Evaluation of cleaved caspase-3 and Ki-67 index on diagnostic biopsy in response to neoadjuvant chemotherapy in the context of post-treatment tumour ypT stage, ypN stage, grade, and molecular subtype.

Introduction: Breast carcinoma is a heterogeneous disease, characterised by diverse clinical behaviour. The aim of this study was to assess how cleaved caspase-3 and Ki-67 index, evaluated on diagnostic biopsy, are related to response to neoadjuvant chemotherapy in the context of molecular subtype, post-treatment tumour, N category, and grade. Material and methods: A retrospective analysis was carried out among 110 breast cancer patients. Ki-67 levels and caspase-3 expression on diagnostic biopsy were explored regarding their relation to tumour grade and molecular subtype, ypT, ypN categories, and T and N categories according to Sataloff tumour response evaluation. Results: A statistically significant relationship was found between Ki-67 levels and tumour grade K-W = 24.2932, p < 0.0001; molecular subtype K-W = 28.5439, p < 0.00000967538; size and invasion of the primary tumour after neoadjuvant chemotherapy K-W = 11.7944, p < 0.0377169; caspase-3 expression after neoadjuvant therapy, evaluated according to the Sataloff classification χ2 = 5.97, df = 1, p = 0.0145. Discussion: No significant difference was found between Ki-67 expression in patients with pathological complete response, compared to those with partial and no response, a statistically significant difference in cases with different molecular subtype, histology grade, and tumour stage after neoadjuvant therapy. Cleaved caspase-3-positive breast cancer cases are often better responders to neoadjuvant therapy, but with no significant correlation to molecular subtype, high-grade categories, or tumour stage. Conclusions: The caspase-3 and Ki-67 index on diagnostic biopsy are related to post-neoadjuvant treatment prognostic factors (ypT stage, grade), proving them useful for prediction of treatment response to neoadjuvant therapy and further patient management.

TREATMENT WITH THERESIENöL OF SURGICAL DISEASES OF THE SKIN.

Theresienöl is a 100 % natural product representing a mixture of animal and vegetable raw materials from Tyrol. Its exact recipe has been preserved untouched and in deep secret for more than six centuries yet, and has been passed down from generation to generation. Six patients were included in this case series one patient with malignant melanoma of the skin after re-excision with subsequent non-free skin surgical plastic, two patients with III degree skin burning and three patients with infected wound successfully treated with Theresienöl. All of them - before the application of Theresienöl - were treated with different operative methods. The treatment of scars from operative interventions with Theresienöl is very effective. That is why it must start directly after the operative intervention. The therapeutic effect of Theresienöl for postoperative scars is commensurable with and even better than the one of all applied until now local medicines, which makes it an agent of choice in those cases. Theresienöl represents a good alternative to the free skin surgical plastic for small burns of III degree. The local treatment of infected wounds with Theresienoil is more effective and economically sound than the treatment with all the rest types of dressings. The effects from the treatment of different surgical diseases with Theresienöl occur very rapidly, while there is a very good response to local hematomas, pain, and itchiness by the medicine, and there are no side effects from its administration.

Warty carcinoma of the uterine cervix: a virus-induced disease?

