Inguinal Node Dissection Research Articles

Intensity Modulated Radiation Therapy for Vulvar Cancer: Predictors of Local Control and Survival

Vulvar cancer is an uncommon disease and limited guidance is available from prospective trials. We reviewed our institutional experience treating vulvar cancer with intensity modulated radiation therapy (IMRT) within the last decade. We retrospectively reviewed patients with vulvar cancer receiving IMRT at our institution between 2005 and 2015. Patients with distant metastatic disease or recurrent disease were excluded. Age, FIGO stage, tumor size, histology, grade, radiation, surgery, number and size of involved LN, ECE, LVSI, surgical margin, depth of invasion, brachytherapy, and concurrent chemotherapy were assessed. Endpoints of interest were local recurrence and overall survival. SAS was used for Cox univariate and multivariate analysis. 44 patients were identified with mean follow-up of 23 months. Six patients were FIGO stage I, 7 patients were stage II, 23 were stage III, and 8 were stage IV. The included FIGO stage IV patients had AJCC T3 disease or positive pelvic LN but no distant metastases. Thirty-five (80%) patients received PET staging and 11 (25%) received MRI staging. Fourteen (32%) patients received definitive radiation, 24 (55%) received adjuvant radiation, and 6 (14%) received neoadjuvant radiation. Twenty-three (52%) patients received bilateral inguinal lymph node dissection and 2 (4.3%) received sentinel LN sampling. All patients received once daily external beam radiation by IMRT to doses ranging 50.4-70 Gy. 5 (11%) patients received RT to the vulva only, while the remainder received RT to the vulva, pelvic, and inguinal nodes. 8 (18%) patients received high dose rate brachytherapy with doses ranging from 10-20 Gy. 14 (32%) patients received concurrent chemotherapy; most commonly weekly cisplatin. 14 (32%) patients developed recurrence: 8 at the vulva (18%), 2 at the inguinal LNs (4.5%) and 4 at distant metastases (9.1%). On univariate and multivariate analysis, tumor size (HR 1.05, P = 0.01) and surgical excision of the vulva (HR 0.13, P<0.01) were the significant factors predicting local control. No significant difference in local control was seen in radiation dose, adjuvant vs neo-adjuvant RT, brachytherapy, or concurrent chemotherapy. Eight (18%) patients ultimately died of vulvar cancer in the follow-up period. Tumor size (HR 1.03, P = 0.03) was the only factor predictive of overall survival on multivariate analysis. Three (6.8%) patients developed lymphangitis as a consequence of treatment. Radiation, either alone or with surgery, plays an important role in achieving local-regional control of vulvar cancer. In this cohort who all received IMRT, tumor size and surgical treatment of the vulva are the major contributors to local control. We achieved a low rate of inguinal node recurrence. The use of concurrent chemotherapy was not correlated with local control or survival.

The role of surgery in metastatic squamous cell carcinoma of the penis.

Prognosis of penile squamous cell cancer (PeSCC) depends on the involvement of the groin(s) as first step. We introduce the current available evidences that should rule the use of surgery in the management of PeSCC. Prophylactic inguinal node dissection in patients with no palpable nodes associates with immediate and long-term side-effects in up to 70% of patients. Recent findings support selective intervention based on early identification of dynamic sentinel node biopsy (DSNB) with false negative rate of 4-12%. Adequate node retrieval and extending surgery to the pelvis have been addressed as important key factors as staging and therapeutic factors in patients with nodal metastases. Pelvic dissections could be spared only in patients with small (< 3 cm), limited (< 3 nodes) and no extranodal extension. Bilateral pelvic dissection should be recommended in case of involvement of bilateral nodes of at least four. Cisplatin-based neo-adjuvant chemotherapy has a moderate activity, whereas adjuvant chemotherapy associates with prolonged survival in a proportion of patients. In case of nodal metastases, surgery still represents the most effective treatment. Preventive surgery could be driven by DSNB, which needs an accurate multistep pathway. Extent of surgery is of paramount importance, and inguinal only and unilateral dissections should be reserved to selected patients with the most favorable features. Definitive conclusions concerning perioperative chemotherapy cannot be drawn.

Pregnancy and cesarean delivery after multimodal therapy for vulvar carcinoma: A case report.

