Obstetrics and Gynecology Clinics of North America, Sep 1, 1999
Uterine atony, inversion, and rupture are potentially fatal events that may occur in pregnancy. T... more Uterine atony, inversion, and rupture are potentially fatal events that may occur in pregnancy. They are obstetric emergencies that require immediate attention. Although all women may experience these complications, identification or known risk factors allow the obstetric team to prepare for rapid diagnosis and intervention. This article includes management options to help prepare for these uncommon events.
Inflammatory conditions of the breast are uncommon and may be encountered in the puerperal and no... more Inflammatory conditions of the breast are uncommon and may be encountered in the puerperal and nonpuerperal setting. Mastitis, in the postpartum period, is identified by a localized wedge-shaped area of erythema and tenderness on examination of the breast. It is usually caused by staphylococci and should be treated with oral antibiotics and continued breastfeeding. Early treatment decreases the risk of abscess formation. Lactational abscesses may be difficult to diagnose if a distinct fluctuant mass is not present on examination, but ultrasound can be helpful in identifying a fluid or pus collection. Although conventional incision and drainage is most frequently used to treat abscesses, ultrasound-guided aspiration or catheter placement may be attempted as alternative treatment approaches. Nonpuerperal mastitis is less common and usually presents with inflammation and chronic abscess formation in the areolar region. This condition is most commonly a result of squamous metaplasia of ...
1. Curr Probl Surg. 2001 Apr;38(4):213-90. Surgery in the pregnant patient. Edwards RK, Ripley DL... more 1. Curr Probl Surg. 2001 Apr;38(4):213-90. Surgery in the pregnant patient. Edwards RK, Ripley DL, Davis JD, Bennett BB, Simms-Cendan JS, Cendan JC, Stone IK. Division of Maternal Fetal Medicine, Department of Obstetrics ...
To evaluate the feasibility and safety of laparoscopic adnexal mass removal in patients without p... more To evaluate the feasibility and safety of laparoscopic adnexal mass removal in patients without preselection for benign pathology and assess the operative complications and findings. All patients presenting to the gynecologic oncology service between April 1992 and April 1996 with adnexal masses were candidates for laparoscopic management. Patients underwent preoperative radiological studies and office pelvic examination. Laparoscopic management was attempted on patients without evidence of gross metastatic disease or masses that extended above the umbilicus. Laparotomy was performed if indicated by pathologic findings or technical difficulty. All removed adnexal masses were sent for immediate pathologic diagnosis. The type of procedure, intraoperative findings, and complications were all recorded at the time of procedure. One hundred sixty patients underwent laparoscopic evaluation for an adnexal mass. Benign pathology was discovered in 139 (87%, 95% confidence interval [CI] 84, 90) patients, and 141 (88%, 95% CI 86, 91) patients were managed laparoscopically. Reasons for laparotomy included technical difficulty, operative complications, or malignancy. Frozen section diagnosis was concordant with the final pathology reports in all but five patients (97% concordance), and no discrepancies resulted in treatment delays. Laparoscopic management of adnexal masses can be successful in a gynecologic oncology population if there is expertise in operative laparoscopy, availability of immediate accurate pathologic examination, and appropriate further treatment where indicated.
Primary adenocarcinoma of the vagina is rare, and mucinous-enteric differentiation is exceptional... more Primary adenocarcinoma of the vagina is rare, and mucinous-enteric differentiation is exceptional. A few sporadic cases of primary vaginal adenocarcinoma with mucinous-enteric differentiation have been reported. Reports of the clinical histories, pathologic findings, and immunohistochemical studies of two cases of primary vaginal adenocarcinomas in a 67-year-old and in a 45-year-old woman are presented. Knowledge of the differentiation of Mullerian epithelium and immunohistochemistry studies are helpful to better characterize these tumors.
Does papillary squamotransitional cell carcinoma (PSTCC) behave differently from conventional squ... more Does papillary squamotransitional cell carcinoma (PSTCC) behave differently from conventional squamous cell carcinoma of the cervix and does PSTCC have true transitional cell differentiation? Twenty cases of PSTCC were identified from archival files. Clinical data were compiled. Immunoperoxidase stains for uroplakin III, p63 and p16 were performed on available tissue blocks. Patients ranged in age from 27 to 85 years. Twelve patients were FIGO Stage I, 4 were Stage II, and 2 were Stage III. Thirteen patients had clinical follow-up ranging from 5 to 132 months. Three patients subsequently had more extensive disease than initial clinical staging indicated. Nine patients had no tumor progression, three had local recurrence and one had metastatic disease. Eight cases were strongly immunoreactive for p63 and p16 and 14 were negative for uroplakin III. PSTCC lacks true transitional cell differentiation and probably shares similar clinicopathologic features with conventional cervical squamous cell carcinoma.
