Ovarian cancer in umbilical hernia.

Laparoscopic extraperitoneal paraaortic lymphadenectomy: a study of its applications in gynecological malignancies

Ovarian cancer is currently the fifth leading cause of cancer-related deaths among women worldwide. It is an aggressive disease that is frequently detected at advanced stages. Patients often present with nonspecific pelvic or abdominal symptoms.

Background: Giant tumors of the abdominal cavity, as a rule, occur in elderly patients with characteristic features and represent a serious problem in terms of choosing a radical method of therapy. Of particular difficulty are cases of giant serous endometrial cancer, requiring a differential diagnosis with ovarian cancer.
 Clinical case description: A clinical case of giant serous endometrial cancer mimicking ovarian cancer in a 55-year-old woman is presented. The patient came to the oncology department with complaints of abdominal enlargement, difficulty breathing and bloody discharge from the genital tract. The examination revealed the following: a giant formation (4065 cm), occupying the entire pelvic and the entire abdominal cavities, ascites, lesions of the retroperitoneal lymph nodes, and the greater omentum, an umbilical hernia. A chest CT showed multiple contrast-accumulating circular shadows of 313 mm (metastases). By the decision of the council, after the preliminary chemoembolization of both the uterine and ovarian arteries, a supravaginal amputation of the uterus with appendages was performed, along with the resection of the greater omentum, removal of the umbilical hernia with positioning a plastic mesh implant and excision of an excess skin flap. The histological examination of the intraoperative material made it possible to verify the diagnosis of a serous endometrial carcinoma with subtotal tumor necrosis, the myometrium invasion of more than a half of its thickness, with the egress to the perimetrium, metastatic lesions of both ovaries, the greater omentum, anterior abdominal wall. Stage T3b (FIGO IIIB). In the postoperative period, 6 courses of Paclitaxel / Carboplatin (AUC4-5) chemotherapy were carried out with a pronounced clinical effect. The patient was discharged in a satisfactory condition. The control PET-CT scan after the 6th chemotherapy course showed no pathology in the thoracic cavity, and no process progress in the abdominal cavity. Currently, the remission of the disease is 9 months.
 Conclusion: An algorithm for the diagnostic measures aimed at making the correct diagnosis is presented, and the tactics of treating a patient with giant serous endometrial cancer is described.

Six patients are reported whose presenting symptom was umbilical herniation. Upon exploration of the umbilicus with the intent to repair the hernia, ovarian cancer and malignant ascites were encountered in each individual. Cancer at the umbilicus, both metastatic and primary, is briefly discussed. The apperance of an acquired umbilical hernia in an otherwise asymptomatic patient should raise the suspicion of intraabdominal malignancy.

The purpose of this study was to evaluate the feasibility and safety of 2-port access (TPA) laparoscopy in gynecologic oncology. This was a retrospective review of 81 consecutive patients who underwent TPA laparoscopic surgery for various gynecologic cancers from March 2009 to September 2011. The TPA system consisted of a single multichannel port at the umbilicus and an ancillary 5-mm port in the suprapubic area. The surgical procedures included comprehensive ovarian cancer staging (33 patients), radical hysterectomy with pelvic lymph node dissection (19 patients), and endometrial cancer staging (29 patients). All surgical procedures were completed laparoscopically with no conversion to laparotomy. Two cases required 1 or 2 additional ports. The mean operating time, estimated blood loss, and number of lymph nodes were 253.8 minutes, 170.7 mL, and 34.9, respectively. Three patients (9.1%) with ovarian cancer and 4 patients (13.8%) with endometrial cancer were upstaged after surgery. The mean postoperative hospital stay was 6.6 days, and the mean postoperative pain scores (0-10 scale) were 3.4 at 6 hours, 3.0 at 24 hours, and 2.5 at 48 hours. Postoperative complications occurred at a low incidence (4.9%) and included one umbilical hernia, one vault dehiscence, and one lumbosacral nerve injury. Two-port access laparoscopic surgery using a single multichannel port system is a feasible and safe procedure in selected patients with gynecologic cancers. Prospective randomized trials will permit the evaluation of the potential benefits of this minimally invasive surgical technique.