Reports of pregnancy following treatment for vulvar carcinoma are extremely uncommon, as the main problem of subsequent pregnancy is vulvar scarring following radical surgery. We herein report the case of a patient who was diagnosed with stage I squamous cell carcinoma of the vulva at the age of 17 years and was treated with multimodal therapy, including neoadjuvant chemotherapy, wide local excision with bilateral inguinal lymph node dissection and adjuvant radiotherapy. The patient became pregnant spontaneously 9 years after her initial diagnosis and the antenatal course was good, except for mild acute pyelonephritis at 25 weeks of gestation. An elective caesarean section was performed at 38 weeks of gestation due to vulvar scarring following multimodal therapy, particularly radiotherapy. The patient remains alive and well, without signs of recurrence or metastasis 12 years after her diagnosis and treatment. Radical vulvectomy as well as multimodal therapy for vulvar carcinoma, particularly radiotherapy, may cause extensive skin scarring. The presence of vulvar scarring following multimodal therapy for vulvar carcinoma may increase the incidence of caesarean delivery.

Adenoid Cystic Carcinoma of Vulva-11Years' Single-Institution Experience.

Adenoid cystic carcinoma of vulva (ACC-vulva) is an extremely rare entity with <100 cases reported in the literature so far. To study the clinical profile and outcome of ACC-vulva treated at a tertiary cancer care centre in South India. This is a retrospective, record-based study of histopathologically confirmed cases of ACC-vulva treated at our centre from January 2005 to March 2016. Only four patients were diagnosed with ACC-vulva during the 11-year period under study. The longest duration of follow-up was 129months. The age at diagnosis ranged from 32 to 43years, with a median of 40years. All patients were married, parous and premenopausal and presented with a painless unilateral vulval swelling. All patients had involvement of the Bartholin's gland site with normal overlying skin. In all patients, wide excision was performed. Unilateral inguinal node dissection was done in one case. Perineural infiltration was documented in two cases, while positive excision margins were present in three cases. None of the patients had any lymph node involvement at diagnosis or during follow-up. Two patients had recurrence of disease. The disease-free interval was 23months for one patient and 118months for the other. In both, local (vulval) and distant (multiple lung) metastases were detected simultaneously. Adenoid cystic carcinoma of vulva is an extremely rare, slowly progressing neoplasm mostly involving the Bartholin's gland. The usual treatment includes wide excision and adjuvant radiotherapy (if required). There may be late local and distant recurrence.

525. Preliminary results of minimally invasive inguinal lymph node dissection in Egypt

525. Preliminary results of minimally invasive inguinal lymph node dissection in Egypt

150. Minimally invasive inguinal lymph node dissection: Case presentation from Egypt

150. Minimally invasive inguinal lymph node dissection: Case presentation from Egypt

Lymph Node Ratio Is Less Prognostic in Melanoma When Minimum Node Retrieval Thresholds Are Not Met

Lymph node ratio (LNR), positive nodes divided by nodes examined, has been proposed for prognostication in melanoma to mitigate problems with low node counts. However, it is unclear if LNR offers superior prognostication over total counts of positive nodes and nodes examined. Additionally, the prognostic value of LNR may change if a threshold number of nodes are examined. We evaluated whether LNR is more prognostic than positive nodes and nodes examined, and whether the prognostic value of LNR changes with minimum thresholds. Using the National Cancer Data Base Participant User File, we identified 74,692 incident cases with nodal dissection during 2000-2006. We compared LNR versus counts of examined and positive nodes based on Harrell's C, a measure of predictive ability. We then stratified by total nodes examined: greater versus fewer than ten for axillary lymph node dissection (ALND) and greater versus fewer than five for inguinal lymph node dissection (ILND). Overall, LNR had a Harrell's C of 0.628 (95% confidence interval [CI] 0.625-0.631). Examined and positive nodes were not significantly different from this, with a Harrell's C of 0.625 (95% CI 0.621-0.630). In ALND, LNR had a Harrell's C of 0.626 (95% CI 0.610-0.643) with ≥10 nodes versus 0.554 (95% CI 0.551-0.558)<10 nodes. In ILND, LNR had a Harrell's C of 0.679 (95% CI 0.664-0.694) with ≥5 nodes versus C of 0.601 (95% CI 0.595-0.606)<5 nodes. LNR provides no prognostic superiority versus counts of examined and positive nodes. Moreover, the prognostic value of LNR diminishes when minimum node retrieval thresholds are not met.

