Biomedical subjects

B Piura

Publications and source records attributed to B Piura.

At least 19 recordsLinked to original sources

PubMed2006

Intraplacental choriocarcinoma metastasizing to the maternal lung.

BACKGROUND: Although normal pregnancy is the precursor of 25% of cases of maternal choriocarcinoma, intraplacental choriocarcinoma in an otherwise normal placenta associated with viable pregnancy has rarely been reported. CASE: Examination of the placenta after delivery of a pale and small-for-date infant at term revealed intraplacental choriocarcinoma. There was no evidence of metastatic disease in the mother or child, but the mother exhibited postpartum rising levels of beta-HCG. The mother refused chemotherapy and disappeared from follow-up. Nine months later, she presented with metastatic choriocarcinoma of the lung. Eleven courses of the multi-drug EMA CO regimen effected a decrease of beta-HCG to normal and disappearance of lung metastases. To date, 28 months after the end of chemotherapy, the patient is alive and without evidence of gestational trophoblastic disease. Moreover, since then she has given birth to an additional two children. CONCLUSIONS: This case is an example of natural disease progression of intraplacental choriocarcinoma metastasizing to the mother. Furthermore, it supports common knowledge that the multi-drug EMA CO regimen is effective treatment in poor prognosis metastatic choriocarcinoma.

Adult↗

PubMed2006

[Umbilical metastasis: Sister Mary Joseph's nodule].

Sister Mary Joseph (1856-1939), who was superintendent nurse at St. Mary's Hospital in Rochester, Minnesota, U.S.A. (at present Mayo Clinic), observed that patients with intra-abdominal or pelvic malignancy often had an umbilical nodule. In 1949 the English surgeon Hamilton Bailey, in his famous textbook "Demonstrations of Physical Signs in Clinical Surgery", coined the term "Sister Joseph's nodule" for umbilical metastases. To date, more than 400 cases of Sister Mary Joseph's nodule have been described in the literature. The nodule may be painful and ulcerated, sometimes with pus, blood, or serous fluid. It is usually a firm nodule measuring 0.5-2 cm, although some nodules may reach up to 10 cm in size. Tumor may spread to the umbilicus through lymph ducts, blood vessels, contiguous extension, and embryologic remnants. Sister Mary Joseph's nodule can be the first manifestation of an underlying malignancy or an indication of a recurrence in a patient with a previous malignancy. The most common origin of Sister Mary Joseph's nodule in women is ovarian carcinoma and in men--gastric carcinoma. Sister Mary Joseph's nodule has traditionally been considered a sign of advanced primary malignancy with an associated poor prognosis; the average survival time has been reported to be 11 months with < 15% of the patients surviving >2 years. In some patients, however, depending on the state of the primary neoplasm and the patient's general condition, surgery and/or chemotherapy may improve survival.

Abdominal Neoplasms↗

PubMed2006

Number and distribution of pelvic lymph nodes and effect of surgical pathologic factors on pelvic lymph node status in patients with early-stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection.

PURPOSE OF INVESTIGATION: To report the number and distribution of pelvic lymph nodes and to identify surgical pathologic factors that best predict positive pelvic lymph nodes in patients with early-stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection (RHND). METHODS: Data from the files of 126 patients with cervical carcinoma treated by RHND at the Soroka Medical Center from 1962 through 2005 were analyzed. RESULTS: The status of pelvic lymph nodes was known in 114 patients. The exact number of lymph nodes removed from the pelvis of each patient was known in 111 patients. The mean number of lymph nodes removed from the pelvis per patient was 26.6 (median 23; range 1-62). Positive pelvic lymph nodes were found in 35 (30.7%) of the patients with a mean of 3.4 (median 2; range, 1-15) positive pelvic lymph nodes per patient. In a univariate analysis, positive lymph vascular space invasion and positive parametrial and/or paracervical involvement were significant predictors of positive pelvic lymph nodes, whereas penetration > or = 50% of the thickness of the cervical wall and grade 2+3 were of borderline significance. In a multivariate analysis, positive lymph vascular space invasion was the strongest and the only significant predictor of positive pelvic lymph nodes, whereas positive parametrial and/or paracervical involvement was of borderline significance. CONCLUSIONS: In patients with early-stage cervical carcinoma treated with RHND, positive lymph vascular space invasion emerged to be the strongest and most significant predictor of positive pelvic lymph nodes.

