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Medicine Dec 2023Cancer with unknown primary site is a kind of disease that is difficult to deal with clinically, accounting for 2% to 9% of all newly diagnosed cancer cases. Here, we... (Review)
Review
RATIONALE
Cancer with unknown primary site is a kind of disease that is difficult to deal with clinically, accounting for 2% to 9% of all newly diagnosed cancer cases. Here, we report such a case with pelvic metastatic squamous cell carcinoma of an unknown primary site and review the relevant literature.
PATIENT CONCERNS DIAGNOSES
A 43-year-old Chinese female patient was referred to our hospital and initially diagnosed as "malignant tumor of right adnexal area?, obstruction of right ureter, secondary hydronephrosis".
INTERVENTIONS
Thereafter cytoreductive surgery was performed which included a total hysterectomy, left adnexectomy, partial omentum resection, pelvic lymph node dissection, and para-aortic lymph node dissection. The primary lesion could not be identified by supplementary examination and postoperative pathology. The patient was diagnosed as pelvic metastatic squamous cell carcinoma whose primary site was unknown. To prevent a recurrence, we administered adjuvant chemotherapy for the patient.
OUTCOMES
The patient was followed up after treatment, complete remission has been maintained for 72 months, and no recurrence or metastasis has been found.
LESSONS
Our case demonstrates that surgery combined with chemotherapy could be helpful for pelvic metastatic squamous cell carcinoma of unknown primary site.
Topics: Adult; Female; Humans; Carcinoma, Squamous Cell; Hysterectomy; Lymph Node Excision; Lymph Nodes; Neoplasms, Unknown Primary
PubMed: 38206704
DOI: 10.1097/MD.0000000000036796 -
International Journal of Surgery Case... Apr 2022Vaginal mesenchymal cancer is one of the rarest cases, covering only 3% of all cases of vaginal malignancies. While risk factors are not heavily studied, genetic...
INTRODUCTION
Vaginal mesenchymal cancer is one of the rarest cases, covering only 3% of all cases of vaginal malignancies. While risk factors are not heavily studied, genetic disorders and hereditary diseases have been stated to be responsible for the increasing incidence of vaginal mesenchymal carcinoma. The diagnosis of leiomyosarcoma could be done through anamnesis to find abnormal uterine discharge and pelvic pain and physical examination to find a protruding mass on the vagina, which then should be confirmed through a series of radiologic examinations and histopathological examinations. Due to its rarity, each case should be properly evaluated for its clinical manifestation, diagnostic results, and outcome of the treatment.
CASE PRESENTATION
A 46-year-old woman came in with vaginal discharge and a protruding mass from the vagina without bleeding or urinary or defecation difficulties, which was suspected to be pedunculated submucous myoma. Based on pelvic USG and MRI, the mass was suspected to have originated from the vagina. Histopathology examinations from biopsy showed a possible mesenchymal malignant type. The patient then underwent total hysterectomy, bilateral salpingo-oophorectomy, and partial vaginectomy. Histopathological evaluation confirmed the diagnosis of leiomyosarcoma in the patient.
DISCUSSION AND CONCLUSION
The patient was diagnosed with a vaginal malignant mesenchymal tumor stage II intraoperatively and underwent total hysterectomy and bilateral salpingo-oophorectomy. Leiomyosarcoma is not commonly diagnosed preoperatively, hence implying the importance of radiologic examination to do an early diagnosis prior to the histopathological analysis. Due to the rarity of vaginal mesenchymal malignancy, further studies are needed to increase understanding of this case.
PubMed: 35318185
DOI: 10.1016/j.ijscr.2022.106864 -
Ginekologia Polska 2022To summarize our five-year experience with managing patients diagnosed with wide range of PAS disorder and treated with prophylactic internal iliac balloon implantation...
OBJECTIVES
To summarize our five-year experience with managing patients diagnosed with wide range of PAS disorder and treated with prophylactic internal iliac balloon implantation prior to cesarean section and to assess maternal and fetal outcomes.
MATERIAL AND METHODS
Retrospective cohort study.
