RESUMEN
Little is known about the anatomic and physiologic changes in the pelvic floor that occur during pregnancy. The purpose of this study was to prospectively document pelvic organ support throughout pregnancy using the standardized system of the International Continence Society, also known as the Pelvic Organ Prolapse Quantification (POPQ) Staging System. Pelvic organ support evaluations were performed in nulliparous pregnant women presenting for routine obstetric care during each trimester. POPQ stage assignments and POPQ component measurements were compared for first-, second- and third-trimester examinations. Overall POPQ stage was significantly higher in the third trimester than in the first (P=0.001). Individual POPQ points which showed significant differences between the first and third trimesters include Aa, PB, Ap, Ba, Bp, TVL and GH. These findings probably represent normal physiologic changes of the pelvic floor during pregnancy, but suggest that significant changes may be objectively demonstrated prior to delivery.
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Diafragma Pélvico/fisiología , Embarazo/fisiología , Adulto , Femenino , Humanos , Personal Militar , Paridad , Estudios Prospectivos , Factores de Riesgo , Prolapso Uterino/fisiopatologíaRESUMEN
BACKGROUND: There are few reported cases of adenocarcinoma of unknown primary site (ACUPS) presenting with Trousseau's syndrome, and no cases presenting as an isolated retroperitoneal pelvic mass. CASE: This is a case of a 36-year-old woman who presented with an isolated "pelvic" mass and Trousseau's syndrome. The patient underwent abdominal hysterectomy and bilateral salpingo oophorectomy with resection of the retroperitoneal lymph nodes. Surgical findings included normal-appearing uterus, fallopian tubes, and ovaries, with bilaterally enlarged pelvic lymph nodes. Pathology was positive for adenocarcinoma only in the pelvic lymph nodes. Uterine, ovarian, and fallopian tube final pathologies were negative for malignancy. Postoperative metastatic survey was negative, and the patient was diagnosed with ACUPS. The patient received adjuvant chemotherapy consisting of etoposide, carboplatin, and taxol. The patient died 18 months after diagnosis. CONCLUSION: This case reminds us that ACUPS can present as Trousseau's syndrome and rarely as an isolated retroperitoneal pelvic mass.
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Adenocarcinoma/complicaciones , Neoplasias Primarias Desconocidas/complicaciones , Neoplasias Retroperitoneales/complicaciones , Trombosis de la Vena/etiología , Adenocarcinoma/tratamiento farmacológico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Resultado Fatal , Femenino , Humanos , Neoplasias Primarias Desconocidas/tratamiento farmacológico , Neoplasias Retroperitoneales/tratamiento farmacológico , SíndromeRESUMEN
BACKGROUND: Ewing sarcoma is a highly malignant childhood bone neoplasm. Extraosseous presentations of Ewing sarcomas include the trunk, extremities, uterus, cervix, and vagina. CASE: A 35-year-old woman, gravida 3, para 3, presented with a painless vaginal mass. After surgical excision, pathology results diagnosed an extraosseous Ewing sarcoma. Chemotherapy was given, followed by external beam and vaginal intracavitary brachytherapy, then more chemotherapy. After 48 months post-treatment, there is no clinical evidence of recurrence. CONCLUSION: Although rare, Ewing sarcoma can present as a vaginal mass.
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Sarcoma de Ewing/patología , Neoplasias Vaginales/patología , Adulto , Femenino , Humanos , Sarcoma de Ewing/terapia , Neoplasias Vaginales/terapiaRESUMEN
OBJECTIVE: Intraoperative lymphatic mapping and sentinel lymph node identification (SLN) have been increasingly evaluated in the treatment of a variety of solid tumors, particularly breast cancer and melanoma. We sought to evaluate the feasibility of these procedures in patients undergoing radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer. METHODS: Twenty patients with normal-appearing lymph nodes underwent intracervical injection of isosulfan blue dye (lymphazurin 1%) at the time of planned radical hysterectomy and bilateral pelvic/low paraortic lymphadenectomy (40 nodal basins). Regional lymphatic tissue was inspected for dye uptake into lymphatic channels and lymph nodes. Tumor characteristics, surgical findings, and specific locations of lymphatic dye uptake were recorded and correlated with final pathology results. RESULTS: Sentinel lymph nodes were identified in 12 of 20 (60%) patients. A total of 23 sentinel nodes were identified in 17 of 40 (43%) nodal basins dissected (range: 0-2 per basin). Successful SLN identification was less likely in patients with tumors >4 cm compared with those with tumors =4 cm (P = 0.035). Of 4 patients with metastatic nodal disease, 3 had tumor involving a SLN; the fourth had no identifiable SLN (inadequate study). In all, 3 of 8 lymph nodes with confirmed metastatic disease were identified using this technique. CONCLUSION: SLN identification and intraoperative lymphatic mapping are feasible and safe. Lymphatic dye uptake appears to be less reliable in patients with larger tumors. Although sentinel node pathology was representative of the lymphatic basin sampled in all cases, the rate of SLN identification was low with this technique. Lymphatic mapping procedures should be further investigated in the treatment of early cervix cancer.
