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BACKGROUND: Sentinel lymph node mapping is a minimally invasive surgical staging procedure that allows identification of macro- and micrometastases. The implementation of sentinel lymph node mapping to women with low-grade endometrial cancer allows detection of lymph node metastases and avoids the morbidity of radical pelvic lymphadenectomy. The extent of myometrial invasion is highly predictive of lymph node metastases but is hard to determine precisely preoperatively. The exact rate of lymph node metastases in the large group of women with <50% myometrial invasion is low but unknown. The benefit of detecting metastases in this group should balance the risk of lymphedema. There is limited knowledge of early and late lymphedema and its impact on the quality of life in women with low-grade endometrial cancer following sentinel lymph node mapping. OBJECTIVE: The primary objective was to investigate the risk of patient-reported lymphedema after SLN mapping in women with low-grade endometrial cancer. In addition, we aimed to evaluate risk factors for lymphedema and the condition-specific quality of life (QoL) among women who reported lymphedema 12 months after surgery. STUDY DESIGN: Women with presumed stage I low-grade endometrial cancer were included in a national prospective cohort study on SLN mapping from March 2017-February 2022. Women completed a package of validated patient-reported outcome measures (PROMs) before surgery, three and 12 months after surgery. The primary outcome was the leg lymphedema domain score from the European Organisation for Research and Treatment of Cancer endometrial cancer-specific module (EORTC QLQ-EN24). The lymphedema assessment was further supplemented by seven validated single items from the EORTC item library addressing lymphedema of legs, genitals, and groin. The disease-specific QoL was assessed using the validated Lymphedema quality of life tool (LYMQOL). Scores were linearly transformed to 0-100. A change from baseline of 8 points in leg lymphedema sum-score was considered clinically important. Mean difference scores over time with 95% CI were estimated. Multiple linear regression models evaluated baseline predictors associated with the 12 month postoperative lymphedema score, and if early lymphedema predicted lymphedema at 12 months after surgery. Lymphedema condition-specific QoL was evaluated for women with lymphedema. RESULTS: Seventy-nine % (486/617) completed PROMs at baseline and 12 months. The mean difference score of leg lymphedema from baseline to 12 months was 5.0, CI [3.3, 6.8], i.e., below the threshold for clinical importance. Baseline leg lymphedema score and BMI were positively associated with the leg lymphedema score at 12 months. The leg lymphedema score at three months was associated with a higher 12-month score. High scores of lymphedema at 12 months were negatively associated with the women's daily activities, appearance, emotional functioning, and global QoL and increased their subjective symptom burden. CONCLUSIONS: Women with low-grade endometrial cancer have a low risk of lymphedema after SLN mapping. Leg swelling at baseline and BMI predicted more lymphedema at 12 months after surgery. Early lymphedema at three months predicted persistent lymphedema. A high leg lymphedema score at 12 months is associated with impairment in several aspects of QoL.
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INTRODUCTION: The objective of the study was to provide a comprehensive description of perioperative morbidity associated with robot-assisted surgery (RAS) in a gynecological oncology setting in order to improve the preoperative counseling of women and support shared decision-making. MATERIAL AND METHODS: All women scheduled for intended RAS between January 2015 and December 2022 were prospectively included in an electronic morbidity database for the analyses of perioperative complications. RESULTS: In total, 2225 women were included. Sixty-four patients (2.9%) experienced an intraoperative complication. Intraoperative complications were associated with a higher rate of conversion to laparotomy (15.6% vs. 1.8%, p < 0.001), a higher rate of major postoperative morbidity (9.3% vs. 2.4%, p < 0.001), and a higher rate of reoperation (9.3% vs. 1.7%, p < 0.001), compared to cases without intraoperative complications. Thirty-day postoperative morbidity was evaluated according to the Memorial Sloan-Kettering Cancer Center Surgical Secondary Events Grading System. Grade 3-5 events were considered major. A total of 57 patients (2.6%) experienced a major event after surgery, postoperative rupture of the vaginal vault being the most common complication requiring surgical intervention. Conversion to laparotomy occurred in 49 cases (2.2%) and was associated with higher intraoperative blood loss (300 mL vs. 25 mL, p < 0.001), a higher rate of postoperative major events (20.4% vs. 2.2%, p < 0.001), and a higher rate of reoperation (11.8% vs. 1.6%, p < 0.001). CONCLUSIONS: Our study demonstrates low rates of major perioperative morbidity and conversion to laparotomy after RAS performed by trained high-volume surgeons in a gynecological oncology setting.
