Search PubMed⌕ Search

Biomedical subjects

B Piura

Publications and source records attributed to B Piura.

At least 55 records · Page 3Linked to original sources
PubMed1999

Malignant melanoma of the vulva: report of six cases and review of the literature.

Six patients with vulvar malignant melanoma are reported. They accounted for 5.2% of all females with vulvar malignancies diagnosed in the south of Israel between 1961 and 1997. Age ranged from 25 to 66 years. Presenting symptoms were pruritus, bleeding and ulcer. Lesion originated in the labia minora in four patients and the labia majora in two, and lesion size ranged from I to 8 cm. Five patients had nodular melanoma, and one had superficial spreading melanoma. Breslow depth ranged from 2.5 to 8 mm, Clark level was IV in four patients and III in two, and Chung level was IV in all patients. Two patients had radical vulvectomy and bilateral groin lymphadenectomy, one had wide local excision, and one refused surgery. The two patients who had radical hemivulvectomy and bilateral groin lymphadenectomy were given adjuvant active specific immunotherapy with allogeneic vaccine and have survived disease-free, whereas the remaining four patients died of disease. It is concluded that vulvar malignant melanoma is a rare and aggressive tumor. For patients who present with deep lesions (Breslow depth > 0.76 mm, Clark level > II, Chung level > II) the recommended treatment is wide radical local excision (or at the most, radical hemivulvectomy) and bilateral groin lymphadenectomy.

Adult↗
PubMed1998

[Mixed uterine mesodermal sarcoma in the population of southern Israel in the years 1996-1971--clinical and pathological characteristics].

During 1971-1996, 17 patients with mixed mesodermal uterine tumors were treated. Average age at diagnosis was 67.3 years, 12/17 were of European and 5/17 of Afro-Asian extraction. The overall 5-year survival was 21%. 10/17 patients had mixed mesodermal tumors with a heterologous mesenchymal element, and 7/17 had a homologous mesenchymal element (carcinosarcoma). 6/17 had another primary malignancy, including breast cancer (3/17), bilateral metachronous breast tumor (2/17), and malignant lymphoma of the neck region (2/17). All 3 with breast cancer had previously been treated with tamoxifen. I had simultaneous mesodermal tumor and ovarian thecoma. Simultaneous autoimmune manifestations occurred in 2/17, including thrombocytopenic purpura in 1, and myasthenia gravis in another. Mesodermal tumor of the uterus is a relatively rare malignancy with aggressive behavior and poor prognosis. It also had unusual associations with other primary tumors, hormonal treatment, and autoimmune manifestations.

Aged↗
PubMed1998

Squamous cell carcinoma of the vulva in the south of Israel: a study of 50 cases.

BACKGROUND AND OBJECTIVES: Vulvar carcinoma accounts for 4.9% of all female genital tract malignancies in the south of Israel. The most common histologic type is squamous cell carcinoma (82%). The purpose of this study was to investigate the clinical findings, treatment, and outcome of patients with vulvar squamous cell carcinoma in the south of Israel. METHODS: Data from the files of 50 patients with vulvar squamous cell carcinoma who were managed at the Soroka Medical Center between January 1961 and December 1996 were evaluated. RESULTS: Mean age at diagnosis was 67.1 years. The most prevailing presenting symptoms were vulvar lump, ulcer, and itching. Mean patient delay in seeking medical help was 48.2 months. Clinical palpation as a test for detecting groin lymph node metastases had a sensitivity and specificity of 57.1% and 61.5%, respectively. The 5-year survival rate was 60.3% overall. By means of univariate analysis, a significant worsening in survival was demonstrated with advancing stage of disease (P < 0.001), tumor >4 cm (P < 0.001), and positivity of surgical margins (P < 0.0001). In a multivariate analysis (Cox proportional hazards model) in a group of 45 patients, stage of disease was the strongest and the only significant predictor of survival (P = 0.0098). CONCLUSIONS: Vulvar squamous cell carcinoma predominantly affects older women. Stage of disease, tumor size, and status of surgical margins are sensitive predictors of survival. The treatment of choice for most patients is surgery consisting of radical vulvectomy and bilateral groin lymphadenectomy.

