Pure Uterine Lipoma with a Combined Mucinous Cystic and Brenner Ovarian Tumor in a Postmenopausal Woman: A Case Report and Review of the Literature.

Lipomatous tumors are rare among uterine mesenchymal tumors. Due to their rarity, information on the clinical development and histological origin are lacking. We report a pure uterine lipoma and present a review of the relevant literature. We encountered a 72-year-old postmenopausal woman who was referred to our hospital. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations revealed degenerative uterine tumors and a left ovarian cystic tumor with a solid portion. Total hysterectomy and bilateral salpingo-oophorectomy were performed, and postoperative histological examination revealed a uterine lipoma and adenomyosis. The cystic portion was a mucinous cystadenoma, and the solid portion was classified as a Brenner tumor. The postoperative course was uneventful, and the patient was discharged and remained well until follow-up. Our observations suggest that imaging examinations are sufficient for the diagnosis of uterine lipomatous tumors. To the best of our knowledge, the coexistence of a pure uterine lipoma and a mucinous Brenner ovarian tumor has not been documented in the existing literature. The histogenesis of uterine lipomas remains unclear. However, our results, and those from the existing literature, indicate that the mesenchymal stem cells surrounding the perivascular tissue may be implicated, because lipomas of the skin are reported to originate from these cells.

Spinal cord infarction following epidural and general anesthesia: a case report.

BACKGROUND: Epidural anesthesia is widely used for postoperative analgesia and rarely causes permanent neurological complications. We report a case of paraplegia following abdominal surgery under combined epidural/general anesthesia. CASE PRESENTATION: A 75-year-old woman underwent a scheduled abdominal total hysterectomy and bilateral salpingo-oophorectomy for suspected endometrial cancer. In the operating room, an epidural catheter was inserted at T11/12 while the patient was conscious. The needle entered smoothly, with no observed bleeding, paresthesia, or pain, and general anesthesia was induced. During surgery, 4 mL of 0.25% levobupivacaine and 0.1 mg of fentanyl were administered via the epidural catheter, and a solution of 2.5 µg/mL fentanyl and 0.2% levobupivacaine was continuously infused at 4 mL/h for postoperative analgesia. The patient promptly regained consciousness and could move her bilateral lower extremities without difficulty upon leaving the operating room. During the first postoperative night, she complained of an absence of sensation and weakness in the lower extremities. By the morning of the second postoperative day, she had developed paralysis and sensory losses associated with touch, temperature, pinprick, and vibration below T5. The epidural infusion was stopped. Magnetic resonance imaging (MRI) revealed a hyperintense area of the thoracic cord from T8 to T11, and spinal cord infarction was suspected. Ossification of the yellow spinal ligaments between T11 and T12, resulting in thoracic canal stenosis and thoracic spinal cord compression, were observed. Notably, the epidural catheter was inserted at the same site where the thoracic canal stenosis was present. CONCLUSIONS: Permanent neurological complications of epidural anesthesia are rare. Studies of neurological complications after epidural/spinal anesthesia have noted the possibility of spinal anomalies, such as lumbar stenosis, in relation to neurological complications after epidural/spinal anesthesia. In this case, the onset of spinal cord infarction may have occurred coincidentally with catheter insertion into the site of existing spinal stenosis. Therefore, it is important to evaluate lower extremity symptoms and consider spinal disease before administering epidural anesthesia. Spinal cord infarction may be prevented by preoperatively identifying spinal lesions using computed tomography or MRI in cases of suspected spinal disease.

High-dose oral tegafur-uracil maintenance therapy in patients with uterine cervical cancer.

OBJECTIVE: The aim of this study was to determine the efficacy and toxicity of oral administration of tegafur-uracil (UFT) at a high dose, 600 mg/day, based on the tegafur dose, against uterine cervical cancer. METHODS: This study consisted of a retrospective analysis. From April 1986 to March 1997, 309 patients with uterine cervical cancer were registered. Oral UFT was administered to 162 patients for maintenance therapy after an initial treatment (the UFT group). The other 147 patients were not treated with UFT (the control group). The survival rate was calculated for both groups and statistically analyzed using the log-rank test. Adverse events were compared between the UFT and control groups. RESULTS: In the UFT group, 103 patients (63.6%) received UFT for ≥90 days. The drug dose was 600 mg/day for 137 patients (84.6%) and 300 to 400 mg/day for the remainder. The overall survival rate was significantly higher in the UFT group than in the control group (p<0.05). The prognosis was particularly favorable in stage III cases, in cases of squamous cell carcinoma, and in cases that were treated by radiotherapy. The most frequent side effects were nausea/vomiting (12.2%), appetite loss (10.1%), and leukopenia/neutropenia (5.8%). CONCLUSION: High-dose oral UFT maintenance treatment prolonged the disease-free survival and overall survival of patients with uterine cervical cancer, particularly of those with advanced disease.

Case of concurrent benign metastasizing leiomyoma in the lung and retroperitoneum, with a focus on its etiology.

We report a rare, simultaneous occurrence of benign metastasizing leiomyoma in the lung and retroperitoneum in a 49-year-old woman who had previously undergone myomectomy at 35 years of age and hysterectomy at 45 years of age for multiple recurrences of histologically benign uterine leiomyomas. At 49 years of age, computed tomography-guided biopsy indicated benign metastasizing leiomyomas in the lung. In addition, a retroperitoneal leiomyoma was found that was resected along with both the ovaries via laparotomy. No sign or symptom of recurrence was observed 5 years later. The coexistence of benign metastasizing leiomyoma in the lung and retroperitoneum following surgery for conventional leiomyomas has rarely been reported. Further, the nature and etiology of benign metastasizing leiomyoma are still not well understood. This case is therefore worth reporting, and exploring its etiology is important.