Treatment of cervical carcinoma in a renal transplant patient with a single pelvic kidney present... more Treatment of cervical carcinoma in a renal transplant patient with a single pelvic kidney presents several management dilemmas. Standard treatment modalities are complicated by the patient's immunosuppressed state and the location of the transplanted kidney in the standard pelvic field, as well as other surgical risks. No information on the best approach to this clinical situation is available in the English language literature. We present this case to discuss factors considered in selecting a treatment plan and possible reasons for the rapid recurrence and demise of this patient.
Objective. Previous studies have demonstrated that normal human endometrium expresses granulocyte... more Objective. Previous studies have demonstrated that normal human endometrium expresses granulocyte macrophage-colony stimulating factor (GM-CSF) and GM-CSF receptors. Because GM-CSF is administer to cancer patients following chemotherapy, GM-CSF may directly or through interaction with ovarian steroids and other cytokines alter the behavior of endometrial cancer. The aim of this study was to determine the expression of GM-CSF and receptors in
Matrix metalloproteinases (MMPs) and their physiological inhibitors, the tissue inhibitors of MMP... more Matrix metalloproteinases (MMPs) and their physiological inhibitors, the tissue inhibitors of MMPs (TIMPs), play a key role in tumor cell invasion, angiogenesis, and growth. The aim of this study was to determine the expression and cellular distribution of MMP-26, TIMP-3, and TIMP-4 in endometrial cancers and benign endometrium throughout the menstrual cycle and the correlation with tumor histological subtype, stage, and grade. Immunohistochemical analysis using polyclonal antibodies generated against pro- and active MMP-26, and mono- and polyclonal antibodies specific to TIMP-3 and TIMP-4, respectively, was performed. MMP-26, TIMP-3, and TIMP-4 are expressed in endometrial carcinomas (N = 86) and benign endometrium (N = 50) from various stages of the menstrual cycle. Semi-quantitative analysis of staining intensity indicated that endometrial carcinomas expressed more MMP-26, TIMP-3, and TIMP-4 compared to benign endometrium from the postmenopausal period, but not from the secretory phase of the menstrual cycle. The highest staining intensity was associated with endometrial epithelial cells, followed by vascular endothelial cells, myometrial smooth muscle cells, and endometrial stromal cells. Increased staining intensity of MMP-26 and TIMP-3 correlated with grade III tumors and MMP-26 and TIMP-4 with the depth of myometrial invasion in tumors histologically characterized as endometrioid adenocarcinoma, clear-cell, and papillary serous carcinoma staged/graded based on FIGO criteria. MMP-26 and TIMP-4 are expressed in endometrium and endometrial carcinoma and their elevated expression and correlation with myometrial invasion suggests that MMP-26 and TIMP-4 may play a key role in endometrial tumor progression.
Current Opinion in Obstetrics and Gynecology, 1996
We review the recent literature on managed care and its application to gynecologic oncology. Alth... more We review the recent literature on managed care and its application to gynecologic oncology. Although the literature is limited, we discuss professional agreement contracts, the role of primary care physicians and specialists in gynecologic cancer screening, changes in health care distribution, changes in physician-patient relationships, and cancer research.
We report a primary uterine sarcoma with classic histologic, immunohistochemical, and ultrastruct... more We report a primary uterine sarcoma with classic histologic, immunohistochemical, and ultrastructural features of a malignant extrarenal rhabdoid tumor (MERT). It arose in a 71-year-old woman who presented with postmenopausal bleeding, ascites, and a right pelvic mass. Malignant cells with rhabdoid morphology were identified by cytologic examination of the peritoneal fluid. Exploratory laparotomy revealed a 10-cm right adnexal mass and disseminated peritoneal tumor. Pathologic study showed diffuse expansion of the endometrial stroma by rhabdoid-like cells with transmural infiltration of the myometrium and extensive involvement of uterine serosa and right ovary by tumor. Neoplastic cells were immunoreactive for vimentin, cytokeratin, and epithelial membrane antigen, and cytoplasmic whorls of intermediate filaments were observed by electron microscopy. Fluorescence in situ hybridization (FISH) studies with chromosome 22-specific probes showed no loss of the INI1 gene, and no coding sequence mutation was identified.
