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Background: The sentinel lymph node biopsy (SLNB) is the standard procedure to assess the lymph node status in women with early stage breast cancer. It is uncertain whether SLNB is useful after neo-adjuvant chemotherapy (NACT) given to women with locally advanced breast cancer. Materials and Methods: A literature search was conducted over a timeframe of 22 years (1994-2016). Forty-three studies evaluating the feasibility and accuracy of SLNB after NACT were identified. Results: The pooled identification rate was 88% and the pooled false negative ratio was 12%. Conclusion: SLNB could be considered as a standard procedure after NACT. [ABSTRACT FROM AUTHOR]

Staging of the axillary lymph nodes is an essential step to determine the appropriate treatment for breast cancer. Sentinel lymph node biopsy (SLNB) is currently the first step in staging and the gold standard. However, if the sentinel node is positive, a full dissection of the axillary lymph nodes should be performed (axillary lymph node dissection or ALND). This technique used to be the gold standard but had considerable sequelae which diminished quality of life. SLNB still has sequelae but the incidence is much lower. The goal of this systematic review is to assess whether MRI can replace or assist the current gold standard for axillary lymph node staging in breast cancer. With the use of these non-invasive techniques, the risk of morbidity could be reduced even more. A comprehensive search and an additional brief search in several databases has been performed using PRISMA. Studies were selected based on titles and abstracts and were included or excluded using predetermined criteria. The studies were assessed for validity and applicability using the QUADAS-2 tool by two readers. Data of three studies using diffusion-weighted imaging (DWI) were pooled and statistical analysis was performed. A total of seven studies were included for review. Three studies used DWI, others used T2-weighted imaging, contrast-enhanced imaging, T1-weighted imaging or an MRI scoring system. Due to the heterogeneously divided MRI modalities, a small meta-analysis of DWI was performed. Other studies were evaluated qualitatively. DWI reached a sensitivity of 87.67% (95% CI 77.88-94.20) and a specificity of 59.31% (95% CI 50.85-67.38), a positive predictive value (PPV) of 52.03% (95 CI 42.84-61.12), and a negative predictive value (NPV) of 90.53% (95% CI 82.78-95.58). MRI can aid in the detection of axillary lymph node metastasis, but it cannot replace the current gold standard (SLNB/ALND). [ABSTRACT FROM AUTHOR]

Aim: The objective of present study was to investigate whether conisation is associated with adverse pregnancy outcomes in Flanders, Belgium. Therefore a retrospective cohort study was conducted at the Antwerp University Hospital. Materials and Methods: The study was approved by the Ethical Committee and based on a questionnaire as well as on medical records. Confounders, like smoking, alcohol use, drug use, chronic illness, and gynaecological disorders during pregnancy were all taken into account. A multiple logistic regression was performed for an association between adverse pregnancy outcomes and confounders. Results: The study showed that there was association between conisation, low birth weight, and caesarean section. After conisation there was a significantly higher risk of 3.275 on a low birth weight. The risk of a caesarean section after conisation was tripled. A gynaecological disorder during the pregnancy had a significantly higher risk of delivering a child with a low birth weight and a higher risk of a caesarean section. Smoking and a chronic illness gave a significant higher risk of caesarean section. Discussion: Conisation is easy to perform and highly effective in the prevention of cervical cancer. Conisation has a high morbidity, as it is associated with severe adverse pregnancy outcome. A conisation should therefore only be performed on a true indication; otherwise it will be the victim of its own success. [ABSTRACT FROM AUTHOR]

Background: Nodular hyperplasia causes enlargement of the Bartholin gland. The standard approach for a painful enlarged gland is marsupialization. Case Report:A 48-year-old woman presented with vulvar pain, which began suddenly 18 months ago. On clinical examination at that time there was a palpable mass of 2 cm. Due to the persisting pain the mass was incised. Pathology report showed that there was nodular hyperplasia. After a while the mass returned accompanied with pain; however the latter also increased during sexual arousal. Multiple treatments were attempted. At the end, it was decided to remove the mass. Pathology examination showed the complete removal of multinodular mucinous gland structures filled with mucus. The hypothesis is that the mucus blocked the gland and caused pain during sexual arousal. Conclusion: The treatment for nodular hyperplasia of the Bartholin gland is excision and not incision. [ABSTRACT FROM AUTHOR]

