Fistula between degenerated uterine leiomyoma and the bladder: case report.

Most common reason for the vesicouterine fistula is a cesarean section; no cases were reported of degenerated uterine leiomyoma communicating with the urinary bladder. We report a case of fistulous communication between the degenerated leiomyoma and the bladder. The patient's initial clinical presentation was consistent with recurrent UTI. She underwent multiple examinations including cystoscopy, cystouretrography, retrograde pyeolography, and MRI. The ultimate treatment was an exploratory laparotomy and en-block resection of the bladder wall, fistula tract, and degenerated leiomyoma. Fistula can develop between the bladder and degenerated leiomyoma and could be one of the reasons for the chronic pelvic pain and dysuria.

Early Diagnosis of a Small Adenocarcinoma in a Rectovaginal Fistula Related to Crohn's Disease.

While adenocarcinomas have occasionally been reported in perianal fistulae, malignant changes occurring in rectovaginal fistulae are rare, with only a handful of reported cases. We report a 73-year-old woman with Crohn's disease who was diagnosed at an early stage with adenocarcinoma in a rectovaginal fistula. This rare disease poses many diagnostic challenges.

Brain metastasis in two patients with stage IA papillary serous carcinoma of the uterus.

We report two cases of brain metastasis in patients initially diagnosed with extremely early stage UPSC after extensive staging surgery. They did not receive either adjuvant chemotherapy or adjuvant pelvic or vaginal cuff radiation. At the same time that these patients were diagnosed with systemic metastasis, they both had a local "drop" metastasis in the vulva or the vaginal cuff. After the initial response to palliative chemotherapy, they both developed brain metastasis. The pattern of recurrence with the lack of adjuvant treatment underscores the urgent need in further evaluation of the potential benefits of adjuvant treatment, including chemotherapy and possibly in combination with radiation in this highly aggressive disease.

Cervicovaginal cytology and diagnosis of ovarian or peritoneal cancer: case report and literature review.

BACKGROUND: The characteristics of women presenting with asymptomatic ovarian or peritoneal cancer diagnosed following evaluation for abnormal cervicovaginal cytology are currently undefined. CASE: We present a case of a 51-year-old woman with asymptomatic stage IIIC ovarian cancer whose diagnosis was triggered by evaluation for adenocarcinoma and atypical glandular cells of undetermined significance (AGUS) on cervical cytology. We also present a case of a 53-year-old woman with AGUS cervical cytology on two occasions, found to have stage III peritoneal cancer at exploratory laparotomy. CONCLUSION: We conducted a systematic search for articles to enable a review of asymptomatic cases of ovarian and peritoneal cancer, which presented via abnormal cervicovaginal cytology. The mean age at presentation with peritoneal cancer was 47.8 years old, which is similar to that of ovarian cancer of 50.5 years. Staging was provided in 13 cases, 11 of which (85%) were at least stage IIIA or greater. In terms of age greater than 50 years old, cervicovaginal cytology interpreted as AGUS, having a negative initial work-up, and advanced disease stage at presentation, the two cases presented are consistent with the literature. Abnormal cervicovaginal cytology as a presenting diagnostic criterion of cancer of the ovary or peritoneum is often representative of advanced disease.

Recurrent benign metastasizing leiomyoma after hysterectomy and bilateral salpingo-oophorectomy.

BACKGROUND: Benign uterine leiomyomas are sometimes found in association with benign smooth muscle tumors outside the confines of the uterus and are given the name benign metastasizing leiomyomas (BML). We present two patients who were on estrogen replacement therapy, in which BML recurred twice despite previous hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO) requiring two additional laparotomies. PATIENTS: Our patients, presented with multiple abdominal masses 6 years after their initial surgery for benign leiomyoma. At exploratory laparotomy multiple benign leiomyomas were resected, and in one case a 2.2 cm leiomyoma was also resected from the left lower lobe of the lung. Both patients had a third laparotomy for another abdominal recurrence approximately 2 years later. RESULTS: Pathology revealed benign leiomyomas with no cytological atypia and a mitotic count of <5 per 10 high power fields (hpf). CONCLUSION: Benign metastasizing leiomyoma rarely follow TAH/BSO in patients with uterine myoma and estrogen replacement therapy may play a role in such occurrence. Despite surgery to remove these tumors, they can still recur; therefore, there is need for prolonged surveillance in such patients after resection.