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Journal of Cancer Research and Clinical... May 2024Ewing's sarcoma (ES) is an aggressive cancer of bone and soft tissue, most of which tend to occur in the bone. Extraosseous Ewing's sarcoma (EES) of the cervix is... (Review)
Review
BACKGROUND
Ewing's sarcoma (ES) is an aggressive cancer of bone and soft tissue, most of which tend to occur in the bone. Extraosseous Ewing's sarcoma (EES) of the cervix is extremely rare.
CASE PRESENTATION
In the present work, we reported a 39-year-old cervical EES patient with a 2.5*2.1*1.8 cm tumor mass. According to previous literatures, our case is the smallest tumor found in primary cervical ES ever. The patient initially came to our hospital due to vaginal bleeding, and then the gynecological examination found a neoplasm between the cervical canal and partially in the external cervical orifice. The diagnosis of EES was confirmed below: Hematoxylin & Eosin staining (H&E) revealed small round blue malignant cells in biopsy specimens. Immunohistochemistry (IHC) showed the positive staining for CD99, NKX2.2, and FLI1. Disruption of EWSR1 gene was found by fluorescence in situ hybridization (FISH), and the EWSR1-FLI1 gene fusion was determined by next-generation sequencing (NGS). The patient received laparoscopic wide hysterectomy, bilateral adnexectomy, pelvic lymphadenectomy, and postoperative adjuvant chemotherapy and remained disease free with regular follow-up for 1 year.
CONCLUSIONS
Through a systematic review of previously reported cervical ES and this case, we highlighted the importance of FISH and NGS for the accuracy of ESS diagnosis, which could assist on the optimal treatment strategy. However, due to the rarity of the disease, there is no standard treatment schemes. Investigation on molecular pathological diagnosis and standardization of treatment regimens for cervical ES are critical to patients' prognosis.
Topics: Humans; Female; Sarcoma, Ewing; Uterine Cervical Neoplasms; Adult; Oncogene Proteins, Fusion; Homeobox Protein Nkx-2.2; RNA-Binding Protein EWS; In Situ Hybridization, Fluorescence; Transcription Factors; Proto-Oncogene Protein c-fli-1; Nuclear Proteins; Homeodomain Proteins
PubMed: 38769118
DOI: 10.1007/s00432-024-05698-2 -
Journal of Mid-life Health 2024Ovarian serous cystadenofibroma (CAF) is a relatively uncommon variant of benign epithelial tumors of the ovary. It is frequently misdiagnosed as malignant ovarian mass,...
Ovarian serous cystadenofibroma (CAF) is a relatively uncommon variant of benign epithelial tumors of the ovary. It is frequently misdiagnosed as malignant ovarian mass, on both ultrasound (USG) and computed tomography (CT). Although most cases are easily treatable by surgery, some cases can present with life-threatening complications increasing patient morbidity and mortality. The present case report briefs about a 69-year-old female, P4 L4, who presented to the gynecology outpatient department with a complaint of pain in the lower abdomen for 2-3 months. USG and CT were suggestive of a suspicious-looking ovarian mass favoring malignancy. A staging laparotomy with pelvic and para-aortic lymphadenectomy with omental biopsy was done. Although the tumor was benign, extensive surgery, due to the suspicion of malignancy led to the patient developing early postoperative small bowel obstruction, mandating a re-exploration. CAF is a specific type of ovarian tumor that exhibits a combination of benign characteristics. This tumor presents as a partly cystic (containing fluid-filled sacs) and partly solid (composed of fibrous tissue) growth within the ovary, displaying a diverse architectural pattern. Mostly the diagnosis is incidental, on USG done for some other indication. CAF of the ovary needs a very high index of suspicion for diagnosis as these are frequently misdiagnosed as malignant ovarian masses. Although an innocent tumor, extensive surgery done for CAF, under suspicion for malignancy, can sometimes lead to serious complications.
PubMed: 38764931
DOI: 10.4103/jmh.jmh_5_24 -
World Journal of Oncology Jun 2024Lymphadenectomy plays an essential role in the staging protocols for gynecologic cancers, as recommended by International Federation of Gynecology and Obstetrics (FIGO)....
