Simple vaginal trachelectomy for early stage cervical cancer: A tertiary cancer center experience

Objectives: Less radical fertility sparing procedures have been introduced to reduce morbidity and adverse obstetric outcome in cervical cancer. Our objective was to describe oncological and obstetric outcomes of women with early-stage cervical cancer who underwent a simple vaginal trachelectomy (SVT). Material and methods: From 01/2013 to 05/2017, 14 women underwent SVT preceded by laparoscopic pelvic lymph node dissection. Results: Patients’ median age was 32 years and all of them were nulliparous. Histology included squamous cell carcinoma and adenocarcinoma in 12 (85.7%) and 2 (14.3%) patients, respectively. Three patients had stage 1A1 with lymphovascular space invasion, 4 1A2 and 7 1B1. After obtaining final histopathology, one patient underwent radical hysterectomy due to positive surgical margin and excluded from analysis. None of the patients had lymph node metastasis. None of the 13 patients developed a recurrence within a median follow-up of 27 (6–56) months. Seven patients have conceived: 4 were term deliveries, 2 were late preterm deliveries and 1 was spontaneous abortion. Conclusions: SVT in well selected early-stage cervical cancer patients seems to be a safe treatment option with excellent oncologic outcome, preserving reproductive function. Literature data will need to be confirmed in large prospective series

See and treat strategy by LEEP conization in patients with abnormal cervical cytology

Objectives: To determine the overtreatment and re-LEEP rates of see and treat strategy (S & T) in women who underwent S & T by LEEP and to identify the risk factors for overtreatment and surgical margin and/or endocervical curettage positivity. Material and methods: A total of 800 patients who underwent S & T in Istanbul University Cerrahpasa Medical Faculty between June 2010 and June 2016 were retrospectively analyzed. Results: Overtreatment rate was found to be 46.6%, decreasing with higher grade of cervical smear abnormalities. Age more than 45, low grade of cervical cytologic abnormality and absence of glandular involvement were associated with higher overtreatment rates. The more advanced the histopathology, the more increased risk of surgical margin on LEEP and ECC positivity (p < 0.0001, for both). Glandular involvement was associated with both surgical margin and ECC positivity. Conclusions: S & T can be used in patients with high grade cytologic anomaly with an acceptable overtreatment rate. In addition, bigger pieces of specimens may need to be removed during LEEP in patients who have suspicious images of higher grade of abnormalities on colposcopy to reduce surgical margin or ECC positivity. When high rate of ECC positivity in patients with HSIL cytology is considered, we suggest performing ECC to every patients with HSIL

Post-coital vaginal cuff dehiscence with small bowel evisceration after laparoscopic type II radical hysterectomy: A case report

Introduction: Vaginal cuff dehiscence after hysterectomy can be life-threating condition. Vaginal evisceration of bowel may lead to intestinal ischemia and intraabdominal infection. Immediate recognition and surgical repair are crucial for succesful management. Case report: Herein, we report a case of vaginal cuff dehiscence with small bowel evisceration in a 32-year old woman who underwent laparoscopic type II hysterectomy for stage IA2 cervical cancer. Conclusion: Patients who have undergone hysterectomy should be advised about when to restart coitus. Vaginal repair of vaginal cuff dehiscence is recommended if intestinal ischemia is excluded

Post-coital vaginal cuff dehiscence with small bowel evisceration after laparoscopic type II radical hysterectomy: A case report

INTRODUCTION: Vaginal cuff dehiscence after hysterectomy can be life-threating condition. Vaginal evisceration of bowel may lead to intestinal ischemia and intraabdominal infection. Immediate recognition and surgical repair are crucial for succesful management

A case with multiple gynecological malignancies

A patient with cervical non-Hodgkin lymphoma was treated with chemotherapy. Fourteen months after the diagnosis of the lymphoma, an endometrial adenocarcinoma was detected as a secondary malignant tumor. The patient was treated with surgery followed by radiotherapy. Approximately 7 years after the diagnosis of endometrial cancer, vaginal invasive squamous cell carcinoma was diagnosed as the third primary malignancy, and a second-line palliative radiotherapy was applied. Seven months after the last radiotherapy, postradiational sarcoma in the vagina was diagnosed. Congenital and acquired immune system disorders, viral oncogenes, and various human leukocyte antigen (HLA) types were investigated. Total blood count and lymphocyte subset analysis were performed, and CD4+ lymphopenia was detected. Serologic tests were carried out for human immunodeficiency virus, hepatitis B virus, human papillomavirus, Epstein-Barr virus, and herpes simplex virus infection. Epstein-Barr virus viral capsid antigen IgG was found positive. Low-risk human papillomavirus panel was detected by Hybrid Capture method in the cervical smear. The HLA investigation revealed HLA-A(2), HLA-A(3), HLA-B-57, HLA-B-35, HLA-B-4, HLA-B-6, HLA-DR3, HLA-DR1, HLA-DR51, HLA-DR52, HLA-DQ(6(1)), and HLA-DQ(7(3)). The patient died because of the disease

Transtubal Transport of Carcinoma Cells Into the Peritoneal Cavity After Saline Infusion via Transcervical Route in Patients With Endometrial Carcinoma

The aim of this study was to evaluate the rate of transtubal passage of carcinoma cells into the abdominal cavity after saline infusion in patients with endometrial carcinoma

Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage (D&C)

To compare diagnostic accuracy and adequacy of pipelle endometrial biopsy with dilatation and curettage