Background
The lymphovascular space invasion (LVSI) is suggested as a prognostic factor for endometrial cancer in many studies, but it has not yet been employed in FIGO staging system. The present study was aimed to evaluate the impact of LVSI on survival in patients with early stage endometrioid endometrial cancer.
Methods
This retrospective cohort was conducted on early stage endometrial cancer patients who underwent surgical staging [total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO)] and omental biopsy at Referral Teaching Hospitals of Tehran from 2005 to 2021. Patient’s age, menopause status, tumor grade, tumor size, depth of myometrial invasion, LVSI and lower segment involvement were recorded. Data were analyzed with SPSS 22.
Results
415 patients with stage I and grade 1–2, endometrioid endometrial cancer were analyzed. 100 patients (24.1%) were LVSI-positive. 3-year and 5-year survival rates were 97.1% and 88.9%, respectively. Recurrence occurred in 53 patients (12.8%). 3-year overall survival rates in LVSI-negative and LVSI-positive were 98.7% and 92%. These rates for 5-year survival were 92.1% and 79%, respectively. Recurrence rates in LVSI-negative were 8.9% while it was 25% in LVSI-positive cases. Multivariate analysis showed that LVSI has significant correlation with 3-year and 5-year overall survival rates.
Conclusions
LVSI in early stage endometrial cancer significantly and independently influences 3-year and 5-year survival rates and acts as a strong prognostic factor in these patients. LVSI should be implemented in endometrial cancer staging systems due to its significant correlation with cancer recurrence rates and 5-year survival rates.
test. Bivariate analysis between characteristics and hCG level tested with chi-square. Results Twelve cases were analyzed, consisted of choriocarcinoma (7/12), Placental Site Trophoblastic Tumor (2/12), invasive mole (2/12), and hydatidiform mole (1/12). The average patient's age was 37 years old. The highest preoperative hCG level was 378.909 mIU/mL. The highest post-operative beta hCG level was 136.710 mIU/mL. The Average decrease of serum beta HCG was 72.317,34 mIU/ mL. Post-operative hCG levels were found to be normal (<5 mIU/mL) only in four cases (33.33%). There was significant difference of hCG level between pre and post hysterectomy (p=0,002) with strong correlation (r=0,773). Clinical characteristic that correlated with normal Beta hCG level after hysterectomy was WHO score (p=0,007). Age, parity, history of miscarriage, last child age, histopathology type, and surgery type were not correlated with normal hCG level after hysterectomy. Conclusion Hysterectomy was a procedure that can effectively decrease serum Beta HCG level in GTN patients. WHO risk score also correlated with the post-hysterectomy level of serum Beta HCG.
Background
Cervical cancer is a rare malignancy in the 1st months of pregnancy. Implantation of this cancer in an episiotomy scar is a condition that is rarely reported.
Case presentation
We reviewed the literature on this condition and reported a 38 year-old Persian patient who had been diagnosed with cervical cancer, clinically stage IB1, 5 months after a term vaginal delivery. She underwent transabdominal radical hysterectomy with ovarian preservation. Two months later she presented with a mass-like lesion in the episiotomy scar which was proved to be of cervical adenocarcinoma origin after biopsy. The patient was scheduled for chemotherapy with interstitial brachytherapy, an alternative to wide local resection, with successful long-term disease-free survival.
Conclusion
Implantation of adenocarcinoma in an episiotomy scar is a rare occurrence in patients with a history of cervical cancer and previous vaginal delivery near the time of diagnosis which requires extensive local excision as a primary treatment when feasible. The proximity of the lesion to the anus can lead to major complications of extensive surgery. Alternative chemoradiation combined with interstitial brachytherapy can be successful in eliminating cancer recurrence without compromising the functional outcome.
GTN (Gestational trophoblastic neoplasm) complications such as uterine rupture or massive bleeding can be life-threatening and usually need a hysterectomy. In young patients who want to preserve fertility, hysterectomy is not suitable. Under specific circumstances, some physicians choose conservative management. Uterine preservation after complicated GTN is rare by itself. This study presents a 26-year-old woman who developed uterine rupture and massive intraperitoneal bleeding under chemotherapy for GTN. The patient strongly desired her fertility to be preserved; thus, conservative surgical management was done, and the patient could become pregnant in upcoming years.In conclusion, conservative management of GTN patients who develop high-risk complications and desire for future pregnancies must be considered an option. In published case reports, outcomes of conservative surgical management have been very good if managed properly.
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