BACKGROUND
Lymphadenectomy plays an essential role in the staging protocols for gynecologic cancers, as recommended by International Federation of Gynecology and Obstetrics (FIGO). While its benefits vary, complications may arise during intra-operative, acute post-operative, or long-term periods. Notably, lymphadenectomy-associated systemic morbidity and specific complications such as lymphocele and lymphedema have been reported.
METHODS
This retrospective study involved 399 patients with cervical, endometrial, and ovarian cancers who underwent pelvic and para-aortic lymphadenectomy. The follow-up period was at least 3 months. Intra-operative complications encompassed adjacent organ injury and significant blood loss, while acute post-operative complications occurred within 29 days. Post-30-day complications included lymphocele and lymphedema. Logistic regression analysis identified predictors for complications.
RESULTS
The overall complication rate was 42.4%, with intra-operative, acute post-operative, and long-term rates of 26.1%, 11.0%, and 14.0%, respectively. Predictors for overall complications included laparotomy, positive lymph nodes, and operative time > 240 min. For intra-operative complications, age > 60 years, laparotomy, positive lymph nodes, and operative time > 240 min were significant predictors. Symptomatic lymphocele and lymphedema occurred in 6.0% and 2.0% of patients, respectively, mainly in the long-term period.
CONCLUSION
Although the overall complication rate after gynecologic surgery was found to be almost half of all cases, the rate of severe complications was low. Additionally, the rates of symptomatic lymphocele and lymphedema were low. Lymphadenectomy in gynecologic cancer surgery can be performed safely.
PubMed: 38751693
DOI: 10.14740/wjon1824 -
Journal of Gynecologic Oncology May 2024To identify a relatively high-risk population in postoperative intermediate-risk cervical cancer and evaluate the effect of platinum-based adjuvant chemotherapy (CT).
OBJECTIVE
To identify a relatively high-risk population in postoperative intermediate-risk cervical cancer and evaluate the effect of platinum-based adjuvant chemotherapy (CT).
METHODS
We retrospectively reviewed the medical records of patients with stage IA2-IIA cervical cancer who had been treated with radical hysterectomy and pelvic lymphadenectomy and classified as the intermediate-risk group for recurrence by postoperative pathological examination from January 2007 to December 2018 at 3 medical centers in Japan. First, patients with intermediate-risk were stratified by histological type and the number of intermediate-risk factors (IRF; large tumor diameter, lymph vascular space invasion, and deep cervical stromal invasion) and then divided into 2 groups: high and low-risk population (estimated 5-year recurrence-free survival [RFS] rate with no further therapy [NFT] <90% and ≥90%, respectively). Second, the efficacy of CT for the high-risk population was evaluated by comparing RFS and overall survival (OS) between the patients receiving CT and those with NFT.
RESULTS
In total, 133 patients were included in the analysis. Among patients with squamous cell carcinoma (SCC) with all IRF or those with non-SCC with 2 to 3 IRF, the 5-year estimated RFS was <90% when treated with NFT. In this population, adjuvant CT was significantly superior to NFT regarding RFS (log-rank, p=0.014), although there was no statistical difference in OS.
CONCLUSION
Patients with SCC with all 3 IRFs and those with non-SCC with 2 to 3 IRFs were at high risk for recurrence. Adjuvant CT is a valid treatment option for these populations.
PubMed: 38725235
DOI: 10.3802/jgo.2025.36.e2 -
Radiology Case Reports Jul 2024Renal cell carcinoma (RCC) is an extremely rare cancer in pediatric, accounting for 0.1% to 0.3% of all pediatric malignancies. Due to its low incidence in this age...
Renal cell carcinoma (RCC) is an extremely rare cancer in pediatric, accounting for 0.1% to 0.3% of all pediatric malignancies. Due to its low incidence in this age group, literature on pediatric RCC is limited. We present a case of localized RCC in pediatric patient treated with nephroureterectomy and lymphadenectomy. A 14-year-old girl with a 2-year history of red urine, blood clots, and left flank pain underwent physical examination, revealing left flank tenderness. Laboratory results showed anemia, leukocytosis, elevated LDH, and erythrocytes in urine. Imaging revealed a hyperechoic area in the left kidney's lower pole (4.0 × 2.8 cm). Contrast abdominal CT scan indicated a solid mass (5.4 × 3.8 × 3.2 cm) in left renal pelvis extending to the minor calyx and severe hydronephrosis. The patient was diagnosed with suspected cT3N0M0 left upper tract urothelial carcinoma and underwent cystoscopy, bladder cuff excision, and left radical nephroureterectomy with paraaortic lymph node dissection. Pathological analysis revealed clear cell type renal cell carcinoma, WHO ISUP grade IV, extending to the perirenal fat, with tumor-free ureteral resection margins, and no paraaortic lymph node metastasis. Follow-up on postoperative period showed a satisfactory outcome. In cases of pediatric localized RCC, surgical therapy, including radical nephrectomy or nephron-sparing surgery (NSS), can be a preferred treatment for small tumor volumes. This approach preserves kidney function and is generally considered safe for achieving tumor-free margins.
