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At least 811 records · Page 45Linked to original sources
PubMed1988

Operative treatment of recurrent cancer of the uterine cervix after radiotherapy.

During the period 1976-83, 47 women were operated on for recurrent or persistent cancer of the uterine cervix following initial radiation therapy. The operations performed were Wertheim's operation combined with dissection of the pelvic nodes, or some type of pelvic exenteration. With a 5-year survival of 31% in our material, surgical treatment of centrally located recurrences is a realistic possibility. We recommend an exenterative procedure as the operation is technically easier and the complications require less radical surgical treatment. The operation should only be done on narrow indications in the hope of achieving a cure, and the selection of patients must thus be stringent.

Aged↗
PubMed1987

Glycogen-rich clear cell carcinoma of the urethra: an ultrastructural study.

A 49-year-old black woman developed a urethral glycogen-rich clear cell carcinoma. She was treated with anterior pelvic exenteration. The resected lymph nodes, vagina, uterine cervix, endometrium, ovaries, and urinary bladder were free of neoplasm. Histologically the neoplasm consisted of clear cells growing in sheets and occasional papillary structures. In some areas, hobnail cells were present. Ultrastructurally, the cells had apical caps, short microvilli, and complex cell bases, and contained abundant glycogen. These features were identified in one, but not the other of two previously reported cases. Because glycogen-rich clear cell carcinomas of the lower urinary tract do not resemble ultrastructurally mesonephric remnants or carcinomas known to arise from them, these glycogen-rich clear cell carcinomas should not be called "mesonephromas" as has been the practice.

Adenocarcinoma↗
PubMed1994

Transrectal ultrasonography in preoperative staging of rectal cancer.

A precise knowledge of the depth of invasion of tumor is essential for the planning of treatment of rectal cancer. Transrectal ultrasonography is a new diagnostic modality that has become useful in determining the depth of invasion preoperatively and the presence or absence of metastatic lymph nodes. Transrectal ultrasonography was used in preoperative staging of 36 patients with rectal cancer. Thirty three patients had a radical resection (17 low anterior resection, 15 abdominoperineal resection and 1 pelvic exenteration), one patient had a local excision. Two among these thirty four patients had preoperative radiotherapy. Preoperative transrectal ultrasonographic staging was compared with pathologic findings. In staging depth of invasion, the overall accuracy was 88.8 percent, overstaged in 5.8 percent, understaged in 5.8 percent. Transrectal ultrasonography is the more accurate method than CT in staging of depth of tumor invasion (61.8% vs 88.8%). In staging of lymph nodes, the overall accuracy of transrectal ultrasonography was 85.3 percent, sensitivity was 71.7 percent and specificity was 88.8 percent. Transrectal ultrasonography is a safe, inexpensive and accurate staging method in the assessment of both depth of invasion and nodal status.

Adult↗
PubMed2006

[Bladder leiomyosarcoma: case report].

OBJECTIVES: To report a new case of bladder leiomyoma in an adult. METHODS: 64-year-old female patient consulting for a four-month hematuria diagnosed of a bladder intraluminal tumor on ultrasound during a routine gynecologic revision. Cystoscopy confirmed the presence of the tumor. Transurethral resection was indicated. RESULTS: Pathology reported a definitive diagnosis of leiomyosarcoma. Anterior pelvic exenteration was subsequently performed. On one year follow-up there is no evidence of disease. CONCLUSIONS: We emphasize the rarity of these neoplasias. We comment on their main characteristics, pointing out the importance of immunohistochemical staining for the definitive histological diagnosis. We refer the therapeutic options described in the literature.

Female↗
PubMed1992

[Complications of Kock continent reservoir. Report of 103 cases].

We installed a Kock continent reservoir in 103 patients after radical cystectomy or pelvic exenteration between Feb. 1986 and Dec. 1989. They consisted of 81 male and 22 female patients. Patients' age ranged from 30 to 78 years with the average being 63 years. Their original diseases were bladder cancer (96 patients), prostatic cancer (2), sigmoid colon cancer (2) and others (3), The Kock reservoir was made by the procedure described by D. G. Skinner et al. The mean operation time for reservoir creation was 220 minutes. In 99 patients with a Kock reservoir for more than 3 months, the capacity of the reservoir was 200-900 ml with the average being 490 ml and the frequency of self-catheterization was 4 to 6 times a day. Early complications occurred within 3 months in 27 (26%) patients. Complications directly related to the reservoir were urine leakage (5 patients), intestine reservoir fistula formation (3) and necrosis of the reservoir (1). Late complications occurred after 3 months in 25 (25%) patients. They consisted of difficulty of catheterization (9 patients), ureteral reflux from reservoir (2), hydronephrosis (8), abscess (4), metabolic acidosis (2) and others. The results indicated that this procedure is an appropriate urinary diversion since the quality of life in the patients with a Kock reservoir is better. However, after this procedure surgical complications were not infrequent. Therefore, this procedure should be performed in selected patients.

