Bilateral Adnexectomy Research Articles

Idiopathic pneumoperitoneum after gynecological surgery: a report of two clinical cases

Abstract Pneumoperitoneum, characterized by the presence of air in the peritoneal cavity, is usually associated with severe clinical conditions, such as perforations of hollow viscera, often requiring urgent surgical intervention. However, in rare cases, pneumoperitoneum occurs without an identifiable cause, thus classified as idiopathic pneumoperitoneum. We present two clinical cases of women who developed pneumoperitoneum after extensive gynecological surgeries. In the first case, a 63-year-old woman underwent elective hysterectomy and bilateral adnexectomy due to a large adnexal mass. In the second case, a 55-year-old woman had a similar surgical history. Both patients were treated conservatively, with a positive outcome. Idiopathic pneumoperitoneum is a diagnostic and therapeutic challenge, especially in the postoperative context. The cases presented underscore the importance of rigorous diagnostic evaluation and a cautious therapeutic approach, suggesting that idiopathic pneumoperitoneum may represent a benign and self-limiting phenomenon rather than a surgical emergency.

Perivascular epithelioid cell tumor of the uterus and pelvic cavity.

Primary perivascular epithelioid cell tumors (PEComas) of the female reproductive tract have been primarily reported as case reports owing to their clinical rarity. Limited incidence rates and clinical case data hinder a comprehensive understanding of the risks and invasiveness of this disease. We discuss herein the diagnosis, treatment, and prognosis of this disease to enhance comprehension and therapeutic strategies. We conducted a clinical analysis of patients with PEComa treated at the Gynecology Department of The West China Second University Hospital of Sichuan University between May 2018 and January 2024. Diagnosis and treatment were evaluated based on pertinent literature. Overall, eight patients (seven patients with tumors in the uterus and one patient with tumors in the pelvic cavity) were evaluated. One patient with PEComa of unknown malignant potential and two patients with malignant PEComa underwent hysterectomy and bilateral adnexectomy with or without adjuvant therapy and did not develop recurrence. Meanwhile, three patients who underwent lesion resection only exhibited radiological evidence of new lesions. Furthermore, postoperative imaging identified new pulmonary nodules in three patients. Although the current criteria are generally effective in assessing the tumor invasiveness of PEComa, emphasizing the significance of complete lesion resection remains crucial. Inadequate treatment significantly increases the risks of recurrence and metastasis. Additionally, the prevalence of pulmonary metastases may have been underestimated. Refining risk stratification to prevent overtreatment of low-grade malignancies or overlooking highly aggressive tumors is an important area for further study.

Clinical and ultrasound features of uterine perivascular epithelioid cell tumors: case series and literature review.

