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Female Pelvic Medicine & Reconstructive... Apr 2021This study aimed to investigate long-term study outcomes of colpocleisis along with concomitant vaginal hysterectomy for pelvic organ prolapse (POP).
OBJECTIVE
This study aimed to investigate long-term study outcomes of colpocleisis along with concomitant vaginal hysterectomy for pelvic organ prolapse (POP).
METHODS
A retrospective cohort study was conducted in elderly women with advanced POP who underwent total colpocleisis with or without hysterectomy from 2012 to 2017.
RESULTS
A total of 242 elderly women were included in this study, of which 172 underwent total colpocleisis along with concomitant vaginal hysterectomy (CH group) and 70 underwent partial colpocleisis-retained uterus (LeFort group). More than one comorbidity was observed among 154 (85.9%) patients in the CH group and 56 (81.4%) patients in the LeFort group. The difference between 2 groups (CH and LeFort) in mean length of hospital staying, mean day of removing urinary catheter, mean day of farting time after operation, and postoperative complications was not statistically significant. In total colpocleisis along with hysterectomy group, a case (0.6%) of early asymptomatic endometrial cancer was diagnosed unexpectedly by pathology after hysterectomy. Median follow-up was 43.0 (19.0-85.0) months in the CH group and 45.0 (26.0-79.0) months in the LeFort group. Only one patient reported recurrence. Subjective satisfaction rate was 98.8% (CH group) versus 98.6% (LeFort group). Regret rate was 0.58% (CH group) versus 0% (LeFort group). No significant difference was observed between the 2 groups.
CONCLUSIONS
Both colpocleisis along with hysterectomy and partial colpocleisis-retained uterus are safe, with fewer complications and high long-term satisfaction. Colpocleisis along with hysterectomy is more conducive to discovery of early asymptomatic malignant tumors of the uterus, which is a suitable alternative for elderly frail women with severe POP.
Topics: Aged; Aged, 80 and over; Cohort Studies; Colpotomy; Combined Modality Therapy; Emotions; Female; Humans; Hysterectomy, Vaginal; Patient Satisfaction; Pelvic Organ Prolapse; Recurrence; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 32618601
DOI: 10.1097/SPV.0000000000000900 -
BMJ Case Reports Jul 2016Vaginal cancer is a rare malignancy accounting for 1-2% of all pelvic neoplasms. Dissemination usually occurs through local invasion and rarely metastasises to distal...
Vaginal cancer is a rare malignancy accounting for 1-2% of all pelvic neoplasms. Dissemination usually occurs through local invasion and rarely metastasises to distal locations. Metastasis of vaginal cancer to the breast is extremely infrequent and unique. A 66-year-old Asian woman presented with vaginal bleeding and was found to have a vaginal mass and a left breast mass. Pathological assessment of the biopsies revealed identical squamous cell characteristics of both masses. We describe a very rare and novel case of a distally located vaginal carcinoma with metastasis to the breast Federation of Gynecology and Obstetrics (FIGO) stage IV (FIGO IVB). Robot-assisted extrafascial total hysterectomy with local vaginal mass excision and partial mastectomy of the left breast were performed. After surgery, the patient underwent adjuvant chemotherapy followed by breast and pelvic radiotherapy, with maintained complete remission after 3 years of follow-up. This combination of findings and treatment is very distinct with a unique and favourable response.
Topics: Aged; Biopsy; Breast; Breast Neoplasms; Female; Follow-Up Studies; Humans; Treatment Outcome; Vaginal Neoplasms
PubMed: 27444140
DOI: 10.1136/bcr-2016-215895 -
OncoTargets and Therapy 2018To investigate the efficacy and safety of neoadjuvant chemoradiotherapy plus anti-epidermal growth factor receptor monoclonal antibody followed by surgery for locally...
BACKGROUND
To investigate the efficacy and safety of neoadjuvant chemoradiotherapy plus anti-epidermal growth factor receptor monoclonal antibody followed by surgery for locally advanced cervical cancer (LACC).
PATIENTS AND METHODS
Patients with histologically proven LACC were enrolled into this prospective study. All patients received intensity-modulated radiation therapy with conventional fractionation. Weekly cisplatin or nedaplatin was administered concurrently with intensity-modulated radiation therapy. Nimotuzumab, a humanized anti-epidermal growth factor receptor monoclonal antibody, was given at a dose of 200 mg per week for 6 cycles. Approximately 1 month after the completion of neoadjuvant treatment, the patients were assessed for clinical tumor response and operability based on MRI and gynecological examination. For those who were considered to be candidates for surgery, radical hysterectomy, and pelvic lymph node dissection were performed 5-6 weeks after the completion of neoadjuvant therapy.
