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Archives of Gynecology and Obstetrics May 2023Malignant mesenchymal tumors of the female genital tract are uncommon gynecological cancers, particularly in the vagina. They are typically aggressive and often relapse,...
Malignant mesenchymal tumors of the female genital tract are uncommon gynecological cancers, particularly in the vagina. They are typically aggressive and often relapse, both locally and at distant sites. The treatment of choice for primary tumors is surgical excision as they are generally refractory to chemotherapy and radiotherapy. We describe the case of a vaginal leiomyosarcoma in a 43-year-old woman who presented with abnormal genital bleeding and discharge. The tumor was excised but recurred locally after just 11 months. It was removed by hysterectomy with double adnexectomy and partial vaginal excision.
Topics: Female; Humans; Adult; Leiomyosarcoma; Vagina; Vaginal Neoplasms; Hysterectomy
PubMed: 35488896
DOI: 10.1007/s00404-022-06581-6 -
American Journal of Obstetrics and... Jun 2010The purpose of this study was to report the morbidity of nonemergent hysterectomy for suspected placenta accreta.
OBJECTIVE
The purpose of this study was to report the morbidity of nonemergent hysterectomy for suspected placenta accreta.
STUDY DESIGN
This was a retrospective study of all patients who underwent nonemergent hysterectomy for placenta accreta at Tampa General Hospital from June 1, 2003 to May 31, 2009.
RESULTS
Twenty-nine patients were identified. Diagnosis was suspected on ultrasound scanning in 26 women (6 women also underwent magnetic resonance imaging) and on direct vision at repeat cesarean section delivery in 3 women. All of the women were multiparous, and 18 women had undergone > or =2 cesarean section deliveries. Twenty-one women had a placenta previa, and 8 women had a low anterior placenta. Final pathologic findings revealed accreta (20 specimens), increta (6 women), and percreta (3 women). Mean total operative time was 216 minutes; blood loss was 4061 mL. Two women had ureteral transection (1 was bilateral); 3 women had cystotomy, and 3 women had partial cystectomy. Postoperative hemorrhage occurred in 5 women; 1 hemorrhage resolved after catheter embolization, and the other 4 hemorrhage required reoperation.
CONCLUSION
Nonemergent hysterectomy for placenta accreta is associated with significant morbidity in the forms of hemorrhage and urinary tract insult.
Topics: Adult; Blood Loss, Surgical; Female; Humans; Hysterectomy; Placenta Accreta; Pregnancy; Retrospective Studies; Ultrasonography; Ureter; Urinary Bladder
PubMed: 20510963
DOI: 10.1016/j.ajog.2010.03.021 -
The Journal of Reproductive Medicine Mar 1994The estimated incidence of twin pregnancy consisting of hydatidiform mole and a coexisting fetus is 1 per 22,000-100,000 pregnancies. Since 1965, nine patients with this... (Comparative Study)
Comparative Study Review
The estimated incidence of twin pregnancy consisting of hydatidiform mole and a coexisting fetus is 1 per 22,000-100,000 pregnancies. Since 1965, nine patients with this entity have been treated at the New England Trophoblastic Disease Center (NETDC), Boston. One patient had a partial hydatidiform mole coexisting with a normal placenta and fetus. The other eight patients had twin pregnancies with a complete hydatidiform mole (CHM) and coexisting fetus. We compared the clinical outcomes in these 8 patients and 14 additional published case reports of multiple gestations composed of CHM and coexisting fetuses with a group of 71 patients with singleton CHM treated at NETDC. Twelve of the 22 patients (55%) with CHM and coexisting fetuses developed persistent gestational trophoblastic tumor, requiring chemotherapy. Five of these patients developed metastases requiring multiple cycles of chemotherapy to achieve remission. The presenting symptoms of multiple conception with CHM and coexisting fetuses were similar to those in patients with a singleton conception and complete mole. However, as compared to singleton CHM, patients having a multiple conception with CHM and coexisting fetuses were diagnosed at a later gestational age, had higher preevacuation beta-human chorionic gonadotropin levels and had a greater propensity to develop persistent tumor. These data indicate that patients with multiple conceptions consisting of CHM and coexisting fetuses are at high risk of developing persistent gestational trophoblastic tumor.
