Ovarian Carcinoma Presenting With a Large Cervical Mass.

Cervical metastasis in ovarian cancer is a rare entity. Therefore, care should be taken in the differential diagnosis of cervical masses as it may mimic a primary tumor. This report aimed to emphasize the importance of a multidisciplinary approach in these tumors. We present a case of a 73-year-old female who presented with post-menopausal vaginal bleeding and cervical mass. The patient was diagnosed with ovarian carcinoma with a multidisciplinary approach. Although cervical metastasis of ovarian cancer is rare, the possibility of secondary cancer should be kept in mind, especially in cervical tumors with atypical clinical course.

Does Preoperative Diagnosis of Endometrial Hyperplasia Necessitate Intraoperative Frozen Section Consultation?

BACKGROUND: In women with endometrial hyperplasia, there is a risk for co-existent endometrial cancer when patients are subjected to immediate surgical treatment. AIMS: The aim of this study was to investigate the frequency of endometrial cancer and the accuracy of frozen section analysis at the time of hysterectomy among patients with endometrial hyperplasia, to reveal whether or not a preoperative diagnosis of endometrial hyperplasia necessitates frozen section consultation. STUDY DESIGN: Retrospective cross-sectional study. METHODS: A department database review was performed to identify patients who were subjected to hysterectomy with a preoperative diagnosis of endometrial hyperplasia, during the period from 2007 to 2014. RESULTS: The study group included 189 cases. The final pathological examination revealed endometrial cancer in 16 women (8.4%). The risk of cancer in patients with endometrial hyperplasia was 1 of 125 (0.8%) in simple hyperplasia without atypia, 1 of 21 (4.8%) in complex hyperplasia without atypia and 14 of 43 (32.5%) in atypical hyperplasia. Of women with cancer, 2 of 16 (12.5%) had high-risk features. Frozen section analysis was requested in 46 cases. Frozen sections helped to identify six out of 11 cases of endometrial cancer (54.5%). The sensitivity, specificity and positive and negative predictive values of frozen section analysis for the detection of endometrial cancer among women with endometrial hyperplasia were 54.4%, 97.2%, 85.7% and 87.5%, respectively. CONCLUSION: Although a significant proportion of patients with atypical endometrial hyperplasia are diagnosed with endometrial cancer following hysterectomy, most of these cases have low-risk features and do not require surgical staging. Additionally, intraoperative frozen section analysis if not helpful for diagnosing concurrent endometrial cancer in patients with endometrial hyperplasia. Therefore, it seems that patients with endometrial hyperplasia can be operated upon in settings with no available method for obtaining frozen sections intraoperatively.

Clinical and pathological characteristics related to parametrial involvement in clinical early-stage cervical cancer.

OBJECTIVES: Since parametrial involvement is believed to be a crucial factor in the management of cervical cancer, our study was designed to investigate the clinical and pathological features which predicted parametrial involvement in patients with clinical early-stage cervical cancer. MATERIAL AND METHODS: The study included patients with clinical early-stage cervical cancer who underwent radical hys-terectomy with pelvic and para-aortic lymphadenectomy between December 2001 and August 2014, at the Hacettepe University Hospital. The clinical and pathological characteristics of the affected patients were evaluated, including age, histologic subtype, tumor size, depth of cervical stromal invasion, lympho-vascular space invasion (LVSI), and lymph node metastasis. Univariate and multivariate analyses were performed to reveal factors associated with parametrial involvement. RESULTS: The study group consisted of 126 patients (mean age: 52.7 years; range: 29-83), including 101 (80.2%) with squamous, 19 (15.1%) with adenocarcinoma, and 6 (4.8%) with adenosquamous histological subtype of cervical cancer. Parametrial involvement and lymph node metastasis were detected in 41 (32.5%) and 46 (36.5%) women, respectively. Univariate analysis showed that deep cervical stromal invasion, LVSI, tumor size > 2 cm and lymph node metastasis were associated with parametrial involvement. Multivariate logistic regression analysis identified the independent risk factors associated with parametrial involvement as LVSI (OR 8.93, 95% CI 1.1-73.5, p = 0.042) and lymph node metastasis (OR 8.8, 95% CI 1.5-9.3, p = 0.004). CONCLUSIONS: LVSI, deep cervical stromal invasion, lymph node metastasis and tumor size are significantly associated with parametrial involvement in patients with clinical early-stage cervical cancer.