Bladder and vaginal transitional cell carcinoma: A case report.

The involvement of the female genital tract in transitional cell carcinoma (TCC) has not been fully elucidated in women, although involvement is usually associated with a poor prognosis. The vagina, in particular, is considered to be the most commonly affected gynecological organ, with an incidence of 4% of total TCC cases. The pathogenesis of vaginal TCC is challenging to determine, although it is essential for the adequate management of the tumor and to determine the appropriate treatment. The present study reports a case of bladder TCC and metachronous vaginal TCC. The patient had a history of high risk non muscle invasive bladder cancer treated by BCG and presented with a recurrent carcinoma in situ. A novel cycle of BCG was initiated but the patient had a persistent disease and a palpable mass on bimanual examination. Radical anterior pelvectomy and bilateral pelvic and inguinal lymph node dissection was performed revealing the presence of TCC of the bladder neck and the invasion into the anterior vaginal wall. The differences between local vaginal invasion and the metastatic spread from a primary bladder TCC, the occurrence of a second primary vaginal tumor and the direct implantation of TCC via urine that contains transitional cancer cells were reviewed and analyzed. Finally, a management plan was determined.

Predictors of Nodal Upstaging in Clinical Node Negative Patients With Penile Carcinoma: A National Cancer Database Analysis

To examine the risk factors associated with upstaging at inguinal lymph node dissection (ILND) in men with penile cancer and clinically negative lymph nodes (cN0) using a large US cancer database. The National Cancer Data Base was queried from 1998 to 2012 to identify men with penile cancer who underwent ILND and had complete clinical or pathologic node status available. Lymphovascular invasion (LVI) was available after 2010. Multivariate logistic regression evaluated factors (cT stage, grade, LVI) associated with pathologic nodal upstaging in those with cN0 disease. Correlations between clinical and pathologic node status were also calculated with weighted kappa statistics. Complete clinical and pathologic LN status was available for 875 patients. Of these, 461 (53%) were cN0. Upstaging occurred in 111 (24%). When stratified by low, intermediate, and high-risk groups, the proportion with pathologically positive LNs was 16%, 20%, and 27%, respectively (P = .12). On multivariate analysis, limited to men with LVI data available (N = 206), LVI (odds ratio 3.10, 95% confidence interval 1.39-6.92), but not increasing stage (univariate only) or grade (univariate only), was significantly associated with upstaging at ILND. In this analysis, of 461 patients with node-negative penile cancer undergoing ILND, upstaging was observed in 24%. LVI was the strongest independent predictor of occult lymph node disease. These findings corroborate the presence of LVI as the significant risk factor for occult micrometastases and suggest a possible improvement in existing risk stratification groupings, with the presence of LVI, regardless of stage or grade, to be considered high-risk disease.

V10-12 ROBOTIC BLADDER NECK CLOSURE AND MITROFANOFF

You have accessJournal of UrologyRobotics – Benign Disease1 Apr 2016V10-12 ROBOTIC BLADDER NECK CLOSURE AND MITROFANOFF Gregory Murphy and Joseph Wagner Gregory MurphyGregory Murphy More articles by this author and Joseph WagnerJoseph Wagner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1592AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Complex urologic reconstruction may be required after morbid cancer operations. Well documented advantages of robotic surgery can be utilized during these reconstructive cases including shorter hospital stay and improved cosmesis. This video demonstrates a robotic bladder neck closure and appendicovesicostomy after radical vaginectomy and urethrectomy in a female with vulvar melanoma. METHODS Our patient is a 72 year old female with vulvar melanoma requiring a radical vaginectomy, urethrectomy and inguinal node dissection by the gynecologists. We performed a concomitant robotic bladder neck closure and Mitrofanoff catheterizable channel. RESULTS Operative time was 368 minutes, of which 204 minutes was robotic time. Estimated blood loss was 200 mL. The patient had an uncomplicated hospital course and was discharged on post-operative day #3. Three weeks after surgery she was taught to catheterize her Mitrofanoff. She is doing well 4 months after surgery without evidence of disease or incontinence. CONCLUSIONS Robotic bladder neck closure and Mitrofanoff are safe and effective means to treat patients after morbid vaginal cancer operations. It offered this patient continence while providing quick recovery and optimal cosmesis. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e949 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Gregory Murphy More articles by this author Joseph Wagner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