RESULTS
A total of 30 patients were included in the study. Hysterectomy was performed in 10 cases - partial hysterectomy in six and total hysterectomy in four. Median estimated blood loss was 1.18 L. In two cases technical complications were noted. In one case bilateral internal iliac artery thrombosis requiring urgent surgical intervention occurred. A total of 30 live infants were delivered. Mean birth weight was 2435 g and mean Apgar score at 1', 5' and 10' minutes was 6.8, 8 and 8.7 respectively. After average 30 days of hospitalization all infants and their mothers were discharged in good clinical condition.
CONCLUSIONS
Placenta accreta spectrum remains a challenge for obstetricians and gynecologists and despite interdisciplinary approach is associated with numerous complications with life-threatening postpartum hemorrhage being the most serious one. Prophylactic placement of iliac balloons is a minimally invasive and safe endovascular technique which allows rapid and effective control of postpartum bleeding in patients with PAS, with low complication rate for both mother and the child.
Topics: Child; Pregnancy; Humans; Female; Cesarean Section; Balloon Occlusion; Retrospective Studies; Placenta Accreta; Iliac Artery; Catheterization; Hysterectomy; Postpartum Hemorrhage; Blood Loss, Surgical
PubMed: 35315022
DOI: 10.5603/GP.a2021.0221 -
Geburtshilfe Und Frauenheilkunde Aug 1988Urinary retention after radical hysterectomy is due to partial or complete denervation of the bladder and proximal urethra which is dependent on surgical radicality. In... (Review)
Review
Urinary retention after radical hysterectomy is due to partial or complete denervation of the bladder and proximal urethra which is dependent on surgical radicality. In contrast, incomplete bladder emptying after surgery for stress induced urinary incontinence, has its origin in an infravesicular functional obstruction and is dependent on the operation performed. The use of drugs (alpha-sympatholytics, parasympathomimetics) seem to be of limited value, especially after stress-incontinence surgery. Preoperative information, perioperative supra pubic bladder drainage, postoperative bladder training and in rare cases intermittent self-catheterisation and transurethral surgery are the key factors in successful treatment of postoperative urinary retention.
Topics: Female; Humans; Hysterectomy; Postoperative Complications; Urethra; Urinary Bladder; Urinary Incontinence, Stress; Urination Disorders
PubMed: 3063586
DOI: 10.1055/s-2008-1026537 -
American Journal of Obstetrics and... Dec 1995
Comparative Study
Modified Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty in the medically compromised elderly: a comparison with vaginal hysterectomy, anterior colporrhaphy, and posterior colpoperineoplasty.
Topics: Adult; Aged; Aged, 80 and over; Anesthesia, Obstetrical; Blood Loss, Surgical; Female; Follow-Up Studies; Gynecology; History, 19th Century; History, 20th Century; Humans; Hysterectomy, Vaginal; Length of Stay; Middle Aged; Postoperative Complications; Retrospective Studies; Time Factors; Uterine Prolapse
PubMed: 8610747
DOI: 10.1016/0002-9378(95)90412-3 -
American Journal of Obstetrics and... Apr 2021Patients younger than 40 years usually present with early-stage endometrial cancer with favorable prognosis. However, such patients are usually in their childbearing age...
BACKGROUND
Patients younger than 40 years usually present with early-stage endometrial cancer with favorable prognosis. However, such patients are usually in their childbearing age and may desire fertility-sparing options. The identification of biomarkers may improve the clinical outcomes in these patients and aid in fertility-sparing management; however, there has been no reports on biomarker analysis so far.
OBJECTIVE
This study aimed to evaluate the prognostic significance of Proactive Molecular Risk Classifier for Endometrial Cancer in the fertility-sparing management of endometrial cancer.
STUDY DESIGN
A total of 57 endometrial biopsy specimens obtained before hormone therapy were evaluated, and patients were classified according to the Proactive Molecular Risk Classifier for Endometrial Cancer molecular subtypes (mismatch repair deficiency, DNA polymerase epsilon mutation, wild-type p53, and abnormal p53). The primary endpoint was the response rate after hormone therapy. The secondary endpoint was the recurrence rate after the complete response, hysterectomy rate owing to treatment failure, and upstaged diagnosis rate after hysterectomy.
