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Biomedical subjects

C C Yuan

Publications and source records attributed to C C Yuan.

At least 91 records · Page 5Linked to original sources
PubMed1999

Primary malignant lymphoma of the cervix in pregnancy. A case report.

BACKGROUND: Malignant lymphoma arising from the uterine cervix is a very rare entity. Only two such patients have been reported as pregnant at the time of diagnosis. CASE: A 35-year-old woman (negative Pap smear at antenatal clinics) was referred because of the accidental finding of a huge cervical mass during labor. The patient underwent cesarean section because of arrest of cervical dilatation and persistent floating of the fetal head. The final diagnosis of this cervical mass was malignant lymphoma, low grade B cell, after radical abdominal hysterectomy. CONCLUSION: Although labor obstructed by a tumor of the pelvic organs is a relatively rare event and the majority of cases are benign leiomyomas of the uterus or cervix, the risk of pelvic malignancies should be considered. Bimanual examination and pelvic ultrasound and/or color Doppler ultrasound should be applied without hesitancy in any uncertain situation during pregnancy or labor.

Adult↗
PubMed1999

Urethral diverticulum presenting with chronic pelvic pain: a case report.

Urethral diverticula are rarely encountered in the gynecologic out-patient setting. However, this condition probably occurs more frequently than it is diagnosed. The patient frequently notes signs of lower urinary tract irritation. Urinary dribbling accompanied with dyspareunia and dysuria constitutes a classic triad for urethral diverticula. Symptoms of chronic pelvic pain only occur in a minority of patients. We report a case of urethral diverticulum presenting chiefly with chronic pelvic pain. The patient underwent multiple investigative operations before a correct diagnosis was made. When confronted with a patient presenting with chronic pelvic pain, a gynecologist should retain a high index of suspicion for a urethral diverticulum in addition to other gynecologic conditions.

Chronic Disease↗
PubMed1999

Whole-body PET with (fluorine-18)-2-deoxyglucose for detecting recurrent ovarian carcinoma. Initial report.

OBJECTIVE: To investigate positron emission tomography (PET) with (fluorine-18)-2-deoxyglucose (FDG) for detecting recurrent ovarian carcinoma. STUDY DESIGN: Wholebody FDG-PET scanning was performed on five patients before surgical exploration. All five patients were suspected of having recurrence based upon clinical findings and underwent surgery after scanning. RESULTS: In all five patients, PET images demonstrated increased FDG uptake in a distribution that correlated with surgical-pathologic findings (100%); computer tomography can detect 60% of such patients with malignant disease. Two cases with unexplained elevated serum CA-125 had lesions localized by PET. CONCLUSION: Recurrence of ovarian carcinoma was clearly imaged with FDG-PET and was confirmed by surgical pathology. FDG-PET might be a fairly effective tool for detecting recurrent ovarian carcinoma.

CA-125 Antigen↗
PubMed1999

Outcome of advanced primary fallopian tube adenocarcinoma.

BACKGROUND: Because of the rarity of primary fallopian tube adenocarcinoma (PFTA), the outcome of advanced primary fallopian tube carcinoma has not been fully evaluated, especially in Taiwan. METHODS: We retrospectively studied patients with proven surgicopathologic stage III PFTA. Thirteen patients from 1965 to 1995 were identified. All patients received standard staging surgery including washing cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, retroperitoneal lymphadenectomy, infracolic omentectomy and excisional biopsy of all suspicious lesions. This was followed by adjuvant chemotherapy with four to eight courses of CAP or CEP (cyclophosphamide 500 mg/m2, adriamycin 50 mg/m2, or epirubicin 50 mg/m2, and cisplatin 50 mg/m2 intravenously, every 3 weeks) regimen. RESULTS: The accumulative disease-free survival rate was 15%. The incidence of retroperitoneal lymph node metastases was high, up to 69%, and the incidence of para-aortic lymph node metastases was 62%. Eighty-five percent of the cases were poorly differentiated carcinoma. Optimal debulking surgery was completed in 62% of patients, contributing to long-term patient survival (25% vs 0%), compared with those without optimal debulking surgery. CONCLUSIONS: The prognosis of stage III PFTA in our study was poor. Careful lymph node dissection in the retroperitoneal space including the para-aortic area is required. Optimal debulking surgery plus postoperative adjuvant chemotherapy appears to be the only option for enhancing long-term disease-free survival.