Analysis of Variance↗

PubMed2005

Vulvar invasive squamous cell carcinoma occurring in a young woman with systemic lupus erythematosus.

BACKGROUND: Although several studies have demonstrated a possible relationship between systemic lupus erythematosus (SLE) and non-Hodgkin's lymphoma, Hodgkin's lymphoma, leukemia and several solid tumors, it is still debatable whether SLE patients have an increased incidence of cancer overall. CASE: We describe a 25-year-old patient with SLE who developed invasive squamous cell carcinoma of the vulva. The patient underwent radical vulvectomy and bilateral groin sentinel lymph node dissection and until to date, one year after surgery, she is alive without evidence of recurrent disease. CONCLUSIONS: Only three cases of vaginal/vulvar cancer associated with SLE have previously been mentioned in the literature, but not described in detail. This is the first detailed case report in the literature of vulvar invasive squamous cell carcinoma occurring in a SLE patient. It can only be speculated that the SLE itself and/or the treatment with immunosuppressive drugs provoked malignant transformation and the development of vulvar squamous cell carcinoma in such a young patient.

Adult↗

PubMed2005

Doxorubicin and ifosfamide-mesna in advanced and recurrent uterine sarcomas.

PURPOSE OF INVESTIGATION: To report the experience of a single institution in the south of Israel with doxorubicin and ifosfamide-mesna in patients with advanced/recurrent uterine sarcomas. METHODS: The hospital records of five patients with advanced/recurrent uterine sarcomas who had combination chemotherapy with doxorubicin and ifosfamide-mesna were retrospectively reviewed. Doxorubicin 30 mg/m2 was given on days 1 and 2 and ifosfamide 2000 mg/m2 (+ mesna, W/W 60%) was given on days 1, 2 and 3 of every 21 days. Dose intensity, relative dose intensity and average relative dose intensity (ARDI) of chemotherapy were calculated. Response was determined using clinical evaluation and radiological reports. Toxicity was graded using the National Cancer Institute (NCI) criteria. RESULTS: The median ARDI of the combination of doxorubicin and ifosfamide received by the patients was 0.68 (range, 0.53-0.74). One (20%) patient had disease complete response lasting three months and four (80%) patients had progressive disease. Toxicity was mainly hematological with grade 3 or 4 leukopenia--four (80%) patients, neutropenia--four (80%), thrombocytopenia--one (20%) and anemia--one (20%). Non-hematological toxicity was negligible. At follow-up, four (80%) patients had died of disease and one (20%) was alive with disease. CONCLUSION: Although the combination of doxorubicin and ifosfamide has certain activity in advanced/recurrent uterine sarcomas, the toxicity is of much concern and the results of treatment in terms of response duration and survival are poor.

Adult↗

PubMed2005

Weekly single-agent carboplatin in heavily pretreated patients with recurrent ovarian, peritoneal and fallopian tube carcinoma.

PURPOSE OF INVESTIGATION: To report the experience of a single institution in the south of Israel with weekly carboplatin in heavily pretreated patients with platinum-sensitive recurrent ovarian, peritoneal and fallopian tube carcinoma. METHODS: The hospital records of ten patients with platinum-sensitive recurrent ovarian, peritoneal and fallopian tube carcinoma who had 2nd-line or later chemotherapy with weekly carboplatin between January 2003 and December 2004 were retrospectively reviewed. Weekly carboplatin, at a dose calculated with use of the Hilary Calvert's formula at AUC = 2, was given intravenously in 500 ml dextrose 5% over 30 minutes on day 1 of every seven days. Response was determined using clinical evaluation, radiological reports and CA-125 level. Toxicity was graded using the National Cancer Institute (NCI) criteria. RESULTS: Overall, 155 courses of weekly carboplatin were given. The median number of courses per patient was 14 (range, 2-37) and median duration of treatment was 22.5 (range, 2-40) weeks. Four patients (40%) had complete response lasting for 8-20 (median, 12) weeks, two (20%) had partial response lasting for five and 14 weeks, respectively, one (10%) had stable disease lasting for 23 weeks and three (30%) had progressive disease. Toxicity was mainly hematological with only grade 1-2 hematological toxicity as follows: anemia--four patients (40%), leukopenia--three (30%), neutropenia--three (30%) and thrombocytopenia--two (20%). CONCLUSION: Weekly carboplatin has considerable activity and low and well tolerated toxicity in heavily pretreated patients with platinum-sensitive recurrent ovarian, peritoneal and fallopian tube carcinoma.

