28057913 Visualization

A 53 Age - year Age - old Age woman Sex presented Clinical_event to our institution Nonbiological_location with progressive Detailed_description abdominal Biological_structure distention Sign_symptom and irregular Detailed_description vaginal Biological_structure bleeding Sign_symptom of several Duration weeks Duration ’ duration.
A contrast Detailed_description CT Diagnostic_procedure abdomen Biological_structure and pelvis Biological_structure revealed an ill Detailed_description - defined Detailed_description , irregular Detailed_description mass Sign_symptom in the lower Biological_structure uterine Biological_structure / cervical Biological_structure region Biological_structure (Figure 1).
There were multiple Detailed_description peritoneal Biological_structure and omental Biological_structure masses Sign_symptom , enlarged Sign_symptom pelvic Biological_structure and paraaortic Biological_structure lymph Biological_structure nodes Biological_structure , and large Detailed_description - volume Detailed_description ascites Sign_symptom .
The initial CBC Diagnostic_procedure was significant for hemoglobin Diagnostic_procedure of 9.2 Lab_value g/dL Lab_value , leukocytosis Sign_symptom of 36 Lab_value 790 Lab_value per Lab_value microliter Lab_value , and thrombocytosis Sign_symptom of 625 Lab_value 000 Lab_value per Lab_value microliter Lab_value .
Serum Biological_structure calcium Diagnostic_procedure was elevated Lab_value at 13.1 Lab_value mg/dL.
BUN Diagnostic_procedure and creatinine Diagnostic_procedure were within Lab_value normal Lab_value limits Lab_value .
Hepatic Diagnostic_procedure function Diagnostic_procedure was within Lab_value normal Lab_value limits Lab_value .
A pelvic Diagnostic_procedure exam Diagnostic_procedure revealed a fungating Detailed_description vaginal Biological_structure mass Sign_symptom .
The patient underwent biopsies Diagnostic_procedure of the endometrium Biological_structure and the vaginal Biological_structure mass Coreference , which revealed a high Severity - grade Severity tumor Sign_symptom with predominantly Detailed_description oval Detailed_description - shaped Detailed_description cells Detailed_description .
Immunohistochemical Diagnostic_procedure staining Diagnostic_procedure was positive Lab_value for vimentin Diagnostic_procedure , CD10 Diagnostic_procedure , and cyclin Diagnostic_procedure D1 Diagnostic_procedure , consistent with a diagnosis of high Severity - grade Severity endometrial Disease_disorder stromal Disease_disorder sarcoma Disease_disorder (Figure 2).
The tumor Coreference was negative Lab_value for ER Diagnostic_procedure , with rare Detailed_description cells Detailed_description positive Lab_value for PR Diagnostic_procedure .
Although immunohistochemical Diagnostic_procedure staining Diagnostic_procedure for cytokeratins Diagnostic_procedure was negative Lab_value , a biphasic Sign_symptom component Sign_symptom could not be entirely ruled out given the small size of the biopsy specimen relative to the tumor.
The patient’s Ca125 Diagnostic_procedure was markedly elevated Lab_value at 1624 Lab_value U/mL Lab_value (nl ≤34).
Contrast Detailed_description CT Diagnostic_procedure chest Biological_structure revealed a right Detailed_description - sided Detailed_description pleural Disease_disorder effusion Disease_disorder but no suspicious Detailed_description nodules Sign_symptom or lymphadenopathy Disease_disorder .
The patient was deemed to have operable Disease_disorder disease Disease_disorder and was scheduled for debulking Therapeutic_procedure surgery Therapeutic_procedure .
However, preoperative laboratory Diagnostic_procedure studies Diagnostic_procedure showed that her serum Biological_structure calcium Diagnostic_procedure had further increased Lab_value to 19.2 Lab_value mg/dL.
She had also developed evidence of acute Detailed_description kidney Biological_structure injury Disease_disorder , with her BUN Diagnostic_procedure rising Lab_value to 37 Lab_value mg/dL Lab_value and creatinine Diagnostic_procedure to 1.81 Lab_value mg/dL.
On physical Diagnostic_procedure exam Diagnostic_procedure , she was noted to be lethargic Sign_symptom , with dry Sign_symptom mucous Biological_structure membranes Biological_structure .
The surgery Therapeutic_procedure was cancelled Clinical_event due to the patient’s medical Disease_disorder instability Disease_disorder .
Further workup revealed an elevated Lab_value PTHrP Diagnostic_procedure of 301 Lab_value pg/mL Lab_value (nl 14–27), a depressed Lab_value PTH Diagnostic_procedure level of 3 Lab_value pg/mL Lab_value (nl 15–65), and a depressed Lab_value 25 Diagnostic_procedure - OH Diagnostic_procedure vitamin Diagnostic_procedure D Diagnostic_procedure level of 16 Lab_value ng/mL Lab_value (nl 30–100), consistent with humoral Disease_disorder hypercalcemia Disease_disorder of Disease_disorder malignancy Disease_disorder .
The patient was treated with pamidronate Medication , calcitonin Medication , and intravenous Administration fluids Medication .
She eventually required temporary Detailed_description hemodialysis Therapeutic_procedure and denosumab Medication for refractory Detailed_description hypercalcemia Sign_symptom .
The patient improved with regard to her electrolyte Coreference abnormalities Coreference .
Given the extent of her disease, she was planned for neoadjuvant chemotherapy Medication followed by surgery Therapeutic_procedure if a good response was achieved.
She was started on a regimen of carboplatin Medication and paclitaxel Medication , which she received for 3 Dosage cycles Dosage .
She also had palliative radiation Therapeutic_procedure to the uterus Biological_structure to control bleeding Sign_symptom .
However, her disease failed to respond significantly to chemotherapy, and she ultimately died Outcome from complications Disease_disorder of Disease_disorder malignancy Disease_disorder .