Para-aortic Research Articles

Impact of hemoglobin on survival of young women with cervical cancer treated with concurrent chemoradiotherapy.

e17529 Background: Cervical cancer is a global public health problem, with higher impact in many low-income and middle income countries. In Peru, cervical cancer is the leading cause of cancer deaths among women. The aim of this study is to investigate the prognostic factors affecting long-term survival in locally advanced cervical cancer young patients treated with concurrent chemoradiotherapy. Methods: This is a retrospective study of young women with locally advanced cervical cancer who underwent radiotherapy with concurrent platinum-based chemotherapy at the national cancer peruvian institute (INEN), from 2008 to 2012. The clinicopathological factors of all patients were collected. To explore the relationship between factors and prognosis, survival rates were estimated by the Kaplan–Meier method. Results: A total of 192 patients under 35 years old . Among all patients, 167 were diagnosed with SCC, 19 with AC, and 5 with ASC. Most of the patients were IIB and IIIB FIGO stage, 69% and 22% respectively. 38 cases had no metastatic lymph nodes and 42 cases were diagnosed of lymph node metastases, of which 30 were positive for pelvic lymph nodes only, and 12 were positive for para-aortic lymph nodes. We obtained pretreatment hemoglobin levels for all patients and found a median of 111 g/L, also we calculated the Prognostic nutritional index (PNI) with a median of 41.87 that correlates with a moderate to severe malnutrition in patients prior treatment. Response to chemoradiotherapy was not available in 13 patients, 136 achieved complete response, 30 patients with persistent disease and 12 with disease progression. Estimated median OS of all patients was 114.1 months [101.8-126.4] and median DFS was 112.3 months [98.9-125.7]. Exploratory analysis was performed to determine potential prognostic factors, only hemoglobin ≤ 100 g/L was statistically significant (p = 0.007). Conclusions: In young patients undergoing chemoradiation for cervical carcinoma, the hemoglobin prior treatment is prognostically significant.

Systematic evaluation of the safety and therapeutic effects of para-aortic lymphadenectomy for advanced gastric cancer: a systematic review and meta-analysis.

At present, there is still no definite conclusion on whether advanced gastric cancer (GC) requires additional para-aortic nodes dissection (PAND). The purpose of this study is to summarize current evidence on the potential benefits of the extended systemic lymphadenectomy (D2+) compared to D2 lymphadenectomy in the treatment of gastric cancer. Systematic literature search was performed across PubMed, Embase, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, VIP Database for Chinese Technical Periodicals, and China Biology Medicine disc using the following terms: gastric cancer, para-aortic lymphadenectomy, D2+ lymphadenectomy and D3 lymphadenectomy. RevMan 5.3 software was used for the meta-analysis. A total of 20 studies involving 5,643 patients were included, consisting of 6 randomized controlled trials (RCT) and 14 non-randomized controlled trials (nRCT). Compared with the D2 group, the operating time in the D2+ group was longer [mean difference (MD)=99.45 min, 95% confidence interval (CI) (48.93, 149.97), p<0.001], with more intra-operative blood loss [MD=262.14 mL, 95% CI (165.21, 359.07), p<0.001]. There were no significant differences in five-year overall survival (OS) [HR=1.09, 95% CI (0.95, 1.25), p=0.22] and post-operative mortality [RR=0.96, 95% CI (0.59, 1.57), p=0.88] between the two groups. The rate of post-operative complications in group D2+ was higher than that in group D2 [RR=1.42, 95% CI (1.11, 1.81), p<0.001]. Prophylactic D2+ surgery is not recommended, since D2+ surgery is associated with an increased rate of post-operative complications and does not improve the long-term survival rate of patients with advanced gastric cancer. However, D2+ surgery (especially D2+PAND) has certain survival advantages for specific patients, and D2+PAND surgery combined with chemotherapy may potentially improve long-term survival rate.

