Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Neoplasm Recurrence, Local ; diagnosis ; drug therapy ; Tuberculosis, Pulmonary ; diagnosis ; Uterine Cervical Neoplasms ; drug therapy

Although in the past two decades there has been a sharp rise in the incidence of extranodal primary lymphomas, non-Hodgkin's lymphoma (NHL) of the female genital tract is still rare. There is still no consensus on the management of cervical lymphomas. The malignant lymphoma localized in uterine cervix is rare and characteristically symptom free expressed. A 26-year-old woman presented in March 2004 with uterine bleeding. After the patient underwent punch biopsy, primary cervical malignant lymphoma was diagnosed. Six courses of chemotherapy were administered in an adjuvant setting. Thirty-nine months (May 2007) after the diagnosis the patient was alive and without signs of recurrent disease. In this report, one case of primary cervical lymphoma diagnosed by punch biopsy is reported and associated literature is discussed.
Adult ; Biopsy ; Cervix Uteri* ; Consensus ; Diagnosis ; Drug Therapy ; Female ; Humans ; Incidence ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Uterine Cervical Neoplasms ; Uterine Hemorrhage

Clinical practice guidelines for gynecologic cancers have been developed by academic society from several countries. Each guideline reflected their own insurance system and unique medical environment, based on the published evidence. The Korean Society of Gynecologic Oncology (KSGO) published the first edition of practice guidelines for gynecologic cancer treatment in late 2006; the second edition was released in July 2010 as an evidence-based recommendation. The Guidelines Revision Committee was established in 2015 and decided to develop the third edition of the guidelines in an advanced format based on evidence-based medicine, embracing up-to-date clinical trials and qualified Korean data. These guidelines cover strategies for diagnosis and treatment of primary and recurrent cervical cancer. The committee members and many gynecologic oncologists derived key questions through discussions, and a number of relevant scientific literature were reviewed in advance. Recommendations for each specific question were developed by the consensus conference, and they are summarized here, along with the details. The objective of these practice guidelines is to establish standard policies on issues in clinical practice related to the management in cervical cancer based on the results in published papers to date and the consensus of experts as a KSGO Consensus Statement.
Committee Membership ; Consensus* ; Diagnosis ; Drug Therapy ; Evidence-Based Medicine ; Insurance ; Korea* ; Uterine Cervical Neoplasms*

A 50-year-old peri-menopausal woman presented with hard palpable mass on her lower abdomen and anemia from heavy menstrual bleeding. Ultrasonography showed a 13x12 cm sized hypoechoic solid mass in pelvis and a 2.5x2 cm hypoechoic cystic mass in uterine endometrium. Abdomino-pelvic computed tomography revealed a hypodense pelvic mass without enhancement, suggesting a leiomyoma of intraligamentary type or sex cord tumor of right ovary with submucosal myoma of uterus. Laparoscopy revealed a large Sertoli-Leydig cell tumor of right ovary with a very rare entity of intra-endometrial uterine leiomyoma accompanied by adenomyosis. The final diagnosis of ovarian sex-cord tumor (Sertoli-Leydig cell), stage Ia with intra-endometrial leiomyoma with adenomyosis, was made. Considering the large size of the tumor and poorly differentiated nature, 6 cycles of chemotherapy with Taxol and Carboplatin regimen were administered. There is neither evidence of major complications nor recurrence during 20 months' follow-up.
Adenomyosis/*diagnosis/drug therapy ; Carboplatin/therapeutic use ; Female ; Humans ; Laparoscopy ; Leiomyoma/*diagnosis/drug therapy ; Male ; Menorrhagia ; Middle Aged ; Neoplasm Recurrence, Local ; Paclitaxel/therapeutic use ; Sertoli-Leydig Cell Tumor/*diagnosis/drug therapy ; Treatment Outcome ; Uterine Neoplasms/*diagnosis/drug therapy

