Infracolic Omentectomy Research Articles

Granulosa cell tumor of the ovary associated with Endometrial Cancer

Sex cord–stromal tumors (SCST) of the ovary comprise 5% to 8% of all ovarian malignancies. Granulosa cell tumors (GCT) are the most common type of malignant ovarian SCST accounting for 2% to 5% of all ovarian malignancies. Most tumors secrete estrogen. This can lead to an estrogen dependent endometrial hyperplasia and in some cases endometrial cancer. We report the case of a 62 year old woman with endometrial adenocarcinoma and adult granulosa cell tumor of the ovary who presented with postmenopausal bleeding and adnexal mass. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, infracolic omentectomy, and pelvic lymphadenectomy, and the specimen was submitted for histopathological examination. Concomitant adult GCT and endometrial Cancer is rare. This diagnosis requires a high index of suspicion along with imaging and histopathology.

Endometrioid Carcinoma Four Years After Hysterectomy: A Rare Case Report

It is quite a fascinating case as we have recently experienced in Mugda Medical College Hospital, a tertiary level teaching hospital in Dhaka, Bangladesh, that a woman was diagnosed and treated for endometrioid adenocarcinoma four years after her vaginal hysterectomy had been done. Our patient was presented with abdominal pain for nearly 2 weeks along with nausea, vomiting and generalized weakness. Ultrasound evaluation revealed a complex pelvic mass (8.6cm × 4.9cm). Chest x-ray revealed a left sided pleural effusion, while CT scan of the abdomen revealed heterogeneously enhancing complex pelvic mass and mild ascites. After a clinical correlation with all the pathological investigations, the patient was advised for a core biopsy. Ultrasonogram guided core biopsy was done. Histopathological examination showed a malignant ovarian epithelial tumor. Then she underwent an interventional or surgical procedure, which included an exploratory laparotomy, bilateral salpingo-oophorectomy with bilateral pelvic lymph node dissection and infracolic omentectomy done under general anesthesia. The final histopathological examination of the removed mass showed an endometrioid adenocarcinoma (Grade 2). Meanwhile, she was referred for radiation therapy (both vaginal brachytherapy and external pelvic radiation) after the patient had recovered from surgery. We will discuss this case as a part of our clinical interest and continuing education for our clinicians and residents. Mugda Med Coll J. 2024; 7(1): 53-55

A randomized controlled trial to compare short-term outcomes following infragastric and infracolic omentectomy at the time of primary debulking surgery for epithelial ovarian cancer with normal-appearing omentum

BackgroundOmentectomy is an important procedure in surgery for epithelial ovarian cancer, but the scope of omentectomy is not recommended in the guidelines. This study was performed to evaluate the benefits and risks of infragastric omentectomy in patients with epithelial ovarian cancer.MethodsThis trial is a single center prospective study. Primary epithelial ovarian cancer patients with normal-appearing omentum were randomly assigned to either the control or experimental group and underwent infracolic or infragastric omentectomy, respectively. The primary endpoint was progression-free survival. This trial is registered on Chinese clinical trial registry site (ChiCTR1800018771).ResultsA total of 106 patients meeting the inclusion criteria for ovarian cancer were included during the study period. Of these, 53 patients underwent infracolic omentectomy, whereas 53 patients received infragastric omentectomy. Multivariate analysis revealed that infragastric omentectomy could improve the detection rate of omental metastases (OR: 6.519, P = 0.005). Infragastric omentectomy improved progression-free survival significantly for those cases with higher than stage IIB disease (HR: 0.456, P = 0.041). Based on the short-term results, infragastric omentectomy did not cause more perioperative complications.ConclusionsCompared with infracolic omentectomy, infragrastric omentectomy may be a more appropriate surgical procedure for stage IIB-IIIC epithelial ovarian cancer patients with normal-appearing omentum.

