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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A rare case of primary stromal sarcoma of the vagina is reported. The age of the patient was 72 years. The presenting symptom was an increase in the size of the mass. Local excision, followed by radiotherapy. The patient succumbed to their disease by metastases in pelvis and lungs 6 months after diagnosis.
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PMID:[Stromal sarcoma of the vagina]. 260 88

Five cases of primary vaginal melanoma were treated at UCLA Medical Center between 1976 and 1986. Two additional cases of melanoma arising at the junction of the vulva and vagina are presented. One of seven (13%) patients is alive, with a median time to recurrence of 7 months, and median survival of 31 months. Four of five vaginal melanomas were located in the distal vagina, and all were advanced at diagnosis (greater than 3 mm depth). Mean size was 3 cm. Initial therapy was local excision in four patients and radical surgery in three. All patients had suboptimal surgical margins: two vaginal primaries had positive margins after local excision, both recurred vaginally within 5 months. Two patients had margins less than 1 mm, one died of distant metastases, the other is alive with disease 30 months after radical distal vaginectomy and hemivulvectomy with post-op pelvic radiotherapy. Three patients had melanoma in situ at the surgical margins, and each had pelvic recurrences between 6 and 26 months. Five of seven cases developed local recurrence as the initial site of treatment failure. All five vaginal cases ultimately developed distant disease, but only two patients had distant disease without local-regional recurrence. Chemotherapy and immunotherapy enabled disease stabilization in three patients. The vulvovaginal junction at the introitus is a high risk site for vaginal and vulvar melanoma. Intraoperative management requires assessment of lateral and deep spread of invasive and in situ melanoma.
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PMID:Vulvovaginal melanoma: report of seven cases and literature review. 264 20

Five patients with a diagnosis of rectal carcinoma were examined by magnetic resonance and computerized tomography (CT) to determine if magnetic resonance imaging (MRI) added any information to that obtained by computerized tomography. In each case, the imaging studies agreed with the surgical description of the tumor. The studies agreed on the presence of perirectal fat invasion and tumor position. Both modalities were positive for involved lymph nodes in the patient with metastatic disease to pelvic nodes, but both studies underestimated the number of nodes involved. These five cases were examined using two magnetic resonance scanners. The older one operated at 0.3 tesla (T) while the newer scanner operated at 1 T. Spatial resolution was improved with the newer scanner. In addition, the difference in signal intensity between tumor tissue and normal tissue was greater on the 1 T scanner. Tissue differentiation was useful in one case in which CT suggested extension of tumor into the vagina. The extension was confirmed on the MRI scan.
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PMID:Magnetic resonance imaging of rectal carcinoma. 272 60

Diagnostic imaging is important in differentiating benign and malignant pelvic tumors and in staging malignant tumors. Many imaging techniques are now available. We describe computed tomographic (CT) and magnetic resonance imaging (MRI) features of gynecologic tumors. The following nine CT parameters were evaluated in 251 cases of cervical cancer (the incidence of each feature is given in parentheses): 1) enlargement of the cervix (58%), 2) low density area(s) (LDA) in the cervical region (28%), 3) presence of a necrotic cavity (11%), 4) pyometra (16%), 5) irregularity or indistinctness of the cervical margin (20%), 6) abnormalities of the parametrium (41%), 7) tumor extension to the vagina (9%), 8) tumor extension to the bladder (20%), 9) lymphadenopathy (8%). The more advanced the stage, the more features tended to be present. On T2-weighted MRI, cervical cancer appeared as a high intensity image. There was a positive correlation (r = 0.79) between MRI and pathologic findings concerning the thickness of the residual cervical myometrium. MRI was distinctly useful in both the staging of cervical cancer and the determination of the extent of tumor invasion of the vagina and bladder. We used three criteria to classify patients with endometrial cancer, which appeared as LDA within the uterus on contrast enhanced CT: 1) LDA occupied less than 50% of the uterine region, 2) the minimum thickness of the normal myometrium was over 0.5 cm, 3) the ratio of maximum to minimum thickness of the normal myometrium was over 0.5. Patients who fulfilled all three criteria constituted group A (n = 33), and those who failed to meet all three were designated group B (n = 30). The rates of myometrial invasion through more than one third the thickness of the uterine wall were 15% in group A and 90% in group B. The rates of lymphatic or vascular invasion were 15% and 57%, respectively, and of extrauterine invasion or metastasis 9% and 47%. Each of these differences was significant (p less than 0.01). Metastasis was detectable by CT in four group B patients. On T2-weighted MRI, endometrial cancer exhibited high intensity. A positive correlation (r = 0.94) was obtained between MRI data and pathologic findings concerning the thickness of residual normal myometrium. Preoperative differentiation of benign and malignant ovarian tumors is important.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Role of X-ray CT and magnetic resonance imaging in the diagnosis of gynecological malignant tumor]. 280 44

