Giant fibroids are very rare in current practice, posing a management challenge. Careful consideration of the benefits and limitations of each treatment option must be considered. This article summarises current management of giant leiomyomas, with a clinical case example and recent review of the literature.
We present a case of a mucinous borderline ovarian tumour in a 16-year-old patient. It was removed by ovarian cystectomy before histological confirmation of its borderline nature.
Pregnant women may require nonobstetricrelated abdominopelvic surgery. Traditionally, a laparotomy has been the preferred approach. Recent data suggest that this method should be reviewed in light of developments in minimal access surgical techniques. This article compares both approaches and, in particular, discusses the use of laparoscopy in the 2nd and 3rd trimesters of pregnancy.
One hundred and forty six patients with advanced germ cell testicular tumours (38 seminomas and 108 malignant teratomas) treated by combination chemotherapy were studied over 10 years. Most of the improvement seen was in patients with malignant teratoma undifferentiated. In the most recently treated patients (1984-1987) 75% of drug resistant cases were malignant teratoma intermediate compared with 26% in the series treated between 1978-1983. The microscopic features of 52 primary testicular tumours were compared with features seen in excised retroperitoneal lymph nodes after completion of chemotherapy. Primary malignant teratoma intermediate had a higher incidence of viable malignancy in the excised tissue than malignant teratoma undifferentiated. Mature teratoma or fibronecrotic tissue within resected tissue was associated with a good prognosis. If resection was complete patients with drug resistant malignant teratoma intermediate had a more favourable prognosis than drug resistant malignant teratoma undifferentiated. It is advised that retroperitoneal node dissection should be considered in the management of patients with advanced germ cell testicular tumours, and that as complete a resection as possible be attempted to avoid the danger of missing residual disease.
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