High-grade serous ovarian carcinoma in a patient with end-stage renal disease

Introduction. Ovarian cancer, being one of the most common gynecologic cancers, has the highest mortality rate. The gold standard for the treatment of patients with advanced ovarian cancer, along with angiogenesis inhibitors applied in certain advanced stages, is cytoreductive surgery, followed by chemotherapy (CHT). The use of chemotherapeutic agents in hemodialysis (HD) patients has some specificities and limitations, and no CHT guidelines exist for treating those patients. Case report. We present a 45-year-old female patient with end-stage renal disease undergoing HD treatment. Abdominal and pelvic magnetic resonance imaging showed a multicystic mass with a total diameter of 93 ? 115 ? 168 mm in the right ovary and two subcapsular lesions in the VI segment of the liver with a diameter of 22 ? 14 mm and 9 mm (stage IVb ovarian cancer). The serum level of the tumor marker cancer antigen 125 (CA-125) was 93 U/mL. A total hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy was performed. Histopathological analysis of the surgical specimen confirmed high-grade serous ovarian adenocarcinoma, FIGO stage IVb. After surgery, she was treated with carboplatin and paclitaxel combination CHT, determining the dose of carboplatin according to the Calvert formula and initiating HD within 20 hrs of infusion. Two years after the diagnosis was made, the presented patient is in good condition. Conclusion. HD patients can be treated with a combination CHT regimen of carboplatin and paclitaxel, determining the dose of carboplatin according to the Calvert formula and initiating HD within 20 hrs from the end of the chemotherapeutic infusion.

#331 : Bilateral Endometriomas Masquerading Synchronous Endometrial and Ovarian Cancer (SEOC) in an Infertile Female

Background and Aims: Endometriomas are diagnosed in clinical practice by imaging (mostly ultrasound) in females presenting with infertility. CA-125 level is an adjuvant investigation which may be indicative of endometriosis. A few research questions that are yet to be answered. Is ultrasound a sufficient modality to diagnose endometrioma? Is there any cut off as far as the measurement of endometrioma is concerned to step up the imaging modality to MRI? Synchronous endometrial and ovarian cancer (SEOC) is a rare phenomenon with an incidence of 1.4 - 3.8%. Mostly in SEOC, the ovarian endometroid carcinoma arises in background of endometriosis with endometrial carcinoma of lower stage and grade in premenopausal age group. Method: A 32-year-old female with Severe Dysmenorrhea and Secondary infertility had clinical evidence of bilateral endometriomas of 4-5 cm on ultrasound. She underwent hysterolaparoscopy. On hysteroscopy, endometrium was polypoidal and vascular, looking suspicious for malignancy. Hence endometrial biopsy was taken. On laparoscopy, B/L ovaries were enlarged, multiloculated, solid-cystic with granular surface and adhered in POD, decision for staging laparotomy with frozen section was taken. Frozen section was suggestive of Borderline tumor. Eventually, fertility sparing surgical staging was done (BSO + infracolic omentectomy + peritoneal biopsies). Peritoneal cytology was negative for malignant cells. Results: Histopathological examination revealed Endometriod adenocarcinoma grade 1a/1a in both endometrial and ovarian components with no involvement of omentum and peritoneum. Immunohistochemistry demonstrated P53 to be moderately positive in endometrium and strongly positive in ovary, whereas ER, PR was positive in both tumors of endometrium and ovary and WT-1 negative in ovaries. Hence diagnosed as SEOC and not metastatic tumor. Mirena was inserted in follow up and repeat biopsy is awaited. Conclusion: Suspicion of ovarian endometroid carcinoma must born in mind in cases with large bilateral endometriomas with long-standing endometriosis.

Omentectomy for oncological surgical staging by transvaginal natural orifice transluminal endoscopic surgery (vNOTES): a preliminary study.

