Endoscopic removal of a complex foreign body from the bladder

Metastatic lesions of the umbilicus are more common than primary malignancies and are commonly referred to as Sister Mary Joseph nodules. Most arise from the stomach or the female genital tract. We describe an unusual case of renal cell carcinoma with peritoneal implants producing a Sister Mary Joseph nodule diagnosed by CT. To our knowledge, no report of a urinary tract malignancy with umbilical involvement has been described in the radiological literature.     

Squalene promotes the formation of non-bilayer structures in phospholipid model membranes

From the study on correlation between the depth of cancer invasion and the results of surgery, early cancer of the biliary tract may be defined as cancer cell invasion limited to the mucosal or muscularis propria in the case of carcinoma of the gallbladder, and to the mucosal or fibro-muscular layer in the case of carcinoma of the bile duct. With few exceptions, these tumors had no lymph node metastasis, venous invasion, perineural infiltration or involvement of the lymphatic vessels. Since the cumulative 5-year survival rate was 100% after resection of early cancer, the choice of surgical procedures was considered to be extended cholecystectomy for early cancer of the gallbladder, and the standard radical resective operation for early cancer of the bile duct. An accurate diagnosis was not made preoperatively in most cases of early cancer of the biliary tract. The diagnostic approach is discussed, including the recently developed imaging modalities, such as endoscopic ultrasonography and percutaneous transhepatic cholecystoscopy or cholangioscopy.     

Subacute orbital abscess in a four-year-old girl with a new kitten

BACKGROUND: Carcinoid tumors are neoplasms of neuroendocrine origin that rarely affect the genital tract. CASE: A 75-year-old woman underwent hysterectomy and bilateral adnexectomy due to vaginal bleeding and uterine pathology (leiomyoma, cervical low grade squamous intraepithelial lesions and endometrial hyperplasia on ultrasound). Pathologic examination of the specimen disclosed a uterine corpus carcinoid tumor. The patient had been taking tamoxifen for adjuvant treatment of breast cancer diagnosed and treated seven years before. CONCLUSION: A review of the literature revealed one case of carcinoid tumor of the uterine wall. There does not appear to be any relationship between tamoxifen and the carcinoid tumors reported.     

Esophageal intramural metastasis from an adenocarcinoma of the gastric cardia: report of a case

We report herein the rare case of a 65-year-old man found to have esophageal intramural metastasis from cancer of the gastric cardia. Endoscopic examination initially revealed an infiltrating ulcerative tumor of the gastric cardia involving the esophagogastric junction, as well as a submucosal tumor of the lower esophagus. A total thoracic esophagogastrectomy with lower mediastinal lymphadenectomy was performed, and the resected specimen demonstrated that both the cardia and esophageal tumors were adenocarcinomas with the same cellular differentiation. As lymphatic invasion and metastases to the paracardial and mediastinal lymph nodes were observed, the esophageal submucosal tumor was considered to be an intramural metastasis from the carcinoma of the gastric cardia resulting from extensive lymphatic spread. The patient died of recurrent disease 9 months after the resection. This case report serves to demonstrate that intramural metastasis may be a local indicator of the systemic spread of disease in patients with gastric carcinoma, as it is in esophageal carcinoma.     

Detection of human immunodeficiency virus type 1 and type 2 in the female genital tract: implications for the understanding of virus transmission

Risk of perinatal or female to male sexual transmission of HIV is likely to be associated with whether, and at what concentration, the virus is present in the cervical and vaginal secretions of the HIV-infected woman. Examining correlates of cervical and vaginal HIV shedding is, therefore, essential for the development of strategies to interrupt HIV transmission. This article presents the rationale for using detection of HIV in the female genital tract as a marker of infectivity, and briefly describes methods for detecting HIV-1 and HIV-2 in cervical or vaginal fluids. Findings from studies incorporating the measurement of HIV in the female genital tract are reviewed, placing particular emphasis on issues relevant to epidemiological studies of HIV transmission.     

