Solitary fibrous tumor of the vulva resulting in spinal metastasis: A case report.

•Solitary fibrous tumors are typically indolent tumors of the pleura.•Primary origin in the female reproductive organs is rare, as are aggressive forms.•We report a case of a vulvar solitary fibrous tumor, notable for extensive spinal metastasis.

Brief Report: A Second Primary Endodermal Sinus Tumor 9 Years after Initial Diagnosis.

BACKGROUND: Ovarian yolk sac tumors (YSTs) are rare malignant germ cell tumors known to present unilaterally, allowing for fertility-sparing surgical treatment with adjuvant chemotherapy. The few published cases of bilateral ovarian involvement were at the time of original diagnosis in patients with widely metastatic disease. We present, to our knowledge, the first case of bilateral ovarian YSTs, diagnosed several years apart, and discuss the implications on recurrence and tumor marker surveillance for these tumors. CASE: This is a case of a young woman who re-presented 9 years after initial treatment, with a YST in the contralateral ovary. SUMMARY AND CONCLUSIONS: YSTs are well established as unilateral tumors, however, in rare cases such as this, they might reappear years later on the contralateral ovary.

Laparoendoscopic single-site surgery for management of adnexal masses in pregnancy: case series.

The incidence of adnexal masses in pregnancy is estimated to be 1% to 4%. In select cases, surgical intervention is required. Recent studies have demonstrated that laparoscopy during pregnancy is safe and confers many advantages over laparotomy. Herein we present a series of nine cases collected prospectively that demonstrate the feasibility, safety, and putative benefits of laparoendoscopic single-site surgery for treatment of adnexal masses in pregnant women.

The risk of umbilical hernia and other complications with laparoendoscopic single-site surgery.

STUDY OBJECTIVE: To estimate the risk of umbilical hernia and other latent complications in women who underwent laparoendoscopic single-site surgery (LESS) for a gynecologic indication. DESIGN: Retrospective, nonrandomized clinical study (Canadian Task Force classification II-2). SETTING: Four tertiary care academic medical centers. PATIENTS: Women undergoing LESS for a benign or malignant gynecologic indication from 2009 to 2011. INTERVENTIONS: A total of 211 women underwent LESS via a single 1.5- to 2.0-cm umbilical incision. All surgeries were performed by advanced gynecologic laparoscopists. Incisions were repaired with a running, delayed absorbable suture. Subject demographics and clinical variables were collected and surgical outcomes analyzed. MEASUREMENTS AND MAIN RESULTS: Median age and body mass index were 45 years and 30 kg/m(2), respectively. Approximately half of study subjects underwent a hysterectomy with or without salpingo-oophorectomy, and 15% had a diagnosis of cancer. Overall, 0.9% of women were diagnosed with a preoperative umbilical hernia, and 2.4% of women experienced a major perioperative complication. After a median postoperative follow-up time of 16 months, 2.4% had development of an umbilical hernia. However, 4/5 of these women had significant risk factors for fascial weakening independent of LESS, including requirement for a second abdominal surgery in 1 subject and a cancer diagnosis with postoperative chemotherapy administration in 2 subjects. When these subjects deemed "high risk" for incisional disruption were excluded from the analysis, the umbilical hernia rate was 0.5% (1/207). On univariable analysis, obesity was the only factor associated with complications (p = .04). CONCLUSION: When performed by advanced laparoscopic surgeons, laparoendoscopic single-site gynecologic surgery is associated with a low risk of major adverse events. Additionally, the overall umbilical hernia rate was 2.4% and was lower (0.5%) in subjects without significant comorbidities.

Abnormal cervical cytology in the diagnosis of uterine papillary serous carcinoma: earlier detection of a poor prognostic cancer subtype?