Adenocarcinoma↗
PubMed1999

Intracavitary cardiac tumor secondary to carcinoma of the cervix: a case report.

Carcinoma of the cervix spreading to the paracervical lymphatics is a common phenomenon followed by involvement of the para-aortic lymph nodes and subsequent distant metastases. The most common extranodal metastases sites are the lungs, followed by the liver and bones. The heart is an extremely rare metastatic target for carcinoma of the cervix. Furthermore, the majority of cardiac metastases involve the pericardium and endocardium and are particularly rare. We present the case of a 56-year-old woman with recurrent squamous cell carcinoma of the cervix who died after aggressive multimodality treatment including concurrent chemoradiotherapy and surgical intervention. The patient died suddenly and the autopsy showed disseminated carcinomatosis with portal vein, hepatic vein, inferior vena cava and right ventricular tumor emboli.

Carcinoma, Squamous Cell↗
PubMed1998

Prognosis-predicting system based on factors related to survival of cervical carcinoma.

OBJECTIVE: To establish a different category system based on grouping of the risk factors in patients with cervical smear. METHODS: Univariate and multivariate analyses of factors associated with survival time were performed in 443 patients with stage Ib-IIa squamous cell carcinoma (SCC) from 1985 to 1989. RESULTS: Univariate analysis showed that parametrial extension, bulky tumor size (> or = 4 cm), uterine body involvement, poor differentiation and pelvic lymph node (LN) metastasis were prognostically significant. However, by multiple regression method, only LN metastasis, deep stromal invasion (DSI), and poor differentiation (PD) were significantly related to the patient's survival time with risk ratios of 2.78, 2.61 and 1.52, respectively. A prognosis-predicting system was established on the basis of these simplified factors: groups of high, intermediate, low and very low-risks, obtained survival rates of 93-96%, 77%, 51% and 25-37%, respectively. CONCLUSIONS: Using this simple model, cervical carcinomas can be classified prognostically for predicting 5-year-survival rates, and for risk-guided therapy in the future.

Adult↗
PubMed1998

Laparoscopic surgery for heterotopic pregnancies: a case report and a brief review.

A heterotopic pregnancy is in effect a multiple pregnancy with one or more intrauterine pregnancies coexisting with an ectopic pregnancy and is rarely spontaneous. With the increasing popularity of ovulation induction performed during assisted reproductive techniques, it will not be surprising to observe that this phenomenon has increased significantly. However, diagnosis is often delayed because of its rarity and difficulty. We report a case of a woman with a viable intrauterine pregnancy who had a complication of ovarian hyper-stimulation syndrome secondary to ovulation induction following in vitro fertilization and embryo transfer, but who, during hospitalization, presented with clinically progressive abdominal pain. An unruptured ectopic pregnancy of the right fallopian tube was diagnosed accidentally by laparoscopy and laparoscopic salpingectomy was immediately performed. Post-operative follow-up revealed that the intrauterine pregnancy continued normally. She delivered a normal female baby at 38 weeks of gestation. The promising neonatal outcome might suggest that laparoscopy might be safely performed to aid differential diagnosis in an uncertain condition during pregnancy: therefore, laparoscopic surgery might be an appropriate method to manage some carefully selected patients with HP. A brief review of the published literature on the role of laparoscopy in the diagnosis and management of heterotopic pregnancy is given.

Adult↗
PubMed1998

Steroid cell tumors of the ovary: clinical, ultrasonic, and MRI diagnosis--a case report.

Steroid cell tumors of the ovary are rare sex-cord neoplasms which account for less than 0.1% of all ovarian tumors. They have been divided into two subtypes according to their cell of origin as follows: stromal luteoma, and Leydig cell tumors, and a third subtype with lineage unknown is a steroid cell tumor, not otherwise specified (NOS). The clinical presentation may take many forms, including pain, abdominal distention and bloating, but perhaps the most interesting and noticeable presentations are those related to the hormonal activity and virilizing properties of the tumor. No radiological features of the steroid cell tumor, NOS have been presented in the literature. This report presents the MRI and ultrasonographic findings of a patient having steroid cell tumor, NOS, of the right ovary with metastasis to the uterus.

