375 research outputs found
Posterior pelvic exenteration and retrograde total hysterectomy in patients with locally advanced ovarian cancer: Clinical and functional outcome
No full textAbstractObjectiveTo evaluate clinical outcomes and postoperative quality of life in patients affected by locally advanced ovarian cancer who underwent pelvic posterior exenteration with Hudson-Delle Piane radical retrograde hysterectomy.Materials and MethodsOur study was done on a retrospective cohort using data from 22 patients who underwent surgery between 2010 and 2014 at the Gynecological Oncologic Center of Parma, Parma, Italy.ResultsResidual disease after surgery (Sugarbacker index) was absent (CC-0) in 68% of cases. Tumor size was < 2.5 mm (CC-1) in 14% of cases and between 2.5 mm and 2.5 cm (CC-2) in 18% of cases. Complications during surgical procedure occurred in 64% of patients (14/22), but without severe consequences. Immediate postoperative complications (≤ 30 days) occurred in 82% of patients (18/22), and delayed complications (> 30 days) occurred in 23% (5/22) of patients. No patient died because of a complication. Urinary and rectal incontinence occurred in 5% and 16% of patients, respectively. Disease recurrence occurred in 58% of patients, median disease-free survival was 14 months (range, 6–36 months), and median overall survival was 21 months (range, 6–42 months).ConclusionOur study confirmed that pelvic posterior exenteration associated with retrograde radical hysterectomy represents the safest radical surgical approach to advanced ovarian cancer, which permits preservation of the pelvic autonomic nerve plexus and, therefore, bladder and colorectal functions
Impact of gadolinium-based contrast agent in the assessment of Crohn's disease activity: Is contrast agent injection necessary?
No full textPurpose: To determine whether magnetic resonance enterography (MRE) performed without intravenous contrast injection is diagnostically noninferior to conventional contrast-enhanced MRE (CE-MRE) in patients with Crohn’s disease (CD).
Materials and Methods: This was an Institutional Review Board (IRB)-approved retrospective study. Ninety-six patients (52 male and 44 female; 47.18 years 6 13.6) with a diagnosis of CD underwent MRE at 1.5T including T2-weighted single-shot turbo-spin-echo, T2-weighted spectral fat presaturation with inversion recovery (SPAIR), T1-weighted balanced fast-field-echo MR sequences, and CE-MRE consisting in T1-weighted breath-hold THRIVE 3D MRI sequences
after administration of gadobenate dimeglumine (0.2 mL/kg of body weight). Unenhanced MRE, CE-MRE, and unenhanced MRE plus CE-MRE were reviewed in separate sessions with blinding by two readers in consensus, and subsequently by two other readers independently considering a subgroup of 20 patients. Crohn’s Disease Endoscopic Index of Severity (CDEIS) and/or histologic analysis of the surgical specimen were considered as reference standards for the
assessment of inflammatory activity.
Results: Patients revealed prevalently active (n 5 55 patients) or quiescent CD (n 5 41 patients). The agreement between unenhanced MRE vs. CE-MRE in interpreting active bowel inflammation was 96% (123/128 bowel segments; one-sided 95% confidence interval [CI], >94.4%). Unenhanced MRE vs. CE-MRE vs. unenhanced MRE plus CE-MRE revealed a diagnostic accuracy of 93% [90/96] vs. 92% [88/96] vs. 97% [93/96] (P > 0.05) in the diagnosis of active CD.
Interreader agreement was very good for all variables (j value 5 0.8–0.9) except for the measurement of the length of disease (j value 5 0.45).
