scholarly journals Stages I to II WHO 2003–Defined Low-Grade Endometrial Stromal Sarcoma: How Much Primary Therapy Is Needed and How Little Is Enough?

2013 ◽  
Vol 23 (3) ◽  
pp. 488-493 ◽  
Author(s):  
Weiwei Feng ◽  
Keqin Hua ◽  
Anais Malpica ◽  
Xianrong Zhou ◽  
Jan P. A. Baak
Keyword(s):  
Early Stage ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Primary Treatment ◽  
International Federation ◽  
World Health ◽  
Low Grade ◽  
Primary Therapy ◽  
Primary Surgery ◽  
Gynecology And Obstetrics

ObjectiveBefore 2003, invasive endometrial stromal sarcomas (ESS) were classified into 2 categories, low-grade and high-grade ESS, according to the mitotic index. In 2003, the World Health Organization changed the definition and the diagnostic criteria. Before 2003, 20% to 35% low-grade ESS recurred, but WHO 2003–defined low-grade ESS has 10 years’ recurrence rates of less than 10%. With so few recurrences, the balance between treatment guaranteeing cure and overtreatment (“not too little” or “too much”) becomes increasingly important. However, primary treatment practices range from limited surgery only to extensive surgery combined with adjuvant chemotherapy and radiotherapy. We focused on the primary treatment of early-stage WHO 2003–defined low-grade ESS.MethodsWe evaluated the effect of different therapeutic strategies in 57 patients with International Federation of Gynecology and Obstetrics 2009 stages I to II expert-reviewed WHO 2003–defined low-grade ESS treated at a single institution between 1992 and 2007.ResultsThe patients’ median age was 43 years (range, 19–63 years). After 68 months’ median follow-up (range, 17–140 months), recurrence and mortality rates were 9% and 2%, respectively. The patients with WHO 2003–defined low-grade ESS with ovary-preserving primary surgery had a much higher recurrence rate (75%) than those without (2%; P < 0.0001). Lymphadenectomy, radical abdominal hysterectomy, and omentectomy did not influence survival. Ten patients refused chemotherapy. With univariate analysis, multiple-agent chemotherapy improved the prognosis (P = 0.02) With multivariate analysis, only ovary preservation-or-not surgery had independent prognostic value.ConclusionsIn International Federation of Gynecology and Obstetrics 2009 stage I to stage II WHO 2003–defined low-grade ESS, total abdominal hysterectomy with bilateral salpingo-oophorectomy is sufficient surgery, but ovary-preserving primary surgery increases the risk of recurrence. More extensive surgical procedures than total abdominal hysterectomy with bilateral salpingo-oophorectomy do not improve prognosis in early-stage WHO 2003–defined low-grade ESS. Chemotherapy may improve progression-free survival in early-stage low-grade ESS, but a large sample size is needed to confirm this.

scholarly journals Coriocarcinoma gestacional primario de cuello uterino. Presentación de un caso

2021 ◽  
Vol 81 (04) ◽  
pp. 406-410
Author(s):  
Viviana García ◽  
◽  
Franco Calderaro Di Ruggiero ◽  
Jorge Hoegl ◽  
Carlos Quintero ◽  
...  
Keyword(s):  
Abnormal Uterine Bleeding ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Gestational Trophoblastic Disease ◽  
World Health ◽  
Molar Pregnancy ◽  
Trophoblastic Disease ◽  
Gestational Choriocarcinoma ◽  
Gynecology And Obstetrics ◽  
Gynecological Examination

Choriocarcinoma represents a type of malignant tumor of gestational trophoblastic disease. It can develop after a molar pregnancy, miscarriage, normal or ectopic pregnancy. Generally its seat site is the uterine body; infrequent places such as the cervix have been described. We report the case of a 37-year-old patient is reported, VI gestations IV deliveries I cesarean section I molar pregnancy, with abnormal uterine bleeding, which is referred to the Hospital Oncology Service. On gynecological examination, an exophytic mass is observed in the cervix. A biopsy was taken that reported: Gestational choriocarcinoma and plasma levels of β-hCG were verified: 13805 IU / L. A total abdominal hysterectomy was performed with preservation of the ovaries. It was concluded as stage I of the International Federation of Gynecology and Obstetrics and 8, according to the score of the World Health Organization (ST I: 8), for which adjuvant was indicated. Currently no evidence of disease. Keywords: Choriocarcinoma, gestational trophoblastic disease, cervix.

