Peritoneal Dissemination Complicating Morcellation of Uterine Mesenchymal Neoplasms

Background: Power morcellation has become a common technique for the minimally invasive resection of uterine leiomyomas. This technique is associated with dissemination of cellular material throughout the peritoneum. When morcellated uterine tumors are unexpectedly found to be leiomyosarcomas or tumors with atypical features (atypical leiomyoma, smooth muscle tumor of uncertain malignant potential), there may be significant clinical consequences. This study was undertaken to determine the frequency and clinical consequence of intraperitoneal dissemination of these neoplasms. Methodology/principal findings: From 2005–2010, 1091 instances of uterine morcellation were identified at BWH. Unexpected diagnoses of leiomyoma variants or atypical and malignant smooth muscle tumors occurred in 1.2% of cases using power morcellation for uterine masses clinically presumed to be “fibroids” over this period, including one endometrial stromal sarcoma (ESS), one cellular leiomyoma (CL), six atypical leiomyomas (AL), three smooth muscle tumor of uncertain malignant potential (STUMPs), and one leiomyosarcoma (LMS). The rate of unexpected sarcoma after the laparoscopic morcellation procedure was 0.09%, 9-fold higher than the rate currently quoted to patients during pre-procedure briefing, and this rate may increase over time as diagnostically challenging or under-sampled tumors manifest their biological potential. Furthermore, when examining follow-up laparoscopies, both from in-house and consultation cases, disseminated disease occurred in 64.3% of all tumors (zero of one ESS, one of one CL, zero of one AL, four of four STUMPs, and four of seven LMS). Only disseminated leiomyosarcoma, however, was associated with mortality. Procedures are proposed for pathologic evaluation of morcellation specimens and associated follow-up specimens. Conclusions/significance: While additional study is warranted, these data suggest uterine morcellation carries a risk of disseminating unexpected malignancy with apparent associated increase in mortality much higher than appreciated currently

The shadow knows: using shadows to investigate the structure of the pretransitional disk of HD 100453

We present GPI polarized intensity imagery of HD 100453 in Y-, J-, and K1 bands which reveals an inner gap ($9 - 18$ au), an outer disk ($18-39$ au) with two prominent spiral arms, and two azimuthally-localized dark features also present in SPHERE total intensity images (Wagner 2015). SED fitting further suggests the radial gap extends to $1$ au. The narrow, wedge-like shape of the dark features appears similar to predictions of shadows cast by a inner disk which is misaligned with respect to the outer disk. Using the Monte Carlo radiative transfer code HOCHUNCK3D (Whitney 2013), we construct a model of the disk which allows us to determine its physical properties in more detail. From the angular separation of the features we measure the difference in inclination between the disks 45$^{\circ}$, and their major axes, PA = 140$^{\circ}$ east of north for the outer disk and 100$^{\circ}$for the inner disk. We find an outer disk inclination of $25 \pm 10^{\circ}$ from face-on in broad agreement with the Wagner 2015 measurement of 34$^{\circ}$. SPHERE data in J- and H-bands indicate a reddish disk which points to HD 100453 evolving into a young debris disk

The Role of Para-Aortic Lymphadenectomy in the Surgical Staging of Women with Intermediate and High-Risk Endometrial Adenocarcinomas

Objectives:. To characterize clinical outcomes in patients with intermediate or high-risk endometrial carcinoma who underwent surgical staging with or without para-aortic lymphadenectomy. Methods:. This is a retrospective cohort study of patients with intermediate or high-risk endometrial adenocarcinoma who underwent surgical staging with (PPALN group) or without (PLN) para-aortic lymphadenectomy. Data were collected, Kaplan-Meier curves were generated, and univariate and multivariate analyses performed to compare differences in adjuvant therapy, disease recurrence, disease-free survival (DFS), and overall survival (OS). Results. 118 patients were included in the PPALN group and 139 in the PLN group. Patients in the PPALN group were more likely to receive adjuvant vaginal brachytherapy (25.4% versus 11.5%, OR = 2.5, P = 0.03) and less likely to receive adjuvant multimodal combination therapy (17.81% versus 28.8%, OR = 0.28, P = 0.002). DFS was improved in the PLN group as compared to PPALN (80% versus 62%, P = 0.02). OS was equivalent (P = 0.93). Patients in the PPALN group who had less than 10 para-aortic nodes removed were twice as likely to recur than patients who had 10 or more para-aortic nodes or patients in the PLN group (HR 2.08, CI 1.20–3.60, P = 0.009). Conclusions:. Patients in the PLN group were more likely to receive multimodal adjuvant therapy and had better DFS than the PPALN group. Pelvic lymphadenectomy followed by adjuvant radiation and chemotherapy may represent an effective treatment option for patients with intermediate or high-risk disease. If systematic para-aortic lymphadenectomy is performed and less than 10 para-aortic lymph nodes are obtained, multimodality adjuvant therapy should be considered to improve DFS

