Search

Objectives: To assess the significance of pathologic ultrastaging (PU) of sentinel (SLN) and non-sentinel (nSLN) lymph nodes (LNs) and the influence on cancer staging in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IB1 cervical cancer., Material and Methods: A retrospective study was conducted with 54 patients divided into two equal-sized groups. In test group (n1), at least one SLN/patient was detected with blue dye. All excised LNs in this group were subjected to PU (4 μm slices/150 μm intervals) with hematoxylin-eosin staining and immunohistochemistry (AE1-AE3 antibodies). In none of the control group (n2) was PU performed, but in 2 patients SLN concept was performed. Patients in both groups underwent radical hysterectomy and lymphadenectomy. The effect of PU was expressed in puTNM and compared with both standard pTNM and FIGO systems. The influence of PU on patients' disease-free survival (DFS) and overall survival (OS) was assessed using Kaplan-Meier curves., Results: In total, 516 LNs were extracted (66 SLNs, 36% bilaterally). Micrometastases (MIC) or isolated tumor cells (ITC) were detected in 34 of the 482 LNs (7.1%), including 16 MICs and 9 ITC in non-SLNs. False negative rates were: 3.7%/side-specific, and 7.4%/both sides. The use of PU resulted in stage change in 2 cases (N and M status change), FIGO stage did not changed. No PU impact on DFS or OS was observed., Conclusions: The risk of TNM stage migration in early cervical cancer is low, is more likely in inattentively evaluated patients, and has indeterminate prognostic and predictive value. Selection of cases with cT ≤ 2 cm and cN0 is sufficient to avoid the risk of improper staging.

Objectives: Borderline ovarian tumors have favorable survival rates, however, prognostic factors are still discussed. The aim was to investigate the outcome for women treated conservatively with respect to different tumor-dependent and tumor-independent prognostic factors., Material and Methods: 194 women treated surgically between years 1978 and 2007. Influence of conservative or radical surgical treatment on survival was evaluated., Results: The overall 5-year survival rate was 93.1% and 96.8% respectively for radical and conservative treatment. The mean time of survival was longer in women treated conservatively (p = 0.03), but this was an outcome of their younger age; when age was eliminated as a determining factor; the type of treatment had not influenced the length of postoperative survival (p=0.57). Conservative treatment was chosen more frequently for younger women. Factors that are detrimental to survival are age, postmenopausal detection of borderline ovarian tumors, an advanced stage of progression, a bilateral localization of tumors, the occurrence of invasive peritoneal implants and a serous rather than a mucinous histological type of borderline ovarian tumor more frequently occurred in women treated radically Borderline ovarian tumors recurred in 16.7% of women after conservative treatment and in 3.5% of women after radical treatment. Of women with preserved fertility 25.7% became pregnant at least once and 21.2% of the group as a whole delivered children at term; none of the pregnancies were fertility-assisted., Conclusions: Conservative treatment does not have a deleterious effect on the prognosis of women provided that unfavorable prognostic factors are identified.

Background: Detection of micrometastases in sentinel lymph nodes (SLN) extends our knowledge of lymphatic spread in endometrial cancer, although its clinical significance has not yet been confirmed., Objectives: The aim of study was to determine the incidence of SLN micrometastases and to analyze the association between micrometastases and disease relapse., Material and Methods: Fifty-four patients with endometrioid endometrial cancer underwent routine surgical therapy and sentinel lymph node biopsy (SLNB). SLNB was performed using two techniques: cervical injection of 99mTc-labelled albumin or blue dye and fundal injection of blue dye. SLNs were subjected to ultrastaging with immunohistochemistry (AE1/AE3, 150µm)., Results: At least one SLN was detected in 51 patients (94.4%) and bilateral SLN detection was achieved in 80.4%. Nodal macrometastases were found in 3 patients (6.3%). SLNB enabled us to detect nodal macrometastases in 2 out of those 3 patients. In the third case, detection of SLN micrometastasis allowed to correctly determine the nodal status, thus avoiding the false negative result of SLNB. In 48 patients with detected 184 SLNs, there were 4 patients (8.3%) with micrometastases and 4 (8.3%) with ITC foci. No significant associations between the presence of risk factors (grade, myometrial invasion, cervical invasion, lymphovascular space invasion) and incidence of micrometastases and/or ITC foci in SLNs were found., Conclusions: Detection of micrometastases may result in lower false-negative rate, thus increasing SLNB safety.

