1,720,999 research outputs found
Endometrial carcinoma metastatic to the vulva: A case report and review of the literature
No full textRandomised prospective study of abdominal wall closure in patients with gynaecological cancer.
No full textAust N Z J Obstet Gynaecol. 2010 Aug;50(4):391-6.
Randomised prospective study of abdominal wall closure in patients with gynaecological cancer.
Berretta R, Rolla M, Patrelli TS, Piantelli G, Merisio C, Melpignano M, Nardelli GB, Modena AB.
SourceDepartment of Obstetrics and Gynecology, University of Parma, Italy. [email protected]
Abstract
BACKGROUND: Median laparotomy is the most common approach to the abdominopelvic cavity in patients with gynaecological tumours.
AIMS: The primary endpoint of the study was to evaluate the onset of incisional hernia. The secondary endpoint was to evaluate the onset of infection, wound dehiscence, wound infection, and scar pain during the post-operative period.
METHODS: A total of 191 patients were eligible for the study. They were divided into three groups. Group A underwent en bloc closure of the peritoneum and fascia with Premilene suture, Group B en bloc closure of the peritoneum and fascia with Polydioxanone suture, and Group C separate closure of the peritoneum and fascia with single stitches of Ethibond suture. Statistical analysis was performed using the Statistical Software Package for Social Sciences 12.0.
RESULTS: Group A and Group B comprised 63 patients, and Group C included 65 patients. The three groups proved homogeneous on statistical analysis (P > 0.05). The statistical analysis did not reveal significant differences between the different suture types and techniques with respect to the incidence of incisional hernia (P > 0.05).
CONCLUSION: In our study, the incidence of incisional hernia was 8%. Randomised patients were homogeneous for sample size and risk factors. No significant differences were found between suture types or techniques. Currently, there is no suture material or technique that can be considered superior to others. When possible, we believe that the best way to prevent incisional hernia is to preserve the integrity of the abdominal wall using minimally invasive techniques
Vaginal versus abdominal hysterectomy in endometrial cancer: a retrospective study in a selective population
No full textInt J Gynecol Cancer. 2008 Jul-Aug;18(4):797-802. Epub 2007 Oct 18.
Vaginal versus abdominal hysterectomy in endometrial cancer: a retrospective study in a selective population.
Berretta R, Merisio C, Melpignano M, Rolla M, Ceccaroni M, DE Ioris A, Patrelli TS, Nardelli GB.
SourceDepartment of Gynecology, Obstetrics and Neonatology, University of Parma, Parma, Italy. [email protected]
Abstract
The purpose of this study was to analyze the outcome of vaginal and abdominal hysterectomy for the treatment of early-stage endometrial cancer in a selected group of elder patients. This retrospective study analyzed a total of 154 patients: 113 (group I) underwent vaginal surgery and 41 (group II) underwent laparotomy. In both groups, we investigated the following parameters: intra- and postoperative complications, mean operative time, mean hospital stay, disease-free survival (DFS), overall survival (OS), and time of local or retroperitoneal recurrence. Medically compromised patients were significantly more frequent in the vaginal surgery group (P = 0.005), and the operative duration in this group was significantly shorter (P = 0.01). Intra- and postoperative complications, along with local and distant recurrence, did not show a statistically significant difference in the two groups. Total survival in the two populations, 85% at 5 years, did not reach statistically significant difference either in terms of DFS or in terms of OS. Vaginal surgery compared to traditional abdominal approach is feasible also in patients with high surgical risk; it does not require general anesthesia, abolishes abdominal trauma correlated to laparotomy, and allows a quicker reprise of the bladder and rectal function; therefore, it achieves high eradication rates and low intra- and postoperative morbidity rates
Preoperative transvaginal ultrasonography and intraoperative gross examination for assessing myometrial invasion by endometrial cancer
Full text linkJ Ultrasound Med. 2008 Mar;27(3):349-55.
Preoperative transvaginal ultrasonography and intraoperative gross examination for assessing myometrial invasion by endometrial cancer.
Berretta R, Merisio C, Piantelli G, Rolla M, Giordano G, Melpignano M, Nardelli GB.
