Background. Non-Hodgkin’s lymphoma (NHL) presenting as a gynecologic malignancy is exceedingly rare. We present two cases of NHL presenting as primary ovarian and cervical cancer, respectively. Case. A 66- year- old ...Background. Non-Hodgkin’s lymphoma (NHL) presenting as a gynecologic malignancy is exceedingly rare. We present two cases of NHL presenting as primary ovarian and cervical cancer, respectively. Case. A 66- year- old female presented with abdominal bloating and increased abdominal girth. She underwent a supracervical hysterectomy, bilateral salpingo-oophorectomy, and omentectomy fora large pelvic mass. Immunophenotyping/flow cytometry revealed monoclonal B-cells positive for the CD 20 marker, consistent with NHL. A 47- year- old female presented with persistent vaginal discharge and an ulcerative lesion of the cervix. Cervical biopsies were non-diagnostic for carcinoma but immunophenotyping demonstrated CD 20 positive B- cells, consistent with NHL. Conclusion. Although uncommon, lymphoma should be included in the differential diagnosis of gynecologic malignancies because of a favorable outcome when properly diagnosed and treated.展开更多
To determine the impact of an aborted radical hysterectomy on morbidity and overall survival in patients undergoing surgical treatment for early stage cervical carcinoma. Following IRB approval, a computerized databas...To determine the impact of an aborted radical hysterectomy on morbidity and overall survival in patients undergoing surgical treatment for early stage cervical carcinoma. Following IRB approval, a computerized database identified 304 women treated with radical surgery for early stage cervical carcinoma from 1994 to 2000 of which 23 (8% ) had an aborted radical hysterectomy. Of the 23 patients, 17 patients had a IB1 lesion, 4 patients had a IB 2 lesion, and 2 patients had a IIA lesion. Median age was 42 years (range 28- 60). Twenty- one patients had squamous cell carcinoma and two patients had adenocarcinoma. Radical hysterectomywas aborted for the following reasons: 11 patients had pelvic extension, seven had positive pelvic nodes, and five patients had positive paraaortic nodes. All 23 patients received postoperative radiation therapy; additionally, 12 patients received concurrent chemotherapy consisting of platinum with or without 5- FU. There were four operative complications (17% ) including deep vein thrombosis, wound infection, blood transfusion, and an ileus. Four patients (17% ) had radiationassociated complications. Six of 23 (26% ) patients experienced a recurrence. The 5- year overall survival was 83% with a median follow- up of 59 months (range 12- 107 months). A small percentage of patients (8% ) with early stage cervical carcinoma will have an aborted radical hysterectomy for pelvic extension or positive nodes. Fortunately, these patients still have a favorable prognosis with postoperative radiation therapy. Aborted radical surgery does not significantly increase overall complications.展开更多
BACKGROUND: Massive obstetric hemorrhage can be catastrophic, with considerable maternal morbidity and mortality. CASE: A 41-year-old term gravida experienced massive postpartum hemorrhage attributed to an amniotic fl...BACKGROUND: Massive obstetric hemorrhage can be catastrophic, with considerable maternal morbidity and mortality. CASE: A 41-year-old term gravida experienced massive postpartum hemorrhage attributed to an amniotic fluid embolism with rapid development of disseminated intravascular coagulation and resultant abdominal compartment syndrome. In this critically ill patient, a fascial prosthesis used for abdominal wall closure was placed to expedite multiple abdominal explorations and packing. Additionally, this device facilitated fascial closure once the abdominal compartment syndrome was resolved. CONCLUSION: Abdominal compartment syndrome resulting from overwhelming obstetric hemorrhagemay necessitate emergent decompressive laparotomy to alleviate increased intra-abdominal pressure and end-organ dysfunction. The fascial prosthesis allows a staged abdominal wall closure to be performed once the abdominal compartment syndrome is resolved.展开更多
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 43...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.展开更多
文摘Background. Non-Hodgkin’s lymphoma (NHL) presenting as a gynecologic malignancy is exceedingly rare. We present two cases of NHL presenting as primary ovarian and cervical cancer, respectively. Case. A 66- year- old female presented with abdominal bloating and increased abdominal girth. She underwent a supracervical hysterectomy, bilateral salpingo-oophorectomy, and omentectomy fora large pelvic mass. Immunophenotyping/flow cytometry revealed monoclonal B-cells positive for the CD 20 marker, consistent with NHL. A 47- year- old female presented with persistent vaginal discharge and an ulcerative lesion of the cervix. Cervical biopsies were non-diagnostic for carcinoma but immunophenotyping demonstrated CD 20 positive B- cells, consistent with NHL. Conclusion. Although uncommon, lymphoma should be included in the differential diagnosis of gynecologic malignancies because of a favorable outcome when properly diagnosed and treated.
文摘To determine the impact of an aborted radical hysterectomy on morbidity and overall survival in patients undergoing surgical treatment for early stage cervical carcinoma. Following IRB approval, a computerized database identified 304 women treated with radical surgery for early stage cervical carcinoma from 1994 to 2000 of which 23 (8% ) had an aborted radical hysterectomy. Of the 23 patients, 17 patients had a IB1 lesion, 4 patients had a IB 2 lesion, and 2 patients had a IIA lesion. Median age was 42 years (range 28- 60). Twenty- one patients had squamous cell carcinoma and two patients had adenocarcinoma. Radical hysterectomywas aborted for the following reasons: 11 patients had pelvic extension, seven had positive pelvic nodes, and five patients had positive paraaortic nodes. All 23 patients received postoperative radiation therapy; additionally, 12 patients received concurrent chemotherapy consisting of platinum with or without 5- FU. There were four operative complications (17% ) including deep vein thrombosis, wound infection, blood transfusion, and an ileus. Four patients (17% ) had radiationassociated complications. Six of 23 (26% ) patients experienced a recurrence. The 5- year overall survival was 83% with a median follow- up of 59 months (range 12- 107 months). A small percentage of patients (8% ) with early stage cervical carcinoma will have an aborted radical hysterectomy for pelvic extension or positive nodes. Fortunately, these patients still have a favorable prognosis with postoperative radiation therapy. Aborted radical surgery does not significantly increase overall complications.
文摘BACKGROUND: Massive obstetric hemorrhage can be catastrophic, with considerable maternal morbidity and mortality. CASE: A 41-year-old term gravida experienced massive postpartum hemorrhage attributed to an amniotic fluid embolism with rapid development of disseminated intravascular coagulation and resultant abdominal compartment syndrome. In this critically ill patient, a fascial prosthesis used for abdominal wall closure was placed to expedite multiple abdominal explorations and packing. Additionally, this device facilitated fascial closure once the abdominal compartment syndrome was resolved. CONCLUSION: Abdominal compartment syndrome resulting from overwhelming obstetric hemorrhagemay necessitate emergent decompressive laparotomy to alleviate increased intra-abdominal pressure and end-organ dysfunction. The fascial prosthesis allows a staged abdominal wall closure to be performed once the abdominal compartment syndrome is resolved.
文摘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.
