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Frontiers in Surgery 2021Carcinosarcoma, also known as malignant mixed Mullerian tumor (MMMT) is a malignant biphasic neoplasm consisting of carcinomatous and malignant non-epithelial...
Carcinosarcoma, also known as malignant mixed Mullerian tumor (MMMT) is a malignant biphasic neoplasm consisting of carcinomatous and malignant non-epithelial components of mesenchymal origin. MMMTs typically arise from the female genital tract in patients over 40 years old. Primary extragenital MMMTs are extremely rare with published literature totaling 40 reported cases. The primary peritoneal carcinosarcoma is an aggressive tumor as patients with this tumor have an average survival of 7.6 months. Surgical debulking is the mainstay of treatment for these tumors and systemic chemotherapy is advised in all cases. A 48-year-old Amish female presented with 5 day history of bloating and abdominal pain superimposed on a 1 year history of worsening fatigue and intermittent bloody bowel movements. She was found to have a pelvic mass on physical exam. Computed tomography scan of the abdomen and pelvis that demonstrated stricturing of the sigmoid colon, and a large multi-cystic mass in the midline pelvis measuring 12.5 × 9.9 × 11.7 cm. Colonoscopy showed stenosis due to external compression without intraluminal lesion. CEA and CA 125 levels were elevated and CA 19-9 was normal. Exploratory laparotomy was performed with en-bloc resection of a 15 cm mass originating from the sigmoid colon mesentery with several other small tumor deposits throughout the mesentery. Pathology diagnosed primary peritoneal carcinosarcoma Mullerian-type with three positive lymph nodes. Malignant mixed Mullerian tumor (carcinosarcoma) caries a universally grim prognosis. Herein, we report a unique case of primary peritoneal carcinosarcoma and discuss the work-up and surgical management of this rare tumor.
PubMed: 34490336
DOI: 10.3389/fsurg.2021.707929 -
Ultrasound in Obstetrics & Gynecology :... Jun 2021To evaluate the utility of pelvic floor ultrasound (US) in the detection and evaluation of suburethral masses, using magnetic resonance imaging (MRI) as the reference... (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate the utility of pelvic floor ultrasound (US) in the detection and evaluation of suburethral masses, using magnetic resonance imaging (MRI) as the reference standard.
METHODS
This was a retrospective analysis of US and MRI scans of all women with a suburethral mass on clinical examination at a single urogynecology clinic over a 13-year period (February 2007 to March 2020). All women were examined using two-dimensional transperineal US (2D-TPUS) with or without three-dimensional endovaginal US (3D-EVUS). All patients underwent unenhanced T1-weighted and T2-weighted MRI, which was considered the reference standard in this study. Presence of a suburethral mass and its size, location, connection with the urethral lumen and characteristics were evaluated on both pelvic floor US and MRI. Agreement between pelvic floor US and MRI was assessed using intraclass correlation coefficients (ICC; 3,1).
RESULTS
Forty women suspected of having a suburethral mass on clinical examination underwent both MRI and US (2D-TPUS with or without 3D-EVUS). MRI detected a suburethral mass in 34 women, which was also detected by US. However, US also identified a suburethral mass in the remaining six women. Thus, the agreement between US and MRI for detecting a suburethral mass was 85% (95% CI, 70.2-94.3%). The ICC analysis showed good agreement between MRI and 2D-TPUS for the measured distance between the suburethral mass and the bladder neck (ICC, 0.89; standard error of measurement (SEM), 3.64 mm) and excellent agreement for measurement of the largest diameter of the mass (ICC, 0.93; SEM, 4.31 mm). Good agreement was observed between MRI and 3D-EVUS for the measured distance from the suburethral mass to the bladder neck (ICC, 0.88; SEM, 3.48 mm) and excellent agreement for the largest diameter of the suburethral mass (ICC, 0.94; SEM, 4.68 mm).