Objectives: The aim the study was to compare two groups of endometrial cancer patients (below and above 45 years of age) in the aspect of clinicopathological and molecular data., Material and Methods: The study encompassed 456 primary tumour samples retrospectively collected from a cohort of endometrial cancer patients, primarily treated by surgery Molecular analysis covered: copy number variations of 10 genes (TOP2A, ERBB1, ERBB2, ERBB3, ERBB4, MYC, CCND1, ESR1, PIK3CA, RAD21) analyzed by quantitative PCR; mRNA expression of 6 genes (SCGB2A2, RAD27, RUNX1, SNAI1, SNAI2, PROM1) analyzed with the use of reverse transcription quantitative PCR; protein expression analysis of 8 markers (PGR, ESR1; ERBB1, ERBB2, ERBB3, ERBB4, TOP2A, pAKT1) performed with the use of immunohistochemistry., Results: The younger group of patients was characterized by less frequent hypertension (p <0.00007), less frequent myometrial infiltration (p=0.002) and longer overall survival (p=0.003). Apart from RAD21 gene aberrations, which were more frequent in younger patients (p=0.02), the study revealed no statistically significant differences between the groups., Conclusions: The study showed no molecular differences in the profile of younger and older endometrial cancer patients. Data on both the prognostic and predictive significance of RAD21 in endometrial cancer are still insufficient. The clinical profile of younger patients with endometrial carcinoma was slightly better when compared to elderly patients. Younger patients were characterized by longer overall survival.

Background: Lymph node (LN) micrometastatic disease has come to prominence since ultrastaging was shown to improve the quality of LN procedures in epithelial cancers. The aim of the study was to evaluate the feasibility and diagnostic usefulness of detecting micrometastases in sentinel (SLN) and non-sentinel LNs (nSLN) in cervical cancer, Material and Methods: Twelve consecutive patients with cervical cancer stages IA to IIA, classified according to the Union for International Cancer Control (UICC) and divided into two groups: A (7) and B (5), with and without SLN procedure with methylene blue dye, who underwent radical hysterectomy and lymph nodes removal, were recruited for the study. All LNs were evaluated in hematoxylin-eosin (HE) staining and immunohistochemically (IHC) in ultrastaging with anti-cytokeratin AE1/AE3 antibodies. A detailed analysis was performed with regard to the technical and histopathological aspects of the procedure., Results: More LNs could be extracted and studied in group A as compared to group B (210 vs. 70, mean 30 vs. 14, respectively p < 0.0005). A total of 13 SLNs were extracted, and the identification rate was 71% (5/7 in group A). One micrometastatic LN was found in each of the groups (16% cases), but the preliminary classification of the advancement stage was changed only in 1 case from the labeled nodes group (group A--from pN0 with HE to pN1 with IHC)., Conclusions: Presence or absence of metastases in SLN(s) should not be sufficient amount of information for a surgeon or an oncologist, who ought to have data about all of the removed lymph nodes (sent to ultrastaging). In order for the surgery to be performed properly it is vital to ensure that SLNs were removed. Assessment of the N status ought to be taken into consideration in the classification according to the International Federation of Gynecology and Obstetrics (FIGO).

In most cancers of epithelial origin, metastases to the lymph nodes constitute the most important prognostic factor and are predictive of the results of the surgical and adjuvant therapies. Data on the lymph node status allows to design an appropriate treatment plan. Despite advances in gynecologic oncology the importance of lymph node micrometastases in cervical cancer especially in nonsentinel lymph nodes which are detected by ultrastaging, has not been fully elucidated. The purpose of the article is to familiarize the reader with the state of current knowledge on cervical cancer micrometastases. The authors attempt to answer the question about the benefits of lymph node assessment in the search for micrometastases in cervical cancer as well as to address emerging doubts.