To describe the clinical and ultrasonographic features of uterine perivascular epithelioid cell tumor (PEComa) using standardized terminology. This was a retrospective analysis of patients with uterine PEComa diagnosed and confirmed by pathology and immunohistochemistry at West China Second University Hospital, Sichuan University, Sichuan, China, between January 2010 and September 2023. The Morphological Uterus Sonographic Assessment (MUSA) consensus and the International Endometrial Tumor Analysis (IETA) consensus were utilized for the standardized description of the sonographic characteristics of uterine PEComa. We summarized the clinical and ultrasound features of uterine PEComa in cases from our center and those found in a review of the literature conducted using PubMed from 1 January 2013 to 30 September 2023 (inclusive). Five patients, aged 33-57 (median, 52) years with a total of six uterine PEComa lesions were included in our cohort. All cases had complete ultrasonographic and pathological images. None of the patients had a history of tuberous sclerosis complex. Two patients had malignant PEComa (one patient had two lesions) and three had benign PEComa, originating from the cervix, myometrium or uterine cavity. Patients presented with symptoms including increased vaginal discharge, vaginal bleeding and pelvic or abdominal pain. The three patients with benign PEComa underwent total hysterectomy and bilateral adnexectomy, tumor excision and conservative management, respectively, while both malignant cases underwent total hysterectomy and bilateral adnexectomy followed by chemotherapy. Regular follow-up (from 6 to 24 months) revealed recurrence in one case. Two lesions were misdiagnosed as uterine fibroids, two as cervical cancer, one as metastatic cervical cancer (with myometrial invasion) and one was indeterminate. Ultrasound examination showed that most lesions displayed regular round or ovoid shapes (66.7%), uniform echoes (66.7%) and hypoechogenicity (66.7%), with one (16.7%) malignant PEComa showing cystic areas and one (16.7%) benign PEComa showing punctate calcifications. All lesions lacked shadowing and the majority showed moderate to abundant vascularity (color score of 3-4, 83.3%). The color score was 2-4 in the periphery in 100% of cases and internally in 83.3% of cases. The three benign PEComas showed similar characteristics in vascular distribution, with scattered internal vessels and peripheral vessels exhibiting a circular pattern. The literature search identified 11 articles describing the ultrasonographic appearance of 18 cases of uterine PEComa, with similar characteristics to those in our cohort. The sonographic features of uterine PEComa include a uniform or non-uniform hypoechogenic mass, typically round or ovoid with regular margins, occasionally containing cystic areas or calcifications, lacking shadowing and often showing moderate to abundant vascularity. Although the preoperative ultrasound diagnosis of uterine PEComa remains challenging, particularly given the non-specific nature of the sonographic characteristics described here, dispersed intratumoral vessels and a peripheral circular vascular distribution may serve as diagnostic clues for uterine PEComa, but more cases are needed for confirmation. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Recurrent Vaginal Vault Leiomyoma following Total Abdominal Hysterectomy and Bilateral Adnexectomy

Recurrent Vaginal Vault Leiomyoma following Total Abdominal Hysterectomy and Bilateral Adnexectomy

Malignant Perivascular epithelioid cell tumour of the uterus without TFE3 gene rearrangement: a case report

BackgroundPerivascular epithelioid cell tumours (PEComas) are soft tissue tumours. These neoplasms belong to the family of mesenchymal tumours, which include angiomyolipomas, clear-cell sugar tumours of the lung, and PEComas not otherwise specified (NOS). The probability of a perivascular epithelioid cell tumour (PEComa) occurring in the uterus is low, and the incidence, diagnosis, treatment, and outcomes of such tumours are still unclear.Case presentationA 51-year-old woman presented a 4-year history of natural menopause. An intrauterine mass was detected via ultrasound examination; the mass showed a tendency to increase but caused no symptoms. The levels of tumour markers were within the normal range. Pathological analysis of the curettage revealed perivascular epithelioid differentiation of the endometrial tumour. Consequently, a laparoscopic total hysterectomy with bilateral adnexectomy was performed. No distant metastasis was detected via whole-body positron emission computed tomography (PETCT) after the operation. Fluorescence in situ hybridization (FISH) revealed no TFE3 gene rearrangement. Next-generation sequencing of bone and soft tissue revealed negative TSC1/2 and TP53 expression. No recurrence or metastasis was observed during the 18-month follow-up period.ConclusionPEComa of the gynecologic tract is a rare and challenging entity. Diffuse HMB-45 expression, TSC alterations and TFE3 rearrangement are characteristic of uterine PEComas. Surgical resection is the first choice. Genetic testing is helpful for determining the nature of the mass and for choosing targeted therapy. Further research is needed to establish treatment protocols.

Advantages of Robotic Surgery for Patients of Reproductive Age with Endometrial Cancer.