CONCLUSIONS
2D-TPUS and 3D-EVUS are useful in the imaging of suburethral masses. US shows good-to-excellent agreement with MRI in identifying and measuring suburethral masses; therefore, the two modalities can be used interchangeably depending on availability of equipment and expertise. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. - Legal Statement: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Topics: Adult; Aged; Female; Genital Neoplasms, Female; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Middle Aged; Pelvic Floor; Predictive Value of Tests; Retrospective Studies; Ultrasonography; Urethra; Young Adult
PubMed: 32936990
DOI: 10.1002/uog.23123 -
PloS One 2020Testicular germ cell tumor (TGCT) incidence has increased in recent decades along with the use and dose of diagnostic radiation. Here we examine the association between...
BACKGROUND
Testicular germ cell tumor (TGCT) incidence has increased in recent decades along with the use and dose of diagnostic radiation. Here we examine the association between reported exposure to diagnostic radiation and TGCT risk.
METHODS
We conducted a case-control study of men with and without TGCT recruited from hospital- and population-based settings. Participants reported on exposures to 1) x-ray or CT below the waist and 2) lower GI series or barium enema, which consists of a series of x-rays of the colon. We also derived a combined measure of exposure. We used logistic regression to determine the risk of developing TGCT according to categories of exposures (0, 1-2, or ≥3 exposures) and age at first exposure, adjusting for age, year of birth, race, county, body mass index at diagnosis, family history of TGCT, and personal history of cryptorchidism.
RESULTS
There were 315 men with TGCT and 931 men without TGCT in our study. Compared to no exposures, risk of TGCT was significantly elevated among those reporting at least three exposures to x-ray or CT (OR≥3 exposures, 1.78; 95% CI, 1.15-2.76; p = 0.010), lower GI series or barium enema (OR≥3 exposures, 4.58; 95% CI, 2.39-8.76; p<0.001), and the combined exposure variable (OR≥3 exposures, 1.59; 95% CI, 1.05-2.42; p = 0.029). The risk of TGCT was elevated for those exposed to diagnostic radiation at age 0-10 years, compared to those first exposed at age 18 years or later, although this association did not reach statistical significance (OR, 2.00; 95% CI, 0.91-4.42; p = 0.086).
CONCLUSIONS
Exposure to diagnostic radiation below the waist may increase TGCT risk. If these results are validated, efforts to reduce diagnostic radiation doses to the testes should be prioritized.
Topics: Abdominal Cavity; Adolescent; Adult; Age Factors; Case-Control Studies; Child; Child, Preschool; Cryptorchidism; Diagnostic Imaging; Humans; Infant; Infant, Newborn; Logistic Models; Male; Middle Aged; Neoplasms, Germ Cell and Embryonal; Pelvis; Radiation; Radiation Injuries; Risk Factors; Testicular Neoplasms; Testis; Young Adult
PubMed: 33175879
DOI: 10.1371/journal.pone.0239321 -
European Journal of Case Reports in... 2024Subepithelial haemorrhage of the renal pelvis is a rare cause of haematuria and can be diagnosed based on radiographic findings. This haemorrhage often appears as a...
UNLABELLED
Subepithelial haemorrhage of the renal pelvis is a rare cause of haematuria and can be diagnosed based on radiographic findings. This haemorrhage often appears as a non-enhancing hyperdense mass in the renal pelvis on computed tomography, which sometimes results in unnecessary nephrectomy because it can mimic renal neoplasms. It can be managed conservatively, and its prognosis is generally benign. We report a case of renal pelvic haemorrhage complicating emphysematous pyelonephritis that needed emergent nephrectomy. Our case highlights the importance of careful observation for complications of urinary tract infection, although complications are rare.
LEARNING POINTS
Renal pelvic haemorrhage is an uncommon cause of haematuria. It can mimic renal neoplasms, which sometimes results in unnecessary nephrectomy.Although the prognosis of renal pelvic haemorrhage is generally benign, careful observation for complications of urinary tract infection is important.
PubMed: 38223272
DOI: 10.12890/2023_004241 -
International Journal of Environmental... Jan 2023This comparative pre-post intervention study investigated the feasibility and benefits of Kegel exercises amongst incontinent women, prior to commencing resistance...