Introduction: Warty carcinoma (WC) of the uterine cervix is a rare subtype of squamous-cell carcinoma (SCC), and its frequency, clinical behaviour, and aetiology are obscure. It originates from condylomas, and a viral carcinogenesis seems logical. Material and methods: Retrospective analysis was performed of all cervical carcinomas (CC), diagnosed at a single institution for a 10-year period. Analysed patients had stage I carcinoma. Patients with WC were identified, and their tumour samples were tested for high-risk HPV (hr-HPV) and EBV, using PCR and ISH. Clinical characteristics and WC rates across all stage I CC patients were assessed. All patients had minimum 3-year follow-up, and overall survival (OS) and 5-year survival rates were calculated. Results: WC comprised 2.2% of all stage I CC (n = 630). The mean age of the patients was 48 years (range: 29-72). The primary tumour size was 2 cm in 4 (28.6%) patients, 2-4 cm in 2 (14.3%) patients, and 4 cm in 8 (57.1%) patients. Lymph node metastasis was found in 1 (7.1%) patient. EBV or hr-HPV were detected in 2 (18.2%) patients using ISH, with no coinfection reported. Hr-HPV was detected in 2 (18.2%) patients; EBV in 4 (36.4%) cases, and in 2 of them (18.2%) there was a co-infection. Thirteen patients had a follow-up of ≥ 5 years and their 5-year OS was 100%. Conclusions: WC is a rare subtype of SCC with good prognosis, regardless of viral status. In contrast to SCC, its aetiology is not related to hr-HPV. The role of EBV remains unclear and cannot currently be denied.

Lymphoepithelioma-like Carcinoma of the Breast Synchronous with a High-Grade Invasive Ductal Carcinoma and Ductal Carcinoma in Situ in a Different Quadrant of the Same Breast: A Case Report.

Lymphoepithelioma-like breast carcinoma (LELC) is a rare type of malignant breast tumor that is not included in the current edition of the World Health Organization (WHO) classification of breast tumors. Currently, there are no clearly defined therapeutic strategies, and the general information on breast LELC is based on sporadic clinical cases described in the medical literature. We present a clinical case that describes a 49-year-old woman with a tumor formation in the right breast, histologically verified as LELC, together with a non-palpable, synchronous high-grade invasive ductal carcinoma and ductal carcinoma in situ Grade 2 (DCIS G2) in a different quadrant of the same breast. To our knowledge, this is the first case described in the literature that combines a LELC with a synchronous carcinoma in the same breast.

Re-excision within a radius of 2 cm in patients with melanoma of the skin - sufficient for local oncological radicalness.

Introduction: Malignant melanoma is one of the most malignant tumours in the human body. Radical re-excision of the tumour bed is a principal part of its surgical treatment. We aim to test the hypothesis that the re-excision with a 2 cm margin in all directions to the scar from the previous biopsy of the primary tumour provides sufficient local control in patients with this disease. Material and methods: This is a prospective descriptive study using STROBE methods, including all 151 patients with malignant melanoma of the skin, diagnosed and treated at the Department of Plastic, Reconstructive, and Aesthetic Surgery, Dr Georgi Stranski University Hospital, Medical University of Pleven, Bulgaria, in the period 2012-2016. Twenty-one cases were omitted from the study during the observation period due to lack of sufficient data. The re-excision was mainly within 2 cm margins in all directions to the scar from the previous biopsy of the primary tumour. Results: Data of all 130 patients with malignant skin melanoma, diagnosed and treated at our single large centre, were prospectively registered and analysed. These were 67 male and 63 female patients with a mean age at diagnosis of 61.6 years (range: 17-91 years). Using the re-excision within 2 cm margins, we identified only 1 (0.77%) patient with a histologically confirmed residual tumour in the re-excised flap. Local recurrence was observed in 13 (10%) patients. Conclusions: Re-excision with a 2 cm margin is sufficient to achieve local surgical radicalness in the treatment of this disease without compromising oncological survival.

Robotic gastrointestinal stromal tumors surgery - initial results.

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) usually present as an exophytic mass localized in stomach. Years ago, conventional surgery was the only option. Laparoscopic and robotic procedures have risen to prominence in recent decades as technology and surgical techniques have advanced.

Initial presentation of renal cell carcinoma as a vaginal mass with excessive bleeding.

