Disseminated peritoneal leiomyomatosis: a rare entity with diagnostic conundrum

Disseminated peritoneal leiomyomatosis (DPL) is a rare, usually benign disease primarily affecting premenopausal women. It is signalized by multiple smooth muscle nodules which grossly or radiologically may simulate peritoneal carcinomatosis or disseminated intraabdominal malignancies. A case study of 45 year female who presented with DPL after 8 years of hysterectomy is reported here

Endometrial cancer: Robotic versus Laparoscopic treatment. Preliminary report

Laparoscopic approach is today the standard treatment for benign and malignant gynecological pathologies. To traditional laparoscopic surgery in the last 10 years we can add the possibility to use a robotic platform. The adoption of this system allows undoubted advantages as the three-dimensional vision, the absence of the physiological tremor with enhanced ergonomics and possibility of using articulable tools. In this study we analyzed the results of 18 patients with endometrial cancer (Stage I) treated with robotic approach. The results were compared with a selected sample of 26 patients, with the same characteristics, treated with traditional laparoscopic approach in the same period by the same surgical team. The mean total operative time was significantly longer for robotic than laparoscopic group (125.6 min vs 102.3 min). However, if to this operative time we remove the time of preparation (docking time) we obtain the following results: 102.5 min for robotic group and 95.7 min for the laparoscopic control group. Intra-operative blood loss are significantly lower in the robotic group than in laparoscopic group. The robotic treatment of gynecological cancer is a safe and feasible technique. The oncological results are also equivalent to those of traditional laparoscopic surgery with advantages in terms of precision and reduction of intraoperative bleeding. Additional clinical studies on larger samples and heterogeneous patients are necessary in order to clarify the real advantages of robotic treatment

Groin recurrence in patients with early vulvar cancer following superficial inguinal node dissection

AbstractObjectiveTo investigate the causes of groin recurrence in patients with vulval cancer who previously had negative nodes following superficial inguinal node dissection (SIND).Material and methodsForty-one patients with squamous cell carcinoma of the vulva (stage I or II) were operated upon. The primary treatment was wide local excision with 2cm safety margin and superficial inguinal lymphadenectomy. Six patients had ipsilateral and one patient had bilateral groin recurrence. Those patients were subjected to deep inguinal node dissection (one patient required bilateral node dissection).ResultsThe mean age at time of diagnosis was 59years (range 51–68). The median follow-up period for all patients was 63months (range 24–71) and that of the recurrent cases was 20months (range 12–38). The mean depth of invasion of the recurrent cases was 5.5mm (range 5–5.9mm) and the mean diameter of the primary tumor in recurrent cases was 3.8cm (range 3–4.5cm). All recurrent cases had a high grade of the primary tumor. The median interval to recurrence was 21months (range 12–57). The groin recurrence rate after negative SIND was 17% (7/41 patients).The mean number of nodes resected per groin was eight (range 1–17). The nodes ranged in size from 0.2 to 4.0cm.ConclusionCarcinoma of the vulva with the following criteria (size of tumor is greater than 3cm, depth of invasion greater than 5mm, and high grade tumors) is at high risk of recurrence

Current Approaches to the Management of Sentinel Node Procedures in Early Vulvar Cancer in Germany : A Web-Based Nationwide Analysis of Practices

Background: Lymph node involvement is the most important prognostic factor for recurrence and survival in vulvar cancer. Sentinel node (SN) procedure can be offered in well-selected patients with early vulvar cancer. This study aimed to assess current management practices with respect to the sentinel node procedure in women with early vulvar cancer in Germany. Methods: A Web-based survey was conducted. Questionnaires were e-mailed to 612 gynecology departments. Data were summarized as frequencies and analyzed using the chi-square test. Results: A total of 222 hospitals (36.27%) responded to the invitation to participate. Among the responders, 9.5% did not offer the SN procedure. However, 79.5% evaluated SNs by ultrastaging. In vulvar cancer of the midline with unilateral localized positive SN, 49.1% and 48.6% of respondents, respectively, would perform ipsilateral or bilateral inguinal lymph node dissection. Repeat SN procedure was performed by 16.2% of respondents. For isolated tumor cells (ITCs) or micrometastases, 28.1% and 60.5% of respondents, respectively, would perform inguinal lymph node dissection, whereas 19.3% and 23.8%, respectively, would opt for radiation without further surgical intervention. Notably, 50.9% of respondents would not initiate any further therapy and 15.1% would opt for expectant management. Conclusions: The majority of German hospitals implement the SN procedure. However, only 79.5% of respondents performed ultrastaging and only 28.1% were aware that ITC may affect survival in vulvar cancer. There is a need to ensure that the management of vulvar cancer follows the latest recommendations and clinical evidence. Deviations from state-of-the-art management should only be after a detailed discussion with the concerned patient

