Adenomyosis of the uterus is defined as the presence of endometrial tissue, including glands and stroma, situated at least 2.5 mm below the endometrial-myometrial junction and widely distributed within the myometrium layer of the uterus. There is no consensus on the appropriate treatment for symptomatic uterine adenomyosis in women who want to preserve their uterus, partly because adenomyosis is somewhat enigmatic in diagnosis and owing to its clinical significance. Hysterectomy, through either exploratory laparotomy or minimally invasive procedures, is a definite treatment for uterine adenomyosis, once the women have completed childbirth or do not require future fertility. However, many women with a uterine pathology still have a strong desire to preserve the uterus, for which conservative and uterine-sparing procedures are increasingly used, and with which fertility preservation or quality-of-life improvement can be achieved. Although medical management can be effective, similar to the management of uterine fibroids (myoma), its effect is often transient and rapid regrowth of adenomyosis and relapse of symptoms and signs always occur once the treatment is stopped. Therefore, other strategies should be selected. Conservative and uterine-sparing surgery might be one of the most familiar procedures of these uterine-sparing procedures. In this article, the latest knowledge and research evidence on uterine-sparing surgery for uterine adenomyosis are reviewed.
Objectives: To compare the clinical outcomes of intravenous carboplatin/paclitaxel chemotherapy plus bevacizumab versus intraperitoneal cisplatin/paclitaxel chemotherapy without bevacizumab as the frontline treatment in women with advanced ovarian, fallopian tube and primary peritoneal cancer. Methods: Between November 2012 and January 2024, medical records of all consecutive women with stage II~IV cancer treated with either frontline adjuvant intraperitoneal cisplatin/paclitaxel without bevacizumab (IP group), intravenous carboplatin/paclitaxel without bevacizumab (IV group) or intravenous carboplatin/paclitaxel with bevacizumab (IVB group) at a tertiary referral center were reviewed. Results: A total of 143 women (IP group, n = 57; IVB group, n = 23; IV group, n = 63) were reviewed. The IP group had greater progression-free survival compared to the IVB group (49.1 months, 95% confidence interval [CI] = 27.8 months to infinity, versus 11.9 months, 95% CI = 11.2 to 16.2 months; adjusted hazard ratio [HR] = 0.45, 95% CI = 0.24 to 0.87, p = 0.017). Additionally, the IP group also had a higher overall survival compared to the IVB group (not reached, 95% CI = 55.6 months to infinity, versus 38.9 months, 95% CI = 21.9 months to infinity; adjusted HR = 0.34, 95% CI = 0.15 to 0.79, p = 0.012). Conclusions: Intraperitoneal cisplatin/paclitaxel chemotherapy without bevacizumab seems to offer a survival advantage when compared with intravenous carboplatin/paclitaxel with bevacizumab in the frontline treatment of women with advanced ovarian cancer.
Endometrial stromal tumors are rare uterine tumors (<1%). Four main categories include endometrial stromal nodule, low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), and uterine undifferentiated sarcoma (UUS). This review is a series of articles discussing the uterine sarcomas. LG-ESS, a hormone-dependent tumor harboring chromosomal rearrangement, is an indolent tumor with a favorable prognosis, but characterized by late recurrences even in patients with Stage I disease, suggesting the requirement of a long-term follow-up. Patients with HG-ESS, based on the identification of YWHAE-NUTM2A/B (YWHAE-FAM22A/B) gene fusion, typically present with advanced stage diseases and frequently have recurrences, usually within a few years after initial surgery. UUS is, a high-grade sarcoma, extremely rare, lacking a specific line of differentiation, which is a diagnosis of exclusion (the wastebasket category, which fails to fulfill the morphological and immunohistochemical criteria of translocation-positive ESS). Surgery is the main strategy in the management of uterine sarcoma. Due to rarity, complex biological characteristics, and unknown etiology and risk factors of uterine sarcomas, the role of adjuvant therapy is not clear. Only LG-ESS might respond to progestins or aromatase inhibitors.
Uterine sarcomas account for 3-7% of all uterine cancers. Because of their rarity, unknown etiology, and highly divergent genetic aberration, there is a lack of consensus on risk factors for occurrence and predictive poor outcomes as well as optimal therapeutic choices. Tumor types according to the World Health Organization classification include leiomyosarcoma, endometrial stroma sarcoma, and undifferentiated sarcoma. Staging is done using the 2014 Federation International Gynecology and Obstetrics and 2010 American Joint Committee on Cancer tumor, lymph node, and metastases systems. Tumor grade can be classified based on the French Federation of Cancer Centers Sarcoma Group system or the Broder's system that incorporates tumor differentiation, mitotic count, and tumor necrosis. This review is a series of articles discussing uterine sarcoma, and this is Part I, which focuses on one of the subtypes of uterine sarcomas-uterine leiomyosarcoma. The clinical characteristics, diagnosis, outcome, and recent advances are summarized in this article.
Background: To compare the short-term outcome of patients undergoing single-port laparoscopic salpingectomy (SP-LS) and conventional three-port laparoscopic salpingectomy (C-LS). Methods: A retrospective evaluation of 112 patients with tubal pregnancies treated by one surgeon at a single teaching hospital. Among these, 47 patients were treated with SP-LS and the remaining 65 were treated with C-LS. Results: The characteristics of patients were similar in both groups. There were no statistically significant differences in operative time, estimated blood loss, intraoperative and immediate postoperative complications, and length of hospital stay between both groups. Time to bowel recanalization (6.2 ± 1.0 vs. 7.2 ± 1.4 h, p < 0.05) and postoperative visual analog scale for pain scores (3.0 ± 0.5 vs. 3.6 ± 0.6, p < 0.005) were significantly lower in the SP-LS group compared with those in the C-LS group. Conclusion: Our study demonstrated the feasibility to use the single-port laparoscopic salpingectomy in the management of women with tubal pregnancy, which showed the similar or better outcome compared with the use of conventional three-port laparoscopic salpingectomy.