RESULTS
Twenty-eight patients were enrolled. Clinical complete response and partial response were found in 8 (28.5%) and 20 (71.5%) patients, respectively. Four patients were not eligible for surgery and 2 patients refused surgery although they were assessed as surgical candidates. They were not included in this analysis. Radical hysterectomy and pelvic lymph node dissection were performed for the remaining 22 patients. Among them, 8 (36.4%) had complete pathology response, 9 (40.9%) presented with persistent atypical cells or cervical intraepithelial neoplasia, and 5 (22.7%) presented with macroscopic and/or microscopic residual disease, according to the pathological evaluation. Median follow-up time was 22 months (range, 5-39 months). The 2-year locoregional control rate, progression-free survival rate, distant metastasis-free survival rate, and overall survival rate were 95.0%, 85.2%, 84.0%, and 90.0%, respectively. Acute toxicities were mild in general and easily manageable. Chronic toxicities were mainly limited to grade 1. No severe late toxicities were observed.
CONCLUSION
Concurrent chemoradiotherapy plus nimotuzumab followed by surgery is highly effective and safe in LACC. Further studies are warranted to confirm the findings.
PubMed: 29997439
DOI: 10.2147/OTT.S164071 -
International Journal of Radiation... Mar 2010An in-depth overview of the normal-tissue radiation tolerance of the urinary bladder is presented. The most informative studies consider whole-organ irradiation. The... (Meta-Analysis)
Meta-Analysis Review
An in-depth overview of the normal-tissue radiation tolerance of the urinary bladder is presented. The most informative studies consider whole-organ irradiation. The data on partial-organ/nonuniform irradiation are suspect because the bladder motion is not accounted for, and many studies lack long enough follow-up data. Future studies are needed.
Topics: Female; Forecasting; Humans; Hysterectomy; Male; Models, Biological; Movement; Prostatectomy; Prostatic Neoplasms; Radiation Injuries; Radiation Tolerance; Radiography; Radiotherapy Dosage; Urinary Bladder; Urinary Bladder Neoplasms; Uterine Cervical Neoplasms
PubMed: 20171505
DOI: 10.1016/j.ijrobp.2009.02.090 -
Laeknabladid Dec 2023We report a case of a 79-year-old woman with a previous history of polycythemia vera, glaucoma and hypertension. Her previous surgeries included a cholecystectomy with...
We report a case of a 79-year-old woman with a previous history of polycythemia vera, glaucoma and hypertension. Her previous surgeries included a cholecystectomy with an incidental finding of a gallbladder carcinoma with following partial liver resection and a hysterectomy. The surgery department was consulted regarding this patient due to abdominal pain in her lower abdomen and tumor in her right groin. A CT scan of the abdomen was obtained that showed a hernia with the appendix vermiformis in the hernia sac. She was operated with a preperitoneal open approach and an inflamed appendix from a femoral hernia sac was removed and a herniorrhaphy with a mesh was performed. The patient was discharged the day after the surgery. Femoral hernia with the appendix in the hernia sac is a rare type of hernia first descriped by Rene-Jacques De Garengeot in 1731 and now bearing his name.
Topics: Female; Humans; Aged; Appendectomy; Hernia, Femoral; Appendix; Herniorrhaphy; Tomography, X-Ray Computed
PubMed: 38031981
DOI: 10.17992/lbl.2023.12.772 -
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 -
World Journal of Clinical Cases Jul 2023Angiosarcoma (AS) is a rare and highly aggressive soft tissue disease that most commonly arises in deep soft tissues. There are only a few reported cases of AS involving...
BACKGROUND
Angiosarcoma (AS) is a rare and highly aggressive soft tissue disease that most commonly arises in deep soft tissues. There are only a few reported cases of AS involving the ovary and even fewer reports of the underlying molecular abnormalities. Here, we briefly review two cases of primary ovarian AS (oAS) with specific molecular events and immune checkpoints. The clinical features and prognosis of the disease, diagnosis, differential diagnosis, and new treatment approaches are discussed based on a literature review.
CASE SUMMARY
Case 1: A 51-year-old female patient was admitted with right lower limb pain for 5 mo, and lower abdominal pain with hematuria for 1 mo. Partial removal of rectus abdominis muscle and fascia, partial hysterectomy, bilateral salpingo-oophorectomy, and inguinal and pelvic lymphadenectomy were performed. Pathology revealed primary oAS. Fluorescence hybridization revealed gene amplification. MESNA + ADM + IFO + DTIC (MAID) regimen was administered, but stable disease was achieved. The patient died 1 mo later. Case 2: A 41-year-old female patient presented with fatigue, nausea, decreased appetite, and diffuse abdominal pain. On physical examination, the abdomen was distended and a complex cystic mass was palpable in the right pelvic cavity. Pathology revealed primary oAS. MAID chemotherapy was administered and programmed death ligand 1 (PD-L1) staining was performed on the tumor samples. The patient benefited from anti-PD-1 immunotherapy and is alive without any evidence of disease 27 mo off therapy in follow-up.
CONCLUSION
Long-term survival benefit for primary oAS can be achieved by alternative therapeutic strategies using pathological indicators to inform treatment.
