RESUMEN
The aim of our study is to present the particularities of a specific subset of gynecological cancer patients in Romania. We present a review of synchronous gynecological neoplasia (SGN) treated in the Bucharest Oncological Institute's surgery departments over a decade. Between 2012 and 2022, 7419 female patients with genital malignancies were treated. We identified 36 patients with invasive synchronous primary gynecological cancers (0.5%) and 12 cases with one primary gynecological and another primary invasive pelvic cancer (rectal/bladder). All recurrent, metastatic, or metachronous tumors detected were excluded. Demographic data, personal history, presenting symptoms, pathologic findings, staging, treatment, and evolution for each case were recorded. Usually, the most common SGN association is between ovarian and endometrial cancer of endometrioid differentiation (low-grade malignancies with very good prognosis). However, we noticed that, given the particularities of the Romanian medical system, the most frequent association is between cervical and endometrial, followed by cervical and ovarian cancers. Moreover, the cancer stage at diagnosis is more advanced. In countries with low HPV vaccination rate and low adherence to screening programs, SGNs can present as extremely advanced cases and require extensive surgery (such as pelvic exenterations) to achieve radicality. This multimodal treatment in advanced cases with high tumor burden determines a reduction in survival, time until progression, and quality of life.
RESUMEN
Malignant extramucosal esophageal tumors are rare. We publish a case of an extramucosal esophageal tumor which turned out to be a yolk sac tumor. This type of tumor is extremely rare. We present the initial and also late management of this case (from the diagnostic to the management of the late complications). The patient was admitted for dysphagia. Contrast thoraco-abdominal CT scan revealed an important retrocardiac mass; echoendoscopy with biopsy confirmed one malignant extra-mucosal esophageal tumor. We performed an esophagectomy through triple approaches (McKeown) â?" right thoracotomy, laparotomy, and left cervicotomy for anastomosis. The pathological report raised the suspicion of a mediastinal tumor with germ cells or a poorly differentiated carcinoma. The immunohistochemistry tests confirmed a yolk sac tumor. The patient was referred to the oncologist and was treated with etoposide and cisplatin chemotherapy. Subsequently, the patient developed respiratory failure secondary to giant hiatal hernia which was surgically treated via laparoscopy.