Female↗
PubMed1998

Elevated cytokeratin-19 expression associated with apoptotic resistance and malignant progression of human cervical carcinoma.

Cytokeratin-19 is an intermediate filament protein associated with the integrity of cell structure, and its elevated expression has been reported to correlate with the disease progression of oesophagus and lung cancers. In this study, we examined the level of cytokeratin-19 in five cervical cancer cell lines by immunobinding and Western blotting analyses. Compared with two control cell lines, FS-4 (foreskin cell line) and G9T (glioma cell line), all five cervical carcinoma cell lines (Caski, CC7T, ME180, HeLa and SIHA) showed higher cytokeratin-19 expression. By double-staining flow cytometry, expression of cytokeratin-19 in cervical cancer cells was suggested to be in a cell cycle-independent manner. Furthermore, we could specifically localize the SIHA cell-derived tumours in nude mice by injecting with cytokeratin-19-recognized radiolabelled MAb Cx-99 antibody, suggesting the possibility of using cytokeratin-19 as a marker of cervical carcinoma. A clinical investigation was therefore performed on 19 patients (11 patients with cervical carcinoma and eight patients with benign neoplasia). In the 11 patients having cervical carcinoma, all eight patients with advanced stages and one out of three patients with early stage diseases showed higher cytokeratin-19 protein contents than the other 10 patients with benign neoplasia. This suggested that elevation of cytokeratin-19 level was associated with cervical cancer staging. In addition, we have studied the biological significance of elevated cytokeratin-19 level in malignant cervical cancer. The apoptotic rate of cervical carcinoma cells in response to cisplatin was increased if their cellular cytokeratin-19 level was reduced by specific antibody MAb Cx-99. These results indicated that elevation of cytokeratin-19 expression could associate with the apoptotic resistance and malignant progression of cervical carcinoma.

Journal Article↗
PubMed1998

Prognosis of primary fallopian tube adenocarcinoma: report of 25 patients.

PURPOSE OF INVESTIGATION: Because of the rarity of primary fallopian tube adenocarcinoma (PFTA), the optimal management has not been well-defined, especially in early-stage disease. Furthermore, prognosis of primary fallopian tube carcinoma has not been fully understood. METHODS: We retrospectively studied patients with proven surgico-pathological stage PFTA and excluded patients without a standard surgicopathological staging procedure. Twenty-five patients from 1970 to 1995 were identified. Eleven were in Stage I, four in Stage II and ten in Stage III and IV. Twenty patients received adjuvant chemotherapy with four to eight courses of CAP or CEP (cyclophosphamide 500 mg/m2, adriamycin 50 mg/m2 or epirubicin 50 mg/m2, and cisplatin 50 mg/m2 intravenously, every three weeks) regimen. One patient received two courses of chemotherapy and another received one course of chemotherapy; both followed with radiotherapy due to refusal of further chemotherapy. The remaining three patients did not receive any adjuvant therapy. RESULTS: Accumulative disease-free survival rate in spite of different st ages was 36%. Univariate analysis showed postoperative adjuvant chemotherapy, optimal debulking surgery, nulliparity, extent of the disease, and tumor differentiation as significant factors for disease-free survival of patients with PFTA. However, multivariate analysis did not show significance due to the small number of cases. CONCLUSION: Nearly half of the patients (44%) were diagnosed in early stage of PFTA, but patient survival was still disappointing. Understanding possibile risk factors for therapeutic failure and more aggressive and effective multi-modality treatments should be further defined.

Adenocarcinoma↗
PubMed1998

Fever of unknown origin in the puerperium. A case report.

