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International Journal of Surgery Case... Apr 2023Neuroendocrine carcinoma of the cervix (NECC) is a rare variant of cervical cancer with poor prognosis and high mortality. Recurrence is seen with multi-organ metastasis...
INTRODUCTION
Neuroendocrine carcinoma of the cervix (NECC) is a rare variant of cervical cancer with poor prognosis and high mortality. Recurrence is seen with multi-organ metastasis including liver.
CASE PRESENTATION
A 65 year old female presented with vaginal bleeding for the past one year. Cervical cancer screening and biopsy demonstrated poorly differentiated squamous carcinoma. Immunohistochemistry showed positive expression of chromogranin, synaptophysin, pancytokeratin, TTP1, and CEA and negative expression of p40 and estrogen receptors. An adenocarcinoma with neuroendocrine tumor was suggested. Hysterectomy with bilateral salpingo-oophrectomy was performed. This was followed by carboplatin and etoposide therapy to have clinical remission for a year. Then recurrence was observed to start same drugs again resulting in to partial improvement. It was followed by radiotherapy. The patient succumbed to death approximately after three months.
CONCLUSION
A metastatic lesion in liver may be a case of Neuroendocrine tumor of cervix, a rare condition that can be easily missed on histopathological examination. More studies are required to establish a standard therapeutic protocol.
PubMed: 36948055
DOI: 10.1016/j.ijscr.2023.107982 -
Taiwanese Journal of Obstetrics &... May 2022To clarify whether "low-risk total PP" patients bleed more than partial/marginal PP patients.
OBJECTIVE
To clarify whether "low-risk total PP" patients bleed more than partial/marginal PP patients.
MATERIALS AND METHODS
The retrospective cohort study was performed involving patients with PP between April 2006 and December 2018. The placental position was determined by ultrasound. From medical charts, the backgrounds as well as obstetric and neonatal outcomes of PP patients were retrieved.
RESULTS
This study included 349 patients with PP, which was classified into three types according to the distance between the placenta and internal ostium: total (n = 174), partial (n = 52), and marginal (n = 123) PP. In total PP patients, three factors (prior CS, anterior placenta, and placental lacunae on ultrasound) significantly increased blood loss at CS, the need for hysterectomy, homologous transfusion (≥10 U), and ICU admission. No significant difference was observed in bleeding-related poor outcomes (rate of blood loss ≥2000 mL, amount of homologous transfusion, need for hysterectomy, and ICU admission) between total PP patients without all three factors: "low-risk total PP patients" and partial/marginal PP patients (19.8 vs. 17.1%; p = 0.604, 3.7 vs. 1.1%; p = 0.330, 1.2 vs. 1.1%; p = 1.000, and 1.2 vs. 1.1%; p = 1.000, respectively).
CONCLUSION
Prior CS, anterior placenta, and placental lacunae on ultrasound were risk factors for a bleeding-related poor outcome in total PP patients. Total PP patients without these three factors showed the same bleeding-related poor outcome as partial/marginal PP patients.
Topics: Female; Hemorrhage; Humans; Infant, Newborn; Placenta; Placenta Accreta; Placenta Previa; Pregnancy; Pregnancy Outcome; Retrospective Studies
PubMed: 35595436
DOI: 10.1016/j.tjog.2022.03.007 -
Cureus Jan 2023The present randomised controlled trial was conducted to compare haemostatic efficiency, operative time, and overall performance of the electrothermal bipolar vessel...
INTRODUCTION
The present randomised controlled trial was conducted to compare haemostatic efficiency, operative time, and overall performance of the electrothermal bipolar vessel sealing (EBVS) system with conventional suturing in abdominal hysterectomy.
MATERIALS AND METHODS
The trial was designed with standard parallel arms, i.e., vessel sealing and suture ligature arms. Sixty patients were block randomised into either arms with 30 patients in each. A hand-held vessel sealing instrument was used to perform a hysterectomy in the vessel sealing arm and the quality of the uterine artery seal achieved at the first attempt was graded on an ordinal scale of 1-3 to quantify haemostatic efficiency. Operative time, intra-operative blood loss, and peri-operative complications were compared between the two arms.