SourceDepartment of Obstetrics and Gynecology, University of Parma, Via A. Gramsci 14, 43100 Parma, Italy. [email protected]
Abstract
OBJECTIVE: Endometrial cancer is the most common gynecologic malignancy. The cornerstone of treatment remains surgery according to International Federation of Gynecology and Obstetrics staging. The aim of this study was to evaluate the concordance between myometrial infiltration detected by ultrasonography and gross examination with respect to definitive histologic examination and to select a population in which lymphadenectomy could be excluded. We also evaluated the concordance for the degree of tumor differentiation between diagnostic biopsy and final histologic results.
METHODS: Our study included 75 patients with International Federation of Gynecology and Obstetrics stage I endometrial cancer. We evaluated preoperative and definitive grading and myometrial infiltration detected by ultrasonography and gross examination. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the procedures under study were determined with the Bayes theorem. To determine the predictive value of preoperative transvaginal ultrasonography and intraoperative gross examination for myometrial invasion, we used a multiple logistic regression model with a statistical software package.
RESULTS: Our study showed 60% concordance between biopsy and histologic results. In 80% of the cases with discordant results, the tumor was undergraded. Ultrasonography had diagnostic accuracy of 73%, whereas gross examination correctly determined myometrial invasion in 82.6% of the patients, with sensitivity of 62% and specificity of 79%.
CONCLUSIONS: Preoperative transvaginal ultrasonography and macroscopic gross examination appear to be simple, fast, and reliable methods to predict in myometrial invasion in patients with a low risk for lymph node metastasis, for which lymphadenectomy can reasonably be avoided
Metastatic extragenital neoplasms to the uterus: A clinicopathological study of four cases.
Full text linkThe aim of this study was to elucidate the clinicopathologic features, the
differential diagnostic problems, and the prognostic consequences of patients
with metastatic extragenital malignancies to uterus. The patients with metastatic
extragenital malignancies to the uterus were evaluated. We considered the
metastases in non-genital tract organs at diagnosis of primary neoplasm, the
distribution of the metastases in the uterus, and the presence of concomitant
metastases in other genital and non-genital tract organs. There were four cases
of metastatic extragenital malignancies to the uterus. The breast was the most
frequent primary site (two cases: 50%). The other two primary tumors were
adenocarcinoma of the cecum and malignant melanoma of the skin. The diagnosis was
facilitated by clinical history, revealing the previous primary neoplasm, and by
specific immunohistochemical study. Almost all the patients died from
disseminated disease. Thus, the prognosis of metastatic extragenital malignancies
to the uterus alone or simultaneously to the uterus and other organs of the
genital tract is poor. Thus, the metastases to the uterus and to other organs of
the genital tract can be considered a preterminal event
RISCONTRO DEL VIRUS HPV NEI TRATTI SUPERIORI DELL’APPARATO GENITALE FEMMINILE: STUDIO MOLECOLARE SU CAMPIONI DI ISTERECTOMIA ED ANNESSIECTOMIA BILATERALE CON CARCINOMA CERVICALE HPV POSITIVO
No full textEndometrial mucinous microglandular adenocarcinoma: morphologic, immunohistochemical features and emphasis in the HPV status
No full textABSTRACT
We report two cases of endometrial microglandular adenocarcinoma, a rare neoplasm, which, in its morphologic features, mimics cervical microglandular hyperplasia and mucinous proliferations of endometrium. The criteria for a
correct pathological diagnosis, such as clinical, morphologic, and
immunohistochemical data, are emphasized. For the first time, we probed to establish whether endometrial mucinous microglandular adenocarcinoma could be correlated to human papilloma virus (HPV) infection by using polymerase chain reaction amplification (PCR) of tumoral DNA. Similar to previous studies reported
in the literature, the present lesions, occurring in postmenopausal women, immunohistochemically showed positivity for B72.3, Ca 125, CEA, Vimentin, estrogen and progesterone receptors, and negativity for p53. Molecular study by
PCR amplification of tumor DNA showed no signal for HPV DNA in any of these cases; thus, this variant of endometrial carcinoma is not caused by the HPV infection, but probably by other pathogenetic mechanisms, such as an accumulation
of the mutations, which arrive in old age or as the consequence of a peculiarhormonal situation
Primary adenocarcinoma of the rectovaginal septum arising in pregnancy in the absence of endometriosis
Full text linkA case of primary adenocarcinoma of the rectovaginal septum (PARVS) is reported
with clinical and pathological findings. A 37-year-old Caucasian woman with a
history of sterility and small posterior leiomyoma, a few months after a cesarean
section, was admitted because of vaginal spotting, abdominal pain and
constipation. Her previous history did not reveal exposure to diethylstil bestrol
(DES). Pelvic computed tomography showed a heterogeneous pelvic mass in the
Douglas pouch, measuring 9 cm in diameter, located in the rectovaginal septum,
involving the rectal and vaginal wall. Histological examination of neoplastic
tissue revealed solid sheet structures, occasional tubular lumen, extensive
necrotic areas and clear cells. The neoplastic elements showed immunoreactivity
for Mullerian markers (cytokeratin 7, CA-125 and vimentin). Because, the present
case of PARVS cannot be due to DES exposure, the clear appearance of the
neoplastic elements could represent only one differentiation of Mullerian rests.