RESULTS
Of 57 patients, 9 (15.8%) had mismatch repair deficiency, 2 (3.5%) had DNA polymerase epsilon mutation, 45 (78.9%) had wild-type p53, and 1 (1.8%) had abnormal p53. Overall, the complete response rate was 75.4% after hormone therapy. Patients with mismatch repair deficiency had a significantly lower complete response or partial response rate than those with wild-type p53 in terms of the best overall response (44.4% [95% confidence interval, 4.0-85.0] vs 82.2% [95% confidence interval, 71.0-94.0]; P=.018) and complete response rate at 6 months (11.1% [95% confidence interval, 0.2-37.0] vs 53.3% [95% confidence interval, 38.0-68.0]; P=.010). Among patients with mismatch repair deficiency, 4 underwent immediate hysterectomy because of treatment failure and 3 presented upstaged diagnosis after hysterectomy.
CONCLUSION
The Proactive Molecular Risk Classifier for Endometrial Cancer molecular classification has prognostic significance in the fertility-sparing management of endometrial cancer, thereby enabling early stratification and risk assignment to direct care. Mismatch repair status could be used as a predictive biomarker for selecting patients who could benefit from hormone therapy. These findings need to be validated in larger studies.
Topics: Adult; Antineoplastic Agents, Hormonal; Biomarkers; Biopsy; DNA Mismatch Repair; DNA Polymerase II; Disease Progression; Endometrial Neoplasms; Endometrium; Female; Fertility Preservation; Humans; Hysterectomy; Intrauterine Devices, Medicated; Medroxyprogesterone Acetate; Megestrol Acetate; Middle Aged; Mutation; Neoplasm Recurrence, Local; Prognosis; Receptors, Progesterone; Retrospective Studies; Tumor Suppressor Protein p53; Young Adult
PubMed: 33039397
DOI: 10.1016/j.ajog.2020.10.003 -
Obstetrics and Gynecology Feb 2023Uterine artery embolization (UAE) is a minimally invasive procedure for treatment of symptomatic uterine leiomyomas, but long-term complications are under-reported.
BACKGROUND
Uterine artery embolization (UAE) is a minimally invasive procedure for treatment of symptomatic uterine leiomyomas, but long-term complications are under-reported.
CASE
This is the case of a healthy 51-year-old woman who had previously undergone UAE for symptomatic uterine leiomyomas. The patient presented with gross hematuria and pelvic pain 10 years later. She was found to have both a vesicouterine and a uteroduodenal fistula. The patient was successfully treated with hysterectomy, excision of the vesicouterine fistula, partial cystectomy, excision of the duodenal fistula, and primary duodenal repair.
CONCLUSION
Complex gynecologic fistulas may occur as a long-term complication in symptomatic women with a history of UAE.
Topics: Female; Humans; Middle Aged; Uterine Artery Embolization; Uterine Neoplasms; Leiomyoma; Hysterectomy; Fistula; Treatment Outcome; Embolization, Therapeutic
PubMed: 36649323
DOI: 10.1097/AOG.0000000000005055 -
International Urogynecology Journal Oct 2018After vaginal hysterectomy, uterosacral ligaments are commonly used to suspend the vaginal vault in order to prevent and to treat recurrence of central prolapse. Shull...
INTRODUCTION AND HYPOTHESIS
After vaginal hysterectomy, uterosacral ligaments are commonly used to suspend the vaginal vault in order to prevent and to treat recurrence of central prolapse. Shull et al. proposed a technique to fix endopelvic fascia and vagina to the higher portion of the uterosacral ligaments using a vaginal approach [1]. This technique is associated with a risk of ureteral obstruction (0-11%) [2, 3]. Although intraoperative cystoscopy is recommended to check ureteral patency at the end of colposuspension, this secondary prevention technique could be false negative due to partial stenosis [4].
METHODS
A 60-year-old woman with stage 3 uterine and anterior compartment descensus assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system underwent vaginal hysterectomy, bilateral adnexectomy, and vaginal vault suspension to the uterosacral ligaments using the Shull technique. Intraoperative cystoscopy with indigo carmine was negative. On postoperative day 0, the patient complained left flank pain. Transabdominal ultrasound showed a left hydroureteronephrosis without ureteral stones, which was confirmed by uro-computed tomography scan. The attempts of ureteral stent positioning and opening the vaginal vault failed to resolve the ureteral obstruction, which was corrected, and a new vault suspension performed using the laparoscopic approach. Prophylactic ureteral stent positioning was performed. Informed consent was obtained from the patient for publication of this case report.