RESULTS
Significantly reduced mean operative time (26.97±8.92 vs 33.67±8.62 minutes; p=0.005) and intra-operative blood loss (111±53.31 mL vs 320±193.90 mL; p=0.001) was observed in the Vessel Sealing Arm compared to Suture Ligature Arm. Of total 60 uterine seals (from bilateral uterine artery transaction in 30 hysterectomies in the Vessel Sealing Arm), 83.34% were Level 1 with Complete Seal and no residual bleeding, 8.33% were Level 2 or Partial Seals with minimal bleeding, requiring the use of vessel sealers for a second time, while 8.33% had Seal Failure (Level 3) with significant bleeding requiring additional re-security of stumps with sutures. Modal pain scores on the first three postoperative days and duration of hospital stay were significantly less in the Vessel Sealer Arm, reflecting reduced postoperative morbidity. Outcomes were comparable across operators.
CONCLUSION
Vessel Sealing System gives superior surgical results with lesser operative time, minimal blood loss, and reduced morbidity.
PubMed: 36843794
DOI: 10.7759/cureus.34123 -
ACG Case Reports Journal Oct 2022Vaginal and uterine varices are well documented in pregnancy, although development of vaginal varices in patients with portal hypertension occurs in an exceptionally...
Vaginal and uterine varices are well documented in pregnancy, although development of vaginal varices in patients with portal hypertension occurs in an exceptionally rare subset. Only 12 cases are reported in the literature; all but 3 of these cases involved patients with a history of hysterectomy, with 1 of the remaining 2 exhibiting partial obliteration of the uterine plexus due to radiation therapy for cervical cancer. We present a case of recurrent vaginal variceal bleeding in a patient with a history of hysterectomy, initially managed with vaginal tamponade and ultimately requiring definitive treatment with transjugular intrahepatic portosystemic shunt insertion.
PubMed: 36247382
DOI: 10.14309/crj.0000000000000878 -
The Journal of International Medical... Feb 2020This study was performed to explore the causes and clinical characteristics of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage.
OBJECTIVE
This study was performed to explore the causes and clinical characteristics of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage.
METHODS
This retrospective study was performed from January 2004 to December 2017. Patients with intractable postpartum hemorrhage were grouped according to the initial pathogenesis as determined by exploratory laparotomy: uterine atony, placental factors, coagulation dysfunction, or uterine rupture.
RESULTS
This study involved 72 patients who underwent emergency exploratory laparotomy, accounting for 0.04% of total deliveries. Uterine preservation surgery and hysterectomy were performed in 31 and 41 patients, respectively. Abnormal events upon returning to the ward were primarily vaginal hemorrhage and pelvic hematoma. The frequency of uterine artery ligation was lower in the hysterectomy group than uterine preservation group. The prothrombin activity level, fibrinogen level, and platelet count before surgery were lower in the hysterectomy group than uterine preservation group. The international normalized ratio and activated partial thromboplastin time were higher in the hysterectomy group than uterine preservation group. In total, 44 patients developed complications.
CONCLUSION
Placental implantation is a primary cause of hysterectomy after emergency laparotomy. However, the possibility of postpartum hemorrhage caused by coagulation disorders should not be ignored.
Topics: Female; Humans; Hysterectomy; Laparotomy; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Uterine Inertia
PubMed: 31662015
DOI: 10.1177/0300060519879294 -
Translational Cancer Research Mar 2020A 36-year-old woman presented with a history of prolonged menstrual period and increased menstrual volume of 4 months. Ultrasonography showed inhomogeneous echo...
A 36-year-old woman presented with a history of prolonged menstrual period and increased menstrual volume of 4 months. Ultrasonography showed inhomogeneous echo measuring 2.5×1.9×2.2 cm in uterine cavity, and it can be seen that the blood flow signal enters the uterine posterior wall. Trophoblastic disease was not ruled out. But the serum β-human chorionic gonadotropin (hCG) was <0.3 mIU/mL. In order to confirm the diagnosis, the patient was planned to undergo hysteroscopy. Hysteroscopy is an ideal solution for early diagnosis. However, the drawback of hysteroscopy is that only local lesions can be removed. If the infiltration degree is deep, a second hysterectomy is required. Our authors present the first case of epithelioid trophoblastic tumor (ETT) under hysteroscopy. After neoplasm partial resection, histopathological examination revealed ETT. The patient underwent hysterectomy to prevent recurrence.