This study aimed to determine the feasibility of performing omentectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for surgical staging of ovarian and high-risk endometrial malignancies. This descriptive study was realized in a non-university hospital in Switzerland. Eighteen patients with suspicious adnexal masses or high-risk endometrial cancer underwent surgical staging comprising infracolic omentectomy by vNOTES between May 2020 and April 2023. Patients underwent oncological surgical staging for suspicious adnexal masses in 14 cases (77.8%) and high-risk endometrial cancer in 4 cases (22.2%). vNOTES omentectomies were performed in all patients without complications. Associated procedures included salpingo-oophorectomy (94.4%), hysterectomy (55.6%), peritoneal biopsies (33.3%), pelvic sentinel lymph node biopsies (22.2%), and appendectomy (5.6%). The median time to perform omentectomies was 9 (4-13) min. All oncological staging were completed by vNOTES. No significant intraoperative complications occurred. We observed 1 case (5.6%) of postoperative fever probably associated with vaginal cuff infection (Clavien-Dindo grade II). This study demonstrated the feasibility of performing vNOTES oncological staging requiring complex extrapelvic procedures such as infracolic omentectomy, supporting its potential role for managing gynecological malignancies such as ovarian and high-risk endometrial cancers. However, before expanding this approach outside study settings, strong evidence of its feasibility, practical benefits, and long-term oncological outcomes are needed.

Serous Borderline Tumor of the Fallopian Tube: A Case Report and Literature Review

Paratubal cysts account for 5-20% of all adnexal lesions. Malignant modifications seldom arise in the paratubal cysts that are usually known as primary carcinomas of fallopian tube. Paratubal borderline tumors are very infrequent conditions and until now only sixteen cases of primary paratubal borderline tumors have been previously reported in the literature. Herein, we describe a rare paratubal serous borderline tumor occurring in a woman of reproductive age and provide insights into its management. A 32-year-old woman referred to Imam Hussein Hospital, Tehran with chief complaint of amenorrhea for the last year and transvaginal sonography (TVS) report indicating a 68×74 mm persistent right adnexal cyst from 10 months ago. The patient was candidate for laparotomy and due to the report of paratubal serous borderline tumor in frozen section she underwent right total salpingectomy and infracolic omentectomy. No evidence of recurrence or metastasis was observed after 3 years of follow up. Persistent adnexal cysts need to be evaluated precisely even in young women in order to rule out the malignancy of fallopian tubes.

Bilateral ovarian mucinous carcinoma (stage III) with omental involvement and incidental hydronephrosis: A rare case report.

IntroductionThough ovarian malignancies are common, mucinous ovarian carcinomas of high grade are rare. They usually occur in a young female under 40 years of age. Here, we present a case of mucinous ovarian carcinoma (stage III), with omental involvement and incidental hydronephrosis in a 67-year-old female patient.Case presentationA 67-year-old female patient presented to us with a history of lower abdominal pain for 2 months and per-vaginal discharge for the last 6 days. On deep palpation of the abdomen, a nodular mass occupying the suprapubic region was found. Bimanual palpation revealed a mass on the right and left adnexa. After visualization of septate cystic mass bilaterally on CECT, she was planned for staging laparotomy with bilateral salpingo-oophorectomy (BSO) with infra-colic omentectomy with peritoneal cytology. Incidentally, a horseshoe-shaped kidney with right mild hydronephrosis was found. After surgery and histopathologic examination, mucinous ovarian carcinoma (stage III), with omental involvement was confirmed.DiscussionMucinous ovarian carcinomas are rare malignancies, with different natural history, molecular profile, and prognosis as compared to other epithelial tumors of the ovary. These carcinomas can be either primary or secondary (those metastasized to the ovary from elsewhere), and this differentiation is essential. The therapeutic approach to the patients depends upon the stage at which these carcinomas are diagnosed.ConclusionMucinous ovarian carcinomas are rare and have unique features among the epithelial ovarian carcinomas. Appreciation of these features will surely make a positive impact in improving the management and thus the prognosis of these carcinomas.

Primary Debulking Via Robotic-Assisted Laparoscopy for Stage IIIc Poorly Differentiated Endometrioid Adenocarcinoma of the Ovary.

