Aged ; Calcinosis ; Diagnosis, Differential ; Female ; Humans ; Leiomyoma ; diagnostic imaging ; pathology ; Radiography ; Uterine Neoplasms ; diagnostic imaging ; pathology

A 48-year-old woman presented with a 50-day history of irregular vaginal bleeding and lower abdominal pain. Ultrasound indicated an extremely large occupying lesion in the pelvic cavity that was highly suggestive of malignancy. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed to further assess the nature of pelvic abnormality. PET/CT images demonstrated a diffusely lobulated mass ranging from cervix up to the inferior pole of kidneys with mild FDG uptake. Simultaneously, multiple nodules in bilateral lungs and a hypodense lesion in the right ventricle were shown without FDG-avidity. Based on the imaging results, the presumptive diagnosis was uterine intravenous leiomyomatosis with intracardiac extension and pulmonary benign metastases, which was subsequently confirmed by MRI and the lesion biopsy.
Female ; Fluorodeoxyglucose F18/chemistry ; Humans ; Leiomyoma/pathology/radiography ; Leiomyomatosis/pathology/*radiography ; Lung Neoplasms/radiography/*secondary ; Magnetic Resonance Imaging ; Middle Aged ; Positron-Emission Tomography ; Tomography, X-Ray Computed ; Uterine Neoplasms/pathology/radiography ; Vena Cava, Inferior/pathology

OBJECTIVE: The aim of this study was to report on the long-term results of transabdominal ultrasound guided conformal brachytherapy in patients with cervical cancer with respect to patterns of failures, treatment related toxicities and survival. METHODS: Three hundred and nine patients with cervical cancer who presented to Institute between January 1999 and December 2008 were staged with magnetic resonance imaging and positron emission tomography and treated with external beam radiotherapy and high dose rate conformal image guided brachytherapy with curative intent. Follow-up data relating to sites of failure and toxicity was recorded prospectively. RESULTS: Two hundred and ninety-two patients were available for analyses. The median (interquantile range) follow-up time was 4.1 years (range, 2.4 to 6.1 years). Five-year failure free survival and overall survival (OS) were 66% and 65%, respectively. Primary, pelvic, para-aortic, and distant failure were observed in 12.5%, 16.4%, 22%, and 23% of patients, respectively. In multivariate analysis, tumor volume and nodal disease related to survival, whereas local disease control and point A dose did not. CONCLUSION: Ultrasound guided conformal brachytherapy of cervix cancer has led to optimal local control and OS. The Melbourne protocol compares favorably to the more technically elaborate and expensive GEC-ESTRO recommendations. The Melbourne protocol's technical simplicity with real-time imaging and treatment planning makes this a method of choice for treating patients with cervical cancer.
Adenocarcinoma/pathology/radiography/secondary/ultrasonography ; Adult ; Aged ; Brachytherapy/adverse effects/*methods ; Carcinoma, Squamous Cell/pathology/radiography/secondary/ultrasonography ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Staging ; Prognosis ; Prospective Studies ; Radiation Dosage ; Radiotherapy, Conformal/adverse effects/*methods ; Treatment Failure ; Ultrasonography, Interventional/*methods ; Uterine Cervical Neoplasms/pathology/*radiography/ultrasonography

Radiotherapy plays a major role in the treatment of cervical cancer. A successful radiotherapy program integrates both external beam and brachytherapy components. The principles of radiotherapy are strongly based on the anatomy of the organ and patterns of local and nodal spread. However, in patients with distorted anatomy, several practical issues arise in the delivery of optimal radiotherapy, especially with brachytherapy. Müllerian duct anomalies result in congenital malformations of the female genital tract. Though being very commonly studied for their deleterious effects on fertility and pregnancy, they have not been recognized for their potential to interfere with the delivery of radiotherapy among patients with cervical cancer. Here, we discuss the management of cervical cancer among patients with Müllerian duct anomalies and review the very sparse amount of published literature on this topic.
Brachytherapy ; Diagnostic Imaging ; Female ; Genital Diseases, Female ; diagnosis ; diagnostic imaging ; pathology ; Humans ; Magnetic Resonance Imaging ; Mullerian Ducts ; abnormalities ; diagnostic imaging ; pathology ; Radiography ; Radiosurgery ; Radiotherapy ; methods ; Uterine Cervical Neoplasms ; radiotherapy ; surgery

PURPOSE: This study was done to examine the difference in cancer screening with mammography and Papanicolaou smear according to Body Mass Index (BMI). METHODS: The participants in this study were 5,912 women ages 40 to 69 yr, selected from the Korean Genomic Regional Cohort in Kangwon province. Mammography and Papanicolaou smear were assessed by questionnaire and body weight (kg) and height (m) measured to calculate BMI. RESULTS: The distribution of BMI was as follows: low weight (1.5%), normal weight (31.1%), over weight (24.6%), mildly obese (36.4%) and severely obese (6.3%). After adjusting for age, education and monthly income, compared with normal weight women, overweight women (odds ratio [OR]=1.283, 95% confidence interval [CI]=1.089-1.513) and mildly obese women (OR=1.214, 95% CI=1.048-1.406) were less likely to have had mammography. In contrast to mammography, cancer screening with Papanicolaou smear was not significantly different by BMI. CONCLUSION: Obese women in rural areas are less likely to screen for breast cancer by using mammography than non obese women. To ensure regular screening for breast cancer, health care providers need to give scrupulous care to obese women and remove barriers originated from obesity. Also, educational and clinical implications are considered to increase the Papanicolaou smear rate.
Adult ; Aged ; *Body Mass Index ; Breast Neoplasms/prevention & control/*radiography ; Cohort Studies ; Demography ; Female ; Humans ; *Mammography ; Middle Aged ; Obesity/psychology ; Republic of Korea ; Rural Population ; Uterine Cervical Neoplasms/*pathology/prevention & control ; *Vaginal Smears ; Women's Health