Topics: Adult; Antineoplastic Agents; Chorionic Gonadotropin; Combined Modality Therapy; Diseases in Twins; Female; Fetal Diseases; Humans; Hydatidiform Mole; Hysterectomy; Incidence; Male; Ploidies; Pregnancy; Prognosis; Remission Induction; Risk Factors; Treatment Outcome; Uterine Neoplasms; Vacuum Extraction, Obstetrical
PubMed: 8035369
DOI: No ID Found -
The Australian & New Zealand Journal of... Jun 2010Management of bulky cervical tumours is controversial. We describe the addition of high dose rate brachytherapy with concomitant chemotherapy to an attenuated protocol... (Clinical Trial)
Clinical Trial
BACKGROUND AND AIMS
Management of bulky cervical tumours is controversial. We describe the addition of high dose rate brachytherapy with concomitant chemotherapy to an attenuated protocol of radiation followed by simple hysterectomy in the management of bulky cervical tumours.
METHODS
Between January, 2003 and December, 2006, 23 patients diagnosed with bulky cervical tumours underwent a fixed chemo-radiation protocol followed by simple hysterectomy. Fractionated external beam pelvic radiation (4500 cGy) followed by two high-dose rate applications of brachytherapy (700 cGy - prescription dose to point A) was given with weekly concomitant cisplatin (35 mg/m(2)). Patients then underwent simple hysterectomy. Clinical information was prospectively collected and patient charts were then further reviewed.
RESULTS
Twenty patients had stage IB2 and three bulky IIA. Median tumour size was 5 cm. Sixteen patients (70%) achieved a clinical complete and seven (30%) a clinical partial response. All patients had a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH BSO). On final pathology, 12 patients (52%) had a pathological complete response, whereas 11 patients (48%) had residual carcinoma in the cervix. Surgical margins were not involved. With a median follow-up time of 20 months (range 10-50 months), four patients (17.4%), all from the pathological partial response group, have suffered a pelvic recurrence, within 6 months from therapy; nineteen patients (82.6%) remain free of disease.
CONCLUSIONS
This attenuated protocol of chemo-radiation using HDR brachytherapy followed by simple hysterectomy is a viable option in the treatment of bulky cervical carcinomas. The rate of residual cervical disease after chemo-radiation is substantial, but simple hysterectomy achieved negative surgical margins in all cases.
Topics: Adenocarcinoma; Adult; Aged; Antineoplastic Agents; Brachytherapy; Carcinoma, Squamous Cell; Cisplatin; Combined Modality Therapy; Female; Humans; Hysterectomy; Middle Aged; Radiotherapy; Uterine Cervical Neoplasms
PubMed: 20618249
DOI: 10.1111/j.1479-828X.2010.01164.x -
The Journal of Obstetrics and... Mar 2022Laparoscopic hysterectomy (LH) have been frequently used because of low complication rates and short duration of hospital stay. Elevated intracranial pressure (ICP), a...
BACKGROUND AND AIM
Laparoscopic hysterectomy (LH) have been frequently used because of low complication rates and short duration of hospital stay. Elevated intracranial pressure (ICP), a disadvantage of laparoscopic surgery, is caused by the Trendelenburg position (TP) and CO pneumoperitoneum (PP). This study aimed to evaluate TP and PP associated changes in ICP by ONSD measurements during LH. The intra-and inter-observer consistency and reliability of ONSD measurements were also investigated.
METHODS
Sixty patients with were enrolled into this prospective study. ONSD for each patient was measured by three anesthesiologists at T0, T1, T2, and T3 time points. ONSD, mean arterial pressure (MAP), end tidal CO (EtCO ), and arterial blood CO partial pressure values (PaCO ) were measured at T0: baseline, T1: 10 min after introducing 20 mmHg PP, T2: 10 min after placing the patient in TP and 15 mmHg PP and, T3: 10 min after PP deflation.
