Thesis (doctoral)--Uppsala University, 1981. / At head of title: From the Department of Oncology, Division of Gynecologic Oncology, University Hospital, Uppsala, Sweden. Bibliography: p. 29-34.

Background: Psoas abscess is a rare clinical disease of various origins. Most common causes include hematogenous spread of bacteria from a different primary source, spondylodiscitis or perforated intestinal organs. But rarely some abscesses are related to malignant metastatic disease. Case presentation: In this case report we present the case of a patient with known squamous cell carcinoma of the cervix treated with radio-chemotherapy three years prior. She now presented with a psoas abscess and subsequent complete inferior vena cava thrombosis, as well as duodenal and vertebral infiltration. The abscess was drained over a prolonged period of time and later was found to be a complication caused by metastases of the cervical carcinoma. Due to the massive extent of the metastases a Whipple procedure was performed to successfully control the local progress of the metastasis. Conclusion: As psoas abscess is an unspecific disease which presents with non-specific symptoms adequate therapy may be delayed due to lack of early diagnostic results. This case report highlights the difficulties of managing a malignant abscess and demonstrates some diagnostic pitfalls that might be encountered. It stresses the necessity of adequate diagnostics to initiate successful therapy. Reports on psoas abscesses that are related to cervix carcinoma are scarce, probably due to the rarity of this event, and are limited to very few case reports. We are the first to report a case in which an extensive and complex abdominal procedure was needed for local control to improve quality of life.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18869号 / 医博第3980号 / 新制||医||1008(附属図書館) / 31820 / 京都大学大学院医学研究科医学専攻 / (主査)教授 武田 俊一, 教授 小西 郁生, 教授 小松 賢志 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background: Psoas abscess is a rare clinical disease of various origins. Most common causes include hematogenous spread of bacteria from a different primary source, spondylodiscitis or perforated intestinal organs. But rarely some abscesses are related to malignant metastatic disease. Case presentation: In this case report we present the case of a patient with known squamous cell carcinoma of the cervix treated with radio-chemotherapy three years prior. She now presented with a psoas abscess and subsequent complete inferior vena cava thrombosis, as well as duodenal and vertebral infiltration. The abscess was drained over a prolonged period of time and later was found to be a complication caused by metastases of the cervical carcinoma. Due to the massive extent of the metastases a Whipple procedure was performed to successfully control the local progress of the metastasis. Conclusion: As psoas abscess is an unspecific disease which presents with non-specific symptoms adequate therapy may be delayed due to lack of early diagnostic results. This case report highlights the difficulties of managing a malignant abscess and demonstrates some diagnostic pitfalls that might be encountered. It stresses the necessity of adequate diagnostics to initiate successful therapy. Reports on psoas abscesses that are related to cervix carcinoma are scarce, probably due to the rarity of this event, and are limited to very few case reports. We are the first to report a case in which an extensive and complex abdominal procedure was needed for local control to improve quality of life.

O carcinoma do colo uterino é um dos tumores mais freqüentes entre as mulheres e o principal fator de risco para o desenvolvimento desta neoplasia é a infecção persistente por tipos de papilomavírus humano (HPV) de alto risco oncogênico. Dentre estes, o HPV-16 é o mais comumente encontrado em lesões de alto grau e carcinoma. HPV cujas seqüências nucleotídicas diferem em até 2% são classificados como variantes de um mesmo tipo, e algumas destas variações genômicas levam a mudanças de aminoácidos em proteínas virais, em regiões potencialmente antigênicas. Além de variações antigênicas, o polimorfismo das moléculas HLA de classe II, responsáveis pela apresentação de antígenos às células T, também pode influenciar a resposta imune. Alguns estudos já descreveram associações entre alelos HLA e risco de câncer do colo do útero e infecção pelo HPV. Este projeto visa avaliar se existem diferenças na distribuição de alelos HLA entre pacientes com carcinoma do colo uterino portadoras de diferentes variantes de HPV-16 e mulheres sem câncer. Foram utilizados 112 casos de carcinoma do colo do útero positivos para presença de DNA de HPV-16 e 257 controles. Em todas as amostras do estudo foram realizadas as tipagens dos genes HLA-DRB1 e DQB1. A caracterização dos genes E6 e L1 de variantes de HPV-16 foi realizada nos 112 casos através de PCR-SSO e permitiu a identificação de infecções por uma única variante de HPV-16 em 89 amostras. Dentre elas foram encontradas variantes européias, asiático-americanas e africanas. A magnitude da associação entre os grupos HLA e as variantes de HPV-16 foi estimada através do cálculo de Odds Ratio e respectivo intervalo de confiança de 95%. Uma associação negativa entre DQB1*05 e câncer do colo do útero portadores de HPV-16 foi descrita anteriormente nesta amostra. Nosso estudo mostrou que esta associação pode ser atribuída as portadoras de variantes não-européias. A associação positiva de DRB1*15 mostrou ser maior entre portadoras de variantes européias que nãoeuropéias. Apesar do pequeno número de casos portadores de variantes africanas, foram encontradas associações positivas com DRB1*0701 e DQB1*0201. O polimorfismo da posição 350 do gene E6, descrito anteriormente como associado a risco de persistência de HPV, também foi avaliado: entre portadores de 350T, que codifica o aminoácido leucina, encontrou-se um efeito protetor dos alelos DRB1*04 e DQB1*0302. Uma maior freqüência de DRB1*15 foi observada entre portadores de variantes 350T quando comparada à freqüência nos controles. Nossos resultados sugerem que a associação entre alelos HLA de classe II e risco de câncer do colo do útero é influenciada pela distribuição de variantes de HPV-16 numa população determinada. / Cervical cancer is one of the most frequent tumor among women and the major risk factor for the development of this neoplasia is persistent infection with high risk oncogenic types of human papillomavirus (HPV). Among these, HPV-16 is the commonest type found in high grade lesions and carcinoma. HPV with less than 2% of divergence in nucleotide sequence are classified as variants of a given type, and these genomic variations can lead to changes in potentially antigenic regions. Besides these antigenic variations, polymorphism of HLA class li molecules, responsible for antigen presentation to T cells, can also influence the immune response. Several studies showed associations between HLA class II polymorphism and risk of cervical cancer and HPV infection. The aim of this study is to investigate if there are differences in the HLA class II alleles distribution between women with invasive cervical cancer (ICC) that harbor different HPV-16 variant and women without cancer. We analyzed 112 HPV-16 positive cases of cervical carcinoma and 257 controls. AII the samples had their HLA-DRB1 and DQB1 genes previously typed. HPV-16 variants in 112 ICC samples were characterized for E6 and L1 genes by PCR-SSO and allowed the identification of infections by single variants in 89 samples. European, Asian-American and African variants were found. The magnitude of association between HLA markers and HPV-16 variants was measured by Odds Ratios (OR) and respective 95% confidence intervals (CI). A negative association between DQB1*05 and HPV-16 positive ICC was previously described in this sample. Our study showed that it may be attributed to non-European variants carriers. The positive association of DRB1*15 was higher for women harboring European than non-European variants. In spite of the small number of women carrying African variants, positive association was found with DRB1*0701-DQB1*0201. The E6 gene polymorphism at residue 350, previously described as associated with risk of HPV persistence, was also investigated: among ICC carrying 350T, that code for leucine, we found a protective effect of DRB1*04-DQB1 *0302 haplotype. A higher frequency of DRB1*15 was found among carriers of 350T variants as compared to controls. Our results suggest that the association between HLA class II polymorphism and risk of invasive cervical cancer is influenced by the distribution of HPV-16 variants in a given population.