Leiomyosarcoma with unusual macroscopic features: a case report

Uterine sarcoma is a rare tumor of mesodermal origin, accounting for 2-6% of uterine malignancies. Leiomyosarcoma [LMS] has been reported in only 1% of all uterine malignancies and is regarded as the most common primary uterine sarcoma. Herein, we present a case of LMS with unusual macroscopic features. The patient was a 61- years-old woman with LMS, which consisted of a large cystic mass [88×136 mm], containing six liters of brownish fluid on the right side of the pelvis and abdomen. The fundus of the uterus was ruptured by the solid part of the tumor. For treatment, total hysterectomy, salpingo-oophorectomy and the optimal resection of tumor were carried out. Overall, the distinctive biological behavior and poor overall survival of uterine sarcoma challenge the post-operative management of this tumor. According to the one-year follow-up, the patient was disease-free. Unfortunately, no further data is available beyond this period

Sentinel node mapping in vulvar cancers: report of two cases and literature review

Vulvar cancer is a rare gynecological malignancy with mainly lymphatic spread. Sentinel node mapping plays an important role in the management of this gynecological malignancy. In the current study, we reported our experience in sentinel node mapping of vulvar cancer and review the literature accordingly. Since the introduction of sentinel node mapping to the surgical oncology community of our university in 2004, we had two operable vulvar cancer patients who were candidate for sentinel node mapping for inguinal lymph node staging. In the current study, we reported these two cases in details and a brief review of literature on sentinel node mapping in vulvar cancer was done. We specifically discussed the overall accuracy, importance of blue dye injection, learning curve effect, frozen section, excisional biopsy and location of the tumors. Overall sentinel node mapping is a safe and effective method for inguinal lymph node staging in vulvar cancers. In order to perform sentinel node mapping efficiently, paying attention to the details is of utmost importance

value of lateral lymphoscintigraphy images of the pelvis for gynecological cancers: are they necessary?

In the current study we evaluated the incremental value of lateral pelvic lymphoscintigraphy imaging of endometrial or cervical cancer patients who underwent sentinel node mapping. Operable endometrial and cervical cancer patients without clinical or paraclinical evidence of lymph node involvement were included in the study. The day before surgery the patients were sent to the nuclear medicine department for injection of the radiotracer. All patients received two intra-cervical injection of 1 mCi/0.2 cc radiotracer in the 6 and 12 hour locations. 18-24 hours after the radiotracer, lymphoscintigraphy imaging in anterior/posterior and lateral views was done. After induction of anesthesia, 2 mL Methylene blue in two aliquots was injected intra-cervically in the same location as the radiotracers. During operation, any hot and/or blue node was harvested as sentinel nodes. Overall 40 patients were included in the study [30 endometrial and 10 cervical cancers]. Sentinel node visualization was achieved in 30 patients. These sentinel nodes were all visualized on the ANT/POST views. Only in 7 patients sentinel nodes could be visualized on the lateral views. Intra-operative sentinel node detection rate was 38 out of 40 [95%]. Radiotracer detection rate was 37/40 [92.5%] and blue dye detection rate was 17/40 [42.5%]. Anterior/Posterior pelvic lymphoscintigraphy imaging is sufficient for imaging in cervical and endometrial cancer patients undergoing sentinel node mapping. Lateral views can be omitted due to limited valued of these projections

Inappropriate intracervical injection of radiotracer for sentinel lymph node mapping in a uterine cervix cancer patient: importance of lymphoscintigraphy and blue dye injection

Herein, we report a case of sentinel lymph node mapping in a uterine cervix cancer patient, referring to the nuclear medicine department of our institute. Lymphoscintigraphy images showed inappropriate intra-cervical injection of radiotracer. Blue dye technique was applied for sentinel lymph node mapping, using intra-cervical injection of methylene blue. Two blue/cold sentinel lymph nodes, with no pathological involvement, were intra-operatively identified, and the patient was spared pelvic lymph node dissection. The present case underscores the importance of lymphoscintigraphy imaging in sentinel lymph node mapping and demonstrates the added value of blue dye injection in selected patients. It is suggested that preoperative lymphoscintigraphy imaging be considered as an integral part of sentinel lymph node mapping in surgical oncology. Detailed results of lymphoscintigraphy images should be provided for surgeons prior to surgery, and in case the sentinel lymph nodes are not visualized, use of blue dye for sentinel node mapping should be encouraged