Cervical cancer should be a historical disease, why are we not succeeding! The prophylactic vaccination will reduce cervical cancer by almost 80 % in Belgium. Cervical cancer screening should therefore remain in order to prevent the remaining 20%. The current used Pap cytology test misses 50% of all clinically significant precancers and cancers at the time of testing. The test should remain but the analysis should be altered. The screening should be modified based on our knowledge of human papillomavirus (HPV) as causal factor. Instead of looking for a cell abnormality, one should look for the presence of HPV. Then depending on the test, only two to ten percent of all relevant lesions are missed. The introduction of the vaccination should lead to the re-introduction of the screening based on HPV. This will not only lead to a considerable reduction in morbidity and mortality, allow longer screening intervals, but it will also be more cost-effective. More for less should be the driving force in cervical cancer screening if we want to be successful. [ABSTRACT FROM AUTHOR]

Background: Due to cervical cancer screening the number of squamous cancer have declined. The number of adenocarcinomas (ADCs) does appear to be rising. ADCs are often missed and human papillomavirus (HPV) testing could be helpful in detecting these abnormalities earlier. Case: A 36-year-old woman, who had a normal smear three years earlier, had a pap smear with atypical glandular cells. The LI HPV test showed that there was no HPV infection. Other HPV tests which looked at E6 and E7 showed an infection with HPV 16. Due to unknown reasons, no action was taken regarding the atypical glandular cells. Two years later the patient was diagnosed with a FIGO Stage IVb ADC of the cervix. The LI HPV test was still negative and the E6/E7 HPV test was still positive. Despite several multiple treatment modalities she succumbed of her disease two years later leaving behind a young family. Conclusion: HPV test looking only at LI can give false negative results if the virus is integrated in the human genome. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 29-year-old woman who was diagnosed of having a desmoplastic small round cell tumor in the ovary. It states that the patient has used contraceptive pills for 14 years due to irregular menstrual cycles and has interrupted the assumption of the pill due to a desire for pregnancy. It adds that a laparoscopic right ovariectomy and an anatomical pathology have confirmed a right ovarian mass of 132 grams (g) in weight and an 8.5 centimeter (cm) in size.

The article presents a case study of a 74-year-old woman who was referred to an orthopedic surgeon for a fibula metastasis. The examination reveals an isolated metastatic bone lesion in the right fibula of a primary squamous carcinoma of the vagina. The patient was given a palliative therapy including bone resection and radiotherapy of the metastatic lesion.

Case: A 58-year old woman presented with microcalcifications in her left breast. A biopsy showed a low-grade ductal carcinoma in situ. A tumorectomy was performed using a harpoon-shaped guide wire to remove the entire lesion. No additional therapy was given. Six months later during follow-up the mammography revealed that the distal end of the guide wire was still present in the left breast. Conclusion: When performing a tumorectomy using a guide wire, the completeness of the wire should be checked during surgery. Additionally cutting of the wire can be prevented by using a scalpel instead of scissors during surgery. [ABSTRACT FROM AUTHOR]

Almost 1% of all cervical cancers occur in pregnant women. The recommended management during the first 20 weeks is to sacrifice the pregnancy and to perform standard therapy, which means the loss of future fertility. A trachelectomy during pregnancy could preserve the ongoing pregnancy and future fertility. The author reports a radical vaginal trachelectomy (RVT) during 18 weeks of pregnancy. Definitive pathology of the trachelectomy specimen showed a tumor of 48 millimeters. Subsequently a radical hysterectomy was performed. At present, eight years and six months later the patient is well with no signs of recurrence. RVT is feasible in the first and second trimester of pregnancy. Clinical examination and MRI however are less accurate in the evaluation of stage and the extent of the tumor during pregnancy. Converting a RVT to a radical hysterectomy in a second time is safe in a pregnant woman.