Adult↗
PubMed1998

Peritoneal papillary serous carcinoma: study of 15 cases and comparison with stage III-IV ovarian papillary serous carcinoma.

BACKGROUND AND OBJECTIVES: Peritoneal papillary serous carcinoma (PPSC) is histologically and clinically similar to stage III-IV ovarian papillary serous carcinoma (OPSC). The purpose of this study was to investigate the clinical findings, treatment, and outcome of PPSC patients compared with stage III-IV OPSC patients. METHODS: Data from the files of 15 PPSC patients and 52 stage III-IV OPSC patients who were managed at the Soroka Medical Center between January 1991 and December 1997 were evaluated. RESULTS: With regard to patients' characteristics, presenting signs and symptoms, type and extent of surgery, tumor response to first-line chemotherapy, recurrence-free interval, recurrence site, tumor response to second-line chemotherapy, and serum CA-125 levels, no significant differences were observed between the PPSC patients and the stage III-IV OPSC controls. The prevailing presenting symptoms were abdominal mass and ascites. The mainstay of treatment was debulking surgery followed by adjuvant platinum-containing chemotherapy. The objective response rate to first-line chemotherapy was 80%. The actuarial 5-year survival rate for the PPSC patients and stage III-IV OPSC patients was 52.0% and 20.5%, respectively (0.05 < P < 0.1). CONCLUSIONS: The clinical and surgical characteristics of patients with PPSC are similar to those of patients with stage III-IV OPSC. When treatment strategies for stage III-IV OPSC are applied to PPSC, the survival of PPSC patients may be similar or even better than that of stage III-IV OPSC patients.

Chemotherapy, Adjuvant↗
PubMed1998

Malignant melanoma metastatic to the ovary.

The diagnosis of malignant melanoma metastatic to the ovary is rarely made in living patients. A case of malignant melanoma metastatic to one ovary, skin of both axillae, and brain occurring 7 years after wide local excision of the primary cutaneous lesion on the patient's back is described. The patient had total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, and selective pelvic retroperitoneal lymphadenectomy, followed by whole brain irradiation and chemoimmunotherapy. This case illustrates the clinical variability and unpredictable biologic behavior of malignant melanoma and it is concluded that malignant melanoma metastatic to the ovary should be suspected in any patient who presents with an adnexal mass and has a history of malignant melanoma.

Axilla↗
PubMed1998

Primary hepatoid carcinoma of ovary in pregnancy.

We report a rare case of a 35-year-old woman with primary hepatoid carcinoma of the ovary during pregnancy associated with abnormal levels of maternal serum alpha-fetoprotein. This tumor should be considered in the differential diagnosis of pregnant women with very high levels of maternal serum alpha-fetoprotein whenever other maternal or fetal sources are excluded.

Adult↗
PubMed1998

Extramammary Paget's disease recurring on the skin of the lower abdomen and entire right leg two and half years after simple vulvectomy for minimally invasive Paget's disease of the vulva.

We encountered an unusual case of extramammary Paget's disease (EMPD) recurring on the skin of the lower abdomen and entire right leg two and a half years after simple vulvectomy for minimally invasive Paget's disease of the vulva. Histologic examination of the skin metastases demonstrated that the proliferation of Paget cells was confined to the dermis, most of them were located in lymphatic vascular spaces. This case confirms that minimally invasive Paget's disease of the vulva may sometimes be an aggressive disease. We consider that lymphatic metastases already existed in this patient at the time of initial surgery; thus, the recurrence of EMPD on extragenital skin sites may have been prevented if initial treatment would have included radical vulvectomy and bilateral groin lymph node dissection instead of simple vulvectomy without groin lymph node dissection.

Abdomen↗
PubMed1998

Delayed recognition of major vascular injury during laparoscopy.

