Epithelial ovarian cancer in female pseudohermaphroditism. A diagnosis by computed tomography and review of the literature.

We describe the case of a patient proven to be a female pseudohermaphrodite with a complete virilization syndrome who developed an epithelial tumor of the ovary of borderline malignancy. The tumor appeared as an abdominal mass with cystic features on ultrasonography. The diagnosis of the intersexual condition and adnexal cancer was made by computed tomography (CT).

Correlation between pretreatment prognostic factors and lymph node metastases in endometrial adenocarcinoma. Clinical application.

PURPOSE: To evaluate the prognosis of stage I endometrial adenocarcinoma, which differs by various prognostic factors. Some of them (tumor grading, histotype, myometrial infiltration, the latter evaluated with Magnetic Resonance Imaging) can be assessed before surgery. These prognostic factors correlate with patient survival and the presence of lymph node metastases. MATERIAL AND METHODS: We used tumor grading, histotype, myometrial infiltration for the preoperative and prospective classification into a low- and a high-risk group of 80 patients with endometrial adenocarcinomas stage I. Low-risk patient [group A: G1-G2, pure adenocarcinoma involving the inner portion of the myometrium (M0-M1)] underwent surgery without lymph node resection, while high-risk patients [group B: G3, pure adenocarcinoma with deep infiltration of the myometrium (M2) and/or clear cell, serous papillary, adenosquamous carcinomas] had pelvic and lumboaortic lymphadenectomy. The minimum 36 months' follow-up (median: 61 months) was requested for all patients. RESULTS: Histotype evaluated by dilatation and curettage and hysteroscopic and/or office biopsy, had 100% agreement with tumor histotype. Tumor grading was in agreement in 72/80 patients (81%). The grade of myometrial infiltration was confirmed in 72/80 cases (81%). Eight misdiagnoses were divided in over--(4 cases) and under--(4 cases) estimated infiltration. All 16 mistakes resulted in 10 inclusion in the wrong risk group (8 in the low-risk and two in the high-risk group). Surgical-pathological staging did not change the prognosis but only staging in 6 preoperatively high-risk group. CONCLUSIONS: This initial study confirms the importance of prognostic factors in the treatment of endometrial adenocarcinoma, as well as that of the different surgical choices which can be made after correct pretreatment prognosis.

Extraperitoneal pelvic leiomyosarcoma. MR findings in a case.

The magnetic resonance imaging (MRI) of a patient with nongynecologic pelvic leiomyosarcoma is presented. A retroperitoneal mass appeared under the broad ligaments, in the right paravesical and parametrial, lateral pararectal site. The mass leaned on the uterus and vagina. On MRI, the mass had solid structure, isointense on T1-weighted images, inhomogeneously iperintense on T2-weighted images with central areas of increased intensity. Late after contrast agent administration, the mass appeared inhomogeneously ipointense with areas of fair late contrast enhancement. The morphology of the tumor, the retroperitoneal site, and MRI sequences make the differential diagnosis. These evidences were useful in treatment planning.

Spontaneous hemorrhage of a liver metastasis from squamous cell cervical carcinoma: case report and review of the literature.

Liver metastases are an uncommon cause of spontaneous bleeding compared with primary benign/malignant liver lesions. Since metastatic lesions tend to maintain the vascular characteristics of the primary tumor, some metastases have a greater proclivity for hemorrhage into the host organ than others. We describe the clinical and computed tomography (CT) features of a patient previously treated for nonkeratinizing small cell squamous carcinoma of the cervix uteri. As the metastatic rupture was diagnosed while still intraparenchymal and subcapsular, with minimal peritoneal reaction, the patient's outcome was favorable.

Multiple nodular metastases in mesenteric panniculitis by uterine papillary serous adenocarcinoma (UPSC): CT appearance of a case.

Intra-abdominal panniculitis is a thickening of the mesentery of the small/large intestine due to infiltration of lipid-laden macrophages associated with a variable amount of fibrosis. This condition is rarely associated with malignant neoplasms. We report the computed tomography (CT) findings of a patient treated for uterine papillary serous adenocarcinoma (UPSC). She had mesenteric panniculitis where metastatic tumor nodules implanted. This was the only intraperitoneal recurrence. To our knowledge, no such finding has been reported in the gynecologic and radiologic literature to date. On CT images, the differential diagnosis is with cystic dilatations of mesenteric lymph vessels.

Magnetic resonance appearance of endometrial sarcoma: report of a case with unusual findings.

We report the MR findings of an endometrial stromal sarcoma. The uterus was enlarged and completely replaced by neoplastic tissue, with full-thickness myometrial infiltration. It had isointense signal on T1- and irregularly hyperintense signal on T2-weighted images and the dynamic study with intravenous gadoteridol showed centripetal enhancement. This sarcomatous-like pattern correlates well with the pathologic and CT findings reported in the literature.

[Rationalization of the use of preoperative thoracic radiography in obstetrics and gynecology]. / Razionalizzazione dell'esecuzione del radiogramma preoperatorio del torace nell'ostetricia e ginecologia.

INTRODUCTION: Rationalizing preoperative chest radiography remains a problem in our Country. Therefore, we tried to use preoperative chest films rationally in obstetrics and gynecology to assess their impact on anesthesia planning and patient management and their use in early postoperative complications. MATERIAL AND METHODS: We examined two groups of patients: group A consisted of 570 women (mean age: 31 years) scheduled to be submitted to cesarean section but with no preoperative chest radiography; group B consisted of 471 patients (homogeneous in age to group A patients) submitted to nononcologic gynecologic surgery and with a single-projection preoperative chest radiograph. Anesthesiologic assessment, preoperative biochemical tests and EKG were performed in all patients. All patients underwent abdominal surgery under general anesthesia. The first 24 postoperative hours were monitored for possible anesthesia-related complications. The anesthesiologist need of chest radiography based on clinical findings was investigated in group A patients, as well as the importance of chest film findings in possible anesthesia-related complications. RESULTS: Group A and group B were homogeneous by mean patient age and anesthesia duration; clinical findings never suggested the need of chest radiography in group A patients. Three cardiorespiratory complications occurred (two respiratory arrests in group A and a gas embolism in group B), but the (un)availability of chest film findings made no difference in treatment. DISCUSSION: The availability of the preoperative chest radiographs of a group of healthy women of 31 years mean age does not make any difference in anesthesia planning and type. In our series, the most severe cardiorespiratory complications were homogeneous in the two groups, which confirms their random character, and the (un)availability of preoperative chest film findings made no real difference, even though the lack of radiographic evidence made patient management more demanding for anesthesiologists.