Early and late complications after inguinofemoral lymphadenectomy for vulvar cancer

Background: We aimed to determine the frequency of early and late complications following groin surgery for vulvar cancer and analyze possible risk factors. Materials and Methods: This retrospective cohort study included 99 women who underwent for vulvar cancer. The early (≤1 month) complications were wound infection, breakdown and lymphocyst and late (>1 month) complications were lower limb lymphedema, incontinence and erysipelas. The risk factors for developing each of the complications were analyzed with regression analysis. Results: In the entire cohort, 29 (29.3%) women experienced early and 12 (12.1%) had late complications. Wound complications including infection and breakdown were the leading early complications (23.2%). In the multivariate analysis, both obesity (body mass index ≥30 kg/m2 ) and advanced age (≥65 years) were found as independent predictive factors for early complications. Obese women of advanced age had 6.32 times more risk of experiencing any of the early complications, when compared to non-obese and young women (55.6% vs 8.7%). The most common late complication was lower limb lymphedema (10.1%) that was more frequently seen in young women. However, neither age nor lymph node count were significantly associated with the occurrence of lower limb lymphedema. Conclusions: More than 40% of the women suffered from postoperative complications after inguinofemoral lymphadenectomy in the current study. While advanced age and obesity were the significant predictors for any of the early complications, there was no identified risk factor for lower limb lymphedema

Stage IB Endometrioid Type Endometrial Cancer: The Role of Lymphadenectomy and Adjuvant Radiation Therapy

Objective: Both performances of lymphadenectomy and benefit of adding adjuvant radiotherapy are controversial for patients with International Federation of Gynecology and Obstetrics stage IB endometrioid type endometrial cancer. We aimed to identify the role of lymphadenectomy and adjuvant radiation therapy as well as clinicopathological prognostic factors for this group of patients. Study Design: Records of all patients (n=132) with stage IB endometrioid endometrial cancer who were referred to or treated in our institution between Jan 1992 and Dec 2013 were retrospectively reviewed. Cox Proportional Hazard Regression Analysis was used to determine the effects of lymphadenectomy and adjuvant radiation as well as other clinicopathological factors on disease free survival and overall survival. Results: Mean age was 59.9 years (range, 45-82). Lymphadenectomy didn't perform in 36 (27.3%) patients and 23 (17.4%) patients did not have any kind of adjuvant treatment. Mean lymph node count was 18.8 (range, 3-67). Federation of Gynecology and Obstetrics grade, lymphovascular space invasion, lymphadenectomy, receiving adjuvant treatment and type of received adjuvant therapy were not associated with disease free survival and overall survival for the entire cohort. In a subgroup of patients with grade1&2 tumor, 5-year disease free survival rates were 80% and 50% (p=0.4), respectively and overall survival rates were 94.8% and 93.8% (p=0.2), respectively for patients who had or didn't have adjuvant radiotherapy. While performance of lymphadenectomy was not significantly associated with disease free survival in this subgroup (p=0.56), this association was statistically significant for overall survival (97.9% vs. 86.4%, p=0.04) Conclusion: Benefit of adjuvant radiotherapy in regard to prevention of recurrence needs to be confirmed by further studies. Lymphadenectomy had a survival benefit for patients with myometrial invasion greater than a half of myometrial thickness

Castleman Disease Mimicking Ovarian Tumour

Castleman disease is a lymphoid disease characterized by herpes virus infection associated hyperplasia of lymphatic tissue. Castleman disease is generally localized in the mediastinum (70%) and the regions that it may be seen outside of the thorax are neck, axilla, pelvis and retroperitoneum. Castleman disease may present unicentrically or multicentrically. Fifty-six year old postmenopausal woman was detected to have a right adnexial mass in her routine gynecological examination. This adnexial mass was also observed in the pelvic ultrasonography and pelvic magnetic resonance imaging (MRI). A retroperitoneal mass was detected in the right hemipelvis. Pathological evaluation revealed Castleman disease, hyaline vascular type. Any lymphadenopathy other than this wasn’t observed in the systemic imaging of the patient. Therefore, she was considered to have unicentric disease and was told to come to follow-up visits. Castleman disease is a rare condition. Since symptoms and imaging findings aren’t specific to the disease, preoperative diagnosis is quite difficult. Castleman disease located in the pelvic retroperitoneum may mimic adnexial masses. It is genearlly related to pelvic walls and iliac vessels. Surgical removal of unicentric Castleman disease is curative. While Castleman disease is observed rarely in gynecological practice, it should be kept in mind in the differential diagnosis of adnexial masses

Comparison of the Histologic Results of Atypical Glandular Cells-Favor Neoplasia and Atypical Glandular Cells-Not Otherwise Specified

Objective: Cervical cancer screening programs are widely performed in all around the world. The interpretation of the Pap smear test is a big challenge in gynecology practice particularly when associated with atypical glandular cells. In this study, we performed a retrospective analysis of cytologic results associated with atypical glandular cells in our institution. Material and Method: We retrospectively reviewed Pap smear tests resulted as “atypical glandular cells”. A total of 122 women had screening tests reported as “atypical glandular cells” between 2003 and 2013 at the Ministry of Health, Etlik Maternity and Women’s Health Teaching Research. The cytology reported as “atypical glandular cells” were evaluated in two main groups: Atypical glandular cells-favor neoplasia (AGC-FN) and atypical glandular cells-not otherwise specified (AGC-NOS) compared by means of histologic results. Results: Thirty-two women have been reported as AGC-NOS on cytologic examination and 90 women were defined as AGC-FN. There was no significant difference between AGC-FN and AGC NOS groups in terms of age. In AGC-FN group, a total of 13 women (13/90) (14.4%) had malignant histological diagnosis. In AGC-NOS group only one woman (1/32) (3.1%) was diagnosed as malignant. All the malignant cases in this study are older than 35 years. Conclusion: The incidence of AGC is less than 1% in all Pap smear examinations. Two main factors were important in the outcome of the AGC. The first one is the subgroup. AGC-FN group has a higher risk of malignancy. The second important factor is the age of the patient. To be older than 35 years old seems to increase the risk of malignancy

Can we predict surgical margin positivity while performing cervical excisional procedures?