Moreover, because no foci of endometriosis were identified in several sections of
the neoplasm, uterine and cervical wall, and tissues nearby the neoplasm could
represent a rare subtype of PARVS arising in the absence of endometriosis
Postmenopausal status, hypertension and obesity as risk factors for malignant transformation in endometrial polyps
No full textABSTRACT
OBJECTIVES: We analyzed clinical data and pathological features of six cases of
malignant endometrial polyps, to compare these with other examples reported in
literature and to define the features of endometrial cancer arising in polyps.
Moreover, to clarify the mechanisms of carcinogenesis in malignant endometrial
polyps we examined the expression of cyclooxygenase-2 (COX-2), P53 and Ki 67 and
their relationships with clinicopathologic characteristics.
METHODS: The surgical pathology files of the Pathology Department of Parma
University were searched for cases of endometrial polyps with nests of
endometrial carcinomas, from the years 2002-2005. Clinical records, histological
slides of endometrial curetting, hysterectomy with salpingo-oophorectomy
specimens and pelvic lymph nodes were reviewed in each case. The main
pathological features analyzed were histological types of endometrial cancer and
the stage of development of neoplasm. The presence of other malignancies in the
genital tract were also considered. Immunohistochemical staining was done using
antibodies COX-2, p53 and Ki 67.
RESULTS: In our study, all malignant endometrial polyps had been detected in
postmenopausal women. The majority of our patients with malignant endometrial
polyps had risk factors for the development of endometrial carcinoma such as
hypertension, obesity and unopposed estrogen therapy. Unlike other studies, no
patients had a history of previous breast carcinoma and Tamoxifen treatment. The
most common subtypes of endometrial carcinoma in malignant polyps are
endometrioid carcinoma and serous papillary carcinoma. Endometrial carcinoma
arising in endometrial polyps is an early endometrial carcinoma with good
prognosis, except for papillary serous carcinoma, which can be associated with
multiple omental involvement, despite low stage of development in the uterus.
Immunohistochemical study showed that COX-2 expression was found in cytoplasm of
tumor cells and this was elevated in all cases, independently of the grade and
the stage of development of the malignancy, histological subtype and deep
invasion of myometrium. P53 and Ki 67 expression, detected in the nuclei of
neoplastic cells, was not correlated with COX-2 immunoreactivity, but these
markers were associated with more advanced stage, grading, and histologic
subtypes of tumor.
CONCLUSIONS: Postmenopausal status, hypertension, obesity could all be considered
as risk factors for carcinomatous transformation within endometrial polyps in
women without a history of breast carcinoma and Tamoxifen treatment. However, our
series is small (only six cases considered) and further studies are necessary to
confirm this hypothesis. In the current study, immunohistochemical data reveal
that COX-2 expression may be associated with the carcinogenesis in endometrial
carcinomas arising in endometrial polyps, but this antibody is not correlated
with tumor aggressiveness, P53 and Ki 67 expression. P53 and Ki 67
overexpression, instead, are associated with advanced stage, histologic subtype
and deep myometrial invasion of neoplasm
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