Introduction: Renal cancer is the seventh most common cancer in men and the tenth most common cancer in women. Renal cell carcinoma accounts for 3% of all adult malignancies and 85% of all primary renal tumours. It metastasizes most often to the lungs, liver, bones, and brain and very rarely to the vagina. Case report: We present a case of a 60-year-old patient, in whom the renal cell carcinoma manifested for the first time as an intense bleeding, soft tumour formation with dimensions 4/6 cm originating in the vagina. Discussion: Renal cell carcinoma metastasizes in about 30% of cases. Metastasizing can be lymphatic, hematogenous, transcoelomic, or by direct invasion. Most commonly it affects the lungs, bones, adrenal glands, liver, lymph nodes, and brain. Much less often, it metastasizes to the thyroid, orbit, nasal structures, vagina, gallbladder, pancreas, sublingual tissues, and soft tissues of distal extremities. Metastases can be synchronous and metachronous. The described cases in the literature of renal cell carcinoma manifested with vaginal metastases are isolated. Conclusions: We present an extremely rare case of renal cell carcinoma manifested by profuse genital bleeding from a vaginal metastasis. In such cases, especially if the vaginal lesion does not appear as the primary vaginal carcinoma, we must consider the possibility of metastasis from renal carcinoma.

Aetiology and Pathogenesis of Cutaneous Melanoma: Current Concepts and Advances.

Melanoma develops from malignant transformations of the pigment-producing melanocytes. If located in the basal layer of the skin epidermis, melanoma is referred to as cutaneous, which is more frequent. However, as melanocytes are be found in the eyes, ears, gastrointestinal tract, genitalia, urinary system, and meninges, cases of mucosal melanoma or other types (e.g., ocular) may occur. The incidence and morbidity of cutaneous melanoma (cM) are constantly increasing worldwide. Australia and New Zealand are world leaders in this regard with a morbidity rate of 54/100,000 and a mortality rate of 5.6/100,000 for 2015. The aim of this review is to consolidate and present the data related to the aetiology and pathogenesis of cutaneous melanoma, thus rendering them easier to understand. In this article we will discuss these problems and the possible impacts on treatment for this disease.

Treatment with Theresienöl - a new option in the management of vulvar leukoplakia.

INTRODUCTION: The term vulvar leukoplakia encompasses a variety of non-inflammatory diseases that lead to skin discoloration of the external genitalia and white colouration. Most commonly, these are vulvar lichen sclerosus (VLS) and squamous cell hyperplasia of the vulva (SCHV). They have similar aetiology, clinical presentation, and treatment but different anatomical pathology. AIM OF THE STUDY: The study aims to determine the effect of Theresienöl herbal oil treatment in patients with clinically proven diagnosis of VLS and SCHV. MATERIAL AND METHODS: This prospective study includes 17 patients with a diagnosis of VLS and SCHV, who underwent a 3-month treatment course with Theresienöl herbal oil. All patients were followed up for 1 year after therapy initiation, and the effect of treatment was reported using a visual analogue scale (VAS) for genital itching. RESULTS: The median age of patients enrolled was 60.6 years (range 42-74); 2 patients dropped out due to failure to attend follow-up visits. The mean score of the VAS taken at the beginning of treatment was 1.65 (0-5); at the 3rd month the mean score was 9 (8-10) and it remained similar at the 12th month - 8.67 (7-10). CONCLUSIONS: Theresienöl herbal oil treatment of vulvar leukoplakia is effective and safe, but studies should be continued.

Adenosquamous Carcinoma of the Uterine Cervix - Impact of Histology on Clinical Management.

