ObjectiveTo evaluate the effect of ovarian preservation on oncologic outcomes for women with low-grade endometrial stromal sarcoma of the uterus.MethodsA systematic search of the Medline, Embase, Cohrane, and Web of Science databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies including patients with low-grade endometrial stromal sarcoma who had hysterectomy were identified. Data on tumor recurrence and death rate were pooled using a random effects model.ResultsA total of 17 studies met the inclusion criteria and reported on 786 patients. Based on available information, ovarian preservation was noted in 190 patients while 501 had bilateral salpingo-oophorectomy. A significantly increased tumor recurrence rate was observed in the ovarian preservation group (89/190, 46.8%) compared with the bilateral salpingo-oophorectomy group (121/501, 24.2%) (OR 2.70, 95% CI 1.39 to 5.28). Based on data from 162 patients, no difference in death rate was noted between the ovarian preservation (2/34, 5.9%) and bilateral salpingo-oophorectomy (9/128, 7%) groups (OR 0.80, 95% CI 0.18 to 3.47).ConclusionsApproximately one-quarter of patients with low-grade endometrial stromal sarcoma were managed with ovarian preservation. These women experienced a higher recurrence rate. Hormone exposure may be responsible for this elevated risk. Given the apparent high salvage rate, however, ovarian preservation may be an option only in a well-informed patient population.
Perianal abscess and fistula are 2 distinct entities that share a common pathology. A horseshoe fistulous abscess, a complex type of these conditions, occurs when the suppurative inflammation spreads through the deep anal space to the bilateral ischiorectal fossae. Following the intersphincteric plane, this infection may extend to the pararectal space, forming a supralevator abscess. We present a very rare case involving a 52-year-old male patient who was admitted to our surgical department with an extraperitoneal purulent inflammation as a complication following multiple drainage procedures for a posterior horseshoe abscess. Emphasis is given to the anatomical and technical considerations of eradication of anorectal sepsis and the management of complex fistula-in-ano along with a concise review of the literature.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. They constitute a distinct group of mesenchymal tumors, presenting different histological aspects in comparison to other types, such as tumors of neural origin (schwannoma and paraganglioma), smooth muscle cell origin (leiomyoma and leiomyosarcoma), fibroblastic tumors, and vascular tumors (angiosarcoma), among others. Gastrointestinal autonomic nerve tumors (GANTs) are rare tumors, probably developing from the myenteric plexus of Auerbach. They are considered as a subgroup of GISTs with specific ultrastructural appearance. Although cytological, immunohistochemical, and ultrastructural characteristics of GIST and GANT appear to be relatively heterogeneous, similarities in pathology may complicate the diagnosis (1).
Background Central pancreatectomy (CP), a partial resection of the pancreas, is indicated for the excision of neuroendocrine tumors (NETs) of the pancreas, when located at the neck or the proximal body. Specifically, CP is preferable in functional NET and in nonfunctional sized 1 to 2 cm or/with proliferation marker Ki67 < 20% (Grade I/II). Postoperative leakage from the remaining pancreas constitutes the most frequent complication of CP (up to 63%). The aim of our study was to share the experience of our center in CP for NET, with pancreaticojejunal anastomosis. Methods In 1 year, we performed CP in two patients, following the aforementioned criteria. They presented with tumor of the body of the pancreas, which was found in random check with computed tomography, with negative hormonal blood tests and they underwent magnetic resonance imaging and endoscopic ultrasound/fine-needle biopsy/pathological examination. Results The patients underwent CP with Roux-en-Y pancreaticojejunal anastomosis of the distal pancreatic stump and jejunal patch of the proximal pancreatic stump. Histological exam revealed NET sized 2.8 cm and 1.45 cm, Grade I and II, respectively. Postoperatively both patients developed small pancreatic leakage, which did not affect their physical condition and stopped after 20 and 30 days. No one needed pancreatic enzymes supplements or developed new-onset diabetes mellitus. Conclusion CP provided adequate, functional remaining pancreatic tissue in both patients. Small leakages were treated conservatively and retreated without septic complications. As a result, CP might be considered as safe and effective technique for pancreatic neck/proximal body NET.
Cecal endometriosis is uncommon and may mimic other tumors of the colon, making it difficult to safely diagnose preoperatively. We report a case of a 50-year-old female who was found to have a cecal lesion during an endoscopic examination, which was performed for the investigation of anemia. It was also confirmed by conducting a computed tomography (CT) scan. Due to the high possibility of this mass identification as a neoplasm, the patient underwent a laparoscopic right hemicolectomy with an extracorporeal side-to-side isoperistaltic anastomosis. However, the postoperative histological diagnosis of the mass was cecal endometriosis, as the histopathology report noted endometrial tissues in the submucosa and muscolaris propria of the ileocecal region. Endometriosis of the cecum is a rare manifestation and can often be misdiagnosed as a malignant tumor. Further research is required, concerning preoperative characteristics of bowel masses in women, in order to provide optimal operative treatment and avoid unnecessary invasive procedures.
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