We present a case of pelvic organ prolapse and inguinal hernia worsened by a benign ovarian tumor with ascites. A 61-year-old woman was referred to us complaining of feeling of something protruding from her vagina. She was diagnosed with Stage III cystocele. Behavioral therapy was administered as she had only slight subjective symptoms. She visited us eight months later due to a rapid aggravation of cystocele and voiding difficulty. She subsequently developed acute abdominal pain caused by incarcerated inguinal hernia. Abdominal ultrasound, MRI and CT showed a 10.6×9.0 cm pelvic mass with ascites. As an ovarian cancer with peritoneal dissemination was suspected, she immediately underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and colposuspension. Pathological diagnosis was fibrothecoma, a benign ovarian tumor. Postoperative course was uneventful, and ascites quickly disappeared in a manner similar to Meigs syndrome. Although no procedure was done to manage inguinal hernia, it was unproblematic for 18 months, after that it worsened, necessitating hernial repair. She had no recurrence of prolapse or ascites.Increased intra-abdominal pressure due to abdominal mass or ascites can worsen prolapse and hernial diseases such as inguinal, umbilical, and abdominal hernia. In this case, ovarian fibrothecoma with ascites seemed to be responsible for worsening of the prolapse and inguinal hernia. To conclude, it is important to consider background diseases when examining patients with prolapse and coexisting hernial diseases.

Background The term collision tumor is used when two unique neoplasms occur in the same organ at the same time. Ovarian collision tumors are extremely rare with different combinations of the following tumors being cited in the literature: surface epithelial tumors, sex-cord stromal tumors, and germ cell tumors. While several cases of combined mucinous neoplasms and granulosa cell tumors have been identified, only one collision case of Sertoli Leydig Cell Tumor (SLCT) and high-grade serous carcinoma (HGSC) has been published (1-6). Methods This case report, diagnosed in late 2022, includes the presentation, clinical management, and ultimately pathologic diagnosis of a rare collision tumor of the ovary composed on SLCT and HGSC. Results A 70 year old female, G4P4 presented to an outside emergency department for an episode of lightheadedness, dizziness, fatigue, and muscle weakness. Her blood pressure was elevated in the 200s and she was diagnosed with malignant hypertension. Her primary care provider worked her up for adrenal masses with a CT scan and she was referred to gynecologic oncology. On physical exam at her referral, her abdomen was soft and nondistended. A small umbilical hernia was noted. Her CA-125 was 578 units/mL and testosterone 99.40 ng/dL. CT, transvaginal ultrasound, and a PET scan all confirmed extensive peritoneal carcinomatosis including omental caking, mesenteric nodules, and posterior pelvic peritoneal mass and a complex 5.0 cm solid cystic right ovarian lesion, suspicious for malignancy. Additionally, a small volume of abdominopelvic free fluid was identified. These findings were consistent with a peritoneal carcinomatosis. The patient was taken for diagnostic laparoscopy, right salpingo-oophorectomy, and biopsies of the omentum and pelvic peritoneum. In the OR, 1-4mm nodules scattered throughout the pelvic and abdominal peritoneum, small bowel mesentery, and diaphragm were noted. Pathologic review confirmed a poorly differentiated SLCT of the right ovary (Stage IIIIC- pT3C Nx M0) with metastasis to the omentum and right pelvic side wall. Additionally, the right ovary was positive for HGSC metastatic from the fallopian tube. After H&E examination immunostains for p53, napsin, PAX8, synaptophysin, CD56, and inhibin were ordered with adequate controls. Tumor cells corresponding to poorly differentiated SLCT were positive for p53, CD56, and inhibin, while negative for PAX8, napsin, and synaptophysin. The metastatic HGSC was only positive for PAX8 and p53. Discussion Serous carcinoma of the fallopian tube is the most common form of ovarian cancer. SLCT are rare and typically found with Stage I disease. Stage III or IV are especially rare and there is little known on these neoplasms presenting at an advanced stage. The mechanism of collision tumor development has many hypotheses, though the most straight forward theory is that each tumor develops independently of the other and by chance collides into the other (7). Conclusion SLCT are rare neoplasms seen even more rarely with a concurrent tumor in the ovary. Additionally, an advanced stage SLCT makes this case even more unexpected. More research needs to be done to further understand collision tumors of the ovary and their associated findings, prognosis, and development.

Sister Mary Jospeh's nodule as metastasis of colorectal cancer. Systematic review of the literature and meta-analysis