Biomedical subjects
Publications and source records attributed to H M Tarraza.
A case of vulvar leiomyomatosis in a young adult with a history of esophagogastrectomy as a child for esophagogastric leiomyomatosis is presented. The steroid receptor profile of the tumor is described. Therapy with a combination of gonadotropin suppression and surgery was undertaken. The literature pertaining to this rare combination is discussed.
Four patients with leiomyosarcoma of the small intestine who presented with a pelvic mass are reviewed. The tumors had clinical and radiographic features resembling ovarian neoplasms. These patients develop sizable tumors and, yet, have relatively few symptoms which would necessarily direct the physician to the intestine as the site of origin. The clinicopathologic features and management of these tumors are reviewed.
We report a case of a 38 year old female who was treated for a Stage IIIb serous cystadenocarcinoma of the ovary with cytoreduction, combination chemotherapy, negative second look laparotomy, and adjuvant chemotherapy, who eight months later presented with Idiopathic Thrombocytopenic Purpura (ITP) and an isolated splenic recurrence. Review of the literature shows only four other cases of gynecologic malignancy which exhibited this pattern of recurrence. This case is the first where the primary lesion was an ovarian carcinoma and the patient presented with thrombocytopenia.
We report a rare case of primary endometrioid carcinoma of the ovary which presented clinically with rectal bleeding mimicking a rectal cancer. The patient's pre-operative evaluation included radiographic and sero-immunologic findings which indicated a primary ovarian neoplasm. Only two other cases of ovarian carcinoma with this presentation have been reported in the literature. Gynecologic processes that can present as bleeding gastrointestinal lesions are reviewed.
A case of invasive squamous cell carcinoma of the vagina in a diethylstilbestrol (DES)-exposed patient is described. Histologic evidence indicates that the invasive lesion arose in dysplastic vaginal adenosis. The medical literature regarding squamous cell neoplasia in DES-exposed patients is discussed.
Three cases of papillary villoglandular carcinoma of the cervix are presented. Each patient was multiparous and presented with abnormal vaginal bleeding. The mean age at presentation was 35 years (range 28-42 years). All patients were staged as FIGO IB and underwent radical Wertheim hysterectomy and bilateral pelvic lymphadenectomy. Disease was limited to the cervix in two patients and extended to involve the lower uterine segment in one patient. There was no evidence of microscopic spread to the lymph nodes. Previous reports that examined patients with papillary villoglandular carcinoma of the cervix found them to have a favorable prognosis. Treatment implications are discussed.
A small cell neuroendocrine carcinoma that arose in Bartholin's gland in a 30-year-old woman is reported. The tumor had light, electron microscopic, and immunohistochemical features typical of pulmonary small cell carcinoma and was metastatic to inguinal lymph nodes at presentation. This is the first reported example of this tumor occurring in Bartholin's gland.
Four cases of carcinosarcoma and mixed müllerian tumors of the fallopian tube are presented. Each patient presented with abnormal bleeding and a pelvic mass. All underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, staging, and cytoreduction. Disease was limited to the pelvis in two patients, analogous to FIGO stage IIB ovarian carcinoma; the other two patients had upper abdominal disease, analogous to FIGO stage III. The primary tumors were intraluminal and papillary. There were equal amounts of carcinoma and sarcoma in three tumors; in one, sarcoma constituted only a small intraluminal focus. The sarcoma was predominantly homologous, with foci of heterologous elements present in three tumors. Adjuvant therapy consisted of pelvic radiation in two patients. One patient died of inanition within one year of diagnosis. The other patient, who had the small focus of sarcoma within a stage IIB carcinoma, had an 11-year disease-free interval before retroperitoneal recurrence of carcinoma. Two patients received chemotherapy. A stage IIB patient, after pelvic radiation, received Cytoxan and Adriamycin; she is clinically free of disease after 6 years. A stage III patient lived over 3 years after treatment with multiple agents; she responded to Cytoxan and cis-platinum before suffering a systemic relapse and death.
Nineteen women with a mean age of 62 were treated for primary adenocarcinoma of the fallopian tube from 1960 to 1980. Common presentations were bleeding or discharge, pelvic mass, and pain. Cervical cytology was positive in five of eleven cases; endometrial curettings revealed adenocarcinoma in three of nine cases. Staging was by a system analogous to the International Federation of Gynecology and Obstetrics (FIGO) classification of ovarian carcinoma: 11% stage I, 44% stage II, 28% stage III, and 17% stage IV. Bleeding and abnormal cervical cytology were associated with earlier stage lesions and better prognosis. The most common treatment was excision of the primary tumor and gross intraperitoneal metastases. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed in 14 cases. Thirteen patients received 40-50 Gray of 2 MeV external beam pelvic radiation. Stages I and II had five-year survival of 100% and 63%. However, 38% of stage II patients had late extrapelvic relapses, and two early stage patients suffered serious complications of radiation therapy. All stage III and IV patients died of disease, 63% within the first 3 years. Based upon these results and review of other modern series, the importance of early diagnosis and complete surgical staging is emphasized, and stage-specific adjuvant therapy recommended.
The bacterium Vibrio parahaemolyticus was found to be pathogenic for the schistosome intermediate host Biomphalaria glabrata (Say). When administered topically, a nonenteritis-associated strain of the bacterium had an LD50 (median lethal dose) of 6.8 x 10(7) cells per snail. A 5% trichloroacetic acid (TCA) extract from V. parahaemolyticus was found to kill B. glabrata. Sublethal effects of V. parahaemolyticus include shell deterioration and increased heart rate. Both albino aquarium populations and naturally occurring Puerto Rican wild populations of B. glabrata are susceptible to V. parahaemolyticus. This bacterium provides a useful model for the study of pathogens and biological control of schistosome vector snails, since it causes significant mortality and is recognized as a pathogen of other invertebrates.