This review presents current knowledge on the surgical treatment of endometrial cancer in young patients. Endometrial cancer is the most common gynecological cancer in Europe. Higher morbidity is correlated with obesity, hypertension and diabetes, which are growing worldwide. However, endometrial cancer at an early age is very rare. The first line of treatment for this cancer is radical hysterectomy, which is controversial in young women. There is an alternative method of fertility-sparing treatment. However, there is a group of young patients for whom surgical treatment is recommended. According to European guidelines, minimally invasive surgery is recommended for endometrial cancer. The aim of the study was to present the advantages of robotic surgery for endometrial cancer detected at a young age. The procedure of radical treatment with robot-assisted laparoscopy is more precise. Better visualization and stabilization of instruments allow a shorter procedure time, a brief hospital stay and fewer complications. Quality of life may be at a similar level. Incisions after trocars are painless and more esthetic than a classical wound. Bilateral adnexectomy in endometrial cancer depends on age, molecular status of the cancer, stage, genetic risk factors and individual decision. Conclusions: Robotic surgery seems to be a better surgical method for endometrial cancer in younger patients.

A report of twenty cases of ovarian Brenner tumor and literature review: a case series study

BackgroundTo explore the clinical characteristics of ovarian Brenner tumors and provide some basis for the treatment regimen of ovarian Brenner tumors.MethodsA retrospective analysis of the pathology database of surgical specimens at the Huzhou Maternal and Child Health Hospital from September 2008 to February 2023 was conducted. Patients who were pathologically diagnosed with ovarian Brenner tumors were included. Clinical data of patients was collected, and their diagnostic and treatment characteristics were summarized and analyzed.ResultsA total of 20 cases were included in this study, all of which were histologically confirmed by surgical pathology. Among them, 8 cases (40%) were combined with serous, mucinous cystadenoma, or simple cyst. One case presented with a benign ovarian Brenner tumor combined with mucinous cystadenoma, underwent right adnexectomy, and relapsed 5 years later as a malignant Brenner tumor (MBT) coexisting with ovarian squamous cell carcinoma. Multiple tumor markers were elevated malignantly, with CA199 being the most significant. Treatments included unilateral adnexectomy in 7 cases, bilateral adnexectomy in 3 cases, total hysterectomy with bilateral adnexectomy in 7 cases, radical hysterectomy in 1 case, and 2 cases underwent ovarian staging surgery. MBT patients received three cycles of postoperative chemotherapy with the carboplatin-paclitaxel (TC) regimen. Follow-up: One case with concomitant cervical cancer was lost to follow-up after surgery in an external hospital; one case with concomitant ovarian cancer received no further treatment after surgery and was lost to follow-up after 2 years; one case with concomitant endometrial cancer received no further treatment after surgery, and had no recurrence after 4 years of follow-up. Regular follow-up for MBT patients continued for 5 years without recurrence. The remaining 16 cases were followed up for a period ranging from 6 months to 7 years, with no reported recurrences.ConclusionClinical manifestations and auxiliary examinations of ovarian Brenner tumors lack obvious specificity. When necessary, a combination of tumor markers and imaging examinations can aid in diagnosis. Surgical strategies should be selected according to the patient's menopausal status.Trial registrationNot applicable.

Synchronous gastric and ovarian cancer successfully treated with FOLFOX therapy: a case report and review of the literature.

Synchronous gastric and ovarian cancer is extremely rare, and there have been no case reports. Here, we present the first case of synchronous gastric and ovarian cancer successfully treated with chemotherapy and surgery. A 72-year-old Japanese woman presented at our hospital with upper abdominal pain and vomiting. She was diagnosed with gastric cancer after undergoing upper gastrointestinal endoscopy. Simultaneously, ovarian cancer was also suspected based on imaging studies which showed a 9cm cystic lesion with a solid part on the right ovary. Since her gastric cancer was considered inoperable due to the extent of the lesion, she was treated with four courses of oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX therapy). Since both gastric and ovarian cancer lesions were found to be reduced in size, laparoscopic total gastrectomy (D1 dissection, with Roux-en-Y reconstruction), bilateral adnexectomy, and partial omentectomy were performed. Based on pathological and immunohistochemical findings, the diagnosis of synchronous cancer of poorly differentiated carcinoma of the stomach and endometrioid carcinoma of the ovary was made, and it became clear that FOLFOX therapy was effective especially against ovarian cancer. The patient is currently undergoing postoperative chemotherapy with FOLFOX + nivolumab. She remains alive 8 months after surgery, with no active lesions. This is the first report of a patient with synchronous gastric and ovarian cancer, suggesting that FOLFOX therapy may be effective as a first-line treatment of endometrioid carcinoma of the ovary.