Antibodies and antibody-secreting cells in the female genital tract after vaginal or intranasal immunization with cholera toxin B subunit or conjugates

We studied the antibody response including antibody-secreting cells (ASC) in the female genital tract of mice after mucosal immunizations with the recombinant B subunit of cholera toxin (rCTB) perorally, intraperitoneally, vaginally, and intranasally (i.n.). The strongest genital antibody responses as measured with a novel perfusion-extraction method were induced after vaginal and i.n. immunizations, and these routes also gave rise to specific immunoglobulin A (IgA) and IgG ASC in the genital mucosa. Specific ASC in the iliac lymph nodes, which drain the female genital tract, were seen only after vaginal immunization. Progesterone treatment increased the ASC response in the genital tissue after all mucosal immunizations but most markedly after vaginal immunization. We also tested rCTB as a carrier for human gamma globulin (HGG) and the effect of adding cholera toxin (CT) as an adjuvant for the induction of systemic and genital antibody responses to HGG after vaginal and i.n. immunizations. Vaginal immunizations with HGG conjugated to rCTB resulted in high levels of genital anti-HGG antibodies whether or not CT was added, while after i.n. immunization the strongest antibody response was seen with the conjugate together with CT. In summary, vaginal and i.n. immunization give rise to a specific mucosal immune response including ASC in the genital tissue, and vaginal immunization also elicits ASC in the iliac lymph nodes. We have also shown that rCTB can act as an efficient carrier for a conjugated antigen for induction of a specific antibody response in the genital tract of mice after vaginal or i.n. immunization.     

Descriptive epidemiology of vulvar and vaginal cancers in Vaud, Switzerland, 1974-1994

BACKGROUND: To analyse trends in incidence, survival and risk of second neoplasms following vaginal and vulvar cancers using data collected by the Swiss Cancer Registry of Vaud over the 21-year period 1974-1994. MATERIALS AND METHODS: Subjects were 257 vulvo-vaginal cancers. Of these, 69 were vaginal, 153 vulvar cancers, and 35 non-specified lower genital tract neoplasms; 94 in situ neoplasms were also registered (85 for the vulva). RESULTS: Invasive vaginal cancer incidence decreased from 0.8 in 1974-1984 to 0.4/100,000 women in 1985-1994, while invasive vulvar cancer incidence remained approximately stable around 1.2/100,000 (world standard); incidence of in situ vulvar cancer increased from 0.8 to 1.3/100,000, the rise being larger in younger women. Significant excesses for second primary neoplasms were observed for pro-pharyngeal and lung cancer, and for non-melanomatous skin neoplasms, as well as for invasive vulvar cancers following in situ cancers. CONCLUSIONS: This population-based dataset confirms that the incidence of in situ vulvar (but not invasive vulvar or vaginal cancer) has been increasing over the last 20 years. The excess second primary neoplasms supports the hypotheses that human papillomavirus and cigarette smoking are related to vulvo-vaginal neoplasms.     

Prevention of exposure to bloodborne pathogens

Vaginal cancer, 2% of all female genital malignancies, has a worse prognosis than cervical cancer. Squamos cell carcinoma, the most common histologic subtype, may be associated partly with human papillomavirus. Most patients present with vaginal bleeding and discharge. Radiation or surgery are the main treatment modalities, but the physical and psychosexual morbidity can be significant.     

Vaginal embryogenesis, estrogens, and adenosis

The recent outbreak of vaginal adenocarcinoma and the associated genital tract anomalies in women with histories of prenatal exposure to diethylstilbestrol (DES) has generated interest in vaginal embryogenesis and the influence of hormones on the developing genital tract. In this report the embryology of the vagina and the role of sex hormones in normal and abnormal sex duct development are presented and discussed in relation to the DES-induced anomalies. Although the teratogenic activity of DES in humans has been confirmed, the available evidence suggests that the clear cell carcinomas are initiated by endogenous estrogens and not the prenatally administered DES.     

Children with chronic arthritis: the management of transition to adulthood

Primary fallopian tube carcinoma represents less than 1% of all gynecologic malignancies and is therefore one of the less common malignancies of the female genital tract. Fallopian tube carcinoma is rarely diagnosed preoperatively and is often mistaken for benign pelvic disease or ovarian cancer. Compared with ovarian carcinoma, fallopian tube cancer more often presents in early stage but seems to have a worse prognosis, stage for stage. Treatment consists of surgical debulking followed by chemotherapy, adjuvant or otherwise. New studies are needed to better delineate the clinical course, prognostic factors, and appropriate chemotherapy recommendations.     