LB-S&T-19 RADICAL VIDEOSCOPIC INGUINAL LYMPHADENECTOMIES IN 70 CASES: A STEP-BY-STEP TECHNIQUE AND PRELIMINARY RESULTS

You have accessJournal of UrologyLate-Breaking S&T Poster1 Apr 2016LB-S&T-19 RADICAL VIDEOSCOPIC INGUINAL LYMPHADENECTOMIES IN 70 CASES: A STEP-BY-STEP TECHNIQUE AND PRELIMINARY RESULTS Yunlin Ye and Hui Han Yunlin YeYunlin Ye More articles by this author and Hui HanHui Han More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.03.100AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical inguinal lymphadenectomy is the standard surgical approach for patients at risk for lymph node metastases as recommended in the guidelines. Recent reports have demonstrated that videoscopic inguinal lymphadenectomy (VIL) was associated with decreased morbidity and comparable oncological control in short-term follow-ups. While, most reported VILs have been performed in the femoral triangle, which might result in residual lymph node tissue. So radical VIL was performed in this study to evaluate its modifications and feasibility. METHODS Radical VIL had been performed in 70 cases of 38 patients, with two modifications. First, the scope of the radical inguinal lymphadenectomy was precisely achieved through improved positioning and fine-needle penetration guidance. The patient was placed in a low lithotomy position; the body and thigh were straight, the thigh was at 20-30° of external rotation, and the legs drooped naturally. During the operation, this positioning was critical to expose the entire Daseler’s area, and the boundaries were defined accurately by fine-needle penetration guidance. Second, the clear dissection plane that was created through the 4-cm incision along the inferior boundary ensured en bloc inguinal lymph node dissection, and we were able to identify three useful anatomic markers, i.e., the white, semi-hyaline membrane, under the superficial layer of Camper’s fascia, the fascia lata and SV. RESULTS From August 2014 to October 2015, 70 VILs were performed in 38 patients. The clinical characteristics of the patients are listed in Table 1. According to the Clavien-Dindo classification, 6 lateral complications were observed in the patients who underwent VIL. Complications were detected as illustrated in Table 2, and no grade III or IV complications were detected. CONCLUSIONS Modified radical video-scopic inguinal lymphadenectomy is feasible and practical with results in less morbidity, but the oncological outcomes require further investigation. The dissecting field and the defined plane were critical to these modifications. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e344 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yunlin Ye More articles by this author Hui Han More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP81-10 OUTCOMES OF CO2 LASER FOR PENILE CARCINOMA IN SITU AT A UK TERTIARY CENTRE

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease II1 Apr 2016MP81-10 OUTCOMES OF CO2 LASER FOR PENILE CARCINOMA IN SITU AT A UK TERTIARY CENTRE Luke McGuinness, Rajan Veeratterapillay, Daniel Conaway, Luke Teo, Sue Asterling, Damien Greene, and Phil Keegan Luke McGuinnessLuke McGuinness More articles by this author , Rajan VeeratterapillayRajan Veeratterapillay More articles by this author , Daniel ConawayDaniel Conaway More articles by this author , Luke TeoLuke Teo More articles by this author , Sue AsterlingSue Asterling More articles by this author , Damien GreeneDamien Greene More articles by this author , and Phil KeeganPhil Keegan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2063AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penile cancer remains a rare cancer in the Western world accounting for <1% of male neoplasms. Penile carcinoma in situ (CIS) is a premalignant condition and can be associated with an up to 30% malignant transformation rate. There has been a trend over the past two decades towards increasing penile preserving surgery for CIS and current EAU guidelines advocate the use of CO2 laser. We describe our outcomes using this technique at a UK penile cancer centre. METHODS Patients with biopsy proven penile CIS at our centre between November 1999 and May 2015 were identified. Retrospective review of patient records who had CO2 laser therapy was undertaken to identify pathological findings, recurrence rates, further treatment and long-term survival. Kaplan Meier plots were used for statistical analysis. RESULTS Forty men had CO2 laser for biopsy proven CIS. Median age at diagnosis was 61yrs (range 33-87) and median follow-up was 32 months (range 6-128). Thirty-nine had laser as primary treatment whilst seven had recurrence following previous organ preserving surgery (wide local excision/circumcision/glansectomy & glanuloplasty). Fourteen men (35%) had recurrent CIS after first laser treatment. Eight were treated with further laser, five had glans resurfacing and one underwent distal penectomy. Five (13%) developed invasive recurrence including three with nodal metastases. Those without nodal disease both underwent distal penectomy. Of those with positive nodes two underwent inguinal node dissection with distal penectomy or radical penectomy. One patient received systemic chemotherapy. Three patients died during follow-up but only one was due to penile cancer (2.5% mortality). CONCLUSIONS CO2 laser is a recognised treatment option for penile CIS SCC. Most require more than one laser treatment and 35% will develop recurrent CIS. Invasive recurrence is less common but patients require careful follow-up and vigilance in self examination to identify these early. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1056-e1057 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Luke McGuinness More articles by this author Rajan Veeratterapillay More articles by this author Daniel Conaway More articles by this author Luke Teo More articles by this author Sue Asterling More articles by this author Damien Greene More articles by this author Phil Keegan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A case of splenic metastasis of ovarian cancer treated with complete laparoscopic splenectomy and transvaginal specimen extraction