Abstract Rupture of a pregnant uterus in early pregnancy and an unscarred uterus are extremely rare, and some non‐specific symptoms might appear before this occurrence. We report the case of a multiparous woman (gravida 3, para 2) with uterine fundal rupture in her early second trimester (17+ weeks of gestational age), who presented upper abdominal discomfort and vomiting for 3 days, and progressed into sudden acute abdomen and shock. During emergent laparotomy, the entire amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus. Although we could not confirm that the appearance of upper gastrointestinal symptoms and severe vomiting was associated with uterine rupture in this pregnant woman, abdominal symptoms or signs might be a hint or cause of severe catastrophic pregnancy‐related complications.
Dear Editor,Cervical squamous cell carcinoma (SCC) and adenocarcinomamay involve the ovary. Although it is not difficult to diagnose inmost cases, on very rare occasions the presentation may showsymptoms related to an ovarian mass, with the cervical cancerbeing undetected, especially endocervical adenocarcinoma [1,2].This is important because the challenge of diagnosing primaryendocervical adenocarcinoma occurs especially in women whoshow no symptoms, and have a grossly normal cervix and anegative Pap smear [3]. The spread of cervical malignancy (bothSCC and adenocarcinoma) is often through lymphatic drainage ordirect invasion [4]; except some reports show that endocervicaladenocarcinoma carries a higher risk of ovarian metastases thanSCC of the cervix [5]. There is an apparent difference in the treat-ment strategy for advanced cervical cancers and ovarian cancers[6,7]. Therefore, making an accurate diagnosis before planningtherapy is of paramount importance. The following is a case reportof advanced cervical adenocarcinoma metastatic to the ovarymimicking primary ovarian cancer.A 54-year-old menopausal woman (G3P3) visited the emer-gency room due to acute sudden onset of abdominal pain afterseveral weeks of abdominal fullness. Her past medical history wasunremarkable. She did not have any Pap smears since the birth ofherlastchild(28yearspreviously).Physicalexaminationrevealedaprotuberant and tense abdomen, but the cervix was essentiallynormal. Transvaginal ultrasound revealed a 15 cm complex cysticmass lesion located at the right adnexal area accompanied withmassive ascites, but the uterus and the left ovary seemed to benormal.Computedtomographyidentifiedandconfirmed theabovefinding (Fig. 1). Serum tumor markers, including CA 125, CA 199,and CEA were 286.0 U/mL, 209.0 U/mL, and 226.0 ng/mL, respec-tively. Other investigations, including hematological andbiochemical tests, a chest X-ray, and upper and lower gastrointes-tinal (GI) tract evaluations were within normal limits.Under the diagnosis of ovarian malignancy, the patient under-went a laparotomy. During surgery, a right ovarian cystic complexmass with a mucinous component (Fig. 2) accompanied withmassive ascites (7000 mL) and peritoneal carcinomatosis wasfound. The immediate frozen pathology report favored a diagnosisof adenocarcinoma-mucinous type. Therefore, the patient under-went an optimal debulking surgery, including total hysterectomy(Fig. 3), bilateral salpingo-oophorectomy, infracolic omentectomyand retroperitoneal lymph node sampling, and multiple biopsies.However, the final pathologic report was primary uterine endo-cervical adenocarcinoma.Pathologic features included hyperchromatic dysplasia of themucinous glandular cells of the uterine endocervix; the mucinoustumor occupied the whole layer of the endocervix and extended tothe lower segment of the uterine body. Other sections of the rightovary, appendix, omentum, abdominal wall, and mesentery allshowed tumor metastases with floating mucinous tumor cellswithin an extensive mucin pool.The patient was treated with adjuvant systemic chemotherapy(8 cycles of topotecan [Hycamtin Injection, GlaxoSmithKline, San
Primary fallopian tube carcinoma (PFTC) is a rare gynecological malignancy with the following characteristics: its preoperative diagnosis is easy to miss or delay because of a lack of specific symptoms and signs; it is difficult to distinguish from serous epithelial ovarian cancer or primary peritoneal serous carcinoma during or even after operation because they have the same histopathological features; and there is uncertainty regarding the optimal management because of the lack of available standard guidelines. All of these factors contribute to the major challenge of undertaking a comprehensive study of this disease. To improve our understanding of this rare disease, the domestic data were summarized first. We searched PubMed on this topic, using the term "primary fallopian tube tumor and Taiwan" (from January 1, 1990 to November 3, 2013) and identified 15 published articles, but only 11 studies focused on the outcome of patients with PFTC in Taiwan. These limited data were not enough to increase our knowledge in dealing with this disease; therefore, the addition of large series or published review articles addressing this topic was needed. According to these reports, we concluded: (1) the main type of PFTC was serous type, often poorly differentiated; (2) the diagnosis of PFTC is frequently missed or delayed; (3) PFTC is often of an earlier International Federation of Gynecology and Obstetrics (FIGO) stage than is epithelial ovarian cancer (EOC), because of the appearance of earlier but nonspecific symptoms or signs, such as abdominal pain, vaginal bleeding, and watery discharge or mass; (4) the most important clinicopathological prognostic factor was FIGO stage; (5) the therapeutic strategy is still uncertain, but is often based on the guidelines for treating EOC. An intensive surgical effort such as a complete surgical resection or optimal cytoreduction surgery with a minimal residual tumor followed by a platinum-paclitaxel combination chemotherapy with/without targeted therapy (for example, antiangiogenesis agents) may provide the best possibility of disease-free or overall survival.
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