Műllerian duct anomalies and their effect on the radiotherapeutic management of cervical cancer

Rastogi, Madhup; Revannasiddaiah, Swaroop; Thakur, Pragyat; Thakur, Priyanka; Gupta, Manish; Gupta, Manoj Kumar; Seam, Rajeev Kumar

doi:10.5732/cjc.012.10222

Cited by 4 publications

(4 citation statements)

References 31 publications

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“…Considering the high incidence of cervical carcinoma worldwide, the absolute number of cervical carcinomas in patients with genitourinary malformation might be expected to be very high, especially in less developed regions. However, the opposite is true, as the number of reported cases is low 5. This may be because the incidence of cervical carcinoma in developed countries is very low; moreover, many less developed regions are less likely to be able to afford imaging prior to surgery or radiotherapy, resulting in a missed diagnose of genitourinary malformations.…”

Section: Introductionmentioning

confidence: 99%

Carcinoma of the lower female genital tract in patients with genitourinary malformations: a clinicopathologic analysis of 36 cases

Zong

Wang

et al. 2019

J. Cancer

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Background : Lower genital tract carcinomas that coexist with genitourinary malformations are rare. The aim of this study was to investigate the clinicopathologic characteristics and outcomes of patients with this rare joint condition. The aim of this study was to investigate the clinicopathologic characteristics and outcomes of these patients to analyze the associations among clinicopathologic features in this rare entity. Methods : The medical records of patients with carcinoma of lower genital tract combined with genital tract malformations who were treated at Peking Union Medical College Hospital (Beijing, China) between January 1995 and December 2017 were retrospectively reviewed and a comprehensive literature review was performed. The correlations between variables were determined using Fisher's exact test. Results : Thirty-six patients were identified, among whom 22 had cervical carcinoma, 10 had vaginal carcinoma, and two had carcinomas of both the cervix and vagina. The most common genital tract anomaly was uterus didelphys (n=17), and 63.9% of patients had with urinary tract malformations. Twenty-five (69.4%) had pathologically confirmed adenocarcinoma, 10 (27.8%) had squamous cell carcinoma (SCC), and 1 had adenosquamous carcinoma. Patients with urinary tract malformations developed adenocarcinoma more frequently than those without malformations (95.7% vs. 30.8% P <0.001). Compared with patients with SCC, patients with adenocarcinoma presented at a younger age (36.1 vs. 47.0 years, P =0.011), had more advanced stages disease (57.7% vs. 10.0% were in stage II-IV, P =0.022), and tended to have poorer five-year overall survival rates (75.6% vs. 100.0%, P =0.279). Conclusions : Patients with simultaneous malformations of the genital and urinary tracts had a high probability of developing adenocarcinoma. It is recommended that rigorous gynecologic exams with Pap smears and imaging analyses be performed periodically in women with genital malformations, as they may be at a risk of genital malignancies.

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Section: Introductionmentioning

confidence: 99%

Carcinoma of the lower female genital tract in patients with genitourinary malformations: a clinicopathologic analysis of 36 cases

Zong

Wang

et al. 2019

J. Cancer

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“…However, it has been estimated that as many as 5% of cervical cancer patients may have undetected malformations. With many cases of cervical cancer diagnosed and treated in economically disadvantaged areas where CT and MRI imaging are not readily available (and as such are not required by FIGO for staging), the true incidence of those with a coexisting uterine anomaly and cervical cancer may be underreported [ 14 ]. Most are treated with surgical approaches when feasible, due to anatomic difficulties in managing these patients from a radiotherapeutic perspective [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…With many cases of cervical cancer diagnosed and treated in economically disadvantaged areas where CT and MRI imaging are not readily available (and as such are not required by FIGO for staging), the true incidence of those with a coexisting uterine anomaly and cervical cancer may be underreported [ 14 ]. Most are treated with surgical approaches when feasible, due to anatomic difficulties in managing these patients from a radiotherapeutic perspective [ 14 ]. Our review of the literature revealed only 2 cases of cervical cancer in women with congenital anomalies of the female reproductive tract treated with definitive radiotherapy with cervical BT as a component of treatment [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Cervical brachytherapy technique for locally advanced carcinoma of the cervix in a patient with septate uterus