Adenocarcinoma↗

PubMed2005

Primary peritoneal malignant mixed müllerian tumor associated with colonic adenocarcinoma.

BACKGROUND: Primary extragenital malignant mixed Müllerian tumors (MMMTs) are very rare neoplasms, with only 28 documented cases in the literature. Two cases coexisted with a colonic adenocarcinoma. CASE: We report on a primary peritoneal MMMT diagnosed shortly after resection of a colonic adenocarcinoma in an 85-year-old woman who presented with a large omental mass. Microscopic examination revealed a biphasic tumor with malignant carcinomatous and sarcomatous components, confirmed immunohistochemically, consistent with MMMT. Despite optimal debulking and uneventful postoperative recovery, the patient died of her disease shortly after surgery due to recurrent disseminated disease. CONCLUSIONS: This is the third case in the literature of primary extragenital MMMT occurring in association with colonic adenocarcinoma. This coexistence may be incidental, but it may also imply a possible linkage between these two tumors.

Adenocarcinoma↗

PubMed2005

Pedunculated aggressive angiomyxoma arising from the vaginal suburethral area: case report and review of literature.

BACKGROUND: Aggressive angiomyxoma (AA) is an uncommon, slow growing, locally infiltrative but non-metastasizing, distinctive mesenchymal tumor that predominantly affects the pelvis and perineum of premenopausal women. The mainstay of treatment is local excision with tumor-free margins; however, recurrences are common and related to inadequate primary excision. CASE: A pedunculated 3-cm mass arising from the vaginal suburethral area in a 49-year-old premenopausal woman was resected around the base of its pedicle. Microscopic examination revealed numerous blood vessels of various sizes set in myxoid stroma with spindle shaped fibroblasts. Immunohistochemical staining was strongly diffusely positive for vimentin, desmin, estrogen receptor (ER) and progesterone receptor (PR), weakly focally positive for CD34, and negative for S-100 protein, actin and Ki-67. These findings are compatible with the diagnosis of AA. To date, six months after surgery, the patient is alive and without evidence of recurrence. CONCLUSIONS: AA is often clinically misdiagnosed and it is only the microscopic examination strengthened with immunohistochemical staining that definitely and undeniably contributes to the final diagnosis of AA. Based on this case report and on the previously reported five cases of pedunculated AA arising from the vulvovaginal region, including one tumor arising from the vaginal suburethral area, it seems that pedunculated AAs arising from the vulvovaginal region are at negligible risk of recurrence after local excision.

Diagnosis, Differential↗

PubMed2004

Giant cell arteritis of the female genital tract.

Giant cell arteritis (GCA) of the female genital tract is rare with only 30 cases, including this case, documented in the literature. We present a patient who had total abdominal hysterectomy and bilateral salpingo-oophorectomy for an ovarian cyst and on histologic examination GCA involving the arteries of the myometrium, cervical stroma, ovaries and tubes was unexpectedly discovered. Upon questioning of the patient and further investigations it became clear that the patient did have symptoms and signs suggestive of systemic GCA including fatigue, low-grade fever, weight loss and elevated erythrocyte sedimentation rate (ESR). Treatment with oral corticosteroids resulted in rapid and complete recovery. It is concluded that an incidental finding of GCA in the genitalia should alert the clinician to the possibility of systemic GCA. If upon questioning of the patient and further investigations the existence of systemic GCA is confirmed, treatment with corticosteroids should be considered.

Aged↗

PubMed2004

Gemcitabine in heavily pretreated patients with recurrent ovarian, peritoneal and fallopian tube carcinoma.