A 61-year-old woman was diagnosed with right inguinal lymph node and splenic metastasis of ovarian serous cystadenocarcinoma. We performed right inguinal lymph node dissection and total laparoscopic splenectomy in the supine position followed by transvaginal specimen extraction (TVSE). First, using three ports, we extracted the right inguinal lymph node. We repaired the posterior wall of the inguinal canal using a mesh plug. We added two ports and displaced the spleen from the retroperitoneum and lifted it using a snake retractor, disconnecting the hilum using an automatic suturing device. Next, the posterior wall of the vagina was intraperitoneally incised. And an Alexis® laparoscopic system was inserted into the vagina. The cap maintained aeroperitoneum, a collection bag was inserted in the abdominal cavity via the vagina, and the spleen was collected. When the spleen was removed from the body, partial fragmentation of the organ was required in the bag. Organ fragmentation was performed only within the bag, and we made sure not to tear the bag. The vaginal wound was laparoscopically sutured. The patient had no operative complications and was able to actively ambulate at the first day after surgery due to a slight postoperative pain. Total laparoscopic splenectomy with TVSE in the supine position may be a safe and feasible method for selected female patients. This technique enables minimally invasive surgery for female patients with splenic disease.

Reducing morbidity with surgical adhesives following inguinal lymph node dissections for the treatment of malignant skin tumors.

Background: Inguinal lymph node dissection (ILND) is associated with a high rate of morbidity. To evaluate the clinical benefit of surgical adhesives to reduce complications in patients undergoing ILND, we compared the use of TissuGlu® Surgical Adhesive and ARTISS® fibrin sealant with a control population. Material and methods: We conducted a retrospective analysis of patients undergoing ILND for metastatic malignant skin tumors at one hospital, Fachklinik Hornheide (Münster, Germany), from January 2011 through September 2013, assessing 137 patients with a total of 142 procedures. Results: Complications occurred in 22/60 procedures in the TissuGlu group (TG), in 8/17 in the ARTISS group (AG), and in 29/65 in the control group (CG). Prolonged drainage and seroma were recorded in 16 (26.7%), four (23.5%), and 26 (40%) respectively (non-significant). TG showed less extended drainage vs. CG (p=0.082). Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000). With regard to wound infection, there was a 15% reduction in TG and 74% increase in AG group. Revision surgery was reduced by 36% in TG and increased by 54% in AG. Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000). Mean total post-operative drain volume was lower in TG and AG vs. CG (p<0.001 among groups, CG vs. TG p<0.001, CG vs. AG p<0.001). The mean body mass index (BMI) was significantly higher in patients with complications, 29.4±5.8 vs. 25.3±4.1 (p=0.000).Conclusion: The use of TissuGlu in our ILND patients was associated with a reduction in post-operative wound related complications and the need for revision surgeries compared to the control group. Daily drainage was significantly lower within the first 7 post-operative days with the use of ARTISS, but the benefit was lost due to the higher occurrence of wound infection and revision surgery. BMI above 29 is a risk factor for complications following ILND.(Level of evidence: level IV, retrospective case study)

Robotic-Assisted Video Endoscopic Inguinal Lymphadenectomy in Carcinoma Vulva: Our Experiences and Intermediate Results.