Concurrent chemoradiotherapy without brachytherapy in locally advanced cervical cancer

Concurrent chemoradiotherapy [EBRT + cisplatin] plus intracavitary brachytherapy is the standard of care in patients with advanced cervical cancer. However, a number of patients could not undergone brachytherapy due to massive residual tumor or anatomical distortion. In this study, we have evaluated the treatment outcome in patients with locally advanced cervical cancer, undergone conventional EBRT plus cisplatin based chemotherapy. In this study, we have selected patients with locally advanced cervical carcinoma [stage: IIB to IIIB] undergone external beam radiotherapy and chemotherapy without brachytherapy at our institute between October of 2007 and October of 2009. The patients have received 50 Gy within 5 weeks to whole pelvic that has followed by a localized boost dose on tumor to 70 Gy concurrently with cisplatin 35 mg/m2 weekly. The treatment has related toxicities, and survival [overall and disease free] have evaluated. 30 cases with a median age of 55 [range; 40 to 73] have been studied. According to FIGO classification, the clinical stages were as follows: stage: IIB 23, IIIA 4, and IIIB 3 cases. Three months after treatment, 19 patients [63.3%] have achieved complete response. With a median follow up time of 18 months [range; 10-33 months], 8/23 cases [34.7%] with stage IIB and 2/7 [28.5%] among stage IIIA-IIIB remained disease free at the end of follow up. Data have shown a 2- year overall survival rate of 58.7% +/- 9% and 2- year disease free survival of 37.7% +/- 9% . Most toxicities were grade I and II. 2 [6.6%] grade III diarrhea and 4 [13.3%] grade III neutropenia have recorded. Although a considerable number of patients have achieved complete response using concurrent chemoradiotherapy without brachytherapy, the overall treatment outcomes especially for stage IIIA-IIIB were unsatisfactory. Using modern radiation therapy techniques with increased delivered boost dose could improve treatment results

Neoadjuvant chemotherapy and radical surgery in locally advanced cervical cancer during pregnancy: case report and review of literature

For pregnant patients with cervical cancer, treatment recommendations are individualized and dependent on the stage of the disease, gestational age at the time of diagnosis, and the patient's desire as to the cosntinuation of the pregnancy. The aim of this study is to describe the outcome of neoadjuvant chemotherapy with radical surgery and pelvic lymphadenectomy in a woman with cervical cancer who wished to maintain her pregnancy This is a report of a 26-week pregnant woman with locally advanced cervical cancer stage I. [FIGO] who was successfully treated with neoadjuvant chemotherapy Paclitaxel plus platinum, followed by C/S and radical surgery. Her neonate was healthy and had no abnormalities. This case was the first cervical cancer during pregnancy that was treated using this method at the tumor clinic, Mashhad University of Medical Sciences/ Iran. Neoadjuvant chemotherapy is an effort to allow time for the fetal to reach viability by preventing the progression of the disease

Evaluation of fetomaternal hemorrhage after post - abortion therapeutic curettage

Hemolytic diseases in fetus and newborn were known for years; the principle of these pathologies is defined Basically entrance of fetal blood cells to maternal circulation results in these ranges of diseases. Risk factor determination, early diagnosis of F.M H and adequate dosage of Anti - D Ig administration will be attempted to prevent subsequent adverse outcome on fetus and newborn. The quantification of fetal cells in the maternal circulation post - curettage miscarriage remains an important goal to prevent active immunization in mother. In this cross sectional study, during six months, from April 2004, one hundred patients post - abortion therapeutic curettage enrolled, in Ghaem Hospital, Mashhad University. Maternal age, gestational age, maternal blood group and Rh, gravidity, severity of maternal hemorrhage, HcT, BP and duration of vaginal bleeding were recorded. The KB test was done in all patients amount of FIMIH and Rh IgG dosage in positive KB patients were calculated. Data were analyzed with SPSS [Ver. 10] software. The KB test was positive in 35% of the patient. Gestational age, maternal H.ct, pain and severity of hemorrhage had significant relation to K.B test positive. F.M.H was 0.1-5 cc in 17 patients and in 18 it was less. Lower gestational age in abortion time decreases FMH risk the usual Rh - IgG dosage [50 micro gr] sounded to be adequate for Rh Immunization after post - abortion therapeutic curettage