Embryonal rhabdomyosarcoma (RMS) of the cervix is rare and most commonly occurs in the late teens and early 20s. We report a case of cervical embryonal RMS in a 52-year-old woman. This patient presented with an abnormal vaginal bleeding for 2 months and a mass protruding from the introitus, measuring 7 × 6 cm. She underwent radical abdominal hysterectomy with bilateral pelvic lymph node dissection and radical vaginectomy. The fi nal pathologic result was cervical RMS, consistent with the Intergroup RMS study group IIC. Immunohistochemistry was positive for desmin, myogenin, and myogenic diffentiation 1. The patient received conservative management in a convalescent hospital without adjuvant treatment due to cerebral hemorrhage and relapsed septic condition after surgery.Keywords: Embryonal rhabdomyosarcoma; Uterine cervix CASE REPORT Received: 2011. 5.30. Accepted: 2011 Embryonal Rhabdomyosarcoma (RMS) is the most common soft tissue tumor in childhood and young adults. RMS is rare in adults, with soft-tissue sarcomas making up less than 1% of malignancies in adults and RMS accounting for 3% of all soft-tissue sarcomas. In University of Tehran data only 6 RMS were found (0.39%) among the 1,528 patients with genital tract malignancies [1]. In Korea, a total of 8 cases of RMS were reported in young adults but there has been no case in which the patient was older than 40 years. We report a case of cervical RMS in a 52-year-old woman who underwent radical surgery. Case ReportA 52-year-old multiparous woman presented with vaginal bleeding for several weeks and the feeling of a mass protruding from the introitus for 2 months. She has normal menstrual cycles. The patient was referred to our institute with a suspicion of a cervical myoma. In her medical history, she had been diagnosed with cerebral arteriovenous malformation and treated with embolization and gamma knife surgery a few months prior. On the vaginal examination, a 7 × 6 cm soft pinkish irregular mass arising from the uterine cervix and reaching up to the introitus was seen (Fig. 1). Biopsy was performed and the result was favoring sarcoma, most likely embryonal RMS. Magnetic resonance imaging and F-18 fl urodeoxyglucose (FDG) positron emission tomography/computed tomography also showed a 7 × 6 cm mass arising from the endocervix and protruding outside the vagina cavity to the perineal portion with FDG uptake (Fig. 2). Moreover, parametrial invasion was seen on posterior aspect of the uterine cervix. The serum level of CA-125 was 58.6 U/mL. Other laboratory tests showed no specifi c abnormality. Her height, weight, and body mass index were 156 cm, 53 kg, and 21.8 kg/m 2 , respectively. Based on the results of these imaging studies and the pathologic result of biopsy, the patient was diagnosed with sarcoma of the uterine cervix.
ObjectiveTo evaluate the clinical, hormonal and metabolic characteristics according to luteinizing hormone (LH)/follicle stimulating hormone (FSH) ratio in women with polycystic ovary syndrome (PCOS). MethodsA total of 225 women with PCOS were included in this study. They were divided into two groups according to LH/FSH ratio; group A (LH/FSH < 2, n=160) and group B (LH/FSH > 2, n=65). We compared clinical, hormonal and metabolic characteristics including age at menarche, body mass index (BMI), blood pressures, ovarian volume, and serum androgen levels between the two groups. Serum glucose and insulin levels, fasting glucose/insulin ratio, homeostatic model assessment of insulin resistance (HOMA-IR), and lipid profi les were also compared between the two groups. Pearson correlation coeffi cients were used to evaluate correlation between the LH/FSH ratio and various parameters. ResultsAge of menarche in the group B was signifi cantly later than that in the group A. BMI, waist-hip ratio and blood pressures were signifi cantly lower in the group B compared to those of the group A. Ovarian volume and serum levels of LH, estradiol, total testosterone, sex-hormone binding globulin, 17-hydroxyprogesterone (OHP), and high density lipoprotein were signifi cantly higher in the group B. Postprandial 2 hours glucose, insulin and HOMA-IR were signifi cantly higher in the group A. After adjustment of BMI, the LH/FSH ratio was signifi cantly positively correlated with age at menarche, ovarian volume, total testosterone levels, and 17-OHP levels. ConclusionThe inappropriate gonadotropin secretion may be negatively correlated with BMI, and positively with age of menarche and increased ovarian androgen production irrespective of BMI in women with PCOS. However, it may not be associated with metabolic characteristics.
ObjectiveThis study aimed to help to understand the Korean women's obstetrical history, especially abortion history, based on the medical records of gynecologic patients admitted to Severance Hospital. MethodsWe identifi ed the tendency of the obstetrical history and investigated the proportion of abortion to gravidity and the proportion of induced abortion to total abortion according to the age group, based on the obstetrical history on admission note of 10,601 patients, who were admitted to our hospital from November 2005 to April 2011. ResultsThe mean age of the patients was 43.1 years (range, 10 to 90 years) and the mean gravidity was 2.65 (±2.31). The mean parity and abortion number was 1.47 (±1.34) and 1.18 (±1.50), respectively. The higher age groups tended to have increased number of gravidity and parity. Number of induced abortion was highest in the age group 60-69 and 70-79 years (1.80 ± 1.99 and 1.80 ± 2.35, respectively). The total abortion proportion was 0.44 and the proportion of total abortion to gravidity tended to increase in the younger age groups (age group 10-19: 0.95 and 20-29: 0.80). The proportion of induced abortion to total abortion was 0.84 in total. The proportion was highest in the age group 10-19 years (0.95) and lowest in the age group 30-39 years (0.72). ConclusionThis data based on the medical records of gynecologic patients will provide important information for the amendment of the new law on abortion.
The carcinoma of the uterine cervix in virgins is extremely rare. A 36-year-old virgin presented with a 4.8 × 2.2 cm sized endocervical mass with bleeding on sonography. Biopsy revealed a squamous cell carcinoma arising in the uterine cervix without human papilloma virus (HPV) DNA. Positron emission tomography revealed cervical cancer with multiple hematogenous lung metastases. After 3 cycles of preoperative chemotherapy, she underwent modified radical hysterectomy and 6 cycles of postoperative chemotherapy. After the treatment, complete resolution was obtained, and she has been followed without recurrence for 4 years. Although > 90% of cervical cancer is caused by HPV infection, we cannot completely deny the possibility of HPV negative cervical carcinoma. [3] reanalyzed HPV-negative cases from the IBSCC study and claimed that the worldwide HPV prevalence in cervical carcinomas was 99.7 percent. However, even with this prevalence, the possibility of HPV unrelated carcinomas still needs to be considered. We performed a literature search in Ovid MEDLINE and PubMed with key words, "cervical cancer, and/or virgin, and/or HPV negative" and identifi ed only 4 cases reported between January 1966 and July 2008 [4,5]. Here we report one case of HPV negative, squamous cell carcinoma of the uterine cervix with diffuse hematogenous lung metastasis in a 36-year-old woman whose hymen was completely intact.
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