Reporte de caso clínico de leiomiomatosis peritoneal diseminada

Leiomyomatosis peritonealis disseminata is a rare entity characterized by multiple benign smooth muscle nodules on the peritoneal surface. This article describes the case of a 58-year-old hypertensive, post menopausal woman who consulted for abdominal pain. She had no prior history of using hormone therapy or had any previous surgical history. When performing complementary studies a large pelvic mass of probable adnexal etiology was detected. An exploratory laparotomy was performed and a large tumor of approximately 30cm was documented. It covered the entire abdominal cavity and was unresectable. During histopathological study two different entities were described: leiomiomatosis peritonealis disseminata and leiomyosarcoma.  La leiomiomatosis peritoneal diseminada es una entidad rara, la cual se caracteriza por nódulos benignos de tejido muscular liso diseminados a nivel del peritoneo. En este artículo se describe el caso de una mujer de 58 años hipertensa, post menopaúsica sin antecedente de uso de terapia hormonal y sin antecedentes quirúrgicos la cual consulta por dolor abdominal. Al realizar estudios complementarios se detecta una gran masa pélvica de probable etiología anexial. Se realiza laparotomía exploratoria en la cual se documenta gran masa tumoral de aproximadamente 30 cm que abarca toda la cavidad abdominal, la cual es irresecable. Durante el estudio histopatológico se describen dos entidades diferentes: leiomiomatosis peritoneal diseminada y además leiomiosarcoma. &nbsp

Controversies in the Management of Endometrial Carcinoma: An Update

Endometrial carcinoma is the commonest type of female genital tract malignancy in the developed countries. Endometrial carcinoma is usually confined to the uterus at the time of diagnosis and as such usually carries an excellent prognosis with high curability. Our understanding and management of endometrial cancer have continuously developed. Current controversies focus on screening and early detection, the extent of nodal surgery, and the changing roles of radiation therapy and chemotherapy and will be discussed in this paper

Cancer of the endometrium: current aspects of diagnostics and treatment

BACKGROUND: Endometrial cancer represents a tumor entity with a great variation in its incidence throughout the world (range 1 to 25). This suggests enormous possibilities of cancer prevention due to the fact that the incidence is very much endocrine-related, chiefly with obesity, and thus most frequent in the developed world. As far as treatment is concerned, it is generally accepted that surgery represents the first choice of treatment. However, several recommendations seem reasonable especially with lymphadenectomy, even though they are not based on evidence. All high-risk cases are generally recommended for radiotherapy. METHODS: A literature search of the Medline was carried out for all articles on endometrial carcinoma related to diagnosis and treatment. The articles were systematically reviewed and were categorized into incidence, etiology, precancerosis, early diagnosis, classification, staging, prevention, and treatment. The article is organized into several similar subheadings. CONCLUSIONS: In spite of the overall good prognosis during the early stages of the disease, the survival is poor in advanced stages or recurrences. Diagnostic measures are very well able to detect asymptomatic recurrences. These only seem justified if patients' chances are likely to improve, otherwise such measures increases costs as well as decrease the patients' quality of life. To date neither current nor improved concepts of endocrine treatment or chemotherapy have been able to substantially increase patients' chances of survival. Therefore, newer concepts into the use of antibodies e.g. trastuzumab in HER2-overexpressing tumors and the newer endocrine compounds will need to be investigated. Furthermore, it would seem highly desirable if future studies were to identify valid criteria for an individualized management, thereby maximizing the benefits and minimizing the risks