RESUMO
Large loop excision of the transformation zone (LLETZ) is one of the fertility sparing treatments for people with high-grade cervical intraepithelial neoplasia, however, this procedure is known to increase the risk of postoperative cervical stenosis by 1.3%-5.2%. We present a case demonstrating the successful use of a copper intrauterine contraceptive device to manage a patient with cervical stenosis secondary to three LLETZ procedures for severe dyskaryosis.
Assuntos
Traquelectomia , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Colposcopia/métodos , Constrição Patológica/cirurgia , Feminino , Humanos , Gravidez , Neoplasias do Colo do Útero/cirurgia , Displasia do Colo do Útero/cirurgiaRESUMO
OBJECTIVE: Analyze long-term (20 years) cytology and histology outcomes after treatment of high-grade cervical intraepithelial neoplasia (HGCIN) with thermal ablation (TA). METHODS: All women having TA for HGCIN between January 1996 and December 1998 (36 months; N = 885) were identified; data were collected on age of patients, symptoms, colposcopy findings, and biopsy reports. Local and national (cytology and colposcopy) databases and colposcopy records were used to collect long-term follow-up data. Probability of CIN recurrence was assessed using Kaplan-Meier "survival" curve. RESULTS: Follow-up data (available for 796) was collected in 2018 capturing 20 years of follow-up data. Two hundred eighty-one women were treated for CIN 2 and 515 women for CIN 3. Seven hundred ninety-one of 796 (>99%) were treated at first visit. Two hundred sixty two of 796 (33%) had evidence of crypt involvement on pretreatment biopsy. Probability of having consistently normal cytological follow-up was 92%, 89%, 86%, and 83% at 5, 10, 15, and 20 years, respectively. Cumulative probability of having recurrent HGCIN was 0.5% at 5 years, 1% at 10 years, 1.9% at 15 years, and 3% at 18 years. There was 1 invasive squamous cell cancer at 11 years after treatment. CONCLUSIONS: Thermal ablation is a safe and effective treatment for HGCIN, which is now shown to have stood the test of time. We advise more widespread adoption in the United Kingdom and globally so long as agreed criteria are met.
Assuntos
Carcinoma de Células Escamosas , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Colo do Útero/cirurgia , Feminino , Humanos , Estudos Retrospectivos , Neoplasias do Colo do Útero/cirurgia , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/cirurgiaRESUMO
The case demonstrates the use of bariatric surgery to improve a patient's candidacy for surgical treatment for endometrial cancer (EC). A 50-year-old morbidly obese woman with early-stage EC was initially treated with levonorgestrel-releasing intrauterine system (52 mg) . She had to reduce her body mass index (BMI) to become eligible for definite EC treatment. Using conservative methods, she was unable to lose weight effectively. She then underwent bariatric surgery that reduced her BMI from 71.3 to 54.3 kg/m2 She maintained her weight and was eligible for total hysterectomy and bilateral salpingo-oopherectomy. Her procedure was successful and had no complications. She has 6-monthly follow-ups, and the most recent review showed no evidence of recurrence.
Assuntos
Cirurgia Bariátrica , Neoplasias do Endométrio , Obesidade Mórbida , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgiaRESUMO
BACKGROUND: The introduction of screening in the UK and other high-income countries led to a significant decrease in the incidence of cervical cancer and increase in survival rates. Minority ethnic groups are often underrepresented in screening participation for reasons that are poorly understood. OBJECTIVE: To explore experiences of cervical screening participation and non-participation of women from minority ethnic populations in Scotland and gain insights to support the development of interventions that could potentially support screening participation and thereby reduce inequalities. DESIGN: Qualitative comparison group study using in-depth, semi-structured individual interviews that were thematically analysed. SETTING AND PARTICIPANTS: This study took place in Scotland. Fifty women were purposively sampled from four ethnic minority groups: South Asian; East European; Chinese; and Black African or Caribbean. White Scottish women were also interviewed. RESULTS: Many experiences described were common regardless of ethnicity, such as difficulties managing competing priorities, including work and care responsibilities. However, important differences existed across the groups. These included going abroad for more frequent screening, delayed introduction to screening and not accessing primary care services, language difficulties in health-care settings despite proficiency in English and not being sexually active at screening commencement. Experiences of racism, ignorance and feeling shamed were also reported. CONCLUSIONS: Key differences exist in the experience of minority ethnic groups in Scotland. These offer potential opportunities to reduce disparity and support screening participation including maximizing co-incidental interactions and developing outreach work.
Assuntos
Etnicidade , Neoplasias do Colo do Útero , Detecção Precoce de Câncer , Feminino , Humanos , Grupos Minoritários , Escócia , Neoplasias do Colo do Útero/diagnósticoRESUMO
Vulval cancers are rare, but after primary treatment, known to recur with a high frequency (30%). Clinico-pathological predictors of recurrence have been established to a great extent. However, there is paucity of literature on predictors of early versus late recurrence. We sought to identify such predictors through a retrospective study of vulval cancer recurrences in a single cancer centre over 11 years. Age of women, depth of invasion/site of primary tumour and presence of background VIN/lichen sclerosus do not appear to affect timing of recurrence. However, vulval cancers that recur after 2 years of primary tumour recognition are more likely to be well-differentiated tumours, have undergone radical surgery and have had a closest disease-free margin >1 cm. Late recurrences are entirely local rather than distant metastases and this translates into a better survival as shown in our study (40 months median survival in the early group versus 112 in the late recurrence group).
