16 research outputs found

    A longitudinal, cross-sectional study of diversity in maternal platelet count kinetics, related to gestational thrombocytopenia

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    Background: Gestational thrombocytopenia (GT) is detected in approximately 8% of healthy pregnant women and >70% of pregnancy-associated thrombocytopenia cases. Diagnosed by exclusion, GT is primarily a benign disorder of unclear pathogenesis, although mechanisms have been proposed such as hemodilution. To better understand GT, we conducted retrospective longitudinal and cross-sectional analyses of variations in platelet count (PC) during gestation period. Methods: PC kinetics was assessed across a test group of 100 pregnant women, accurately representative of 341 in total, and in a control group of 200 non-pregnant women. Results: In the test group, median PC was comparable to the control group in early gestation but decreased by 8% by delivery day (DD). PC decreased by >5% in 59 pregnancies and increased by >5% in 19. 12 cases were thrombocytopenic. Median PC fluctuation, 2.5th percentile, and 97.5th percentile were each most extreme in final 5 weeks. Longitudinal analysis established five gestational pattern types defined by curvature and Change Ratio. The GT-type pattern (8 cases) showed relatively low PC in early gestation, mild downwards slope in the 2nd trimester, one or more peaks or “lifts” in the final weeks, followed by a “V-shape” of decrease beyond 15 x 104/μL to DD and sharp post-partum increase. Some of the GT-associated characteristics above appeared identifiable in a majority of pregnancies regardless of absolute PC value: Distinct PC “lift” occurring within the final ten weeks [later than in GT cases] followed by the V-shape [decrease to DD less pronounced than in GT], suggesting that diverse PC kinetics relate to the placental cytokine and receptor system. Conclusion: Our novel identification of diverse kinetic patterns in platelet count over gestational period suggests that, instead of a universal decrease caused by hemodilution alone, homeostatic conditions are affected by a diversity of varying factors such as the placental thrombopoietic system

    Primary Omental Myxoid Leiomyosarcoma: Report of a Case and a Review of the Literature

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    A 41-year-old Japanese woman who presented with right lower abdominal pain underwent partial omental resection with tumor excision, leaving no residual tumor. The tumor was diagnosed as a myxoid leiomyosarcoma that apparently originated in the greater omentum. A recurrent omental tumor was excised at 4.5 months after the first operation, and then at 5.5 months after this, CT revealed metastatic sarcoma at the surface of the liver (S7) and the left upper abdomen. She died 20 months after the last operation despite treatment of the metastases with MAID therapy (mesna, adriamycin, ifosfamide, dacarbazine). A literature review revealed that this tumor mainly occurs in the uterus, soft tissue, and cardiovascular system, with a preponderance among middle-aged to elderly women. The present report is the first description of primary omental myxoid leiomyosarcoma

    Tumors Sharply Increased after Ceasing Pazopanib Therapy for a Patient with Advanced Uterine Leiomyosarcoma: Experience of Tumor Flare

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    Pazopanib has activity in patients with soft-tissue sarcoma. We report an advanced uterine leiomyosarcoma case that suddenly worsened after cessation of pazopanib therapy. A 47-year-old woman had a primary uterine leiomyosarcoma tumor and multiple lung metastases, which progressed during her initial treatment. In subsequent treatment with pazopanib for 3 months, the sum of her tumor diameters after cessation sharply increased for two weeks. Symptoms such as dyspnea suddenly worsened also. She died of the disease one month after cessation of pazopanib therapy. Given the poor prognosis of recurrent uterine leiomyosarcoma and the rapid tumor enlargement after ending pazopanib therapy, control of this disease is especially important. Therefore, the decision to discontinue pazopanib therapy requires careful consideration
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