Computerized tomography in the assessment of metastatic facial adenopathy

The facial lymph nodes are classified in five groups: mandibular, buccinator, infraorbital, malar and retrozygomatic nodes. This paper reports the CT appearance of neoplastic involvement of these nodes, an unusual and not well documented event. The CT examinations of 62 patients with a history of primary or recurrent cancer of the epidermal structures of the face, oral cavity and sinonasal region were retrospectively reviewed to assess the presence of facial adenopathy. Nine cases of neoplastic involvement of facial nodes were found. Most commonly the buccinator nodes (4 cases) were involved, the infraorbital, mandibular (2 cases) and retrozygomatic nodes (1 case) being less commonly involved. No malar nodes were found. Neoplastic involvement of these nodes was caused by squamous cell carcinoma in 6 cases, by adenocarcinoma in 2 cases and by a lymphoma in 1 case. Normal nodes could not be confidently identified on CT studies. CT diagnosis of neoplastic involvement of facial nodes is based on the presence of a nodular lesion which lies along the lymphatic pathways of the primary neoplasm in an anatomically compatible location. CT diagnosis of facial nodes is very important for treatment planning if the nodes are deep or at a distance from primary cancer. This is especially true for retrozygomatic and buccinator nodes.     

Cardiac adaptation to increased systemic blood pressure in borderline hypertensive men

Two women, aged 28 and 32, presented with primary infertility and severe dysmenorrhea. The younger woman developed recalcitrant and recurrent firm vaginal, cervical and possibly endometrial lesions over a period of six years; the older patient had similar material in the cervix, endometrium and a fallopian tube. The lesions were composed of amorphous eosinophilic hyaline or necrotic material, shown by histochemical and immunoperoxidase stains to be partly fibrin. Pathologic examination showed that the lesions were similar to those of ligneous (pseudomembranous) conjunctivitis, a rare disease that may occasionally affect the lower female genital tract. However, neither patient had eye disease, and ligneous conjunctivitis has not previously been reported to involve the upper genital tract. Endometrial and tubal involvement could readily explain primary infertility and dysmenorrhea in these patients.     

Anatomical anterior exenteration with urethral and vaginal preservation: illustrated surgical method

PURPOSE: We describe in detail a method for urethral and vaginal preservation in women considering orthotopic urinary tract reconstruction after bladder removal. MATERIALS AND METHODS: We retrospectively reviewed the pathological reports of patients treated with anterior exenteration at our hospital between 1984 and 1997 for specific evidence of urethral, vaginal, cervical or uterine involvement by the primary bladder tumor. Based on our findings we describe our approach to anterior exenteration in 6 patients. RESULTS: A total of 46 patients were treated at our center with en bloc anterior exenteration and pelvic lymphadenectomy for primary bladder cancer between 1984 and 1997. In 7 patients (15%) pathological review of the surgical specimen documented urethral involvement by the primary tumor. In 1 patient (2%) microscopic evidence of tumor was identified in the cervix and 1 (2%) had tumor extension to the vagina documented in the final pathology report. CONCLUSIONS: The observed rates of vaginal and urethral involvement agree with those reported by others, and suggest that in the majority of women treated with anterior exenteration sacrifice of the urethra and vagina is usually not necessary from an oncological perspective. This procedure is particularly appropriate in women concerned with postoperative sexual function and those considering orthotopic reconstruction of the lower urinary tract after exenterative bladder cancer surgery.     

Abdominal pain with anorexia in patients with breast carcinoma

Breast cancer is the second commonest primary tumour responsible for gastrointestinal metastases after malignant melanoma. The real incidence of gastrointestinal metastases in breast cancer patients is probably underestimated owing to the non-specific presenting symptoms and death of patients caused by other more obvious metastases. The predominant histological subtype of gastrointestinal metastases of breast cancer is invasive lobular carcinoma and the median interval from diagnosis of primary breast cancer to gastrointestinal metastases is five years. We report two cases of disseminated breast cancer with gastrointestinal involvement with a rather long survival.     

Indications for laparoscopic surgery in cases of gynecological malignancies (endometrial cancer)

The role of surgery in the treatment of patients with invasive cervical cancer is undisputed, but how radical surgery should be is debatable. Every case requires detailed knowledge of the development and spread of cervical cancer. Tumor volume is the most important diagnostic factor in cervical cancer and also correlates with vascular invasion and lymph node involvement. As radical hysterectomy requires in cervical cancer besides the laparoscopically easy performable lymphadenectomy also the resection of parametria with sceletonisation of ureters we started to treat endometrial cancer with a combined laparoscopic and vaginal approach. In patients with the suspicion of stage I endometrial cancer prior to laparoscopic staging, the prerequisites of histological grading with ploidy and measurement of monoclonal antibodies were performed. All patients underwent a general check with radiography, computer tomography, liver scan, bone scan and lymphography. The performance of lymphadenectomy in cases of stage I endometrial cancer remains a controversial subject. We believe that laparoscopic assisted surgical staging of stage I endometrial cancer is an attractive alternative to the traditional laparotomy-surgical approach. The change from laparotomy to a laparoscopic assisted vaginal approach allows for a similar success rate with the less invasive approach. No complications occurred in this series and the results of our pilot study were satisfactory.     

