Eradication of isolated para-aortic nodal recurrence in a patient with an advanced high grade sorous ovarian carcinoma: our experience and review of literature

Abstract: We report a case report regarding the eradication of isolated lymph-nodal para-aortic recurrence in the aortic region down the left renal vein (LRV) in a patient treated two years earlier in another hospital for a FIGO stage IC2 high-grade serous ovarian carcinoma with a video showing the para-aortic space after eradication of the metastatic tissue. A 66 year-old woman was admitted 24 months after the initial surgical procedure for an increased Ca 125 level and CT scan that revealed a 3 cm para-aortic infrarenal lymph-nodal recurrence that was confirmed by PET/CT scan. A secondary cytoreductive surgery (SCS) with a para-aortic lymph-nodal dissection of the tissue down the LRV and radical omentectomy were performed: during the cytoreduction, the right hemicolon was mobilized. The anterior surface of the inferior vena cava (IVC), aorta and LRV were exposed. The metastatic lymph nodes were detected in the para-ortic space down the proximal part of the LRV and eradicated; an en bloc infrarenal lymph-node dissection from the aortocaval region was performed. The operative time during the surgical procedure was 212 min with a blood loss of 120 mL. No intra- and postoperative complications, including ureteral or vascular injury or renal dysfunction, occurred. At histological examination, three dissected lymph nodes were positive for metastasis, and the patient was discharged five days after laparotomy without side effects and underwent chemotherapy 3 weeks later; after a follow-up of 42 months, no recurrence was detected. In conclusion, secondary debulking surgery can be considered a safe and effective therapeutic option for the management of recurrences, although long-term follow-ups are necessary to evaluate the overall oncologic outcomes of this procedure

Pregnancy Complications After Hysteroscopic Metroplasty: A Ten-Year Case-Control Study

INTRODUCTION: Septate uterus is one of the most common congenital uterine anomalies and it may effect female reproductive health causing different obstetric complications, in particular miscarriages and reduction of fertility. MATERIALS AND METHODS: We conducted a retrospective case-control (1:4) comparative study (Canadian Task Force Classification II-2) with the purpose to evaluate pregnancy complications (abnormal fetal presentations, preterm deliveries, and caesarean sections) and reproductive outcome after hysteroscopic metroplasty. We studied retrospectively two groups: 62 women that delivered after metroplasty (group A); and a control group of 248 women with no history of hysteroscopic metroplasty that delivered in the same period in our hospital (group B). RESULTS: The rate of abnormal fetal presentations was significantly higher in study group A versus control group B (22.58% [14/62] vs. 4.03% [10/248], p<0.0001). Caesarean section rate was significantly higher in group A versus group B (66.12% [41/62] vs. 35.08% [87/248], p<0.0001), and preterm deliveries rate was significantly higher in group A versus group B (14.51% [9/62] vs. 6.45% [16/248], p= 0.037). Furthermore, in group A, we observed a significant reduction of the abortion rate and an increase in the total number of live births after metroplasty. CONCLUSIONS: In our series of cases, we have observed a high rate of some pregnancy complications after metroplasty compared to the general population, such as preterm deliveries and fetal malpresentations with a higher rate of caesarean sections. Hysteroscopic metroplasty has been proven to improve the overall reproductive outcome by reducing miscarriage rate and increasing live birth rate. In our opinion, benefits obtained after metroplasty must be considered greater than the adverse pregnancy outcomes observed with our series

Diagnostic accuracy of hysterectomy vs dilation and curettage (D&C) for atypical endometrial hyperplasia in patients performing hysterectomy or serial follow-up

Background: Endometrial hyperplasia (EH) is considered a heterogeneous pre-neoplastic clinical entity characterized by an abnormal glandular proliferation, with less than half of the tissue area occupied by the stroma. The aim of this retrospective study was to evaluate the correlation between the histological diagnosis of atypical endometrial hyperplasia (AEH) obtained through office hysteroscopy (OH) or uterine dilation and curettage (D&amp;C) and the definitive histological evaluation after hysterectomy. Methods: Among 112 patients with atypical EH, 45 (40%) underwent hysteroscopy and 67 (60%) curettage. Results: The diagnostic accuracy of OH was very high: in particular, it showed a diagnostic coincidence in 87% of cases with the definitive histological diagnosis through hysteroscopy. The curettage, instead, had diagnostic coincidence only in 14% of cases. Conclusion: Office hysteroscopy is the ideal procedure for both diagnosis and follow-up of endometrial hyperplasia

Endometriosis: seeking optimal management in women approaching menopause

The incidence of endometriosis in middle-aged women is not minimal compared to that in the reproductive age group. The treatment of affected women after childbearing age to the natural transition toward menopause has received considerably poor attention. Disease management is problematic for these women due to increased contraindications regarding hormonal treatment and the possibility for malignant transformation, considering the increased cancer risk in patients with a long-standing history of the disease. This state-of-the-art review aims for the first time to assess the benefits of the available therapies to help guide treatment decisions for the care of endometriosis in women approaching menopause. Progestins are proven effective in reducing pain and should be preferred in these women. According to the international guidelines that lack precise recommendations, hysterectomy with bilateral salpingo-oophorectomy should be the definitive therapy in women who have completed their reproductive arc, if medical therapy has failed. Strict surveillance or surgery with removal of affected gonads should be considered in cases of long-standing or recurrent endometriomas, especially in the presence of modifications of ultrasonographic cyst patterns. Although rare, malignant transformation of various tissues in endometriosis patients has been described, and management is herein discussed