ABSTRACT
BACKGROUND: We did not have any data about vulvar cancer - as a fourth cause of gynecological cancer in the worldwide - in our country. STUDY DESIGN: Our study is designed to evaluate the frequency, stage and outcome of patients with vulvar cancer. MATERIALS AND METHODS: In this retrospective observational study, we studied patients' records with diagnosis of vulvar cancer who referred to department of gynecology oncology, Emam-Khomeini Hospital (EKH), Tehran, Iran, between January 1998 and December 2018. A total of 106 cases of vulvar cancers were found in the records of outpatient oncology clinic of medical university of Tehran university. Survival was estimated using the Kaplan-Meier analysis with SPSS version of 24. RESULTS: Mean age of the 106 patients in the study was 59.2 years. The most site of tumor involvement was major labial (39.1%). Vulvar cancer significantly was more in multiparous (P < 0.001) and menopause patients (P < 0.001). Squamous Cell Carcinoma was the most pathology of vulvar cancer (72.2%). Ninety patients (84.9%) had surgery as a primary treatment and 48 (53.3%) of these patients received adjuvant radiotherapy or chemoradiation after surgery. Mean duration of patient's follow up was 82.4 ± 68.3 month. Five-year survival of our patients in all stages was 71%. CONCLUSIONS: Our findings are located between developed and underdeveloped countries. Our patients are diagnosed nearly in earlier stages of disease and 84.9%t of them had surgery as a primary treatment, so earlier surgery resulted in good survival of patients.
ABSTRACT
Choriocarcinoma and placental site trophoblastic tumor (PSTT) are rare varieties of gestational trophoblastic disease (GTD). PSTT alone constitutes about 1-2% of all trophoblastic tumors, which presents at early reproductive age and the serum beta-hCG level is much lower than choriocarcinoma. This tumor usually invades the myometrium and its depth of penetration is a prognostic factor. The first case report is regarding a 33-year-old woman with vaginal bleeding 3 months after abortion. The ultrasound exhibited heterogeneous and hypervascular mass related to previous cesarean scar. Serum beta-hCG level was 67 mIU/ml and chemotherapy was administered. However, due to severe vaginal bleeding and no regression in mass size, total abdominal hysterectomy was performed. Histopathological examination and IHC staining confirmed PSTT from previous cesarean section. The second case report is regarding a 33-year-old woman with cervicoisthmic choriocarcinoma, which was mistaken as cesarean scar pregnancy. The ultrasonography and elevated serum beta-hCG level suggested cesarean scar pregnancy. The patient was treated with methotrexate without any effect. Eventually, cervicoisthmic choriocarcinoma was detected after hysterectomy. A diagnostic error was made leading to possible uterus perforation along with incorrect chemotherapy that resulted in a life-threatening condition. It is concluded that PSTT and choriocarcinoma are the two important differential diagnoses of sustained elevated beta-hCG when imaging evidence is also suggestive. Although PSTT and cervicoisthmic choriocarcinoma are rare, they do exist and are on the rise.
ABSTRACT
PURPOSE: The accuracy of intra-operative gross visual examination of myometrial invasion of uterine specimen has been evaluated in several studies with controversial results. The intra-operative frozen section (IFS) analysis is used to identify patients at high risk for pelvic and para-aortic nodal metastasis in order to avoid lymphadenectomy in low-risk patients. However, there is still some controversy concerning the efficiency of IFS. The aim of this study was to evaluate the accuracy and validity of frozen section diagnosis and gross examination of uterine specimen compared to the final histological results in patients with endometrial cancer. METHODS: The study group comprised 31 patients with a pre-operative histopathological diagnosis of endometrial carcinoma. Comprehensive surgical staging was performed in all patients. Intra-operative gross examination of the uterine cavity and wall with frozen section analysis was performed. Lymphadenectomy was performed in all patients. After frozen section analysis, the uterus together with removed lymph nodes was stored and subjected to final pathologic diagnoses. RESULTS: Gross examination accurately identified microscopic invasion of myometrium in 86.6% of the patients with 88.9% sensitivity, 85.7% specificity and negative and positive predictive values of 72.7 and 94.7%, respectively. The kappa was 0.70 (p < 0.0001) with a 95% CI 0.432-0.968. Frozen section in 90% of cases was correctly reporting final histopathological myometrial invasion with sensitivity 88.9%, specificity 90%, positive and negative predictive values 80 and 94.7%, respectively. The kappa was 0.76 (p < 0.0001) with a 95% CI 0.51-1.009. CONCLUSION: These data confirm the previous reports for the accuracy of gross examination and frozen section diagnosis in early stage and low-grade tumors.
