Laparoscopic en bloc resection of a para-cervical cancer with OHVIRA syndrome

Objective: There are some reports of cervical cancer with uterus didelphys but a case of clear cell carcinoma (CCCC) with Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome is extremely rare. The aim of this paper was to report a case of CCCC with OHVIRA syndrome and the difficulty in making a preoperative diagnosis. Case report: A 65 years old woman presented with postmenopausal bleeding and pelvic examination showed right paracervical mass. Preoperative confirmation of cervical carcinoma was difficult due to the location of the mass, which was inaccessible by cervical punch biopsy. Pelvic examination revealed a large mass in pelvic cavity without parametrial invasion and ultrasound showed approximately 70 mm cervical tumor. Laparoscopic surgery revealed clear cell carcinoma of the para-endocervix with OHVIRA syndrome. Conclusion: In the case of cervical carcinoma with OHVIRA syndrome, laparoscopic surgery is preferable for the diagnosis and management

Carcinoma In Situ with Pelvic Cystic Formation in Early Cervical Cancer After Hysterectomy and Long-Term Treatment for Vaginal Intraepithelial Neoplasma

Background: Microinvasive cervical cancer at International Federation of Gynecology and Obstetrics stage IA1 can be treated with conization or hysterotomy with favorable outcomes. Vaginal intraepithelial neoplasma (VAIN) after hysterectomy for early cervical cancer is sometimes encountered; however, carcinoma in situ (CIS) resulting from VAIN with pelvic cystic formation is extremely rare. Case: CIS with pelvic cystic formation occurred 11.5 years after a hysterectomy was performed to treat microinvasive cervical cancer and long-term treatment for persistent VAIN in a 57-year-old multigravida patient. Laparoscopic tumorectomy and adhesiolysis were performed. Results: Pathology testing showed CIS. This occurrence was considered to be derived from persistent human papilloma virus infection caused by VAIN. Concurrent chemoradiation was performed, and the patient currently has no evidence of disease. Conclusions: CIN or microinvasive cancer can develop subsequent to VAIN even after hysterectomy and can result in progression to cancer. Careful follow-up is the key to early detection of secondary disease

Spontaneous Healing of Vaginal Cuff Dehiscence in a Uterine Cervical Cancer Following Laparoscopic Radical Hysterectomy and Chemoradiation

Vaginal cuff dehiscence (VCD) after hysterectomy has a low incidence but has serious sequelae. Given that there is no consensus about the ideal management of VCD, it depends on the patient\u27s condition, including that of the patient\u27s eviscerated organ. Surgical repairs are performed in most cases. Case: VCD occurred in a 51-year-old patient with uterine cervical cancer following a laparoscopic radical hysterectomy and chemoradiation. It was decided to wait for spontaneous vaginal closure and to reassess the condition of this patient\u27s vagina every 3 months. Results: Three months after this patient\u27s VCD diagnosis, her vaginal opening became smaller and was already covered by a thin membrane. This membrane gradually became thicker and the vaginal opening was completely closed after 2 years. Conclusions: Radiation therapy may impair wound healing and affect surgical outcomes of treating VCD. It may take time to heal the wound completely following radiation therapy. However, in cases with fibrotic vaginal mucosa post radiation therapy or in patients who have undergone previous multiple surgeries wherein another surgery—either vaginal or abdominal—would be risky, nonclosure can be another option for approaching VCD

Spontaneous Healing of Vaginal Cuff Dehiscence in a Uterine Cervical Cancer Following Laparoscopic Radical Hysterectomy and Chemoradiation

Vaginal cuff dehiscence (VCD) after hysterectomy has a low incidence but has serious sequelae. Given that there is no consensus about the ideal management of VCD, it depends on the patient\u27s condition, including that of the patient\u27s eviscerated organ. Surgical repairs are performed in most cases. Case: VCD occurred in a 51-year-old patient with uterine cervical cancer following a laparoscopic radical hysterectomy and chemoradiation. It was decided to wait for spontaneous vaginal closure and to reassess the condition of this patient\u27s vagina every 3 months. Results: Three months after this patient\u27s VCD diagnosis, her vaginal opening became smaller and was already covered by a thin membrane. This membrane gradually became thicker and the vaginal opening was completely closed after 2 years. Conclusions: Radiation therapy may impair wound healing and affect surgical outcomes of treating VCD. It may take time to heal the wound completely following radiation therapy. However, in cases with fibrotic vaginal mucosa post radiation therapy or in patients who have undergone previous multiple surgeries wherein another surgery—either vaginal or abdominal—would be risky, nonclosure can be another option for approaching VCD

Total Laparoscopic Repair of Vaginal Cuff Dehiscence During Chemoradiation in an Endometrial Cancer Following Laparoscopic Staging

ackground: The field of minimally invasive surgery is progressing rapidly and extends to the field of gynecologic oncology. To date, the number of gynecologic oncologists who use laparoscopic surgery to treat endometrial cancer is increasing. As minimally invasive therapy advances technically and instrumentally, more-complicated procedures are being performed, thereby increasing the number of complications. Vaginal cuff dehiscence (VCD) is one of complications that may arise. VCD is a rare but severe complication. Case: A nonobese 55-year-old female underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and dissection of pelvic and para-aortic lymph nodes for endometrial cancer. Subsequently, this patient underwent total laparoscopic repair of VCD during chemoradiation that was used to treat her endometrial cancer following the laparoscopic staging. Results: After the second surgery, this patient received 2 cycles of chemotherapy without brachytherapy, and follow-up examination did not show any evidence of recurrence. Conclusions: Radiation therapy may impair wound healing and affect surgical outcomes; thus, the treatment of VCD should be decided by the patient\u27s general condition, including any evisceration, and assessment of her risk factors