The aim of this study was to review published reports on the feasability, results, and reliability of sentinel node biopsy in cases of ipsilateral recurrent breast cancer. A Medline search on publications from January 1999 to December 2007 and cross-references in published articles were looked for. We identified 16 reports on sentinel node biopsy in recurrent breast cancer, including a total of 287 patients. In 210/287 (73.2%) a sentinel node was identified, 77/210 (37.7%) had had previous axillary lymph node dissection and 131 (62.3%) a previous sentinel node procedure. Aberrant lymphatic drainage, other than the ipsilateral axilla was noted in 68/210 (32.4%). Of these 16/68 (23.6%) were located in the contralateral axilla. Of the removed contralateral axillary sentinel nodes 8/17 (47.1%) were invaded by cancer. We conclude that sentinel node biopsy in cases of recurrent ipsilateral breast cancer is feasible. In about one out of three cases drainage to the contralateral axilla with invasion in almost half the cases takes place. The therapeutical consequences of these findings need further study.

Purpose: To collect information about HPV in men and the (possible) correlation with HVP infection in women., Methods: Review of the literature., Results: An overview of HPV-related penile and anal malignancies in men and the risk factors of acquiring HPV., Conclusion: In men HPV is also partially responsible for anogenital malignancies. Although the prevalence of HPV-related malignancies in men is much lower than in women, it is useful to gain more knowlege. Especially knowing if men are really the HPV reservoir and transmitters for women can make a difference in deciding whether men should also be screened for HPV and if they are good candidates for vaccination.

Optimal cytoreductive surgery is essential in the treatment of ovarian cancer. Unfortunately many patients do not receive optimal treatment, despite numerous guidelines. The survival of patients receiving optimal surgery is twice the survival of patients receiving suboptimal surgery. There is no difference in complication rates between optimal and non-optimal surgery. An estimated 10% of the operated patients will have some kind of treatment-related morbidity. One of the most serious complications is acute abdomen in the postoperative period. Despite a long list of life-threatening situations there is sometimes also the unexpected complication, such as forgotten pain medication.

The purpose of this study is to report the use of a gemcitabine-vinorelbine-cisplatin (GVP) regimen as a successful treatment for a patient with recurrent squamous cervical cancer. The patient was initially diagnosed with a Stage IIb squamous carcinoma of the uterine cervix. A radical hysterectomy with pelvic lymphadenectomy was performed. Adjuvant radiotherapy was given. Eighteen years later, a pelvic recurrence with involvement of the pelvic sidewall was diagnosed and treated with the combination of GVP. A complete clinical and radiological response was achieved and a complete pathological response was confirmed afterwards. Currently, 67 months later, the patient is well and there are no signs of disease. We reviewed the literature concerning the staging and the chemotherapeutical and surgical treatment of recurrent cervical. Based on the recent literature, we conclude that pelvic examination, MRI, PET/CT and laparoscopy are essential in staging recurrent disease, and that laterally extended endopelvic resection (LEER) as well as pre-exenterative chemotherapy are promising novel therapeutic modalities for recurrent cervical cancer with pelvic extension in an irradiated area. In order to make recent data more transparant and practical we designed a classification and flow-chart for the management of recurrent cervical cancer.

Abdominal apoplexy is defined as intraabdominal haemorrhage without an identifiable pathology. This life-threatening situation is hardly mentioned in the literature. The clinical tableau is non-specific. The onset can be with nausea, mild to severe abdominal pain, a palpable mass in the abdomen or flank and sings of hypovolemic shock. The approach should be resuscitation, look for a likely underlying cause and control the bleeding. The present report will describe a case of abdominal apoplexy in a patient using a levonorgestrel intrauterine system. The management and possible origins of abdominal apoplexy will be discussed.