Role of postmenopausal bleeding pattern and women's age in the prediction of endometrial cancer.

BACKGROUND: Women with postmenopausal bleeding should be evaluated efficiently to exclude endometrial carcinoma. AIMS: To estimate the risk of endometrial cancer using individual case characteristics among women with postmenopausal bleeding in whom the endometrial thickness is >4 mm. METHODS: Women with postmenopausal bleeding underwent clinical evaluation followed by transvaginal ultrasonography and endometrial biopsy. Clinical evaluation included age, body mass index, duration of menopause, number of bleeding episodes and amount of bleeding. RESULTS: This study included 142 women, and endometrial carcinoma was found in 18 (12.7%). Older age, higher body mass index, longer duration of menopause, longer lasting bleeding episodes, higher amount of bleeding and recurrent bleeding episodes were the clinical characteristics associated with endometrial cancer. However, multivariate analysis revealed >55 years of age during postmenopausal bleeding, history of recurrent bleeding episodes and bleeding exceeding 5 pads per day in each episode as significant parameters, which predicted the presence of endometrial cancer among women with postmenopausal bleeding. CONCLUSIONS: Prompt evaluation is required in women with postmenopausal bleeding to exclude endometrial cancer. Transvaginal ultrasonography is a reasonable first-line approach, and invasive sampling is required when ultrasonographic endometrial thickness is above 4 mm. However, about 90% of women with postmenopausal bleeding will finally be found to have a nonmalignant condition. Therefore, women who are at increased cancer risk should further be distinguished. This may be achieved using individual patient characteristics that result in a more accurate evaluation strategy with lower rates of unnecessary invasive procedures.

Use of hyaluronic acid for vaginal stenosis in a woman with a history of imperforate hymen and transverse vaginal septum: a case report.

BACKGROUND: Female reproductive tract abnormalities are common and may occur in various combinations. Management usually involves surgery. However, therapeutic failures may be experienced and repeated surgical interventions may be required. CASE: A 26-year-old woman who was subjected to surgery for imperforate hymen coexistent with transverse vaginal septum 10 years previously presented with hypomenorrhea and severe dysmenorrhea. Vaginal stenosis at the level of partially excised transverse septum was detected. The patient was successfully managed with complete surgical excision of transverse vaginal septum with application of hyaluronic acid to prevent restenosis. CONCLUSION: Women presenting with a reproductive tract abnormality should be evaluated carefully to detect the presence of combined abnormalities and to avoid the need for additional interventions. Also, further studies are needed to warrant the use of adhesion-preventing agents as an adjunct to surgical procedures to avoid therapeutic failures.

Prognostic factors for recurrence and survival in primary vulvar squamous cell cancer.

OBJECTIVE: To evaluate survival estimates and clinico-pathological variables in women with primary vulvar squamous cancer. DESIGN: Retrospective observational study. Setting. University hospital in Turkey. POPULATION OR SAMPLE: Patients treated for primary vulvar squamous cancer. METHODS: Retrospective evaluation of demographic, pathologic and follow-up data of 91 patients obtained from hospital records and private gynecologic oncology files. MAIN OUTCOME MEASURES: Recurrence rate and survival estimates. RESULTS: The mean age at the time of diagnosis was 62 years. Of the women, 62% had early stage disease (stages I-II), while 39% had advanced stages (stages III-IV) at diagnosis. The overall recurrence rate was 13%. Recurrence rates were significantly higher in the presence of local wide-deep excision as an initial treatment, larger initial tumor size, positive lymph node involvement, advanced stage, presence of ulcerative lesions and adjuvant radiotherapy. The overall and 5-year survival estimates were 92 and 83%, respectively. CONCLUSION: Lymph node invasion, stage, having ulcerative lesion, receiving adjuvant therapy, tumor diameter larger than 10 mm and having local excision as primary surgery may increase the risk of recurrent disease.