RESULTS
The ONSD measured at T1 (5.97 ± 0.49 cm) and T2 (5.95 ± 0.57 cm) were higher than T0 (5.63 ± 0.53 cm) and T3 (5.72 ± 0.47 cm) (p < 0.05). There were no correlations between MAP and ONSD, and also between PaCO , EtCO , and ONSD measurements at any time points. Inter-observer intraclass correlation coefficient (ICC) values of ONSD measurements by all examiners had moderate (at T1) to good (at T0, T2, T3) reliability. Intra-observer agreements were reasonable for each observer.
CONCLUSION
ONSD measurements increase with CO PP and TP in patients undergoing LH. Transorbital sonography is a reliable method to monitor intraoperative changes in ONSDs. This study underlines the need for careful training and the importance of standardization in order to obtain reliable results in the examination technique of ONSD measurements.
Topics: Female; Head-Down Tilt; Humans; Hysterectomy; Laparoscopy; Male; Optic Nerve; Pneumoperitoneum; Prospective Studies; Prostatectomy; Reproducibility of Results; Ultrasonography
PubMed: 35048472
DOI: 10.1111/jog.15147 -
BMC Cancer Dec 2022Preoperative neoadjuvant chemotherapy (NACT) has been widely used in developing countries for the treatment of patients with International Federation of Gynecology and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Preoperative neoadjuvant chemotherapy (NACT) has been widely used in developing countries for the treatment of patients with International Federation of Gynecology and Obstetrics (FIGO) stages IB3 and IIA2 cervical cancer. However, the effectiveness of NACT and treatment options for NACT-insensitive patients have been concerning. This study will assess prognostic differences between NACT and primary surgery treatment (PST), determine factors associated with prognosis, and explore better adjuvant treatment modalities for NACT-insensitive patients.
METHODS
This study analyzed clinical characteristics, pathological characteristics, treatment options, and follow-up information of 774 patients with FIGO stages IB3 and IIA2 cervical cancer from 28 centers from January 2016 to October 2019 who participated in a multicenter, prospective, randomized controlled trial.
RESULTS
For patients undergoing NACT, the 5-year OS and PFS rate was 85.8 and 80.5% respectively. They were similar in the PST group. There was no significant difference in OS and PFS between clinical response (CR)/partial response (PR) groups and stable disease (SD)/progressive disease (PD) groups. Apart from deep cervical invasion (p = 0.046) affecting OS for patients undergoing NACT, no other clinical and pathological factors were associated with OS. 97.8% of NACT-insensitive patients opted for surgery. If these patients did not have intermediate- or high-risk factors, whether they had undergone postoperative adjuvant therapy was irrelevant to their prognosis, whereas for patients with intermediate- or high-risk factors, adjuvant chemotherapy resulted in better PFS (chemotherapy vs. no therapy, p < 0.001; chemotherapy vs. radiotherapy, p = 0.019) and OS (chemotherapy vs. no therapy, p < 0.001; chemotherapy vs. radiotherapy, p = 0.002).
CONCLUSIONS
NACT could be a choice for patients with FIGO stages IB3 and IIA2 cervical cancer. The main risk factor influencing prognosis in the NACT group is deep cervical invasion. After systematic treatment, insensitivity to NACT does not indicate a poorer prognosis. For NACT-insensitive patients, Chinese prefer surgery. Postoperative adjuvant therapy in patients with no intermediate- or high-risk factors does not improve prognosis, and chemotherapy in patients with intermediate- and high-risk factors is more effective than radiation therapy and other treatments.
TRIAL REGISTRATION
The study was prospectively registered on ClinicalTrials.gov (NCT03308591); date of registration: 12/10/2017.
Topics: Female; Humans; Neoadjuvant Therapy; Uterine Cervical Neoplasms; Prospective Studies; Neoplasm Staging; Retrospective Studies; Treatment Outcome; Chemotherapy, Adjuvant; Hysterectomy; Antineoplastic Combined Chemotherapy Protocols
PubMed: 36471257
DOI: 10.1186/s12885-022-10355-3 -
Diagnostic Pathology Sep 2023The locally advanced cervical cancer (LACC) of FIGO stage IB3-IIA2 is characterized by large local mass, poor prognosis and survival rate. Tumor response to neoadjuvant... (Review)
Review
BACKGROUND
The locally advanced cervical cancer (LACC) of FIGO stage IB3-IIA2 is characterized by large local mass, poor prognosis and survival rate. Tumor response to neoadjuvant chemotherapy for LACC, utilized as a surrogate endpoint, is urgently needed to improve. Given that the antitumor immune response can be suppressed by programed death-1 axis, the treatment paradigm of neoadjuvant chemotherapy combined with immunotherapy has been explored as one of the prognostic treatments in a variety of solid carcinoma. So far, the application of sintilimab, a domestic immune checkpoint inhibitor, combined with neoadjuvant chemotherapy is still limited in LACC, especially in large lesions.
