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Biomedical subjects

B Piura

Publications and source records attributed to B Piura.

At least 37 records · Page 2Linked to original sources
PubMed2001

Lymphoma-like lesion of the uterine cervix.

Lymphoma-like lesion of the uterine cervix is a benign reactive lymphoid hyperplasia associated with chronic cervicitis that may pose a problem in differential diagnosis from malignant lymphoma. It is a rare entity and only about 20 cases have been reported in the world literature. Two cases of cervical lymphoma-like lesion are described. In both patients, the diagnosis was based on microscopic examination of biopsies taken from the uterine cervix. One patient subsequently had a cervical conization that confirmed the diagnosis of lymphoma-like lesion. Both patients are well, alive and with no evidence of malignant lymphoma. It is concluded that the diagnosis of lymphoma-like lesion is based on the well-established characteristic microscopic features of this lesion. Immunohistochemical staining is usually not helpful in distinguishing this lesion from malignant lymphoma. No specific treatment is necessary for this condition.

Adult↗
PubMed2001

Three primary malignancies related to BRCA mutation successively occurring in a BRCA1 185delAG mutation carrier.

The 185delAG and 5382insC mutations in the BRCA1 gene and the 6174delT mutation in the BRCA2 gene (the Ashkenazi mutations) have been found to be significantly more common among Jews of eastern European ancestry (1 in 40, 2.5%) in comparison to the general population (1 in 800 to 1 in 300, 0.12-0.33%). Carriers of these mutations, especially the BRCA1 185delAG mutation, have a significantly increased lifetime risk of breast and ovarian carcinoma and other carcinomas as compared to non-carriers. A case of three primary malignancies related to the BRCA1 185delAG mutation successively occurring in a carrier of this mutation, is described. The patient successively developed breast carcinoma, ovarian micropapillary serous carcinoma and peritoneal papillary serous carcinoma. Immunohistochemical staining results have indicated that these tumors are three separate primary malignancies. This case illustrates that ovarian serous borderline tumors (including micropapillary serous carcinoma) and peritoneal papillary serous carcinomas should be considered, like breast and ovarian carcinomas, tumors expressed in BRCA mutation carriers.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2001

[Intraperitoneal chemotherapy in ovarian carcinoma].

Current standard treatment of ovarian carcinoma includes primary cytoreductive surgery followed by postoperative first-line intravenous combination chemotherapy with taxol and cisplatin. Despite a remarkable high initial response rate, the tumor recurs in most patients and its response to further surgery and additional lines of intravenous chemotherapy is dismal. Intraperitoneal chemotherapy is gaining impetus in relation to ovarian cancer since, even in an advanced stage or recurrence, it usually remains confined to the peritoneal cavity. Intraperitoneal chemotherapy allows direct exposure of the tumor to high concentrations of cytotoxic drugs without increasing systemic toxicity. A cytotoxic drug is considered qualified for intraperitoneal administration if its molecular weight is high enough not to permit an easy transfer through the peritoneal/plasma barrier. Intraperitoneal chemotherapy can be administered intraoperatively and/or post-operatively. The most common complication of intraperitoneal chemotherapy is peritonitis. A significant advantage of intraperitoneal first-line chemotherapy over intravenous first-line chemotherapy was demonstrated in only two of five phase III clinical trials. The results of eight phase II studies showed a borderline advantage of intraperitoneal consolidation chemotherapy over intravenous consolidation chemotherapy, or no consolidation chemotherapy. In 13 phase II studies, a borderline advantage of intraperitoneal salvage chemotherapy over intravenous salvage chemotherapy was noticed only in patients with minimal residual disease. In five stage I/II studies, a vague advantage of intraperitoneal hyperthermic chemotherapy over other treatments was noticed. However, this treatment was well-tolerated by the patients. All studies demonstrated that patients with minimal residual disease are the best candidates for intraperitoneal chemotherapy. Additional phase III studies are required in order to reinforce the status of intraperitoneal chemotherapy in the treatment of ovarian carcinoma.

Animals↗
PubMed2000

Patients with double primary tumors in the breast and ovary- clinical characteristics and BRCA1-2 mutations status.

