Conservative treatment by endoscopy of a cesarean scar pregnancy: two case reports.

BACKGROUND: Cesarean section scar pregnancy is the rarest form of ectopic pregnancy and the most dangerous due to the high risk of uterine rupture and hemorrhage. CASE: We present two case reports of women diagnosed with an ectopic cesarean scar pregnancy. We performed conservative treatment because both patients desired fertility preservation. The first case was treated with laparoscopy and hysteroscopy simultaneously. For the second case the treatment started with an ultrasound-guided injection of methotrexate. Surgical laparoscopy and hysteroscopy were subsequently performed simultaneously. Four months later, the first woman had a spontaneous singleton pregnancy. An elective cesarean was performed. CONCLUSION: In these two case reports we have presented our experience with endoscopic surgery in the management of two patients who had a cesarean scar pregnancy and desired to preserve their fertility.

Neurofibroma of the vaginal wall.

BACKGROUND: Von Recklinghausen's disease is characterized by cutaneous manifestations but it is a systemic disease which may affect the genitourinary tract. CASE: A 20-year-old woman with a history of type-1 neurofibromatosis attended our center due to a vaginal nodule. Surgical treatment consisted of an incisional biopsy of the nodule. The anatomopathological diagnosis was plexiform neurofibroma. CONCLUSION: Periodical check-ups are recommended in asymptomatic vaginal neurofibroma whereas its radical excision should be avoided as such surgery is highly aggressive.

Lymphadenectomy in ovarian cancer.

Current guidelines for the surgical staging of ovarian cancer include the removal of retroperitoneal lymph nodes (pelvic and aortic). In most centres this is achieved by means of laparotomy, but advanced laparoscopic techniques have also been performed and still further prospective controlled studies with long-term follow-up are necessary to validate the efficacy. Lymph node sampling, short of complete dissection, should be avoided because it may be insufficient to detect metastasis. In any case, laparoscopic lymphadenectomy as well as open surgery, should be in the hands of properly trained subspecialists in gynaecologic oncology. Of 97 patients with ovarian carcinoma studied in our hospital, 68% were treated by means of complete staging laparotomy (FIGO). Lymphadenectomy was spared in 14 cases with stage I tumours (mainly serous) without changes in overall survival. In 15% metastases in pelvic lymph nodes were present. In the same proportion aortic lymph nodes were positive. In 5.5%, aortic metastases were present in the absence of pelvic involvement.

Ovarian germ cell tumors.

UNLABELLED: Ovarian germ cell tumors (OGCT) are a special type of ovarian cancers due to their histology, age of presentation, prognosis and treatment. MATERIAL AND METHODS: Eighteen cases of OGCT out of 313 total ovarian cancer diagnosed in Hospital Materno-Infantil Vall d'Hebredn between 1975 and 1994 are present. RESULTS: Mean age of the patients was 36 years. The most frequent symptom at diagnosis was abdominal bloating (44.5%). Echography was the most used diagnostic method (67%). Surgery was conservative in 44% of the cases, radical in 50% of the cases and palliative in one case. The histological types were 6 dysgerminomas and 6 malignant teratomas (33.3%), 3 malignant dermoid cysts (16.7%), 2 yolk sac tumors (11%) and 1 embryonal carcinoma. According to FIGO 1987 staging classification 14 patients were in stage I disease and 4 in stage III disease. Polychemotherapy was performed on 6 patients and postsurgical radiotherapy was performed on 2 patients. Five patients recurred in an average time of 25 months. The five-year survival rate, according to the Kaplan-Meier method, was 80% in stage I and 0% in stage III. Five-year survival rate of patients only surgically treated was 65% and in patients who underwent postsurgical co-adjuvant treatment it was 100%. CONCLUSION: Conservative surgery followed by a BEP regimen may be performed nowadays with efficacy and acceptable toxicity while conserving the fertility of these patients.