PubMed: 37583851
DOI: 10.12998/wjcc.v11.i21.5122 -
Taiwanese Journal of Obstetrics &... Sep 2022To present a rare case of xanthogranulomatous inflammation (XI) mimicking a uterine sarcoma and invading the ureter and colon. (Review)
Review
Xanthogranulomatous inflammation caused by K. pneumonia and nocardiosis mimicking a uterine tumor and invading the ureter and colon: A case report and review of the literature.
OBJECTIVE
To present a rare case of xanthogranulomatous inflammation (XI) mimicking a uterine sarcoma and invading the ureter and colon.
CASE REPORT
A 66-year-old woman presented with lower abdominal pain. Pelvic examination showed tenderness over the lower abdominal region without cervical discharge. Per-rectal examination showed a hard tumor on the posterior uterine wall, while ultrasonography showed a tumor-like mass extending from the posterior uterine wall to the rectum. Magnetic resonance imaging showed signs of endometrial cancer invading the rectum. However, the tumor markers carbohydrate antigen (CA) 125, CA199, and carcinoembryonic antigen were in the normal range. Cystoscopy, panendoscopy, and colonoscopy showed no significant findings. On performing exploratory laparotomy, we observed pus and severe adhesion on the posterior uterine wall and rectum. Hysterectomy, bilateral adnexectomy, colectomy, and partial left ureter resection were performed. The final pathology showed XI. The pus culture revealed Klebsiella pneumonia and PCR revealed nocardiosis. The patient received 2 weeks of antibiotic treatment and was discharged thereafter.
CONCLUSION
XI in elderly women is rare, and hence, differential diagnoses should be carefully considered.
Topics: Aged; Colon; Female; Humans; Inflammation; Nocardia Infections; Pneumonia; Suppuration; Ureter; Uterine Neoplasms
PubMed: 36088063
DOI: 10.1016/j.tjog.2021.12.006 -
BMC Surgery May 2022Transvaginal intestinal evisceration is an extremely rare surgical emergency with potentially fatal consequences. Only a few more than 100 cases with this pathology have...
BACKGROUND
Transvaginal intestinal evisceration is an extremely rare surgical emergency with potentially fatal consequences. Only a few more than 100 cases with this pathology have been described in the literature. Aetiology is also unclear and multifactoral.
CASE PRESENTATION
We report the case of an 80-year-old female who presented with sudden severe abdominal pain and spontaneous small bowel evisceration through the vagina along with associated high-grade uterine prolapse. The loops and their mesentery appeared edematous, thickened and dusky, but without apparent necrosis. An urgent laparotomy was performed with subsequent reduction of the prolapsed small bowel into the abdomen, hysterectomy, partial resection of the vagina and vaginal closure. Additional cholecystectomy was necessary because of the visible pathologic changes of the gallbladder. The postoperative period was uneventful. The unique feature of our case is that there was no trigger factor (trauma, constipation or a coughing episode that would increase the intra-abdominal pressure), provoking the vaginal rupture and intestinal evisceration through it in the context of pelvic floor weakness.
CONCLUSIONS
Early detection and surgical management are crucial for preventing bowel ischemia and abdominal sepsis. If the eviscerated intestine is ischaemic and non-viable, this requires resection and anastomosis. The approach should be individualized and performed by a multidisciplinary team.
Topics: Abdominal Pain; Aged, 80 and over; Female; Humans; Hysterectomy; Intestine, Small; Laparotomy; Uterine Prolapse; Vagina
PubMed: 35509095
DOI: 10.1186/s12893-022-01615-x -
Surgical Case Reports Dec 2016Endometriosis generally occurs in the ovary. Intestinal endometriosis is rare. About 1 % of all endometriosis cases become malignant. Malignant transformation of small...
Endometriosis generally occurs in the ovary. Intestinal endometriosis is rare. About 1 % of all endometriosis cases become malignant. Malignant transformation of small intestinal endometriosis is very rare. A 55-year-old woman who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy and omentectomy for endometriosis 7 years ago presented to her primary care doctor with melena. A tumor was detected in the right lower abdomen by ultrasonography. The doctor referred her to our hospital. Computed tomography demonstrated a lobulated tumor ventral to the right common iliac vessels. Magnetic resonance imaging demonstrated that the tumor had heterogeneous intensity on T2-weighted images. Several small cysts with high intensity were observed caudal to the tumor on T2-weighted images. We performed partial small intestinal resection for the lesion. The tumor was diagnosed as endometrioid adenocarcinoma of the small intestine. She has been relapse-free for 5 years after surgery. Only three cases of malignant transformation of small intestinal endometriosis have been reported previously. It is very rare for long-term survival to be obtained with surgery alone, as in our case. This case report highlights the imaging findings for malignant transformation of intestinal endometriosis.
PubMed: 27624553
DOI: 10.1186/s40792-016-0226-6