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Ganglios Linfáticos/patología , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Histerectomía , Cuidados Intraoperatorios , Escisión del Ganglio Linfático , Metástasis Linfática , Persona de Mediana Edad , Pelvis , Proyectos Piloto , Biopsia del Ganglio Linfático CentinelaRESUMEN
OBJECTIVE: TSG101 was first described as a possible tumor suppressor gene in breast cancer. To determine whether TSG101 might play a role in cervical carcinogenesis, we examined a panel of cervical cancer cell lines and primary tumor specimens for transcript abnormalities and mutations in TSG101. METHODS: Total RNA was derived from cell line cultures or primary tumor specimens. We performed nested reverse transcription polymerase chain reaction (RT-PCR) with eight overlapping primer sets, followed by single-strand conformational polymorphism (SSCP) analysis, to screen for mutations in the TSG101 open reading frame. Representative normal and shifted SSCP bands were sequenced. To identify abnormal-sized transcripts, we performed RT-PCR with primers flanking the open reading frame followed by gel electrophoresis. RESULTS: Mutational analysis was performed on cDNAs from 20 primary cervical tumors and 8 cervical carcinoma cell lines. Two polymorphisms were identified, neither of which resulted in an altered amino acid sequence. Transcript analysis was performed on a subset of 16 primary cervix tumors and 6 cervix carcinoma cell lines. The wild-type transcript (1228 bp) was the dominant transcript expressed in all samples. A transcript measuring 330 bp was detected in 5 of 6 cell lines and 11 of 16 primary tumor specimens. CONCLUSION: Our results suggest that mutations in TSG101 rarely occur in carcinomas of the uterine cervix. However, the presence of minor aberrant TSG101 transcripts is a common feature. The relationship between aberrant transcription and carcinogenesis should be further investigated.
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Ácido Anhídrido Hidrolasas , Proteínas de Unión al ADN/fisiología , Genes Supresores de Tumor , Proteínas de Neoplasias , Factores de Transcripción/fisiología , Neoplasias del Cuello Uterino/etiología , Mapeo Cromosómico , Cromosomas Humanos Par 11 , Proteínas de Unión al ADN/análisis , Proteínas de Unión al ADN/genética , Complejos de Clasificación Endosomal Requeridos para el Transporte , Femenino , Humanos , Mutación , Sistemas de Lectura Abierta , Proteínas/genética , Factores de Transcripción/análisis , Factores de Transcripción/genética , Células Tumorales CultivadasRESUMEN
OBJECTIVE: Patients with severe preeclampsia and the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) are at increased risk for perinatal and maternal morbidity, especially in very preterm gestations. When this condition affects a pregnancy on the cusp of viability, a therapeutic intervention to prolong gestation without undue risk to the mother or fetus could be beneficial. METHOD: A single case report and review of the literature. RESULT: We report a patient with HELLP syndrome in whom antenatal administration of high-dose dexamethasone helped achieve disease stabilization and delivery postponement for 9 days of a very preterm fetus estimated to weight less than 600 g. Both mother and infant did well postpartum. CONCLUSION: Administration of antenatal high-dose dexamethasone can be used in carefully selected preterm patients with HELLP syndrome to delay delivery while in utero fetal maturation is accelerated and the maternal condition is optimized. This can be beneficial in carefully selected pregnancies without apparent adverse maternal or perinatal impact.