<h3>Study Objective</h3> It has been demonstrated that minimally invasive surgery (MIS) is feasible and effective for interval cytoreduction after neoadjuvant chemotherapy for advanced ovarian cancer patients. MIS is also widely used to assess resectability in the setting of newly diagnosed advanced ovarian cancer. However, the role of MIS in the primary debulking of advanced ovarian cancer is less clear. Here, we present a case of a patient with stage IIIC high-grade endometrioid ovarian cancer, which was optimally debulked to no gross residual(R0) via robotic-assisted laparoscopy. <h3>Design</h3> This is a presentation of a patient who underwent primary ovarian cancer debulking via robotic-assisted laparoscopy. <h3>Setting</h3> The patient was taken to the operating for a planned robotic left ovarian oophorectomy, myomectomy and resection of endometriosis. Diagnostic laparoscopy revealed peritoneal tumor implants consistent with advanced ovarian cancer. The frozen section confirmed epithelial ovarian cancer. <h3>Patients or Participants</h3> This case involves a 37-yo patient who was found to have advanced ovarian cancer at the time of a planned robotic surgery for a complex left ovarian cyst and resection of fibroids and endometriosis. <h3>Interventions</h3> The patient underwent robotic-assisted total hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, resection of pelvic peritoneal, rectosigmoid, and diaphragmatic tumor nodules, pelvic and paraaortic lymph node dissection as well as pelvic washing. Final pathology showed stage IIIC poorly differentiated endometrioid adenocarcinoma of the ovary. <h3>Measurements and Main Results</h3> Complete gross resection (R0) was achieved. The estimated blood loss was 50 cc. The operative time was 3 hours and 10 mins. She was discharged on postoperative day 1. Her postoperative course was uncomplicated. Adjuvant chemotherapy with IV carboplatin and paclitaxel was initiated three weeks after surgery. <h3>Conclusion</h3> MIS is a feasible option for primary debulking in select cases of advanced ovarian cancer.

The first case report of a solitary metastasis of the transitional cell carcinoma of the ovary to the spleen

Background. Primary transitional cell carcinoma (TCC) of the ovary is characterized by the presence of papillary projections of malignant transitional epithelial cells or their aggregates in the fibrous stroma. This type of tumor represents nearly 1% of all ovarian surface epithelium carcinomas. We presented the first report of a solitary splenic metastasis of primary ovarian TCC. Case report. A 60-year-old female patient was admitted because of an asymptomatic splenic tumor in December 2018. Two years prior, she underwent a total abdominal hysterectomy, bilateral adnexectomy, and infracolic omentectomy for the primary TCC of the ovary. Control abdominal ultrasonography, computed tomography, and magnetic resonance imaging performed two years after primary surgery showed a splenic tumor. An open splenectomy was performed, with the intraoperative finding of a hilar splenic tumor and the absence of other pathological lesions in the abdomen. Frozen section analysis showed a TCC metastasis, which was subsequently confirmed by definitive histopathological examination. During the one-year follow-up, there was no relapse of the disease. Conclusion. This is the first report of a solitary splenic metastasis of primary ovarian TCC based on the literature review. This case may serve as an example of the diagnostic and therapeutical role of splenectomy in isolated splenic metastases of ovarian cancer.

Endometrial stromal sarcoma- A case report

Endometrial stromal sarcomas are rare malignant tumours of the uterus. Most details about this tumour is obtained from previous case reports. In most of the cases, diagnosis is made only postoperatively. A 29 year old female, came with complaints of heavy menstrual bleeding, lower abdominal pain, mass in lower abdomen for 2 months. Clinical examination and investigations showed bulky irregularly enlarged uterus probably Fibroid Uterus. Patient was planned for Myomectomy. Intraoperatively, uterus was irregularly enlarged with cauliflower like growth of size 7 x 5 cm over fundus suggestive of Carcinoma. Total abdominal hysterectomy with bilateral salphingo oophorectomy with bilateral pelvic lymphnode dissection with infracolic omentectomy was done. Histopatholgy examination revealed as Low Grade Endometrial Stromal Sarcoma with Negative Lymph Node Spread. Postoperatively, Patient was evaluated for ER sensitivity and started on Tab. Anastrazole. Keywords: Uterine sarcoma, Endometrial stromal sarcoma, Malignant uterine tumour.

