1例子宫横纹肌肉瘤并发子宫外翻的病例报道

Background. Alveolar rhabdomyosarcoma is an uncommon malignant soft tissue tumor rarely found in the genital tract. This tumor is associated with a poor prognosis, especially in the adult population. Equally as rare are non- puerperal uterine inversions secondary to sarcomas. Case. A 21- year- old obese woman was initially evaluated with excessive vaginal bleeding. On exam, a large pedunculated mass protruding from the cervix was seen and biopsy of this mass revealed an alveolar rhabdomyosarcoma. The patient was treated with adjuvant chemotherapy consisting of VAC (Vincristine, Actinomycin, and Cyclophosphamide) for a presumed cervical rhabdomyosarcoma. After five cycles of chemotherapy the patient underwent a total abdominal hysterectomy and bilateral salpingo- oophorectomy, at which time a complete uterine inversion was noted with the tumor located at the fundus of the uterus. Final pathology showed alveolar rhabdomyosarcoma of the uterus. The patient then received additional postoperative VAC regimen for a total of 10 treatments and remains in good health with no evidence of disease 20 months from diagnosis. Conclusion. This case report describes the only reported case of uterine inversion secondary to alveolar rhabdomyosarcoma of the uterus and discusses current therapeutic options for adults.

宫颈癌结局预测

Background. To determine the impact of race and other factors on the management and outcomes of women treated for cervical cancer in a rural state. Methods. Following IRB approval, a retrospective review identified 434 eligible women treated for cervical cancer from 1994 to 2000. Collected data included: demographics, clinicopathologic data, primary and adjuvant therapy, recurrence, and survival. Statistical analyses were performed with the Chi-square test, Kaplan-Meier method, and Cox regression. Results. 304 (70%) of the women were white and 130 (30%) were non-white. Non-whites were more likely to present with advanced stage disease Stage IIB-IVB (25%vs 13%; P < 0.01). Whites were more likely to smoke, be married, be employed, and have private insurance. Non whites were more likely to have medical co-morbidities such as diabetes and hypertension. Although whites with early stage disease were more likely to undergo surgery as their primary therapy than non-whites (93%vs 84%; P < 0.01), survival was similar. Survival outcomes for advanced stage disease were similar between groups. Conclusions. Non-whites diagnosed with cervical cancer are more likely to present with advanced stage disease than whites; however, overall survival was similar between groups. Non-whites with early stage disease were more likely to receive primary radiation therapy than whites. The decision to use radiation therapy vs surgery does not appear to have a detrimental effect on overall survival, but may impact quality of life.

阴性表浅腹股沟淋巴结切除术后Ⅰ/Ⅱ期外阴癌患者的结局

Objectives. To investigate the patterns of recurrence associated with superficial inguinal lymphadenectomy (SupIL) and vulvectomy for patients with Stage Ⅰ/Ⅱ vulvar cancer. Methods. A retrospective chart review identified patients from 1990-2001 with Stage Ⅰ/Ⅱ vulvar cancer that underwent SupIL and vulvectomy. Survival was analyzed using the Kaplan-Meier method with Fisher Exact and Chi-square tests for comparisons between groups. Results. 65 patients with Stage Ⅰ/Ⅱ vulvar cancer with a pathologically negative SupIL were identified (30 Stage Ⅰ, 35 Stage Ⅱ ). Three patients recurred in the inguinal region, (4.6% ) and 11 patients (16.9% ) recurred on the vulva. Two of the 11 patients died of disease, six patients are alive without evidence of disease after additional therapy. Five-year disease-free survival and overall survival were 66% and 97% , respectively. Risk of recurrence was not associated with smoking status, stage, or margin status. Conclusions. SupIL and vulvectomy for Stage Ⅰ /Ⅱ vulvar cancer have a low recurrence rate in the inguinal region when nodes are negative. The local recurrence rate (17% ) is acceptable, and overall survival is good using this conservative approach.

复发性外阴基底鳞状上皮细胞癌

Background.:Basosquamous cell carcinoma (BSC) of the vulva is a rare entity with interesting prognostic and therapeutic implications. Currently,there is no definitive treatment due to its low incidence. Case.:A case of recurrent BSC of the vulva treated with unilateral radical vulvectomy and unilateral lymph node dissection is reported. Conclusion.:BSC is a rare disorder of the vulva. The metastatic potential of this tumor is not fully understood,but likely is intermediate between squamous cell carcinoma and basal cell carcinoma. Local recurrence is common and close follow-up is warranted.