Conclusion: Unenhanced MRE was noninferior to CE-MRE in diagnosing active inflammation in patients with CD
Retroperitoneal squamous cell carcinoma involving the pelvic side wall arising from endometriosis: a case report
No full textIntroduction: Squamous cell carcinoma (SCC) arising from endometriosis is very rare. Moreover, endometriosis located on the pelvic side wall is uncommon, while its cancerization is quite unusual. We herein report the first case of retroperitoneal SCC arising from endometriosis. Case presentation: A case of 52-year-old woman with retroperitoneal pararectal right mass is presented. The pelvic magnetic resonance imaging showed a retroperitoneal tumor extended to the right pelvic side wall. The neuropelveological examination completed the preoperative assessment, showing a right-sided sciatica and overactive bladder symptoms. Tumor removal was completely managed by minimally invasive technique through laparoscopic laterally extended endopelvic resection (L-LEER) procedure and pelvic neurolysis. Final histology revealed a SCC in a context of diffuse endometriosis with a histologic continuity between the SCC and the endometriosis. The patient underwent adjuvant chemotherapy with no recurrence after six months. Discussion/conclusion: To the best of our knowledge, the present case represents the first evidence of retroperitoneal SCC of the pelvic side wall arising from endometriosis completely resected by laparoscopic approach. Although its rare occurrence, the gynecologist oncologist should maintain a high index of suspicion for malignant endometriosis transformation in case of retroperitoneal pelvic mass and history of endometriosis
Time-intensity curves obtained after microbubble injection can be used to differentiate responders from nonresponders among patients with clinically active Crohn disease after 6 weeks of pharmacologic treatment
No full textPurpose: To assess whether contrast material-enhanced ultrasonography (US) can be used to differentiate responders from nonresponders among patients with clinically active Crohn disease after±weeks of pharmacologic treatment. Materials and Methods: This prospective study was approved by our ethics committee, and written informed consent was obtained from all patients. Fifty consecutive patients (26 men and 24 women; mean age, 34.76 years±9) with a proved diagnosis of active Crohn disease who were scheduled to begin therapy with biologics (infliximab or adalimumab) were included, with enrollment from June 1, 2013, to June 1, 2015. In each patient, the terminal ileal loop was imaged with contrast-enhanced US before the beginning and at the end of week±of pharmacologic treatment. Time-intensity curves obtained in responders (those with a decrease in the Crohn disease endoscopic index of severity score of 25-44 before treatment to 10-15 after treatment, an inflammatory score ,7, and/or a decrease ≥70 in the Crohn disease activity index score compared with baseline) and nonresponders were compared with Mann-Whitney test. Results: Responders (n = 31) and nonresponders (n = 19) differed (P , .05) in the percent change of peak enhancement (240.78±62.85 vs 53.21±72.5; P = .0001), wash-in (234.8±67.72 vs 89.44±145.32; P = .001) and washout (25.64±130.71 vs 166.83±204.44; P = .002) rate, wash-in perfusion index (242.29±59.21 vs 50.96±71.13; P = .001), area under the time-intensity curve (AUC; 246.17±48.42 vs 41.78±87.64; P = .001), AUC during wash-in (243.93±54.29 vs 39.79±70.85; P = .001), and AUC during washout (249.36±47.42 vs 42.65±97.09; P = .001). Responders and nonresponders did not differ in the percent change of rise time (5.09±49.13 vs 6.24±48.06; P = .93) and time to peak enhancement (8.82±54.5 vs 10.21±43.25; P = .3). Conclusion: Analysis of time-intensity curves obtained after injection of microbubble contrast material±weeks after beginning pharmacologic treatment can be used to differentiate responders from nonresponders among patients with clinically active Crohn disease
Biochemical Markers and MR Imaging Findings as Predictors of Crohn Disease Activity in Patients Scanned by Contrast-enhanced MR Enterography
No full textRationale and Objectives: To define the best independent predictors for active inflammation in patients with Crohn disease (CD) examined
by contrast-enhanced magnetic resonance (MR) enterography.
Materials and Methods: Ninety-one patients (47 men and 44 women; aged 39.58 17.1 years) with a diagnosis of CD; CD activity index
(CDAI)$150 (n = 19 patients) or <150 (n = 72) underwentMR enterography including T2-weighted half-Fourier acquisition single-shot turbo
spin-echo, T2-weighted spectral fat presaturation with inversion recovery, T1-weighted balanced steady-state free precession, and
T1-weighted breath-hold resolution isotropic high volume three-dimensional MR imaging sequences before and after administration of
gadobenate dimeglumine during arterial (30 seconds), portal venous (70 seconds), and delayed phase (3 and 5 minutes from contrast injection).
Two readers analyzed the MR images in consensus. Reference standard was the Crohn’s Disease Endoscopic Index of Severity
(CDEIS) with deep mucosal biopsy or the histologic analysis of the surgical specimen in those patients (n = 30) who underwent elective
small-bowel resection. Univariate and multivariate logistic regression analyses were performed to assess CDAI, biochemical markers
(C-reactive protein and fecal calprotectin levels) and MR imaging findings as potential predictors of inflammatory CD activity.
Results: Patients revealed prevalently active (n = 47 patients) or quiescent CD with mural fibrosis (n = 44 patients). The bowel wall T2
hyperintensity (odds ratio [OR], 9.20; 95% confidence interval [CI], 2.71–31.19) and total length of disease (OR, 1.29; 95% CI,
1.11–1.49) were found as the best independent predictors of active CD. CDAI, C-reactive protein, and fecal calprotectin were not found
independent predictors of active CD.