Obstetrics and Gynecology Clinics of North America, Sep 1, 1999
Uterine atony, inversion, and rupture are potentially fatal events that may occur in pregnancy. T... more Uterine atony, inversion, and rupture are potentially fatal events that may occur in pregnancy. They are obstetric emergencies that require immediate attention. Although all women may experience these complications, identification or known risk factors allow the obstetric team to prepare for rapid diagnosis and intervention. This article includes management options to help prepare for these uncommon events.
Inflammatory conditions of the breast are uncommon and may be encountered in the puerperal and no... more Inflammatory conditions of the breast are uncommon and may be encountered in the puerperal and nonpuerperal setting. Mastitis, in the postpartum period, is identified by a localized wedge-shaped area of erythema and tenderness on examination of the breast. It is usually caused by staphylococci and should be treated with oral antibiotics and continued breastfeeding. Early treatment decreases the risk of abscess formation. Lactational abscesses may be difficult to diagnose if a distinct fluctuant mass is not present on examination, but ultrasound can be helpful in identifying a fluid or pus collection. Although conventional incision and drainage is most frequently used to treat abscesses, ultrasound-guided aspiration or catheter placement may be attempted as alternative treatment approaches. Nonpuerperal mastitis is less common and usually presents with inflammation and chronic abscess formation in the areolar region. This condition is most commonly a result of squamous metaplasia of ...
1. Curr Probl Surg. 2001 Apr;38(4):213-90. Surgery in the pregnant patient. Edwards RK, Ripley DL... more 1. Curr Probl Surg. 2001 Apr;38(4):213-90. Surgery in the pregnant patient. Edwards RK, Ripley DL, Davis JD, Bennett BB, Simms-Cendan JS, Cendan JC, Stone IK. Division of Maternal Fetal Medicine, Department of Obstetrics ...
To evaluate the feasibility and safety of laparoscopic adnexal mass removal in patients without p... more To evaluate the feasibility and safety of laparoscopic adnexal mass removal in patients without preselection for benign pathology and assess the operative complications and findings. All patients presenting to the gynecologic oncology service between April 1992 and April 1996 with adnexal masses were candidates for laparoscopic management. Patients underwent preoperative radiological studies and office pelvic examination. Laparoscopic management was attempted on patients without evidence of gross metastatic disease or masses that extended above the umbilicus. Laparotomy was performed if indicated by pathologic findings or technical difficulty. All removed adnexal masses were sent for immediate pathologic diagnosis. The type of procedure, intraoperative findings, and complications were all recorded at the time of procedure. One hundred sixty patients underwent laparoscopic evaluation for an adnexal mass. Benign pathology was discovered in 139 (87%, 95% confidence interval [CI] 84, 90) patients, and 141 (88%, 95% CI 86, 91) patients were managed laparoscopically. Reasons for laparotomy included technical difficulty, operative complications, or malignancy. Frozen section diagnosis was concordant with the final pathology reports in all but five patients (97% concordance), and no discrepancies resulted in treatment delays. Laparoscopic management of adnexal masses can be successful in a gynecologic oncology population if there is expertise in operative laparoscopy, availability of immediate accurate pathologic examination, and appropriate further treatment where indicated.
Primary adenocarcinoma of the vagina is rare, and mucinous-enteric differentiation is exceptional... more Primary adenocarcinoma of the vagina is rare, and mucinous-enteric differentiation is exceptional. A few sporadic cases of primary vaginal adenocarcinoma with mucinous-enteric differentiation have been reported. Reports of the clinical histories, pathologic findings, and immunohistochemical studies of two cases of primary vaginal adenocarcinomas in a 67-year-old and in a 45-year-old woman are presented. Knowledge of the differentiation of Mullerian epithelium and immunohistochemistry studies are helpful to better characterize these tumors.
Does papillary squamotransitional cell carcinoma (PSTCC) behave differently from conventional squ... more Does papillary squamotransitional cell carcinoma (PSTCC) behave differently from conventional squamous cell carcinoma of the cervix and does PSTCC have true transitional cell differentiation? Twenty cases of PSTCC were identified from archival files. Clinical data were compiled. Immunoperoxidase stains for uroplakin III, p63 and p16 were performed on available tissue blocks. Patients ranged in age from 27 to 85 years. Twelve patients were FIGO Stage I, 4 were Stage II, and 2 were Stage III. Thirteen patients had clinical follow-up ranging from 5 to 132 months. Three patients subsequently had more extensive disease than initial clinical staging indicated. Nine patients had no tumor progression, three had local recurrence and one had metastatic disease. Eight cases were strongly immunoreactive for p63 and p16 and 14 were negative for uroplakin III. PSTCC lacks true transitional cell differentiation and probably shares similar clinicopathologic features with conventional cervical squamous cell carcinoma.