Uterine tumors resembling ovarian sex cord tumors: A retrospective analysis of 7 cases from a single institution.

To investigate the clinicopathological features, diagnosis, surgical treatment and prognosis of uterine tumors similar to ovarian sex cord tumors (UTROSCT). The clinical data, surgical approach, histopathological, and immunohistochemical features of 7 cases of UTROSCTs were retrospectively reviewed and followed up. All 4 patients were premenopausal women. The most common clinical presentation was menorrhagia (n = 4) followed by postmenopausal lower abdominal mass (n = 2) and postmenopausal bleeding (n = 1). Gynecological ultrasonography suggested uterine fibroids in 4 cases, adenomyosis with uterine fibroids in 2 cases, and an intrauterine mass in 1 case. Pelvic MRI was performed preoperatively in only 2 cases, and both indicated uterine fibroid degeneration, including 1 patient with suspected malignancy. Preoperative serum tumor markers were measured in 6 patients, and only 1 patient had elevated CA125 levels, up to 158 U/mL. Total hysterectomy with bilateral adnexectomy or salpingectomy was the most common treatment pattern (n = 6). The tumors were located within the myometrium (n = 4), submucosa (n = 1), and isthmus to external cervical os (n = 1), with a range of 2 to 12 (mean = 8) cm. Edema and degeneration were observed in 2 cases, and necrosis in 1 case. Postoperative follow-up ranged from 31 to 82 (mean = 43) months. Unfortunately, 1 patient died at 54 months of follow-up without undergoing hysterectomy. The remaining 6 cases showed no tumor recurrence or metastasis after surgery. Histological examination revealed a tumor composed of epithelioid tumor-like cells arranged in cords, trabeculae, and nests. All 7 tumors showed expression of 2 sex cord differentiation markers. Furthermore, all tumors expressed the smooth muscle marker, while epithelial marker CK (4/7). endometrial stromal marker CD10(0/7). The Ki-67 proliferation index was found to be <5% (5/7). The option of total hysterectomy may be considered for women who do not have any fertility requirements. However, for young women who desire to maintain their reproductive capacity, surgery to preserve the uterus may be an alternative, although it necessitates careful postoperative monitoring. In terms of follow-up monitoring, MRI is more suitable than ultrasound. The diagnosis of UTROSCT heavily relies on histopathological examination and immunohistochemical analysis.

Primary Ewing’s sarcoma of the uterine cervix: a case report and review of the literature

BackgroundEwing’s sarcoma (ES) is an aggressive cancer of bone and soft tissue, most of which tend to occur in the bone. Extraosseous Ewing’s sarcoma (EES) of the cervix is extremely rare.Case presentationIn the present work, we reported a 39-year-old cervical EES patient with a 2.5*2.1*1.8 cm tumor mass. According to previous literatures, our case is the smallest tumor found in primary cervical ES ever. The patient initially came to our hospital due to vaginal bleeding, and then the gynecological examination found a neoplasm between the cervical canal and partially in the external cervical orifice. The diagnosis of EES was confirmed below: Hematoxylin & Eosin staining (H&E) revealed small round blue malignant cells in biopsy specimens. Immunohistochemistry (IHC) showed the positive staining for CD99, NKX2.2, and FLI1. Disruption of EWSR1 gene was found by fluorescence in situ hybridization (FISH), and the EWSR1–FLI1 gene fusion was determined by next-generation sequencing (NGS). The patient received laparoscopic wide hysterectomy, bilateral adnexectomy, pelvic lymphadenectomy, and postoperative adjuvant chemotherapy and remained disease free with regular follow-up for 1 year.ConclusionsThrough a systematic review of previously reported cervical ES and this case, we highlighted the importance of FISH and NGS for the accuracy of ESS diagnosis, which could assist on the optimal treatment strategy. However, due to the rarity of the disease, there is no standard treatment schemes. Investigation on molecular pathological diagnosis and standardization of treatment regimens for cervical ES are critical to patients’ prognosis.