Assuntos
Recidiva Local de Neoplasia/patologia , Neoplasias Vulvares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Líquen Escleroso e Atrófico/complicações , Pessoa de Meia-Idade , Invasividade Neoplásica , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Non-Hodgkin lymphoma (NHL) predominantly affects the lymph nodes and bone marrow. Extranodal sites of NHL include the thymus, spleen, and Waldeyer ring. Very rarely NHL affects the gynecologic tract (<0.5%), and secondary spread is more common than primary involvement. CASE REPORT: We report a case of primary NHL of the vagina diagnosed in a young woman who presented with a painless vaginal mass. Although the initial clinical diagnosis was that of an inflamed Gartner duct, atypical presentation of the mass prompted further imaging, such as pelvic ultrasonographic imaging and magnetic resonance imaging. The latter showed presence of similar masses in the posterior cervix and vagina, and after a multidisciplinary team discussion, biopsy of the mass showed primary vaginal NHL. Subsequently, we referred her to hematologists who commenced chemotherapy. Only 57 cases of primary vaginal NHL have been reported in the literature, and our case elucidates the workup of atypical vaginal masses to facilitate a diagnosis and appropriate management. CONCLUSIONS: NHL of the female genital tract is uncommon. Early diagnosis translates to better survival for these women because extranodal NHLs bear a worse prognosis when compared with that of nodal lymphomas mainly owing to delay in diagnosis.
Assuntos
Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/patologia , Neoplasias Vaginais/diagnóstico , Neoplasias Vaginais/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pelve/diagnóstico por imagem , Radiografia , Ultrassonografia , Adulto JovemRESUMO
BACKGROUND: Large loop excision of the transformation zone (LLETZ) is the preferred treatment modality among colposcopists for cervical intraepithelial neoplasia. We report a unique case of cervical septum after LLETZ and the subsequent management. CASE: Large loop excision of the transformation zone was performed on a young woman for a severely dyskaryotic cervical smear and colposcopic impression of high-grade abnormality. At her 6-month follow-up, double cervical ostium was seen resulting from cervical septum formation. This was surgically divided to enable a single cervical ostium for future smear taking and follow-up. CONCLUSIONS: This case report is to make clinicians aware of a rare complication such as double cervical ostium after LLETZ and its management.
Assuntos
Colo do Útero/patologia , Colposcopia/efeitos adversos , Displasia do Colo do Útero/patologia , Displasia do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Adulto , Biópsia por Agulha , Colo do Útero/cirurgia , Cicatriz/etiologia , Cicatriz/patologia , Cicatriz/cirurgia , Colposcopia/métodos , Feminino , Seguimentos , Humanos , Histerossalpingografia/métodos , Histeroscopia/métodos , Imuno-Histoquímica , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/cirurgia , Medição de Risco , Resultado do Tratamento , Esfregaço Vaginal/métodosRESUMO
PURPOSE: To compare the frequency of visceral relapse of BRCA1/2-deficient ovarian cancer to that of nonhereditary controls. PATIENTS AND METHODS: All patients diagnosed in Scotland with epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and a germline BRCA1/2 mutation were identified. Those with previous malignancy were excluded. Each remaining patient who experienced relapse was matched with two nonhereditary controls. RESULTS: Seventy-nine patients with EOC/PPC and germline BRCA1/2 mutations were identified. Fifteen had inadequate clinical data, two had carcinosarcoma, 27 had previous breast cancer, and 16 were in remission. Of the remaining 19 patients who were BRCA1/2 deficient, 14 patients (74%) developed visceral metastases compared with six (16%) of 38 patients in the control group. The percentages of liver, lung, and splenic metastases were 53%, 32%, and 32%, respectively, in the patients compared with 5%, 3%, and 5%, respectively, in the controls. When events occurring outside the matched follow-up period were omitted, the percentages of visceral, liver, lung, and splenic metastases were 58%, 42%, 16%, and 32% in the patients compared with 5%, 0%, 0%, and 3% in controls (P < .001, P < .001, P = .066, and P = .011, respectively). In an independent validation set, the corresponding percentages of visceral, liver, lung, and splenic metastases were 63%, 46%, 13%, and 17% in the patients compared with 11%, 4%, 2%, and 2% in controls (P < .001, P < .001, P = .153, and P = .052, respectively). CONCLUSION: Although sporadic EOC commonly remains confined to the peritoneum, BRCA1/2-deficient ovarian cancer frequently metastasizes to viscera. These data extend the ovarian BRCAness phenotype, imply BRCA1/2-deficient ovarian cancer is biologically distinct, and suggest that patients with visceral metastases should be considered for BRCA1/2 sequencing.