GW Ori: Interactions Between a Triple-star System and its Circumtriple Disk in Action

GW Ori is a hierarchical triple system which has a rare circumtriple disk. We present Atacama Large Millimeter/submillimeter Array (ALMA) observations of 1.3 mm dust continuum and 12CO J=2-1 molecular gas emission of the disk. For the first time, we identify three dust rings in the disk at ~46, 188, and 338 AU, with estimated dust mass of ~70-250 Earth masses, respectively. To our knowledge, the outer ring in GW Ori is the largest dust ring ever found in protoplanetary disks. We use visibility modelling of dust continuum to show that the disk has misaligned parts and the innermost dust ring is eccentric. The disk misalignment is also suggested by the CO kinematics modelling. We interpret these substructures as evidence of ongoing dynamical interactions between the triple stars and the circumtriple disk.Comment: 17 pages, 3+3 figures, 2 tables; accepted by ApJL on 2020-04-2

The collapse of protoplanetary clumps formed through disc instability: 3D simulations of the pre-dissociation phase

We present 3D smoothed particle hydrodynamics simulations of the collapse of clumps formed through gravitational instability in the outer part of a protoplanetary disc. The initial conditions are taken directly from a global disc simulation, and a realistic equation of state is used to follow the clumps as they contract over several orders of magnitude in density, approaching the molecular hydrogen dissociation stage. The effects of clump rotation, asymmetries, and radiative cooling are studied. Rotation provides support against fast collapse, but non-axisymmetric modes develop and efficiently transport angular momentum outward, forming a circumplanetary disc. This transport helps the clump reach the dynamical collapse phase, resulting from molecular hydrogen dissociation, on a thousand-year timescale, which is smaller than timescales predicted by some previous spherical 1D collapse models. Extrapolation to the threshold of the runaway hydrogen dissociation indicates that the collapse timescales can be shorter than inward migration timescales, suggesting that clumps could survive tidal disruption and deliver a proto-gas giant to distances of even a few AU from the central star.Comment: Accepted for publication in MNRA

Differences in the gas and dust distribution in the transitional disk of a sun-like young star, PDS 70

We present ALMA 0.87 mm continuum, HCO+ J=4--3 emission line, and CO J=3--2 emission line data of the disk of material around the young, Sun-like star PDS 70. These data reveal the existence of a possible two component transitional disk system with a radial dust gap of 0."2 +/- 0."05, an azimuthal gap in the HCO+ J=4--3 moment zero map, as well as two bridge-like features in the gas data. Interestingly these features in the gas disk have no analogue in the dust disk making them of particular interest. We modeled the dust disk using the Monte Carlo radiative transfer code HOCHUNK3D (Whitney et al. 2013) using a two disk components. We find that there is a radial gap that extends from 15-60 au in all grain sizes which differs from previous work

Subaru/HiCIAO HKsHK_{\rm s} imaging of LkHα\alpha 330 - multi-band detection of the gap and spiral-like structures

We present $H$- and $K_{\rm s}$-bands observations of the LkH$\alpha$ 330 disk with a multi-band detection of the large gap and spiral-like structures. The morphology of the outer disk ($r\sim$0\farcs3) at PA=0--45$^\circ$ and PA=180--290$^\circ$ are likely density wave-induced spirals and comparison between our observational results and simulations suggests a planet formation. We have also investigated the azimuthal profiles at the ring and the outer-disk regions as well as radial profiles in the directions of the spiral-like structures and semi-major axis. Azimuthal analysis shows a large variety in wavelength and implies that the disk has non-axisymmetric dust distributions. The radial profiles in the major-axis direction (PA=$271^\circ$) suggest that the outer region (r\geq0\farcs25) may be influenced by shadows of the inner region of the disk. The spiral-like directions (PA=10$^\circ$ and 230$^\circ$) show different radial profiles, which suggests that the surfaces of the spiral-like structures are highly flared and/or have different dust properties. Finally, a color-map of the disk shows a lack of an outer eastern region in the $H$-band disk, which may hint the presence of an inner object that casts a directional shadow onto the disk.Comment: 12pages, 16 figures, 2 tables, accepted for publication in A