PubMed: 35117550
DOI: 10.21037/tcr.2019.12.24 -
Ginekologia Polska 2022To summarize our five-year experience with managing patients diagnosed with wide range of PAS disorder and treated with prophylactic internal iliac balloon implantation...
OBJECTIVES
To summarize our five-year experience with managing patients diagnosed with wide range of PAS disorder and treated with prophylactic internal iliac balloon implantation prior to cesarean section and to assess maternal and fetal outcomes.
MATERIAL AND METHODS
Retrospective cohort study.
RESULTS
A total of 30 patients were included in the study. Hysterectomy was performed in 10 cases - partial hysterectomy in six and total hysterectomy in four. Median estimated blood loss was 1.18 L. In two cases technical complications were noted. In one case bilateral internal iliac artery thrombosis requiring urgent surgical intervention occurred. A total of 30 live infants were delivered. Mean birth weight was 2435 g and mean Apgar score at 1', 5' and 10' minutes was 6.8, 8 and 8.7 respectively. After average 30 days of hospitalization all infants and their mothers were discharged in good clinical condition.
CONCLUSIONS
Placenta accreta spectrum remains a challenge for obstetricians and gynecologists and despite interdisciplinary approach is associated with numerous complications with life-threatening postpartum hemorrhage being the most serious one. Prophylactic placement of iliac balloons is a minimally invasive and safe endovascular technique which allows rapid and effective control of postpartum bleeding in patients with PAS, with low complication rate for both mother and the child.
Topics: Child; Pregnancy; Humans; Female; Cesarean Section; Balloon Occlusion; Retrospective Studies; Placenta Accreta; Iliac Artery; Catheterization; Hysterectomy; Postpartum Hemorrhage; Blood Loss, Surgical
PubMed: 35315022
DOI: 10.5603/GP.a2021.0221 -
World Journal of Clinical Cases Sep 2022Rhabdomyosarcoma is a soft tissue tumor of primitive mesenchymal cells origin, occurring predominantly in children and adolescents, but extremely rare in adults and the...
BACKGROUND
Rhabdomyosarcoma is a soft tissue tumor of primitive mesenchymal cells origin, occurring predominantly in children and adolescents, but extremely rare in adults and the data regarding its treatment are sparse. Here, we would like to share our experience in the treatment of a locally advanced primary embryonal rhabdomyosarcoma of cervix in a 39-year-old female.
CASE SUMMARY
The patient was admitted with symptoms of intermenstrual bleeding and postcoital bleeding for six months. Physical examination revealed a friable, polyp-like mass (5 cm × 5 cm) in her cervix protruding into the vagina, while the uterus was mobile and normal-sized. Colposcopy-directed biopsy was performed, and a pathological diagnosis of embryonal rhabdomyosarcoma was made. Magnetic resonance imaging of the pelvis showed that the cervical volume was significantly increased, with a hypointense and hyperintense soft tissue mass on the right side, invading the cervical stroma; the mass was 5 cm × 5 cm with a clear boundary and confined to the cervix; there were no obvious findings indicating tumor invasion in the vaginal wall, parametrium, or pelvic wall; no enlarged lymph nodes were observed in the pelvic cavity. Based on our findings, the tumor was classified as stage IA according to the intergroup rhabdomyosarcoma studies criteria and IB3 stage according to The International Federation of Gynecology and Obstetrics 2018. The patient underwent two courses of neoadjuvant chemotherapy and a partial remission was achieved. Subsequently, she underwent laparoscopic radical hysterectomy, bilateral salpingo-oophrectomy and pelvic lymph node dissection and there were no risk factors revealed by postoperative pathological examination. Adjuvant chemotherapy was performed after surgery. The patient was disease-free until the last follow-up, 49 mo after completing the entire treatment.
CONCLUSION
Our experience suggests that neoadjuvant vincristine, dactinomycin, and cyclophosphamide chemotherapy followed by radical surgery and adjuvant chemotherapy might be reasonable therapeutic option for bulky cervical rhabdomyosarcoma in adults without fertility desire. Since large-scale studies on such rare conditions are rather impossible, further case reports and systematic reviews could help optimize the treatment of primary, bulky cervical rhabdomyosarcoma in adults.