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Neoplasias dos Genitais Femininos , Procedimentos Cirúrgicos em Ginecologia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos , Humanos , Feminino , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Adulto , Estudos de Coortes , Idoso , Estudos Prospectivos , Reoperação/estatística & dados numéricosRESUMO
INTRODUCTION: It is unclear if sentinel node (SLN) mapping can replace pelvic- (PLD) and paraaortic lymphadenectomy (PALD) for high-risk endometrial cancer (EC). A diagnostically safe surgical algorithm, taking failed mapping cases into account, is not defined. We aimed to investigate the diagnostic accuracy of SLN mapping algorithms in women with exclusively high-risk EC. METHODS: We undertook a prospective national diagnostic cohort study of SLN mapping in women with high-risk EC from March 2017 to January 2023. The power calculation was based on the negative predictive value (NPV). Women underwent SLN mapping, PLD and PALD besides removal of suspicious and any FDG/PET-positive lymph nodes. Accuracy analyses were performed for five algorithms. RESULTS: 170/216 included women underwent SLN mapping, PLD and PALD and were included in accuracy analyses. 42/170 (24.7%) had nodal metastasis. The algorithm SLN and PLD in case of failed mapping, demonstrated a sensitivity of 86% (95% CI 74-100) and an NPV of 96% (95% CI 91-100). The sensitivity increased to 93% (95% CI 83-100) and the NPV to 98% (95% CI 94-100) if PLD was combined with removal of any PET-positive lymph nodes. Equivalent results were obtained if PLD and PALD were performed in non-mapping cases; sensitivity 93% (95% CI 83-100) and NPV 98% (95% CI 95-100). CONCLUSION: SLN-mapping is a safe staging procedure in women with high-risk EC if strictly adhering to a surgical algorithm including removal of any PET-positive lymph nodes independent of location and PLD or PLD and PALD in case of failed mapping.
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Neoplasias do Endométrio , Endometriose , Linfonodo Sentinela , Feminino , Humanos , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/cirurgia , Linfonodo Sentinela/patologia , Estudos Prospectivos , Estudos de Coortes , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/cirurgia , Excisão de Linfonodo/métodos , Endometriose/cirurgia , Algoritmos , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Linfonodos/patologia , Estadiamento de NeoplasiasRESUMO
OBJECTIVE: The SENTIREC-endo study aims to investigate risks and benefits of a national protocolled adoption of sentinel lymph node (SLN) mapping in women with early-stage low-grade endometrial cancer (EC) with low- (LR) and intermediate-risk (IR) of lymph node metastases. METHODS: We performed a national multicenter prospective study of SLN-mapping in women with LR and IR EC from March 2017-February 2022. Postoperative complications were classified according to Clavien-Dindo. Lymphedema was assessed as a change score and as incidence of swelling and heaviness evaluated by validated patient-reported outcome measures at baseline and three months postoperatively. RESULTS: 627 women were included in the analyses; 458 with LR- and 169 with IR EC. The SLN detection rate was 94.3% (591/627). The overall incidence of lymph node metastases was 9.3% (58/627); 4.4% (20/458) in the LR- and 22.5% (38/169) in the IR group. Ultrastaging identified 62% (36/58) of metastases. The incidence of postoperative complications was 8% (50/627) but only 0.3% (2/627) experienced an intraoperative complication associated with the SLN procedure. The lymphedema change score was below the threshold for clinical importance 4.5/100 CI: (2.9-6.0), and the incidence of swelling and heaviness was low; 5.2% and 5.8%, respectively. CONCLUSION: SLN mapping in women with LR and IR EC carries a very low risk of early lymphedema and peri- and postoperative complications. The national change in clinical practice contributed to a more correct treatment allocation for both risk groups and thus supports further international implementation of the SLN technique in early stage, low grade EC.
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Neoplasias do Endométrio , Endometriose , Linfedema , Linfonodo Sentinela , Feminino , Humanos , Linfonodos/cirurgia , Linfonodos/patologia , Biópsia de Linfonodo Sentinela/efeitos adversos , Biópsia de Linfonodo Sentinela/métodos , Metástase Linfática/patologia , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Linfonodo Sentinela/cirurgia , Linfonodo Sentinela/patologia , Estudos Prospectivos , Neoplasias do Endométrio/patologia , Endometriose/cirurgia , Linfedema/epidemiologia , Linfedema/etiologia , Linfedema/patologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Medição de Risco , Estadiamento de NeoplasiasRESUMO
This is a case report of a 56-year-old woman with a history of postmenopausal bleeding, who presented with an endometrioid adenocarcinoma and a co-existing non-gestational choriocarcinoma. We performed robotic assisted hysterectomy, bilateral oophorectomy and pelvic lymphadectomy, and histopathologic examination revealed a malignant tumour showing an endometrioid adenocarcinoma grade 2 with a minor component of choriocarcinoma incorporated into the adenocarcinoma. We compared data from exome sequencing of DNA from tumour and blood to show, that the choriocarcinoma component was most likely non-gestational.