PubMed: 38721391
DOI: 10.1016/j.radcr.2024.03.022 -
Urology Journal Jun 2024One of the most common cancers of the urinary tract is bladder tumors. Bladder cancers are divided into two groups: non-muscle-invasive bladder cancer (NMIBC) and... (Comparative Study)
Comparative Study
One of the most common cancers of the urinary tract is bladder tumors. Bladder cancers are divided into two groups: non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer. (1) Trans-Peritoneal Radical Cystectomy (RC) with pelvic lymphadenectomy is the standard technique in muscle invasive and high risk non-muscle invasive bladder cancer (2). and Urologist around the world are more familiar with trans-peritoneal technique. In some articles extra-peritoneal Radical Cystectomy (RC) implied as an decreased postoperative complications techniques. In this letter we want to compare these two techniques and find out the pros and cons of these techniques.
Topics: Cystectomy; Humans; Urinary Bladder Neoplasms; Lymph Node Excision; Postoperative Complications; Peritoneum; Neoplasm Invasiveness
PubMed: 38716611
DOI: 10.22037/uj.v20i.8140 -
Archivos Espanoles de Urologia Apr 2024Bladder cancer (BC) is the most common malignant tumour of the urinary system, and radical cystectomy combined with pelvic lymph node dissection (LND) is the standard... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Bladder cancer (BC) is the most common malignant tumour of the urinary system, and radical cystectomy combined with pelvic lymph node dissection (LND) is the standard treatment for BC. We conducted this meta-analysis to explore the efficacy and safety of extended lymph node dissection in radical cystectomy for BC.
METHODS
PubMed, Embase, ProQuest PsycINFO, CINAHL, Web of Science and The Cochrane Library databases were searched for studies on extended lymph node dissection during radical BC surgery. The search time limit was from the establishment of the database to December 2023. Screening and quality assessment of literature were conducted. This meta-analysis was conducted to evaluate the influence of different lymph node dissection methods on recurrence-free survival (RFS), overall survival (OS), operation time, 90-day readmission rate and postoperative complication rate.
RESULTS
A total of 15 studies were included, including 4854 patients. All studies were of high quality. This meta-analysis showed no statistically significant difference in the operation time, postoperative complications and 90-day hospitalisation rate between the two groups of patients. The harvested volume of lymph nodes, RFS and OS rate were not statistically different.
CONCLUSIONS
Among patients with BC undergoing radical cystectomy, extended lymph node dissection did not have a significant effect on operative time, 90-day readmission rates or postoperative complication rates. Thus, extended lymph node dissection is a safe treatment that does not increase the patient's surgical risk.
Topics: Humans; Lymph Node Excision; Urinary Bladder Neoplasms; Cystectomy; Treatment Outcome; Postoperative Complications
PubMed: 38715172
DOI: 10.56434/j.arch.esp.urol.20247703.40 -
Cancer Treatment and Research... 2024To evaluate the effectiveness of methylene blue dye in detecting sentinel lymph nodes (SLNs) in women with early-stage operable (defined as FIGO I-IIA) cervical cancer....
OBJECTIVE
To evaluate the effectiveness of methylene blue dye in detecting sentinel lymph nodes (SLNs) in women with early-stage operable (defined as FIGO I-IIA) cervical cancer. It also aims to evaluate procedural challenges and accuracy.
METHOD
This prospective study, which focused on 20 women with early-stage cervical cancer, was carried out between June 2016 and December 2017. These patients had SLN mapping with methylene blue dye injections and thorough examinations, including imaging. All patients underwent radical hysterectomy and complete bilateral pelvic lymphadenectomy. No additional investigation was done on the lymph node in cases where a metastasis was found in the first H&E-stained segment of the sentinel node.
