ABSTRACT
Purpose: To identify the MRI features that aid in the characterization of ovarian granulosa cell tumors. Materials and methods: 11 MR pelvis of an adult woman with pathology-proven ovarian granulosa cell tumors with surgical pathology.We evaluated the patient's age, Ca-125, size, laterality, and with MRI features such as indirect signs (i.e., thickened endometrium > 0.9 cm), morphology (cystic, solid-cystic, or solid), subacute hemorrhage, T2 signal (low or intermediate-to-high), restricted diffusion (B values: 0, 50, 1000 sec/mm3/ADC), and dynamic enhancement (intense or similar to myometrium). Also, the presence of ascites, peritoneal implants, or adenopathy. Results: The final cohort included 11 women with a surgical-pathological diagnosis of granulosa cell tumors. The median age was 52.4 years (range, 17-80). The Ca-125 level was with a median within normal limits. The median size was 9.4 cm. Most cases were unilateral (81.8%) and more frequent on the left (54.5%). MRI Analysis: 36.4% had endometrial thickening. Ovarian granulosa cell tumors were polymorphous: cystic (54.6%), mixed solid-cystic (9.1%), and solid (36.3%). Most GC had intermediate to high signal on T2 (90.9%), restricted diffusion (81.8%), intense enhancement (81.8%), and 36.4% had intraparenchymal bleeding. 9.1% had associated implants/adenopathy/ascites at diagnosis. Conclusion: The MRI features characteristic of ovarian granulosa cell tumors were the polymorphous morphology, an intense enhancement to the myometrium, restricted diffusion, and the presence of intraparenchymal hemorrhage.
ABSTRACT
Objectives: to describe the perioperative and oncological outcomes of a serie of cases treated with laparoscopic surgery for isolated nodal metastasis of gynecologic malignancies at the Gynecology Service of Hospital Italiano de Buenos Aires and conduct a literature review on the surgical treatment provided to patients with this condition. Methods: A search was conducted in the surgery records of the Gynecology Service of Hospital Italiano of patients who underwent laparoscopic cytoreductive surgery for isolated nodal recurrence of a gynecologic primary tumor in the period 2009-2015. The medical records were reviewed and data on the patients' characteristics, the tumor, the surgery and its complications were collected and analyzed. A literature search was conducted in Pubmed by the term "isolated nodal recurrence in gynecology" and a subsequent snowball search was performed. Results: As results, nine patients are presented. The median age was 66 years old (RI 7). The initial cancer location was: ovary (n=3), endometrium (n=3), cervix (n=2) and breast (n=1). The location site of the single nodal recurrence was the para-aortic area (n=8) and the pelvic area (n=1). The median of the disease-free interval to recurrence was 42.8 months (RI 40.2). Either the retroperitoneal or the transperitoneal approach was used based on the location of the recurrence. The median surgery time was 120 minutes (RI 36). No conversion to laparotomy was performed in any patient. No intraoperative or postoperative complications were reported, nor any requirement for blood transfusion. The median hospital stay was 36 hours. Adjuvant treatment with chemotherapy was applied to 8/9 patients. Only one patient recurred in para-aortic lymph nodes and peritoneal carcinomatosis after eight months and died of her disease. The literature review confirms the possibility of laparoscopic resection of the single nodal recurrence with low complication rate. Conclusion: The laparoscopic lymph node cytoreductive surgery is a valid and safe treatment option considering the perioperative and oncological outcomes in our hospital.
Objetivos: Describir los resultados perioperatorios y oncológicos de una serie de casos operados con laparoscopía por metástasis única ganglionar de cánceres ginecológicos en el Servicio de Ginecología del Hospital Italiano de Buenos Aires y realizar una revisión bibliográfica sobre el tema. Métodos: Se llevó a cabo una búsqueda de pacientes en los registros de cirugía del servicio de Ginecología del Hospital que hayan recibido tratamiento quirúrgico de citoreducción laparoscópica por recurrencia ganglionar aislada de un tumor primario ginecológico en el período 2009-2015. Se revisaron las historias clínicas y se recolectaron y analizaron datos referidos a características de las pacientes, del tumor, de la cirugía y sus complicaciones. Se realiza una búsqueda bibliográfica en Pubmed con el concepto "isolated nodal recurrence in gynecology" y posterior búsqueda en bola de nieve. Resultados: Se presentan 9 pacientes. La mediana de edad fue de 66 años (RI 7). La localización del cáncer inicial fue ovario (n=3), endometrio (n=3), cuello (n=2) y mama (n=1). El sitio de localización de la recurrencia ganglionar única fue el área lumboaórtica (n=8) y el área pelviana (n=1). La mediana de intervalo libre de enfermedad a la recurrencia fue de 42.8 meses (RI 40.2). Se utilizó un abordaje retroperitoneal o transperitoneal según la localización de la recurrencia. La mediana de tiempo operatorio fue de 120 minutos (RI 36). No se realizó conversión a laparotomía en ninguna paciente. No se reportaron complicaciones intraoperatoria o postoperatorias, así como tampoco requerimiento de transfusión sanguínea. La mediana de estadía hospitalaria fue de 36 horas. Realizaron tratamiento adyuvante con quimioterapia 8/9 pacientes. Solo 1 paciente recurrió a nivel lumboaórtico y peritoneal luego de 8 meses y falleció de su enfermedad.La revisión de la literatura confirma la posibilidad de realizar la resección de la recurrencia ganglionar única por vía laparoscópica con baja tasa de complicaciones. Conclusión: la citorreducción ganglionar laparoscópica es una opción de tratamiento válida y segura en relación a los resultados perioperatorios y oncológicos en nuestra institución.
Subject(s)
Carcinoma/surgery , Cytoreduction Surgical Procedures/methods , Genital Neoplasms, Female/surgery , Laparoscopy/methods , Lymph Node Excision/methods , Aged , Argentina , Disease-Free Survival , Female , Humans , Middle Aged , Perioperative Period , Recurrence , Treatment OutcomeABSTRACT
STUDY OBJECTIVE: To compare the clinical and oncological outcomes of four different approaches of cervical excision (CE) during radical trachelectomy (RT) for early cervical cancer. DESIGN: A retrospective comparative observational study was performed at Gynecology Department of the Hospital Italiano de Buenos Aires in Buenos Aires, Argentine. The study was composed of all consecutive women who had undergone laparoscopic RT for early cervical cancer between May 2011 and July 2016. They were divided in four groups according with different surgical approaches to perform the CE during RT; which are also detailed. (Canadian Task Force Classification III). SETTING: Tertiary care hospital. INTERVENTION: CE during radical trachelectomy for early cervical cancer. MEASUREMENT AND MAIN RESULTS: A total of 7, 6, 6 and 3 patients undergone Type A, B, C and D cervical excision during RT, respectively. No significant differences in terms of age, BMI, surgical time and length of hospital stay were found according with different types of CE. Patients in Type D had, however, a significantly higher EBL, p =.006. Similar histology characteristics in terms of histology type, tumor grade and size, as well as lymph node count were observed among groups. Only grade 1-2 postoperative complications were noted in 9 patients. One local recurrence after Type B CE was treated with radical surgery plus chemoradiaton; while other patient after Type A CE relapsed with peritoneal carcinomatosis managed with chemotherapy. CONCLUSION: Different types of cervical excision that are here described should be used according to each case based on specific clinical factors.
