Early Diagnosis of Congenital Uterine Anomalies: Is the Three Dimensional Ultrasound Approach the Suitable Choice? 3D in Uterine Anomalies

Purposes: Congenital uterine anomalies (CUA) are benign conditions associated with relatively serious complications affecting the reproductive life. Due to their infrequency CUA are often misdiagnosed, exposing the patient to possible future complications. Case description: We report the cases of three women affected by an unknown CUA, which underwent three different diagnostic and surgical approaches. Conclusions: A correct and early diagnosis of CUA is mandatory to allow a correct clinical and therapeutic management. In our opinion we might avoid the use of MRI considered as the second line technique after 2D-US, keeping in mind that in CUA the diagnostic value of 3D-US has the same accuracy as MRI

An Update of Laparoscopy in Cervical Cancer Staging: Is It a Useful Procedure?

Objective: It was the aim of this study to report on the role of laparoscopic staging in a large series of locally advanced cervical cancer (LACC) patients and its impact on prognosis. Methods: Consecutive patients with LACC were considered for surgical staging: gynecological examination, cystoscopy and laparoscopy with peritoneal biopsies and peritoneal fluid cytology. Results: Between February 2000 and September 2010, a total of 167 women were evaluated. In 5 patients, laparoscopy could not be performed. One hundred and sixty-two patients had correct laparoscopic staging: 49 International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIA (>4 cm), 67 IIB, 39 III, and 7 IVA. Abdominal spread was found in 33 cases (20%). There was a minor laparoscopy complication rate of 1%. We found a significant difference in the distribution of peritoneal spread for tumor grade and FIGO stage (p = 0.01 and p < 0.0001, respectively), whereas no statistically significant difference for the histological type was found [p = not significant (NS)]. The median follow-up was 80 months (range 4-144). The median overall survival was 65 months. The patients without abdominal spread did not benefit from a significantly longer survival (median overall survival of 59 vs. 70 months; p = NS). Conclusions: Laparoscopic staging in cervical cancer is a safe and feasible technique but it does not modify the prognosis of LACC patients. © 2013 S. Karger AG, Basel

Circulating tumor cells as trigger to hematogenous spreads and potential biomarkers to predict the prognosis in ovarian cancer.

Despite several improvements in the surgical field and in the systemic treatment, ovarian cancer (OC) is still characterized by high recurrence rates and consequently poor survival. In OC, there is still a great lack of knowledge with regard to cancer behavior and mechanisms of recurrence, progression, and drug resistance. The OC metastatization process mostly occurs via intracoelomatic spread. Recent evidences show that tumor cells generate a favorable microenvironment consisting in T regulatory cells, T infiltrating lymphocytes, and cytokines which are able to establish an "immuno-tolerance mileau" in which a tumor cell can become a resistant clone. When the disease responds to treatment, immunoediting processes and cancer progression have been stopped. A similar inhibition of the immunosuppressive microenvironment has been observed after optimal cytoreductive surgery as well. In this scenario, the early identification of circulating tumor cells could represent a precocious signal of loss of the immune balance that precedes cancer immunoediting and relapse. Supporting this hypothesis, circulating tumor cells have been demonstrated to be a prognostic factor in several solid tumors such as colorectal, pancreatic, gastric, breast, and genitourinary cancer. In OC, the role of circulating tumor cells is still to be defined. However, as opposed to healthy women, circulating tumor cells have been demonstrated in peripheral blood of OC patients, opening a new research field in OC diagnosis, treatment monitoring, and follow-up

P66. Pilot Study on Subserosal and Intramural Uterine Leiomyomas and Magnetic Resonance-guided Focused Ultrasound Surgery ( MRgFUS): Are there New Predictive Indexes?

Background: Uterine fibroids, found in 20–35% of women over the age of 35, are symptomatic in one-third. From 20 to 50% of cases symptoms are severe enough to justify a treatment. Surgery is the most employed management, with severe morbidity ac- counting for 3%. Additional semi-invasive approaches were in- troduced. Magnetic Resonance-guided Focus Ultrasound Surgery ( MRgFUS) was presented as a new totally non-invasive leiomyomas thermal ablation. Objectives: Evaluate eligibility, feasibility and outcomes of Magnetic Resonance-guided Focused Ultrasound Surgery ( MRgFUS) and find predictive indexes for treatment success. Methods: Single-centre prospective pilot study to evaluate MRgFUS for subserosal/intramural uterine leiomyomas. Post- treatment leiomyomas’ volume reduction and symptoms im- provement were assessed, with a 3 months apart follow-up. Results: 102 pre-menopausal women with symptomatic uter- ine leiomyomas were screened in the Gynaecology and Radi- ology Departments of ‘‘Sapienza’’ University of Rome (August 2010-August 2011). Eligible patients were 36 (35%); 24 women23%) performed MRgFUS, 12 refused. Three patients (12%) underwent surgical myomectomy for severe pelvic pain and meno-menometrorrhagia within one month from MRgFUS. For 20 patients, symptomatology decreased of 30% after 3 months, according to Symptom Severity Score (SSS) values (p < 0.01). Mean volume change ratio was significant (p < 0.01) at 6 months, with 27% of reduction, reaching 47% at 12 months. Feasibility rate was 35%. A Vascularity Index < 1 showed significant posi- tive difference with symptoms improvement (p-value 0,04), with a decrease of 32% (23% for VI > 1, SSS). Fibroids £ 70 mm of diameter showed a significant (p-value < 0,05) volume reduction ( - 21%) if compared to greater ones ( - 14%). Conclusions: Most women with leiomyomas are unsuitable for MRgFUS (anatomical limits and urgent fertility desire). In eligible patients, rapid symptom reduction rates were obtained; otherwise, volume reduction ratio is slower and incomplete. Vascularity Index (VI) and fibroids’ size ( £ 70 mm) could be used as predictive indexes. An accurate patient selection is needed for higher success and lower re-intervention rates

