A 54-year old, single, nulligravid, without history of sexual contact, was admitted due to postmenopausal bleeding. Transrectal ultrasound revealed myoma uteri and thickened endometrium. She was thus scheduled to undergo endometrial curettage. However, prior to the performance of the endometrial sampling procedure, there was profuse vaginal bleeding with note of a possible prolapsed submucous myoma. She thus underwent emergency exploratory laparotomy with total hysterectomy and bilateral salpingooophorectomy.

Intraoperatively, necrotic masses were noted within the endocervical canal. Frozen section of the uterus and these masses revealed malignancy. Intraoperative referral to a gynecologic oncologist was done and bilateral pelvic lymphadenectomy and surgical staging were performed. Final histopathologic report revealed Cervical Adenosquamous Carcinoma. She subsequently underwent external beam radiotherapy and vaginal brachytherapy.

With the knowledge that almost all cases of cervical cancer is due to the Human Papilloma Virus (HPV), that this virus is almost exclusively transmitted by sexual contact, and the fact that she never engaged in sexual practices, there was doubt as to the source of the cancer. To help resolve this issue, an HPV DNA Polymerase Chain Reaction assay was performed on paraffin block samples and these all turned out negative for HPV. She may possess one of the rarest forms of cervical cancer - one that is not associated with the Human Papilloma Virus.

Human ; Female ; Middle Aged ; Uterine Cervical Neoplasms ; Papillomaviridae ; Brachytherapy ; Carcinoma, Adenosquamous ; Laparotomy ; Myoma ; Leiomyoma ; Endometrium ; Uterine Hemorrhage ; Hysterectomy

A 38-year old G3P1 (1011) was diagnosed with Invasive Ductal Carcinoma of the right breast on her 23rd week of gestation. The malignancy was estrogen and progesterone receptor assay and HER2/neu negative. She subsequently had 5 cycles of Cyclophosphamide-Doxorubicin chemotherapy beginning at 25 weeks gestation, repeat cesarean section with bilateral salpingo-oophorectomy at 36 weeks gestation 4 more courses of chemotherapy with Docetaxel starting 1 month postpartum, modified radical mastectomy, and radiotherapy. With a strong family history of breast and ovarian cancers, she underwent genetic testing for the BRCA gene mutation. She was positive for deleterious mutations of BRCA1 and BRCA2. She subsequently underwent "risk-reducing" simple mastectomy of the contralateral breast 2 years postpartum. Three sisters between the ages of 40 and 50 were likewise discovered to have a variety of BRCA gene mutations, one of whom also developed breast cancer. All sisters subsequently had risk-reducing mastectomies and salpingo-oophorectomies. The American Society of Clinical Oncology (ASCO) recommends genetic testing for cancer predisposition when the individual has a personal or family history suggestive of a cancer susceptibility syndrome. The benefits of genetic testing include a more precise estimation of cancer risks for the individual and her family members, and the identification of those individuals who could participate in risk-reducing surgeries in an effort to virtually eliminate the probability of developing a particular inherited malignancy. Risk-reducing bilateral simple mastectomy can be performed for high-risk women who have beendocumented to carry the BRCA gene mutation. On the other hand, risk-reducing contralateral simple mastectomy isrecommended for women with breast cancer who previously underwent modified radical mastectomy (MRM). Consequently, risk-reducing bilateral salpingooophorectomy is strongly recommended in women with BRCA gene mutations because of the high mortality rate associated with ovarian cancer and the lack of effective screening and preventive approaches for this malignancy.
Human ; Female ; Adult ; .x

A 28-year old G2P1 (1011) experienced repeated episodes of vaginal bleeding starting a month after an uncomplicated curettage for a miscarriage. Transvaginal sonography with Doppler studies revealde findings suggestive of uterine arteriovenous malformation (AVM). She underwent successful conservative management consisiting of bilateral internal iliac artery ligation followed by excision of an endometrial mass and overlying myometrium. Arteriovenous malformation of the uterus is a rare clinical entity that may present as a life-threatening condition warranting immediate definitive management. With the utilization of diagnostic imaging modalities such as endovaginal sonography with Doppler studies, computed tomography scan, magnetic resonance imaging or angiography, artriovenous malformation of the uterus can be diagnosed per-operatively and appropriate treatment strategies can subsequently be implemented.
Human ; Female ; Adult ; ARTERIOVENOUS MALFORMATIONS ; UTERUS