Management of Bilateral Borderline Ovarian Tumor in a 26-year-old Patient in a Resource-Limited Setting

&amp;lt;i&amp;gt;Background&amp;lt;/i&amp;gt;: borderline ovarian tumors are rare epithelial tumors, more common before the age of 40, with challenging preoperative diagnosis. Our aim is to describe the management of a case in a resource-limited context in Burkina Faso. &amp;lt;i&amp;gt;Case report:&amp;lt;/i&amp;gt; a 26-year-old primigravida with a 4-year-old child presented with an abdominal mass evolving over one year in the context of secondary amenorrhea. Clinical examination revealed weight loss, cutaneous-mucosal pallor, increased abdominal volume with tender deep palpation, and an irregular, mildly firm mass around the umbilicus extending to the iliac fossae, with a depressed area along the midline. Speculum examination was normal. On vaginal examination, the cervix was unremarkable, the uterus was of normal size, but the lateral fornices and Douglas pouch were filled. Further investigations revealed microcytic hypochromic anemia and a borderline normal CA 125 level. The rest of the laboratory tests were normal. Abdominal and pelvic ultrasound and CT revealed a strong suspicion of a bilateral ovarian tumour, with no signs of secondary localisation. MRI was not available. The diagnosis of probably malignant bilateral ovarian tumour was retained, and laparotomy was indicated. When the parietal peritoneum was opened, two ovarian tumours with a budding appearance occupied the entire lower half of the abdomen. A part of the omentum was in contact with both masses. Bilateral adnexectomy, total hysterectomy and partial omentectomy were performed in the absence of an extemporaneous histological study. Histological study of the surgical specimens concluded that the tumour was borderline ovarian. Follow-up at 3 years showed no signs of recurrence or tumour extension. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: borderline ovarian tumours are managed surgically, and the choice of conservative or radical surgery is not easy when there is a desire to have children, and when the ovaries are bilaterally involved. Fortunately, the vital prognosis is favourable.

Peritoneal Carcinomatosis from Ovarian Cancer: A Case Report

Epithelial ovarian cancer is one of the most common causes of cancer-related death in women. More than half of patients are diagnosed at an advanced stage, usually due to the locoregional spread of peritoneal carcinomatosis. We present the case of a 49-year-old woman who suffered from constitutional syndrome and abdominal distention. The imaging tests revealed two large, vascularized, and heterogeneous masses that depended on both ovaries. Bilateral adnexectomy was performed and the result of the anatomopathological study was endometrioid carcinoma moderately differentiated. The patient was treated according to the latest recommendations of the NCCN guidelines. A combination of systemic chemotherapy and cytoreductive surgery has been the standard treatment since the mid-1990s. However, a combination of hyperthermic intravenous and intraperitoneal chemotherapy may reduce plasma toxicity and increase therapeutic effectiveness.

Remimazolam in perioperative management of Eisenmenger syndrome: a case report.

Eisenmenger syndrome (ES) is characterized by severe and irreversible pulmonary hypertension stemming from an uncorrected intracardiac shunt of significant size. The imbalance between systemic and pulmonary artery pressures predisposes patients with ES to the risk of cardiac arrest. Remimazolam has caused less circulatory depression, which may be advantageous for ES. However, no studies reported the use of remimazolam in perioperative ES management. A 45-year-old female patient with ES derived from a ventricular septal defect was scheduled to undergo bilateral adnexectomy for an ovarian tumor. Her oxygen saturation was 80% with 3 L/min oxygen at rest, and her pulmonary and systemic flow ratio was 0.53. She underwent general anesthesia with remimazolam, and intraoperative hemodynamics was stable without hypotension or reduced oxygen saturation. Our successful management of ovarian tumor surgery in a patient with ES using remimazolam reveals its potential effectiveness in perioperative care.