Platta¹,

Wallace²,

Gondi³

et al. 2014

jcb

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PurposeTo describe an approach to cervical brachytherapy in a patient with congenital septate uterus and locally advanced cervical carcinoma.Material and methodsThe patient is a 34-year-old female with septate uterus presenting with pelvic pain. Workup demonstrated a stage IIB cervical adenocarcinoma with imaging evidence of an involved right external iliac lymph node. The patient received whole pelvic radiation, with concurrent weekly cisplatin (40 mg/m2), to a dose of 45 Gy in 25 fractions followed by a parametrial boost of 5.4 Gy and an additional nodal boost of 9 Gy.ResultsThe patient was initiated on cervical brachytherapy following fraction 23 of pelvic radiation. To conform to her septated uterus, a Rotte-Y tandem was used. Additionally, 2 CT-compatible ovoids were placed in the vaginal apex to enhance dose distribution and coverage of the target volume. Each fraction of brachytherapy was performed with CT-based planning. A high-risk clinical target volume (HR-CTV) and normal structures were defined and constrained per American Brachytherapy Society (ABS) and Groupe Européen de Curiethérapie/European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) guidelines. The brachytherapy dose was 27.5 Gy in 5 fractions of 5.5 Gy each, prescribed to the HR-CTV.ConclusionsHerein, we report the first documented case of cervical brachytherapy in a patient with septate uterus and locally advanced cervical carcinoma. Using CT-guided planning, in conjunction with the ABS and GEC-ESTRO guidelines, the patient was effectively treated with adapted cervical brachytherapy, meeting criteria for HR-CTV coverage and normal tissue tolerances.

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“…A transverse vaginal septum resulting from defects in vertical fusion may be associated [9,13]. According to the American Fertility Society (AFS) classification, uterus didelphys belongs to the Class III, which includes malformations arising from complete absence of fusion of the two Mu¨llerian ducts [9,[12][13][14].…”

Section: Embryologymentioning

confidence: 99%

Herlyn–Werner–Wunderlich syndrome: pre- and post-surgical MRI and US findings

Dias

Jogo

2015

Abdom Imaging

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Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare congenital anomaly of the female urogenital tract that associates Mu¨llerian duct anomalies with mesonephric duct anomalies. The triad of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis characterizes this syndrome. Patients generally present with non-specific symptoms after menarche. Pelvic pain, dysmenorrhea, and palpable mass due to hematocolpos or hematometra are the most common findings. Pyohematocolpos and pyosalpinx may appear as acute complications, while endometriosis and pelvic adhesions constitute potential long-term complications. When a prenatal diagnosis of unilateral renal agenesis in newborn girls is known, a gynecological imaging study should be performed to exclude uterine and vaginal abnormalities. These patients should be followed up to ensure that a timely surgical correction is performed. The diagnosis of HWWS is difficult due to the lack of specific symptoms or findings upon physical examination. An accurate imaging description of these congenital anomalies is crucial to guide patients toward surgical treatment, relieving acute complications, and preserving the normal fertility. The authors provide a pictorial review of the magnetic resonance imaging and ultrasonography findings of the HWWS with correlation to embryological, clinical, and surgical features.

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Műllerian duct anomalies and their effect on the radiotherapeutic management of cervical cancer

Cited by 4 publications

References 31 publications

Carcinoma of the lower female genital tract in patients with genitourinary malformations: a clinicopathologic analysis of 36 cases

Carcinoma of the lower female genital tract in patients with genitourinary malformations: a clinicopathologic analysis of 36 cases

Cervical brachytherapy technique for locally advanced carcinoma of the cervix in a patient with septate uterus

Herlyn–Werner–Wunderlich syndrome: pre- and post-surgical MRI and US findings

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