CASE DESCRIPTION
We present three postmenopausal women diagnosed with FIGO stage IB3-IIA2 cervical squamous cell carcinoma with lesions larger than 5 cm. Demographic, clinical, histopathological, laboratory and imaging data were record. At the completion of the neoadjuvant therapy with paclitaxel plus carboplatin combined with sintilimab, all patients underwent hysterectomy. After neoadjuvant treatment, a pathologic complete response in case 1 and partial responses in case 2 and case 3 were achieved, and neither patient showed any relapse during the follow-up period of 16 to 22 months.
CONCLUSIONS
This report provide evidence to support the combination of sintilimab with neoadjuvant chemotherapy in cervical cancer, which has yet to be validated in prospective studies. More clinical data are needed to verify the effectiveness of the combined regimens. This literature review also collected studies involving potential predictors of response to NACT and immunotherapy, which would be helpful in stratifying patients for future trials.
Topics: Humans; Female; Neoadjuvant Therapy; Carcinoma, Squamous Cell; Uterine Cervical Neoplasms; Prospective Studies; Antineoplastic Combined Chemotherapy Protocols; Neoplasm Recurrence, Local; Paclitaxel; Carboplatin; Neoplasm Staging; Chemotherapy, Adjuvant; Hysterectomy
PubMed: 37752528
DOI: 10.1186/s13000-023-01394-w -
JAMA Sep 2019Vaginal hysterectomy with suture apical suspension is commonly performed for uterovaginal prolapse. Transvaginal mesh hysteropexy is an alternative option. (Comparative Study)
Comparative Study Randomized Controlled Trial
Effect of Vaginal Mesh Hysteropexy vs Vaginal Hysterectomy With Uterosacral Ligament Suspension on Treatment Failure in Women With Uterovaginal Prolapse: A Randomized Clinical Trial.
IMPORTANCE
Vaginal hysterectomy with suture apical suspension is commonly performed for uterovaginal prolapse. Transvaginal mesh hysteropexy is an alternative option.
OBJECTIVE
To compare the efficacy and adverse events of vaginal hysterectomy with suture apical suspension and transvaginal mesh hysteropexy.
DESIGN, SETTING, PARTICIPANTS
At 9 clinical sites in the US Pelvic Floor Disorders Network, 183 postmenopausal women with symptomatic uterovaginal prolapse were enrolled in a randomized superiority clinical trial between April 2013 and February 2015. The study was designed for primary analysis when the last randomized participant reached 3 years of follow-up in February 2018.
INTERVENTIONS
Ninety-three women were randomized to undergo vaginal mesh hysteropexy and 90 were randomized to undergo vaginal hysterectomy with uterosacral ligament suspension.
MAIN OUTCOMES AND MEASURES
The primary treatment failure composite outcome (re-treatment of prolapse, prolapse beyond the hymen, or prolapse symptoms) was evaluated with survival models. Secondary outcomes included operative outcomes and adverse events, and were evaluated with longitudinal models or contingency tables as appropriate.
RESULTS
A total of 183 participants (mean age, 66 years) were randomized, 175 were included in the trial, and 169 (97%) completed the 3-year follow-up. The primary outcome was not significantly different among women who underwent hysteropexy vs hysterectomy through 48 months (adjusted hazard ratio, 0.62 [95% CI, 0.38-1.02]; P = .06; 36-month adjusted failure incidence, 26% vs 38%). Mean (SD) operative time was lower in the hysteropexy group vs the hysterectomy group (111.5 [39.7] min vs 156.7 [43.9] min; difference, -45.2 [95% CI, -57.7 to -32.7]; P = <.001). Adverse events in the hysteropexy vs hysterectomy groups included mesh exposure (8% vs 0%), ureteral kinking managed intraoperatively (0% vs 7%), granulation tissue after 12 weeks (1% vs 11%), and suture exposure after 12 weeks (3% vs 21%).