We designed this study to evaluate any factors associated with positive surgical margin in conisation specimens and to determine the optimal cone size. The medical records of patients who had undergone a loop electrosurgical excision procedure (LEEP), cold-knife conisation (CKC) and needle excision of the transformation zone (NETZ) procedure were reviewed retrospectively. Two hundred and sixty eight women fulfilled the inclusion criteria. Univariate analyses showed that ‘postmenopause’, ‘HSIL on smear’, ‘previous colposcopic examination revealing HSIL in endocervical curettage (ECC) material and in two or more ectocervical quadrants’ and ‘managing with LEEP’ were significant predictors of surgical margin positivity. Nulliparous patients showed significantly lower rate of surgical margin positivity. ‘Postmenopause’, ‘previous colposcopic examination revealing HSIL in ECC material and in two or more ectocervical quadrants’ and ‘HSIL on smear’ were identified as independent predictors of surgical margin positivity according to multivariate analyses.IMPACT STATEMENT What is already known on this subject? Previous studies demonstrated ‘menopause’, ‘Age ≥50’, ‘managing with LEEP’, ‘disease involving >2/3 of cervix at visual inspection’, ‘training level of the surgeon’, ‘cytology squamous cell carcinoma’ and ‘mean cone height’ as factors associated with positive surgical margin in conisation specimens. What do the results of this study add? In our study, univariate analyses showed that ‘postmenopause’, ‘HSIL on smear’, ‘previous colposcopic examination revealing HSIL in endocervical curettage material and in two or more ectocervical quadrants’ and ‘managing with LEEP’ were associated with surgical margin positivity. On the other hand, nulliparous women showed significantly lower rate of surgical margin positivity compared with parous women. Multivariate analyses showed that ‘postmenopause’, ‘previous colposcopic examination revealing HSIL in endocervical curettage material and in two or more ectocervical quadrants’ and ‘HSIL on smear’ were independent predictors of surgical margin positivity in conisation specimens. What are the implications of these findings for clinical practice and/or further research? We can predict high-risk patients with regard to surgical margin positivity. Prediction of high-risk patients and management with a tailored approach may help minimise surgical margin positivity rates

EMA/CO Combination Chemotheraphy in Gestational Trophoblastic Neoplasia: Update of Our Results

OBJECTIVE: In this study, we aimed updating our experience about the treatment success of EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) chemotherapy in high-risk gestational trophoblastic neoplasia (GTN). MATERIAL AND METHOD: Patients were scored according to FIGO’s modified WHO system. Risk scoring of patients before 2000 was remade by using this system. Thirty-nine patients who were treated with EMA-CO between 1992 and 2013 because of high risk GTN or the resistance to single agent methotrexate and MAC III chemotherapy combinations were evaluated retrospectively. Adjuvant surgery and radiotherapy were used in selected patients. Response and effects of the prognostic factors to the response rate were analyzed. RESULTS: Median follow-up time of the patients was 74.8 months (range, 1-203). Complete clinical response was obtained in 36 (92.3%) patients with only EMA-CO or EMA-CO and surgery. The response rate of treatment was 91.3% (n:21/23) in patients taking primary EMA-CO, 93.8% (n:15/16) in patients taking secondary EMA/CO chemotherapy. Resistance to the EMA-CO treatment developed in 6 (15.3%) patients and 3 of the patients with drug resistance died. During the follow-up time disease recurred in 3 (7.7%) patients. When the antecedent pregnancy was term pregnancy or the histopathological diagnosis was choriocarcinoma or when there was liver metastasis, the treatment success decreased. The effects of tumor dimension and the presence of metastasis tended to be statistically significant in determining the resistance to therapy. CONCLUSION: EMA-CO regimen is highly effective for treatment of high-risk GTN. Because of the differences in many studies, risk factors for predicting the success of the treatment are not clear

Meigs’ Syndromes with Extremelly High CA125 Level Mimicking Advanced Ovarian Cancer

Meigs' syndrome is defined as pelvic mass with ascites and pleural effusion which can mimic ovarian malignancy. Additionally, elevated serum CA125 level can be seen in Meigs' syndrome. We present 2 cases with solid adnexal mass, ascites and bilateral pleural effusion with high serum CA125 level (2824 IU/mL and 1400 IU/mL) which were diagnosed as ovarian malignancy preoperatively. In both cases level of CA125 were extremely high for Meigs’ syndrome and high level of CA125 in Meigs’ Syndrome is unusual. Solid adnexal mass and serous ascites was detected in explorative laparotomy in 2 cases also. Other genital and abdominal structures were normal. In both cases the right salpingo oophorectomy was performed. In addition, the ovarian fibroma was reported in one case and nonspecific for other case during frozen/section examination. Contralateral salpingo-oophorectomy and total hysterectomy was performed because of the age of patients in one case and non- diagnostic frozen section examination in the other case. Final pathology confirmed the diagnosis of ovarian fibroma in first case and thecoma in the second one. Despite the suggestion of ovarian malignancy in preoperative period, the frozen/section examination is the mainstay in the management of adnexal masses