Mediastinal Metastasis Isolated in Ovarian Cancer: A Systematic Review.

BACKGROUND: Isolated mediastinal metastases from ovarian carcinoma are considered exceptional. Since such metastases are considered advanced stage disease, systemic therapy is the indicated therapeutic approach; however, some articles report that surgical excision is also feasible. METHODS: We reviewed the English-language literature to detect cases of isolated mediastinal ovarian cancer metastases and present the management applied as well as their outcomes. RESULTS: From 1998 to 2022, 15 such cases have been reported, with 4 of those cases being primary ovarian cancer presentation and 11 being ovarian cancer recurrence. The histology of the tumor was serious in all of the cases. Regarding the management of cancer, various methods were applied. In total, 11 of the patients underwent a surgical resection of the mediastinal metastasis, 2 received systemic therapy, 1 received a combination of palliative chemotherapy and radiation and the last patient was treated with laser debulking and radiotherapy. The mean reported follow-up was 11 months. CONCLUSIONS: Solitary mediastinal metastasis from ovarian cancer is very rare; physicians should pay close attention when routinely evaluating thoracic scans from patients with ovarian malignancy as well as individualizing the management in such patients, since surgical resection can also be performed. However, definitive conclusions cannot be drawn from the small number of case reports available.

Robotic-assisted fertility sparing surgery in gynecological oncology.

While gynecological malignancies are more commonly diagnosed in elderly women, a substantial proportion of women will still be diagnosed with some type of gynecologic cancer during their reproductive age. Over 10% of newly diagnosed ovarian cancers and over one third of newly diagnosed cervical cancers involve women who are under the age of 45. This, coupled with the rising trend of women having their first child after the age of 35, has led to a concerning prevalence of complex fertility issues among women who have been diagnosed with cancer. Since the advent of robotic-assisted surgeries in gynecology, there has been a rise in the occurrence of these procedures. Fertility preserving gynecological surgeries require precise management in order to avoid fertility disorders. Therefore, we conducted a narrative review of robotic assisted fertility sparing surgery in gynecologic malignancies in order to highlight the role of this approach in preserving fertility.

Inguinal Lymph Node Metastasis as Sole Manifestation of Ovarian / Fallopian Tube Cancer: a Review of the Literature.

Background: Ovarian/fallopian tube cancer is the deadliest gynecological malignancy. Most cases are diagnosed at an advanced stage, typically after the cancer has spread to the peritoneal cavity, or via lymphatic drainage. The presence of distant lymph node metastasis in the inguinal region is a rare manifestation of lymphatic metastasis. Since the 2014 FIGO staging revision, ovarian cancer patients with inguinal metastasis are classified as stage IVB. However, the clinical significance of such an upstaging remains under investigation. Materials and Methods: Both Scopus and PubMed / MEDLINE databases were utilized, by inputting the following combination of keywords: (Ovarian cancer OR Fallopian tube cancer) AND (Inguinal lymph node AND Metastasis) on June 31st, 2023. The time of publication and text availability were not considered when searching the databases and all relevant articles in English were initially accepted. Results: Twelve patients from equal number of case reports were included in our review. Mean age of diagnosis was 56,5 years old, with 3 out of 12 women to be premenopausal at the time of diagnosis. Regarding the histologic type, 67% (8 out of 12) of the cases were serous adenocarcinoma and 4 patients (33%) were diagnosed with fallopian tube malignancy. All patients, except one, were treated with primary cytoreductive surgery. In all patients optimal cytoreductive surgery was achieved. All patients, except one, received adjuvant chemotherapy. Regarding the disease-free survival, mean DFS is calculated approximately at 2 years (23,1 months). Conclusion: Inguinal lymph node metastases from ovarian / fallopian tube malignancy as initial site of metastasis is extremely rare. However, patients with inguinal masses should be investigated for ovarian / fallopian malignancy. Further investigation ought to be conducted to enlighten the pathway and the oncological significance of inguinal lymph node metastasis in ovarian cancer patients.

Uterine collision tumor (PEComa and endometrioid carcinoma) in a tuberous sclerosis patient: a case report.

Perivascular epithelioid cell tumors are very rare mesenchymal neoplasms arising in various locations, such as the female genital tract, kidney, lung, prostate, bladder, pancreas, soft tissues, and bone. They possess a unique immunophenotype, co-expressing myogenic and melanocytic markers; molecular findings include mutations of tuberous sclerosis complex and translocations of transcription factor E3, a member of the microphthalmia transcription factor gene family. We herewith report a uterine collision tumor consisting of a perivascular epithelioid cell tumor and a moderately differentiated endometrial endometrioid carcinoma in a patient with genetically proven tuberous sclerosis; two leiomyomas were also found in contact with the tumor. Although two such cases one with a benign and another with a malignant perivascular epithelioid cell tumor have previously been reported, ours is, to our knowledge, the first reported in a tuberous sclerosis patient.

