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Research Interests: Medicine, Probability, Prospective studies, Humans, Female, and 15 moreAbdominal Muscles, Body Mass Index, Blood Vessels, Sensitivity and Specificity, Reference Values, Equipment Design, Laparoscopy, Abdomen, Laparotomy, Veress Needle, Equipment safety, Intraoperative complications, Paediatrics and reproductive medicine, Cannula, and Abdominal wall
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Background: Squamous cell carcinoma of the vulva is a rare malignancy that affects elderly women. About one-third of vulvar cancers are diagnosed in an advanced stage, requiring extensive surgery. Neoadjuvant chemotherapy (NACT) has been... more
Background: Squamous cell carcinoma of the vulva is a rare malignancy that affects elderly women. About one-third of vulvar cancers are diagnosed in an advanced stage, requiring extensive surgery. Neoadjuvant chemotherapy (NACT) has been introduced to reduce local tumor burden. In this retrospective study, we analyze the efficacy and toxicity of NACT followed by radical surgery. Methods: Patients with locally advanced vulvar cancer (LAVC) treated at our institution with neoadjuvant platinum and paclitaxel-based chemotherapy ± ifosfamide followed by surgery at our institution were retrospectively identified. Results: Fourteen patients (93%) completed NACT with tolerable toxicities (G3–G4 toxicity: 30%). Thirteen patients (87%) underwent surgery. The overall clinical response rate on vulvar disease was 66% (20% complete response, 46% partial response), confirmed by histopathologic analysis, while on inguinal lymph nodes it was 69% (23% complete response, 46% partial response). At the pathologic examination, all patients had negative surgical margins. Three out of 9 patients (33%) with lesions infiltrating the urethral meatus and 4 patients out of 7 (57%) with anal involvement did not require urethral amputation or colostomy, respectively, after NACT. No severe postoperative complications were described. Overall survival at 5 years was 60%, and median overall survival was 76 months. Conclusion: NACT followed by surgery in locally advanced vulvar cancer is well tolerated and allows surgical modulation.
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Primary vaginal cancer is a rare condition, accounting for about 1–2% of gynecologic malignancies. Few cases about the concurrence of a vaginal tumor with irreducible uterine prolapse are reported in literature and there is no consensus... more
Primary vaginal cancer is a rare condition, accounting for about 1–2% of gynecologic malignancies. Few cases about the concurrence of a vaginal tumor with irreducible uterine prolapse are reported in literature and there is no consensus on optimal treatment [1]. The surgical option—when feasible—has the potential to treat malignancy, restore the anatomy and improve bladder/kidneys function. Moreover, native tissue non-obliterative procedures allow both proper reconstruction when a large portion of vagina is excised and adjuvant brachytherapy when necessary. The featured case is a 73-year-old woman who was referred to our Urogynecologic Unit for vaginal bulging, impaired bladder voiding, enuretic urinary incontinence and vaginal bleeding. The gynecological evaluation demonstrated a stage IV prolapse and a concomitant velvet warty/ polypoid lesion on the left anterior vaginal wall suspected for vaginal tumor (Fig. 1). Ultrasonography showed positive post-void residuals and severe bilateral hydronephrosis and CT-scan confirmed severe bilateral uretero-hydronephrosis. Biopsy of the mass revealed an HPV-related in situ squamous carcinoma. Tumor markers were negative. Bilateral ureteral stents were preoperatively positioned to manage hydronephrosis and prevent iatrogenic ureteral injuries. Initial evaluation and treatment planning involved multidisciplinary counselling with gynecologic oncologists.