PURPOSE OF INVESTIGATION: To report the experience of a single institution in the south of Israel with gemcitabine in heavily pretreated patients with platinum-resistant recurrent ovarian, peritoneal and fallopian tube carcinoma. METHODS: The hospital records of 21 patients with ovarian, peritoneal and fallopian tube carcinoma who had salvage chemotherapy with gemcitabine between October 1998 and November 2003 were retrospectively reviewed. Gemcitabine, 1000 mg/m2, was given on days 1, 8, and 15 of every 28 days. Dose intensity and relative dose intensity of gemcitabine were calculated. Response was determined using clinical evaluation, radiological reports and CA-125 level. Toxicity was graded using the National Cancer Institute (NCI) criteria. RESULTS: The median relative dose intensity of gemcitabine received by the patients was 0.91, with 17 (81%) patients receiving more than 80% of the planned standard dose intensity. Two (9.5%) patients had complete response of disease lasting for ten and 33 months, respectively, eight (38.1%) had stable disease and 11 (52.4%) had progressive disease. Three (14.3%) patients had CA-125 complete response, five (23.8%) had CA-125 partial response, six (28.5%) had CA-125 stable levels and seven (33.3%) had CA-125 progressive levels. Toxicity was mainly hematological with grade 3-4 toxicity as follows: leukopenia--two (9.5%) patients, neutropenia--four (19%), thrombocytopenia--three (14.3%) and anemia--one (4.7%). CONCLUSION: Gemcitabine has some activity and low and well tolerated toxicity in heavily pretreated patients with platinum-resistant recurrent ovarian, peritoneal and fallopian tube carcinoma.

Adult↗

PubMed2003

[Matrix metalloproteinases and their tissue inhibitors in malignancies of the female genital tract].

The matrix metalloproteinases (MMPs) are a family of proteolytic enzymes, which are capable of degradation of the proteins composing the extracellular matrix and basement membrane. Their proteolytic activity depends on their binding to metal Zinc and is controlled by tissue inhibitors of MMP (TIMPs). Degradation of the extracellular matrix and basement membrane is an important component of the process of tumor invasiveness, progression, angiogenesis and metastatic spread. Since MMPs may serve as markers of tumor behavior and as predictors of survival and since synthetic inhibitors of MMP may have a place in the treatment of cancer, researching MMPs and their tissue inhibitors in malignant diseases has attracted growing attention. Studies on MMPs and their tissue inhibitors in malignancies of the female genital tract have shown the following: 1) In ovarian carcinoma and cervical carcinoma, over-expression of MMP-2 and MMP-9 is associated with invasiveness, metastatic spread and poor prognosis; 2) In endometrial carcinoma, MMP-7 (matrilysin) is the main MMP associated with invasiveness, metastatic spread and poor prognosis; 3) In cervical intra-epithelial neoplasia (CIN), measuring MMP-2 can assist in identifying high-risk for progression CIN I and CIN II; 4). In vulvar squamous cell carcinoma, over-expression of MMP-13 is associated with invasiveness, metastatic spread and poor prognosis. It is speculated that using synthetic drugs that inhibit MMPs in combination with conventional chemotherapy may contribute to the improvement of treatment results in cancer patients.

Biomarkers, Tumor↗

PubMed2002

Effect of BRCA mutations on the length of survival in epithelial ovarian tumors.

PURPOSE: To study the role of BRCA mutations in ovarian cancer survival. PATIENTS AND METHODS: Blood samples and specimens of ovarian tumors (whenever blood samples were not available) at the time of the primary surgery were obtained in the course of a nationwide case-control study of women with ovarian cancer in Israel. The three common BRCA mutations in Israel (185delAG, 5382insC, and 6174delT) were analyzed with a multiplex polymerase chain reaction to amplify the exons containing the three mutations using fluor-labeled primers in a single reaction. Because each mutation is a small insertion or deletion, they can be detected as length polymorphisms. Patients were followed for up to 5 years (range, 20 to 64 months). Statistical analysis was performed using the Kaplan-Meier method and the log-rank test. Stepwise Cox regression analysis was used for determination of independent prognostic factors. RESULTS: This report is based on 896 blood or tumor specimens analyzed for the presence of the BRCA mutations. Of these, 234 women (26.1%) were found to be positive. A significant difference in survival pattern was found between BRCA1/BRCA2 carriers and noncarriers among the women with invasive ovarian cancer (median survival, 53.4 months v. 37.8 months; 3-year survival, 65.8% v. 51.9%, respectively). These differences were independent of age at diagnosis or stage of the disease. CONCLUSION: Our data indicate that the survival of patients with ovarian cancer is affected by BRCA germline mutation, at least in the early years after diagnosis.

