ABSTRACT
Introduction@#Cancer patients are more susceptible to coronavirus disease-19 (COVID-19) infection because they are immunosuppressed by their disease or therapy, most of them have coexisting medical conditions, and they frequently visit hospitals for treatment and surveillance. @*Objective@#The objective of this study was to determine the prevalence of COVID-19 infection among gynecologic oncology patients receiving treatment in a COVID-19 referral hospital. @*Materials and Methods@#A descriptive, cross-sectional study involving 47 gynecologic cancer patients receiving treatment from June 2020 to December 2020 was performed. All patients underwent SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) swab test and symptom and exposure assessment before the start of cancer treatment. Patients with negative SARS-CoV-2 RT-PCR swab test results received their planned treatment, and a repeat swab test and triage assessment were done midtreatment and after treatment. @*Results@#Five (10.6%) patients had positive baseline SARS-CoV-2 RT-PCR swab results, but all proceeded with treatment after negative results were obtained. Only 1 (2.13%) patient had a positive SARS-CoV-2 RT-PCR swab test result at midtreatment. All patients had no COVID-19-associated symptoms and none of them tested positive for COVID-19 infection posttreatment. @*Conclusion@#The prevalence of COVID-19 infection among gynecologic cancer patients receiving cancer treatment is 2.13%. All patients who had positive SARS-CoV-2 RT-PCR swab test results at baseline or midtreatment were able to continue and complete treatment. There were no severe clinical events or mortalities among those affected with COVID-19 infection.
Subject(s)
COVID-19ABSTRACT
@#Endometrial cancer is frequently diagnosed at an early stage and exhibits a good prognosis. However, 10%–15% of tumors recur usually within 3 years. Common sites of recurrence are the vaginal vault and pelvis. Only a number of case reports exist for tumor recurrence in a previous incision site. We present a case of a 71‑year‑old Filipino woman, a diagnosed case of Endometrial Adenocarcinoma Stage III A, FIGO Grade 1, who underwent surgical management, chemotherapy, and radiation therapy 9 years prior, presenting with an abdominal mass at the inferior aspect of the previous surgical scar with the foul‑smelling discharge of 1‑year duration. Physical examination revealed a 6 cm × 4 cm, friable, movable, nontender abdominal mass, with associated edema of the mons pubis. Surgical resection showed that the mass was confined to the abdominal wall, with no extension beneath the fascia and no evidence of tumor in the pelvic and abdominal cavity. Histological examination revealed a moderately differentiated adenocarcinoma in the abdominal wall, confirming tumor recurrence in an atypical location, probably arising from the previous incision site.
Subject(s)
Endometrial Neoplasms , RecurrenceABSTRACT
@#Extramammary Paget’s disease (EMPD) of the vulva is a rare vulvar neoplasm but commonly arises during the postmenopausal period. Intraepithelial Paget’s disease may persist for prolonged periods without demonstrating invasion but with high rates of recurrence. Appearance of Paget’s disease in a split-thickness skin graft, is associated with an occurrence outside the grafted area. It demonstrates retrodissemination as the pathologic process hypothesized in the spread of the disease within the skin via lymphatics and vessels creating tissue bridges between sites of involvement. We present a case of an 81-year-old female, the patient came in for complaints of vulvar pruritus beginning at the left inguinal area three years prior to her diagnosis. She consulted with a dermatologist and was initially treated with steroids and emollients. Persistence of symptoms and enlargement of the lesion prompted a vulvar punch biopsy which showed Paget’s disease and referral to the Gynecologic Oncology service. Wide local excision with split-thickness skin grafting was performed. However, one year after her surgery, patient noted vulvar pain and palpable vulvar lesions. Biopsy was done which showed Extramammary Paget’s Disease recurrence. Patient underwent repeat wide local excision with frozen section, and split-thickness skin grafting. With the aid of frozen section, the intraepithelial involvement was noted to spread beyond the grossly apparent lesion. After 6 months post re-excision, patient noted vulvar pruritus and palpable vulvar lesions. Biopsy was done which showed Extramammary Paget’s Disease recurrence. Due to the proximity of the lesion to the sphincter and need for a colostomy, the patient did not consent for re-excision. Imiquimod 5% was chosen as the mode of treatment. The challenges of interventions are to remove or treat disease that may not be visible, without overtreatment and to minimize morbidity from radical surgery. Surgery remains the primary management for EMPD of the vulva. Imiquimod 5% can be used in recurrences. Despite the advances in the knowledge and management of vulvar Paget’s disease the high rate of recurrent disease remains a challenge for optimal management and would require frequent and long-term follow-up.