INTRODUCTION: Historically, the incidence rate of cervical cancer (CC) in Eastern Europe and particularly in Bulgaria has constantly been higher than that in the other European countries. Adenosquamous carcinoma (ASC) is a rare histological subtype of CC with incidence rate of less than 6 per 100,000. We aimed to analyze the epidemiology and prognosis of all Bulgarian patients with ASC, registered at the Bulgarian National Cancer Registry (BNCR), and to compare patients' characteristics and outcomes with those of patients, treated at a large specialized institution - the Department of Gynecologic Oncology, University Hospital in Pleven, Bulgaria. MATERIALS AND METHODS: This is a retrospective study of all cases of ASC, registered at the BNCR for a 10-year period of time. The Kaplan-Meier analysis with Log rank test was used to estimate the significant differences. RESULTS: The incidence rate of ASC was calculated as 3.2% of all CC registered in BNCR and 4.97% of all stage I patients, treated in our department. The 5-year overall survival (OS) rate of all patients with ASC tumors from the registry was 50.5%. A total of 171 (48.4%) of the patients had T1 tumors and a 5-year OS of 67.1%. Lymph node status was a significant prognostic factor for OS (p=0.001). Thirty-one patients with T1 tumors and ASC histology were treated in our department for the same period of time. Lymph node metastases were found in 10 of them (32.2%). The 5-year observed OS in ASC group was 74.19%. CONCLUSION: The histological subtype of cancer of the uterine cervix has an impact on prognosis and should not be simply considered as a descriptive characteristic but a poor prognostic feature and should be an integral part of the decision-making in clinical management of patients.

First-stage clear-cell endometrial carcinoma with paraaortic lymph node recurrence: a case report.

INTRODUCTION: Endometrial cancer (EC) is the sixth most common malignancy in women worldwide; in developed countries this oncological entity climbs to fourth place. In 2012 worldwide 319 600 new cases were registered and about 1/3 of those were diagnosed in Europe, i.e. more than 100 000 cases. Statistics in Bulgaria show an increase in the incidence; the National Cancer Registry reported an incidence rate of 8.6% for 2013, with 1293 new cases; about 300 women die because of this diagnosis every year. Clear-cell endometrial carcinoma (EC) is relatively rare, in 1-6% of cases, with significantly shorter survival rates even for early stages (I and II), compared to the other histological subtypes. CASE REPORT: A 62-year-old patient was subjected to surgery for clear-cell endometrial carcinoma, stage pT1N0M0, FIGO stage IA. Despite radical surgical treatment as per Bulgarian oncological standards - total hysterectomy with bilateral adnexectomy and pelvic lymph node dissection with postoperative radiotherapy - there was a recurrence in a the paraaortic lymph node 15 months later. A second surgical intervention with radical resection of the parailiac metastatic lymph nodes on the left was done with subsequent pseudo-adjuvant platinum-based chemotherapy, and no further relapse has occurred 36 months later. CONCLUSIONS: Clear-cell EC is an aggressive disease with worse prognosis than the endometroid subtype. Therefore, comprehensive surgery and surgical staging should be performed, including pelvic and paraaortic lymph node dissection, regardless of stage.

Post-radiation soft tissue damage in endometrial carcinoma: a case report.

INTRODUCTION: Radiotherapy (RT) is a widely used treatment modality of malignant tumours of the uterine cervix and body. There are different techniques to deliver RT to the tumour lesions, including external beam radiation and brachytherapy. All international guidelines recommend RT as treatment modality for many stages of uterine cervical and body cancers because it improves a number of oncological outcomes, such as disease-free and overall survival. However, it may also lead to a number of complications, which can be roughly divided into early or late, depending on the time of their manifestation. The most frequent RT-induced early complications involve the skin and the soft subcutaneous tissues. They typically present as inflammatory conditions of all abdominal wall layers: dermatitis, cellulitis, and necroses of subcutaneous fatty tissue, muscles, or fasciae. CASE REPORT: This paper presents a case report of a 38-year-old woman diagnosed with endometrial cancer (EC). She was initially treated with open abdominal surgery, and subsequently the treatment was continued with external beam adjuvant RT. DISCUSSION: While RT was ongoing, a necrosis of the anterior abdominal wall in the surgical scar developed. It manifested at the end of the RT treatment and is thus regarded as an early complication of the RT for EC. It was successfully managed with surgery, and there was no compromise in the treatment of the oncological condition. CONCLUSIONS: RT-induced necrosis of the surgical scar of the anterior abdominal wall is a very rare complication. Surgical treatment is the main method of treatment of this condition.

Relation between type of hysterectomy and survival rate in patients with ovarian cancer - single-center study.