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Research Interests: Medicine, Probability, Prospective studies, Humans, Female, and 15 moreAbdominal Muscles, Body Mass Index, Blood Vessels, Sensitivity and Specificity, Reference Values, Equipment Design, Laparoscopy, Abdomen, Laparotomy, Veress Needle, Equipment safety, Intraoperative complications, Paediatrics and reproductive medicine, Cannula, and Abdominal wall
Research Interests: Oncology, Medicine, Humans, Gynecologic Oncology, Female, and 15 moreCisplatin, Aged, Middle Aged, Adult, Retrospective Studies, Prognosis, Uterus, Carcinosarcoma, Adjuvant Chemotherapy, Pathological, Combined Modality Therapy, Disease Free Survival, Neoplasm staging, Neoplasm metastasis, and Paediatrics and reproductive medicine
The objective of this retrospective multicenter study was to assess the rates, times, and sites of recurrences of 126 patients with uterine leiomyosarcomas. Surgery was the initial therapy for all patients. Median follow-up of survivors... more
The objective of this retrospective multicenter study was to assess the rates, times, and sites of recurrences of 126 patients with uterine leiomyosarcomas. Surgery was the initial therapy for all patients. Median follow-up of survivors was 50 months (range, 3-168 months). Of the 90 patients with stage I-II disease, 26 received postoperative irradiation and/or chemotherapy. Thirty-five (38.9%) patients developed recurrent disease after a median time of 16 months (range, 2-102 months). Recurrence was pelvic in 5 (14.3%) patients, distant in 23 (65.7%), and pelvic plus distant in 7 (20.0%). The overall recurrence rate was similar in patients who received adjuvant treatment and in those who did not. None of the 15 patients who underwent pelvic irradiation developed local recurrences, but 5 of them failed in distant sites. Of the 16 patients with stage III leiomyosarcomas, 2 died of intercurrent disease within 1 month from surgery and 11 received postoperative irradiation and/or chemotherapy. Thirteen patients developed recurrent tumor after a median time of 8 months (range, 1-21 months). Recurrence was pelvic in 3, distant in 4, and pelvic plus distant in 6 patients. Of the 20 patients with stage IV leiomyosarcomas, after surgery 6 were clinically free of disease (group A) and 14 had clinically evaluable residual disease (group B). With regard to group A, 3 patients received postoperative irradiation and/or chemotherapy. Five patients developed recurrent disease after a median time of 11 months (range, 8-16 months). Recurrence was distant in 3 patients and pelvic plus distant in 2. With regard to group B, 11 patients underwent postoperative chemotherapy. Eleven patients died after a median time of 6 months (range, 1-15 months), and 3 are still alive with clinical evidence of disease after 4, 5, and 8 months, respectively, from surgery. Cox model showed that stage (P = 0.0001), mitotic count (P = 0.0002), and age (P = 0.0048) were independent prognostic variables for disease-free survival. In conclusion, uterine leiomyosarcomas have an aggressive clinical behavior, with a propensity to recur both locally and moreover at distant sites. Tumor stage is the strongest prognostic variable. Only patients with early-stage disease have a chance of surviving, whereas the treatment of patients with advanced or recurrent disease is palliative.
Research Interests: Surgery, Chemotherapy, Medicine, Humans, Gynecologic Oncology, and 15 moreFemale, Follow-up studies, Aged, Middle Aged, Adult, Retrospective Studies, Leiomyosarcoma, Proportional Hazards Models, Gynecologic, Clinical evaluation, Local Recurrence, Disease Free Survival, Neoplasm staging, Treatment Failure, and Paediatrics and reproductive medicine
ABSTRACT Villoglandularpapillary adenocarcinoma (VPA) of the cervix is often indolent, and surgical treatment has a favorable outlook. Risk factors include depth of invasion, lymphovascular invasion, and the presence of other histologic... more
ABSTRACT Villoglandularpapillary adenocarcinoma (VPA) of the cervix is often indolent, and surgical treatment has a favorable outlook. Risk factors include depth of invasion, lymphovascular invasion, and the presence of other histologic types of cancer. An amputation of the cervical portio was required to satisfactorily resect a 2.5-cm ectocervical lesion in a 28-year-old nulligravida. A diagnosis of pure VPA with a depth of invasion less than 2 mm was established. During a subsequent pregnancy, second trimester ultrasound showed extreme effacement of her cervix and an abdominal cerclage was placed. The pregnancy continued until delivery of a healthy infant at 36 weeks. In cases of tumor invasion less than 3 mm, and in the absence of lymphovascular space involvement, extrauterine spread of pure VPA has not been described. When conservative treatment is planned, amputation of the cervical portio may be better suited than conization to the achievement of an adequate margin of resection. Cervical cerclage may be needed to offset the extensive cervical surgery.