The paper is concerned with the results of interstitial radiotherapy of 31 patients aged 30 to 76. Of them 18 patients had recurrences or metastases to the vagina, 9 patients--vulvar cancer, 4 patients--vaginal cancer. Interstitial radiotherapy with Co and 252Cf sources was used. A method of successive manual administration of intrastats and ionizing radiation sources was employed. The chief modality was interstitial radiotherapy supplemented with teletherapy or application gamma-beam therapy taking into account the time and doses of previous radiotherapy. Complete tumor regression was observed over time (4-27 mos.) in 23 (74.2%) of 31 patients. Radiation effects were manifested in hyperemia, edema of the mucous membrane and filmy epitheliitis at the site of administration of radioactive sources. Interstitial therapy can be a method of choice for a certain group of patients, especially in case of a limited tumor without infiltration to the adjacent organs.
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PMID:[Interstitial irradiation of malignant neoplasms of the female genitalia]. 281 27

From 1964 to 1980, 97 patients with Stage IIb carcinoma of cervix uteri were treated by external 60Co irradiation alone. Of these 97 patients, 94 (96.9%) had squamous cell carcinoma. The parametrial extension of the lesion almost reached the pelvic wall in 73.2% and vaginal extension reached to the upper half of vaginal in 24.7% of the patients. A tumor dose of 60 Gy was given to the whole pelvis by a four field technic (opposing parallel AP and lateral portals) in 6-8 weeks. A booster dose of 10 Gy was delivered to the cervix by a pair of reduced opposing parallel AP portals or a perineal portal in a week. The doses delivered were equivalent to the Time-Dose-Fractionation (TDF) value of 110-130 at the center of pelvis and 90-110 in the whole pelvis. The 5-year survival rate for all 97 patients was 56.7%. It was 59.8% when those who died of other diseases were excluded. The prognosis of patients without residual tumor on the cervix and/or vagina was better than that with residual tumor (p less than 0.01). Thirty-seven patients died of cancer (23 died of recurrence, 8 of distant metastases, 2 of both, and 4 were lost before the fifth year). Of these 37 patients, 97.3% died within 3 years after initial treatment. During the radiation treatment, reactions were moderate. Late complications included 19 (19.6%) with mild cystitis and 16 (16.5%) with mild proctitis, 2 (2.7%) developed recto-vaginal fistula. These results were slightly poorer than those using intracavitary and external irradiation or the combination of preoperative irradiation plus surgery. Yet, for patients with extensions nearing the pelvic wall or with contra-indications to surgery or intracavitary radiotherapy, external irradiation alone is still of value.
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PMID:External cobalt 60 irradiation alone for stage IIB carcinoma of the uterine cervix. 292 Nov 35

Seventy-three patients with metastatic high-risk gestational trophoblastic disease were treated with methotrexate, actinomycin D, and cyclophosphamide chemotherapy at the Brewer Trophoblastic Disease Center between 1968 and 1982. Forty-six patients were treated primarily with methotrexate, actinomycin D, and cyclophosphamide because of the presence of one or more high-risk factors. Twenty-seven additional patients who had not responded to initial single-agent chemotherapy with methotrexate and/or actinomycin D were subsequently treated with methotrexate, actinomycin D, and cyclophosphamide. Adjuvant surgery and radiotherapy were used in selected patients. The overall cure rate was 51% (37 of 73): 63% (29 of 46) for primary treatment and 30% (eight of 27) for secondary treatment (P less than .01). Several factors that influenced response to primary treatment with methotrexate, actinomycin D, and cyclophosphamide chemotherapy were determined: 1) clinicopathologic diagnosis of choriocarcinoma versus invasive mole (59 versus 100%), 2) metastases to sites other than the lung and/or vagina (44 versus 74%), 3) antecedent term gestation compared with hydatidiform mole or abortion (50 versus 75%), and 4) presence of three or more high-risk factors (27 versus 74%). There were no significant differences in cure rates during the course of the study period.
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PMID:Treatment of high-risk gestational trophoblastic disease with methotrexate, actinomycin D, and cyclophosphamide chemotherapy. 298 66

