Prevalence of vulvar intraepithelial neoplasia: Experience in a tertiary Government Hospital / Philippine Journal of Obstetrics and Gynecology

@#Vulvar intraepithelial neoplasia (VIN) is a precancerous lesion involving the squamous epithelium of the vulva. This retrospective descriptive study aims to determine the prevalence of VIN in a tertiary government hospital in a developing country. Medical records of outpatient consultations with the diagnosis of VIN from January 2000 to June 2012 were reviewed. The prevalence of VIN was 1.6/100,000 women over the 12 years. The diagnosis was based on biopsy results of an incidental finding of vulvar lesions on physical examination. The profile of a patient with VIN was a woman aged 40 years old and above, married, multigravid, nonsmoker, high school graduate, and unemployed. Vulvar lesions noted were multiple hyperpigmented papules located at the posterior labia majora. VIN was associated with abnormal colposcopy findings, and 40% were associated with concomitant cervical disease. Treatment was wide local excision. Prompt diagnosis and appropriate treatment of VIN aim to prevent its progression to vulvar carcinoma. Although vulvar carcinoma is a rare condition, there has been a notable rise in prevalence in recent years. Hence, gynecologists should be vigilant and have a high index of suspicion to detect the disease early in its course.

Early experience of gynecologic robotic surgery in a tertiary government hospital / Philippine Journal of Obstetrics and Gynecology

Background@#Robotic surgery is a form of minimally invasive surgery wherein the surgeon controls the camera and instruments in a console, remote from the operating room table. Currently, the system in place is the da Vinci Surgical System which was approved by the United States Food and Drug Administration in 2000 for laparoscopic surgery. Since its approval in 2005 for Gynecologic procedures, the da Vinci Surgical System has been used for hysterectomies, lymph node dissections, sacrocolpopexies, myomectomies, and cerclage.@*Objective@#This paper presents the initial seven cases of benign gynecologic diseases operated on utilizing the da Vinci Surgical System in our institution – six hysterectomies and one myomectomy.@*Methodology@#Seven gynecologic surgeries that utilized the da Vinci Surgical System in 2019 until the first quarter of the year 2020 were done. Medical records of the seven patients were reviewed.@*Results@#The average docking time was 38 minutes (range: 25 – 65 minutes) and the average console time was 227 minutes (range: 175 – 345 minutes). The average blood loss was 576 cc (range: 80 – 1200 cc). No cases converted to an abdominal laparotomy and no morbidities were reported. While two cases underwent blood transfusion intraoperatively, all cases were stable post-operatively and were for discharge after two days. On follow-up, all patients were stable with an unremarkable clinical course.@*Conclusion@#Our initial experience demonstrates that robotic surgery appears as a viable alternative to traditional approaches. As more cases are to be done in the future, fine-tuning of the logistical set-up and surgical skills are expected, as well as venturing into other gynecologic diseases such as malignancies. Further research must be conducted on various aspects of robotic surgery, such as but not limited to outcome comparison with traditional and other laparoscopic approaches, long term outcomes, patient safety, and patient experience and preference, among others.

A systematic approach to stillbirth examinationin a tertiary hospital

Background@#Stillbirth has a complex pathophysiology, hence the difficulty in arriving at a specific cause.@*Objectives@#The study aimed to identify the probable causes of stillbirth in a tertiary hospital based on gross examination of the placenta and the fetus, as well as, to identify the demographic profile of the stillbirths.

