16 research outputs found
HE4 Tissue Expression as A Putative Prognostic Marker in Low-Risk/Low-Grade Endometrioid Endometrial Cancer: A Review
No full textLow-grade stage I endometrioid endometrial carcinomas should have an excellent prognosis, but a small subset of these cancers can relapse. The search for putative immunohistochemical prognostic markers for relapse in low-risk/low-grade endometrioid endometrial cancers remains open. Among the candidate molecules that may implicate the roles of immunohistochemical risk markers, we focused our attention on human epididymis protein 4 (HE4) after a review of the literature. Few authors have devoted themselves to this topic, and none have found a correlation between the tissue expression of HE4 and the molecular classification of endometrial cancer. Five different variants of HE4 mRNA and multiple protein isoforms of HE4 were identified many years ago, but current HE4 assays only measure the total HE4 expression and do not distinguish the different proteins encoded by different mRNA variants. It is important to have an approach to distinguish specific variants in the future
2022-RA-1512-ESGO Multidisciplinary and tailored management in young patients with borderline ovarian tumor recurrence: a case series
No full textIntroduction/Background: In young women with a recurrence of borderline ovarian tumor (BOT) a second conservative
treatment for the preservation of reproductive potential and endocrine function should be mandatory. In our study, we
reported three cases of ovarian BOT recurrences assessed to oncofertility consultation and underwent fertility sparing surgery (FSS), highlighting the importance of the tailored clinical management in the context of a multidisciplinary meeting.
Methodology: From July 2020 to April 2022, we managed three cases of young women with controlateral ovarian
BOT recurrence after unilateral adnexectomy. Median age at diagnosis was 26 years (I.Q.R 25–28). After multidisciplinary meeting each patient has been addressed to oncofertility consultation with the gynecologic oncologist and the reproductive physician. Two patients had strong desire to conceive furthermore they underwent a controlled ovarian hyperstimulation (COH) with concomitant letrozole and ovarian cryopreservation. In one case the ART (assistedreproductive-technology) procedures has been performed with tumor onsite.
Results: Second surgery consisted in unilateral laparoscopic cystectomy in all cases. In those patients who have undergone COH, two and five mature oocytes were cryopreserved, respectively. After 11 months of surgery one patient became pregnant spontaneously and she gave birth at 39 weeks with an excellent obstetrical outcome. In one case the oocytes cryopreservation has been rejected by the patient, but the endocrine function has been preserved.
Conclusion: In young women, with BOT ovarian recurrence, a second conservative treatment should be always considered and an oncofertility consultation should be recommended. Clinical management must be tailored on a case-by-case basis by a gynecologic oncologist and reproductive physician meeting
2022-RA-1155-ESGO Feasibility of hand assisted laparoscopic sentinel node biopsy in vulvar cancer using combined radioactive and fluorescence guidance
No full textIntroduction/Background: The aim of this preliminary retrospective study was to assess the feasibility and accuracy of
Indocyanine Green (ICG) sentinel lymph node (SLN) sampling using a laparoscopic camera during vulvar cancer staging.
Methodology: Retrospective study. Between 2016 and 2022, 9 women with diagnosis of vulvar cancer underwent radical vulvectomy and inguinofemoral lymphadenectomy; in 2 (22%) selected cases we performed ICG SLN mapping using the IMAGE1 laparoscopic camera combining with Tc99(m)-nanocolloid during open surgery.
Results: The median age of patients was 73 (range 84–60) years. Mean operative time 212.5 minutes. The overall detection rate of SLN mapping was 100%. No post-operative short or long-term complications related to the procedure were observed.
Conclusion: Real-time NIR technology supported by the IMAGE1 S by Storz is a reliable system and represents a consolidated method for SLN mapping in selected cases with vulvar cancer. In our study we confirmed the feasibility of Hand-Assisted Laparoscopy during an open procedure to detect groin SLN with ICG in vulvar cancer. This approach can be used in combination with Tc99(m)-nanocolloid, increasing the detection rate or it can be an appropriate option to detect SLN in those countries where Tc99(m)-nanocolloid is not available or cannot be practiced. The use of laparoscopic camera for ICG SLN mapping seems to be accessible and inexpensive. Further studies are
needed to evaluate the accuracy and oncological outcomes
Effective Surgical Management of a Large Serous Ovarian Cyst in a Morbidly Obese Middle-Aged Woman: A Case Study and Literature Review
No full textBackground: In contemporary gynecological practice, encountering giant ovarian tumors is a rarity. While most are benign and of the mucinous subtype, the borderline variant only accounts for approximately 10% of these cases. This
paper addresses the paucity of information about this specific subtype, emphasizing critical elements of managing borderline tumors that can pose life-threatening complications. Additionally, a review of other documented cases of the borderline variant in the literature is also included to foster a deeper understanding of this uncommon condition.
Case Report: We present the multidisciplinary management of a 52-year-old symptomatic woman with a giant serous borderline ovarian tumor. Preoperative assessment showed a multiloculated pelvic-abdominal cyst responsible for
compression of the bowel and retroperitoneal organs, and dyspnea. All tumor markers were negative. Together
with anesthesiologists and interventional cardiologists, we decided to perform a controlled drainage of the
cyst of the tumor, to prevent hemodynamic instability. Subsequent total extrafascial hysterectomy, contralateral salpingo-oophorectomy, and abdominal wall reconstruction, followed by admission to the intensive care
unit, were also conducted by the multidisciplinary team. During the postoperative period, the patient experienced a cardiopulmonary arrest and acute renal failure, which were managed by dialysis. After discharge, the
patient underwent oncologic followup, and after 2 years, she was found to be completely recovered and disease free.