Advanced gynecologic neoplasms continue to pose major therapeutic problems; 22,500 deaths were estimated for 1987. Between December 1983 and October 1985, there were 25 patients evaluated at our institution who on joint evaluation by the radiation oncologist and gynecologic oncologists were found to have extensive disease not amenable to standard therapy. Patients were to be treated by a combined modality approach with Mitomycin-C and 5-Fluorouracil given concomitantly with radiotherapy. Nineteen patients were treated definitively and six patients were treated with palliative intent (24 primary, 1 recurrent). The patients ranged in age from 27 to 90 years with a mean of 57.3 and a median of 57. Primary sites at presentation were: cervix--14 patients, vagina--7 patients, and vulva--4 patients. The initial FIGO stages at time of the initial diagnosis were: Stage I--1 (recurrent), Stage II--4, Stage III--15, and Stage IV--5. Chemotherapy consisted of 5-fluorouracil 1 gm/m2 given continuous infusion for 4 days with Mitomycin-C 10 mg/m2 IV push on day 1. Radiation therapy was started on day 1. Only 2 of 25 patients (8%) required chemotherapy reductions. All 25 patients received mega-voltage irradiation. The external beam dose range was 2000-6500 cGy and 14/25 patients received intracavitary or interstitial therapy. In the definitive patient group, there was no reduction in the therapeutic dose. Only four patients underwent surgical therapy. With a minimum follow-up of 8 months and a median follow-up of 28 months, the survival for the entire population was 56%. Fourteen of the 19 patients (74%) treated definitively are surviving with 12 patients having no evidence of disease. Survival by site in the definitive therapy group was cervix--70%, vulva--100%, and vagina--66%. The overall response rate was 84% at 3 and 9 months (3 months; CR--36%, PR--48%, and 9 months; CR--60%, PR--24%). There were no local recurrences in the 12 patients who achieved a complete response. Three patients died of metastatic disease alone and the overall local control was 60%. Evaluation of therapeutic side effects was performed. Hematologic analysis by the Southeastern Oncology Group criteria showed neutropenia in 14 patients (1--life-threatening, 2--severe, and 11 patients--mild/moderate) and thrombocytopenia was observed in 11 patients (all mild or moderate). All hematologic complications resolved. Acute complications did not appear increased except for the addition of mild oral mucositis (12 patients). Six patients demonstrated late effects with only 2 patients felt to have severe complications.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Concomitant 5-fluorouracil, mitomycin-C, and radiotherapy for advanced gynecologic malignancies. 314 19

A retrospective analysis was performed on 93 patients who developed recurrent endometrial carcinoma in the pelvis, vaginal vault, and lower 1/3 vagina. There were 12 lower 1/3 vaginal recurrences, 24 vault recurrences and 57 pelvic recurrences from the 1005 patients treated between 1960 and 1976. Median time to recurrence was 30 months. Twenty-six patients had distant metastases also present at the time of recurrence in the sites mentioned above. Thirty-three percent of lower 1/3 vaginal recurrences, 12.5% of vault recurrences, and 5.3% of pelvic recurrences were salvaged with further treatment. The 10-year actuarial survival rates of isolated lower 1/3 vaginal, vaginal vault, and pelvic recurrences were 50%, 45%, and 24% respectively.
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PMID:The salvage of recurrent endometrial carcinoma in the vagina and pelvis. 318 20

A case of a primary amelanotic melanoma of the vagina is reported. The patient was a 58-year-old Japanese female. A polypoid tumor was found on the lateral wall of the vagina and a cytologic examination of a scraping showed a few large atypical cells with cleaved nuclei and intranuclear vacuoles. A lateral junctional spread was histologically observed and stage II melanosomes were found in the cytoplasm. Two years after a radical operation, the patient died of a widespread melanotic metastases. The authors survey the number of incidences of malignant melanoma in the female genital organ. In Japanese women, melanoma is seen more frequently in the vagina than in the vulva, which is quite the opposite in cases of malignant melanomas of the genital organs in women of the United States and Europe.
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PMID:[Primary amelanotic malignant melanoma of the vagina--a case report]. 331 36


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