Case-Control Studies↗

PubMed2002

Primary breast carcinoma of the vulva: case report and review of literature.

The occurrence of ectopic breast tissue within the vulva is uncommon and the development of breast carcinoma within vulvar ectopic breast tissue is very rare. To date, only 12 cases of primary vulvar breast carcinoma have previously been reported in the English literature. This paper presents the 13th reported case of primary breast carcinoma of the vulva. The patient presented with a vulvar ulcerated lump and the diagnosis was based on a morphologic pattern consistent with breast carcinoma and the presence of estrogen and progesterone receptors. Primary surgery consisted of radical vulvectomy and bilateral groin dissection. The groin lymph nodes were involved bilaterally. Adjuvant therapy consisted of systemic chemotherapy (4 cycles of adriamycin and cyclophosphamide followed by 4 cycles of paclitaxel) and pelvic radiotherapy. Oral tamoxifen 20 mg/day was started for the next five years. It is concluded that the management of primary breast carcinoma of the vulva should be modeled after that for primary carcinoma of the orthotopic breast with primary surgery followed by systemic chemotherapy and pelvic radiotherapy. Chemotherapy should be similar to that employed for breast carcinoma. Tamoxifen should be prescribed for patients whose tumors contain estrogen receptors.

Adenocarcinoma↗

PubMed2002

[Hormone replacement therapy and the risk of breast cancer].

There is a growing use of hormone replacement therapy during menopause in the western world. Although most of epidemiologic studies have not found a cause-effect relation between this therapy and breast cancer, the fear of breast cancer related to this therapy limits its vast use. Controversy continues to surround the issue of the relationship between postmenopausal hormone therapy and the risk of breast cancer. Physicians, willing to prescribe this treatment, have often been asked by their patients if these hormones can cause breast cancer. Sufficient evidence exists to indicate the possibility of a slightly increased risk of breast cancer with long duration of hormone replacement therapy. However, the epidemiologic data on this cause and effect relation are inconsistent. Therefore, they cannot provide a definitive conclusion on this issue. Furthermore, evidence has shown that women treated with hormone replacement therapy have only localized disease with less metastasis than non-users. This might be due to detection/surveillance bias, but it might also be due to acceleration/deceleration of preexisting disease that reflects our misunderstanding of the breast cancer pathogenesis. Hormone replacement therapy has a cardinal role in the treatment and prevention of immediate and late sequela of menopause such as osteoporosis, cardiovascular diseases, urinary incontinence, etc. A large group of doctors such as family doctors, orthopedics, cardiologist, gynecologists and others recommend this therapy. Patients must also consider all the risks and advantages in their informed decision-making. Therefore we believe that it is important to review this treatment in connection with breast carcinoma.

Breast Neoplasms↗

PubMed2002

Peritoneal tuberculosis mimicking ovarian carcinoma with ascites and elevated serum CA-125: case report and review of literature.

Peritoneal tuberculosis is rare in the western world, although its incidence has been increasing in recent years. The presenting signs and symptoms, imaging examinations and CA-125 status in peritoneal tuberculosis may resemble that of ovarian carcinoma. Thus, the possibility of peritoneal tuberculosis should be considered in the differential diagnosis of ovarian carcinoma, especially in women immigrants from countries with a high prevalence of tuberculosis. A case of peritoneal tuberculosis mimicking ovarian carcinoma in a young woman immigrant from India is described. The patient presented with ascites, abdominopelvic masses and elevated serum CA-125 (1,081 U/ml). Laparoscopy confirmed the diagnosis of peritoneal tuberculosis and no malignancy, and thereby unnecessary extended surgery was avoided. Following treatment with the 4-drug anti-tuberculosis regimen, the patient recovered with disappearance of ascites and abdominopelvic masses, and return of CA-125 to normal range. It is concluded that laparoscopy, if feasible, seems to be a sufficient and safe method to provide diagnosis of peritoneal tuberculosis.