To describe the technique of robotic-assisted video endoscopic inguinal lymphadenectomy (R-VEIL) in patients with carcinoma vulva and discuss the advantages of the technique and oncological outcome. Twelve patients of squamous cell cancer of vulva underwent 22 R-VEIL procedures from February 2011 to February 2015. Their preoperative, intraoperative, and postoperative data were retrospectively analysed. The mean age of patients was 61 years (range, 32-78 years). The mean operative time was 69.3 minutes (range, 45-95 minutes). The mean blood loss was 30 mL (range, 15-50 mL). No intraoperative complication was observed. The mean drain output was 119 mL (range, 50-250 mL), and the drains were removed at a mean of 13.9 days (range, 8-38 days). The average number of superficial and deep inguinofemoral lymph nodes retrieved was 11 (range, 4-26). Two patients had positive lymph nodes on histopathology (16.67%). Postoperative complications were lymphocele (6 groins), chronic lower limb lymphedema (6 cases), prolonged lymphorrhea (1 groin), and cellulitis (2 groins). Over a follow-up period ranging from 7 to 67 months, 1 patient developed recurrence in the inguinal nodes and died 7 months after the recurrence. The R-VEIL allows the removal of inguinal lymph nodes within the same limits as the open procedure for inguinal lymph node dissection and has a potential to reduce the surgical morbidity associated with the open procedure. Long-term oncological results are not available though our initial results appear promising. Prospective multi-institutional studies are required to prove its efficacy over open inguinal lymph node dissection.

A Case of Splenic Metastasis of Ovarian Cancer Treated with Complete Laparoscopic Splenectomy and Transvaginal Specimen Extraction

A 61-year-old woman was diagnosed with right inguinal lymph node and splenic metastasis of ovarian serous cystadenocarcinoma. We performed right inguinal lymph node dissection and total laparoscopic splenectomy in the supine position followed by transvaginal specimen extraction (TVSE). First, using three ports, we extracted the right inguinal lymph node. We repaired the posterior wall of the inguinal canal using a mesh plug. We added two ports and displaced the spleen from the retroperitoneum and lifted it using a snake retractor, disconnecting the hilum using an automatic suturing device. Next, the posterior wall of the vagina was intraperitoneally incised and an Alexis® laparoscopic system was inserted into the vagina. The cap maintained aeroperitoneum, a collection bag was inserted in the abdominal cavity via the vagina, and the spleen was collected. When the spleen was removed from the body, partial fragmentation of the organ was required in the bag. Organ fragmentation was performed only within the bag, and we made sure not to tear the bag. The vaginal wound was laparoscopically sutured. The patient had no operative complications and was able to actively ambulate at first day after surgery due to a slight postoperative pain. Total laparoscopic splenectomy with TVSE in the supine position may be a safe and feasible method for selected female patients. This technique enables minimally invasive surgery for female patients with splenic disease.

Video endoscopic inguinal lymphadenectomy for radical management of inguinal nodes in patients with penile squamous cell carcinoma.

Background:Inguinal lymph node involvement is an important prognostic factor in penile cancer. Inguinal lymph node dissection allows staging and treatment of inguinal nodal disease. However, it causes morbidity and is associated with complications such as lymphocele, skin loss, and infection.Aims:To report our institutional experience with video endoscopic inguinal lymphadenectomy (VEIL) for radical management of inguinal nodes in patients with penile squamous cell carcinoma.Materials and Methods:It is a prospective analysis of data of patients that underwent VEIL, by a single surgeon, from 2008 to 2015. 14 patients of penile carcinoma were suitable for VEIL technique were included in this study and followed. Data analyzed included mean operative time, mean lymph node yield, intraoperative complications, cutaneous complication, lymph-related complications, and surgical emphysema.Results:The mean age of patients was 57.8 years (range: 45–70 years). Mean operative time for VEIL was 194.86 min (178–210 min). Mean lymph node yield was 7.68 (range: 5–11 nodes). No intraoperative complication was experienced during series. We noted no cutaneous complications, localized lymphocele were seen in total 6 units out of 22 units (27.2%). Surgical emphysema is seen in 3 limbs (13.63%). There was significantly decreased overall morbidity in our study. Follow-up of 10 out of 14 patients with median of 48 months shows no recurrence.Conclusions:In our early experience, VEIL is a safe and feasible technique in patients with penile carcinoma who require radical inguinal lymphadenectomy. It allows the removal of inguinal lymph nodes within the same limits as in conventional surgical dissection and reduces surgical morbidity substantially.