Treatment of cervical carcinoma in a renal transplant patient with a single pelvic kidney present... more Treatment of cervical carcinoma in a renal transplant patient with a single pelvic kidney presents several management dilemmas. Standard treatment modalities are complicated by the patient's immunosuppressed state and the location of the transplanted kidney in the standard pelvic field, as well as other surgical risks. No information on the best approach to this clinical situation is available in the English language literature. We present this case to discuss factors considered in selecting a treatment plan and possible reasons for the rapid recurrence and demise of this patient.
Objective. Previous studies have demonstrated that normal human endometrium expresses granulocyte... more Objective. Previous studies have demonstrated that normal human endometrium expresses granulocyte macrophage-colony stimulating factor (GM-CSF) and GM-CSF receptors. Because GM-CSF is administer to cancer patients following chemotherapy, GM-CSF may directly or through interaction with ovarian steroids and other cytokines alter the behavior of endometrial cancer. The aim of this study was to determine the expression of GM-CSF and receptors in
Matrix metalloproteinases (MMPs) and their physiological inhibitors, the tissue inhibitors of MMP... more Matrix metalloproteinases (MMPs) and their physiological inhibitors, the tissue inhibitors of MMPs (TIMPs), play a key role in tumor cell invasion, angiogenesis, and growth. The aim of this study was to determine the expression and cellular distribution of MMP-26, TIMP-3, and TIMP-4 in endometrial cancers and benign endometrium throughout the menstrual cycle and the correlation with tumor histological subtype, stage, and grade. Immunohistochemical analysis using polyclonal antibodies generated against pro- and active MMP-26, and mono- and polyclonal antibodies specific to TIMP-3 and TIMP-4, respectively, was performed. MMP-26, TIMP-3, and TIMP-4 are expressed in endometrial carcinomas (N = 86) and benign endometrium (N = 50) from various stages of the menstrual cycle. Semi-quantitative analysis of staining intensity indicated that endometrial carcinomas expressed more MMP-26, TIMP-3, and TIMP-4 compared to benign endometrium from the postmenopausal period, but not from the secretory phase of the menstrual cycle. The highest staining intensity was associated with endometrial epithelial cells, followed by vascular endothelial cells, myometrial smooth muscle cells, and endometrial stromal cells. Increased staining intensity of MMP-26 and TIMP-3 correlated with grade III tumors and MMP-26 and TIMP-4 with the depth of myometrial invasion in tumors histologically characterized as endometrioid adenocarcinoma, clear-cell, and papillary serous carcinoma staged/graded based on FIGO criteria. MMP-26 and TIMP-4 are expressed in endometrium and endometrial carcinoma and their elevated expression and correlation with myometrial invasion suggests that MMP-26 and TIMP-4 may play a key role in endometrial tumor progression.
Current Opinion in Obstetrics and Gynecology, 1996
We review the recent literature on managed care and its application to gynecologic oncology. Alth... more We review the recent literature on managed care and its application to gynecologic oncology. Although the literature is limited, we discuss professional agreement contracts, the role of primary care physicians and specialists in gynecologic cancer screening, changes in health care distribution, changes in physician-patient relationships, and cancer research.
We report a primary uterine sarcoma with classic histologic, immunohistochemical, and ultrastruct... more We report a primary uterine sarcoma with classic histologic, immunohistochemical, and ultrastructural features of a malignant extrarenal rhabdoid tumor (MERT). It arose in a 71-year-old woman who presented with postmenopausal bleeding, ascites, and a right pelvic mass. Malignant cells with rhabdoid morphology were identified by cytologic examination of the peritoneal fluid. Exploratory laparotomy revealed a 10-cm right adnexal mass and disseminated peritoneal tumor. Pathologic study showed diffuse expansion of the endometrial stroma by rhabdoid-like cells with transmural infiltration of the myometrium and extensive involvement of uterine serosa and right ovary by tumor. Neoplastic cells were immunoreactive for vimentin, cytokeratin, and epithelial membrane antigen, and cytoplasmic whorls of intermediate filaments were observed by electron microscopy. Fluorescence in situ hybridization (FISH) studies with chromosome 22-specific probes showed no loss of the INI1 gene, and no coding sequence mutation was identified.
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