Sentinel lymph node in early stage ovarian cancer; a literature review

Although sentinel lymph node mapping has been widely implemented in gynecological malignancies in order to minimize the number of unnecessary lymph node dissections and to diminish postoperative morbidity rate, little is known about ovarian cancer sentinel lymph node mapping. This article presents a literature review regarding the effectiveness, safety and benefits of this method. Sentinel lymph node detection in early stage ovarian cancer seems to be a safe and effective method, able to minimize the rate of patients submitted to unnecessary lymph node dissection. The second goal of the procedure, to minimize the risk of missing involved lymph nodes, seems also to have been achieved, most studies reporting a very small number of cases diagnosed with positive non-sentinel lymph nodes. Considering all these data we can note that this procedure is not yet included as part of the standard therapeutic protocol, so that further studies would be necessary to include it as a common therapeutic approach in the case of patients with early stage ovarian cancer

Pancreatic Resections for Metastatic Disease

Although the incidence of metastases to the pancreas from various primaries is very low, these lesions are usually being described as part of the systemic recurrence of different malignancies, in certain cases isolated pancreatic metastases might be encountered. When it comes to the malignancies, which might lead to the apparition of pancreatic metastases, the most common origins have been reported to be renal cell carcinoma, colon cancer, ovarian cancer and melanomas. In certain cases, patients with pancreatic metastases might be submitted to surgery with curative intent. However, it should not be omitted that pancreatic resections can be associated with higher rates of perioperative morbidity; therefore, a precise selection of the cases that are considered suitable for such procedures is mandatory. It seems that the best results in regard with long-term survival are expected in cases with isolated pancreatic metastases as well as in cases with limited extrapancreatic lesions, amenable to complete cytoreductive surgery. This chapter reviews the most important studies conducted on the theme of pancreatic resections for metastatic disease from various primaries

HPV Infection and Vulvar Cancer

Although the strong association between human papilloma virus (HPV) and cervical cancer has been widely demonstrated, it seems that uterine cervix cancer is not the only gynecologic malignancy induced by this pathogenic agent. It has been shown that HPV infection plays a central role in the development of vulvar cancer too, HPV 16 and 18 being the most frequently reported genotypes that might induce this kind of lesions. This aspect presents a particular importation, patients diagnosed with HPV-related vulvar cancer reporting a more favorable trend in regard with the long-term outcome. The current chapter aims to describe the pathogenesis as well as the therapeutic options and the long-term outcomes of patients in which association between HPV and vulvar cancer can be assessed

Surgical Advances in the Treatment of Gallbladder Carcinoma at Different Stages

Gallbladder carcinoma remains the most common cancer originating from the biliary tract, which is associated with poor prognosis and poor survival rates. It is estimated that only one-third of patients with histopathological diagnostic of gallbladder cancer had been correctly diagnosed preoperatively, in the remaining cases the diagnostic being established intraoperatively or postoperatively, based on the histopathological examination. Moreover, although surgery remains the most appropriate therapeutic approach in order to improve survival, it is estimated that only 25% of cases with gallbladder carcinomas present resectable lesions. The current chapter reviews the most appropriate surgical options in patients diagnosed with both early stage and advanced stage gallbladder cancer, by minimally invasive as well as by open approach. In the meantime, the therapeutic strategies in incidentally diagnosed gallbladder cancer will be discussed

Gracilis myocutaneous flap for perineal defect reconstruction after left hemivulvectomy for locally invasive vulvar cancer – A case report and a literature review

Performing radical surgery for locally advanced vulvar cancer is usually associated with the occurrence of large perineal defects. In order to provide a better healing process of the perineal wound, different reconstructive techniques have been proposed. We present the case of a 63-year-old female patient diagnosed with locally advanced vulvar cancer for which a left hemivulvectomy with bilateral inguinal lymph node dissection was performed. After completion of the resection phase, the reconstruction with gracilis myocutaneous flap was performed. The patient developed a non-union of the flap. However, it slowly healed without any surgical re-intervention. Gracilis myocutaneous flap seems to be an effective and feasible method of perineal reconstruction after extended perineal resection for gynecological malignancies, including vulvar cancer. The method appears effective even in pre-irradiated patients with larger perineal wounds resulting after total pelvic exenteration for locally advanced gynecological malignancies