PubMed: 36159439
DOI: 10.12998/wjcc.v10.i26.9454 -
The Journal of Clinical Endocrinology... Oct 2021We previously reported that anti-Müllerian hormone (AMH), a marker of ovarian reserve, is positively associated with breast cancer risk, consistent with other studies.
CONTEXT
We previously reported that anti-Müllerian hormone (AMH), a marker of ovarian reserve, is positively associated with breast cancer risk, consistent with other studies.
OBJECTIVE
This study assessed whether risk factors for breast cancer are correlates of AMH concentration.
METHODS
This cross-sectional study included 3831 healthy premenopausal women (aged 21-57, 87% aged 35-49) from 10 cohort studies among the general population.
RESULTS
Adjusting for age and cohort, AMH positively associated with age at menarche (P < 0.0001) and parity (P = 0.0008) and inversely associated with hysterectomy/partial oophorectomy (P = 0.0008). Compared with women of normal weight, AMH was lower (relative geometric mean difference 27%, P < 0.0001) among women who were obese. Current oral contraceptive (OC) use and current/former smoking were associated with lower AMH concentration than never use (40% and 12% lower, respectively, P < 0.0001). We observed higher AMH concentrations among women who had had a benign breast biopsy (15% higher, P = 0.03), a surrogate for benign breast disease, an association that has not been reported. In analyses stratified by age (<40 vs ≥40), associations of AMH with body mass index and OCs were similar in younger and older women, while associations with the other factors (menarche, parity, hysterectomy/partial oophorectomy, smoking, and benign breast biopsy) were limited to women ≥40 (P-interaction < 0.05).
CONCLUSION
This is the largest study of AMH and breast cancer risk factors among women from the general population (not presenting with infertility), and it suggests that most associations are limited to women over 40, who are approaching menopause and whose AMH concentration is declining.
Topics: Adult; Aging; Anti-Mullerian Hormone; Biomarkers; Body Mass Index; Breast Diseases; Breast Neoplasms; Cohort Studies; Cross-Sectional Studies; Female; Humans; Middle Aged; Ovarian Reserve; Pregnancy; Premenopause; Risk Factors
PubMed: 34157104
DOI: 10.1210/clinem/dgab461 -
Joint Commission Journal on Quality and... Jul 2020Overprescribing of opioids after surgery contributes to long-term abuse. Evaluating opioid prescription patterns and patient-reported opioid use offers an evidence-based...
BACKGROUND
Overprescribing of opioids after surgery contributes to long-term abuse. Evaluating opioid prescription patterns and patient-reported opioid use offers an evidence-based method to identify potential overprescription. This quality improvement initiative aimed to reduce and standardize opioid prescriptions upon discharge from an ambulatory oncologic surgery center and evaluate the effect of this change on patients' subsequent opioid use and reported pain.
METHODS
Between March 2018 and January 2019, consecutive opioid-naïve patients aged ≥ 18 years who underwent robotic or laparoscopic hysterectomy, radical prostatectomy, or partial nephrectomy, or total mastectomy with or without immediate reconstruction were surveyed 7-10 days postoperatively. Data collected in the pre- (n = 551) and post-standardization (n = 480) cohorts included perception of pain relief, opioids prescribed (verified by electronic medical record review) and consumed, and refills received.
RESULTS
Pre-standardization, the median opioid prescription at discharge was 20 pills (interquartile range [IQR] 20-28) or 140 oral morphine milligram equivalents (MME) (IQR 100-150). Median opioid consumption was 2 pills (IQR 0-7) or 10 MME (IQR 0-40) among all services. Opioid prescriptions were later standardized to 7, 8, and 10 pills (35, 40, and 75 MME), in the gynecology, urology, and breast services, respectively. The change was not associated with an increase in reported pain. Refill requests increased postintervention across all surgeries from 4.4% to 7.7%, with the largest increase among patients who underwent breast surgery.
CONCLUSION
The number of opioid pills given at discharge to patients undergoing ambulatory or short-stay cancer surgery can safely be reduced.
Topics: Analgesics, Opioid; Breast Neoplasms; Female; Humans; Male; Mastectomy; Pain, Postoperative; Practice Patterns, Physicians'; Prescriptions; Retrospective Studies
PubMed: 32499083
DOI: 10.1016/j.jcjq.2020.04.004