BACKGROUND: Postpartum fever is a common problem for obstetricians, but fever of unknown origin (FUO) occurring in the puerperium may be relatively unfamiliar and a challenge to the majority of obstetricians. CASE: A 29-year-old woman had a FUO detected during the puerperium. Despite serial examinations and therapeutic trials, the fever persisted for three weeks without a clinical improvement or definite infection source. The presence of a huge uterine myoma was observed. The patient finally underwent myomectomy, and a pathology review revealed a cellular leiomyoma associated with massive infarction and acute inflammation. The fever subsided substantially on the third day postoperatively. CONCLUSION: Although a uterine leiomyoma as a cause of fever in the puerperium is not new, rarely does it cause prolonged fever. It should be taken into consideration in pregnant women known to have uterine myomas during pregnancy and in the puerperium, especially if FUO develops. Nonsteroidal antiinflammatory drugs can be a tool for making the differential diagnosis in such a patient, and exploratory laparotomy can be delayed until an emergency condition occurred, especially important during pregnancy.

Adult↗
PubMed1998

Placenta previa accreta with cervical involvement causing tenacious postpartum hemorrhage: a case report.

Conservative treatment for placenta accreta has recently been popularly accepted even though serious postpartum hemorrhage, resulting in maternal death, may occur. We report a case of placenta previa accreta with cervical involvement resulting in tenacious postpartum hemorrhage. A 28-year-old pregnant woman, gravida-2 para-1, who had undergone a previous cesarean section, was scheduled for a repeat cesarean section because of complete placenta previa associated with placenta accreta. The patient underwent cesarean section and delivered a 3,700 g, male infant. Manual removal of the placenta was performed with some difficulty and redundant placental tissue remained adhered to the uterine wall. Oxytocin, ergometrine, uterine arterial ligation and packing of the lower uterine segment were used to control bleeding; the wound was closed as usual after achieving adequate hemostasis. While closing the abdominal wall, vaginal bleeding was noted. After conservative treatment, shock progressively emerged due to persistent vaginal bleeding. Emergency laparotomy found active bleeding from the cervix and total abdominal hysterectomy was performed without hesitation. Careful evaluation is mandatory to preserve the uterus. In the case of cervical involvement, aggressive treatment such as hysterectomy should be undertaken promptly to decrease the risks of both morbidity and mortality.

Adult↗
PubMed1998

High resistance index of Doppler ultrasound in tuberculous peritonitis presenting as abdominal carcinomatosis: report of two cases.

The radiologic features of tuberculous peritonitis (TB peritonitis) are seldom reported, and the use of color Doppler ultrasound in the diagnosis of TB peritonitis is even less common. Herein, we present two patients (a 29-year-old woman and a 56-year-old woman) who were evaluated for months of progressive enlargement of the abdomen, poor appetite and weight loss. In both patients, clinical and laboratory examinations suggested carcinoma, except a very high vascular resistance (resistance index 1.0 and 0.89, respectively) of the tumor feeding vessels detected by color Doppler ultrasound. TB peritonitis was finally diagnosed by exploratory laparotomy. Both patients were treated using a four-drug regimen of isoniazid, rifampicin, ethambutol hydrochloride and pyrazinamide for nine months and were clinically cured. In conclusion, if color Doppler ultrasound reveals normal ovaries, ascites containing thin, delicate incomplete or complete septa, and only a few high-resistance tumor feeding vessels in the abdominal cavity (resistance index > or = 0.80), TB peritonitis should be considered.

Abdominal Neoplasms↗
PubMed1998

Small cell carcinoma of the cervix: analysis of clinical and pathological findings.

PURPOSE OF INVESTIGATION: An attempt to better identify small cell carcinoma of the cervix and evaluate its prognosis. METHODS: From January of 1970 to March of 1995, a total of seven patients diagnosed with small cell carcinoma of the cervix by pathologic revision were retrospectively reviewed. Clinical information including age, clinical stage, lymph-vascular space invasion, lymph node metastases, prognoses were analyzed. RESULTS: All specimens stained positive for neuron-specific enolase (NSE) and four were positive for chromogranin (CGR). The majority of patients (71%) died of disease within 18 months. Only one patient had an abnormal Pap smear before definite diagnosis, and only one patient was well and alive after a combination of surgery and multi-agent chemotherapy (p<0.05). CONCLUSION: Pap smears may not be an appropriate screening method for detecting small cell carcinoma of the cervix. Immunohistological staining may be helpful in diagnosis of small cell carcinoma of the cervix. Because of a very poor prognosis, more effective therapeutic protocol should be further defined in the management of cervical small cell carcinoma.

Adult↗