Limitations of serodiagnosis in chlamydial genital tract infections

Infection with Chlamydia trachomatis results in the formation of a variety of antibodies with group, species, subspecies and serovarspecificity. Sera from patients with genital tract infections often show broad reactivity in serological tests. This may be due to the presence of cross-reacting antibodies, repeated infections by different serotypes or concurrent genital and respiratory infections by different chlamydial species. Other factors contributing to difficulties in interpretation include how antibody titres in acute mucosal infections, the occurrence of latent infections and reactivations, and the persistence of IgG which does not allow the differentiation of past from current infections. For these reasons, serology alone is inadequate for the diagnosis of uncomplicated lower genital tract infections. In upper genital tract infections, however, because of difficulties with sampling from the infected site, a positive serology may be the only indications of chlamydial involvement. This paper discusses the principles of chlamydial antibody assays, difficulties with their interpretation and their role in the diagnosis of upper and lower genital tract infections.     

Metastases of the heart and pericardium

Tumours metastasizing to the heart are one of the least investigated subjects in clinical oncology. Nevertheless, this problem holds great practical significance in relation to the operability and type of treatment of neoplastic patients. Of 4769 patients autopsied at the Institute of Pathological Anatomy of Trieste from 1994 through 1995, 1148 males (42%) and 780 females (38%) had a primary tumour. Among them, 162 subjects had cardiac metastases (8.4%) of all cancers), with a significant decrease in frequency in elderly patients. Mesothelioma, melanoma and lung cancer showed the highest frequency of heart involvement in males (100, 50 and 31%, respectively). Melanoma, lung tumours and renal neoplasms had the highest percentages of secondary heart lesions in females (45, 26 and 20%, respectively). In lung cancer, anaplastic small-cell carcinoma (37%) and adenocarcinoma (33%) showed the most frequent heart involvement in males, while squamous carcinoma (43%) and anaplastic small-cell carcinoma (29%) had the highest frequency of heart metastases in females. Adenocarcinoma (82%) and anaplastic small-cell carcinoma (74%) of the lung, mesothelioma (100%) and breast tumours (73%) had the highest frequency of metastases to the pericardium. A particularly high frequency of myocardial involvement was observed in squamous cell carcinoma of the lung (62%), urinary tract tumours (60%) and melanoma (45%).     

Scanning and transmission electron microscopic studies of vaginal adenosis and the cervical transformation zone in progeny exposed in utero to diethylstilbestrol

Much attention has recently been focused on vaginal adenosis and other cervical and vaginal alterations occurring in female offspring exposed to diethylstilbestrol (DES) in utero. These alterations consist of heterotopic glandular epithelium in the vagina, a characteristic cervical transformation zone, and the frequent presence of a cervical collar, or hood. It is believed that these changes occur during embryonic differentiation of the lower genital tract following failure of squamous epithelium to migrate in a cephalad direction to replace columnar epithelium which normally lines the vagina and ectocervix. A number of cases clear-cell carcinoma have occurred in DES-exposed girls who also had adenosis. In an attempt to characterize the cellular populations of these areas of adenosis, we have made an ultrastructural study which is herein reported.     

Invasive micropapillary carcinoma of the breast

Nine examples of a rare variant of invasive breast carcinoma characterized by the formation of micropapillae within clear spaces separated by a fibrocollagenous or delicate fibrovascular stroma are presented. Designated as invasive micropapillary carcinoma, the unusual morphology of this tumor requires its distinction from metastatic ovarian serous papillary carcinoma and extensive vascular/lymphatic invasion by either a primary or metastatic breast carcinoma. The micropapillary pattern is retained in metastatic foci and areas of recurrence. This pattern also occurs admixed with regular infiltrating duct carcinoma either in the primary mammary tumor or when it recurs.     

Metastasis of a sigmoid carcinoma to the breast

Breast metastases are usually a rare event. We present the case of a 42-year-old patient with a primary carcinoma of the sigmoid metastatic to the breast and metastasis in the liver as well. Although seldom, it is important that metastatic cancer to the breast be differentiated from primary breast carcinoma as both the treatment and the prognosis differ significantly.