Mira Hellmann

Early-stage carcinosarcoma of the uterus: the significance of lymph node count

Carcinosarcoma is a rare tumor of the uterus with a poor prognosis, even when identified and treated at an early stage. The purpose of this study was to identify and analyze prognostic pathologic features and treatment outcomes in patient with stages I and II carcinosarcoma of the uterus. Patients with carcinosarcoma of the uterus who received primary surgical treatment between 1984 and 2004 were identified through an institutional tumor registry. Inclusion criteria were clinical stage I/II disease following hysterectomy and selective pelvic and para-aortic lymph node sampling. Regression analysis was used to determine risk factors for recurrence and survival. Disease-free and overall survival were then determined using Kaplan–Meier analysis. Forty-seven patients with stages I and II carcinosarcoma of the uterus were identified. Age, heterologous or homologous histology, and type of adjuvant treatment were not associated with recurrence or survival. Depth of myometrial invasion was found to correlate to disease-free survival but not overall survival. The number of lymph nodes collected correlated to risk of recurrence and survival. Disease-free and overall survival were greater in patients with higher lymph node count. We conclude that the number of lymph nodes collected was the only risk factor that was found to be correlated to recurrence and survival in patients with early-stage carcinosarcoma. These results support mounting evidence that lymphadenectomy is crucial in patients with carcinomas of the uterus in order to discover occult metastatic disease and potentially provide patients with a therapeutic benefit

Is body mass index an independent risk factor of survival among patients with endometrial cancer

Objective:To evaluate whether body mass index (BMI) is an independent risk factor for survival in patients with endometrial adenocarcinoma. Methods:Women treated for endometrial cancer at the State University of New York (SUNY), Downstate and Kings County Hospital between January 1982 and September 2003 were eligible. Patients were divided into groups based upon their histology at the time of diagnosis. The first included patients with low-grade endometrioid adenocarcinoma (FIGO grades 1 and 2); the second included grade 3 endometrioid adenocarcinoma; and the third contained papillary serous and clear cell carcinomas. Data regarding BMI, patient age, race, grade, and stage of disease and overall survival, were assessed by survival analysis, with P < 0.05 considered significant throughout. Results:The analysis included 442 patients. Mean BMI was 32.6 ± 8.2. There were 312 patients (70%) treated for low-grade endometrial adenocarcinoma; 64 patients (14%) for grade 3 endometrioid adenocarcinoma; and 71 patients (16%) for papillary serous and clear cell adenocarcinoma. Increased BMI was associated with improved overall survival (P = 0.003). BMI was also correlated to tumor grade, stage at diagnosis, age, and race. Tumor grade, stage, age, and race were correlated to survival. Statistical analyses revealed the majority of the association between BMI and survival can be attributed to the association between BMI and these other risk factors for survival in endometrial cancer. Conclusions:Increased BMI is associated with survival advantage among patients with endometrial cancer. Because of the relationship between obesity and other confounding variables obesity alone is not an independent predictor of survival.

Transvaginal sonography of hematotrachelos and hematometra causing acute urinary retention after previous repair of intrapartum cervical lacerations

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 Rarely these abnormalities may be unilateral, associated with lateral fusion defects of the mullerian duct and concurrent ipsilateral renal agenesis. 4 Symptoms noted in adolescents in conjunction with congenital obstruction of the lower female genital tract usually consist of primary amenorrhea and dsymenorrhea, 1 - 3 although acute urinary retention has also been rarely reported. 5 - 7 We present an unusual case in which transvaginal sonographic findings of marked hematotrachelos and hematometra were depicted in a multi-parous patient with acute urinary retention 2 years after repair of cervical lacerations sustained during vaginal delivery.

Primary spindle cell sarcoma of the vagina treated with neoadjuvant radiation and pelvic exenteration.

Objective. Malignant neoplasms of the vagina are rare gynecologic tumors. Primary vaginal sarcomas are even more unusual lesions, representing fewer than 2% of malignant vaginal lesions. Case. We present a case of a primary vaginal spindle cell sarcoma, treated with neoadjuvant radiation followed by total pelvic exenteration. The patient remains without evidence of disease 2 years after surgery. Conclusions. The mainstay of treatment of vaginal sarcomas is surgical. Neoadjuvant radiation treatment may decrease surgical morbidity and lead to long-term cure.

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.

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.

Transvaginal Sonographic Diagnosis of a Large Retroperitoneal Pelvic Epidermoid Cyst (Monodermal Teratoma)

Germ cell tumors are most commonly located within the gonads. 1 Rare extragondal locations of these tumors include the retroperitoneum, mediastinum, sacrococcygeum, and central nervous system and are considered to result from aberrant migration of germ cells from the yolk sac during fetal development. 1 - 3 We present the transvaginal sonographic diagnosis of a large retroperitoneal pelvic epidermoid cyst (monodermal teratoma).