This comparative pre-post intervention study investigated the feasibility and benefits of Kegel exercises amongst incontinent women, prior to commencing resistance training (RT), to reduce the risk of stress urinary incontinence (SUI) compared to a group of women without prior Kegel exercises (KE). Incontinence severity index (ISI) score, pelvic floor muscle strength (PFMS), and body composition (such as body mass index (BMI), fat, and muscle mass), were obtained pre and post intervention. Results demonstrated that RT reduced SUI to a significantly greater extent only if preceded by KE as was observed in the Kegel exercise plus RT group (KE + RT) over time. The improvements in total ISI in both the KE + RT and RT groups were large (d = 1.50 and d = 1.17 respectively). A two-way ANOVA indicated a statistically significant improvement in average PFMS within the KE + RT group over time and between the two groups. A positive correlation was found between the average strength of pelvic floor muscles and SUI. Participants in KE + RT group demonstrated a significant increase in muscle mass ( ≤ 0.001) and concomitant reduction in fat mass ( = 0.018). This study determined a dedicated program of KE preceding a RT program improved average pelvic floor muscle strength and was effective in reducing SUI among incontinent women.
Topics: Female; Humans; Urinary Incontinence, Stress; Resistance Training; Pelvic Floor; Exercise Therapy; Urinary Incontinence; Treatment Outcome
PubMed: 36674234
DOI: 10.3390/ijerph20021481 -
The Indian Journal of Radiology &... Jul 2021Aggressive angiomyxoma (AAM) is a rare mesenchymal tumor predominantly affecting the pelvis and perineum of females. Due to its variable clinical presentation, it is...
Aggressive angiomyxoma (AAM) is a rare mesenchymal tumor predominantly affecting the pelvis and perineum of females. Due to its variable clinical presentation, it is often misinterpreted and treated as other pathologies like Bartholin gland cyst, vulvar abscess, and hernia. The tumor is locally infiltrative, making its complete surgical removal difficult. The aim of the study is to highlight and illustrate the imaging and pathological features of AAM. After obtaining clearance from the Institutional Ethics Committee, a retrospective study was conducted on patients with histopathological diagnosis of AAM, presenting to the dedicated sarcoma clinic between 2016 and 2019. The demographic, clinical, radiological, pathological, and treatment details were obtained from the institute's database. The magnetic resonance imaging (MRI) and computed tomography images were reviewed to assess different imaging parameters. Follow-up imaging was assessed for residual or recurrent mass in the pelvis or perineum and distant metastasis. A total of four patients were included with an age range of 28 to 50 years. The baseline MRI of these four patients shows pelvic mass extending into the perineum, infiltrating along the surrounding fascial planes with the characteristic laminated appearance on T2-weighted image and gradual intense enhancement following contrast administration. All patients had residual disease post-surgery and were put on hormonal therapy. AAMs are locally aggressive, rarely metastasizing mesenchymal tumor that has a specific predilection for the perineum and pelvis of females. MRI features like laminated or striated appearance, post-contrast enhancement, and finger-like infiltrating projections should raise the suspicion of the diagnosis on baseline imaging.
PubMed: 34790299
DOI: 10.1055/s-0041-1735913 -
American Journal of Human Biology : the... Aug 2022Imaging methods to measure the human pelvis in vivo provide opportunities to better understand pelvic variation and adaptation. Magnetic resonance imaging (MRI) provides...
OBJECTIVES
Imaging methods to measure the human pelvis in vivo provide opportunities to better understand pelvic variation and adaptation. Magnetic resonance imaging (MRI) provides high-resolution images, but is more expensive than dual-energy X-ray absorptiometry (DXA). We sought to compare pelvic breadth measurements collected from the same individuals using both methods, to investigate if there are systematic differences in pelvic measurement between these imaging methods.
METHODS
Three pelvic breadth dimensions (bi-iliac breadth, bi-acetabular breadth, medio-lateral inlet breadth) were collected from MRI and DXA scans of a cross-sectional sample of healthy, nulliparous adult women of South Asian ancestry (n = 63). Measurements of MRI and DXA pelvic dimensions were collected four times in total, with one baseline data collection session and three replications. Data collected from these sessions were averaged, used to calculate technical error of measurement and entered into a Bland-Altman analysis. Linear regression models were fitted with a given MRI pelvic measurement regressed on the same measurement collected from DXA scans, as well as MRI mean bias regressed on DXA mean bias.