Ovarian serous eystadenofibroma: Towards a preoperative diagnosis

Background: Ovarian cystadenofibromas are rare benign ovarian neoplasms which contain epithelial and fibrous stromal components which give rise to complex cystic and solid areas which will be visualized sonographically as malignant tumours. The management of cystadenofibroma of ovary is complete surgical removal of the tumour. The prognosis is generally excellent with prompt and appropriate treatment as there is a very low risk of recurrence. Case Presentation: A 45-year-old woman presented to the gynaecology clinic complaining of irregular menstrual bleeding, secondary dysmenorrhea and left sided lower abdominal pain of one month duration. On bimanual examination a cystic, nontender, left adnexal mass was found. Imaging revealed a complex cystic mass in left ovary (10 x 9.6 x 8 cm). There was a thin film of pelvic free fluid adjacent to the inferior margin of the lesion. Few non-specific subcentrimetric para aortic, left iliac lymph nodes were seen. CA-125 level was 179 U/ml. A staging laparotomy was performed and included total abdominal hysterectomy, bilateral salphyngoophorectomy and infracolic omentectomy. Bilateral multilocular ovarian cysts (left cyst – 10 x 8cm and right cyst – 3 x 4cm) were present. Histology revealed bilateral serous cystadenofibromas. No atypical or malignant cells were observed in peritoneal washings. Conclusion: Ovarian cystadenofibromas appear malignant on imaging and macroscopy. Frozen sections does not appear to be reliable indicator and only MRI appears to be dependable in predicting the diagnosis of a cystadenofibroma prior to histological confirmation.

Huge Subserosal Leiomyoma fed by serpentine omental blood vessels

Leiomyoma is considered the most common benign tumor of genital tract with variable presentation and diverse operative findings. We are presenting a case of asymptomatic huge subserosal pedunculated leiomyoma in a 37 years unmarried nullipara lady diagnosed as highly vascular abdominopelvic mass preoperatively as suggested by imaging studies but of uncertain origin, imposing surgical challenge due to diagnostic dilemma and its vascularity. Laparotomy revealed solid mass of 26 x 24 cm occupying whole abdomen covered with torturous dilated serpentine vessels derived from omentum. The mass was arising from the fundus of bulky uterus with small pedicle suggesting suserosal pedunculated leiomyoma. Myomectomy with infracolic omentectomy with round ligament plication was done and her post operative recovery was smooth. Histological examination confirmed it as leiomyoma.&#x0D; Keywords: Omentum, Pedunculated Leiomyoma, Serpentine

Incidental finding of an ovarian epithelial tumor, adequate approach and fertility preservation: A case report

Introduction. Ovarian carcinoma is the fifth leading cause of death in women. In 3?14% of cases, it occurs in women under the age of 40 who intend to have children. Studies have shown a high survival rate if the tumor is diagnosed and treated at an early stage, with a 5-year survival rate of 91.2%, which makes a conservative treatment a valid option. Preserving fertility is safe for grade 1 and 2 of the International Federation of Gynecology and Obstetrics (FIGO) stage I epithelial ovarian carcinomas. A sparing operation involves salpingoophorectomy on the tumor side, multiple biopsies of suspected sites, blind biopsies and infracolic omentectomy, as well as cytological analysis of the wash. Case report. A 25-year-old patient, G0, P0, went to the gynecologist due to severe pain in the lesser pelvis. An ultrasound examination revealed a cystic hypoechoic alteration in the right ovary of about 5 ? 6 cm, suspected for torsion, and the patient was urgently operated. A right cystectomy was performed. The histopathological finding of the surgically removed cyst was: endometrioid adenocarcinoma of the ovary, histological grade 2 (HG2) and nuclear grade 2 (NG2), without lymphovascular invasion and no penetration of the capsule, submitted in parts. As the surgery performed did not reveal the degree of ovarian malignant tumor spreading, the FIGO stage could not be determined, and a second operation was necessary to stage the disease according to the FIGO protocol for ovarian cancer. Conclusion. Fertility preservation in patients with malignant ovarian epithelial tumors is a major challenge. The intense desire of the patient to have children has to be satisfied without reducing the success of treatment for this type of disease. The staging of the disease spreading is of paramount importance in order to make an adequate decision regarding the treatment.

