagnosis and therapy may abrogate the scarring potential of this debilitating disease process.  相似文献   

18.
BACKGROUND: Ovarian fibromatosis is a very rare nonneoplastic disease. Due to the rarity and atypical clinical presentations, they may give rise to a misdiagnosis of malignancy and unnecessary extensive surgical interventions. Literature lacks definitive data about this rare disease and its preoperative evaluations. MRI together with the intraoperative frozen section may help us to define the benign nature of the disease. In this report, we aimed to review the literature and give a highlight to the gynecologic oncologists about this rare disease. CASE HISTORY: A 19-year-old female patient admitted to our hospital with the complaints of menstrual irregularity, hirsutism, and increased abdominal girth. Physical examination revealed bilateral ovarian mass, hirsutism, and ascites. Serum CA-125 levels were slightly elevated. Preoperative MRI study showed bilateral hypointense lobulated ovarian masses. With the initial diagnosis of ovarian tumor, we performed explorative laparotomy and excised both masses. Final pathology was reported as bilateral ovarian fibromatosis. CONCLUSION: Ovarian fibromatosis commonly presents with ascites and solid pelvic mass and can be misdiagnosed as a malignant ovarian tumor. In young patients, clinicians should consider ovarian fibromatosis in differential diagnosis of pelvic mass. Preoperative MRI findings and intraoperative frozen examination may be used to avoid unnecessary aggressive surgical management.  相似文献   

19.
A 66-year-old patient was treated with external radiation therapy for an advanced carcinoma of the vulva. Seven years later, a lymphangiosarcoma developed in her edematous lower extremity. Lymphangiosarcomas have been reported to occur in postmastectomy patients; however, this is only the third case in a patient with a gynecologic primary malignancy. In anticipation of possible increased use of radiation therapy in vulvar carcinoma, gynecologists should be aware of this rare, highly aggressive neoplasm.  相似文献   

20.
ObjectiveLow-risk, early stage, ovarian endometrioid carcinoma seems to have little chance to recur in clinical practice. Such a patient developed widespread, life-threatening pulmonary metastases is also extreme rare and is worthy to be reported.Case reportA 53-year-old female, who was diagnosed to have stage IA, grade 2, ovarian endometrioid carcinoma, developed a life threatening widespread lung metastasis in 2 years after primary surgery. She received salvage systemic chemotherapy with paclitaxel plus carboplatin. Bevacizumab was added after occurrence of paroxysmal supraventricular tachycardia during chemotherapy. The patient had clinical improvement and radiological stable after systemic therapy.ConclusionOur case report enhances the aggressive post-operative surveillance including chest field would still be recommended even in the low-risk patients. To detect distant metastases earlier probably has higher chance of cure by systemic therapy.  相似文献   

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