Total Radical Hysterectomy Research Articles

Lymphoepithelioma-like carcinoma of the cervix: Diagnostics, treatment, monitoring

Lymphoepithelioma-like carcinoma of the cervix (LELC) is a rare subtype of squamous cell carcinoma. This is a case report of a 40-year-old female patient diagnosed with LELC. The tumor is clinically presented as an exophytic mass on the front lip of the cervix. Magnetic resonance imaging (MRI) of the pelvis revealed a cervical tumor mass with a diameter of 21 mm. The findings of the preoperative pathohistological analysis of the biopsy tissue indicated LELC. The disease was clinically and radiologically staged as IB1 stage according to the 2009 FIGO classification, and the patient underwent surgical treatment. A total radical hysterectomy with pelvic lymphadenectomy was performed, followed by external beam radiotherapy. The patient was regularly monitored with the last check-up on February 2024 (36 months) and MRI control of the pelvis and abdomen without signs of recurrence of the underlying disease. The patient is in good general condition, without subjective complaints and side effects of the applied therapy.

Ovarian transposition in order to preserve fertility before irradiation in a young patient with cervical cancer

Ovarian transposition has been imagined for young women diagnosed with pelvic malignancies who are submitted to surgery, who are further candidates for irradiation and who deserve fertility preservation. The most commonly indication for this procedure are represented by rectal and hematological malignancies; in certain cases diagnosed with gynecological malignancies in early stages such as cervical cancer ovarian preservation can be also taken in consideration in order to preserve fertility; however, ovarian transposition should be taken in consideration in order to remove the ovaries from the radiation field. The aim of the current paper is to report the case of a 31 year old patient diagnosed with a stage IIA cervical cancer in whom a total radical hysterectomy en bloc with right adnexectomy and pelvic lymph node dissection was performed; meanwhile the left ovary was transposed at the level of the left lumbar area, 2 cm above the left iliac crest and metallic clips were placed at the inferior margins in order to be easily identified when performing adjuvant radiation therapy.

Total Laparoscopic Radical Hysterectomy and Bilateral Pelvic Lymphadenectomy: Our Institutional Experience

Purpose To study the outcome, feasibility, morbidity and safety of total radical hysterectomy and bilateral pelvic lymphadenectomy at our institution.

A Rare Case of Pelvic Primitive Neuroectodermal Tumor in a 37-Year-Old Patient

Primitive neuroectodermal tumors (PNETs) belong to the group of malignant bone tumors. Their frequency is about 1% of sarcoma. The principal distinctive feature is a translocation concerning the EWS gene or t(11;22)(q24; q12). They are even rarer when located in the extra-skeletal pelvic region. We report a case of a 37-year-old female patient with a PNET in the pelvic region that is found after a spontaneous abortion. The tumor is localized on the right latero-uterine ligament. The tumoral size is of 10 cm. After the coelioscopic diagnosis, the patient was treated with neo-adjuvant chemotherapy according to vincristine, ifosfamide, doxorubicin, and etoposide (VIDE) protocol, which ensured an important diminishing of the size of the tumor. She then had a total radical hysterectomy associated with a lymph node resection. The diagnosis was confirmed by histology, immunohistology examinations and molecular biology by hybridization in situ . The tumoral cells were classically small and round. They expressed CD99 and vimentin. Translocation t(11;12)(q24;q12) was positive. Two months later, the patient presented a tumoral relapse and received an adjuvant chemotherapy by vincristine, dactinomycin, and ifosfamide (VAI) twice with a limited chemical and hematological tolerance that brought along palliative treatment. Extra-skeletal PNETs found in the pelvic region are very rare. Our present case is also rare by the way in which it was found, by the age of the patient and its being in the pelvic region. Prognosis with these tumors is still very bad regardless of the optimization of a multidisciplinary answer. The research of new biomarkers and target therapy could be a hope for the treatment of these rare and pejorative tumors. J Med Cases. 2016;7(2):58-59 doi: http://dx.doi.org/10.14740/jmc2372w

Combined robotic and vaginal approach in radical hysterectomy for the patient with bulky cervical cancer

Objectives: Robotic surgery is gradually being incorporated into gynecologic oncology. Robotic radical hysterectomy offers some advantages over other surgical approaches with respect to operative time, blood loss, and hospital stay. Due to the necessary location of the robot docking system, however, there is not enough space to enable the performance of vaginal procedures. Therefore, robotic-assisted total radical hysterectomy is in the mainstream for early-stage cervical cancer treatment. In bulky cervical cancer, however, intrauterine manipulation is difficult to install and increases the risk of intra-abdominal tumor seeding. Especially difficult is determination of the level of vaginal cutting. For this reason, the vaginal approach is preferred for robot-assisted radical hysterectomy in bulky cervical cancer.