Ovarian Carcinoma - A Single Centre Case-Series Descriptive Analysis of Surgical Procedures.

Background: Ovarian surface epithelial cancer (OSEC) are an entity in which, according to genomics and pathology data accumulated in the last couple of decades, several different nosological entities with distinct etiologies are aggregated. In ovarian cancer, surgery is the pivot of treatment, to which medical oncological treatment is added by recommendation in most cases. Materials and Methods: This is a single centre sample of 263 cases with OSEC operated from January 2014 until December 2021 with a 28-month period of follow-up, until 30th April 2024. OSEC surgical procedures in stages IIB to III and IV of the disease are complex interventions in order to have the R0/optimal cytoreduction achieved, so we summarised and coded them as follows: 1 = biopsy (of the tumour/peritoneum); 2 = bilateral/unilateral adnexectomy (BA/UA) +- total hysterectomy (TH) +- omentectomy +- peritoneal biopsies; 3 = (2) with total hysterectomy with bilateral adnexectomy (THBA) +- by extraperitoneal/subperitoneal route+peritonectomies (exclusively diaphragmatic) and electrocauterization of peritoneal carcinomatous lesions; 4 = (3) with visceral (multiple) resections +- stoma; 5 = (4) with diaphragmatic peritonectomies/stripping/partial resection of the diaphragm; 6 = palliative surgery. Results: Debulking surgery (DS) was carried out for n = 182 patients with no residual tissue = R0 being registered in n = 41. Results for patients with residual tissue (n = 141) after DS recorded the following findings: 1 cm (49% cases), 1.1-2 cm (29%) and 2 cm (22%). Recorded results for endometrial ovarian carcinoma (EC) n = 27 shown a tumour free survival probability estimate (%) at 60 months of 66% as both surgery and platinum based chemotherapy are efficient. For clear cell ovarian carcinoma (CCC) n = 7 recorded results shown a tumour free estimate (%) at 60 months of 14%, being known the controversy as to whether or not paclitaxel is an active drug for CCC. Major complications were recorded in 25 patients with a fatality ratio of 5/25. Conclusion: Considering OSEC is a relatively rare disease and the importance of collecting substantial numbers of samples by histotypes to further knowledge about ovarian cancer it comes crucial to establish collaborative endeavour of tertiary centers with standardised and quality control strategies.

Endometrial carcinoma with co-existing granulosa cell tumour in a post-menopausal woman: a case report

Background: Granulosa cell tumors (GCT) of the ovary are extremely infrequent tumors accounting for about 3% of the entire ovarian malignancies with a very high rate of recurrence. Due to its ability to secrete estrogen unopposed, it can give rise to endometrial cancer thus leading to the coexistence of the two tumors on rare occasions. Case presentation: We present here, the case of a 58-year-old post-menopausal Nigerian woman with GCT coexisting with endometrial carcinoma. She presented with abdominal pain, weakness, and post-menopausal vaginal bleeding. Examination revealed an irregular 30-week size abdominopelvic mass while an abdominopelvic ultrasonography showed a right ovarian mass and multiple uterine fibroids. However, the diagnosis of GCT coexisting with endometrial carcinoma was histologically confirmed. She has been clinically stable for ten months post-surgical intervention and completion of adjuvant chemotherapy (Cisplatin [75mg/m2] and Docetaxel [75mg/m2]). Conclusion: Although rare, GCT can exist synchronously with endometrial carcinoma. This should form an important differential diagnosis in a post-menopausal woman with bleeding par vaginum as this is its most important clinical presentation. Total abdominal hysterectomy with bilateral adnexectomy should be done in older patients with GCT. Additionally, adjuvant chemotherapy may be of tremendous benefit to diagnosed patients.

