Beyond Sentinel Lymph Node: Outcomes of Indocyanine Green-Guided Pelvic Lymphadenectomy in Endometrial and Cervical Cancer

Background: The aim of our study was to compare the number of lymph nodes removed during indocyanine green (ICG)-guided laparoscopic/robotic pelvic lymphadenectomy with standard systematic lymphadenectomy in endometrial cancer (EC) and cervical cancer (CC). Methods: This is a multicenter retrospective comparative study (Clinical Trial ID: NCT04246580; updated on 31 January 2023). Women affected by EC and CC who underwent laparoscopic/robotic systematic pelvic lymphadenectomy, with (cases) or without (controls) the use of ICG tracer injection within the uterine cervix, were included in the study. Results: The two groups were homogeneous for age (p = 0.08), Body Mass Index, International Federation of Gynaecology and Obstetrics (FIGO) stages (p = 0.41 for EC; p = 0.17 for CC), median estimated blood loss (p = 0.76), median operative time (p = 0.59), and perioperative complications (p = 0.66). Nevertheless, the number of lymph nodes retrieved during surgery was significantly higher (p = 0.005) in the ICG group (n = 18) compared with controls (n = 16). Conclusions: The accurate and precise dissection achieved with the use of the ICG-guided procedure was associated with a higher number of lymph nodes removed in the case of systematic pelvic lymphadenectomy for EC and CC

Bilateral gluteal metastases from a misdiagnosed intrapelvic gastrointestinal stromal tumor

<p>Abstract</p> <p>Background</p> <p>The location of gastrointestinal stromal tumors (GIST) outside of the gastrointestinal system is a rare event.</p> <p>Case presentation</p> <p>A 56-year old woman presented with a GIST of the pelvis was misdiagnosed and treated as a uterine leiomyosarcoma. The diagnosis was made after the CD117 (KIT) positivity in the biopsy of the excised bowel mass four years from the first presentation. During this period she presented a bilateral muscle and subcutaneous metastasis in the gluteal area.</p> <p>Conclusion</p> <p>The correct diagnosis of the extra-gastrointestinal stromal tumor is a challenge even for experienced pathologists. CD117 (KIT) positivity is the most important immunohistochemical feature in the histological diagnosis. To our knowledge a metastatic EGIST (extra-gastrointestinal stromal tumor) to the skeletal muscle bilaterally has not been described previously in the English medical literature.</p

Significance of vascular endothelial growth factor in growth and peritoneal dissemination of ovarian cancer

Vascular endothelial growth factor (VEGF) is a key regulator of angiogenesis which drives endothelial cell survival, proliferation, and migration while increasing vascular permeability. Playing an important role in the physiology of normal ovaries, VEGF has also been implicated in the pathogenesis of ovarian cancer. Essentially by promoting tumor angiogenesis and enhancing vascular permeability, VEGF contributes to the development of peritoneal carcinomatosis associated with malignant ascites formation, the characteristic feature of advanced ovarian cancer at diagnosis. In both experimental and clinical studies, VEGF levels have been inversely correlated with survival. Moreover, VEGF inhibition has been shown to inhibit tumor growth and ascites production and to suppress tumor invasion and metastasis. These findings have laid the basis for the clinical evaluation of agents targeting VEGF signaling pathway in patients with ovarian cancer. In this review, we will focus on VEGF involvement in the pathophysiology of ovarian cancer and its contribution to the disease progression and dissemination

Delivering into the mounting evidence of a probable link between maternal hypothyroidism and breech presentation at term: What do we know until now?

Approximately 3–5% of all women at term have a breech baby [...

Spontaneous hepatic rupture during third trimester of pregnancy

Hepatic rupture is a rare and devastating complication in pregnancy, mainly associated with pre-eclampsia and HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count). It has an incidence of I case in 45,000225,000 births. Nearly 200 cases have been reported in the international literature. We report a case of a hepatic rupture with severe haemorrhage caused by HELLP in a third trimester pregnancy. The case was managed successfully with no pathological complications for either the mother or the infant. The physician should be aware of this condition when dealing with intra-abdominal haemorrhage during pregnancy

Vaginal malignant melanoma: surgical challenge and need for combination treatment

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Pelvic splenosis: A systematic review of the literature

BACKGROUND: Splenosis is the presence of ectopic autotransplantation of splenic tissue in various compartments of the human body, occurring after rupture of the splenic parenchyma. METHODS: A systematic PubMed and Scopus search was conducted. RESULTS: The mean age of the patients was 51.7 years. The majority of patients were of female gender. An emergency presentation was noted in 30 out of 85 patients, having abdominal pain as main symptom. The principal reason for splenectomy were traffic accidents. The time span between splenectomy and the initial symptoms ranged between 1 and 57 years. The most frequent symptom at presentation of pelvic splenosis was abdominal pain. Almost a quarter of the included patients were without any symptom. Presence of extrapelvic splenosis was de-scripted in almost half of the included patients. With regards to the type of treatment provided, exploratory laparotomy, laparoscopic surgical exploration / laparoscopy, robotic removal of splenium and watchful waiting, were performed in 35 (41.2%), 32 (37.6%), 3 (3.5%) and 15 (16.3%) patients, respectively. No fatality was reported. CONCLUSION: Pelvic splenosis is a rare clinical condition. It may mimic several clinical conditions and mislead diagnosis. The clinical history of splenectomy for trauma or different other reasons may es-tablish diagnosis and exclude other morbidities. Excision and complete removal of pelvic splenosis nodules is not always necessary and it depends on the clinical symptomatology. Careful imaging and precise assessment with the assistance of nuclear medicine may lead to correct diagnosis and avoid unnecessary surgical interventions.UnknownThe article is available via Open Access. Click on the 'Additional link' above to access the full-text

Sonographic antenatal diagnosis of congenital dacryocystoceles

Congenital dacryocystoceles are a relatively rare variant of nasolacrimal duct obstruction, accounting for only 0.1% of infants with congenital nasolacrimal duct obstruction. We report a new case of bilateral congenital dacrocystoceles diagnosed in an otherwise uncomplicated fetal ultrasound examination during the 33rd week of pregnancy. The diagnosis was confirmed postnatally. The neonate, who did not present postpartum respiratory distress, was scheduled for endoscopic marsupialization-probing of the cystic structures. Parents must be well informed about the risk of respiratory distress, and facial appearance. Complete resolution is achieved after surgical intervention. (C) 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 201

Management of Large Retroperitoneal Lipoma in a 12-Year-Old Patient

Retroperitoneal lipomas are rare tumors. The etiology of their proliferation is uncertain. Metabolic and genetic causes have been reported. We present the case of a 12-year-old patient with a large pelvic lipoma causing dysuria and pelvic pain. Magnetic resonance imaging revealed the existence of a large retroperitoneal fat tumor. Ultrasound-guided fine needle biopsy was performed to exclude malignancy. The biopsy specimen revealed tissue consistent with a benign lipoma tumor. Exploratory laparotomy revealed a solid lipoma of the retroperitoneal space 8 × 6 cm and weighing 300 g. The patient had a good postoperative performance status. Lipomas should be considered in the differential diagnosis of a solid tumor in the retroperitoneal space. © 2009 Elsevier Inc. All rights reserved