Robert R. Taylor

Equal care ensures equal survival for African-American women with cervical carcinoma

BACKGOUND.

Collision of uterine rhabdoid tumor and endometrioid adenocarcinoma: a case report and review of the literature.

Extrarenal malignant rhabdoid tumors have been reported in a variety of anatomic sites but infrequently in the female genital tract. In the uterus, they have been described as a pure tumor, in association with endometrial stromal sarcomas, and as a component of a malignant mullerian mixed tumor. This study reports an unusual uterine neoplasm in a 49-year-old woman, in which a malignant rhabdoid tumor occurred as a collision tumor with a well-differentiated endometrioid adenocarcinoma. The tumor was a 14-cm polypoid mass that filled the endometrial cavity. The two neoplastic components were distinct on microscopic and immunohistochemical examination. Ultrastructural examination confirmed the rhabdoid phenotype of the sarcomatous component. The patient died of disease 4 months after diagnosis with progression of the malignant rhabdoid tumor. The highly aggressive behavior of the rhabdoid (i.e., nonepithelial) component in this collision tumor lends support for a distinction of this neoplasm from a malignant mullerian mixed tumor, with which it may be confused.

Cystoscopy after computed tomography scan to identify bladder invasion in cervical cancer.

Objective To determine the clinical utility of cystoscopy to rule out bladder invasion in cervical cancer patients who have had pelvic computed tomographic (CT) scan. Methods We reviewed charts of 49 patients at Walter Reed and Tripler Army Medical Centers who had International Federation of Gynecology and Obstetrics stage II or greater cervical cancer and who underwent both cystoscopy and CT scan before treatment. Data retrieved included diagnosis, race, age, cystoscopy results, and CT scan reports. These patients were evaluated and treated between January 1, 1991, and September 1997. Results The mean age of the patients was 50 years. Seven of the women were Asian, five black, six white, one Hispanic, and 30 Pacific Islander. There were 40 squamous cell carcinomas and nine adenocarcinomas. There were 25 stage II, 20 stage III, three stage IV, and one recurrent stage II carcinomas. Three patients with bladder invasion were identified by cystoscopy and all also were identified with possible bladder invasion by CT scan. Two additional cases of possible invasion seen on CT scan proved not to be invasion with cystoscopy. The positive predictive valve of CT scan in predicting bladder invasion was 60% (three of five). The negative predictive valve of CT scan in predicting bladder invasion was 100%. Conclusion The utility of performing cystoscopy to rule out bladder invasion in a patient with no evidence of bladder involvement on CT scan is low and might not be necessary.