Erken Evre Serviks Kanserinde Sedlis Kriterleri Gözönünde Bulundurularak Uygulanan Adjuvant Radyoterapi Sonuçları

Background/Aims:&#x0D; Investigation of the efficacy of adjuvant RT in cervical cancer stage I-IIA according to FIGO (2018) in terms of risk factors and oncologic outcomes.&#x0D; Methods: &#x0D; The study included 113 patients with FIGO stage I-IIA. Patients who received adjuvant external pelvic RT and/or intracavitary brachytherapy (ICBT) after surgery retrospectively analyzed for demographic data , histology, grade, tumor size , stage, LVSI, stromal invasion depth, type of lymphadenectomy, number of dissected pelvic / paraaortic lymph nodes , surgical margin, adjuvant therapies, local relapse, distant failure, overall survival, and progression-free survival.&#x0D; Results:&#x0D; After a median follow-up of 160 months, local recurrence was observed in 3 patients, distant metastasis in 6 patients and all-cause death in 15 patients. It was observed that only SID had a statistically significant effect on overall survival among the Sedlis criteria (p=0.04). The ten-year DFS and OS rates were 95% and 94%, respectively .&#x0D; Conclusions:&#x0D; Promising oncological results were obtained in early stage cervical cancer with adjuvant RT based on Sedlis criteria.

Late recurrent gastric carcinoma 12 years after surgery with attenuation of CD44 variant 9 expression

BackgroundLate recurrence of gastric cancer at 10 years post-gastrectomy is extremely rare, and the underlying mechanism remains unclear. We report a para-aortic lymph node metastasis case that recurred 12 years postoperatively.Case presentationA 44-year-old woman pathologically diagnosed with moderately to poorly differentiated adenocarcinoma with pT2(SS)pN2cM0pStageIIIA according to the Japanese Classification of Gastric Carcinoma (the 13th Edition) underwent laparoscopic distal gastrectomy with D1 + lymph node dissection. She received adjuvant chemotherapy with tegafur-uracil (400 mg/day) for 2 years. At postoperative year (POY) 5, a swollen lymph node was detected in the No.16b1lat lymph node station. However, positron emission tomography (PET) revealed normal uptake, and the levels of tumor markers were within normal limits; hence, the possibility of metastasis was considered low, and the patient was placed under observation. At POY 12, computed tomography revealed an enlargement of the No.16b1lat lymph node station, and PET showed abnormal uptake. Endoscopic ultrasound-guided fine-needle aspiration revealed a moderately differentiated adenocarcinoma. Hence, a diagnosis of recurrence of gastric cancer was made. The patient underwent para-aortic nodal dissection (PAND) of No.16b1lat & int stations. Immunochemical staining results also suggested the recurrence of gastric cancer. However, the expression of CD44 variant 9 (CD44v9), a cancer stem cell marker for gastric adenocarcinoma, was attenuated in the recurrent lesions compared with that in the primary lesions. Postoperatively, she received chemotherapy with tegafur–gimeracil–oteracil (80 mg/day) for 1 year. Bone metastasis was observed at POY 4 after PAND, and the IHC analysis showed a HER2 score of 3 + in a needle biopsy specimen of bone metastasis. The expression of CD44v9 was slightly positive. The patient is being treated with chemotherapy with FOLFOX + trastuzumab.ConclusionsA defense mechanism against reactive oxygen species has been reported as a mechanism causing recurrence of CD44v9-positive gastric cancer. Consequently, CD44v9-positive gastric cancer grows in metastatic organs, repeatedly self-renews, and proliferates to form recurrent lesions. In the present case, the degree of CD44v9 staining in recurrent lesions was suggested to be related to the recurrence time.