Goblet cell adenocarcinoma of the appendix with ovarian metastasis and synchronous adenocarcinoma of the sigmoid colon: A case report

Appendiceal goblet cell adenocarcinoma (GCA) is an amphicrine tumor composed of goblet-like, and variable numbers of endocrine and Paneth-like cells, typically arranged as tubules resembling intestinal crypts. As a rare cancer, the characteristics of and appropriate treatment strategy for GCA have not been fully elucidated. Here, we describe a case of an appendiceal GCA detected during sigmoidectomy for synchronous sigmoid colon adenocarcinoma and discuss whether appendiceal GCA coexisted incidentally. A 78-year-old woman was referred to our institution due to severe anemia. Colonoscopy and computed tomography revealed circumferential sigmoid colon cancer and a primary or metastasized ovarian tumor. We performed a laparoscopic sigmoidectomy and bilateral adnexectomy. The appendix appeared infiltrative and indurated, and appendectomy was performed. Immunohistochemistry revealed sigmoid colon adenocarcinoma and appendiceal GCA with ovarian metastasis. GCAs should be considered when ovarian tumors are detected with other abdominal malignancies.

Physiological Uptake Characteristics of Breast on 68Ga-FAPI-04 PET/CT.

Gallium 68 (68Ga)-labeled fibroblast activation protein inhibitor (FAPI) PET/CT is sensitive on breast cancer staging, but its clinical utility may be limited by the high physiological 68Ga-FAPI-04 uptake in normal breast tissue that can obscure primary tumors. The aim of this study was to elucidate the characteristics of physiological 68Ga-FAPI-04 uptake in normal breast. A total of 143 consecutive women with 68Ga-FAPI-04 PET/CT data were reviewed retrospectively. SUVmax, density and thickness of breast, as well as SUVmax of nipple, were measured. Univariate and multivariate regression analyses were used to identify factors related to the breast and nipple SUVs. Twenty-eight premenopausal, 62 menopausal and 10 post-operative (after bilateral adnexectomy) women with 103 examinations were included. All had a diffuse, symmetrical uptake in breast. There was no difference in 68Ga-FAPI-04 uptake between bilateral breasts (right: median, 1.14[IQR, 0.85-1.54] vs. left: median, 1.09[IQR, 0.86-1.54]; P = 0.253). Patients in menstrual status with expected high estrogen level (late follicular, ovulatory and mid luteal phases) had higher breast SUVs (median SUV, 3.91 [IQR, 2.85-4.35]) than those with expected moderate (early follicular, early luteal and late luteal phases; median SUV, 1.57 [IQR, 1.39-2.08]; P < 0.001) or low level (menopause and post-operation; median SUV, 0.98 [IQR, 0.83-1.21]; P < 0.001). Menstrual status was an independent predictors of breast SUV (r2 = 0.689, P < 0.001). All the patients had a focal, symmetrical uptake in nipples. Nipple SUV did not correlate with menstrual status (P = 0.913).

A medical and literature undescribed case of acute abdomen - Consequences of bilateral torsion of the adnexa: Case report

ntroduction: Torsion is the turning of the adnexa around its axis. It accounts for 3% of all gynecological emergencies. It also happens during pregnancy, as much as 20-25% of all torsions. It most often occurs in pathologically altered ovaries, 60-80% of cases. Causes in pregnancy are more often benign than in nonpregnant women. The diagnosis is established by clinical picture, physical and ultrasound examination. Due to the specificity of pregnancy, it is more difficult to diagnose, especially in the third trimester. Torsion is treated surgically by laparoscopy or laparotomy. Options are detorquation or removal of the necrotic adnexa. Case report: We report the first case of bilateral adnexal torsion in the third trimester of pregnancy. A 32-year-old pregnant woman came to our institution in the 28th week of a spontaneous twin pregnancy with pain in the right hemiabdomen and an episode of vomiting. After clinical, laboratory and ultrasound evaluation, as well as artificial maturation of fetal lungs, cesarean section and bilateral adnexectomy were successfully performed. Pathohistological findings showed infarction and necrosis of the adnexa. Conclusion: Torsion of the adnexa is not uncommon in pregnancy, with 20-25% of all torsions occurring in pregnant women. Torsion of the adnexa should be considered in the differential diagnosis of pain in pregnancy, especially if it is accompanied by nausea, vomiting and fever.

