We identified seven cases of uterine PEComa diagnosed and treated at our center. The search strategy identified 51 papers for a total of 121 cases of uterine PEComa.The uterine corpus was the most frequent localization (n=55; 45.7%), and uterine bleeding was the clinical presentation in 36 (32.5%) cases. In most cases, the diagnosis was at the final pathological examination (n=39; 83%). Among those who recurred or dead due to disease, the median time to recurrence was 18 (2-82; IQR 4-21.7) months and the median time to death was 17.5 (5-43; IQR 12-35) months. The malignant group reported a higher rate of recurrence and cause-specific death than the benign group in all classifications. The Bennet system (figure 1-2) reported the highest HR for relapse and death due to PEComa in the malignant group versus the benign group (HR 14.17; 95% CI 4.29 -46.72 for relapse; HR 33.17, 95% CI 4.39 -4246.79 for death). Conclusion Preoperative diagnosis of uterine PEComa is uncommon without specific clinical presentation. Among proposed classification systems, the Bennet system reported the highest ability to distinguish between benign and malignant behaviors.
Introduction/Background The 2020 WHO classification of gynaecological tumors has introduced as the main criteria for classification of vulvar squamous cell carcinomas (VSCC) their etiological relationship with human papillomavirus(HPV) infection, dividing VSCC into two categories: HPV-associated and HPV-independent VSCC. Additionally, recent evidence suggests that HPV-independent tumors should be further divided according to p53 mutational status. We aimed to evaluate the clinical and prognostic implications of these new criteria. Methodology We retrospectively identified patients treated for VSCC in our hospital from 1985 to 2022 (n=196). Tumors were reviewed and classified in compliance with 2020 WHO criteria, according to p16 immunohistochemistry and HPV testing. HPV-independent tumors were subclassified as p53 wild-type and mutant. The clinical and pathological features of tumors were compared and disease free-survival (DFS) and disease-specific survival (DSS) were evaluated using univariate and multivariate analysis.
We identified seven cases of uterine PEComa diagnosed and treated at our center. The search strategy identified 51 papers for a total of 121 cases of uterine PEComa.The uterine corpus was the most frequent localization (n=55; 45.7%), and uterine bleeding was the clinical presentation in 36 (32.5%) cases. In most cases, the diagnosis was at the final pathological examination (n=39; 83%). Among those who recurred or dead due to disease, the median time to recurrence was 18 (2-82; IQR 4-21.7) months and the median time to death was 17.5 (5-43; IQR 12-35) months. The malignant group reported a higher rate of recurrence and cause-specific death than the benign group in all classifications. The Bennet system (figure 1-2) reported the highest HR for relapse and death due to PEComa in the malignant group versus the benign group (HR 14.17; 95% CI 4.29 -46.72 for relapse; HR 33.17, 95% CI 4.39 -4246.79 for death). Conclusion Preoperative diagnosis of uterine PEComa is uncommon without specific clinical presentation. Among proposed classification systems, the Bennet system reported the highest ability to distinguish between benign and malignant behaviors.
were present during the procedures. We analyzed the oncologic outcome and the complications to evaluate the feasibility and safety of the procedure. Results From September 2020 to February 2022, a total of three patients with aggressive pelvic tumors underwent cytoreductive surgery. The first and third patients were diagnosed with high-grade serous ovarian cancer, whereas the second suffered from stromal proliferation. The left external iliac vein resection was performed in the first patient, with no reconstruction needed due to the presence of collaterals. In patient 2, partial resection and reconstruction of the left external iliac artery was performed. The infrarenal inferior vena cava was resected in patient 3. Low-molecular-weight heparin and antiembolism stockings were administered as thromboprophylaxis. In all three patients, intra/post-operative transfusions of blood components were needed. Vascular postoperative complications were edema of the left inferior limb(patient 1); and compartment syndrome with initial neurologic damage(patient 2), requiring thrombectomy and stenting of the left common iliac, deep and superficial femoral artery, and medial and lateral left lower limb fasciotomy. Both patients with ovarian cancers received adjuvant chemotherapy. Follow-up visits and total body CT scans at 3 and 6 months were negative for recurrence. Conclusion Surgical management of tumors involving vascular structures can lead to extended and challenging procedures. From our small case series, we believe that in case of tumor infiltrating major vessels, complete resection is feasible and should be performed to achieve optimal cytoreduction.
Introduction/Background Scarce evidence supports Cancer Antigen 125 (CA125) as a reliable recurrence biomarker in patients affected by Ovarian Cancer (OC) on maintenance treatment with PARP inhibitors (PARPi) or Bevacizumab after response to platinum-based therapy.Our aim is to assess concordance between CA125 increase and Response Evaluation Criteria In Solid Tumours (RECIST) progression in these patients. Methodology The study includes 109 patients affected by CA125-sensitive OC on maintenance treatment with Bevacizumab (group A) or PARPi (group B) for at least two months after complete/partial response to platinum-based therapy. 55 patients underwent PARPi, 54 Bevacizumab. Data were concordant if CA125 increased within a month from radiological progression; otherwise they were considered discordant.Results 38 (34.9%) patients relapsed under maintenance treatment; 18 (47.4%) had recurrence with PARPi, 20 (52.6%) under Bevacizumab.In group A concordant cases were 12 (60%), discordant cases accounted for 8 (40%). In this last category of patients in half cases CA125 increased before radiological progression, while in the other half marker was permanently negative; CA125 never increased after radiological progression.In group B concordant cases were 7 (38.9%), discordant ones were 11 (61.1%). In this last category of patients in 4 cases (36.4%) CA125 increased after radiological progression, while in the other 7 (63.6%) CA125 was constantly negative; marker never increased before radiological progression. Conclusion In patients treated with PARPi CA125 does not always correlate with disease progression; in fact, in cases of relapse highlighted with imaging techniques, marker remains within the normal range. This contrasts with what happens in patients treated with Bevacizumab.In conclusion, CA125 and imaging should always be evaluated together.
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