Prognostic Importance of Lymph-Vascular Space Involvement in Stage I Endometrioid Type Endometrial Cancer

Objective:The study aimed to investigate the prognostic significance of lymph-vascular space invasion (LVSI) in patients with stage I endometrioid-type endometrial carcinoma (EC) and to determine its impact on overall survival (OS) and disease-free survival (DFS).Methods:Medical records of 611 patients with stage I endometrioid-type EC who underwent surgery at our Ankara Dr. Zekai Tahir Burak Women's Health Training and Research Hospital Gynecology Clinic were retrospectively analyzed. The patients were divided into two groups based on the presence or absence of LVSI. The primary outcome measures were DFS and OS, and the prognostic significance of LVSI was assessed using univariate and multivariate analyses.Results:We identified 52 LVSI-positive patients among 611 patients with stage I endometrioid EC during the study period; 489 (80%) were classified as stage IA and 122 (20%) as stage IB. The total number of recurrences was 26 (4.3%). LVSI was observed in only 4 patients with recurrence (15.3%). For the LVSI positive patients, the 5-year DFS was 88.7%, whereas the 5-year OS rate was 91.6%. Age >60 years [hazard ratio (HR) 4.08, 95% confidence interval (CI) 1.57-10.59; p=0.004] and tumor size >2.8 cm (HR 2.48, 95%, CI 1.001-6.148; p=0.05) were found to be independent prognostic factors of decreased OS.Conclusion:We found that LVSI in stage I endometrioid-type EC was not a significant predictor of DFS and OS. Patient’s age and tumor size were independent prognostic factors of crude survival. These results suggest that LVSI may not be a useful prognostic marker in this patient population and that further studies are needed to identify more reliable predictors of survival in EC

“Three-Step Approach” Versus “See-and-Treat Procedure” in women with “High Grade Squamous Intraepithelial Lesion” (HSIL) or “Atypical Squamous Cells cannot exclude HSIL” (ASC-H) Cytology

Objective: The purpose of this study was to examine the correlation between histological findings in women with HSIL or ASC-H who have undergone loop electrosurgical excisional procedure with “Three-Step Approach” and “See-and-Treat Procedure". Study Design: A retrospective review was performed in 171 women with cytologically detected HSIL or ASC-H. Sixty five women with HSIL cytology and 35 women with ASC-H cytology were managed by “Three-Step Approach”, 35 women with ASC-H and 36 women with HSIL cytology were managed by "See-and-Treat Procedure”. Rates of histopathological findings were compared in two strategies with respect to previous cytology. Results: Fifteen women with ASC-H (42.9%), and 24 women with HSIL (68.5%) had CIN 2-3 at loop electrosurgical excisional procedure specimens in the “See-and-Treat” group whereas 14 women with ASC-H (38.8%), and 43 women with HSIL (66.2%) had CIN 2-3 at loop electrosurgical excisional procedure specimens in the “Three-Step Approach” group. There was no significant difference in the rate of CIN 2+ lesions when two strategies were compared in women with HSIL and ASC-H (p=0.71 and p=0.72, respectively). The overtreatment rates were 22.9% and 48.6% for HSIL and ASC-H cytology, respectively in the “See and Treat” group. Conclusion: In the ASC-H group, the rate of CIN 2+ lesions is significantly high (51.4%). It seems rational to perform “See-and-Treat procedure” in the setting of ASC-H smears although the overtreatment rate seems to be high. Because of the rate of overtreatment, the “Three-Step Approach” seems to be more reasonable in women with ASC-H cytology who also have fertility concerns. After a cytological diagnosis of HSIL, “see and treat” approach seems to be a safe and time saving strategy

Malignant peripheral nerve sheath tumor of the vulva, an unusual differential diagnosis for vulvar mass

INTRODUCTION: Malignant peripheral nerve sheath tumors (MPNSTs) are rare, up to one half of the MPNSTs occur in patients with neurofibromatosis type-1 (NF-1), while the rest are sporadic. Here, we present a 52-year-old woman with MPNST of the vulva without NF-1. We will discuss basics of the disease, treatment options and follow-up strategies. PRESENTATION OF CASE: 52-year-old female admitted to our hospital with complaint of abnormal uterine bleeding and rapidly growing vulvar mass. Excisional biopsy of the mass showed MPNST of the vulva. Afterwards, the patient underwent radical vulvectomy with inguinofemoral lymph node dissection. Short after the surgery, multiple lung metastasis were shown and responded to chemotherapy, but rapid local recurrence occurred short after the completion of the chemotherapy. DISCUSSION: The primary treatment option in MPNSTs is surgical excision with or without adjuvant therapy. There is not enough data about the role of systemic chemotherapy in the management of MPNSTs and it still remains controversial. CONCLUSION: In general, radiation therapy has not been demonstrated to improve overall survival. Complete surgical resection of the primary tumor is the mainstay of the treatment

Mucoepidermoid Carcinoma Of Uterine Cervix: A Distinct Pathological And Clinical Entity

Mucoepidermoid carcinoma of uterine cervix is a rare tumor that has some individual features. Defining risk factors after surgery shape the postoperative treatment modality on cervical cancer patients. Although there is not a well-known strategy for the postoperative follow-up of mucoepidermoid carcinoma, the aggressive behaviour of this tumor makes the gynecological oncologists choose liberal therapies on these patients