We report an unusual case of left common iliac artery and vein injury during laparoscopy. The injury was recognized 3 h after the completion of the laparoscopy. The patient was promptly treated by explorative laparotomy and repair of the lacerated vessels. Major vascular injury during laparoscopy is usually caused by the Verres needle or the first laparoscopic trocar. Failure to recognize the injury during the laparoscopic procedure itself can be attributed to the intraperitoneal CO2 pressure compressing the bleeding vessels and to the decreased venous return caused by the steep Trendelenburg position. Major vascular injury should be recognized as early as possible since it is a life threatening condition that necessitates immediate and prompt treatment.

Adult↗
PubMed1998

Uterine papillary serous carcinoma: study of 19 cases.

OBJECTIVE: Uterine papillary serous carcinoma (UPSC) is an uncommon highly malignant variant of endometrial carcinoma that histologically and clinically resembles ovarian papillary serous carcinoma. The purpose of this study was to present the conjoined experience of two regional hospitals in the south of Israel (Soroka Medical Center, Beer-Sheva and Kaplan Hospital, Rehovot) of handling this tumour. STUDY DESIGN: Data from the files of 19 patients with UPSC who were managed at these hospitals between July 1991 and June 1997 were evaluated. RESULTS: The three-year survival rate was 57.3% overall; 83.3% for Stage I and 21.2% for Stages II, III, and IV combined (P<0.02). Eighteen patients had primary surgery which included total abdominal hysterectomy and bilateral salpingo-oophorectomy and 15 (83.3%) of them received postoperative adjuvant therapy which included radiotherapy and/or systemic chemotherapy. CONCLUSIONS: The prognosis of patients with UPSC is worse than that of patients with other forms of endometrial carcinoma. Primary surgery comprised of total abdominal hysterectomy, bilateral salpingo-oophorectomy and staging is the mainstay of treatment. The type of postoperative treatment is not consistent. By and large, adjuvant pelvic radiotherapy is usually given in early-stage disease and adjuvant systemic chemotherapy is usually prescribed in advanced-stage disease.

Adult↗
PubMed1998

Long-term disease-free survival following surgery and active specific immunotherapy with allogeneic vaccine in a patient with high-risk malignant melanoma of the vulva.

Vulvar malignant melanoma with deep vertical penetration of the tumor and involvement of regional lymph nodes carries a very poor prognosis. The case of a 25-year-old woman with a history of a Breslow depth 6.0 mm and Clark Level IV primary vulvar malignant melanoma, involving the anterior part of the left labium major, 1 cm from the clitoris, is reported. The patient had undergone a left radical hemivulvectomy and bilateral groin dissection. There were two of thirteen superficial left groin nodes containing metastatic melanoma. The patient had been treated postoperatively with an allogeneic specific anti-melanoma vaccine in combination with high-dose cimetidine and has survived without disease for more than five years. To the best of our knowledge this is the first case report in the literature of active specific immunotherapy with allogeneic vaccine in vulvar malignant melanoma. This case illustrates that the behavior of malignant melanoma, including vulvar malignant melanoma, is unpredictable and active specific immunotherapy with allogeneic vaccine may have a role in the postoperative treatment of high risk vulvar malignant melanoma.

Adult↗
PubMed1998

Clinical-pathological study of uterine leiomyomas with high mitotic activity.

OBJECTIVE: To evaluate clinical-pathological aspects of mitotically active leiomyomas. STUDY DESIGN: Twenty patients with smooth muscle tumors of the uterus, with 5-9 mitotic figures per 10 high power fields and without atypia or necrosis were studied. The clinical and pathological characteristics of these tumors were reviewed and analyzed. RESULTS: Patients' ages ranged from 33 to 63 years (mean 42.5 years). The size of the tumors ranged from 1.5 to 9.5 cm (mean 5.4 cm). On gross examination all tumors appeared as typical leiomyomas. Treatment included hysterectomy in 16 patients and myomectomy in four. Follow-up periods ranged from 1.5 to 11 years (mean 6.8 years). None of the patients developed a recurrent tumor. CONCLUSION: The benign clinical behavior of such tumors supports their current designation as mitotically active leiomyomas, thus deleting the previous misnomer 'smooth muscle tumors of uncertain malignant potential'. Myomectomy is an appropriate treatment, particularly in young patients interested in reproduction.

