Objective. Surgical staging of endometrial cancer identifies those patients with microscopic metastatic disease most likely to benefit from adjuvant therapy and may also confer therapeutic benefit. Our objective was t...Objective. Surgical staging of endometrial cancer identifies those patients with microscopic metastatic disease most likely to benefit from adjuvant therapy and may also confer therapeutic benefit. Our objective was to compare survival of patients who underwent resection of grossly positive lymph nodes (LN) to those with microscopically positive LN. Methods. Patients had stage IIIC endometrial cancer with pelvic and/or aortic LN metastases and underwent surgery between 1973 and 2002. Exclusion criteria included pre-surgical radiation and second primary cancer. Survival was analyzed using Kaplan-Meier method and Cox proportional hazards model. Results. Mean age of 96 patients with stage IIIC endometrial cancer was 64. There were 45 cases with microscopic LN involvement and 51 with grossly enlarged LN. Overall, 41%had disease in aortic LN, which in 18%represented isolated aortic LN metastasis. Adjuvant therapies were given to 92%of patients (85%radiotherapy, 10%chemotherapy, 10%progestins). Among those with grossly involved LN, 86%were completely resected. Five-year disease-specific survival (DSS) was 63%in 45 patients with microscopic metastatic disease compared to 50%in 44 patients with grossly positive LN completely resected and 43%in 7 with residual macroscopic disease. In multivariable analyses, gross nodal disease not debulked (HR = 6.85, P = 0.009), serosal/adnexal involvement (HR = 2.24, P = 0.036), diagnosis prior to 1989 (HR = 4.33, P < 0.001),older age (HR = 1.09, P < 0.001), and >2 positive lymph nodes (HR = 3.12, P = 0.007) were associated with lower DSS. Conclusion. Grossly involved LN can often be completely resected in patients with stage IIIC endometrial cancer. These retrospective data provide evidence suggestive of a therapeutic benefit for lymphadenectomy in endometrial cancer.展开更多
Introduction. Ocular metastasis always involves the uveal tractus, especially the choroid. Papillary metastases have been exceptionally described, and represent only 5 percent of the ocular metastatic locations. We re...Introduction. Ocular metastasis always involves the uveal tractus, especially the choroid. Papillary metastases have been exceptionally described, and represent only 5 percent of the ocular metastatic locations. We report in this observation a case of papillary metastasis in a patient treated for a metastatic adenocarcinoma. Observation. A 35- year- old woman was given chemotherapy for four months for metastatic adenocarcinoma involving the pleura and bones. She consulted for significant decline of visual acuity in the left eye associated with headache and vomiting. The fundus examination revealed a yellowish papillary lesion with edema associated with an inferior peripapillary serous retinal detachment. The fluorescein retinal angiography showed a choroidal lesion highly suggestive of choroidal metastasis. Cerebro- orbital CT scan revealed the presence of multiple cerebral metastases. The patient died four months after diagnosis of ocular metastasis and eleven months after diagnosis of adenocarcinoma. Conclusion. Presence of a papillary lesion suggests the possible diagnosis of papillary metastasis despite the lack of a history of neoplasia. Carcinomatosis tumors, especially breast and the lung carcinomas are the most frequent causes of papillary metastasis.展开更多
Background. Positron emission tomography (PET) is commonly used to detect occult or recurrent malignancy, including tumors of the female genital tract. Recently, there have been reports of PET scans used in patients w...Background. Positron emission tomography (PET) is commonly used to detect occult or recurrent malignancy, including tumors of the female genital tract. Recently, there have been reports of PET scans used in patients with Gestational Trophoblastic Disease (GTD). Case. A 22- year- old female presented with vaginal bleeding and elevated β - hCG 7 months after a spontaneous vaginal delivery of a healthy infant. She had a history of molar pregnancy and persistent GTD requiring multi- agent chemotherapy. Metastatic evaluation with computed tomography and magnetic resonance imaging showe d no evidence of GTD. A positron emission tomography/computed tomography (PET/CT) scan revealed a focus of metabolic activity in the left pelvis. The patient underwent an exploratory laparotomy that revealed metastatic choriocarcinoma in the left broad ligament. Conclusion. PET/CT may be useful in the evaluation of occult choriocarcinoma when conventional.展开更多
Background: We report our data in 35 patients who underwent preoperative conventional and fluorescence-based staging laparoscopy. We use the data to address the questions of whether fluorescence examination increases ...Background: We report our data in 35 patients who underwent preoperative conventional and fluorescence-based staging laparoscopy. We use the data to address the questions of whether fluorescence examination increases the yield of metastatic lesions and alters treatment intervention. Methods: Fluorescence laparoscopy was successfully performed in 30 patients with GI malignancies. After sensitization with 5-aminolevulinic acid, conventional white-light mode and fluorescence-light laparoscopies were sequentially performed. A suspected malignancy was biopsied. Observations: In 5 patients, examinations were incomplete because of adhesions. In 9 of 10 patients, hepatic or peritoneal metastases were detected by white-light examination. In 4 of these 9, blue-light examination yielded more metastatic lesions. In one patient with no lesions by white-or blue-light examination, surgery revealed hepatic metastasis in a location not accessible to laparoscopic examination. In 18 patients, surgery confirmed the absence of metastatic lesions. Conclusions: A fluorescence, blue-light examination yielded more lesions than the conventional white-light examination but did not alter treatment intervention and did not enhance yield when metastatic lesion is in an inaccessible location. Continued research should focus on whether treatment intervention will be altered by the fluorescence examination.展开更多