RESULTS
Technical error of measurement was higher in DXA measurements of bi-iliac breadth and medio-lateral pelvic inlet breadth and higher for MRI measurements of bi-acetabular breadth. Bland Altman analyses showed no statistically significant relationship between the mean bias of MRI and DXA, and the differences between MRI and DXA pelvic measurements.
CONCLUSIONS
DXA measurements of pelvic breadth are comparable to MRI measurements of pelvic breadth. DXA is a less costly imaging technique than MRI and can be used to collect measurements of skeletal elements in living people.
Topics: Absorptiometry, Photon; Adult; Body Mass Index; Cross-Sectional Studies; Female; Humans; Magnetic Resonance Imaging; Pelvis
PubMed: 35460113
DOI: 10.1002/ajhb.23753 -
Women's Health (London, England) 2022Pelvic floor dysfunction has a high prevalence among women worldwide. However, in the Kingdom of Saudi Arabia, it is underreported. Thus, we aimed to estimate the...
OBJECTIVE
Pelvic floor dysfunction has a high prevalence among women worldwide. However, in the Kingdom of Saudi Arabia, it is underreported. Thus, we aimed to estimate the prevalence and risk factors of pelvic floor dysfunction in women in the Kingdom of Saudi Arabia.
METHODS
We conducted a cross-sectional study on literate non-pregnant women aged ⩾18 years who agreed to participate in our survey. We used the validated and translated Australian pelvic floor questionnaire and conducted a multivariate logistic regression analysis to assess the risk factors of pelvic floor dysfunction.
RESULTS
A total of 824 participants completed the questionnaire. While 60.2% of the participants had pelvic floor dysfunction, 67.7% reported signs of bowel dysfunction. Urinary dysfunction, prolapse, and sexual dysfunction were present in 44.1%, 67.7%, and 55.4% of the participants, respectively. Age, high body mass index, chronic medical illness, heavy weight lifting, and multiparity were found as the risk factors of bladder function problems. Meanwhile, chronic medical illness, heavy weight lifting, and multiparity were found as the risk factors of bowel dysfunction and prolapse. Age group and marital status were the independent factors associated with sexual dysfunction.
CONCLUSION
We noted a high rate of pelvic floor dysfunction in the Kingdom of Saudi Arabia, which calls for the need to provide holistic approaches for the prevention and management of pelvic floor dysfunction among women.
Topics: Adolescent; Australia; Cross-Sectional Studies; Fecal Incontinence; Female; Humans; Pelvic Floor; Pelvic Floor Disorders; Prevalence; Saudi Arabia; Surveys and Questionnaires; Urinary Incontinence
PubMed: 35100887
DOI: 10.1177/17455065211072252 -
The Journal of Maternal-fetal &... Dec 2023While a basic understanding of pelvic size and typology is still important for obstetricians, pelvic measurement data for Japanese women are very scarce. To our best... (Observational Study)
Observational Study
OBJECTIVE
While a basic understanding of pelvic size and typology is still important for obstetricians, pelvic measurement data for Japanese women are very scarce. To our best knowledge, no large-scale pelvimetry studies of Japanese women have been made for the past 50 years. This study aimed to investigate the accurate size, particularly the obstetric conjugate (OC) and transverse diameter of the pelvic inlet (TD), of modern Japanese women, using three-dimensional (3D) computed tomography (CT), and to obtain their reference values.
METHODS
This retrospective, single-center observational study enrolled Japanese non-pregnant women aged between 20 and 40 years, who underwent pelvic CT examination from 2016 to 2021. CT was performed for various reasons, including acute abdomen, search for cancer metastases, and follow-up of existing disease. However, no cases were taken for pelvic measurements. Pelvimetry was performed retrospectively using a 3D workstation. The OC was measured on a strict lateral view and the TD was measured on an axial-oblique view. Other clinical data, such as age, height, and weight, were also extracted from the medical charts and analyzed.