Adult↗
PubMed1998

Primary squamous cell carcinoma of the vagina: report of four cases and review of the literature.

Four patients with primary vaginal invasive squamous cell carcinoma are reported. They accounted for 0.3% of all females with genital tract malignancies diagnosed in the south of Israel between 1961 and 1996. One patient had Stage I disease, one--Stage II, one--Stage III and one--Stage IV. One patient was treated with external radiotherapy followed by intracavitary brachytherapy, one patient was treated with external radiotherapy followed by interstitial brachytherapy, one patient had systemic chemotherapy and one patient had no treatment. At the time of writing, one patient was alive without disease, one was alive with progressive disease, one had died of disease and one had died of intercurrent disease. It is concluded that primary vaginal carcinoma is a very rare entity with an estimated incidence of about 0.1-0.2/100,000 women. Most patients present with tumor extending beyond the vaginal wall (Stage II, III and IV) and the mainstay of treatment for these patients is radiotherapy. The overall 5-year survival rate is about 50%.

Adult↗
PubMed1998

Primary sarcoma of the ovary: report of five cases and review of the literature.

Primary ovarian sarcomas are rare and usually behave very aggressively. Over a ten-year period (1987-1996) five cases of primary ovarian sarcoma were managed at the Soroka Medical Center, Beer-Sheva, Israel. Four patients had malignant mullerian-mixed mesodermal tumor (MMMMT): two had Stage IIIC tumor with chondrosarcoma being the predominant sarcomatous element, one had Stage IIIC tumor with high-grade endometrioid stromal sarcoma (ESS) being the predominant sarcomatous element and one had Stage IC tumor with rhabdomyosarcoma being the predominant sarcomatous element. One patient had Stage IA leiomyosarcoma (LMS). All four patients with MMMMT received postoperative adjuvant chemotherapy, whereas the patient with LMS did not. The four patients with MMMMT died of their disease 10, 10, 13 and 25 months, respectively, after initial surgery. The patient with LMS died of intercurrent disease 21 months after initial surgery. It is concluded that most patients with primary ovarian sarcoma present with extraovarian disease and the prognosis is poor. The mainstay of treatment is debulking surgery consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy and extirpation of tumor masses. The benefit of postoperative adjuvant chemotherapy and/or radiotherapy is still a subject of debate and has yet not been established.

Aged↗
PubMed1998

Tumor necrosis factor-alpha and interleukin-6 are differently expressed by fresh human cancerous ovarian tissue and primary cell lines.

The expression levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were evaluated in normal and cancerous ovarian tissue and primary cell lines (PCL). Seven normal and 10 cancerous, formalin-fixed ovarian samples were examined for TNF-alpha and IL-6 expression by immunohistochemical staining using polyclonal rabbit anti-human TNF-alpha and IL-6 antibodies. Fresh normal and cancerous specimens were also examined for TNF-alpha and IL-6 secretion by bioassay and immunoassay prior to and following in vitro stimulation with lipopolysaccharide (LPS). The levels of IL-6 and TNF-alpha were higher in cancerous tissues than in normal specimens. In vitro stimulation of normal and cancerous ovarian tissues and PCL revealed their capacity to secrete IL-6. Cancerous tissue and PCL secreted higher levels than normal tissue and PCL. Stimulation of both groups with LPS increased their capacity to secrete IL-6. Optimal secretion of IL-6 by the cancerous tissue was observed after 72 hours with or without LPS (10 microg/ml). Normal tissue secreted maximal levels of IL-6 after 96 hours with or without LPS. PCL from normal ovarian tissue secreted IL-6 constitutively and optimal expression was detected after 96 hours. Carcinoma PCL from cancerous ovarian tissue demonstrated optimal secretion of IL-6 after 24 hours. Stimulation of both types of cells with LPS, IL-1 or TNF-alpha increased their capacity to secrete IL-6. TNF-alpha activity was detected in vitro only in supernatants of ovarian cancerous tissue and only after LPS stimulation; optimal levels were detected after 48 hours and 1 microg/ml LPS. Our results indicate that IL-6 and TNF-alpha are expressed in cancerous ovarian tissue at a higher level than in normal ovarian tissues. Carcinoma cells of ovarian tissues are the main cellular source of these cytokines. The conditions controlling the secretion of these cytokines, under in vitro conditions, are different in cancerous and normal ovarian tissues.