OBJECTIVE: The aim of this study was to define the prevalence, clinical characteristics, and BRCA1-2 mutation carrier status of ovarian cancer (OvC) patients with a previous primary malignancy in the breast (PPMBr). METHODS: The study population comprised 1240 consecutive Jewish Israeli women with pathologically confirmed epithelial OvC diagnosed between March 1, 1994, and December 31, 1997. Demographic and clinical data were obtained from medical files and from a detailed questionnaire taken through a nationwide epidemiological case-control study on OvC. Blood samples and tumor tissues were collected for analysis of the three predominant germline BRCA1-2 Jewish founder mutations (185delAG, 5382insC, and 6174delT). RESULTS: Fifty nine (4.7%) patients with OvC had a PPMBr. The median age at diagnosis of OvC was 60 years. The mean interval between the two diagnoses was 104 months (range 0-363 months). In the majority of the patients (n = 53), the diagnosis of breast cancer (BrC) preceded the OvC by more than 1 year. The ovarian tumors were diagnosed in 47% of the cases following investigation of patients' symptoms. In 41%, diagnosis was made as a consequence of check-up exams performed during the routine follow-up of BrC survivors. Patients with PPMBr were more likely to present with FIGO ovarian stage III-IV, compared to women with solitary OvC (73% vs 60. 3%, P < 0.05), and less likely to have borderline tumors (3.4% vs 17. 9%, P = 0.007). Family history of OvC/BrC was recorded in 26% of this group of patients compared to 10.5% among patients with solitary OvC (P = 0.003). Patients with PPMBr had an exceptionally high prevalence of BRCA1-2 mutations (57%), irrespective of family history. CONCLUSIONS: Patients with PPMBr present with more advanced disease and invasive-type epithelial ovarian tumors when compared to cases associated with solitary OvC. The rate of BRCA1-2 mutations in Jewish women with OvC who had PPMBr is at least twice as high as in Jewish women with OvC as the solitary disease.

BRCA2 Protein↗
PubMed2000

Diagnosis of urinary leak following abdominal total hysterectomy using renal scintigraphy.

Surgical trauma to the urinary system is a relatively rare complication following gynecological surgery. A case of urinary leak from rupture of the bladder following abdominal hysterectomy was diagnosed by Tc-99m-DTPA renal scintigraphy and confirmed by direct radio-isotopic cystography. Renal scintigraphic techniques should be very helpful in early diagnosis of surgical damage to the urinary tract.

Adult↗
PubMed2000

Primary carcinoma of the fallopian tube: study of 11 cases.

OBJECTIVE: Primary fallopian tube carcinoma is a rare tumor that histologically and clinically resembles primary ovarian carcinoma. The purpose of this study was to present the experience of the Soroka Medical Center (SMC), Beer-Sheva, Israel of handling this tumor. STUDY DESIGN: Data from the files of 11 patients with primary fallopian tube carcinoma who were managed at the SMC between January 1978 and December 1998 were evaluated. RESULTS: The mean age of the patients was 59.4 years. Presenting symptoms and signs included abdominal pain, postmenopausal bleeding, watery vaginal discharge and adnexal mass. In all patients, the diagnosis of primary fallopian tube carcinoma was not made preoperatively. In ten patients in whom the adnexal mass was discovered preoperatively it was thought to be an ovarian tumor and in one patient the adnexal mass was first noticed during vaginal hysterectomy. Postoperatively, multi-drug chemotherapy was given to seven patients, multi-drug chemotherapy followed by pelvic radiotherapy to one patient, pelvic radiotherapy followed by single-agent chemotherapy to two patients, and one patient received no further treatment. The actuarial 5-year survival rate was 50%. CONCLUSIONS: Fallopian tube carcinoma is rarely suspected preoperatively. The symptom complex of 'hydrops tubae profluence', said to be pathognomonic for this tumor, is rarely encountered. The treatment approach is similar to that used for ovarian carcinoma and includes primary surgery comprised of total abdominal hysterectomy, bilateral salpingo-oophorectomy and staging followed by chemotherapy. The prognosis of patients with primary fallopian tube carcinoma is similar to that of patients with primary ovarian carcinoma.

Abdominal Pain↗
PubMed2000

Micropapillary serous carcinoma of the ovary: case report and review of literature.