scholarly journals Retrospective analysis of clinical, pathological characteristics and prognosis of the patients with endometrial stromal sarcomas

2020 ◽  
Vol 7 (1) ◽  
pp. 360-363
Author(s):  
Hacı Öztürk Şahin ◽  
Mehmet Bayrak
Keyword(s):  
Clinical Characteristics ◽  
Endometrial Stromal Sarcoma ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Lymph Node Involvement ◽  
Endometrial Biopsy ◽  
Low Grade ◽  
High Grade ◽  
Gynecology And Obstetrics ◽  
Paraaortic Lymph Nodes

Objective: Endometrial stromal sarcoma (ESS) is a rare mesenchymal tumor of the uterus.Literature has limited data about the ESS. The aim of the present study was to contribute to literature by reporting the histo-pathological findings, clinical characteristics of ESS patients and the data about the accuracy of preoperative diagnosis and prognosis. Material and Methods: A total of 33 patients who were diagnosed and followed up with ESS at Department of Gynecology and Obstetrics of Bursa Uludağ University between 2007 and 2017 were retrospectively analyzed with regard to clinical and pathologic characteristics, surgical procedures they underwent and survival. Results: Mean age of the patients was 49.5 years and 60.2 years for low grade ESS (LG-ESS) and high grade ESS (HG-ESS) (p=0,01). Post-menopausal hemorrhage was the most common complaint on admission.  Correct histological diagnosis was made in only 72.7% of the patients from whom pre-operative endometrial biopsy was obtained. Twelve out of 16 cases (75%) were in Stage 1. While all patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO), 14 underwent pelvic and para-aortic lymphadenectomy for surgical staging. Lymph node involvement was detected in no patients who underwent lymphadenectomy. The patients with LG-ESS were found to have a good prognosis however the ones with HG-ESS had a high mortality rate even in the early stages (mean survival of 10 months). Conclusion: High grade ESS cases show different clinical characteristics and prognosis than LG-HSS. Diagnostic accuracy of endometrial sampling is much lower when compared to epithelial uterine malignancies. Metastasis of pelvic-paraaortic lymph nodes of which removal is reported which not to contribute to survival is rare.

scholarly journals Adenoid Basal Carcinoma of Cervix: A Rare Case Report

2020 ◽  
Vol 3 (2) ◽  
pp. 392-394
Author(s):  
Alina Karna ◽  
Nisha Sharma
Keyword(s):  
Pap Smear ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Adenoid Cystic ◽  
Carcinoma Of Cervix ◽  
Rare Case Report ◽  
Intraepithelial Lesion

Adenoid basal carcinoma of the uterine cervix is a rare low-grade tumor and its cell origin is still obscure. Adenoid basal carcinoma can be confused with adenoid basal hyperplasia, adenoid cystic carcinoma, and basaloid squamous cell carcinoma of the cervix. We present here a case of a 59 year-old-female who initially presented with a high-grade squamous intraepithelial lesion on Pap smear. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathology revealed focal invasive adenoid basal carcinoma with extensive areas of a high-grade squamous intraepithelial lesion involving the endocervical gland. The immunohistochemical stain was positive for p16.

scholarly journals Successful outcome of placenta previa percreta with bladder invasion

2017 ◽  
Vol 10 (2) ◽  
pp. 93
Author(s):  
Syeda Sayeeda ◽  
Nahreen Akhter ◽  
Firoza Begum ◽  
Sajid Hasan
Keyword(s):  
Coming Out ◽  
Placenta Previa ◽  
Blood Clot ◽  
Previous History ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Watery Diarrhoea ◽  
Successful Outcome ◽  
Low Grade ◽  
Bladder Irrigation

<p>A 41 year old multiparous lady, with previous history of one cesarean section presented at her 24 weeks of gestation with frank hematuria. The case was diagnosed as placenta previa percreta with the bladder involvement by ultrasound doppler and confirmed by MR urogram. So, peripartum hysterectomy was planned. On opening of the abdomen, a hugely distended bladder was found, which when retracted engorged blood vessels were found over the lower segment of uterus. Baby was delivered by giving a transverse incision in the upper segment. By keeping placenta in situ, total abdominal hysterectomy was done with quick successive clamping. Severe per-operative bleeding was occurred. Bladder irrigation started following total abdominal hysterectomy. Continuous small clots were coming out through catheter. A large old blood clot was removed by cystostomy done by an urologist. A sprouting vessel and a linear injury were noticed at the base of the bladder. The vessel was ligated and the injury was repaired. After proper hemostasis, the abdomen was closed in layers. The patient was shifted to ICU. Patient developed complications like MI, watery diarrhoea, low grade fever which was managed accordingly. She was discharged healthy on her 19th post-operative day.</p>

