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

Case Report: Gastric Carcinoma Diagnosed at the Second Trimester of Pregnancy

We report a rare case of gastric cancer in pregnancy. A 26-year-old woman presented at the 20th week of pregnancy complaining of nausea and vomiting. Although the patient considered the condition to be related with pregnancy and underestimated its importance, her complaints persisted over the following weeks and she was hospitalized for investigation. The diagnostic workup revealed a metastatic gastric cancer. Gastric cancer is very rare in pregnancy, and therefore it may be left out of differential diagnosis by physicians. Diagnosis may be further delayed because of overlapping symptoms occurring during normal pregnancy (nausea, vomiting, and fatigue). All these factors may contribute to a very high mortality of this malignancy during pregnancy

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

Is endometriosis a preneoplastic condition?

"Ovarian cancer risk increased significantly over time, and the risk was particularly elevated among women with a long-standing history of ovarian endometriosis...

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

Sex Cord-Stromal Tumor with Annular Tubules of the Ovary

Sex cord-stromal tumors with annular tubules (SCTAT) of the ovary are rare. They have two clinical presentation forms: the syndromic form, which is associated with Peutz-Jeghers syndrome, and the non-syndromic form, which is frequently seen in the second or third decades. We describe a 13-year-old patient who underwent left oophorectomy. Macroscopically, the mass was 16x13x8 cm in diameter, encapsulated, and lobulated. It showed a yellow-to-orange solid cut surface with small cystic areas and hemorrhagic cleft-like spaces. Microscopically, the tumor had nodular areas that were separated with fibrous stroma. They were composed of tubules, which were lined by columnar shaped cells with eosinophilic cytoplasm, nuclear palisading, and central Periodic Acid Schiff (PAS)-positive eosinophilic hyaline bodies. Immunohistochemically, the tumor cells were strongly positive for inhibin. Finally, the tumor was diagnosed as non-syndromic ovarian SCTAT

Surgery for Isolated Liver Metastasis of Ovarian Cancer

Few studies have been published on liver resection alone or in combination with cytoreductive surgery for liver metastases of ovarian carcinoma. Methods: Eight patients who underwent liver resection for metastasis of ovarian cancer were included in the study. Total abdominal hysterectomy and bilateral salpingo-oophorectomy had been performed before liver surgery in all patients. The demographic data, follow-up details before and after liver resection, histopathology of the primary ovarian cancer, type of surgery and outcome were evaluated. Results: The mean age of the patients was 56.1 (46–68) years. The mean hospitalization time was 8 (7–10) days. The mean disease-free interval was 5.38 years from the time of initial surgery to surgery for metastatic liver lesions, and 39 months after liver resection to secondary metastases. Four patients did not have any evidence of disease after liver surgery. Conclusion: Indications for liver resection should be considered in selected patients who have a limited extent of metastatic disease from ovarian carcinoma. Liver resection for metastases of ovarian carcinoma could be an effective and feasible approach