Multi-institutional Development and Validation of Contouring Guidelines for Para-aortic Elective Nodal Irradiation in Prostate Cancer Based on Patterns of Involvement on Targeted Molecular Imaging Positron Emission Tomography/Computed Tomography

Molecular imaging better identifies anatomic regions of metastatic spread of prostate cancer compared with conventional imaging, resulting in para-aortic (PA) nodal metastases being increasingly identified. Consequently, some radiation oncologists electively treat the PA lymph node region in patients with gross or high risk of PA nodal involvement. The anatomic locations of at-risk PA lymph nodes for prostate cancer are unknown. Our objective was to use molecular imaging to develop guidelines for the optimal delineation of the PA clinical target volume (CTV) in patients with prostate cancer. We conducted a multi-institutional retrospective cohort study of patients with prostate cancer undergoing 18F-fluciclovine or 18F-DCFPyL prostate-specific membrane antigen positron emission tomography (PET)/computed tomography (CT). Images of patients with PET-positive PA nodes were imported into the treatment planning system, avid nodes were contoured, and measurements were taken in relation to anatomic landmarks. A contouring guideline that encompassed the location of ≥95% of PET-positive PA nodes was created using descriptive statistics and then validated in an independent data set. Five hundred fifty-nine patients had molecular PET/CT imaging in the development data set (78% 18F-fluciclovine, 22% prostate-specific membrane antigen). Seventy-six patients (14%) had evidence of PA nodal metastasis. We determined that expanding the CTV to 1.8 cm left of the aorta, 1.4 cm right of the inferior vena cava (IVC), 7 mm posterior to the aorta/IVC or to the vertebral body, and superiorly to the T11/T12 vertebral interface, with the anterior border 4 mm anterior to the aorta/IVC and inferior border at the bifurcation of the aorta/IVC, resulted in coverage of ≥95% of PET-positive PA nodes. When the guideline was used in the independent validation data set (246 patients with molecular PET/CT imaging, of whom 31 had PA nodal metastasis), 97% of nodes were encompassed, thereby validating our guideline. We used molecular PET/CT imaging to determine the anatomic locations of PA metastases to develop contouring guidelines for creating a prostate cancer PA CTV. Although the optimal patient selection and clinical benefits of PA radiation therapy remain uncertain, our results will aid in delineating the optimal target when PA radiation therapy is pursued.

Controversies in the Staging of Patients with Locally Advanced Cervical Cancer.

Approximately 10-25% of patients with locally advanced cervical cancer harbor metastases to the para-aortic lymph nodes. Staging of patients with locally advanced cervical cancer can be performed with imaging techniques, such as PET-CT; however, false negative rates can be as high as 20%, especially for patients with pelvic lymph node metastases. Surgical staging can identify patients with microscopic lymph nodes metastases and aid in accurate treatment planning with the administration of extended-field radiation therapy. Data from retrospective studies investigating the impact of para-aortic lymphadenectomy on the oncological outcomes of patients with locally advanced cervical cancer are mixed, while data from randomized controlled trials do not demonstrate a progression-free survival benefit. In the present review, we explore controversies in the staging of patients with locally advanced cervical cancer and summarize the available literature.

Largest testicular tumour in South-East Asia: a case report

We present the largest testicular tumour that first ever reported in Malaysia and we believed first reported in Southeast Asia. A 21 years old Malay gentleman presented to us with painless large scrotal swelling. After the initial workup and investigations were done and followed by a CT scan which yield a multiple paraaortic lymph nodes, the patient was scheduled listed in the earliest list for high ligation right orchidectomy with an inguinal approach. The patient seeks treatment at that point because he can't bear the embarrassment and fear of the treatment.

Small Cell Carcinoma of the Cervix: A Case Report and Literature Review

Cervical small cell carcinoma (SCC) is a rare disease, with a high degree of malignancy and a poor prognosis. Para-aortic lymph nodes (PALN) are frequent sites of recurrence after pelvic chemoradiotherapy. In the present study, we report the case of a 26-year-old female patient with cervical SCC who suffered for two times PALN relapses. Our research results have shown that PALN lesions can be effectively controlled with permanent radiation therapy. Prophylactic PALN radiotherapy may be an effective option for patients with cervical SCC who require radical pelvic radiation therapy.