Sentinel lymph node in early stage ovarian cancer; a literature review

Although sentinel lymph node mapping has been widely implemented in gynecological malignancies in order to minimize the number of unnecessary lymph node dissections and to diminish postoperative morbidity rate, little is known about ovarian cancer sentinel lymph node mapping. This article presents a literature review regarding the effectiveness, safety and benefits of this method. Sentinel lymph node detection in early stage ovarian cancer seems to be a safe and effective method, able to minimize the rate of patients submitted to unnecessary lymph node dissection. The second goal of the procedure, to minimize the risk of missing involved lymph nodes, seems also to have been achieved, most studies reporting a very small number of cases diagnosed with positive non-sentinel lymph nodes. Considering all these data we can note that this procedure is not yet included as part of the standard therapeutic protocol, so that further studies would be necessary to include it as a common therapeutic approach in the case of patients with early stage ovarian cancer

Diagnosis and management of pericardial effusion

Pericardial effusion is a common pathology in clinical practice. The etiology of pericardial effusion is diverse, from infectious diseases, malignancies, autoimmune diseases, chronic renal failure, to drug-related or after an invasive cardiac intervention. Clinical presentation of pericardial effusion is variable, depending on the volume of the fluid and the rate of accumulation. Clinical manifestations are dramatic if the pericardial fluid accumulates rapidly. Classical symptoms in pericardial effusion include pleuritic chest pain associated with dyspnea. In case of cardiac tamponade, orthopnea, jugular venous distension, pulsus paradoxus, hypotension, and shock appear. Transthoracic echocardiography is the gold standard investigation for the diagnosis of pericardial effusions. The echocardiographic signs of cardiac tamponade are represented by the collapse of the right atrium and right ventricle, respiratory alteration of mitral and tricuspid flow, and changes of the inferior vena cava. Management of pericardial effusion is guided by several factors, including hemodynamic impact and etiology. Pericardiocentesis guided by echocardiography is a life-saving procedure in cases of large pericardial effusions and cardiac tamponade. This is a review of the diagnosis and treatment of pericardial effusion

High-grade cervical dysplasia in pregnancy – psychological and medical challenges

Despite being rare, the incidence of pregnancy-related cancer is expected to rise as women continue to delay childbearing and give birth later in their reproductive years. In this broad category, tumors like breast cancer, dermatological neoplasia and cervical cancer are most common and tend to arise in women of childbearing age. All pregnant women with clinical and cytologic suspicion of cervical cancer, except for squamous atypia or low-grade squamous intraepithelial lesions, should undergo colposcopy, with or without biopsy, the latter being avoided if possible due to possible complications which, although rare, may involve preterm labor initiation. Some studies have attempted to assimilate comparable results of USG with MRI during the gestational period by determining the sensitivity, specificity, and accuracy of trans-rectal ultrasound (TRUS) in comparison to magnetic resonance imaging (MRI). In order to identify the proper way to diagnose and treat the disease, because of the complexity due to pregnancy, a multidisciplinary team consisting of a gynecologist, medical and surgical oncologist, and radiologist should be assembled. Both maternal and fetal wellbeing should be taken into consideration when the medical team must choose among termination of pregnancy, delay of maternal treatment, and iatrogenic preterm delivery. Psychological counseling also plays an important role and due to the sensitivity of the issue, should continue through gestation and the postpartum. In order to develop optimal guidelines for diagnosis, treatment, and outcome issues, large scale prospective studies are needed, but feasibility may be limited due to the scarcity of cervical cancer cases associated with pregnancy