Experience With J-Plasma Device in Achieving Complete Cytoreduction in Patients With Ovarian Cancer.

BACKGROUND/AIM: Ovarian cancer remains one of the most lethal malignancies in women. Optimal surgical cytoreduction is the most important prognostic factor of survival in patients with advanced ovarian cancer. The helium gas plasma device (J-Plasma) has recently been introduced into surgical treatment of these patients with some promising results. The aim of this study was to evaluate the utility of J-Plasma in the debulking surgery of patients with ovarian cancer. PATIENTS AND METHODS: A single center retrospective analysis of the characteristics of patients with ovarian cancer who had cytoreductive surgery with the use of J-Plasma device from January of 2020 until July of 2022 was conducted. RESULTS: A total of 13 patients were included in our study. Six patients were treated with primary debulking surgery, whereas seven underwent interval debulking surgery after neoadjuvant chemotherapy. Complete cytoreduction was achieved in nine patients (64%), and CC-1 in four patients. Most of the patients did not face any major complications; only 1 patient suffered from small bowel fistula that needed relaparotomy. CONCLUSION: J-Plasma can safely be used in ovarian cancer debulking surgeries performed by gynecologic oncologists in tertiary centres. This technology can safely increase the complete cytoreduction rates.

Follow the River to the Lake: Sentinel Lymph Node Identification Using the Robotic Platform in Endometrial Cancer Patients.

Sentinel lymph node biopsy for the management of endometrial cancer patients has been introduced into surgical staging of these patients. Several articles and guidelines have evaluated and found sentinel lymph node biopsy as an efficient and oncological safe procedure. The aim of this article is to highlight the most important tips and tricks in order to optimize sentinel lymph node identification and dissection based on our experience. Each step of sentinel lymph node identification technique is analyzed. Tips and tricks, such as site and time of indocyanine green dye injection are essential in optimal identification of sentinel lymph node in patients with endometrial cancer. The standardization of the technique and the recognition of anatomic landmarks are essential as they lead to an improved and effective identification of sentinel lymph node.

Does Obesity Forbid Robotic Gynecological Surgeries? An Urban Legend.

Introduction: Obesity is a worldwide problem that considered to be a challenge in optimal surgical management. A breakthrough in the technologies of minimal invasive surgery over the last ten years has turned robotic approach into the widespread method for surgical management of obese population. Aim: In this study we emphasize the benefits of the robotic assisted laparoscopy versus open laparotomy and conventional laparoscopy in obese women with gynecological disorders. Methods: We conducted a single center experience retrospective study of obese women (BMI 30 Kg/m2) that underwent robotic assisted gynecologic procedures from January 2020 till January 2023. "Iavazzo" score was used in order to predict preoperatively the feasibility of robotic approach as well as the overall operative time. The perioperative management a well as the postoperative course of obese patients were documented and analyzed. Results: 93 obese women underwent robotic surgical management for benign and malignant gynecological disorders. 62 of these women had BMI between 30 and 35 kg/m2 and 31 had BMI 35 kg/m2. None of them was converted into laparotomy. All of the patients had a smooth postoperative course without any complications and were discharged at the first postoperative day. Mean operative time was 150 min. Conclusions: Our 3-year experience in robotic-assisted gynecologic surgery in obese patients has revealed numerous benefits concerning perioperative management and postoperative rehabilitation.

Pancreatic endometriosis: a systematic review.

Background: Extrapelvic manifestations of endometriosis can be identified in nearly every part of the female body, and the true prevalence of extrapelvic locations is unknown. Pancreatic endometriosis may manifest in several ways, ranging from emergency presentations to asymptomatic cysts. Method: A systematic PubMed and Scopus search was conducted. Results: Eighteen patients from 17 case reports were included. The patients' mean age was 39.3 (range: 21-72) years. An emergency presentation was noted in 8 of the 18 (44.4%) patients. Menstrual irregularity was present in 3 (16.7%) patients, while in 3 (16.7%) cases there was simultaneous presence of endometriosis elsewhere. The most frequent symptoms at presentation of pancreatic endometrial cysts were epigastric pain, acute left upper quadrant pain, back pain, nausea/vomiting/diarrhea, which occurred in 12 (66.7%), 11 (61.1%), 4 (22.2%), and 6 (33.3%) patients, respectively. Only one case presented as an asymptomatic pancreatic cyst. The maximum diameter of the endometrial cysts ranged from 1-16 cm. In the majority of cases, surgical treatment was offered (16/18, 88.9%). Recurrence of pancreatic endometrial cyst occurred in one case only, following needle aspiration of the endometrial cyst. No fatality was reported. Conclusions: Review of the available published literature suggests that pancreatic endometriosis is a rare condition that should be included in the differential diagnosis of pancreatic masses. Further clinical and experimental studies are necessary to investigate the pathogenesis of extrapelvic and pancreatic endometriosis.