A rare clinical case of uterine cancer with a congenital malformation of the genital organs

Endometrial cancer is one of the most common options malignant neoplasms of the female reproductive system. At the same time, in the general structure of female oncopathology, cases of this disease in patients with developmental anomalies of the genital organs are extremely rare. When studying scientific publications, only 26 described clinical cases of uterine cancer in patients with genital malformations were found. The article presents a clinical case of endometrioid carcinoma in a 75-year-old woman with a duplication of uterus. Based on clinical performance, ultrasound investigation results, magnetic-resonance imaging and histological studies of endometrial scrapings was diagnosed duplication of uterus with endometrial cancer IB (cT1вNхМ0), G2 (morphological type endometrioid carcinoma). With this pathology, surgical treatment is considered as the most effective way to fight uterine cancer, in some cases combined with other methods. Both laparotomic and laparoscopic interventions are recommended, provided that pelvic and lumbar lymph node dissection can be performed according to indications. The operation was carried out in the amount of laparotomy, B2 type modified radical hysterectomy, with C3 pelvic lymph node dissection, omentectomy. The result of the postoperative histological examination confirmed the preoperative diagnosis. The postoperative period was without specific findings. The presented rare clinical case demonstrates necessity to give careful attention to patients with a congenital malformation of the genital organs. Timely diagnosis and diagnosis verification will allow for adequate treatment, which will affect the prognosis of survival. At the same time, the prognosis is largely determined by the stage of the process, the depth of the invasive lesion, and the histological type of the tumor.

An Extraordinary Location of Sentinel Lymph Nodes in a Patient with Endometrial Cancer

To show dissection of sentinel lymph nodes. A step-by-step demonstration of the technique with narration. Endometrial cancer (EC) is the most common gynecologic malignancy worldwide. Sentinel lymph node biopsy with indocyanine green (ICG) has become more widely used and has been featured in recently published guidelines for EC [1]. Minimally invasive approaches with the sentinel lymph node concept (conventional laparoscopy, laparoscopic-assisted vaginal surgeries or robotic) to EC staging have resulted in lower rates of peri- and postoperative complications than conventional staging procedures [2]. No video article has been published in the literature about high pelvic, para-aortic sentinel lymph node dissection. An informed consent form was obtained from the patient. An institutional review board approval was not required. A 45-year-old female with gravidity 0, parity 0, and body mass index of 23.4 kg/m2 presented with complaints of abnormal uterine bleeding (spotting). Increased endometrial thickness was detected on transvaginal ultrasound (10 mm) in the postmenstrual period. Endometrioid-type endometrial adenocancer with focal squamous differentiation International Federation of Gynecology and Obstetrics grade I was detected on endometrial biopsy. The patient had hepatitis B virus positivity and no other chronic disease. A laparotomic myomectomy had been performed in 2016. Laparoscopic high pelvic, low para-aortic sentinel lymph node dissection with ICG and hysterectomy (without uterine manipulator)+bilateral salpingo-oophorectomy were performed (Supplemental Video 1). The operation time for the procedure was 110 minutes and the estimated blood loss was <20 mL. No major complications occurred during or after the surgery. The patient stayed in the hospital for 1 day. The final pathology result showed an International Federation of Gynecology and Obstetrics grade I, endometrioid-type endometrial adenocancer with focal squamous differentiation, as a 1.5×1 cm tumorous mass invading less than one-half of the myometrium. Neither lymphovascular invasion nor sentinel lymph node metastasis was detected. A multicenter, prospective study showed that sentinel lymph node dissection with ICG in clinical stage 1 EC is feasible and has a high degree of diagnostic accuracy in detecting EC metastases. In that study, isolated para-aortic sentinel lymph node was detected in 3 of 340 patients (<1%) [2]. Another study reported the detection rate of isolated para-aortic sentinel lymph node to be 1.1% in patients with intermediate- and high-risk EC [3]. There are in some cases 2 distinct channels emanating from one side, and it is important to follow each and to acknowledge there may be more than one sentinel, one of which is lower in a typical location and one higher as in this case. This video article is the first video demonstration of bilateral isolated high pelvic, para-aortic sentinel lymph node dissection in EC.