Long-term quality of life outcomes of women treated for early-stage endometrial cancer

2020 ◽  
pp. ijgc-2020-002145
Author(s):  
Saira Sanjida ◽  
Andreas Obermair ◽  
Val Gebski ◽  
Nigel Armfield ◽  
Monika Janda
Keyword(s):  
Quality Of Life ◽  
Endometrial Cancer ◽  
Early Stage ◽  
Age Groups ◽  
Laparoscopic Hysterectomy ◽  
Well Being ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy

ObjectiveTo compare long-term quality of life in women treated for early-stage endometrial cancer with population norms, and to compare quality of life outcomes of patients who had total laparoscopic or total abdominal hysterectomy.MethodsOnce the last enrolled patient had completed 4.5 years of follow-up after surgery, participants in the Laparoscopic Approach to Cancer of the Endometrium (LACE) clinical trial were asked to complete a self-administered questionnaire. Two instruments—EuroQol 5 Dimension 3-level (EQ-5D-3L) and the Functional Assessment of Cancer Treatment-General Population (FACT-GP)—were used to determine quality of life. The mean computed EQ-5D-3L index scores for LACE participants at different age categories were compared with Australian normative scores; and the FACT-GP scores were compared between patients treated with surgical treatments.ResultsOf 760 women originally enrolled in the LACE trial, 259 (50.2%) of 516 women consented to provide long-term follow-up data at a median of 9 years (range 6—12) after surgery. On the EQ-5D-3L, long-term endometrial cancer survivors reported higher prevalence of anxiety/depression than normative levels across all age groups (55–64 years, 30% vs 14.9%; 65–74 years, 30.1% vs 15.8%; ≥75 years, 25.9% vs 10.7%). For women ≥75 years of age, the prevalence of impairment in mobility (57.6% vs 43.3%) and usual activities (58.8% vs 37.9%) was also higher than for population norms. For the FACT-GP, the physical (effect size: −0.28, p<0.028) and functional (effect size: −0.30, p<0.015) well-being sub-scale favored the total laparoscopic hysterectomy compared with total abdominal hysterectomy recipients.ConclusionCompared with population-based norms, long-term endometrial cancer survivors reported higher prevalence of anxiety/depression across all age groups, and deficits in mobility and usual activities for women aged ≥75 years. Physical and functional well-being were better among women who were treated with total laparoscopic hysterectomy than among those receiving total abdominal hysterectomy.

scholarly journals Ovarian Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

2021 ◽  
Vol 19 (2) ◽  
pp. 191-226
Author(s):  
Deborah K. Armstrong ◽  
Ronald D. Alvarez ◽  
Jamie N. Bakkum-Gamez ◽  
Lisa Barroilhet ◽  
Kian Behbakht ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Gynecologic Cancer ◽  
Germ Cell Tumors ◽  
Mucinous Carcinoma ◽  
The United States ◽  
Parp Inhibitors ◽  
Primary Treatment ◽  
Low Grade ◽  
Nccn Guidelines ◽  
Primary Surgery

Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States and is the country’s fifth most common cause of cancer mortality in women. A major challenge in treating ovarian cancer is that most patients have advanced disease at initial diagnosis. These NCCN Guidelines discuss cancers originating in the ovary, fallopian tube, or peritoneum, as these are all managed in a similar manner. Most of the recommendations are based on data from patients with the most common subtypes─high-grade serous and grade 2/3 endometrioid. The NCCN Guidelines also include recommendations specifically for patients with less common ovarian cancers, which in the guidelines include the following: carcinosarcoma, clear cell carcinoma, mucinous carcinoma, low-grade serous, grade 1 endometrioid, borderline epithelial, malignant sex cord-stromal, and malignant germ cell tumors. This manuscript focuses on certain aspects of primary treatment, including primary surgery, adjuvant therapy, and maintenance therapy options (including PARP inhibitors) after completion of first-line chemotherapy.

scholarly journals Case 1 − A case of gynecological PEComa

2017 ◽  
Vol 5 (1) ◽  
pp. 31-34
Author(s):  
Caterina Fontanella ◽  
Maria Luisa Carcangiu ◽  
Domenica Lorusso ◽  
Bruno Vincenti
Keyword(s):  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Epithelioid Cell ◽  
Perivascular Epithelioid Cell ◽  
Primary Surgery ◽  
Dilation And Curettage ◽  
Formalin Fixed Paraffin ◽  
Expert Pathologist ◽  
Formalin Fixed Paraffin Embedded ◽  
Magnetic Resonance Imaging Mri