Malignant Eccrine Poroma of the Vulva: An Intriguing Case of a Rare Tumor at an Unusual Site.

Malignant eccrine poroma is a rare malignancy of the eccrine sweat glands, occurring most frequently on the lower extremities. It affects both sexes equally usually in the 6th to 7th decade of life. Metastasis to regional lymph nodes may occur in 20% that may be fatal in 60% cases. Its aggressive nature, rarity of occurrence, and unusual presentations make it very important to be evaluated properly by the clinician. We hereby report a case of a 75-year-old female presenting with two exophytic tumors over her vulva with local extension. On histopathological examination, it was diagnosed as malignant eccrine poroma. On magnetic resonance imaging of the pelvic region, metastatic extension in regional lymph nodes was found. She was treated by radical vulvectomy with bilateral inguinal and femoral lymph node dissection followed by radiotherapy.

Anterior pelvic exenteration for pre-chemo-irradiated locally invasive vulvar cancer

Vulvar carcinomas are rare gynecologic malignancies. In cases presenting local invasion oncologic treatment such as chemo-irradiation might be performed. However complete remission is achieved in rare cases, most of the patients necessitating an aggressive surgical therapy such as pelvic exenteration. We present the case of a 78 year old patient who was diagnosed with a poorly differentiated squamous cell vulvar cancer with urethral invasion in whom a total vulvectomy en bloc with anterior pelvic exenteration, pelvic, para-aortic and inguinal lymph node dissection was performed.

Synovial sarcoma of the penis: A case report

s / Urological Science 26 (2015) 294e300 298 MP3-3: SYNOVIAL SARCOMA OF THE PENIS: A CASE REPORT Chao-An Chen , Kam-Fai Lee , Kuo-Cai Huang , Kuo-Hsiung Chiu , TzuHsin Yang , Yin-Lun Chang , Jian-Hui Lin , Yung-Chin Huang , Dong-Ru Ho , Chih-Shou Chen , Wei-Yu Lin . Division of Urology, Department of Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Anatomic Pathology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan Purpose: Primary synovial sarcoma of the penis is extremely rare. We report a case of synovial sarcoma initially discovered as a painless penile mass with no image evidence of distal metastasis. Synovial sarcoma was reported in the final pathology. Materials and Methods: A 59-year-old male patient is a case of panic disorder under alprazolam treatment for 4 years. He came to our outpatient department for gradual enlargement of penile mass in recentmonths. He is a married man without circumcision. The mass was painless, spherical, and movable over penile base, without skin abnormality or infection signs. Computed tomography revealed a 3.2 cm hypodense mass lesion over left side of corpus cavernosum without enlargement of pelvis or retroperitoneal lymph nodes. Partial penectomy with bilateral inguinal lymph node dissection was performed. Synovial sarcoma within tunica abluginea (pT2) was reported in the final pathology. Results: To our knowledge; this is the first case of primary synovial sarcoma of penis in Taiwan. MP3-4: ADENOCARCINOMA OF URINARY BLADDERe A CASE REPORT Ping-Hao Tsai, Heng-Chieh Chiang, Pao-Hwa Chen. Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan This 78 years old manwho was under regular follow-up post transurethral rsection of prostate gland. During last cystoscope, tumor biopsy was done and the pathologic report reveal possibility of urothelial carcinoma with glandular differentiation, which primary adenocarcinoma or secondary adenocarcinoma involvement especially colorectal origin may be consideration on July, 2015. Afterward, we arranged MRI for tumor staging and it reveals T3N0M0, Stages III. Then, after explain to patient, transurethral resection of bladder tumor was performed on Aug, 2015. The final pathologic report reveals adenocarcinoma arising from urinary bladder. We also arranged colon scope which reveals negative finding. PET scan reveals no uptake for gastrointestinal tract. As exclude colorectal origin of adenocarcinoma, patient is under radiotherapy and chemotherapy for adneomcarcinoma currently. MP3-5: ASSOCIATION BETWEEN HUMAN GLUTATHIONE S-TRANSFERASE OMEGA RS4925 POLYMORPHISM AND BLADDER CANCER Zhon-Min Huang , Jow-Yu Sheu , Min-Che Tung , Chia-Chang Wu, Yuan-Hung Wang . Divisions of Urology, Department of Surgery, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan; Divisions of Urology, Shuang Ho Hospital, Taipei Medical University New Taipei City,