On the basis of two cases we discuss the important issues regarding the sentinel lymph node detection biopsy (SLNB) in endometrial cancer with combined cervical administration of the radiocolloid and the subserosal blue dye injection. The first patient (endometrioid adenocarcinoma G2, invasion > 50% myometrium) had 4 SLNs detected. Three were both hot and blue (detected on SPECT-CT). The fourth, paraaortic SLN was blue only. None of the lymph nodes contained metatstases. The second patient (endometrioid adenocarcinoma G1, invasion > 50% myometrium) had 4 SLNs detected. Three were blue (but two of them had also very low radioactivity). The fourth SLN was hot only. Blue only node contained macrometastasis. In the past patients underwent cervical amputation. Diverse distribution of each tracer confirms the advantages of the combined tracers administration in SLNB. The radiotracer is the crucial component--uptake was present in 6 of 8 SLNs. Although the blue dye is more a complimentary method, its suberosal injection significantly increases the safety of the SLNB procedure. In the first case we have detected blue only SLN in paraaortic region which otherwise would be missed using the cervical approach only. More importantly in the second case the tracer uptake was very limited due to the previous surgery and the blue dye administration allowed correct SLNs detection (including the metastatic node). Presented clinical cases confirms that the combined cervical and subserosal tracers administration together with preoperative SPECT-CT constitute an optimal SLN detection method and correctly provides information about the regional lymph node status.

Objectives: According to recommendations, the sentinel node (SN) procedure results causes of less radical treatment and reduction of morbidity., Design: The aim of this study was to determine the feasibility of sentinel lymph node identification using radioisotopic lymphatic mapping with technetium-99m labelled nanocolloid and blue dye injection in patients with early-stage cervical cancer., Material and Methods: 100 patients with FIGO stage from IB1 to IIA primary carcinoma undergoing radical hysterectomy with pelvic lymphadenectomy have been investigated., Results: 84% of the patients have been diagnosed with at least one-sided SN and 66% of them with two-sided SN. The sentinel detection rates, depending on the stages, were as following: 181-96.6%, IB12-66.7%, IIA-62.5%. Successful identification of SN was less likely in patients with tumors > 2cm (54% of SN) compared with those with tumors < or = 2cm (96% of SN). The false negative rate for the SN procedure was 3% (3/100). In all false negative SNs the primary cervical tumor was above 2cm and there was an isthmus infiltration. SN detection had 86.4% sensitivity, 100% specificity, and 95.3% negative predictive value., Conclusion: Sentinel node mapping method for cervical cancer patients undergoing primary surgical therapy is a feasible option. The sentinel node detection rate is relatively high and depends on FIGO stage and the tumor size. The appliance of SN into cervical cancer procedures allows us to refrain from a surgery in favor of radiochemiotherapy, seems to be the right course of action in deciding treatment and may result in fewer postoperative complications rate.

This is a report of two cases of haemorrhage after pelvic exenteration in patients with vulvar cancer and cervical cancer treated by temporary pelvic packing at the Department of Gynaecology of the Medical University in Gdańsk. The packing was successful and the sponges were removed after 24 and 48 hours. There were no major postoperative complications in both cases and one wound dehiscence. Both patients recovered after surgery. In cases with severe intraoperative haemorrhage, intraabdominal packing can be effective mode of treatment, especially in bleeding which originates from the sacral venous plexus.

Objectives: The pelvic exenteration is a method of treatment in cases of recurrence or locally advanced gynecological tumors without distance metastases. The total pelvic exenteration has been used as salvage therapy especially for advanced gynecological malignancy., Design: The aim of study was to analyse the group of women who underwent pelvic exenteration., Material and Methods: A series of 13 patients who underwent pelvic exenteration for advanced vulvar cancer at the Department of Gynecology, Medical University of Gdańsk Poland between 1996-2003 was retrospectively reviewed., Results: The more often performed exenteration in patients with vulvar cancer was posterior pelvic exenteration in 11 cases, total pelvic exenteration in 2 cases. The mean age at diagnosis was 56 years. The estimated blood transfusion due to operation ranged from 300 ml to 3580 ml with a mean of 1200 ml. The operating time ranged from 4 hours to 7 hours 30 minutes with a mean of 6 hours and 5 minutes. Patients stayed in hospital from 14 to 54 days after operation with a mean 33 days. The overall complication rate after pelvic exenteration was 61.5% with 8 of the 13 patients. Three times it was infection, six times wound dehiscence, in 1 case it was: ARDS, thrombophlebitis, ureter damage. There was no late complication., Conclusion: Pelvic exenteration offers the last chance for some women with gynecological malignancy.