RESULTS
A total of 1,263 patients were enrolled, with the mean age of 32.7 years (standard deviation [SD] 6.2). The mean height, weight, and body mass index were 158.8 cm (SD 5.8), 54.8 kg (SD 11.7), and 21.7 kg/m (SD 4.4), respectively. The mean OC length was 127.0 mm (SD 9.5, 95% confidence interval [CI] 126.5-127.5), while the mean TD length was 126.8 mm (SD 7.5, 95% CI 126.4-127.2). Both values were normally distributed. Height was significantly associated with OC (regression coefficient = 0.75 [95% CI 0.66-0.84], < .001) and TD (regression coefficient = 0.63 [95% CI 0.56-0.70], < .001). Age showed a weak but statistically significant positive association with TD (regression coefficient = 0.14 [95% CI 0.07-0.20], < .001) and OC (regression coefficient = -0.10 [95% CI -0.18 to -0.01], = .026).
CONCLUSION
The 3D CT pelvimetry in 1,263 non-pregnant Japanese women of childbearing age revealed the mean OC and TD of 127.0 mm, and 126.8 mm, which were 11.8 mm and 4.3 mm larger, respectively, than those in the survey in 1972. Our data will be referred to in clinical practice as the standard pelvic measurement values for the Japanese population.
Topics: Pregnancy; Humans; Female; Young Adult; Adult; Pelvimetry; Retrospective Studies; East Asian People; Pelvis; Tomography, X-Ray Computed
PubMed: 36927362
DOI: 10.1080/14767058.2023.2190444 -
Medicine May 2023To investigate the characteristics of pelvic floor surface electromyography parameters on the basis of Glazer assessment in women 42 days postpartum, and to analyze the... (Randomized Controlled Trial)
Randomized Controlled Trial
To investigate the characteristics of pelvic floor surface electromyography parameters on the basis of Glazer assessment in women 42 days postpartum, and to analyze the predictive value of surface electromyography (sEMG) in postpartum stress urinary incontinence. This is a retrospective study. Three thousand twenty-nine females in total who were screened 42 days postpartum in Jinniu District Maternal and Children's Health Hospital of Chengdu from January 2019 to December 2020 were selected, and were randomly allocated into stress urinary incontinence (SUI) (n = 509) and the non-SUI group (n = 2520). Pelvic floor surface electromyography was performed by the same physiotherapists. The evaluation parameters included the average EMG value in the pre-resting baseline, the maximum sEMG value, the rising time, the descent time in the fast-twitch phase, and the average sEMG value in the slow-twitch phase. Mean value and modifiability of EMG value in post-resting stage. The disparities of the mentioned parameters hereinabove in the SUI and non-SUI groups were made comparison, and the relationship between stress urinary incontinence and sEMG parameters was analyzed by multiple logistic regression analysis. The prevalence of SUI was 16.8% in women 42 days after delivery. Body mass index and vaginal delivery were risk factors for SUI. Among the sEMG parameters of the SUI group and the non-SUI group, the maximum EMG values in the fast-twitch phase (28.81 ± 14.41 vs 30.41 ± 15.15), the rising time in the fast-twitch phase (0.55 ± 0.36 vs 0.51 ± 0.30), and the Phase descent time (0.76 ± 0.76 vs 0.68 ± 0.65), mean slow-twitch phase EMG (17.82 ± 10.10 vs 19.69 ± 15.62), slow-twitch phase variability (0.28 ± 0.12 vs 0.26 ± 0.10), are statistically different (P < .05). In the SUI group, body mass index (estimated parameter = 0.029, P = .023), mean EMG during slow-twitch phase (estimated parameter = -0.013, P = .004) were relevant to stress urinary incontinence after delivery. The sEMG based on Glazer protocol indicates the activity of slow-twitch muscle fibers in SUI patients are decreased, and there is a correlation with the occurrence of stress urinary incontinence. sEMG can be applied as a quantitative evaluation tool of the pelvic floor analysis in postpartum SUI.
Topics: Child; Humans; Female; Electromyography; Urinary Incontinence, Stress; Cross-Sectional Studies; Pelvic Floor; Retrospective Studies; Postpartum Period; Muscular Diseases
PubMed: 37233412
DOI: 10.1097/MD.0000000000033851