Pelvic exenteration for recurrent or persistent cervical cancer: experience of five years at the National Cancer Institute in Mexico.

Cervical cancer constitutes a major health problem in Mexico and other developing countries. The purpose of our study was to assess the experience of a comprehensive national oncological reference center on pelvic exenteration for post-radiotherapy recurrent or persistent cervical cancer, describing the prognostic value of time to recurrence, procedure complications, and survival. Medical records from 42 patients with post-radiotherapy recurrent or persistent cervical cancer who underwent a pelvic exenteration with curative purposes from 1984 to 1989 were retrospectively reviewed. Histological diagnoses were squamous cell carcinoma (32 patients), adenosquamous carcinoma (9 patients), and adenocarcinoma (1 patient). Average follow up was of 56.3 mo after the procedure and global survival at 5 yr was 65.8%. Survival for patients with early recurrence was 56.9% vs 78% for patients with late recurrence (p = 0.05). Complications were observed in 65.3% of the cases with a surgical mortality of 4.8%. Pelvic exenteration is a surgical procedure with high morbidity in spite of the recent medical advances. Pelvic exenteration should not be indicated with palliative purposes owing to the high rate of complications. Patients with tumor persistence or early recurrence have a worse prognosis. In well-selected cases, exenteration may provide a survival benefit.

[Experience with 14 cases of pancreatic pseudocyst]. / Experiencia con 14 casos de pseudoquiste pancreático.

INTRODUCTION: Pseudocyst of the pancreas (PP) develops in 2 to 5% the cases of acute pancreatitis (AP). Most cases of PP regress spontaneously. PP has been misdiagnosed as a malignant pancreatic cyst neoplasm, reason why the patients are referred to specialized institutions. OBJECTIVE: To describe the cases of PP treated in a 15 year-period. MATERIAL AND METHODS: Review of clinical records of 14 cases treated from 1975 to 1989. RESULTS: There were 5 men (36%) and 9 women (64%) Mean age was 41 years (range 18 to 77). In 50% of the cases the patient had a history of severe alcoholic abuse, cholelithiasis in 28% and abdominal trauma in 15%. Five patients (35%) had AP. The period between AP symptoms and the diagnosis of PP was a mean of 5.7 months. Abdominal pain and abdominal mass were present in all of the cases, in all cases, ultrasonography and CT scan made the diagnosis of PP. Thirteen cases were treated by surgery, 12 with internal drainage, one by resection and one by external drainage. An enterocutaneous fistula (7%) was recorded in one case. There were no operative mortality. The mean follow-up time was of 10 years and 4 months. CONCLUSIONS: PP is a uncommon pathology in oncologic centers. Internal drainage was the most frequent treatment. The diagnosis of cystic neoplasms of the pancreas should be ruled out.

Intracardiac extension of malignant uterine tumors. Echocardiographic detection and successful surgical resection.

The echocardiographic findings of two unusual cases of malignant uterine tumors that invaded the heart are reported. A woman previously operated on for invasive cervical carcinoma had multiple embolic phenomena and evidence of obstruction to mitral flow. An echocardiogram showed a mass in the left atrium that reached the mitral valve ring. The tumor was implanted in a pulmonary vein and was removed with no complications. Cell type indicated metastatic carcinoma of the cervix. In the second case the patient had a large abdominal mass and precordial manifestations of obstruction and regurgitation of the tricuspid valve. An echocardiogram showed that a mass emanating from the inferior vena cava filled the right atrium and part of the right ventricle. The trajectory of the tumor was followed to its origin in an ovarian vein by tomography. The entire tumor was removed and identified as endometrial stromal sarcoma. An increase in operations with or without radiation therapy for malignant tumors has augmented the frequency of metastatic invasion of the heart; intracavitary extension tends to results from embolization or propagation along great veins. This is the first report of a uterine carcinoma reaching the heart by way of the pulmonary veins and of invasion of the heart by endometrial stromal sarcoma, both with successful excision.