A systematic approach to stillbirth examination in a tertiary hospital

BACKGROUND: Stillbirth has a complex pathophysiology, hence the difficulty in arriving at a specific cause.OBJECTIVES: The study aimed to identify the probable causes of stillbirth in a tertiary hospital based on gross examination of the placenta and the fetus, as well as, to identify the demographic profile of the stillbirths.METHODS: A cross-sectional descriptive study was conducted among 29 stillbirths delivered in a tertiary hospital from March 2016 to September 2016. The probable causes of stillbirth were categorized as obstetrics complications, placental abnormalities, umbilical cord abnormalities, fetal malformations, infections, hypertensive disorders, medical complications, and undetermined causes.RESULTS: 86% of stillbirths in this study had a probable cause of death. Umbilical and placental abnormalities were the most probable causes (62% and 41%, respectively). The two most common identified cord abnormalities were short cord length (34%) and marginal insertion (23%), while small placenta (27%) was the most common for placental abnormalities.CONCLUSION: To be able to come up with the probable cause of stillbirth, the delivering physician or health personnel should always account the gross findings of the fetus and placenta after delivery.

The accuracy of frozen section of uterine lesions in the practice of gynecologic surgery. A retrospective assessment study in a government tertiary training hospital / Philippine Journal of Obstetrics and Gynecology

Objective@#This study aimed to determine the accuracy, sensitivity and specificity of frozen section (FS) in the diagnosis of uterine neoplasm in a tertiary government training hospital.@*Methodology@#This is a retrospective validation study from 2004-2015 involving cases of uterine lesions from gynecologic surgeries. All histopathologic results of frozen and paraffin sections were retrieved and reviewed. Chi square test with 2x2 Fischer Exact test adjustment was used to check for associations. Accuracy indices of FS tool were estimated such as sensitivity, specificity, likelihood ratios, negative and positive predictive values, and overall accuracy. A p-value of < 0.05 alpha is considered significant.@*Results@#A total of 143 uterine specimens were submitted for frozen section analysis. The utilization rate of FS is 1% per year. The FS results were correlated with the final histopathologic diagnosis with 96% agreement rate. Utilizing a median number of 3 sections per specimen provides an overall accuracy rate of 97%. The accuracy rate of FS is equal between combined benign-premalignant and malignant cases at 96%. The accuracy rate is not statistically affected by the procedure by which the specimen was taken, as well as the source and gross morphology of the specimen. Moreover, a minimum of 11 sections per specimen is needed to obtain an accuracy rate of 99-100%. The accuracy rate particularly for endometrial lesions is between 94 and 100%.@*Conclusion@#Accuracy rates of frozen section on uterine lesions are high regardless of the sampling procedure and source of the specimen. Increasing the number of sections during FS parallels that of the final histopathologic diagnosis. FS for uterine lesions is a vital and cost-effective intraoperative decision tool to maximize care of patients.

Collision tumors of the cervix - A case series: Its clinical significance in the management of an early stage disease

@#<p>Majority of cervical cancer are squamous cell carcinoma and adenocarcinoma. The co-existence of two histologic types is rare. This article presents three cases of collision tumors of the cervix within a 10-year review. All underwent radical hysterectomy for an early stage disease. Likewise, it aims to review clinicopathologic features, management, response to treatment and prognosis of these types of tumor in the light of recent literature.</p>

Epidemiology, prevention and treatment of cervical cancer in the Philippines / 부인종양

Cervical cancer remains to be one of the leading malignancies among Filipino women. High-risk human papillomavirus (HPV) types, such as 16 and 18, are consistently identified in Filipino women with cervical cancer. Factors identified to increase the likelihood of HPV infection and subsequent development of cervical cancer include young age at first intercourse, low socioeconomic status, high parity, smoking, use of oral contraception and risky sexual behaviors. Cancer screening programs presently available in the Philippines include Pap smears, single visit approach utilizing visual inspection with acetic acid followed by cryotherapy, as well as colposcopy. However, the uptake of screening remains low and is further compounded by the lack of basic knowledge women have regarding screening as an opportunity for prevention of cervical cancer. Prophylactic HPV vaccination of both quadrivalent and bivalent vaccines has already been approved in the Philippines and is gaining popularity among the Filipinos. However, there has been no national or government vaccination policy implemented as of yet. The standard of treatment of cervical cancer is radiotherapy concurrent with chemotherapy. Current researches are directed towards improving availability of both preventive and curative measures of cervical cancer management.