Intravascular leiomyomatosis: an exceptional entity.

Intravenous leiomyomatosis (IVL) is a rare benign condition characterized by the proliferation of smooth muscle cells originating from either the uterine venous wall or a uterine myoma. This leiomyomatosis extends most frequently to pelvic vessels, but also occasionally into the inferior vena cava and right cardiac chambers. Preoperative diagnosis is difficult and it should be suspected in the presence of cardiac or pelvic masses in women who have undergone hysterectomy or myomectomy previously. The treatment is hysterectomy, normally associated with a bilateral oophorectomy and removing the mass or metastasis if any. The post-surgical follow-up should be performed at long-term and include exploration and imaging, either ultrasound or MRI. The association of antiestrogenic drugs can be useful for disease control, especially in cases where oophorectomy is not performed and the tumor cannot be removed completely.

Conservative treatment of early stage ovarian cancer: oncological and fertility outcomes.

BACKGROUND: Ovarian cancer may appear in young women during their reproductive age. As a result of late childbearing nowadays, fertility preservation has become a major issue in young women with gynecological cancer. The aim of this review is to update the current knowledge on conservative treatment and fertility preservation of women affected of early stage epithelial ovarian cancer. MATERIAL AND METHODS: A web-based search in Medline and CancerLit databases on conservative treatment for early stage ovarian cancer has been carried out. All relevant information has been collected and analyzed. RESULTS: Less than 40% of ovarian cancers are diagnosed at early stages. Conservative treatment may be considered in young patients with a relapse rate that ranges from 9% to 29%, and a 5-year survival ranging from 83% to 100%. Recurrences in the controlateral ovary has been reported to be less than 5%, with most of these patients being alive after savage treatments. Moreover, it has been reported good fertility outcomes after conservative treatment with a successful conception rate that ranges from 60% to 100%, with an abortion rate under 30% in all series reported. CONCLUSIONS: Conservative treatment for early epithelial ovarian cancers could be a safe option for women younger than 40 years who wish to preserve their childbearing potential. We need a strict case selection such as FIGO stage I grade 1 and 2, although grade 3 cases could be considered.

Nodal involvement evaluation in advanced cervical cancer: a single institutional experience.

PURPOSE: To assess the usefulness of different imaging techniques in the detection of nodal involvement in patients with advanced cervical carcinoma. Moreover, to analyze the correlation between the presurgical (FIGO) and postsurgical (pTNM) staging classifications. MATERIALS AND METHODS: All patients diagnosed with advanced cervical cancer (FIGO Stages IIB-IV) from 2005 to 2012 were selected. The medical charts of 51 patients that underwent presurgical assessment with posterior surgical staging by means of para-aortic lymphadenectomy, were reviewed. Nodal status assessment by computed tomography scan (CT scan), magnetic resonance imaging (MRI), positron emission tomography (PET), and sonography was compared, as well as the size given in imaging techniques compared to the final pathologic report information. RESULTS: Presurgical analysis by CT scan, MRI, PET, and sonography showed pelvic nodal involvement in 51.3% of patients, and para-aortic involvement in 30.8% of cases. CT scan showed positive pelvic nodes in 35% of cases, but pathologic confirmation was observed in just 17.6% of cases. However, MRI resulted in higher rates of up to 48.8% of cases. Concerning para-aortic nodal involvement, CT scan showed positive nodes in 25% of cases, MRI in 3.2% of cases, and the pathologic report in 15.6% of cases. The authors found significant differences between staging groups among both classifications (FIGO vs. pTNM; p < 0.001). Eight cases (15.7%) were understaged by FIGO classification. CONCLUSIONS: Despite all imaging techniques available, none has demonstrated to be efficient enough to avoid the systematic study of para-aortic nodal status by means of surgical evaluation.