Paratesticular rhabdomyosarcoma: a rare case report from Syria.

In this paper, the authors report a case of a 6-year-old child who presented to the clinic with a painless mass in the right side of the scrotum. The mass was misdiagnosed and had evolved rapidly over 2 weeks. The mass measured 16×32mm on ultrasound, and therefore, an orchiectomy was performed. The histological examination of the excised tissue confirmed the diagnosis of paratesticular RMS. Paratesticular RMS mainly presented as a painless mass in the scrotum. It was a very metastatic lesion that required an immediate management. However, a lot of cases of paratesticular RMS misdiagnosed at first time, which worsens the overall prognosis. Eventually, paratesticular RMS should be always taken into consideration when a scrotal mass is suspected. Due to its extremely serious metastatic potential, this condition requires early diagnosis and management. The treatment is currently well codified combining surgery, chemotherapy, and radiotherapy.

Case of a 38-year-old man with NEMO deficiency syndrome complicated by marginal zone lymphoma

Here, we present a unique case of a 38-year-old man with history of Nuclear Factor-Kappa B Essential Modulator (NEMO) deficiency syndrome, whose course was complicated by marginal zone lymphoma. At 7 years of age, he was found to have MAI infection and throughout his life, developed further complications of MAI including osteomyelitis, intracranial lesions, adrenal abscesses, and cavitary pulmonary disease. Genetic testing revealed 1207 C-to-T mutation in NEMO, leading to R-for-C substitution at position 417 in the zinc finger domain. He has had a long history of recurrent viral and bacterial sinopulmonary infections since infancy continuing into adulthood, with over thirty lifetime episodes of serious pneumonia requiring hospitalizations, which has led to bronchiectasis.At 36 years of age, he presented to the hospital for five months of progressively worsening dyspnea and wheezing, hypoxemic respiratory failure, and a 15-pound weight loss. CT imaging demonstrated increased consolidation and nodularity, and sputum culture revealed methicillinsusceptible Staphylococcus aureus and Corynebacterium pneumonia treated with vancomycin. He was incidentally found to have a new 7.5 cm left periaortic lymph node conglomerate on CT abdomen/pelvis. Lymph node biopsy showed B-cell lymphoma with plasmacytic differentiation and with increased large cells, most concerning for marginal zone lymphoma. He received eight doses of rituximab as well as radiation therapy, with subsequent improvement on imaging. Following this diagnosis, lung biopsy was obtained, demonstrating nodular fibrosis in a primarily airwaycentered distribution with patchy, focal organizing pneumonia, most consistent with fibrosing chronic organizing pneumonia, treated with high dose prednisone. However, his course had since been complicated by increasingly frequent hospitalizations for acute on chronic hypoxemic respiratory failure corresponding with superimposed respiratory infectious as well as exacerbations of his organizing pneumonia.Hematopoietic stem cell transplantation was strongly considered as this would be a definitive treatment for his NEMO syndrome, as he has multiple severe complications of his NEMO deficiency syndrome. Unfortunately, after multidisciplinary discussions, he was ultimately considered to not be a candidate given his very poor pulmonary status. The patient was started on rituximab for his organizing pneumonia and continued on antibiotic prophylaxis with immunoglobulin replacement.