Carcinoma In Situ

Background: Microinvasive cervical cancer at International Federation of Gynecology and Obstetrics stage IA1 can be treated with conization or hysterotomy with favorable outcomes. Vaginal intraepithelial neoplasma (VAIN) after hysterectomy for early cervical cancer is sometimes encountered; however, carcinoma in situ (CIS) resulting from VAIN with pelvic cystic formation is extremely rare. Case: CIS with pelvic cystic formation occurred 11.5 years after a hysterectomy was performed to treat microinvasive cervical cancer and long-term treatment for persistent VAIN in a 57-year-old multigravida patient. Laparoscopic tumorectomy and adhesiolysis were performed. Results: Pathology testing showed CIS. This occurrence was considered to be derived from persistent human papilloma virus infection caused by VAIN. Concurrent chemoradiation was performed, and the patient currently has no evidence of disease. Conclusions: CIN or microinvasive cancer can develop subsequent to VAIN even after hysterectomy and can result in progression to cancer. Careful follow-up is the key to early detection of secondary disease

Laparoscopic technique of para-aortic lymph node dissection: A comparison of the different approaches to trans- versus extraperitoneal para-aortic lymphadenectomy

Since Dr Dargent first reported endoscopic surgery using retroperitoneal pelvicoscopy to perform pelvic lymph node sampling in 1987, many literature reviews on the safety and feasibility of laparoscopic staging surgery of gynecologic malignancies have been published. However, the procedure of laparoscopic lymphadenectomy is more difficult to perform due to the limited surgical space and associated technical problems. Especially in the para-aortic lymphadenectomy procedure, there are many barriers to overcome in the surgical field, learning curve, and technique. We present a review of lymphadenectomy, especially para-aortic lymphadenectomy

Isolated incisional recurrence in a patient with early-stage endometrial cancer: A case report and review of the literature

Isolated incisional recurrence in a patient with early-stage endometrioid carcinoma is extremely rare. The mechanism of this recurrence also remains unclear. We describe a case of an isolated incisional recurrence of endometrioid carcinoma from the uterine corpus 4 years after the primary surgery. We review the previous literature and discuss the possible mechanism of isolated incisional recurrence. A 56-year-old woman diagnosed with the International Federation of Gynecology and Obstetrics Stage IA and Grade 2 endometrioid carcinoma in the uterine corpus showed an isolated cystic mass in the abdominal wall 4 years after the primary surgery. She underwent resection of the abdominal tumor, and the pathological findings showed endometrioid carcinoma, which was the same as the primary tumor. She received chemotherapy and remained disease free 8 months after chemotherapy. Long-term follow-up is required to detect recurrence, even in patients with early-stage uterine corpus carcinoma

Drug-induced aortitis in a patient with ovarian cancer treated with bevacizumab combination therapy

Objective: To review and evaluate drug-induced vasculitis, which is an extremely rare complication of chemotherapy. Case report: A 47-year-old woman with ovarian cancer developed aortitis during bevacizumab combination chemotherapy. Contract-enhanced CT showed concentric thickening of the descending aorta. Antibiotics were administered, but a repeat CE-CT scan showed no resolution of the aortitis. To treat the aortitis, she was started on oral prednisolone. A subsequent CE-CT scan showed no signs of aortitis. She was thus re-started on a modified chemotherapy regimen. Conclusion: Aortitis should be considered in patients receiving bevacizumab combination therapy who develop persistent fever and upper-abdominal pain. Contrast-enhanced CT is useful for detecting drug-induced aortitis. Keywords: Aortitis, Ovarian cancer, Bevacizumab, G-CS

Successful pregnancy with stage IB2 uterine cervical cancer: A case report

Abstract Background Although cervical cancer is one of the most common malignancies in pregnancy, its management mainly follows the guidelines for nonpregnant disease state. Within the limited time, patients, and healthcare workers must make difficult decisions to either delay treatment until documented fetal maturity or start immediate treatment based on the disease stage. Case The patient was a 37‐year‐old woman: gravida 1, para 0. Her cervical cytology revealed a high‐grade squamous intraepithelial lesion at 8 weeks' gestation. Moreover, invasive squamous cell carcinoma was suspected based on the findings of uterine cervix biopsy. Cervical conization was performed at 11 weeks' gestation, confirming a histopathological diagnosis of squamous cell carcinoma, pT1b2. Cervical cytology findings continued to be negative for intraepithelial lesion or malignancy from 2 weeks after conization until 2 weeks before a cesarean section. In addition, we performed abdominal pelvic lymphadenectomy at 16 weeks' gestation to determine whether the patient could continue her pregnancy. No lymph node metastasis or local recurrence was observed. Finally, a cesarean section and modified radical hysterectomy were performed at 35 weeks' gestation. There was no carcinoma invasion or metastasis. A baby girl weighing 2056 g was delivered with 1‐ and 5‐min Apgar scores of 8 and 9, respectively. Five years postoperatively, there was no evidence of cancer recurrence. Conclusion Management of cervical cancer during pregnancy by using a combination strategy of deep conization and pelvic lymphadenectomy could be an effective strategy for carefully and safely assessing risks of recurrence and metastasis