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Antiinflamatorios/uso terapéutico , Dexametasona/uso terapéutico , Síndrome HELLP/complicaciones , Trabajo de Parto Prematuro/complicaciones , Trabajo de Parto Prematuro/prevención & control , Adulto , Femenino , Síndrome HELLP/sangre , Humanos , L-Lactato Deshidrogenasa/sangre , Recuento de Plaquetas , Embarazo , Factores de Riesgo , Factores de TiempoRESUMEN
The purpose of this study was to determine the efficacy of adenovirus-based p53 gene therapy in the treatment of ovarian cancer using an intraperitoneal microscopic tumor animal model system. Adenovirus-mediated wild-type p53 gene was introduced into the NIH:OVCAR-3 human ovarian cancer cell line in vitro and in vivo. In order to study microscopic intraperitoneal tumor, athymic nude mice were inoculated intraperitoneally (i.p.) with 1 x 107 OVCAR-3 cells and observed for tumor growth. Three days after inoculation with OVCAR-3 cells, the mice were divided into 3 treatment groups. One group received three daily i.p. injections of 1 x 108 pfu Ad-CMV-p53, a second group received three daily i.p. injection of 1 x 108 pfu of the control adenovirus construct expressing beta galactosidase (Ad-CMV-betagal) and a third group received three daily i.p. injections of normal saline. Adenovirus-mediated introduction of the wild-type p53 gene in the ovarian cancer cell line resulted in transient high levels of p53 protein for 24-48 h. Cell cycle analysis revealed G1 arrest, as well as the appearance of apoptosis. In vitro cell growth assays showed growth inhibition of cancer cells infected with Ad-CMV-p53 compared to cells infected with Ad-CMV-betagal or normal saline. There was a significant increase in survival in the Ad-CMV-p53 adenovirus treated animals compared to the PBS treated animals (P = 0.004). Likewise, the survival in Ad-CMV-p53 treated mice was also significantly greater than mice treated with Ad-CMV-betagal (P < 0.0001). These results demonstrated that Ad-CMV-p53 treatment is effective in inhibiting tumor growth and prolonging survival in this microscopic cancer xenograft model. The results of this study constitute a step in translating promising in vitro and in vivo data from an adenovirus-based gene therapeutic model system into practical and scientifically based human cancer therapeutic trials.
RESUMEN
BACKGROUND: Chromosome 3p14.2 contains FRA3B, the most active chromosome breakage site in the human genome. The fragile histidine triad (FHIT) gene, a putative tumor suppressor gene, overlaps FRA3B. Human papillomavirus (HPV), a known cofactor in cervical carcinogenesis, can integrate into FRA3B. We examined abnormalities in FHIT and its RNA transcripts in cervical cancer cell lines and tumors. We also investigated the relationship between loss of heterozygosity (LOH) in FHIT/FRA3B and the presence of oncogenic HPV types. METHODS: Eleven cell lines, 40 tumors (20 fresh and 20 archival), and 10 normal cervical epithelia were examined. Two intragenic polymorphic markers (D3S1300 and D3S4103) and the polymerase chain reaction (PCR) were used to examine FHIT LOH. Reverse transcription-PCR (RT-PCR) analysis and single-strand conformation polymorphism analysis of RT-PCR products were used to characterize FHIT transcripts. Oncogenic HPV types were identified by PCR, using general and type-specific primers. RESULTS: All normal epithelia, 19 of 20 fresh tumors and nine of 11 cell lines expressed wild-type and, occasionally, exon 8-deleted FHIT transcripts. Additional aberrant FHIT transcripts were seen in nine of 20 fresh tumors and in seven of 11 cell lines. DNA sequencing of the aberrant transcripts revealed a variety of insertions and deletions but no point mutations. Three cell lines also had homozygous FHIT deletions. Oncogenic HPV types (i.e., 16, 18, 31, and 33) were detected in 18 of 20 archival tumors, and, in these tumors, LOH within FHIT was identified in nine of 16 informative cases. HPV 16 was found to be associated with LOH in the FHIT/FRA3B region (P = .041). CONCLUSION: FHIT/FRA3B is frequently altered in cervical cancer, demonstrating LOH, occasional homozygous deletions, and frequent aberrant transcripts not found in normal epithelia. However, the presence of wild-type transcripts and the lack of protein-altering point mutations raise questions about FHIT's function as a classic tumor suppressor gene in cervical tissue.
Asunto(s)
Deleción Cromosómica , Fragilidad Cromosómica , Cromosomas Humanos Par 3/genética , ADN Complementario/genética , ADN de Neoplasias/genética , Infecciones por Papillomavirus/complicaciones , Infecciones Tumorales por Virus/complicaciones , Neoplasias del Cuello Uterino/genética , Neoplasias del Cuello Uterino/virología , Femenino , Heterocigoto , Humanos , Papillomaviridae , Reacción en Cadena de la Polimerasa/métodos , Polimorfismo Conformacional Retorcido-Simple , Transcripción Genética , Células Tumorales CultivadasRESUMEN
BACKGROUND: Intraamniotic infection may be caused by a wide variety of microorganisms. Significant maternal and neonatal morbidity have been associated with both subclinical and clinical infection. CASE: We identified a case in which Pseudomonas aeruginosa was isolated as the cause of intraamniotic infection, fulminant neonatal sepsis and neonatal death. CONCLUSION: Though P aeruginosa is an unusual cause of intraamniotic infection, it is important because of its high virulence.