AIM OF THE STUDY: To evaluate the survival rate of patients with advanced ovarian carcinoma in relation to the type of surgical intervention - total abdominal hysterectomy with bilateral adnexectomy and omentectomy as a minimal standard compared to extended hysterectomy with a retroperitoneal approach. MATERIAL AND METHODS: The study was implemented based on retrospectively obtained data from 104 patients operated on for advanced epithelial ovarian carcinoma (FIGO stages II-IV) in the period from 2004 to 2012. Total abdominal hysterectomy, bilateral adnexectomy, and omentectomy were performed on 23 patients. Extended hysterectomy with a retroperitoneal approach and varying degrees of peritonectomy, omentectomy, and appendectomy were performed on 74 patients. Seven patients were treated with adnexectomy or biopsy alone. We divided the patients into two groups according to the mode of surgery. The first one comprised the patients who underwent radical hysterectomy and the second one comprised total abdominal hysterectomy plus bilateral adnexectomy. The two groups were examined for their overall survival rate, relapse-free survival rate, and 5-year survival rate. RESULTS: Mean overall survival rate, relapse-free survival rate, and 5-year survival rate in the group with extended hysterectomy were higher compared to the group with total abdominal hysterectomy. CONCLUSIONS: The extended hysterectomy with a retroperitoneal approach with or without systematic lymph node dissection seems to be more appropriate in the surgical treatment of advanced ovarian carcinoma. The procedure is related to the improvement of survival rate as a result of the inclusion of macroscopically invisible lesions in the surgical removal.

Vulvar leukoplakia: therapeutic options.

Vulvar leukoplakia is not a histological diagnosis and involves several diseases. Most commonly, these are vulvar lichen sclerosus and squamous cell hyperplasia of the vulva. These two conditions have similar aetiology, clinical presentation and treatment but different histopathological changes. They both lead to significant impairment of quality of life, risk of malignancy, as well as recurrence after treatment. Treatment of these conditions includes topical corticosteroids as a first-line therapy, but they have their side effects and not all patients are receptive to this therapy. This requires the use of alternative therapeutic options such as topical calcineurin inhibitors, topical and systemic retinoids, other steroid creams, various destructive techniques and, as a last resort, surgical removal of affected tissues. Surgical treatment should be avoided, despite the malignant potential, because of recurrence risk in both diseases New therapeutic approaches are coming into effect in gynaecological practice due to potential risks of the above-mentioned methods. Platelet-rich plasma therapy, ablative and non-ablative laser treatment, and new topical medicines, are some of the new options applied to improve the efficacy of treatment avoiding the side effects of conventional medications. A number of them are still in their initial phase of application and time will tell their effectiveness.

Aetiology, diagnosis, and clinical management of vulvodynia.

Chronic vulvar pain or discomfort for which no obvious aetiology can be found, i.e. vulvodynia, can affect up to 16% of women, and it may be found in girls and women across all age groups and ethnicities. Most patients describe it as burning, stinging, irritation, or rawness. The symptoms may spread to the whole vulva (generalised vulvodynia) or only to part of it, such as the clitoris (clitorodynia) or the vestibule of the vagina (vestibulodynia). This condition is often underreported and underrecognised by health care providers. Vulvodynia is a significant burden to society, the health care system, the affected women, and their intimate partners. It has a negative impact on quality of life. Vulvodynia is a diagnosis of exclusion with unknown aetiology. The gynaecologist plays a key role in excluding other causes of vulvar pain, and collaborating with other health care providers to manage the patient's pain. Although many therapeutic options are available, such as vulvar care measures, psychological approaches, local treatment, oral medications, surgical procedures, electrical nerve stimulation, and laser therapy, there is no single treatment effective for all patients. That is why individualised management is needed. An individualised, holistic, and often multidisciplinary approach is needed to effectively manage the patient's pain and pain-related distress.

Uterine smooth muscle tumours of uncertain malignant potential: single-centre experience and review of the literature.

