Constantine Gorelick

Sonographic findings of a large vulvar lipoma

Lipomas of the vulva are rare benign tumors that consist of mature fat cells often interspersed with strands of fibrous connective tissue. They arise from the vulvar fatty pads and present as soft, multilobulated subcutaneous neoplasms. Histological examination reveals a thin capsule surrounding a lobular proliferation of lipocytes. Liposarcomas of the vulva have been described rarely. We present the sonographic findings of a large lipoma of the vulva, and demonstrate the contribution of topical application of a high‐frequency transvaginal transducer in depicting lobular structural features, characteristic of this soft tissue tumor. Copyright

Transvaginal sonographic findings of a large intramural uterine hematoma associated with iatrogenic injury sustained at termination of pregnancy

We report a case in which a patient presented with severe right lower abdominal pain associated with nausea and vomiting 3 days after termination of pregnancy. Transvaginal ultrasonography showed a large intramural mass in the anterior aspect of the lower segment of an acutely retroflexed uterus. Computed tomography and magnetic resonance imaging findings were consistent with an intramural hematoma as a result of iatrogenic injury sustained during the preceding termination of pregnancy. The patient was managed expectantly. Systematic review of the literature confirmed that this is the first report of sonographic findings associated with an intramural uterine hematoma some days after the injury sustained at termination of pregnancy. This case supports utilization of real‐time ultrasound guidance during intrauterine surgery of selected cases to decrease procedure‐related morbidity. Copyright

Sonographic and Magnetic Resonance Imaging Findings of an Isolated Vaginal Leiomyoma

Leiomyomas represent the most common uterine neoplasms, noted clinically in 20% to 30% of all women older than 30 years, and are found in 75% of hysterectomy specimens. 1 Although rare, the most common mesenchymal neoplasm of the vagina is the leiomyoma. 2 The mean patient age at detection of a vaginal leiomyoma, is approximately 40 years, with a reported range between 19 and 72 years. 2 Vaginal leiomyomas vary from 0.5 to 15 cm in diameter, averaging approximately 3 cm in size, and may occur anywhere within the vagina, usually in a submucosal location. Although these rare lesions are often asymptomatic, larger tumors may be associated with pain, dystocia, dyspareunia, or obstructive urinary symptoms. We report the sonographic and magnetic resonance imaging (MRI) findings of a patient with an isolated vaginal wall leiomyoma.

Color Doppler Imaging and 3-Dimensional Sonographic Findings of Urinary Bladder Leiomyoma

Leiomyomas of the genitourinary tract may originate from the renal pelvis, bladder, urethra, or epididymis. 1 Interestingly, leiomyomas of the bladder are more common among women (76% of cases).2 Development is usually endovesical (63%), yet extravesical (30%) and intramural cases are not rare.3 Patients may be asymptomatic or may have obstructive urinary symptoms, irritative symptoms, hematuria, flank pain, or, rarely, dysmenorrhea or dyspareunia. 2-5 Leiomyomas of the bladder have been reported in association with neurofibromatosis type 1, in which leiomyomas occur most often in the gastrointestinal tract (proximal small bowel) and tend to be multiple.6 Rarely, urinary bladder leiomyomas have been diagnosed during pregnancy 7,8 and in a woman with a previous hysterectomy. 9 Diagnostic imaging modalities used include both transabdominal and transvaginal sonography, computed tomography, and magnetic resonance imaging.10-12 Although asymptomatic, nonobstructive, and nonproblematic leiomyomas may be managed expectantly, treatment is surgical by a transurethral approach, laparoscopy, or laparotomy 1-4 We present color Doppler imaging and 3-dimensional sonographic findings of a woman with a urinary bladder leiomyoma.

Acquired hematometra and hematotrachelos in an adolescent with dysfunctional uterine bleeding

Obstruction of the lower female genital tract leading to proximal dilatation and development of hematocolpos, hematotrachelos, and hematometra is most commonly a result of congenital abnormalities. 1-3 These conditions include an imperforate hymen, a complete transverse vaginal septum, and vaginal and, rarely, cervical atresia. 1-3 Acquired obstruction of the lower female genital tract is rare. Etiologies of such acquired lesions include iatrogenic trauma to the uterine cervix such as cone biopsies, loop electrosurgical procedures, dilation and curettage, obstetric lacerations, cervical or endometrial carcinoma, and radiation therapy. 4-8 Spontaneous obstruction is extremely rare yet has been reported recently. 9 We describe an unusual case in which sonographic findings of marked spontaneous hematometra and hematotrachelos were depicted in an adolescent with dysfunctional uterine bleeding.

Transvaginal sonographic findings of isolated intramural uterine choriocarcinoma mimicking an interstitial pregnancy

The differential diagnosis of highly vascular, intramural lesions of the myometrium Includes arteriovenous malformation, gestational trophoblastic neoplasia, hemangiomata, sarcoma, and interstitial pregnancy. We present an unusual case in which a patient with irregular uterine hemorrhage in the presence of increasing serum β-human chorionic gonadotropin (β-hCG) levels exhibited transvaginal sonographic and color Doppler imaging findings considered consistent with an interstitial pregnancy. After laparoscopy and curettage yielded normal findings but with the continuously rising serum β-hCG levels and the concern for gestational trophoblastic neoplasia, the patient underwent vaginal hysterectomy. Histopathologic findings confirmed choriocarcinoma.