Conclusions: Intraoperative controlled drainage of Giant ovarian tumor fluid, planned by a multidisciplinary management team, constitutes a valid and safe alternative to the popular choice of “en bloc” tumor resection. This approach avoids rapid changes in body circulation, which are responsible for intraoperative and postoperative severe
complications
Early-Stage Cervical Cancer: Is There a Place for Conservative Treatment?
No full textRecent advances in screening and early diagnosis have decreased cervical cancer incidence and mortality rate in high-resource settings. The postponement of childbearing and the young age of women at diagnosis produced new challenges in the management of this disease. In recent years, attention has been directed to assessing more conservative procedures that can reduce treatment-related morbidity, without compromising oncologic safety and reproductive potential. Fertility sparing surgery (FSS) procedures, including cervical conization, simple or radical trachelectomy with pelvic nodes dissection or sentinel lymph node assessment, and neoadjuvant chemotherapy followed by conization, have shown encouraging results. In this chapter, we discuss the role of conservative surgery in the management of early-stage cervical cancer focusing on obstetrical and oncological outcomes
2022-VA-1522-ESGO New Keystone flap application in vulvo-perineal reconstructive surgery for vulvar cancer
No full textIntroduction/Background: This report aimed to illustrate the video-guided application of the Keystone perforator island
flaps (KPIF) technique in a patient with diagnosis of vulvar cancer.
Methodology: Eight patients were selected for the study: seven of them underwent radical vulvectomy for vulvar squamous cell carcinoma (SCC), and one underwent vulvar wide excision for Paget disease. The Keystone perforator island flaps technique was adopted for all these vulvar reconstruction. The team approach comprised both a gynecologic oncologist and a plastic surgeon in all procedures. The defects were successfully covered by the Keystone flap technique in all patients.
Results: Bilateral Keystone flaps were taken from the medial and proximal region of the thigs, with incision lines coinciding with the natural skin folds. When flaps vitality was determined, each one was positioned along the perineal midline for labia majora and vaginal opening reconstruction. Final reconstructive step coincided with skin and vaginal mucosa suture. No post-operative short complications in the described case were observed.
Conclusion: The Keystone technique is an extremely simple and effective solution, easily applicable and reproducible. KPIF technique warrants an excellent vascular supply and does not require delicate perforator dissection. Additionally, it is associated with minimal morbidity in donor sites, a lower risk of flap necrosis and lower intraoperative and postoperative complications. Keystone flap method also yields good aesthetic and functional results by preserving shape and contour, avoiding differences in skin coloration and preserving sensitivity with an excellent cosmetic outcome in terms of patient satisfaction and postoperative scars and with an acceptable complication rate. Further studies with larger sample size are required to evaluate the efficacy of this technique
Lymphatic Mapping for Endometrial Cancer
No full textThe staging for endometrial cancer is surgical and it should include both pelvic and para-aortic lymphadenectomy. The majority of endometrial cancers are diagnosed at early stage and lymphadenectomy gives no benefit for staging while adding surgical risks. Performing a systematic lymphadenectomy in very obese women is almost impossible. Preoperative lymphatic mapping (via planar lymphoscintigraphy, single photon emission computed tomography, or positron emission tomography) has poor correlation with surgical mapping of sentinel lymph nodes (SLNs), that has been proposed to avoid systematic lymphadenectomy in early stages. However, surgical SLN mapping is a very challenging procedure in endometrial cancer because the uterus has a complex lymphatic drainage. In the last 20 years, different authors used different tracers (vital stains, radioactive isotopes, or fluorescent dye), different sites of tracer injection (cervix, endometrium, or myometrium), and different surgical approaches (laparotomic, laparoscopic, or robotic) to find out the best procedure for SLNs identification. A well-designed, prospective, randomized, international multicenter tri¬al aimed at validating the accuracy of a uniform procedure is still lacking. In the meantime, to reduce the false-negative rate of intra-operative SLN mapping a surgical algorithm limits systematic pelvic lymphadenectomy to the hemi-pelvis without SLNs mapping and includes removal of any suspicious, although not mapped, node together with mapped SLNs
Risk factors for sentinel lymph node involvement in patients with apparent early-stage endometrial cancer: a retrospective single-center study
No full textIntroduction/Background Sentinel lymph node (SLN) mapping
with indocyanine green (ICG) has become the standard of
care in apparent early-stage endometrial cancer. The aim of
this study is to evaluate the possible risk factors (RFs) for
lymph-nodal metastases, differentiating by the type of
metastasis.
Methodology This is an observational single-center retrospective
study. We reviewed 96 patients with a diagnosis of
apparent early-stage endometrial cancer submitted to hysterectomy
with salpingo-oophorectomy and SLN mapping from
December 2015 to March 2022. Possible RFs for nodal
metastasis were considered including clinical (age, BMI),
and biochemical (CA125, CA 19.9, HE-4) parameters, anatomopathological
characteristics (Myometral invasion – MI,
Lymphovascular space invasion (LVSI), grade, histotype) and
immunohistochemical findings (L1CAM, Ki67, estrogen
receptor – ER, progesterone receptor- PR). Odds ratios(ORs) were calculated, and then RFs were confronted with
logistic regression.
Results Overall detection rate was 94.8%, 83.3% bilateral,
and 11.5% unilateral. We removed 181 suspected SLNs. The
preponderance of SLNs was found at the external iliac and
interiliac stations (69%). 7 patients had macrometastases, 5
micrometastases, and 7 ITCs. Higher ER percentage resulted
in a protective factor (PF) for lymph nodal metastasis. MI
more than 50%, LVSI, and p53 positivity resulted in RFs for
lymph nodal metastases. Histotype, age, and L1CAM showed
a slight, not significant, correlation as possible RFs. The multivariate
multinomial analysis didn’t find any statistically significant
differences between the RFs and the type of
metastasis