Muir-Torre syndrome associated with endometrial carcinoma.

Muir-Torre syndrome (MTS) is an autosomaldominant skin condition of genetic origin, characterized by tumors of the sebaceous glands or keratoacanthomas that are associated with malignant visceral diseases. MTS associated with gynecologic malignancy has rarely been reported. Here we report a woman with no family history of colorectal cancer who developed endometrial carcinoma, stage 3a, at 49 years of age and at age 51 years, developed two skin tumors, a nasal squamous cell carcinoma and a sebaceous carcinoma of the right eyelid. The appearance pattern of these skin tumors suggested MTS. Although MTS associated with endometrial carcinoma is rare, patients with endometrial carcinoma should undergo evaluation for visceral malignancies (mainly colon cancer) and sebaceous skin lesions, regardless of whether or not there is a family history of colorectal cancer.

[Successful treatment of primary peritoneal carcinoma with paclitaxel and carboplatin combination chemotherapy].

BACKGROUND: A standard treatment for primary peritoneal carcinoma has not been established to date. We report three patients with primary peritoneal carcinoma who were successfully treated with paclitaxel and carboplatin combination chemotherapy. CASE: Three patients, 66-, 73-, and 71-year-old women who presented with abdominal swelling, were referred to our hospital. Following detailed physical examination, they underwent exploratory laparotomy and were diagnosed with primary peritoneal carcinoma. Postoperatively, the sole treatment was comprised of combination chemotherapy of paclitaxel and carboplatin following which the tumor marker(CA125)levels normalized. Moreover, there was no evidence of tumors on CT scan, and the patients showed good recovery. CONCLUSION: Paclitaxel and carboplatin combination chemotherapy are effective for treatment of primary peritoneal carcinoma and can be considered one of the medical treatment options.

Poor nutrition in prepubertal Japanese children at the end of World War II suppressed bone development.

OBJECTIVE: To assess the extent to which malnutrition in childhood affects bone mineral density (BMD) decades later. METHODS: BMDs were compared in healthy women (35-59 years old) who visited our hospital for annual examinations between 1992 and 1993 (group 1) and between 1999 and 2002 (group 2). RESULTS: The BMDs of 50- to 54-year-old women in group 1 averaged 0.86+/-0.15 g/cm2, which was significantly (p<0.001) lower than age-matched women in group 2 (1.02+/-0.16 g/cm2). CONCLUSION: At the end of World War II (1945) undernutrition was rampant throughout Japan, and there were unprecedented numbers of cases of malnutrition. BMD was lower in women who experienced those conditions while they were 5 years old in average, a time when rapid skeletal growth was beginning. Thus, nutrition in childhood is a particularly crucial determinant of lifelong bone health.

[Successful treatment of endometrial carcinoma associated with lung metastasis by paclitaxel and carboplatin chemotherapy].

BACKGROUND: Prognosis of patients with advanced endometrial cancer accompanied by distant metastases is poor. Moreover, there is no established therapy for this cancer. CASE: We treated a 32-year-old woman with endometrial cancer with multiple lung metastases (pT4N0M1). In August 2001, this patient presented with a complaint of abnormal genital bleeding. Endometrial cytology and histology revealed endometrial carcinoma, and chest XP and CT scan detected multiple lung metastases. MRI indicated invasion to the uterine cervix. Therefore, radical hysterectomy with pelvic lymph node dissection was performed. Postoperatively, this patient underwent TJ chemotherapy (paclitaxel 300 mg/body over 3 h, carboplatin 600 mg/body, area under the curve (AUC 5). A total of 9 courses of the regimen were given. Multiple lung shadows on chest XP and computed tomography (CT) were reduced in number and size after 2 courses of TJ chemotherapy. The multiple lung metastases either disappeared or remained as scars after 6 courses. There has been no evidence of recurrence for 20 months after the chemotherapy. CONCLUSION: TJ chemotherapy is considered effective as a postoperative chemotherapy in patients with endometrial cancer with multiple lung metastases.

Unilateral ovarian abscess caused by Salmonella.

BACKGROUND: Patients with unilateral ovarian abscesses due to Salmonella are rare. CASE REPORT: A 48-year-old woman with a left ovarian abscess caused by Salmonella group 07 is reported. CONCLUSION: In our patient, the ovary may have been seeded hematogenously by salmonellae and may have evolved into a local infection.

Tubo-ovarian abscess occurring 16 years after supracervical hysterectomy.

BACKGROUND: Supracervical hysterectomy is seldom performed and there are few reports of tubo-ovarian abscess (TOA) after supracervical hysterectomy. CASE: The case of a 49-year-old woman with a right TOA is reported. This patient had received a supracervical hysterectomy 16 years earlier due to rupture of the uterus. At this admission, she presented with complaints of, lower abdominal pain and fever. Bimanual and transvaginal ultrasound examinations demonstrated a tender mass in the right adnexal region. Laparotomy, pathologic examination and microbiologic study confirmed the diagnosis of right TOA. CONCLUSION: After supracervical hysterectomy, patients may develop endocervicitis, parametritis and/or TOA. This series may be a subtype of ascending infections in the female genital tract.