Acute spontaneous hematotrachelos following methotrexate treatment of a suspected tubal pregnancy

Hematotrachelos, engorgement of the uterine cervix with retained blood, may represent congenital or acquired conditions. Congenital hematotrachelos may be associated with obstruction distal to the cervix in cons ditions that include imperforate hymen, complete transverse vaginal septum, and, rarely, agenesis of the vagina with cervical atresia. 1-3 In contrast, acquired hematotrachelos is usually associated with cervical stenosis as a result of destructive cervical surgeries, including cone biopsy and loop electrosurgical excision procedures performed in the clinical management of cervical dysplasia. 4-8 We report an unusual case in which the development of acute spontaneous hematotrachelos was sonographically depicted in a multiparous patient during a 5-week period in proximation with intramuscular methotrexate treatment of a suspected tubal pregnancy.

Transvaginal sonographic findings of endometrial metastases of mammary ductal carcinoma

Metastases to the uterus are rare and account for less than 10% of all metastases to the female genital tract from extragenital cancers. 1 The endometrium is even less frequently affected by metastases. 1 The most common type of breast cancer that metastasizes to the uterus is infiltrating lobular carcinoma. 1 Other histologic types of breast carcinoma that may metastasize to the endometrium include infiltrating ductal carcinoma and signet ring breast carcinoma. 1-5 We report an unusual case in which a postmenopausal patient with infiltrating mammary ductal carcinoma receiving tamoxifen presented because of recent mild uterine bleeding. Transvaginal sonography depicted a symmetrically thickened endometrium and a small hydrometra. Tissue obtained at curettage confirmed metastatic carcinoma consistent with mammary ductal carcinoma.

Abstract C44: Ex vivo cytotoxicity of PNC-27 on primary human ovarian and endometrial cancers

We have developed a series of anti-cancer peptide drugs, PNC-27 and PNC-28 from the MDM2- binding domain of the p53 protein (AA12–26 and 17–26, respectively) and a newly designed membrane residency peptide (MRP) that allows the drug to insert itself into cellular plasma membrane. To date, we have treated in vitro cells from over 20 different human epithelial cancer cell lines, including pancreatic, colon, lung, breast and ovarian cancer with PNC-27 and PNC-28. In all cases both peptides induce tumor cell necrosis within minutes to hours. Recent biophysical and ultrastructural studies have shown that cancer cell necrosis is due to the formation of transmembrane pores by PNC-peptide inducing direct cell lysis. Furthermore, we have found that PNC-28 destroys a highly metatstatic pancreatic cancer (BMRPA1.TUC-3) xenotransplanted into Nu/Nu mice. Remarkably, the PNC-peptides have no effect on the growth or viability of normal cells in culture such as human fibroblasts, keratinocytes and normal pancreatic acinar cells. Most importantly, the PNC-peptides have shown no effect on human umbilical-cord derived human hematopoetic stem cells in vitro to differentiate into mature blood cells and in vivo on blood cell differentials from tumor bearing and PNC-peptide treated animals. These results strongly indicate that PNC-27 and PNC-28 are potent anti-cancer drugs. The results strongly suggest the drugs9 considerable potential against different epithelial cancers without exerting the limiting side effects of suppressing a patient9s bone marrow, hematopoesis, normal cell growth and differentiation. Clearly, the cytotoxic efficacy of the PNC-peptides against long-established cancer cell lines is not directly transferable to a primary cancer in a future patient. Thus, to study the effect of PNC-peptide on a primary human cancer as close as possible to the in vivo (the tumor) situation, we freshly established in culture, under an IRB-approved protocol, cancer cells from the tissues of two primary human ovarian cancers and human uterine cancers. The cells released from the tumor tissue placed into a tissue culture dish were collected and their derivation as a homogenous cell population and from their respective tumors confirmed by immune-cytopathological comparative analysis. The cells9 cancerous properties were confirmed in vitro within the first four passages (p) of the newly established primary cells when the cells9 genomic makeup is still virtually identical (>99%) to that present in the tumor tissue per se. Cell growth and cell death in cells from p1–p4 and treated with PNC-27 or a control peptide PNC-29 were measured using MTT cell proliferation and LDH cytotoxicity assays. The results clearly demonstrate that PNC-27 effectively kills these primary human ovarian and uterine cancer cells in a dose-dependant manner with an LD50 of 100 and 150μg/ml, respectively. Throughout these experiments the effect of PNC-27 on the cancer cells9 morphology was recorded, demonstrating the cells9 complete disruption during the course of the treatment whereas the cancer cells treated with PNC-29 (up to 500μg/ml) remained morphologically indistinguishable from untreated cancer cells. These findings demonstrate for the first time the potentials of PNC-27 anti-cancer peptide as an efficient drug against freshly established and thus primary cells from these rather frequent human gynecological malignancies. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the Second AACR International Conference on Frontiers in Basic Cancer Research; 2011 Sep 14-18; San Francisco, CA. Philadelphia (PA): AACR; Cancer Res 2011;71(18 Suppl):Abstract nr C44.