Primary female genital system lymphoma complicated by a recurrent mucinous borderline ovarian tumor: a case report and review of the literature

Background Primary female genital system lymphoma (PFGSL) is an infrequent entity. All genital organs may be affected, and most PFGSLs are localized to the cervix, uterine body, and ovaries. The clinical manifestations are nonspecific, which complicates a timely diagnosis. We report an unexpected case of PFGSL and discuss the disease characteristics by reviewing the literature. Case presentation A 48-year-old G3/P2 woman presented to the Department of Gynecology with a physical examination. Ultrasound examination and CT revealed pelvic masses. The woman underwent surgical treatment because of the pelvic masses and underwent a hysterectomy for a recurrent mucinous borderline ovarian tumor. However, the results of the postoperative pathological examination showed diffuse large B-cell lymphoma of the endometrium. After four courses of chemotherapy, the woman was in good condition. The clinical manifestations were nonspecific, which made a timely diagnosis complex. Conclusion This case highlights the importance of the difficulty in detecting early PFGSL early and how easily nonspecific manifestations can be ignored. It may lead to missing the best time for early treatment.

Prevention of Incisional Hernia in Ovarian Cancer Patients Undergoing Midline Laparotomy

BACKGROUND: Incisional hernias (IH) are a frequent complication of midline laparotomies in abdominal surgery. This study was conducted in order to determine the efficacy of mesh placement and assess the optimal fascia closure technique to reduce the IH rate in patients surgically treated after being diagnosed with malignant or borderline ovarian tumors.METHODS: Retrospective data from patients undergoing midline laparotomy for borderline or ovarian cancer in Hospital del Mar, Barcelona, from January 2008 to December 2019 were collected. Patient demographic, preoperative and intraoperative characteristics and risk factors for hernia were reported. The incidence of IH between groups (mesh and non-mesh) and the technique used in fascial closure for each patient (small bites technique vs large tissue bites) was reported. RESULTS: In total, 133 patients with available data for follow-up were included. After clinical and radiological examination, 25 (18.79%) of them showed IH. 18 of 61(29.5%) patients in non-mesh group developed IH, compared with 7 of 72 (9.7%) in mesh group (OR 0.25, 95% CI 0.09-0.66, p<0.005). Patients of large tissue bites group showed higher prevalence of IH compared with small bites technique group without statistical significance (OR 0.46, 95% CI 0.17-1.24, p=0.119). The combination of mesh reinforcement and small bites technique for fascial closure significantly reduce IH risk (p=0.021). CONCLUSION: Incidence of IH is high in patients undergoing midline laparotomy for ovarian cancer or borderline ovarian tumor. The addition of a prophylactic mesh and use of small bites technique may reduce the incidence of IH and potentially minimize the social impact and costs of this complication.

Borderline ovarian tumor frozen section diagnoses with features suspicious of invasive cancer: a retrospective study

Background A frozen section diagnosis of a borderline ovarian tumor with suspicious features of invasive carcinoma (“at least borderline” or synonymous descriptions) presents us with the dilemma of whether or not to perform a full ovarian cancer staging procedure. Quantification of this dilemma may help us with the issue of this clinical decision. The present study assessed and compared both the prevalence of straightforward borderline and “at least borderline” frozen section diagnoses and the proportion of these women with a final histopathological diagnosis of invasive carcinoma, with a special interest in histologic subtypes. Methods A retrospective cohort study was performed in three hospitals in The Netherlands. All women that underwent ovarian surgery with perioperative frozen section evaluation in one of these hospitals between January 2007 and July 2018 were identified and included in case of a borderline or “at least borderline” frozen section diagnosis and a borderline ovarian tumor or invasive carcinoma as a final diagnosis. Results A total of 223 women were included, of which 41 women (18.4%) were diagnosed with “at least borderline” at frozen section. Thirteen of forty-one women (31.7%) following “at least borderline” frozen section diagnosis and 14 of 182 women (7.7%) following a straightforward borderline frozen section diagnosis were diagnosed with invasive carcinoma at paraffin section evaluation (p < 0.001). When compared to straightforward borderline frozen section diagnoses, the proportion of women diagnosed with invasive carcinoma increased from 3.1 to 35.7% for serous tumors (p = 0.001), 10.0 to 21.7% for mucinous tumors (p = 0.129) and 50.0 to 75.0% (p = 0.452) in case of other histologic subtypes following an “at least borderline” frozen section diagnosis. Conclusions Overall, when compared to women with a decisive borderline frozen section diagnosis, women diagnosed with “at least borderline” frozen section diagnoses were found to have a higher chance of carcinoma upon final diagnosis (7.7% vs 31.7%). Especially in the serous subtype, full staging during initial surgery might be considered after preoperative consent to prevent a second surgical procedure or chemotherapy in unstaged women. Further studies are needed to evaluate whether additional sampling in case of an “at least borderline” diagnosis may decrease the risk of surgical over-treatment.