RESULTS
The patient was discharged on postoperative day 5 with normal renal function. The ureteral stent was removed after 1 month, and renal ultrasound at 3 and 6 months' follow-up showed normal renal pelvis caliber. No recurrence of genital prolapse was observed at gynecological examination.
CONCLUSIONS
Laparoscopy can be a wise alternative option to manage ureteral obstruction secondary to vaginal colposuspension for genital organ prolapse.
Topics: Adnexa Uteri; Colposcopy; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Middle Aged; Postoperative Complications; Stents; Suburethral Slings; Ureter; Ureteral Obstruction; Uterine Prolapse; Uterus; Vagina
PubMed: 29855661
DOI: 10.1007/s00192-018-3675-6 -
Journal of Surgical Oncology Mar 2020Venous thromboembolism (VTE) is a significant source of postoperative morbidity and mortality in patients undergoing common oncologic procedures. We sought to estimate...
BACKGROUND
Venous thromboembolism (VTE) is a significant source of postoperative morbidity and mortality in patients undergoing common oncologic procedures. We sought to estimate the effect of surgical approach on the risk of developing a VTE.
METHODS
IBM Watson Health Marketscan Database was used to conduct this retrospective study. In total, 12 938 patients who underwent either a radical prostatectomy, partial colectomy, or hysterectomy via a minimally invasive or open approach. We used a propensity-weighted logistic regression analysis to assess the independent effect of surgical approach on VTE. The primary outcome of interest was the 90-day rate of VTE after surgery.
RESULTS
Patients undergoing minimally invasive surgery across all three surgical procedures were noted to have a lower odds of developing a VTE: (radical prostatectomy, odds ratio [OR]: 0.667, 95% confidence interval [CI]: 0.500-0.891; P = .006 |partial colectomy: OR, 0.620, 95% CI: 0.477-0.805; P < .001| hysterectomy: OR, 0.549 95% CI: 0.353-0.854; P = .008).
CONCLUSION
We found that a minimally invasive approach was associated with significantly lower odds of VTE compared with undergoing the same open procedure. This study highlights how surgical approach may be an independent risk factor for development of VTE and may elucidate potential risk mitigation strategy.
Topics: Adult; Colectomy; Female; Follow-Up Studies; Humans; Hysterectomy; Incidence; Male; Middle Aged; Minimally Invasive Surgical Procedures; Neoplasms; Postoperative Complications; Prognosis; Prostatectomy; Retrospective Studies; Risk Factors; Venous Thromboembolism
PubMed: 31916588
DOI: 10.1002/jso.25832 -
The International Journal of Medical... Dec 2017Recent studies have suggested that the use of robotic surgery for prostatectomy has been increasing, but characterization of the diffusion of robotic surgery in other... (Observational Study)
Observational Study
BACKGROUND
Recent studies have suggested that the use of robotic surgery for prostatectomy has been increasing, but characterization of the diffusion of robotic surgery in other procedures has not been available.
METHODS
Data were analysed for the years 2006-2014 using hospital episode statistics (HES), a database of all admissions to National Health Service (NHS) hospitals in England. OPCS codes were used to determine the annual number of prostatectomy, partial nephrectomy, and total abdominal hysterectomy procedures. Concurrent OPCS codes were then used to identify whether these procedures were robotic, conventional laparoscopic or open surgery.
RESULTS
The proportion of robotic cases varied depending on the surgical procedure. Diffusion of robotic surgery was relatively rapid in prostatectomy, moderate in partial nephrectomy, and slow in total abdominal hysterectomy.
CONCLUSIONS
Although high institutional cost might explain the earliest delays in diffusion, this barrier does not fully account for the different rates of diffusion among surgical procedures.
Topics: Diffusion of Innovation; England; Female; Humans; Hysterectomy; Male; National Health Programs; Nephrectomy; Prostatectomy; Regression Analysis; Retrospective Studies; Robotic Surgical Procedures; Robotics; Time Factors
PubMed: 29105982
DOI: 10.1002/rcs.1870