HPV-related vulvar diseases and perspectives of p16INK4a immunochemistry: a review of the literature

Two different types of vulvar intraepithelial neoplasia (VIN), HPV-related and HPV-unrelated, should be considered as two separate entities with different management options. The incidence of HPV-related VIN is increasing worldwide and is implicated in carcinogenesis. Our objective is to investigate the use of p16INK4a immunostaining or p16INK4a/p53 double staining for the detection of HPV-related disease to overcome the problem that histological criteria often have significant overlap

Long-term experience of vaginal vault prolapse prevention at hysterectomy time by modified McCall culdoplasty or shull suspension. clinical, sexual and quality of life assessment after surgical intervention

Objectives: The aim of this study was to evaluate the effectiveness of modified McCall culdoplasty or Shull suspension in preventing vaginal vault prolapse after vaginal hysterectomy and the long-term impact on quality of life and sexual function. Study design: Retrospective analysis in 414 patients underwent vaginal hysterectomy for pelvic organ prolapse (POP) and vaginal suspension through modified McCall culdoplasty (group A) or Shull suspension (group B) was evaluated. Clinical features and concomitant surgical procedures were assessed. Surgical data and perioperative and postoperative complications have also been analyzed. Clinical characteristics, urinary symptoms, POP-Q score classification, Quality of Life and Sexual Function were evaluated at baseline and at median follow up with P-QoL, ICIQ-UI-SF, PISQ-12, FSFI, FSDS questionnaires. Results: The median follow up was 8.9 year (5.1–14.2 years). 200 women in group A and 214 in group B were evaluated. Vaginal vault prolapse occurred in 2 patients in group A and in 2 patients in group B. POP-Q score for all compartments showed a significant (p < 0.001) decrease for both groups without significant differences between the 2 groups. The total vaginal length (TVL) was reduced in greater proportion in McCall group (p < 0.001). P-QoL and ICIQ-UI-SF questionnaires documented an improvement for both groups (p < 0.001). The number of patients who regularly practice sexual activity increased in both groups, but patients in group B experienced a better quality of sexual life evaluated with PISQ-12 and FSFI. Conclusions: Both surgical techniques showed effectiveness and safety in preventing vaginal vault prolapse in women who underwent vaginal hysterectomy, with a significant improvement in quality of life and sexuality. Shull technique demonstrated greater improvement in sexual function

Ultrasonography reappraisal of tubal patency in assisted reproduction technology patients: Comparison between 2D and 3D-sonohysterosalpingography. A pilot study

BacKGroUND: The aim of this study was to compare 2D and 3D-sonohysterosalpingography (2D-3D-HyFoSy) with previous diagnostic laparoscopy in the diagnosis of tubal patency, and compare each procedure in terms of procedure’s time, perceived pain and complication rate. MeTHoDS: We prospectively recruited infertile women, previously submitted to laparoscopy and randomly allocated into 2D-HyFoSy (group I) and 3D-HyFoSy (group II). We analyzed the results in term of sensitivity, specificity, positive predictive value and negative predictive value in tubal patency evaluation of both procedures in comparison with laparoscopy. RESULTS: We enrolled 50 women, 25 in group I and 25 in group II. 2D-HyFoSy findings obtained in group I, were concordant with laparoscopy in 81% of cases, with a sensitivity of 80% and a specificity of 92%. In group II, a correspondence was present in 88% of examinations, with a sensitivity and specificity of 98% and 91.4% respectively. 3D-HyFoSy was found to be faster and less painful than 2D (P<0.001). coNclUSioNS: in the diagnosis of tubal occlusion, in the high-risk population, it seems advisable to us using the 3D-HyFoSy as the first-level examination, while, in low-risk patients, if the tubes appear obstructed in 2D-HyFoSy, the 3D-HyFoSy should be indicated before submitting patients to operative laparoscopy

Beyond circulating microRNA biomarkers: urinary microRNAs in ovarian and breast cancer

.Breast cancer is the most common malignancy in women worldwide, and ovarian cancer is the most lethal gynecological malignancy. Women carrying a BRCA1/2 mutation have a very high lifetime risk of developing breast and ovarian cancer. The only effective risk-reducing strategy in BRCA-mutated women is a prophylactic surgery with bilateral mastectomy and bilateral salpingo-oophorectomy. However, many women are reluctant to undergo these prophylactic surgeries due to a consequent mutilated body perception, unfulfilled family planning, and precocious menopause. In these patients, an effective screening strategy is available only for breast cancer, but it only consists in close radiological exams with a significant burden for the health system and a significant distress to the patients. No biomarkers have been shown to effectively detect breast and ovarian cancer at an early stage. MicroRNAs (miRNAs) are key regulatory molecules operating in a post-transcriptional regulation of gene expression. Aberrant expression of miRNAs has been documented in several pathological conditions, including solid tumors, suggesting their involvement in tumorigenesis. miRNAs can be detected in blood and urine and could be used as biomarkers in solid tumors. Encouraging results are emerging in gynecological malignancy as well, and suggest a different pattern of expression of miRNAs in biological fluids of breast and ovarian cancer patients as compared to healthy control. Aim of this study is to highlight the role of the urinary miRNAs which are specifically associated with cancer and to investigate their role in early diagnosis and in determining the prognosis in breast and ovarian cancer