INTRODUCTION: Uterine smooth muscle tumours of uncertain malignant potential (STUMPs) are a rare histologically heterogeneous group of uterine smooth muscle tumours (SMTs). Their malignant potential and clinical differentiation between leiomyoma and leiomyosarcoma remain uncertain prior to surgical removal. AIM OF THE STUDY: To investigate the patients and tumour characteristics of patients with STUMPs and to propose algorithms for optimal diagnosis, treatment, and follow-up management. MATERIAL AND METHODS: This was a single-centre retrospective cohort study of all patients who underwent surgery for a preoperative diagnosis of uterine myoma at the University Hospital "Dr. Georgi Stranski", Pleven, Bulgaria during a period of 33 months (from January 2013 until October 2015). Data were obtained from the medical history records. We performed descriptive analysis to characterise the patient population (e.g. demographics, age, contraceptive use, and complaints that led to the diagnosis) and the tumour characteristics. Last data were obtained prior May 2019. RESULTS: A total of 320 medical records were retrospectively evaluated. The preoperative diagnosis of myoma was confirmed in 279 of the cases (89.4%). In 27 (8.3%) cases the final histological result was completely different. In 14 (2.3%) a histological postoperative diagnosis of STUMP was identified. All 14 STUMP lesions were intramural with a median size of 7.5 cm (range 3.5 to 15 cm). The median age at diagnosis of STUMP was 45.4 years (range 36 to 52 years), and 92.9% (n = 13) of the patients were premenopausal. Ultrasound data of a rapidly growing myoma were a reason for diagnosis in only three patients (25%), whereas 92.9% of the patients (n = 13) presented with heavy menstrual bleeding with or without anaemia. After surgery, none of the patients with STUMP experienced a relapse of the disease within the median follow-up time of 48 months (R = 40-78). CONCLUSIONS: STUMP tumours are rare tumours, predominantly diagnosed in premenopausal women. They define a group of patients with very good long-term prognosis. Therefore, longer follow-up is needed to allow for conclusions on recurrence rate and survival.

An unusual case of fulminant generalized peritonitis secondary to purulent salpingitis caused by Prevotella bivia - case report with literature review.

INTRODUCTION: Prevotella bacilli are prevalent in the body as members of the normal flora and in some cases they can be involved in infections throughout the body. Prevotella bivia is a member of a nonpigment group found in the resident flora of the female genital tract and it is occasionally seen in the oral cavity. CASE REPORT: We describe the very rare case of a 39-year-old woman with fulminant generalized peritonitis secondary to purulent salpingitis caused by Prevotella bivia. DISCUSSION: In most cases described in the literature, Prevotella bivia was mixed with aerobes and caused bacterial vaginosis and pelvic inflammatory disease, whereas in our case study Prevotella bivia was the only microbe that was isolated. The infection was fulminant and caused generalized peritonitis. Rapid and systemic infections typically occur in immunocompromised hosts, however our patient was in good health condition and immunocompetent. CONCLUSIONS: Prevotella bivia may cause rapid and systemic infections, even in immunocompetent hosts. Multidisciplinary team management is mandatory in order to estimate the optimal treatment regimen.

Discordance for Potter's Syndrome in a Dichorionic Diamniotic Twin Pregnancy-An Unusual Case Report.

INTRODUCTION: Potter's syndrome, also known as Potter's sequence, is an uncommon and fatal disorder. Potter's sequence in a multiple pregnancy is uncommon, and its frequency remains unknown. Worldwide in a diamniotic twin pregnancy, there are only a few cases described. CASE REPORT: We present an unusual case discordance for Potter's syndrome in a dichorionic diamniotic twin pregnancy. Twin A had the typical physical and histological Potter's findings. Twin B had normal respiratory function and normal physical examination findings. There are many controversies about this condition in diamniotic twin pregnancy. One case report concluded that that the presence of a normal co-twin in diamniotic pregnancy prevented the cutaneous features seen in Potter's syndrome and ameliorated the pulmonary complications, whereas two other case studies reported that the affected twin had extrarenal features typical of the syndrome. CONCLUSION: We performed an autopsy and calculated lung weight/body weight ratio to diagnose pulmonary hypoplasia. Histopathologic examination of lungs and kidneys was performed. We concluded that the appearance of extrarenal features in the affected twin depends on the amniocity.