Perivascular epithelioid cell tumors (PEComas) are a heterogeneous group of rare mesenchymal neoplasms composed of epithelioid cells which express melanocytic and myogenic markers, such as HMB-45, desmin and actin. In March 2013, we visited a postmenopausal 51-year-old woman with a suspected diagnosis of uterine PEComa diagnosed by a dilation and curettage of the lining of the uterus. After the histological revision of the formalin-fixed paraffin-embedded (FFPE) material by our expert pathologist, we confirmed the diagnosis and referred the patient for complete primary surgery. On November 2013, the patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with no macroscopically detectable residual cancer. However, in January 2014, due to voiding dysfunction and inconstant vaginal bleeding, the patient underwent magnetic resonance imaging (MRI) which documented multiple irregular lesions in the pelvis suspected as recurrent PEComa. Considering the early relapse of PEComa after optimal primary surgery, we suggested a systemic treatment with the combination of gemcitabine and docetaxel. For logistic reasons, the patients started the chemotherapy in her district hospital. After two cycles of chemotherapy the patient died due to treatment-related complications.

scholarly journals Granulosa cell tumor complicated by torsion, rupture and hemoperitoneum

2021 ◽  
Vol 10 (6) ◽  
pp. 2489
Author(s):  
Kripa Sherchan
Keyword(s):  
Postmenopausal Woman ◽  
Granulosa Cell ◽  
Ovarian Tumor ◽  
Vaginal Bleeding ◽  
Granulosa Cell Tumor ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Cell Tumor ◽  
Primary Therapy ◽  
Malignant Ovarian Tumor

Granulosa cell tumor, a sex cord stromal estrogen secreting tumor presents with vaginal bleeding and is seen in all ages. It accounts for <5% of all ovarian neoplasm. We reported a rare case of granulosa cell tumor in a postmenopausal woman undergoing staging laparotomy with total abdominal hysterectomy and bilateral salpingo-oopherectomy for malignant ovarian tumor, which was complicated by torsion, rupture and hemorrhagic ascitis. Any ovarian tumor with vaginal bleeding should arouse suspicion of granulosa cell tumor in the background of postmenopausal woman. For most patients, surgery alone is sufficient primary therapy, Radiation and chemotherapy are reserved for the treatment of recurrent or metastatic disease.

scholarly journals Breast ovarian cancer syndrome

2021 ◽  
Vol 8 (8) ◽  
pp. 2454
Author(s):  
Abhirup H. R. ◽  
Priyanka Kenchetty ◽  
Aishwarya K. Chidananda
Keyword(s):  
Ovarian Cancer ◽  
Early Stage ◽  
Radical Mastectomy ◽  
Abdominal Distension ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Care Patient ◽  
Human Beings ◽  
Cancer Syndrome ◽  
Brca1 And Brca2

BRCA1 and BRCA2, known as breast and ovarian cancer predisposition genes, were discovered in the 1990s. As part of a normal genetic structure, these genes are intrinsic to all human beings, but they are mutated in some individuals increasing the risk for breast and ovarian cancers development. BRCA1 is not only expressed in endocrine tissues but is also detected in other cells such as the neuroepithelial cells in the early stage of cell development. Like BRCA1, BRCA2 is also expressed in a wide variety of tissues and is observed with higher rates in the breast and thymus and with lower rates in the lung, ovary and spleen. We presented to you a case of 40 year old female admitted in surgical ward with lump in the left breast since 2 months with ipsilateral discrete axillary lymphadenopathy. Bilateral sono-mammography showed BIRADS V lesion in left breasts with satellite nodules. Ultrasonography of abdomen and pelvis showed large left adnexal solid mass lesion and right sided ovarian cyst with retrocaval, preaortic lymphadenopathy. Patient underwent a diagnostic laparoscopy which was converted to a laparotomy. Total abdominal hysterectomy with bilateral salphingo-oophorectomy was done. For the breast lump, patient underwent left sided modified radical mastectomy. Gene testing for revealed BRCA1 positivity. Chemotherapy was given to cover both breast and ovarian carcinoma. Patient came back with abdominal distension after 9 months and was offered palliative care. Patient succumbed for disease after 1 year after diagnosis. We reviewed the literature for the same.

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