About the Rare Case of a Pelvic Primitive Neuro-ectodermal Tumor in a 37 Year Old Patient

Introduction: Primitive Neuro-Ectodermal Tumors (PNETs) belong to the group of malignant bone tumors. Their frequency is about 1% of sarcoma. The principal distinctive feature in a translocation concerning the EWS gene or t(11; 22)(q24; q12). They are even rarer when located in the extra-skeletal pelvic region. Case report: We report a case of a 37 year old female patient with a PNET in the pelvic region that is found after a spontaneous abortion. The tumor is localized on the right latero-uterine ligament. The tumoral size is of 10 cm. After the coelioscopic diagnosis, the patient was treated with neo-adjuvant chemotherapy according to VIDE protocol and ensuring an important diminishing of the size of the tumor. She then had a total radical hysterectomy associated with a lymph node resection. The diagnosis was confirmed by histology, immunohistology examinations and molecular biology by hybridation in situ. The tumoral cells were classically small and round. They expressed CD99 and vimentine. Translocation t(11;12)(q24;q12) was positive. Two months later, the patient presented a tumoral relapse and received an adjuvant chemotherapy by VAI twice with a limited chemical and hematological tolerance that brought along palliative treatment. Discussion: Extra skeletal PNETs found in the pelvic region are very rare. Our present case is also rare by the way in which it was found, by the age of the patient and its being in the pelvic region. Prognosis with these tumors is still very bad regardless of the optimization of a multidisciplinary answer. Conclusion: The research of new biomarkers and target therapy could be a hope for the treatment of these rare and pejorative tumors.

Preservation of Autonomic Nerves in Laparoscopic Total Radical Hysterectomy

The aim of this study was to evaluate the feasibility, complications, margin status, and functional outcome (on urinary and sexual functions) of nerve-sparing radical hysterectomy (NSRH) performed laparoscopically. Patients with cervical carcinoma of stage Ia2 and Ib1 underwent laparoscopic NSRH along with pelvic lymphadenectomy. We performed the technique in simple comprehensible steps with anatomic delineation of the autonomic nerves and selective cutting of the uterine and cervical branches. Laparoscopic NSRH was feasible in 85.7% of patients. Mean operative time was 160 minutes and all 7 patients had clear surgical margins. There were no complications and no blood transfusions were required. The median hospital stay was 3 days. The median return time for normal bladder function was 2 days and none of them required catheterization beyond 2 weeks. The mean residual urine volume was <50 mL. Urodynamic studies performed at 3 weeks after the operation showed no impairment of maximum flow rate (maximal flow rate: 20 ± 2 mL). The postoperative results of sexual dysfunction were inconclusive. Understanding this technique and the knowledge of laparoscopic anatomy of pelvic autonomic nerves is important in both benign and malignant pelvic surgeries. These preliminary results indicate that nerve sparing is easier done laparoscopically and its results are comparable to that of conventional laparoscopic radical hysterectomy in terms of lateral margin status and lymph node yield. Whether quality of life can be benefited by L-NRSH technique and its long-term oncological sequelae need further evaluation.

Carcinoma neuroendocrino de células pequeñas del endometrio. Reporte de caso

Small cell neuroendocrine carcinoma is a very rare tumor and the endometrium is the least common site of occurrence. We present the case of a 41-year-old woman who reported abnormal genital bleeding for approximately 1 year before consulting. Endometrial biopsy revealed small cell carcinoma. The patient underwent a total radical hysterectomy with pelvic and para-aortic lymphadenectomy. The carcinoma was surgical stage II. The histopathological report showed the presence of rounded small cell carcinoma of the endometrium with scanty cytoplasm and hyperchromatic nuclei, ordered in a solid-trabecular pattern with perivascular arrangement. Special immunohistochemical study showed the neuroendocrine origin of the tumor.

Laparoscopic total radical hysterectomy by the Pune technique: Our experience of 248 cases

Study objective To describe our experience and technique of total laparoscopic radical hysterectomy with pelvic lymphadenectomy, which is the largest single- institution study. Design Retrospective, nonrandomized study (Canadian Task Force classification II-2). Setting Private hospital. Patients Two hundred forty-eight patients with International Federation of Gynecology and Obstetrics stage IA2 (n = 32) and IB1 (n = 216) of cancer of the cervix. Intervention Total laparoscopic type III radical hysterectomy with bilateral pelvic lymphadenectomy was done. Simple repetitive steps were used to perform this surgery and develop an easily replicable technique. Harmonic Shears, bipolar coagulation, and vascular clips were used. Resection of the cardinal and uterosacral ligaments was performed with LigaSure (LigaSure Vessel Sealing System; Valleylab, Tyco Healthcare, Boulder, CO) or the Harmonic Shears (Ethicon Endo-Surgery, Inc., Cincinnati, OH). Pelvic lymph node dissection was done. Measurements and main results Histopathologically, there were 183 (73%) cases of squamous carcinoma, 52 (20%) adenocarcinomas, and 13 (5%) adenosquamous carcinomas. Four patients needing anterior exenteration because of bladder involvement were excluded from data analyses. The operation was performed entirely by laparoscopy in all patients and by the same surgical team. The patients’ median age was 61 years. The median operative time was 92 minutes (range 65–120 minutes). The median number of resected pelvic nodes was 18. The median blood loss was 165 mL. The median length of stay was 3 days. All 15 intraoperative complications were tackled laparoscopically. No patients were converted to the open technique. There were no deaths in our series. Seventeen patients had complications within 2 months of surgery. Seven patients had recurrences after a median follow-up of 36 months. Conclusion Our technique of total laparoscopic radical hysterectomy, developed over 248 cases, can be performed safely. It is an easily replicable technique. This procedure reduces the morbidity associated with abdominal radical hysterectomy. All of the complications can also be tackled laparoscopically, which does not further add to the morbidity.