Subject(s)
Female , Paget Disease, Extramammary , Vulvar NeoplasmsABSTRACT
@#Multiple primary tumors can be classified as synchronous or metachronous. Cases have been reported, with a prevalence, in gynecologic malignancies, of 1.9 to 4.3%, and commonly occurring in endometrial and ovarian malignancies. Renal tumors coexisting with primary cervical cancer are mostly metastatic tumors, and at present, no case of cervical carcinoma metachronous with renal cell carcinoma has been reported on literature. This is a case of Papillary Squamous Cell Carcinoma of the cervix who developed a metachronous Clear Cell Renal Cell Carcinoma. Several months after the diagnosis of cervical cancer, she presented with an abdominal mass and signs of uremia secondary to obstructive uropathy. She underwent radical nephrectomy with contralateral percutaneous nephrostomy. Definitive plan for the cervical mass is concurrent chemotherapy and radiation, depending on the improvement in renal function. Currently, there are no clearly established guidelines in managing metachronous cervical and renal masses, and this presents a unique opportunity to document this case, and study its implications on management and prognosis.
Subject(s)
Neoplasms, Multiple PrimaryABSTRACT
@#Basal cell carcinoma (BCC) is a rare tumor of the vulva because BCC is frequently seen in skin sites exposed to sun. Vulvar basal cell carcinoma accounts for < 1% of all BCCs and 2-5% of all vulvar carcinomas. The standard treatment for vulvar BCC is surgical excision and it produces good survival outcomes. This is a case report of an 83 year-old female who presented with a vulvar nodule associated with pruritus and bleeding. Initial vulvar biopsy revealed squamous cell carcinoma (SCCA). Patient underwent concurrent chemoradiation therapy for a Stage IIIB disease. Radical vulvectomy was subsequently done for tumor persistence. Surprisingly, the histopathology report of the persistent vulvar nodule revealed pigmented nodular basal cell carcinoma with lymphovascular invasion (LVSI). Patient was advised postoperative systemic chemotherapy but patient and relatives did not consent for the systemic treatment. Patient had no evidence of disease at 8 months post-surgery.
Subject(s)
Carcinoma, Basal CellABSTRACT
Background@#Menopause is a normal and natural event. It is defined as the final menstrual period and is usually confirmed when a woman has missed her periods for 12 consecutive months. Dealing with issues regarding menopause is just as important in the care of patients afflicted with cancer as it is to the general population undergoing this singular experience. By knowing the patients’ knowledge, attitudes, and practices (KAP) regarding menopause and its treatment, both patients and health care providers will be given a better perspective and useful insights on the matter which, hopefully, will translate to an improved and more holistic patient care. @*Objective@#To determine the knowledge, attitudes, and practices regarding menopause of gynecologic oncology patients treated at the Philippine General Hospital (PGH). Methods: This was a prospective study which employed a KAP survey on menopause using a structured questionnaire designed by the author. The questionnaire was patterned after the Menopause Health Questionnaire of the North American Menopause Society (NAMS) and the Menopause Rating Scale (MRS). Descriptive statistics were employed in the analysis of data using frequency and percentages. @*Results@#There was a total of 100 respondents of the KAP survey conducted at the PGH Cancer Institute Section of Gynecologic Oncology Outpatient Clinic. Majority of the respondents were aware of the more common symptoms of menopause such as irritability (61%) and hot flushes (49%) but had limited knowledge regarding the other symptoms. Majority are not aware of the different treatment modalities available to address menopausal symptoms. Only 13% of the respondents knew about hormonal replacement therapy as a treatment option for menopause. Only a small proportion of the respondents were familiar with the different forms of complementary and alternative medicine. Most of the respondents viewed menopause as a natural event in a woman’s life and needs no treatment. @*Conclusion@#Majority of the gynecologic oncology patients included in the survey do not know about the symptoms of menopause and the treatment options available to address these symptoms. An overwhelming majority of the women included in this survey consider menopause as a normal part of a woman’s life and view menopause in a positive light. Most of the respondents also do not feel that it is a condition that warrants treatment. Although they also experienced some of the symptoms of menopause, majority of the respondents did not avail of any treatment.