Advanced Ovarian Yolk Sac Tumor in Nine-Year-Old Girl: Case Report and Literature Review, 2023

Background: Yolk sac tumor or primary endodermal tumor is a rare and aggressive malignant tumor, representing 15% to 20% of germ cell tumors of the ovaries, characterized by its high sensitivity to chemotherapy, often-present adolescents from 18 to 30 years old. Case Report: This is a 9 years old female presented with abdominal pain and distention associated with constitutional symptoms and significant weight loss, which she cannot exactly quantify. She had no family history of similar problems and denies any change in bowel habit, vaginal discharge or bleeding. Besides, she had no development of any secondary sex characteristics. On physical examination, she was not in distress with stable vital signs. Chest was clear to auscultation and abdomen was distended with slight deviation to the right side, which is hard, non-tender mobile, with irregular border about 20x18cm size, reaching to the level of umbilicus. There was no sign of fluid collection or inguinal lymph node enlargement. serum tumor markers revealed alpha fetoprotein level &gt;1210 ng/dl, CA 125 of 70.1U/mland CT scan showed right ovarian mass with paraa ortic lymph node enlargement and attachment of the mass to the rectum. Under general anesthesia, midline incision done and about 120mla serous ascetic fluid of was evacuated. Hard, irregular right adnexa mass was identified and a huge retroperitoneal mass fixed to big blood vessels with multiple enlarged para aortic lymph nodes was identified. The omentum was with multiple kicks and the liver surface was irregular with multiple nodules at its lower edges. Peritoneal fluid cytology revealed malignant metastasis and the histopathology analysis was consistent with yolk sac tumor. She was staged surgically as 4B and discharged after clinical improvement to go abroad for chemotherapy treatment. Conclusion: The histopathology, cytology and intraoperative clinical finding were consistent with serum tumor markers that she had advanced stage yolk sac tumor with poor prognosis. Community and health professionals’ awareness for early recognition of the disease for better prognosis and initiation of pediatric chemotherapy in Eritrea is crucial, as these diseases are highly responsive to radio-chemotherapy.

A uterine leiomyoma with the prolapse large pedunculated submucosal myoma: a case report

Introduction: Leiomyoma is a benign tumor that originates from the smooth muscle cells of the uterus and is one of the most common tumors in women. Sometimes, this tumor can become very large and even stick out of the vagina, which is called prolapse pedunculated myoma. Having a large fibroid with prolapse myoma that protrudes out of the vagina can cause problems like a low blood count or anemia, infection risk, blockage of other organs, and tissue necrosis. Therefore, this condition needs a different treatment approach than other cases. Case Report: A 50-year-old woman, P1A1, complained of bleeding from the vagina accompanied by a mass that protrudes out of the vagina, and also having an enlarged abdomen. On physical examination, the patient appears pale. Abdominal examination presence of a mass as high as the umbilicus. On a gynecological examination, Fluxus was found. In the vagina, there is a blue-black mass the size of a fist coming out of it. Hemoglobin examination obtained a result of 10.2 gr/dl. Gynecologic ultrasound examination showed the uterus with a size of more than 9.42 x 15.68 x 13.27 cm, a positive endometrial thickening, and there also appeared a hyperechoic mass with a size of 7.38 x 8.11 cm. Abdominal MSCT examination using contrast showed enlargement of the uterus with solid inhomogeneous mass and intramural calcification. There is also a mass and cervical prolapse to the perineum, mild hydronephrosis, and right proximal hydroureter. It is also found multiple lymphadenopathies in paraaortic and common iliac lymph nodes. The patient then decided to perform a total abdominal hysterectomy. Conclusion: Total abdominal hysterectomy is one of the procedures that can be done on patients who are experiencing symptoms, such as bleeding caused by a large leiomyoma size and the presence of prolapse pedunculated submucosal myoma.

A Rare Case Report: Anal Malignant Melanoma and Evaluation of the Literature

Introduction: Anal malignant melanomas are relatively rare tumors. Because of their polypoid structure, they can be confused with benign anorectal diseases. Wide excision and lymph node dissection is recommended especially in melanomas including lymph node metastasis because it reduces local recurrence. Case report: We performed abdominoperineal resection + bilateral inguinal + bilateral iliac + paraaortic lymph node dissection in our 77-year-old female patient with the diagnosis of anal malignant melanoma as a result of colonoscopic biopsy performed on the polypoid mass in the anal canal. Since 2 lymph nodes located outside the pararectal fascia persisted in postoperative MRI, we performed lymph node excision with a posterior approach. And the pathology result of the excision performed in this second session was found to be compatible with metastasis. Conclusion: Lymph node dissections are beneficial in terms of local recurrence and survival, especially in patients with anal malignant melanoma with lymph node metastases.