OBJECTIVE: Early detection of uterine papillary serous (UPSC), clear cell (CCC), and grade 3 endometrioid carcinomas (G3EC) - all poor prognostic variants of endometrial carcinoma (EC) - is of particular clinical relevance. The study objective was to assess the utility of liquid-based cytology (Pap) in the detection of high-grade EC. STUDY DESIGN: A retrospective, two-institution analysis of patients diagnosed with UPSC, CCC, or G3EC with a preoperative Pap from 1999 to 2010 was conducted. RESULTS: One hundred and one patients were evaluated; 51.5% had UPSC, 27.7% had CCC, and 20.8% had G3EC. Stage I/II disease was found in 69.3% of patients, and 46/101 patients (45.5%) had abnormal Paps. Significantly more patients with UPSC had abnormal Paps (65.7%) than those with CCC (25%) or G3EC (23.8%; p < 0.001). An abnormal Pap was the only presenting clinical finding in a significant number of asymptomatic UPSC patients (26.9%) compared with 4% of patients with CCC and G3EC (p = 0.005). On multivariate analysis, UPSC histology was the only variable associated with an abnormal Pap. CONCLUSIONS: A high incidence of abnormal cervical cytology was observed in women with high-grade EC, particularly in UPSC patients. Although hypothesis generating, a proportion of asymptomatic UPSC patients had abnormal cytology, signifying that Pap smear screening may help detect the disease before the patient develops symptoms.

Laparoendoscopic single-site surgery (LESS) in gynecology: a multi-institutional evaluation.

OBJECTIVE: The study objectives were to determine the surgical outcomes of a large series of gynecology patients treated with laparoendoscopic single-site surgery (LESS). STUDY DESIGN: This was a retrospective, multi-institutional analysis of gynecology patients treated with LESS in 2009. Patients underwent surgery via a single 1.5- to 2.5-cm umbilical incision with a multichannel single port. RESULTS: A total of 74 women underwent LESS. Procedures were performed for benign pelvic masses (n = 39), endometrial hyperplasia (n = 9), endometrial (n = 15) and ovarian (n = 6) cancers, and nongynecologic malignancies (n = 5). Median patient age and body mass index were 47 years and 28, respectively. A Pearson product-moment correlation coefficient was computed and demonstrated a significant linear relationship between the operating time and number of cases for cancer staging (r = -0.71; n = 26; P < .001) and nonstaging (r = -0.78; n = 48; P < .002) procedures. Perioperative complications were low (3%). CONCLUSION: LESS is feasible, safe, and reproducible in gynecology patients with benign and cancerous conditions. Operative times are reasonable and can be decreased with experience.

Three case reports of laparoscopic management of granulosa cell tumor with intraoperative rupture and subsequent upstaging.

Granulosa cell tumors (GCT) of the ovary account for 2% to 5% of all ovarian tumors and typically demonstrate an indolent clinical course. For a young woman with stage IA disease who wishes to preserve fertility, conservative surgery with laparoscopic techniques can be a safe and effective method. Three patients with clinical presumptive stage IA GCT of the ovary were initially treated with conservative laparoscopic surgery with intraoperative rupture of the tumor. On repeat surgical exploration, all 3 patients were found to have peritoneal disease. Postoperative chemotherapy was required. Several important aspects of laparoscopic management of adnexal masses are highlighted by these 3 case reports. A thorough knowledge about GCT is important. Complete and clean removal of an unknown adnexal mass is imperative.

Inguinal node metastasis as the initial presentation of primary fallopian tube cancer.

BACKGROUND: An initial presentation of inguinal metastasis in primary fallopian tube cancer in an asymptomatic patient is uncommon. All previously described palpable lymphadenopathies in fallopian tube cancer have been associated with widely disseminated intra-abdominal disease. CASE: This is the first case of inguinal node metastasis from fallopian tube cancer in a 72-year-old asymptomatic patient with a previous hysterectomy with no evidence of intra-abdominal disease. The metastasis was detected in the contralateral inguinal area. CONCLUSION: Fallopian tube cancer can present with inguinal metastasis, although this is an uncommon occurrence. A high index of suspicion must be maintained, especially in asymptomatic patients with negative imaging studies.

Primary insular carcinoid of the ovary.

BACKGROUND: Primary insular carcinoid tumor of the ovary is a rare tumor and accounts for fewer than 1% of all cases of carcinoid in the body. With the exception of a single reported case, all previously described functioning ovarian carcinoid tumors have measured at least 10 cm in diameter. Thus, there appears to be a good correlation between the size of the tumor and the presence of the carcinoid syndrome. CASE REPORT: We describe a case of a functioning primary insular carcinoid tumor of the ovary measuring just 6 cm in maximal diameter. CONCLUSION: Although primary ovarian carcinoid tumor is very rare, a high clinical index of suspicion must be maintained, especially in a patient presenting with carcinoid syndrome and a small adnexal mass.