Teratoma in pregnancy: a case report.

BACKGROUND: Mature teratoma is a common complication of pregnancy. To the best of the authors' knowledge this is the largest teratoma in pregnancy documented in the literature. CASE: A 19-year-old woman, gravida 1, at 14 weeks' gestational age with a 37-cm fundal height, was found to have a 30 x 28 x 17 cm mass on ultrasound. She underwent an exploratory laparotomy, and a teratoma was excised. CONCLUSION: A teratoma that could limit the growth of an intrauterine pregnancy, is suspected for rupture or torsion, is causing severe pain, and/or may be suspicious for malignancy should be excised.

Genomic-directed targeted therapy increases endometrial cancer cell sensitivity to doxorubicin.

OBJECTIVE: We aimed to utilize genome-wide expression analysis to identify molecular pathways that may contribute to endometrial cancer resistance to doxorubicin (DOX) and that also represent therapeutic targets to increase DOX sensitivity. STUDY DESIGN: Ten endometrial cancer cell lines were subjected to gene expression analysis. Sensitivity of each endometrial cell line to DOX was quantified by dimethylthiazoldiphenyltetrazoliumbromide cell proliferation assay. Pearson's correlation test was used to identify genes associated with response to DOX. Genes associated with DOX responsiveness were analyzed, and identified pathways were subjected to targeted inhibition. RESULTS: Pearson's correlation analysis identified 2871 genes associated with DOX resistance (P < .05), which included members of the Src pathway. Targeted inhibition of the Src pathway increased DOX sensitivity in RL 95-2 (P < .0001), HEC 1B (P < .001), MEF 296 (P < .05), and MEF 280 (P = .14) cell lines. CONCLUSION: Genomic analysis can identify therapeutic targets such as the Src pathway that may influence endometrial cancer DOX sensitivity.

Placenta increta and cocaine abuse in a grand multipara leading to a second trimester rupture of an unscarred uterus: a case report.

A case of a uterine rupture in a grand multiparous patient with an unscarred uterus at 19 weeks' gestation secondary to placenta increta and cocaine abuse is presented. This was a diagnostically difficult case where abnormal implantation of the placenta, grand multiparity, and cocaine abuse were all contributors to the uterine rupture.

The accuracy of frozen pathology at time of hysterectomy in patients with complex atypical hyperplasia on preoperative biopsy.

OBJECTIVE: The purpose of this work was to estimate the accuracy of frozen pathologic analysis, compared with final pathological diagnosis in patients with a preoperative diagnosis of endometrial complex atypical hyperplasia (CAH). STUDY DESIGN: We performed a retrospective review of frozen and final pathology in patients with a preoperative diagnosis of CAH from January 1987 through August 2004. Clinical and pathological information was obtained from patient charts. RESULTS: We identified 23 of 41 patients with diagnosis of CAH who had a frozen section. Nine of the frozen pathology results (39.1%) correlated with the final pathological diagnosis. In 14 of 23 of the cases (60.8%), the frozen and final pathology reports disagreed. Eight of 14 patients initially diagnosed with CAH by frozen section (57%) were diagnosed with endometrial adenocarcinoma on final pathology. CONCLUSION: Our data suggest that intraoperative frozen analysis of the endometrium is not a reliable indicator of final pathology in patients with a preoperative diagnosis of CAH.

Upper vaginectomy for the treatment of vaginal intraepithelial neoplasia.

OBJECTIVE: The purpose of this study was to evaluate the use of upper vaginectomy for the treatment of vaginal intraepithelial neoplasia (VAIN). STUDY DESIGN: We conducted a retrospective review. Between August 1, 1985 and April 30, 2004, 105 patients were identified who had undergone upper vaginectomy for VAIN. RESULTS: Thirty-six patients had previously been treated for VAIN. Mean operative time and estimated blood loss were 55 minutes and 113 mL, respectively. Ten percent had intraoperative complications. Twenty-three (22%) patients had negative findings on final pathologic examination, and invasive cancer was found in 13 (12%) patients. Four patients had postoperative complications. Follow-up was available in 52 patients; 46 (88%) remain without recurrence at a mean follow-up of 25 months. CONCLUSION: In our patients, upper vaginectomy was efficacious for the treatment of VAIN. The procedure led to the diagnosis of occult invasive cancer in 12% of these women.