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Carcinoma Endometrioide , Coriocarcinoma não Gestacional , Coriocarcinoma , Carcinoma Endometrioide/diagnóstico , Carcinoma Endometrioide/cirurgia , Coriocarcinoma/diagnóstico , Coriocarcinoma/cirurgia , Coriocarcinoma não Gestacional/diagnóstico , Coriocarcinoma não Gestacional/cirurgia , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Gravidez , ÚteroRESUMO
PURPOSE: Malignant cells exhibit increased rates of aerobic glycolysis. Here, we tested whether the accumulation of fluoro-deoxyglucose-6-phosphate (FDG6P) in ovarian cancers of differential malignancy reflects inversely correlated elevations of hexokinase (HK) and glucose-6-phosphatase (G6Pase) activities. PROCEDURES: Twenty-nine women with suspected ovarian cancer had positron emission tomography (PET) prior to surgery. From fresh-frozen tissue, we determined the activities of HK and G6Pase, and from the PET images, we determined the tumor maximum standardized uptake value (SUVmax) of 2-deoxy-2-[18F]fluoro-D-glucose. RESULTS: The SUVmax of malignant lesions significantly exceeded the SUVmax of benign (p < 0.005) and borderline lesions (p < 0.0005) that did not differ significantly. We found no significant correlation between measured HK or G6Pase activities and histological tumor type or SUVmax except that G6Pase activities were higher in malignant than borderline lesions (p < 0.05). Measured HK and G6Pase activities correlated inversely (p < 0.05). The slopes from the regression lines of the three correlations yielded positively correlated abscissa and ordinate intercepts, designated HKmax and G6Pasemax, respectively (r = 0.67, p < 0.0001). The positive correlations between the abscissa and ordinate intercepts with SUVmax had regression coefficients of r = 0.44, p < 0.05; and r = 0.39, p < 0.05, respectively. CONCLUSIONS: The results distinguished two ovarian cancer phenotypes, one with elevated HK activity and low G6Pase activity, and another with the opposite characteristics.
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Glucose-6-Fosfatase/metabolismo , Hexoquinase/metabolismo , Neoplasias Ovarianas/enzimologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluordesoxiglucose F18/farmacocinética , Humanos , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To describe the outcome of adult granulosa cell tumor (AGCT) with respect to initial clinical findings, methods of surgery, and perioperative treatment. STUDY DESIGN: Retrospective follow-up study. SETTING: All hospitals in Jutland. SAMPLE: 163 women diagnosed with AGCT. METHODS: Follow-up by hospital data files, general practitioner, death certificate, and autopsy report. Revision of histopathology by a single pathologist. MAIN OUTCOME MEASURES: Survival and relapse by clinical data, stage, and type of surgery. RESULTS: The incidence of AGCT was 1.37 per year per 100,000 women (95% CI: 1.08, 1.68). The median follow-up time was 15 years and for the 79 surviving women 22 years. Stage I was found in 94% of cases. Relapse occurred in 24% of women in stage I and 100% of the other stages. Survival in stage I was 95%, 89% and 84% after 5, 10 and 20 years respectively. Increased survival of stage I in postmenopausal women was associated with surgery including hysterectomy and bilateral oophorectomy (p<0.001). In women younger than 40 years no difference in survival was found due to type of surgery. Endometrial carcinoma was found 138 times (95% CI: 48, 275) more prevalent than the expected rate. CONCLUSION: The survival of women was better in AGCT than in epithelial ovarian tumor. Age and type of surgery, besides stage, influenced survival. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is the recommended treatment with advancing age. At younger age less extensive surgery was associated with similar survival compared to extensive surgery, but with advancing age conservative surgery increased the risk of relapse and death.