Adult↗
PubMed1995

[Primary seminoma of the prostate and embryonal cell carcinoma of the left testis in one patient: a case report].

A 27-year-old Japanese male presented with gross hematuria and right frank pain, and was diagnosed of having a right ureteral stone by IVP. Though the stone was passed spontaneously, gross hematuria continued, and his urinary stream became week. The prostate was moderately enlarged. The prostate biopsy was initially thought to represent prostate rabdomyosarcoma. He underwent a pelvic extenteration followed by chemotherapy with dacarbazing and ADM. Three years after the pelvic exenteration, coin lesions were found on a chest X-ray film. He was diagnosed as embryonal cell carcinoma of the left testis with pulmonary metastasis and received 3 courses of PVB therapy. At this time, the former diagnosis of prostatic rabdomyosarcoma was changed to prostatic rabdomyosarcoma was changed to prostatic seminoma, because placental-ALP staining was positive. This patient had two distinct germinal cell tumors in the prostate and the left testis. He was alive without any tumor recurrence 20 months after PVB chemotherapy. To the best of our knowledge our report represents the first patient of seminoma of the prostate in the world.

Adult↗
PubMed1996

[Mesonephric adenocarcinoma arising in the female urethral diverticulum].

A forty four-year-old house-wife presented with gross hematuria and difficulty on urination of a year and 3 months duration. Transvaginal examination showed a hen egg-sized soft mass on the anterior vaginal wall. Urine cytology revealed many clusters of malignant cells suggestive of adenocarcinoma. Cystourethrography revealed two urethral diverticula, whose orifices were cystoscopically located at the proximal and distal side of urethral sphincter, respectively. By vaginal digital pressing, a soy-bean sized papillary tumor came out of the proximal diverticulum. Histopathological examination of the biopsied tumor suggested poorly differentiated transitional cell carcinoma with inverted growth. Under the diagnosis of carcinoma arising in the urethral diverticulum, anterior pelvic exenteration with formation of Indiana pouch was carried out. The tumor in the proximal diverticulum was histologically composed of a variety of adenocarcinomatous pattern, such as tubular, papillary and cystic structure with a distinctive pattern of tubules lined by a superficial layer of hobnail cells, leading to the diagnosis of mesonephric adenocarcinoma of urethral diverticulum. Postoperative radiation therapy was given because the diverticulum was adherent to the pubic bone, though lymph node metastasis was negative. She has been well with no evidence of the disease for 1 year and 4 months after the operation. Although the histogenesis of female urethral mesonephric adenocarcinoma was still controversial, this case seems to be the forty fourth case in the world literature.

Adult↗
PubMed2002

[Multiple synchronous primary malignant tumors of fibrosarcoma and squamous cell carcinoma in the urinary bladder: a case report].

A 65-year-old housewife presented with a diagnosis of malignant spindle cell tumor of the bladder which had been diagnosed by work up for chance hematuria. Urine cytology revealed a small number of squamous epithelial cells showing dyskeratosis but no spindle cells. Computed tomography and magnetic resonance images showed a markedly enhanced mass, 4 cm in diameter, on the anterior wall of the urinary bladder, which appeared to be adhesive to the pubic bone. However, no metastasis was found. Under the suspicion of sarcoma of the urinary bladder, we performed anterior pelvic exenteration with construction of an ileal conduit. Although the anterior wall of the urinary bladder was mildly adhesive to the pubic bone, the surgical margin was negative for malignant cells. The tumor corresponded to a fibrosarcoma that infiltrated the adipose tissue surrounding the urinary bladder. The entire mucosa of the bladder showed diffuse squamous metaplasia, and well differentiated squamous cell carcinoma with pearl formation was found in part. These two malignant tumors were clearly apart from each other, resulting in the histologic diagnosis of synchronous multiple malignant tumors of the bladder. The patient developed a local relapse and pulmonary metastasis of fibrosarcoma one month postoperatively and died two month later without any response to chemotherapy (CYVADIC) and radiotherapy. The current case seems to be the first one in Japan (third in the world) of a patient with multiple synchronous primary malignant tumors, carcinoma and sarcoma, airsing in the urinary bladder.

Aged↗
PubMed1995

Transrectal and transperineal sonography during guided intrauterine procedures.

Transrectal sonography was used to provide intraoperative guidance for dilatation and curettage and placement of intrauterine tandem apparatus in 20 patients in whom the external cervical os could not be visualized adequately. Transrectal sonography was found to be useful in providing guidance for these procedures and at the same time helped avoid uterine perforation. This method also was used during cerclage placement in two patients who had undergone several conizations. Transperineal sonography was used in three patients whose area of abnormality was best approached transperineally. These cases included transvaginal biopsy of a metastatic trophoblastic tumor and one guided aspiration of a perirectal abscess after pelvic exenteration. The potential advantages and pitfalls in the intraoperative use of transrectal and transperineal sonography for guided intrauterine procedures are discussed and illustrated.