Cell Line↗
PubMed1997

Uterine sarcoma in the south of Israel: study of 36 cases.

BACKGROUND: Uterine sarcomas are rare, charaterized by rapid clinical progression and poor prognosis, and their management has been a challenge. The purpose of this study was to investigate the clinical and histologic findings, treatment, and outcome of patients with uterine sarcoma in the south of Israel. METHODS: Data from the files of 36 patients with uterine sarcoma who were managed at the Soroka Medical Center between January 1961 and December 1994 were evaluated. RESULTS: The 5-year survival rate was 32% overall; 63% for 9 patients with endometrial stromal sarcoma (ESS). 30% for 14 patients with mixed mesodermal sarcoma (MMS) and 18% for 13 patients with leiomyosarcoma (LMS): 41% for 22 patients with Stage I and 19% for 14 patients with Stages II, III, and IV. Only the difference in the 5-year survival rate between ESS and LMS was statistically significant (P < 0.05). Eleven patients (30.6%) were treated with surgery alone, 4 (11.1%) with surgery followed by pelvic radiotherapy, 11 (30.6%) with surgery followed by chemotherapy, 8 (22.2%) with surgery followed by pelvic radiotherapy and chemotherapy, one (2.8%) with chemotherapy alone, and one (2.8%) had no treatment. CONCLUSIONS: Uterine sarcomas are aggressive tumors with a poor prognosis. The treatment is surgery generally followed by adjuvant pelvic radiotherapy and/or systemic chemotherapy.

Adult↗
PubMed1997

Endometrial carcinoma in the south of Israel: study of 231 cases.

BACKGROUND AND OBJECTIVES: Endometrial carcinoma is the commonest female genital tract malignancy in the south of Israel. The purpose of this study was to investigate the clinical and histologic findings, treatment and outcome of patients with endometrial carcinoma in the south of Israel. METHODS: Data from the files of 231 patients with endometrial carcinoma who were managed at the Soroka Medical Center between January 1961 and December 1994 were evaluated. RESULTS: Endometrial carcinoma was more prevalent among Jewish as compared to Arab-Beduin women, and among Ashkenazi as compared to Sephardic Jewish women. The prevailing presenting symptom was postmenopausal bleeding and most patients (68.8%) had Stage I disease. Most patients (209/225, 92.9%) underwent surgery, 131/222 (59%) had radiotherapy and 15/214 (7%) received chemotherapy. The 5-year survival rate was 79.1% overall; 89% for Stage I, 71.7% for Stage II, 21.6% for Stage III and 0% for Stage IV; 89.8% for Grade 1, 70% for Grade 2 and 60.9% for Grade 3; 100% for adenoacanthoma, 82% for endometrioid carcinoma, 65.8% for adenosquamous carcinoma and 51.6% for papillary serous carcinoma. CONCLUSIONS: Endometrial carcinomas are characterized by a relatively favorable prognosis with a 5-year survival of about 80%. Surgical stage, histologic differentiation and histologic subtype are sensitive predictors of survival. The mainstay of treatment is surgery with adjuvant pelvic radiotherapy when necessary.

Adult↗