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Tumor de Células da Granulosa/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Ovarianas/cirurgia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dinamarca/epidemiologia , Feminino , Seguimentos , Tumor de Células da Granulosa/epidemiologia , Tumor de Células da Granulosa/patologia , Humanos , Histerectomia , Incidência , Lactente , Recém-Nascido , Menopausa , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Estadiamento de Neoplasias , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/patologia , Ovariectomia , Estudos Retrospectivos , Salpingectomia , Taxa de Sobrevida , Adulto JovemRESUMO
We present a case study of a 43 year-old female immigrant from Turkey with abdominal pain, ascites and elevated cancer antigen 125. The symptoms were similar to those of ovarian cancer, and imaging (computed tomography (CT), positron emission tomography/computed tomography and magnetic resonance imaging) supported this suspicion. Peritoneal biopsy from laparoscopy showed granulomas with central necrosis. Microscopy, culture and polymerase chain reaction from biopsy samples were negative for Mycobacterium tuberculosis. Follow-up with a CT scan after six months of full tuberculosis treatment showed normal conditions. Peritoneal tuberculosis is a diagnostic challenge, but should be considered in case of immigrants from high-risk areas.
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Peritonite Tuberculosa/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imagem Multimodal , Neoplasias Ovarianas/diagnóstico , Peritonite Tuberculosa/diagnóstico por imagem , Peritonite Tuberculosa/patologia , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: We report a rare case of a cervical adenosquamous carcinoma, initially diagnosed during delivery, with subsequent implantation in the episiotomy scar 5 weeks postpartum. CASE: A 35-year-old woman with cervical adenosquamous carcinoma diagnosed during delivery was treated with radical abdominal hysterectomy with bilateral pelvic lymphadenectomy. Five weeks later the metastatic tumor at the episiotomy site was excised, and the patient received adjuvant chemotherapy and radiation therapy. Relapse occurred rapidly, and surgical exenteration was initiated but abandoned intraoperatively due to the presence of intra-abdominal carcinomatosis. The patient was declared terminal 6 months postpartum and died 2 months later. CONCLUSION: This case illustrates the importance of inspection of the perineal area during delivery in patients diagnosed with cervical cancer.
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Carcinoma Adenoescamoso/patologia , Cicatriz/patologia , Episiotomia , Complicações Neoplásicas na Gravidez/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Carcinoma Adenoescamoso/diagnóstico , Carcinoma Adenoescamoso/terapia , Quimioterapia Adjuvante , Terapia Combinada , Evolução Fatal , Feminino , Humanos , Histerectomia , Excisão de Linfonodo , Metástase Linfática/patologia , Recidiva Local de Neoplasia , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico , Complicações Neoplásicas na Gravidez/terapia , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/patologia , Transtornos Puerperais/terapia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapiaRESUMO
OBJECTIVES: To compare the prevalence of urological symptoms in a population of women, who had a transcervical endometrial resection (TCER) only, and a population of women, who had a TCER and a subsequent hysterectomy. The superior goal was to evaluate the possible association between hysterectomy and urinary incontinence. DESIGN: All women, who had a TCER at our department during the period of 1990-1996 received a questionnaire with focus on urological symptoms. The answers from women, who later had a hysterectomy were compared to the answers from women, who were sufficiently treated with TCER only. RESULTS: Of 356 women, who were alive, 16 were lost to follow-up, leaving 340 women to receive the questionnaire, which was returned by 310 women (85%). Ninety-three (31%) had a subsequent hysterectomy mainly indicated by metrorrhagia or dysmenorrhea. Of the hysterectomized women 24% reported bothersome stress incontinence against 14% in the group of women, who had TCER only (p = 0.03). No significant difference was seen with respect to urge incontinence, urgency, pollakisuria or nocturia. Significantly more women with a normal sized uterus reported bothersome stress incontinence after the hysterectomy compared to women with a slightly enlarged uterus. CONCLUSION: Hysterectomy is significantly associated with stress urinary incontinence in women, who previously had a TCER.
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Histerectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Incontinência Urinária por Estresse/epidemiologia , Adulto , Dinamarca/epidemiologia , Dismenorreia/cirurgia , Feminino , Seguimentos , Humanos , Histeroscopia , Menorragia/cirurgia , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo , Incontinência Urinária de Urgência/epidemiologia , Útero/anatomia & histologiaRESUMO
Sarcoidosis rarely affects the female genitalia. We report a 36-year-old woman who had a hysterectomy for metrorrhagia. Histologic examination showed sarcoid granulomas in the endometrium and myometrium. Subsequent examinations revealed pulmonary sarcoidosis as well.