RESULT
20 patients were included in the analysis. The median age of the subjects was 53, and 95 % of them had squamous cell carcinoma. 90 % of the time, the identification of SLNs was effective, and 55 SLNs were found, of which 52.7 % were on the right side of the pelvis and 47.3 % on the left. The obturator group had the most nodes, followed by the external and internal iliac groups in descending order of occurrence. Metastasis was detected in 3 patients, resulting in a sensitivity of 100 % and a specificity of 93.75 % for SLN biopsy. Notably, no false-negative SLNs were found. Complications related to methylene blue usage included urine discoloration in 30 % of patients.
CONCLUSION
This trial highlights the promising efficacy and safety of methylene blue dye alone for SLN identification in early-stage operable cervical cancer, with a notably higher success rate. Despite limitations like a small sample size, healthcare professionals and researchers can build upon the insights from this study to enhance cervical cancer management.
Topics: Humans; Female; Uterine Cervical Neoplasms; Sentinel Lymph Node Biopsy; Methylene Blue; Prospective Studies; Middle Aged; Lymph Node Excision; Adult; Neoplasm Staging; Pelvis; Aged; Hysterectomy; Lymphatic Metastasis; Carcinoma, Squamous Cell; Sentinel Lymph Node; Coloring Agents
PubMed: 38714022
DOI: 10.1016/j.ctarc.2024.100816 -
Journal of the Anus, Rectum and Colon 2024A total mesenteric excision (TME) with lateral pelvic lymph node dissection (LLND) is the standard treatment for advanced low rectal cancer in Japan. Recently,...
OBJECTIVES
A total mesenteric excision (TME) with lateral pelvic lymph node dissection (LLND) is the standard treatment for advanced low rectal cancer in Japan. Recently, neoadjuvant (chemo)radiotherapy (n(C)RT) has been used with LLND to improve outcomes at multiple Japanese institutes. This study evaluates the benefits of adding nCRT to TME with LLND.
METHODS
Seventy-two consecutive patients who underwent TME and LLND with or without nCRT between 2006-2019 to treat advanced low rectal cancer were retrospectively reviewed. The clinicopathological data were compared and the risk factors for local recurrence were evaluated.
RESULTS
Fifty-seven patients (79.1%) underwent TME and LLND with nCRT, and 15 patients (20.9%) without nCRT. There was no significant difference in the clinicopathological characteristics except the clinical T stage. The occurrence of postoperative complications was statistically insignificant. The 5-year local recurrence rate of patients with nCRT was significantly lower than those without (4.0% versus 26.6%, in all patients, =0.002). Multivariate analysis revealed that the absence of nCRT was an independent risk factor for local recurrences in patients who underwent TME with LLND (hazard ratio: 6.04, =0.04).
CONCLUSIONS
The administration of nCRT prevented local recurrences more effectively in patients with advanced low rectal cancer who underwent TME with LLND.
PubMed: 38689781
DOI: 10.23922/jarc.2023-038 -
World Journal of Clinical Oncology Apr 2024In this editorial, we proceed to comment on the article by Chua , addressing the management of metastatic lateral pelvic lymph nodes (mLLN) in stage II/III rectal cancer...
In this editorial, we proceed to comment on the article by Chua , addressing the management of metastatic lateral pelvic lymph nodes (mLLN) in stage II/III rectal cancer patients below the peritoneal reflection. The treatment of this nodal area sparks significant controversy due to the strategic differences followed by Eastern and Western physicians, albeit with a higher degree of convergence in recent years. The dissection of lateral pelvic lymph nodes without neoadjuvant therapy is a standard practice in Eastern countries. In contrast, in the West, preference leans towards opting for neoadjuvant therapy with chemoradiotherapy or radiotherapy, that would cover the treatment of this area without the need to add the dissection of these nodes to the total mesorectal excision. In the presence of high-risk nodal characteristics for mLLN related to radiological imaging and lack of response to neoadjuvant therapy, the risk of lateral local recurrence increases, suggesting the appropriate selection of strategies to reduce the risk of recurrence in each patient profile. Despite the heterogeneous and retrospective nature of studies addressing this area, an international consensus is necessary to approach this clinical scenario uniformly.
PubMed: 38689627
DOI: 10.5306/wjco.v15.i4.472