Abscess↗
PubMed1999

[Treatment of post-operative recurrence of colorectal cancer].

The survival rate of patients with colorectal cancer is fairly good after curative surgery. Approximately 80 and 75% of patients suffering from colo-rectal cancer survive for 5 years after curative operation, respectively. However, 30% of patients experience recurrence (mainly liver, lung, and local lesions) postoperatively. Resection of the recurrence is carried out in an attempt to achieve prolonged survival. Thirty percent to 40% of patients survive after curative surgery for liver metastases and 35% to 45% after that for lung metastases. Total pelvic exenteration is performed in patients with local recurrence of rectal cancer and 30% to 40% survive for 5 years. However, for patients with unresectable recurrence, chemotherapy and radiation contribute to a better quality of life and prolonged survival. A 70% response rate is achieved in patients with liver metastases after continuous infusion chemotherapy into the hepatic artery. Currently, the most important factor in achieving prolonged survival after colorectal surgery is to follow patients carefully in order to detect recurrence as early as possible. In the treatment of recurrence, the possibility of curative surgery, a combined treatment strategy and the quality of life of patients must be considered.

Colorectal Neoplasms↗
PubMed1999

Cryosurgery: adjuvant treatment at the time of resection of a pelvic recurrence in rectal cancer.

We report a case in which cryosurgical ablation was used to treat recurrent rectal cancer. Several years after low anterior resection for rectal cancer, the patient was found to have a large pelvic recurrence with involvement of the presacral space. After resection of the pelvic mass, cryosurgery was applied to the presacral space, extending to the lateral pelvic wall and up to the sacral promontory. After a 24-month follow-up, the patient remains disease-free with a Karnofsky performance status of 100 per cent. Cryosurgery can be used as an adjuvant therapy at the time of resection to successfully treat a pelvic recurrence.

Adenocarcinoma↗
PubMed2000

Orthotopic bladder substitution in women using the ileal neobladder.

Before 1990, orthotopic bladder substitution was limited to men and urethrectomy was routinely performed in women--making orthotopic reconstruction impossible. Following studies on pelvic exenteration for transitional cell bladder cancer patients, and after anatomic studies of the female urethra, the first report on orthotopic bladder substitution was published in 1994. Here, we present our ileal neobladder technique, which was applied for the treatment of bladder cancer in three women, and sigmoid colon cancer with vesical metastasis in one woman. This surgical procedure preserves the urethral sphincter, the endopelvic fascia, and the pubourethral ligaments. The innervation of the sphincter is also maintained. A 45-cm segment is isolated from the distal ileum and arranged in a W-shaped configuration. An anastomosis between the ileal bladder and the urethra is made and an antireflux ureteroileal implantation is created. Postoperatively, all patients reported daytime continence. The average urinary flow rate was 13.5 +/- 2.1 mL/sec 3 months after surgery. The reservoir had low pressure and high capacity. There was no reflux or deterioration of renal function. In properly selected female patients undergoing radical cystectomy, an ileal neobladder is now an option.

Aged↗
PubMed2000

[Local recurrence after radical surgery for rectal carcinoma].

The incidence rate of local recurrences after radical operative treatment of rectal carcinoma and the risk factors involved, methods of early diagnosis and surgical therapeutic approach are comprehensively analyzed. Reference is also made to 86 scientific publications on the issue. During the 20-year follow-up period, no tendency of the incidence of local rectal carcinoma relapses to decrease is noted. The risk factors contributing to their occurrence are distributed in two groups depending on the primary tumor characteristics (location, stage of development, locoregional spreading, differentiation degree, genetic features), and operative intervention used (type, distal resection line, application of total mesorectal excision, extensive minor-pelvis lymph dissection etc.). The early diagnosis is based on mandatorily performed procedures, such as rectoscopy (coloscopy), endo-ultrasonography with purposeful thin-needle biopsy, assessment of tumor markers and immunoscintigraphy. The surgical tactics in coping with a local recurrence of rectal carcinoma becomes increasingly aggressive and radical by resorting to re-resection, abdomino-perineal extirpation, en-bloc resections and even minor pelvic exenteration. Postoperative 5-year survivorship amounts to 54.5 per cent.

Digestive System Surgical Procedures↗
PubMed2001

Use of a urethral occlusion device for treatment of incontinence in a patient with heterotopic urinary diversion.

Incontinence is a frequent complication of continent cutaneous urinary diversion that usually requires surgical intervention for correction. We report a novel nonsurgical therapy for reservoir incontinence in a woman who underwent anterior pelvic exenteration with formation of an Indiana pouch urinary diversion for treatment of adenocarcinoma of the urethra. When she subsequently developed urinary incontinence that was only partially responsive to anticholinergic therapy, stomal continence was restored by using a disposable urethral occlusion device.

Adenocarcinoma↗