A single institution’s experience with minimally invasive surgery for ovarian cancer, and a systematic meta-analysis of the literature

BackgroundThis study assesses the feasibility of minimally invasive surgery (MIS) for well-selected epithelial ovarian cancer (EOC) patients.MethodsWe performed a review of data prospectively collected from a single center from 2017 to 2022. Only patients with histologically confirmed EOC, with a tumor diameter of less than 10 cm, were eligible. We also performed a meta-analysis of similar studies comparing the outcomes of laparoscopy and laparotomy. We used MINORS (Methodological Index for Non-Randomized Studies) to assess the risk of bias and calculated the odds ratio or mean difference.ResultsEighteen patients were included; 13 in re-staging group, four in PDS group, and one in IDS group. All achieved complete cytoreduction. One case was converted to laparotomy. The median number of removed pelvic lymph nodes was 25 (range 16–34), and 32 (range 19–44) for para-aortic nodes. There were two (15.4%) intraoperative urinary tract injuries. The median follow-up was 35 months (range 1–53). Recurrence was observed in one case (7.7%). Thirteen articles for early-stage ovarian cancer were included in our meta-analysis. Analysis of the pooled results found that MIS had a higher frequency of spillage (OR, 2.15; 95% CI 1.27–3.64). No differences were observed in recurrence, complications, or up-staging.ConclusionsOur experience supports the possibility of conducting MIS for EOC in well-selected patients. Except for spillage, our meta-analysis findings are consistent with previous reports, the majority of which were also retrospective. Ultimately, randomized clinical trials will be needed to authenticate the safety.

A meta-analysis of the effect of pelvic and para-aortic lymph node dissection on the prognosis of patients with endometrial cancer

ABSTRACT Endometrial cancer (EC) is the second most common malignant tumor of the female reproductive system, and it occurs in the peri- and post-menopausal periods. The metastasis routes of EC include direct spread, hematogenous metastasis and lymph node metastasis. Symptoms such as vaginal discharge or irregular vaginal bleeding may occur in the early stage. The pathological stage of the patients treated at this time is mostly in the early stage, and comprehensive treatment such as surgery, radiotherapy and chemotherapy can improve the prognosis. This article investigates whether endometrial cancer requires pelvic and para-aortic lymph node dissection. The clinical data of 228 patients with endometrial cancer who underwent pelvic lymphadenectomy in our hospital from July 2020 to September 2021 were retrospectively analyzed. All patients underwent preoperative clinical staging and postoperative pathological staging. This paper compared lymph node spread rates of endometrial carcinoma in different stages, depth of muscle invasion, and pathological characteristics to analyze lymph node metastasis risk factors. Results showed metastasis rates of 7.5% in 228 cases of endometrial cancer, increasing with deeper myometrial invasion. Different clinicopathological factors had varying lymph node spread rates. Different clinicopathological factors have different pelvic lymph node spread rates in surgical patients. The lymph node spread rate of differentially differentiated carcinoma is higher than that of well-differentiated carcinoma. The lymph node spread rate of serous carcinoma is 100%, but there is no difference between the lymph node metastasis rate of special type carcinoma and adenocarcinoma. Statistical significance (P > 0.05).