Despite recent advances in the early detection method and treatment modalities (surgery and/or radiation and/or chemotherapy), cervical cancer is still an important malignant disease in women. Almost half a million new cases occur every year in the world. The management of recurrent cervical cancers depends on primary treatment, the extent of disease, and performance status. Patients who received primary surgical treatment without radiotherapy (RT) may undergo curative RT. However, most recurrences occur in patients with advanced-stage disease already treated by primary RT. For patients who failed primary RT or surgery plus adjuvant RT and had central relapse without pelvic sidewall recurrence, pelvic exenteration may be necessary. For patients who had pelvic sidewall recurrences, pelvic exenteration is usually not an option with curative intent. In such situation, combined operative and radiotherapeutic treatment (CORT), and laterally extended endopelvic resection (LEER), intraoperative radiotherapy (IORT) have been executed with some success. Simple or radical hysterectomy can be considered for patients who had small uterine and/or vaginal recurrences, but the high frequency of associated morbidities such as urinary and bowel tract injury or fistula is the problem. Patients with multiple or distant metastases are destined to receive cisplatin-based palliative chemotherapy. Recently there was a GOG 179 study that had firstly shown a statistically significant improvement on the overall response rate, median progression-free survival, and median survival. Until now, however, the role of chemotherapy has been very limited.
Diagnosis* ; Disease-Free Survival ; Drug Therapy ; Female ; Fistula ; Humans ; Hysterectomy ; Neoplasm Metastasis ; Pelvic Exenteration ; Radiotherapy ; Recurrence ; Uterine Cervical Neoplasms*

Neuroendocrine carcinomas of the uterine cervix are very rare cervical neoplasms. It has frequent distant metastasis at diagnosis and high recurrent rate against multimodality therapies such as surgery, chemotherapy and radiation therapy. In 1997, four categories of endocrine tumors of uterine cervix were recommended by the Cancer Committee of the College of American Pathologists and the National Cancer Institute. It has been suggested that infection of human papillomavirus and molecular biologic abnormalities in genomic level are causes of this disease. Although a lot of studies about this disease concerning therapies and prognostic factors have been reported, there is no standard therapeutic regimens because of low incidence and difficulties of histologic diagnosis, so further studies about this issues are required. We report a case of large cell neuroendocrine uterine cervical carcinoma treated with chemotherapy followed by surgery.
Carcinoma, Neuroendocrine* ; Cervix Uteri* ; Diagnosis ; Drug Therapy ; Female ; Humans ; Incidence ; National Cancer Institute (U.S.) ; Neoplasm Metastasis ; Uterine Cervical Neoplasms

In 2014, 9 topics were selected as major advances in clinical research for gynecologic oncology: 2 each in cervical and corpus cancer, 4 in ovarian cancer, and 1 in breast cancer. For cervical cancer, several therapeutic agents showed viable antitumor clinical response in recurrent and metastatic disease: bevacizumab, cediranib, and immunotherapies including human papillomavirus (HPV)-tumor infiltrating lymphocytes and Z-100. The HPV test received FDA approval as the primary screening tool of cervical cancer in women aged 25 and older, based on the results of the ATHENA trial, which suggested that the HPV test was a more sensitive and efficient strategy for cervical cancer screening than methods based solely on cytology. For corpus cancers, results of a phase III Gynecologic Oncology Group (GOG) 249 study of early-stage endometrial cancer with high-intermediate risk factors are followed by the controversial topic of uterine power morcellation in minimally invasive gynecologic surgery. Promising results of phase II studies regarding the effectiveness of olaparib in various ovarian cancer settings are summarized. After a brief review of results from a phase III study on pazopanib maintenance therapy in advanced ovarian cancer, 2 outstanding 2014 ASCO presentations cover the topic of using molecular subtypes in predicting response to bevacizumab. A review of the use of opportunistic bilateral salpingectomy as an ovarian cancer preventive strategy in the general population is presented. Two remarkable studies that discussed the effectiveness of adjuvant ovarian suppression in premenopausal early breast cancer have been selected as the last topics covered in this review.
Biomedical Research/*trends ; Endometrial Neoplasms/drug therapy/pathology/surgery ; Female ; Genital Neoplasms, Female/diagnosis/*therapy ; Humans ; Ovarian Neoplasms/drug therapy/pathology/surgery ; Uterine Cervical Neoplasms/drug therapy/pathology/surgery