The term "micropapillary serous carcinoma" (MPSC) has recently been introduced to define a subset of ovarian serous borderline tumors morphologically characterized by a micropapillary pattern and clinically associated with a more aggressive behavior than that of the typical ovarian serous borderline tumors. Ovarian MPSC's are associated with extra-ovarian invasive peritoneal implants and invasive recurrences much more frequently than typical ovarian serous borderline tumors. The case of a women, who at age 28 had bilateral ovarian cystectomy and four months later total abdominal hysterectomy and bilateral salpingo-oophorectomy for bilateral ovarian MPSC, is reported. She was free of disease for the next 15 years and then presented with a central pelvic mass. At laparotomy, a recurrence in the form of a solitary invasive peritoneal implant was discovered and completely resected. No postoperative adjuvant therapy was given. To date, 16 years after initial diagnosis of MPSC, and one year after detection of recurrence, the patient is alive, well and without disease. Literature data and this case report support the view that MPSC's should be classified separately from both typical serous borderline tumors and invasive carcinomas of the ovary.

Adult↗
PubMed2000

Mullerian adenosarcoma of the uterus: case report and review of literature.

Mullerian adenosarcoma--a variant of mullerian mixed mesodermal tumor of the uterus--is typically composed of benign but sometimes mildly atypical glandular epithelial elements admixed with malignant sarcomatous stroma. This rare tumor, which accounts for only about 8% of all uterine sarcomas, usually originates in the endometrium and grows as a polypoid mass within the endometrial cavity. The most prevailing presenting symptom is abnormal vaginal bleeding and the most common finding is a polypoid mass protruding through a dilated cervical canal. The case of a woman, who at age 62 presented with symptoms and signs of acute pelvic inflammatory disease and on vaginal examination an infected mullerian adenosarcoma protruding through a dilated cervical canal was discovered, is reported. Treatment consisted of extensive antibiotic treatment and surgery comprised of total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by postoperative adjuvant pelvic radiotherapy. One year later, the patient is alive with no evidence of disease.

Adenosarcoma↗
PubMed1999

Basal cell carcinoma of the vulva.

BACKGROUND AND OBJECTIVES: Vulvar basal cell carcinoma (BCC) accounts for 7% of all vulvar cancers at two hospitals in the south of Israel. The purpose of this study was to investigate the clinical findings, treatment and outcome of patients with vulvar BCC treated at these institutions. METHODS: Data from the files of eight patients with vulvar BCC who were managed at two regional hospitals in the south of Israel (Soroka Medical Center, Beer-Sheva and Kaplan Hospital, Rehovot) between January 1961 and December 1997 were evaluated. RESULTS: Mean age at diagnosis was 70.5 years. A history of other primary cancers was encountered in two patients. Prevailing presenting symptoms were vulvar lump, ulcer, itching, and bleeding. The tumor was most often located on the labium major and its mean size was 2.25 cm. Six patients had wide local excision, one had excisional biopsy, and one had hemivulvectomy. Two patients developed local recurrence and were treated by wide local reexcision and hemivulvectomy, respectively. At follow-up, no patient developed regional and/or distant metastases, or died of BCC. CONCLUSIONS: Vulvar BCC is characterized by an indolent behavior with a very low propensity for metastatic spread. The treatment of choice is wide local excision. Because of a substantial risk of local recurrence and high frequency of other primary cancers, close long-term follow-up is essential.

Aged↗
PubMed1999

Glassy cell carcinoma of the uterine cervix.

BACKGROUND AND OBJECTIVES: Glassy cell carcinoma (GCC) of the uterine cervix is a rare and highly malignant tumor, accounting for only 1%-2% of all cervical carcinomas. The purpose of this study was to investigate the clinical findings, treatment, and outcome of patients with cervical GCC in the south of Israel. METHODS: Data from the files of 5 patients with cervical GCC who were managed at the Soroka Medical Center, Beer-Sheva, Israel, between January 1961 and June 1999 were evaluated. RESULTS: Age at diagnosis ranged from 32 to 84 years, with 1 patient pregnant at the time of diagnosis. Vaginal bleeding was the prevailing presenting symptom. The cervical lesion was exophytic in 4 patients and endophytic ("barrel-shaped") in 1 patient. Mean tumor size was 3.9 cm. Three patients with stage IB(1) disease had radical hysterectomy and bilateral pelvic lymph node dissection followed by either external pelvic radiotherapy or brachytherapy or both. All 3 patients were alive without disease 4, 12, and 18 months after initial diagnosis, respectively. One patient with stage IIIB disease had external pelvic radiotherapy alone and died of disease 12 months after initial diagnosis. One patient with stage IVB disease refused treatment and died of disease 3 months after initial diagnosis. CONCLUSIONS: Cervical GCC is a rare variant of cervical cancer with distinct histologic features and an alleged aggressive clinical behavior. For early-stage disease, the treatment of choice seems to be radical surgery followed by chemoradiotherapy.

