Parapharyngeal Space Venous Malformation: An Imaging Mimic of Pleomorphic Adenoma.

Venous malformations in the parapharyngeal space are rare and may be challenging to diagnose with imaging secondary to multiple overlapping features with pleomorphic adenoma, which is much more commonly found in this region. While both lesions are T1 isointense and T2 hyperintense relative to skeletal muscle and demonstrate contrast enhancement, more uniform T2 hyperintensity and progressive contrast pooling on delayed postcontrast T1WI may allow the radiologist to include venous malformation in the differential diagnosis. This is important because it has the potential to alter management from surgical resection to observation. The primary aim of this study was to review the imaging appearance of parapharyngeal venous malformations through a retrospective case series.

Treatment of aggressive angiomyxoma with aromatase inhibitor prior to surgical resection.

Aggressive angiomyxoma (AA) is a rare, locally infiltrating soft tissue tumor typically located in the genital tract of young, reproductive age women. Surgical excision has been the mainstay of treatment. Recently, gonadotropin-releasing hormone agonist therapy has been reported to decrease the size of estrogen-receptor positive AA. We present the first case of a postmenopausal woman treated with an aromatase inhibitor to shrink the size of tumor prior to surgical resection.

Colonic perforation in unsuspected amebic colitis.

Unsuspected amebic colitis presenting as inflammatory bowel disease, as in our patient, has been previously reported (4, 7, 8). Misdiagnosis, delay in antibiotic treatment, and institution of immunosuppression were the result of failure to identify the parasite in stool specimens and have resulted in suffering, morbidity, mortality, and surgery. In all previously reported cases, routine stool studies failed to identify E. histolytica (4, 7, 8). The correct diagnosis was only established after reviewing the surgical specimen or biopsies obtained endoscopically. Because the erroneous diagnosis of inflammatory bowel disease can lead to disastrous complications, it is imperative to exclude amebic colitis prior to undertaking steroid therapy, especially in patients with a prior history of travel to or residence in areas with endemic E. histolytica (17). We recommend obtaining at least three stool specimens for microscopic examination, as well as testing for serum amebic antibody. Patients should submit fresh stool specimens directly to the laboratory to allow for prompt diagnostic evaluation. Such an approach might lead to the improved diagnosis of amebiasis.

Modified radical hysterectomy in the treatment of early squamous cervical cancer.

OBJECTIVE: The aim of this study was to evaluate the results of modified radical hysterectomy in the treatment of early cervical cancer. MATERIAL AND METHODS: A retrospective chart review of 56 patients with stage I (IA in 35, IB in 21) squamous cervical carcinoma treated with modified radical hysterectomy and followed for a minimum of 5 years (mean, 12 years; range, 5.1-29) was conducted. All pathology slides were reviewed for tumor size, grade, depth of invasion, and lymph-vascular permeation. RESULTS: The mean depth of invasion was 0.5 cm (range, 0.1-2.5 cm), and the mean tumor size was 1.1 cm (range, 0.1-7 cm). Only 3 patients (5.4%) had positive nodes. None of the patients with tumors 2 cm or less in size had positive nodes, whereas 33.3% of the patients with tumors more than 2 cm in size had positive nodes. A recurrence developed in 2 patients (5-year recurrence rate of 3.6%). There were 10 deaths during the entire follow-up period, but only 2 were related to cervical cancer. The disease-specific and overall 5-year survival rates were 96.4 and 94.6%, respectively. The disease-specific 5-year survival rate was 100% among the 47 patients with tumors 2 cm or less and 75% for the 9 patients with tumors larger than 2 cm. Univariate analysis identified stage, lymph node status, and tumor size as statistically significant prognostic factors for overall survival. Tumor grade, lymph-vascular permeation, and depth of invasion (1-3 mm vs >3 mm) were not statistically significant for overall survival. CONCLUSIONS: Modified radical hysterectomy appears to be effective surgical therapy for patients with squamous cervical carcinoma 2 cm or less in size.

Cost-effective evaluation of indeterminate urinary cytology.

PURPOSE: We reviewed our management of indeterminate urinary cytologies to determine which patients warrant urological evaluation. Our goal was to develop a cost-effective evaluation scheme that detects the most cancers. MATERIALS AND METHODS: We analyzed case histories of 389 patients with indeterminate urinary cytology who had undergone complete urological evaluations. Upper urinary tract imaging and cystoscopy were required to exclude malignancy, and tissue biopsy results were recorded in all individuals diagnosed with cancer. Multivariate analysis was used to assess the significance of clinical factors that would suggest the necessity of complete urinary system evaluation. Marginal cost-effectiveness rates were applied to various clinical scenarios. RESULTS: Of 389 patients 60 (15%) had urinary tract malignancy. A history of urothelial malignancy and hematuria were the only significant factors that suggested complete evaluation was necessary. If smoking history were included 59 of the 60 malignancies would have been detected. CONCLUSIONS: Patients with indeterminate urinary cytology who are nonsmokers and have neither hematuria nor a history of urothelial cancer are at low risk for malignancy and do not warrant complete evaluation.

Benign gynecologic conditions associated with a CA-125 level > 1,000 U/mL. A case report.

BACKGROUND: CA-125 was initially investigated as a marker of ovarian cancer. However, various studies have noted that it can be minimally elevated in benign conditions. CASE: A case of CA-125 > 1,000 U/mL was associated with benign gynecologic conditions. A 37-year-old woman with a history of endometriosis and premature ovarian failure underwent hormonal therapy for donor in vitro fertilization. After an unsuccessful cycle, severe dysmenorrhea developed. Investigation revealed a CA-125 level of 1,036 U/mL and a uterine mass. On exploratory laparotomy, cystic adenomyosis and uterine endometriosis was found. After excision of these areas, the CA-125 levels returned to normal. In this case, cystic adenomyosis and endometriosis of the uterine serosa were responsible for the elevated CA-125 level. CONCLUSION: Very high levels of CA-125 are not always associated with a malignant process.

Delayed mammary tumor progression in Muc-1 null mice.

The mucin gene, Muc-1, encodes a high molecular weight integral membrane glycoprotein that is present on the apical surface of most simple secretory epithelial cells. Muc-1 is highly expressed and aberrantly glycosylated by most carcinomas and metastatic lesions. Numerous functions have been proposed for this molecule, including protection of the epithelial cell surface, an involvement in epithelial organogenesis, and a role in tumor progression. Mice deficient in Muc-1 were generated using homologous recombination in embryonic stem cells. These mice appeared to develop normally and were healthy and fertile. However, the growth rate of primary breast tumors induced by polyoma middle T antigen was found to be significantly slower in Muc-1 deficient mice. This suggests that Muc-1 plays an important role in the progression of mammary carcinoma.