Prophylactic Extended-Field Irradiation Versus Pelvic Irradiation in Patients With Cervical Cancer With 2018 FIGO Stage IIIC1 Disease

To compare the survival rates and toxicities of prophylactic extended-field radiation therapy (EFRT) and pelvic radiation therapy (PRT) among cervical cancer patients with 2018 FIGO stage IIIC1 disease. We retrospectively analyzed patients with 2018 FIGO stage IIIC1 disease who were treated with definitive concurrent chemoradiotherapy at our institute between 2011 and 2015. A dose of 50.4 Gy in 28 fractions was delivered to the pelvic region (by PRT) or the pelvic plus para-aortic lymph node region (by EFRT) with intensity-modulated radiation therapy. The first-line regimen of concurrent chemotherapy was weekly cisplatin. A total of 280 patients were included, with 161 patients treated with PRT and 119 patients treated with EFRT. After propensity score matching (1:1), 71 pairs of patients were selected. The respective 5-year rates of the patients treated with PRT and EFRT were 61.9% and 85.0% for overall survival (p=0.025), 53.0% and 77.9% for disease-free survival (DFS, p=0.004) after matching. In the subgroup analysis, patients were grouped into a high-risk group (122 patients) and a low-risk group (158 patients) based on three factors: positive common iliac lymph nodes, ≥ 3 pelvic lymph nodes and 2014 FIGO stage IIIB disease. In both the high-risk and low-risk groups, EFRT significantly improved DFS compared with PRT. The rates of ≥ grade 3 chronic toxicities were 1.2% and 5.9% in the PRT and EFRT groups, respectively (p=0.067). In comparison to PRT, prophylactic EFRT was associated with improved OS, DFS, and PALN control in cervical cancer patients with FIGO stage IIIC1 disease. The incidence of grade 3 or higher toxicities was higher in the EFRT group than in the PRT group, although the difference was not significant.

An unusual case of a tibial metastasis as the first clinical presentation of a serous papillary carcinoma of the ovarian epithelial type of the testis.

Among testicular neoplasms, ovarian-type epithelial tumors constitute an exceedingly rare group, with only a few cases reported in the literature. We describe the case of an 82-year-old man, presented with complaints of right leg pain and difficulty walking, who was found to have a large right tibial metastasis of unknown primary origin. Whole body CT scan did not reveal any cranial, thoracic or abdominal tumor masses, but it showed abnormal para-aortic lymph nodes and right spermatic cord swelling. An extemporary ultrasound examination found a right testicular mass. The patient underwent radical orchiectomy, and the diagnosis of a serous papillary carcinoma of the ovarian epithelial type of the testis was made. To the best of our knowledge, this is the first case in the literature of isolated bone metastasis from ovarian-type epithelial tumor of testis.

Balloon Trocar Is a Suitable Instrument for Retroperitoneal Para-aortic Lymphadenectomy in Gynecologic Malignant Diseases

To demonstrate the surgical technique of retroperitoneal para-aortic lymphadenectomy to prevent peritoneal rupture in gynecologic malignant disease. In this video, the authors describe how to use a balloon trocar to create a safe and efficient working space without peritoneal rupture. A step-by-step video demonstration of a surgical technique. Department of Gynecology and Obstetrics, Mie University, Tsu, Japan. Para-aortic lymphadenectomy is a part of most gynecologic oncology procedures for primary and recurrent gynecologic malignancies. There are 2 approaches to para-aortic lymphadenectomy: transperitoneal and retroperitoneal approaches. Although there are no significant differences between these approaches (such as in terms of the number of isolated lymph nodes or related complications), they are performed based on the operator's preference. The retroperitoneal approach is an unfamiliar surgical technique compared with usual laparotomy and laparoscopic surgery, and its disadvantages include a steeper learning curve for attaining proficiency. It is also difficult to develop the retroperitoneal space without a peritoneal rupture. In this video, we demonstrate the use of balloon trocars to create a retroperitoneal compartment. The patient was placed in the lithotomy position with the pelvis elevated at 5° to 10°. The left internal iliac approach, which is considered the standard approach, was used in this case (Fig 1). After identifying the left psoas muscles and the ureter crossing the common iliac artery, dissection of the left para-aortic lymph node was initiated (Supplemental Video 1, 2). Herein, we demonstrated a successful surgical technique for retroperitoneal para-aortic lymphadenectomy to prevent peritoneal ruptures.