Acute disseminated intravascular coagulation (DIC) associated with gastric cancer is not common and has short survival of 1 to 3 weeks. Systemic chemotherapy in spite of hematologic unstability for gastric cancer may prolong survival time. A 47-year-old woman who complained of dyspnea, vaginal bleeding and easy bruisibility was diagnosed to stage IV gastric cancer with acute disseminated intravascular coagulation based on the laboratory data. She also had multiple bone metastases and bone marrow involvement. This is the first case treated with combination chemotherapy of irinotecan and cisplatin for advanced gastric cancer complicated by disseminated intravascular coagulation at the time of diagnosis. With systemic chemotherapy, some of the bleeding symptoms and the DIC process improved, even not completely recovered. However the patient died of disease progression and survival time was 12 weeks.
Bone Marrow ; Cisplatin* ; Dacarbazine ; Diagnosis ; Disease Progression ; Disseminated Intravascular Coagulation* ; Drug Therapy ; Drug Therapy, Combination* ; Dyspnea ; Female ; Hemorrhage ; Humans ; Middle Aged ; Neoplasm Metastasis ; Stomach Neoplasms* ; Uterine Hemorrhage

The breast cancer is the second most common malignancy in pregnancy after cervical cancer. Pregnancy- associated breast caner tends to show unfavorable prognosis, because it is diagnosed at more advanced stage due to delay of diagnosis and treatment. For appropriate management, collaboration with physicians and obstetricians should make precise decisions considering gestational weeks and cancer stage at the time of diagnosis in a point of view from mother and fetus. A case of successful gestation and delivery after chemotherapy in a woman with inflammatory breast cancer diagnosed in the second trimester is presented with review of literature.
Breast Neoplasms* ; Breast* ; Cooperative Behavior ; Diagnosis ; Drug Therapy ; Female ; Fetus ; Humans ; Inflammatory Breast Neoplasms ; Mothers ; Pregnancy ; Pregnancy Trimester, Second ; Prognosis ; Uterine Cervical Neoplasms

In 2013, 10 topics were selected for major clinical research advances in gynecologic oncology; these included three topics regarding cervical cancer, three regarding ovarian cancer, two regarding endometrial cancer, and one each regarding breast cancer and radiation oncology. For cervical cancer, bevacizumab was first demonstrated to exhibit outstanding clinical efficacy in a recurrent, metastatic setting. Regarding cervical cancer screening, visual inspections with acetic acid in low-resource settings, p16/Ki-67 double staining, and the follow-up results of four randomized controlled trials of human papillomavirus-based screening methods were reviewed. Laparoscopic para-aortic lymphadenectomy before chemoradiation for locally advanced cervical cancer was the final topic for cervical cancer. Regarding front-line ovarian cancer therapies, dose-dense paclitaxel and carboplatin, intraperitoneal chemotherapy, and other targeted agents administered according to combination or maintenance schedules were discussed. Regarding recurrent ovarian cancer treatment, cediranib, olaparib, and farletuzumab were discussed for platinum-sensitive disease. The final overall survival data associated with a combination of bevacizumab and chemotherapy for platinum-resistant disease were briefly summarized. For endometrial cancer, the potential clinical efficacy of metformin, an antidiabetic drug, in obese patients was followed by integrated genomic analyses from the Cancer Genome Atlas Research Network. For breast cancer, three remarkable advances were reviewed: the long-term effects of continued adjuvant tamoxifen for 10 years, the effects of 2-year versus 1-year adjuvant trastuzumab for human epidermal growth factor receptor 2-positive disease, and the approval of pertuzumab in a neoadjuvant setting with a pathologic complete response as the surrogate endpoint. Finally, the recent large studies of intensity-modulated radiotherapy for gynecologic cancer were briefly summarized.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Biomedical Research/*methods ; Early Detection of Cancer/methods ; Endometrial Neoplasms/therapy ; Female ; Genital Neoplasms, Female/*therapy ; Humans ; Lymph Node Excision/methods ; Ovarian Neoplasms/drug therapy ; Papillomavirus Infections/complications/diagnosis ; Uterine Cervical Neoplasms/diagnosis/virology