Objectives: Sexual life after supracervical or total hysterectomy is still controversial., Design: The aim of study was to compare the impact of hysterectomy on frequency and quality of a woman's sexual life in women after supracervical vs total hysterectomy with nonmalignant conditions., Material and Methods: A total of 539 women after total hysterectomy performed in Department of Gynecology in Gdansk and 65 women after supracervical hysterectomy operated in the hospital in Kartuzy in 1990-2000 were interviewed about symptoms as well as advantages and disadvantages after hysterectomy., Results: There was no statistical difference between those groups comparing: sexual desire, dyspareunia, frequency of sexual relation, orgasm, vaginal dryness after operation., Conclusion: Total hysterectomy is recommended in benign conditions of uterine because of risk of cancer in the cervical stump after supracervical hysterectomy.

Objectives: Intraperitoneal hyperthermic perfusion chemotherapy (IPCH) is a complex method used for the treatment of the ovarian cancer. During the procedure, chemotherapeutic agent is administrated into the peritoneal cavity using continuous perfusion and hyperthermic conditions., Design: This experiment was performed to simulate the main features of IPCH and to determine the hydrodynamic characteristics of this method in the laboratory conditions., Materials and Methods: The model was made in a natural scale, regarding the anatomical proportions. In order to establish the dispersive properties of the model we determined the distribution of the tracer as a function of the drains' location and intensity of flow., Results and Conclusions: The important practical conclusion of the study is that the most advantageous variant is 'slanted' location of inflow and outflow drains. It is also possible to confirm that the hydrodynamic features applied during IPCH enable adequate drug distribution in the peritoneal cavity. The employed location of drains could be reconsider including the possibility of introducing cyclic flow direction alteration (increasing the dispersive properties of the system). We would like thank the Department of Cardiacthoracic Surgery, Rigshospitalet, Copenhagen, Denmark for lending the peristaltic pump.

During pregnancy increased incidence of maternal cardiac arrhythmias is observed. We reported a 31 year old primipara after two incidents of cardiac arrest due to ventricular fibrillation during pregnancy at 10th and 16th week of gestation. The implantable cardioverter defibrillator was implanted at the 19th week of gestation. There was no complication after ICD implantation. A healthy child was born by cesarean section at 38th week of gestation.

Objectives: The evaluation of sexual life after hysterectomy is still controversial., Design: The aim of the study was to analyse the impact of hysterectomy on frequency and quality of the woman's sexual life., Material and Methods: The total of 539 women operated in II Department of Obstetrics and Gynecology in 1990-2000 were interviewed about symptoms as well as advantages and disadvantages after abdominal hysterectomy., Results: Sexual desire after operation decreased. The rate of dyspareunia dropped. Frequency of sexual intercourse and orgasm decreased non-significantly. The percentage of women non reporting vaginal dryness decreased significantly from 18.5% to 37.3% after hysterectomy., Conclusion: Sexual activity overall improved after hysterectomy.

The report of case in which bleeding from the anterior abdominal wall vessels occurred after the trocar insertion through the umbilicus. Directly after trocar removing there was insignificant bleeding from the trocar incision. Despite initial hemostasis with a suture ligation a postoperative blood loss and peritonitis syndrome necessitated transfusion and diagnostic laparoscopy. No vessel injury was localised during the subsequent laparoscopy. The bleeding originated from the trocar incision--a small artery was injured. The hemostasis suture was fastened. The reported case is a unique example of a laparoscopic complication. The umbilicus seemed to be a very safe localisation for the first trocar insertion--there are no reports of appearance of abdominal vessels within the umbilicus. Besides the suture ligation usually ensures an effective hemostasis--the diagnostic laparoscopy or laparotomy is are performed in exceptional situations.

Objective: Intestinal operations in advanced ovarian carcinoma due to intestinal obstruction are still controversial., Design: The aim of study was to analyse the efficacy of intestinal operation and making anus praeter in the patient with advanced ovarian carcinoma., Material and Methods: A total of 497 patient with ovarian carcinoma were operated in II Department of Obstetrics and Gynecology in 1990-2001. 66 patients with advanced ovarian cancer were analysed with a view to interventions for intestinal obstruction and making the anus praeter., Results: In the group of 497 patients with ovarian carcinoma there were a operations of making anus praeter in 66 cases (13.28%). It was performed during first operation in 40.9%, during SLO in 22.72%, TLO in 16.67% and following operations in 19.70%. In 5 cases (7.58%) there was a liquidatio of anus praeter after an average 8.8 months after intestinal operation., Conclusion: Surgical intervention can be of value in removing life-threatening intestinal obstruction and to achieving longer survival with a possibility of receiving a further antineoplastic therapy.