Adult↗
PubMed1999

Dermatomyositis and peritoneal papillary serous carcinoma.

We describe an unusual case of peritoneal papillary serous carcinoma (PPSC) arising in a female patient with dermatomyositis (DM). Despite periodic extensive searches for an underlying malignancy, no malignancy had been detected in this patient during the first 2.5 years after the diagnosis of DM. It was only when the patient presented with pleural effusion and ascites that the underlying intra-abdominal malignancy was detected by laparoscopy. Treatment with four cycles of pre-operative chemotherapy (taxol and cisplatin) resulted in tumor regression with amelioration in the muscular manifestation of the DM, but without parallelic amelioration in the skin manifestations of the DM. Explorative laparotomy confirmed the presence of papillary serous carcinoma in the omentum, surface of the left ovary and the retroperitoneal lymph nodes, and established the diagnosis of PPSC. Following two cycles of postoperative chemotherapy, the patient is alive with no evidence of internal malignancy. However, although muscle strength and enzymes have remained normal, no effect on the skin manifestation of DM has been observed. This case illustrates that, alongside the more frequently occurring ovarian carcinoma, PPSC should also be considered in the differential diagnosis of the underlying malignancy that may occur in the female patient with DM.

Aged↗
PubMed1999

Abnormal uterine bleeding as a presenting sign of metastases to the uterine corpus, cervix and vagina in a breast cancer patient on tamoxifen therapy.

Metastases to the female genital tract from extragenital cancers are uncommon. The ovaries are most often affected with the breast and gastrointestinal tract being the most common sites of the primary malignancy. Metastases to the uterus from extragenital cancers are significantly rarer than metastases to the ovaries and in the majority of cases the ovaries are also involved. A case of metastases restricted to the uterine corpus, cervix and vagina from breast carcinoma, without involvement of the ovaries, is described. The patient who had been on tamoxifen therapy presented with postmenopausal bleeding. The diagnosis of uterine metastases was established during endometrial ablation and confirmed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. This case illustrates that abnormal uterine bleeding in a breast cancer patient, regardless of whether she is receiving or not receiving tamoxifen, should always alert the physician to consider the possibility of uterine metastases from breast carcinoma.

Antineoplastic Agents, Hormonal↗
PubMed1999

Sigmoid colon carcinoma metastatic to the myometrium.

Metastases to the uterus from extragenital cancers are significantly rarer than metastases to the ovaries. Of the approximately 200 cases of metastases to the uterus from extragenital cancers that have been reported in the literature, more than half are cases of metastases from breast carcinoma and only 16 are cases of metastases from colorectal carcinoma. A case of isolated metastases restricted to the myometrium of the right uterine comu from sigmoid colon carcinoma, without involvement of the ovaries, is described. The patient who six months previously had surgery for sigmoid colon carcinoma presented with right lower abdominal pain and a palpable mass in the region of the right uterine cornu. The diagnosis of isolated metastases restricted to the myometrium of the right uterine cornu was confirmed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. This case illustrates that a growing uterine mass in a patient with a history of primary extragenital cancer, regardless of whether abnormal uterine bleeding is present or absent, should alert the physician to consider the possibility of uterine metastases.

Abdominal Pain↗
PubMed1999

Extramammary Paget's disease of the vulva: report of five cases and review of the literature.

Five patients with vulvar extramammary Paget's disease (EMPD) are reported. They accounted for 4.4% of all vulvar malignancies diagnosed in the south of Israel between 1961-1997. Mean age was 64.4 years and the predominant symptom was vulvar pruritus. Three patients had intra-epidermal lesions (managed by wide local excision or, at most, simple vulvectomy), one had a minimally invasive lesion (managed by simple vulvectomy) and one had EMPD with an underlying apocrine gland adenocarcinoma (managed by radical vulvectomy and bilateral groin dissection followed by pelvic radiotherapy). EMPD recurred in two patients: 1) local recurrence after simple hemivulvectomy for an intra-epidermal lesion was successfully treated by wide local excision; 2) widespread recurrence at distant skin sites after simple vulvectomy for a minimally invasive lesion was unsuccessfully treated with systemic chemotherapy. It is concluded that vulvar EMPD is an uncommon neoplasm that primarily affects postmenopausal women. Its histogenesis is uncertain and most commonly it is an intra-epidermal lesion. The high rate of recurrent disease remains a challenge for optimal management.

Aged↗