Adult↗

PubMed2002

Primary malignant melanoma of the vagina: case report and review of literature.

Primary vaginal malignant melanoma is rare, with < 250 reported cases to date. It accounts for < 1% of all melanomas in women, < 10% of all female genital tract melanomas, and < 3% of all vaginal malignancies. Its clinical behavior is notoriously more aggressive than that of cutaneous and vulvar melanoma, with a 5-year survival rate ranging from 5% to 25%. Tumor size is the strongest predictor of survival, whereas tumor thickness is a weak predictor of survival. A case of F.I.G.O. stage I vaginal melanoma encircling and embracing the entire circumference of the middle third of the vagina is described. Tumor size and thickness were 6 cm and 9 mm, respectively. The patient was treated by wide local excision and pelvic radiotherapy, and to date, 11 months after surgery, she is alive and with no evidence of disease. It is concluded that wide local excision followed by pelvic radiotherapy is an appropriate treatment for melanoma confined to the vagina.

Aged↗

PubMed2002

[Heat shock proteins and malignancies of the female genital tract].

Heat shock proteins (Hsp) are cytoplasmic proteins that act as molecular chaperones for protein molecules in various intra-cellular processes. They play an important role in protein-protein interactions, including folding and conformation, and prevention of inappropriate protein aggregation. They are called "heat shock proteins" since they were first discovered in cells exposed to high temperatures. However, their synthesis is also accentuated under other stress conditions, such as exposure of the cell to inflammation, infection, ischemia, toxins, cytotoxic drugs and malignant transformation. Hsp have been classified into families according to their molecular weight. In ovarian carcinoma, over-expression of Hsp27 was associated with increased resistance to chemotherapy and a worse prognosis. In endometrial carcinoma, over-expression of Hsp70 was associated with poorly differentiated tumors and a worse prognosis, whereas over-expression of Hsp27 and Hsp90 were associated with well-differentiated tumors and better prognosis. The association between increasing expression of Hsp90 and better differentiation and prognosis seems to reflect high levels of sex steroid receptors in well-differentiated endometrial carcinomas. In cervical carcinoma, the presence of Hsp70 was associated with a worse outcome. Since Hsp are highly antigenic, their property to bind with tumor proteins and proteins produced by viruses may be used for the development of vaccines against cancers and viral diseases. It is speculated that examination of the lower genital tract secretions for IgA antibodies against Hsp will contribute to early detection of malignancies. Since Hsp may affect the growth of the tumor and its response to chemotherapy, it is speculated that using drugs that inhibit Hsp in combination with conventional chemotherapy may contribute to the improvement of the treatment results.

Cancer Vaccines↗

PubMed2001

Psammomacarcinoma of the peritoneum.

Psammomacarcinoma is a rare histologic subtype of serous carcinoma originating in the ovary or peritoneum, characterized by massive psammoma body formation, invasiveness, and low-grade differentiation. Its clinical behavior appears similar to that of serous borderline tumors rather than that of typical invasive serous carcinomas. Peritoneal psammomacarcinoma is even rarer than its ovarian counterpart with only 10 cases have previously been documented in the literature. A case of F.I.G.O. stage IIIC peritoneal psammomacarcinoma is described. Optimal debulking surgery, including omentectomy, total abdominal hysterectomy, bilateral adnexectomy, and resection of segment of jejunum, was performed. The patient received adjuvant chemotherapy with taxol and cisplatin, and to date, 15 months after surgery, she is alive and with no evidence of disease. It is concluded that peritoneal psammomacarcinoma is a very rare tumor that behaves less aggressively than typical serous carcinoma. The mainstay of treatment is surgical debulking. The role of adjuvant chemotherapy has as yet not been established.

Adnexa Uteri↗