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Ritodrine for Intractable Uterine Pain Due to Extrapelvic Malignant Tumor Metastases: A Case Report

Sugiura, Yasoo MD*; Nemoto, Etsuo MD, PhD*; Kadohira, Ikuko MD, PhD; Kaseda, Shizuka MD, PhD*

doi: 10.1097/AJP.0b013e31828c4c13
Online Articles: Case Reports

Background: Effective pain management is an essential component of cancer treatment as approximately 75% of all cancer patients experience excruciating nociceptive pain even at maximum safe doses of nonsteroidal anti-inflammatory drugs and/or opioids. We report a case where ritodrine hydrochloride effectively controlled refractory pain due to uterine metastases from thymic carcinoma.

Case presentation: A 40-year-old woman presented at our hospital with chest discomfort, severe right femoral pain, and intermittent hypogastralgia. Computed tomography, magnetic resonance imaging, and positron emission tomography revealed a large mass in the anterior mediastinum, multiple nodules in the lungs, and multiple metastases on the uterus, lumbar vertebrae, and pelvic bones. Needle biopsies of the mediastinal and uterine cervical tumors revealed undifferentiated carcinoma of the thymus metastasizing to the uterus. Oxycodone and nonsteroidal anti-inflammatory drugs relieved the right femoral pain but not the hypogastralgia. We speculated that hypogastralgia did not result from somatalgia but from splanchnodynia. Ritodrine was administered in an effort to inhibit uterine contractions and to reduced the refractory pain and improved her quality of life.

Conclusion: Ritodrine relieved the pain caused by uterine contraction due to metastases and enhanced the quality of life.

*National Hospital Organization, Kanagawa National Hospital, Pulmonary and Thoracic Surgery, Hadano, Kanagawa

Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan

Written informed consent was obtained from our patient in accordance with institutional guidelines based on the Declaration of Helsinki. The patient also gave her consent for publishing a case report documenting her clinical course.

The authors declare no conflict of interest. The author and coauthors have no funding received for this work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s).

Reprints: Yasoo Sugiura, MD, National Hospital Organization, Kanagawa National Hospital, Pulmonary and Thoracic Surgery, 666-1 Ochiai, Hadano, Kanagawa 257-8585, Japan (e-mail: yasoos@hotmail.com).

Received August 27, 2012

Accepted February 7, 2013

© 2013 by Lippincott Williams & Wilkins