Mucoepidermoid Carcinoma of the Uterine Cervix-Single-Center Study Over a 10-Year Period.

Background and objectives: Adenosquamous cancer of the uterine cervix is a rare type of cervical cancer with both malignant squamous and glandular components. A very rare subtype is mucoepidermoid carcinoma (MEC), which was first described as a salivary gland tumor. It has been described as having the appearance of a squamous cell carcinoma without glandular formation and contains intracellular mucin. The postoperative evolution of this tumor and the potentially poorer prognosis may indicate an intensification of the follow-up. The objective of our study was to analyze the frequency of mucoepidermoid carcinoma in hospitalized women with cervical cancer, clinical characteristics and prognosis. Material and Methods: A retrospective study of all cases of mucoepidermoid carcinoma of the cervix at Department of Gynecologic Oncology,University Hospital-Pleven, Pleven Bulgaria between 1 January 2007 and 31 December 2016 was performed. All patients were followed-up till December 2019. We analyzed certain clinical characteristics of the patients; calculated the frequency of mucoepidermoid carcinoma of the cervix from all patients with stage I cervical cancer; and looked at the overall survival rate, correlation between overall survival, lymph node status and the size of the tumor. Results: The frequency of MEC was 1.12% of all patients with stage I cervical cancer in this study. The median age of the patients with MEC was 46.7 years (range 38-62). Four patients (57.1%) were staged as FIGO IB1, and three patients (42.8%) were FIGO IB2. The size of the primary tumor was <2 cm in 2 patients (28.57%), 2-4 cm in 2 patients (28.57%) and >4 cm in 3 patients (42.8%). Metastatic lymph nodes were found in two patients (28.57%), and nonmetastatic lymph nodes were found in five patients (71.43%). There were two (28.57%) disease-related deaths during the study period. The five-year observed survival in the MEC group was 85.7% and in the other subtypes of adenosquamous cancer group was 78.3%. Conclusions: MEC of the uterine cervix is a rare entity diagnosis. As a mucin-producing tumor, it is frequently regarded as a subtype with worse clinical behavior and patients' outcomes. Nevertheless, our data did not confirm this prognosis. New molecular markers and better stratification are needed for better selection of patients with CC, which may benefit more from additional treatment and new target therapies.

Leiomyosarcoma of the vulva: a case report.

INTRODUCTION: Leiomyosarcoma of the vulva is a rare disease accounting for about 1% of all primary vulvar neoplasia but it is the most common type of vulvar sarcomas. Usually it arises from the smooth muscles, blood vessels, rough ligaments, and erector-pili muscles. No treatment algorithms have been established yet. Tumour excision with clean resection lines is considered sufficient, with radiation therapy applied in certain cases. CASE REPORT: We report a case of a 73-year old patient in whom the disease was manifested by pain syndrome and rapidly growing mass with irregular margins in the symphysis area and satellite nodules. She underwent extensive local excision followed by radiation therapy. DISCUSSION: Isolated cases and limited series of LMS cases have been described in literature. Leiomyosarcoma is most commonly localized to the labia majora, the Bartholin gland area, clitoris and labia minora. It most often affected perimenopausal women but in younger and pregnant patients was described. The diagnosis is not always easy and different histological markers has to be used. There are no definitive therapeutic algorithms due to the rarity of the disease. The management is surgical treatment and the entire tumour must be removed with histologically verified clean resection margins, followed by radiation therapy in some cases. CONCLUSIONS: Vulvar tumours are difficult to distinguish macroscopically. Accurate histological diagnosis allows adequate treatment.