CONCLUSIONS AND RELEVANCE
Among women with symptomatic uterovaginal prolapse undergoing vaginal surgery, vaginal mesh hysteropexy compared with vaginal hysterectomy with uterosacral ligament suspension did not result in a significantly lower rate of the composite prolapse outcome after 3 years. However, imprecision in study results precludes a definitive conclusion, and further research is needed to assess whether vaginal mesh hysteropexy is more effective than vaginal hysterectomy with uterosacral ligament suspension.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT01802281.
Topics: Aged; Female; Follow-Up Studies; Gynecologic Surgical Procedures; Humans; Hysterectomy, Vaginal; Kaplan-Meier Estimate; Ligaments; Middle Aged; Postmenopause; Postoperative Complications; Surgical Mesh; Treatment Outcome; Uterine Prolapse; Uterus; Vagina
PubMed: 31529008
DOI: 10.1001/jama.2019.12812 -
Taiwanese Journal of Obstetrics &... Jun 2017Intravenous/intravascular leiomyomatosis is characterized by intravenous proliferation of a histologically benign smooth muscle cell tumor mass that is... (Review)
Review
OBJECTIVE
Intravenous/intravascular leiomyomatosis is characterized by intravenous proliferation of a histologically benign smooth muscle cell tumor mass that is non-tissue-invasive. Although benign, intravenous leiomyomatosis may cause remarkable systematic complications, presents significant diagnostic difficulties, and also is characterized by a relatively increased possibility of recurrence. We determine patients' characteristics, and recurrence and treatment of intravenous leiomyomatosis.
MATERIALS AND METHODS
Prognostic factors are analyzed with univariate analysis. Differences in categorical data are evaluated by the X test. A P value below 0.05 is regarded as indicating a significant difference.
RESULTS
The data results accord with the widely held view that complete excision of intravenous leiomyomata achieves favorable prognoses regarding remission. The efficacy of using Gonadotropin releasing hormone agonists to prevent growth or recurrence of tumors in unresected or incompletely resected intravenous leiomyomatosis foci.
CONCLUSION
If complete surgical resection is not possible, partial resection followed by hormone therapy using gonadotropin-releasing hormone agonists is recommended, which in this study achieved the same favorable prognosis with regard to remission.
Topics: Adult; Female; Gonadotropin-Releasing Hormone; Humans; Hysterectomy; Leiomyomatosis; Middle Aged; Neoplasm Recurrence, Local; Risk Factors; Uterine Neoplasms; Vascular Neoplasms; Veins
PubMed: 28600049
DOI: 10.1016/j.tjog.2017.04.017 -
The Journal of International Medical... Feb 2020This study was performed to explore the causes and clinical characteristics of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage.
OBJECTIVE
This study was performed to explore the causes and clinical characteristics of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage.
METHODS
This retrospective study was performed from January 2004 to December 2017. Patients with intractable postpartum hemorrhage were grouped according to the initial pathogenesis as determined by exploratory laparotomy: uterine atony, placental factors, coagulation dysfunction, or uterine rupture.
RESULTS
This study involved 72 patients who underwent emergency exploratory laparotomy, accounting for 0.04% of total deliveries. Uterine preservation surgery and hysterectomy were performed in 31 and 41 patients, respectively. Abnormal events upon returning to the ward were primarily vaginal hemorrhage and pelvic hematoma. The frequency of uterine artery ligation was lower in the hysterectomy group than uterine preservation group. The prothrombin activity level, fibrinogen level, and platelet count before surgery were lower in the hysterectomy group than uterine preservation group. The international normalized ratio and activated partial thromboplastin time were higher in the hysterectomy group than uterine preservation group. In total, 44 patients developed complications.
CONCLUSION
Placental implantation is a primary cause of hysterectomy after emergency laparotomy. However, the possibility of postpartum hemorrhage caused by coagulation disorders should not be ignored.
Topics: Female; Humans; Hysterectomy; Laparotomy; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Uterine Inertia
PubMed: 31662015
DOI: 10.1177/0300060519879294