Hereditary breast and ovarian cancer triggered by occult fallopian tube cancer: a case report

BackgroundAt the time of benign gynecological surgery, a prophylactic salpingo-oophorectomy or salpingectomy is increasingly being performed concurrently to reduce the risk of future ovarian and fallopian tube cancer. We herein describe a case of hereditary breast and ovarian cancer syndrome in which a hysterectomy and bilateral adnexectomy were performed with a preoperative diagnosis of benign tumor. A detailed pathological examination revealed occult fallopian tube cancer, and additional staging surgery provided an accurate pathology diagnosis.Case presentationA 72-year-old Japanese woman with a past history of breast cancer underwent a hysterectomy and bilateral oophoro-salpingectomy for the preoperative diagnosis of uterine myoma and a right para-ovarian cyst. In the detailed pathological examination, high-grade serous carcinoma of the right fallopian tube was detected incidentally, and a subsequent staging laparotomy confirmed single para-aortic lymph node metastasis. Furthermore, a mutation in germline BRCA2 was detected postoperatively, and the patient was finally diagnosed with hereditary breast and ovarian cancer syndrome. She was diagnosed with fallopian tube cancer International Federation of Gynecology and Obstetrics Stage IIIA1(i) and started on adjuvant therapy (six courses of paclitaxel and carboplatin followed by maintenance therapy with olaparib), and 18 months after surgery, she was free of disease.ConclusionThis is a case of fallopian tube cancer that was diagnosed incidentally and then accurately staged with additional advanced staging surgery. Even in the absence of grossly malignant findings, a detailed pathological search of the fallopian tubes and accurate staging surgery are important to make the necessary treatment decisions for the patient.

Impact of perioperative characteristics on the recurrence risk and survival of patients with uterine leiomyosarcoma.

To analyze the impact of perioperative characteristics on the risk of recurrence in patients with uterine leiomyosarcomas. A sub-analysis of the SARComa of the UTerus (SARCUT) study, which is a multicentric cross-sectional pan-European study that included 390 patients diagnosed with leiomyosarcoma, between 2001 and 2007. Perioperative factors related to risk of recurrence and survival were analyzed. The 5-year and 10-year disease-free survivals (DFS) were 46% and 55%, respectively. Overall survival at 5 and 10 years was 34% and 47%, respectively. The most important factors related to global recurrence were the incomplete cytoreduction (hazard ratio [HR] 2.87; 95% confidence interval [CI] 1.91-4.31); performing bilateral adnexectomy (HR 2.71; 95% CI 1.23-5.93); tumor persistence after any treatment (HR 2.38; 95% CI 1.39-4.06); and adjuvant chemotherapy administration (HR 2.55; 95% CI 1.82-3.58) or adjuvant radiotherapy (HR 2.26; 95% CI 1.53-3.32). The major factors significantly associated with pelvic relapse were tumor persistence after any treatment (HR 3.63; 95% CI 1.83-7.20) and adjuvant radiotherapy (HR 2.74; 95% CI 1.44-5.20). Incomplete cytoreduction was the most important factor associated with distant relapse (HR 1.91; 95% CI 1.22-2.97). The most important factors related to overall survival were tumor persistence after any treatment (HR 4.59; 95% CI 2.51-8.40), incomplete cytoreduction (HR 3.68; 95% CI 2.44-5.56), tumor margin involvement (HR 2.41; 95% CI 1.64-3.55) and adjuvant chemotherapy (HR 1.91; 95% CI 1.31-2.78). Complete cytoreduction is the main prognosis factor impacting the DFS and overall survival of patients with uterine leiomyosarcoma. Adjuvant chemotherapy administration was associated with decreased rates of DFS and overall survival. The adjuvant radiotherapy was associated with a higher risk of global recurrence.