Ectopic breast tissue occurs when the mammary ridge fails to resolve during embryonic development. Ectopic breasts, either supernumerary or aberrant, have an incidence of 6%. Ectopic breast tissue is however hardly mentioned in the literature. Also benign and malignant alterations in these "breasts" are under-reported. The lifetime risk of women being diagnosed with breast cancer is 13%. It should be recommended that these "breasts" be included in the screening. Due to the unawareness this is generally not happening. The present article describes a case of ectopic breast cancer and discusses therapeutic management. A subcutaneous mass along the 'milk line' should be examined carefully and any suspicious lesions should be approached according to the guidelines for the management of symptomatic breast disease. Ipsilateral prophylactic mastectomy has no role in the management of a single ectopic breast cancer tissue.

Myelolipomas are benign tumours composed of haematopoietic tissue and mature adipocytes. They occur predominantly in the adrenal glands although rarely extra adrenal sites have been described. Their presentation and location can cause them to be easily confused with a malignant tumour. Here we present a myelolipoma in the paravesical space. To the best of our knowledge this location has not been reported before. The growing use of imaging will lead to an increase in incidence of these tumours. Understanding the natural history and their differentiation from other tumours is therefore important. The purpose of the present report is to raise awareness for this unusual tumour type in this location.

Biphasic sarcomatoid carcinoma of the breast represents only 0.2% of all breast cancer. Due to its rarity and repetitive reclassifications little is known about optimal treatment modalities. These tumours form a diagnostic and therapeutic challenge. The present report describes our experience with a case of biphasic sarcomatoid carcinoma of the breast and a review of the relevant literature is discussed.

Small cell cancers of the cervix are very rare and aggressive tumours. It is difficult to manage these tumours. They are often diagnosed in an advanced stage and their prognosis is generally poor. There are no clinical trials, due to their rarity, that would suggest optimal treatment. The present report describes a patient with a neuroendocrine small cell cancer of the cervix Stage IB2 with a positive lymph node. The treatment consisted of radical hysterectomy and node dissection, adjuvant chemotherapy, chemoradiation and brachytherapy. Currently, after 52 months, the patient is well and free of disease. Since 1996, there has been a classification for neuroendocrine tumours (NETs) of the cervix in four categories (large cell, small cell, typical carcinoid and atypical carcinoid). The aggressive behaviour of neuroendocrine small cell cancer is demonstrated by the high percentage of early lymphatic node and vessel invasion (68 and 90%). Almost half of the patients with Stage I and II will recur with an estimated 5-year survival from 14% to a maximum of 55%. Multimodal therapy for these tumours appears to give good response but often implies severe side-effects.

Small cell carcinoma of the ovary is a rare type of ovarian carcinoma with a poor prognosis. Two types should be distinguished: the hypercalcemic type and the pulmonary type. We report the case history of a 54-year-old woman with both a Stage IIIC small cell carcinoma, pulmonary type and a well-differentiated endometrioid adenocarcinoma of the left ovary in combination with a Brenner tumor in the right ovary. A review of the literature on small cell carcinoma of the ovary is given and the findings of our patient are brought into perspective in terms of both histopathogenesis and treatment outcome.

Primary squamous cell carcinoma of the breast is a rare neoplasm. We herein report two cases of primary squamous cell carcinoma of the breast, each with a different clinical manifestation. A 75-year-old patient with bilateral breast cancer and a 73-year-old woman with a mastitis carcinomatosa. Histopathology revealed that both tumours were squamous cell carcinomas. In the first case there was a coexisting adenocarcinoma in the contralateral breast. The diagnostic and therapeutic challenges are discussed in a review of the literature. The initial management of primary squamous cell carcinoma should be slightly different to that of more common types of breast cancer.