Conclusions: The bowel wall T2 hyperintensity and the length of the involved bowel tract were predictors of active inflammation in patients
with CD examined by contrast-enhanced MR enterography
Detection of sentinel lymph node in vulvar cancer using 99mTc-labeled colloid lymphoscintigraphy, blue dye, and indocyanine-green fluorescence: a meta-analysis of studies published in 2010–2020
No full textObjectives Sentinel lymph node (SLN) biopsy is widely accepted in the surgical staging of early vulvar cancer, although the most accurate method for its identification is not yet defined. This meta-analysis aimed to determine the technique with the highest pooled detection rate (DR) for the identification of SLN and compare the average number of SLNs detected by planar lymphoscintigraphy (PL), single-photon emission computed tomography/computed tomography (SPECT/CT), blue dye and indocyanine green (ICG) fluorescence. Methods The meta-analysis was conducted according to the PRISMA guideline. The search string was: "sentinel" and "vulv*", with date restriction from 1st January 2010 until Dec 31st, 2020. Three investigators selected studies based on: (1) a study cohort or a subset of a minimum of 10 patients with vulvar cancer undergoing either PL, SPECT/CT, blue-dye, or ICG fluorescence for the identification of SLN; (2) the possibility to extrapolate the DR or the average number of SLNs detected by a single technique (3) no evidence of other malignancies in the patient history. Results A total of 30 studies were selected. In a per-patient and a per-groin analysis, the DR for SLN of PL was respectively 96.13% and 92.57%; for the blue dye was 90.44% and 66.21%; for the ICG, the DR was 91.90% and 94.80%. The pooled DR of SPECT/CT was not calculated, since only two studies were performed in this setting. At a patient-based analysis, no significant difference was documented among PL, blue dye, and ICG (p = 0.28). At a per-groin analysis, PL and ICG demonstrated a significantly higher DR compared to blue dye (p < 0.05). The average number of SLNs, on a per-patient analysis, was available only for PL and ICG with a median number of 2.61 and 1.78 lymph nodes detected, respectively, and no significant statistical difference. Conclusions This meta-analysis favors the use of ICG and PL alone and in combination over blue dye for the identification of the SLN in vulvar cancer. Future studies may investigate whether the combined approach allows the highest DR of SLN in patients with vulvar cancer
Uterine smooth muscle tumors of uncertain malignant potential (STUMP): pathology, follow-up and recurrence
No full textThe term smooth uterine muscle of uncertain malignant potential (STUMPs) indicates a group of uterine smooth muscle tumors (SMTs) that cannot be diagnosed unequivocally as benign or malignant. Diagnosis, surgical management, and follow-up of this neoplasm remain controversial, especially in pre-menopausal women with fertility desire, due to the non aggressive behaviour and prolonged survival rate when compared to leiomyosarcomas. However, recurrence is estimated between 8.7% and 11% and may include delayed-recurrences. We reported five cases of uterine masses treated by surgical procedure diagnosed as STUMP on final pathology. Four patients underwent a total abdominal hysterectomy with or without salpingo-oophorectomy. One patient underwent excision of uterine mass and subsequent total abdominal hysterectomy plus bilateral salpingo-oophorectomy after the diagnosis of STUMP. All patients in our study remained recurrence-free to date (with a follow up period ranging from 6 to 81 months). Based on our experience and in consideration of the lack of consensus regarding the malignant potential, diagnostic criteria, gold-standard treatment and follow-up, we believe that close multidisciplinary management is mandatory in the event of STUMP. We suggest that gynaecologist, dedicated pathologist (with high level of expertize in gynaecological pathology) and oncologist should work as a team in the counselling and management of this neoplasm from detection till completion of follow up. Furthermore, we recommend immunohistochemistry to investigate the overexpression of p16 and p53 in order to identify the cohort of patients at increased risk of recurrence who may benefit from more aggressive surgical-oncological strategies
Primary site disease and recurrence location in ovarian cancer patients undergoing primary debulking surgery vs. interval debulking surgery
No full textIntroduction: The natural history and patterns of ovarian cancer (OC) relapse are still unclear. Recurrent disease can be peritoneal, parenchymal, or nodal. This study aims to analyze the location and pattern of OC recurrence according to the primary site of disease and to the type of surgical approach used. Material and methods: All OC patients underwent primary debulking surgery (PDS) or interval debulking surgery (IDS), with 2014 FIGO stage III-IV, and with platinum-sensitive recurrence were included in the study. Primary disease location and site of recurrences were divided into peritoneal, parenchymal, and nodal, according to the presence of peritoneal carcinomatosis, parenchymal metastasis, and nodal involvement, respectively. Results: A total of 355 patients were initially considered; of them, 295 met the inclusion criteria. Two hundred thirty-three patients obtained no macroscopic residual tumor at the end of primary surgical treatment. Primary parenchymal disease relapsed in 84.6% cases at a parenchymal site (p < 0.001), 97.2% of peritoneal diseases relapsed on the peritoneum (p < 0.001), and 100% of nodal diseases had a nodal recurrence (p < 0.001). Stratifying by the surgical approach all these correlations have been confirmed both in the PDS (p < 0.001) and IDS (p < 0.001) groups. Conclusion: Our study shows that the site of relapse in cases of platinum-sensitive OC recurrence is closely related to the primary location of the disease, regardless of the type of initial treatment. Therefore, more attention during followup should be paid to areas where the initial tumor was present
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