STUDY OF OVARIAN MALIGNANCY IN GYNEONCOLOGY UNIT IN ELSHATBY HOSPITAL IN ALEXANDRIA AS A TERTIARY REFFERAL CENTER

Malignant ovarian neoplasms cause more deaths than any other cancer of the female genital tract and is the seventh most common cancer diagnosed.Staging for ovarian cancer is principally surgical and should include total abdominal hysterectomy with bilateral salpingo-oophorectomy, only unilateral adnexectomy in fertility preservation surgery, at least infra-colic omentectomy, multiple peritoneal biopsies, lymph node sampling including pelvic and para-aortic lymph nodes up to renal veins, peritoneal wash and appendectomy in case of suspicion of mucinous histology.During initial surgery, early stage ovarian cancer patients are often incompletely staged. This oversight can have unfavorable sequelae for the prognosis of such patients, as the completeness of surgical staging is an independent prognostic parameter for survival. The aim of this work was to retrospectively review patients with ovarian malignancy from period 2017-2019 in gyne-oncology department of Elshatby hospital.This retrospective study was conducted on records of women admitted to gyne-oncology department in Elshatby hospital during period from 1/6/2017 to 1/6/2019 diagnosed with ovarian malignancy.

Elevated CA 125 level in a mucinous cystadenoma and a teratoma: a case report

BackgroundThe presence of a suspicious ovarian cyst with elevated cancer antigen 125 level in a woman of reproductive age poses a serious therapeutic dilemma. Mature cystic teratomas and mucinous cystadenomas may also cause an increase in cancer antigen 125.Case presentationA 43-year-old Sinhalese woman with a history of anovulatory subfertility for 5 years presented with heavy menstrual bleeding and secondary dysmenorrhea of 6 months’ duration. Imaging (pelvic ultrasound and computed tomography of the abdomen and pelvis) revealed a hemorrhagic cyst (6 × 4 cm) on the right side and a multilocular cyst with solid areas (10 × 7 cm) on the left side. Her cancer antigen 125 level was 2715 U/ml. Following a multidisciplinary team meeting, a fertility-sparing staging laparotomy was performed, which included right cystectomy, left oophorectomy, infracolic omentectomy, and peritoneal washings. Histology revealed a mucinous cystadenoma of the right ovary and a mature cystic teratoma on the left ovary. No malignant cells were observed in peritoneal washings. The patient’s cancer antigen 125 level dropped to 74.8 U/ml 1 month after surgery.ConclusionRarely, teratomas and mucinous cystadenomas may also give rise to an extremely high cancer antigen 125 level. The risk of malignancy index and risk of malignancy algorithm may both be misleading in these instances. Therefore, multidisciplinary input, fertility-sparing surgery, and follow-up are paramount to achieve optimal treatment and patient satisfaction.

Laparoscopic extraperitoneal salpingo-oophorectomy in women with suspicious ovarian mass, a way to reduce the risk of spillage

: The objective of the present paper is to provide a step by step description of the laparoscopic extraperitoneal salpingo-oophorectomy, a surgical technique useful to reduce the risk of spillage in women with suspected ovarian masses. The patient was a 52-year-old woman with sonographic diagnosis of a multilocular, 5 cm lesion, with Color Score 3 at right ovary. Computed tomography (CT) scan excluded any other localization of disease. Tumor markers were negative, except for Ca 19.9 that was 85 IU/mL. Preliminary diagnostic laparoscopy was performed and peritoneal carcinomatosis was excluded. In order to obtain a histological diagnosis, an extraperitoneal right salpingo-oophorectomy was performed. At frozen section analysis it was diagnosed an ovarian adenocarcinoma. Therefore, a laparoscopic complete surgical staging including total hysterectomy, controlateral salpingo-oophorectomy, infracolic omentectomy, multiple peritoneal biopsies, and pelvic and para-aortic lymphadenectomy, was performed. Operative time was 240 minutes and estimated blood loss was about 50 mL. No intra or post-operative complications were observed, and the patient was discharged 3 days after surgery. Final histology showed the presence of clear cell high grade carcinoma in both ovaries without fallopian tubes infiltration. Uterus, omentum, peritoneal biopsies and lymph nodes were negative for metastatic localization. Final FIGO stage was IB. After multidisciplinary discussion into the institutional tumor board, 6 cycle of adjuvant platinum-based chemotherapy were administered. After 20 months, no evidence of recurrence was observed during routinely follow-up visits.