Malignant mixed müllerian tumour (MMMT) of the ovary is a rare and aggressive tumour with a poor prognosis. We present a case of a 57-year-old woman with a large pelvic mass, omental cake, ascites and pleural effusions, clinically highly suspect of an ovarian neoplasm. Paracentesis and ultrasound-guided biopsy of the ovary were negative for malignant disease. Therefore a CT-guided true cut biopsy was performed. The latter gave a histopathologic diagnosis of an endometrioid adenocarcinoma of the ovary. However after cytoreductive surgery anatomopathologic examination revealed a malignant mixed müllerian tumour of the ovary with heterologous differentiation. Apparently only one of the two components was found in the puncture. Adjuvant chemotherapy, active against the sarcomatous and the carcinomatous component, was given. At present the patient is well and disease free 35 months after the initial diagnosis. Cytological examination of ascites may be negative in the presence of malignant disease. If a tumour consists of two components, puncture can miss one, which may lead to undertreatment. Punctures should be discouraged as a diagnostic tool in patients in whom an ovarian malignancy is suspected.

More and more malignancies are identified by laparoscopy. Concerns have been risen about the safety of these procedures, especially after the publications on trocar metastases. General laparoscopic techniques should include safety measures in order to reduce the risk of implantation metastasis.

Mucoepidermoid carcinoma is a very rare primary tumour of the breast. Until now only 17 cases have been described in the literature. Generally these malignancies have a good prognosis, especially if well differentiated. We report a case of low-grade which recurred as high-grade after 32 months. She also developed a poorly differentiated adenocarcinoma in the other breast 12 years after her initial treatment. At present the patient is well without any sign of disease for 156 months. A literature review of this rare entity is presented.

Vaginal melanoma is a rare and highly malignant disease. This report describes the characteristics and clinical course of all patients treated at one institute (Northern Gynaecological Oncology Centre, UK) over the last 25 years. Of a total of nine patients identified with a primary malignant vaginal melanoma, only one patient survived for more than five years. A literature review revealed only 21 reported cases with a survival greater than five years. The most important factor for survival appears to be the tumour size. Treatment modality varied equally within the group of long-term survivors (27% radical surgery, 27% wide local excision, 27% radiotherapy, 14% wide local excision and radiotherapy, and 5% unknown therapy). The prognosis of patients with primary malignant melanoma is poor, regardless of primary therapy (conservative or radical). Conservative treatment and accurate investigation of every discoloured lesion is recommended.

The current report describes a 57-year-old patient with multiple bone metastases 14 years after her initial treatment for breast cancer. The only therapy the patient received for her osteolytic lesions was oral clodronate (800 mg/daily), as she refused any other kind of treatment. On bone scintigraphy the number of visible bone metastases diminished slowly and after two years only a few minor lesions could be seen. Together with this report the value of oral clodronate as anti-osteolytic therapy in breast cancer patients is discussed.

A 74-year-old patient with recurrent Paget's disease of the vulva in the gluteus maximus island myocutaneous flap 11 years after a hemivulvectomy with reconstruction is presented. This report is only the second case of recurrent noninvasive Paget's disease in a reconstructive flap. The English literature on this subject is reviewed with special attention to the biological behavior of these tumors.

Worldwide there is a strong relation between the presence of human papillomavirus (HPV) and the development of cervical cancer. This study investigated the prevalence and genotype of HPV in women with normal smears, women with premalignant lesions and women with cervical cancer in Antwerp, Belgium. Type-specific polymerase chain reaction (PCR) for HPV types 16 and 18 and general primer PCR (GP5+/6+) was performed on DNA extracted from paraffin-embedded tissue from women with lesions or fresh material from controls. HPV was detected in 11% of controls, 61% of women with atypia, 77% of women with CIN lesions and 88% of women with cervical carcinoma (chi2 trend, 273, p<0.001). The odds ratio for high-risk HPV types was 9.3 for atypia (95%CI. 4.3-19.8), 33.6 for CIN lesions (95%CI, 19.3-58.6) and 78.8 for cervical cancer (95%CI, 39.2-158.3). In total, 19 different HPV genotypes were detected, including five low risk HPV types. Seven of the 14 high-risk HPV types were detected in cervical cancer patients. Based on our study it is suggested that a prophylactic vaccine based on a cocktail of a limited number of high-risk HPV types should be considered in order to protect most women from developing cervical cancer.