文摘Objective. Surgical staging of endometrial cancer identifies those patients with microscopic metastatic disease most likely to benefit from adjuvant therapy and may also confer therapeutic benefit. Our objective was to compare survival of patients who underwent resection of grossly positive lymph nodes (LN) to those with microscopically positive LN. Methods. Patients had stage IIIC endometrial cancer with pelvic and/or aortic LN metastases and underwent surgery between 1973 and 2002. Exclusion criteria included pre-surgical radiation and second primary cancer. Survival was analyzed using Kaplan-Meier method and Cox proportional hazards model. Results. Mean age of 96 patients with stage IIIC endometrial cancer was 64. There were 45 cases with microscopic LN involvement and 51 with grossly enlarged LN. Overall, 41%had disease in aortic LN, which in 18%represented isolated aortic LN metastasis. Adjuvant therapies were given to 92%of patients (85%radiotherapy, 10%chemotherapy, 10%progestins). Among those with grossly involved LN, 86%were completely resected. Five-year disease-specific survival (DSS) was 63%in 45 patients with microscopic metastatic disease compared to 50%in 44 patients with grossly positive LN completely resected and 43%in 7 with residual macroscopic disease. In multivariable analyses, gross nodal disease not debulked (HR = 6.85, P = 0.009), serosal/adnexal involvement (HR = 2.24, P = 0.036), diagnosis prior to 1989 (HR = 4.33, P < 0.001),older age (HR = 1.09, P < 0.001), and >2 positive lymph nodes (HR = 3.12, P = 0.007) were associated with lower DSS. Conclusion. Grossly involved LN can often be completely resected in patients with stage IIIC endometrial cancer. These retrospective data provide evidence suggestive of a therapeutic benefit for lymphadenectomy in endometrial cancer.
文摘Introduction. Ocular metastasis always involves the uveal tractus, especially the choroid. Papillary metastases have been exceptionally described, and represent only 5 percent of the ocular metastatic locations. We report in this observation a case of papillary metastasis in a patient treated for a metastatic adenocarcinoma. Observation. A 35- year- old woman was given chemotherapy for four months for metastatic adenocarcinoma involving the pleura and bones. She consulted for significant decline of visual acuity in the left eye associated with headache and vomiting. The fundus examination revealed a yellowish papillary lesion with edema associated with an inferior peripapillary serous retinal detachment. The fluorescein retinal angiography showed a choroidal lesion highly suggestive of choroidal metastasis. Cerebro- orbital CT scan revealed the presence of multiple cerebral metastases. The patient died four months after diagnosis of ocular metastasis and eleven months after diagnosis of adenocarcinoma. Conclusion. Presence of a papillary lesion suggests the possible diagnosis of papillary metastasis despite the lack of a history of neoplasia. Carcinomatosis tumors, especially breast and the lung carcinomas are the most frequent causes of papillary metastasis.
文摘Background. Positron emission tomography (PET) is commonly used to detect occult or recurrent malignancy, including tumors of the female genital tract. Recently, there have been reports of PET scans used in patients with Gestational Trophoblastic Disease (GTD). Case. A 22- year- old female presented with vaginal bleeding and elevated β - hCG 7 months after a spontaneous vaginal delivery of a healthy infant. She had a history of molar pregnancy and persistent GTD requiring multi- agent chemotherapy. Metastatic evaluation with computed tomography and magnetic resonance imaging showe d no evidence of GTD. A positron emission tomography/computed tomography (PET/CT) scan revealed a focus of metabolic activity in the left pelvis. The patient underwent an exploratory laparotomy that revealed metastatic choriocarcinoma in the left broad ligament. Conclusion. PET/CT may be useful in the evaluation of occult choriocarcinoma when conventional.
文摘Background: We report our data in 35 patients who underwent preoperative conventional and fluorescence-based staging laparoscopy. We use the data to address the questions of whether fluorescence examination increases the yield of metastatic lesions and alters treatment intervention. Methods: Fluorescence laparoscopy was successfully performed in 30 patients with GI malignancies. After sensitization with 5-aminolevulinic acid, conventional white-light mode and fluorescence-light laparoscopies were sequentially performed. A suspected malignancy was biopsied. Observations: In 5 patients, examinations were incomplete because of adhesions. In 9 of 10 patients, hepatic or peritoneal metastases were detected by white-light examination. In 4 of these 9, blue-light examination yielded more metastatic lesions. In one patient with no lesions by white-or blue-light examination, surgery revealed hepatic metastasis in a location not accessible to laparoscopic examination. In 18 patients, surgery confirmed the absence of metastatic lesions. Conclusions: A fluorescence, blue-light examination yielded more lesions than the conventional white-light examination but did not alter treatment intervention and did not enhance yield when metastatic lesion is in an inaccessible location. Continued research should focus on whether treatment intervention will be altered by the fluorescence examination.