Borderline ovarian tumor staging by conventional laparoscopic single port: a technical approach

Borderline ovarian tumors are ovarian neoplasm intermediate between benign and malignant category-The Who classification describe 6 histologic sub-types standard treatment include complete surgical resection (cystectomy or oophorectomy) and surgical staging including (infracolic omentectomy,peritoneal biopsy, perironeal cytology and for mucinous tumors, appendectomy) LESS (Laparo-endoscopic single site surgery) is an alternative to conventional laparoscopy for benign and malignant gynecologic tumors The objective of this study is to evaluate the feasabilty for management of early stage BOT by single Port access Material and methods:retrospective study we evaluate our ten consecutive cases feasability, operative time,hospital stay-the possible single day surgery

A Retrospective Study of Ovarian Sex Cord Stromal Tumors at the Egyptian National Cancer Institute

Background: Ovarian sex cord-stromal tumors are an uncommon heterogeneous group of tumors with different biological behaviors and clinico-patho- logic aspects. Aim of the Work: This study will review the clinico-pathologic aspects of sex-cord stromal ovarian tumors at the National Cancer Institute (NCI), Cairo University, Egypt, as well as their management and follow-up regarding disease free survival and overall survival. Patients and Methods: This retrospective study was conducted at the National Cancer Institute Cairo University, Egypt on female patients with ovarian sex cord stromal tumors in the period from January 2008 to December 2012 with a follow-up period of 24 to 84 months. The age of the patients, different clinical presentations, radiological findings, associated uterine bleeding (need for endometrial biopsy), pre-operative CA125 levels, surgical management done, different histopathological types, different biological behaviors, presence of ascites (and its correlation with the histopathology), Adjuvant chemotherapy (according to biological behavior and pathological type), and follow-up of non-benign cases for up to 84 months will all be documented and studied. Results: The mean age at presentation was 47.34; abdominal pain and mass were the commonest presentations 54.5% and 53.2% respectively; the main radiologic findings were a pelvic mass +/- ascites which had no correlation to the pathological type (p = 0.075). Endometrial hyperplasia and endometrial carcinoma were associated with 22% and 2.5% of cases respectively. Stages I and II represented 95% of patients with non-benign tumors (48 patients). Panhysterectomy +/- infracolic omentectomy or fertility sparing surgery were done in 70.1% and 29.9% of patients respectively. AGCTs were the commonest pathological type (49.4%). Adjuvant chemotherapy was given to 14 patients (46.7%) with non-benign tumors. 6 recurrences (20%) in 30 patients with non-benign tumors on regular follow-up were documented. The median of disease free survival (DFS) was 50.5 months. The median overall survival was 49.5 months. Conclusion: Ovarian SCSTs are uncommon neoplasms with different biological behaviors where AGCTs are the commonest among Egyptian females. Hormonal manifestations are uncommon where abnormal vaginal bleeding is the commonest one. The presence of ascitic fluid has no correlation with the pathological type of the tumor. Early stages (I and II) represented about 95% of non-benign tumors. Surgical management without lymphadenectomy +/- adjuvant chemotherapy is the main line of treatment at our institute. The OS was shorter than that documented in the literature. A small number of patients, reluctance of follow-up and unavailability of some patients’ data were the main drawbacks in this study.

Selective Infracolic Omentecomy and Fixation Reduces Complications after Laparoscopic Assisted Peritoneal Dialysis Catheter Placement

Peritoneal dialysis (PD) as a treatment for patients with end-stage renal disease (ESRD) provides a competitive alternative to hemodialysis (HD). Long-term catheter survival remains challenging and techniques are not standardized. Advanced laparoscopic placement with fixation and omentectomy might increase catheter survival. The goal of our study was to evaluate if selective infracolic omentectomy and fixation reduced complications after CAPD catheter placement.