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Clinical benefit of surgical staging in locally advanced cervical cancer has not yet been proved. The goal of this study was to analyze the prognostic and therapeutic value of laparoscopic para-aortic lymphadenectomy with selective excision of suspicious pelvic nodes in patients with locally advanced cervical cancer.This is a retrospective study including 109 women treated in a single institution from 2000 to 2009. The International Federation of Gynecology and Obstetrics stage was IB2 in 12 women, IIB in 58 women, and IIIB in 39 women. None had suspicious para-aortic nodes by presurgical imaging evaluation. All patients underwent extraperitoneal para-aortic laparoscopic lymphadenectomy with selective excision of enlarged pelvic nodes and received pelvic radiotherapy with concomitant chemotherapy. Extended lumboaortic radiation therapy was added to patients with metastatic para-aortic nodes. The mean ± SD follow-up time was 43.1 ± 33.7 months.Metastatic lymph nodes were identified in 23 (21.1%) of 109 patients in the para-aortic area and in 24 (53.3%) of 45 patients who underwent selective excision of pelvic nodes. Patients with nodal metastases had increased risk of mortality than those with negative nodes independently of the location (pelvic and/or para-aortic) of the metastases (hazard ratio, 4.07; 95% confidence interval, 1.36-12.16 for patients with pelvic metastases [P = 0.012]; and 3.73; 95% confidence interval, 1.38-10.09 for patients with para-aortic metastases [P = 0.010]). In the subset of women with para-aortic metastases treated by extended lumboaortic radiation therapy, neither the number of lymph nodes removed nor the number of positive nodes were associated with survival (P = 0.556 and P = 0.195, respectively).Para-aortic and pelvic lymphadenectomy provides valuable information about mortality risk in patients with locally advanced cervical cancer. [ABSTRACT FROM AUTHOR]

Introduction Germ cell tumors (GCT) represent less than 3% of all ovarian malignancies. They occur predominantly at young ages. The immature ovarian teratoma is the third commonest of the GCT, accounting for less than 1% of ovarian cancer cases worldwide. Growing teratoma syndrome (GTS) is a clinical entity characterized by a rapidly enlarging benign tumor mass, that arises during or after adjuvant chemotherapy for malignant ovarian GCT in presence of normal tumor markers. Its incidence has been reported to be from 2.5% to 19% of immature teratomas. We report an unusual case of GTS in a patient previously treated for recurrent stage IA immature teratoma of the ovary. Patients and results A 32-year-old nulligravida woman underwent right laparoscopic salpingo-oophorectomy because of suspected teratoma. Preoperative transvaginal ultrasound had identified a 12 cm complex cystic ovarian mass, with thin wall, a central solid component of 7 cm in size and two septa. Computed tomography (CT) did not show carcinomatosis nor other signs of disseminated disease. Serum tumor markers were normal except from α-fetoprotein (AFP)=156ng/ml. Removal of specimen was performed within an endobag. Intraoperatory histological examination informed benign teratoma. Final pathology revealed the presence of isolated foci of neuroepithelial immature tissue in one low magnification field of only one histological preparation, prompting the diagnosis of grade- 1 stage IA immature teratoma. The cytologic examination of peritoneal washing did not detect malignant cells. Tumor board decided to perform follow-up and this was agreed with the patient. Three months after surgery the patient consulted again for abdominal pain. Transvaginal ultrasound revealed the presence of a 15 cm complex solid mass in the right adnexal fossa. CT described a vast 20cm pelvic mass, a 7 cm left iliac fossa tumor, two Douglas pouch implants (2 and 2.5 cm), one 1.5 cm subhepatic implant and a 2 cm right iliac fossa implant. Elevated serum tumor markers were: CA-125=250U/ml, CA-19.9=97U/ml, TAG-72=19.8U/ml and AFP=3054ng/ml). Optimal citorreductive open surgery was performed, removing the pelvic tumor, cecal appendix, greater omentum and implants in Douglas pouch, uterine serosa, left ovarian surface, pelvic peritoneum and sigmoid colon serosa. Final pathology revealed a grade-3 immature teratoma in all resected lesions. The patient underwent adjuvant chemotherapy postoperatively with cisplatin, etoposide, and bleomycin (BEP x 4 cycles). Five months after surgery, a control CT scan was performed showing multiple 3 to 5 cm implants in the abdominal cavity. All tumor markers were normal. Another complete citorreduction that required a right hemicolectomy was achieved. Final pathology informed 39 implants, all of them presenting mature teratoma histology. Close follow-up was agreed. Conclusion Immature teratoma is an aggressive tumor that usually shows a good response to chemotherapy. Its aggressiveness remains on the proportion of tissue containing immature neural elements found. The occurrence of GTS should be bared in mind when dealing with immature teratoma. Surgical treatment with no residual disease is fundamental and should be always attempted. Long-term close follow-up is always needed. [ABSTRACT FROM AUTHOR]