Postoperative diaphragmatic herniation after cytoreductive surgery in advanced stage ovarian cancer

Ovarian cancer is frequently associated with upper abdominal involvement necessitating extensive resections at this level. In such cases a significant increase of the postoperative complications is to be expected, the most commonly encountered one being represented by pleural effusion. Another complication which is described less frequently but which is associated with higher risks is represented by upper abdominal herniation at the level of the thorax. The aim of this paper is to discuss the risk factors and the therapeutic strategies in such cases.

The role of embolization in unresectable, haemorrhagic, gynaecological tumors

Once the techniques of interventional radiology improved, various methods have been proposed in order to achieve a good control of bleeding with different origins. When it comes to the role of arterial embolization for uncontrollable gynaecological bleeding, the method proved to be particularly efficient when it comes to uterine fibroids. Meanwhile, it has been also proposed as salvage therapy in cases presenting massive vaginal bleeding due to unresectable gynaecological malignancies. The aim of the current paper is to review the efficiency of the method in patients presenting large tumoral masses with uterine origin.

Ureteric injury in gynecology

Ureteric damage is a rare but a well known complication in obstetric and gynaecological practice. It has repercussions in terms of morbidity and medico-legal practice. There is wide variation of reported incidence is related to the type of surgery. Preoperative and intraoperative precautions can prevent the injury up to a point the injury but the effectiveness of these actions has not been fully assessed.

Endometrial scratching technique

Problems of female subfertility are a current challenge. Implant failure of the embryo after an assisted human reproduction technique is undesirable and unpleasant, and strategies to improve this implant rate are welcome. One of these techniques is endometrial scratching. We performed a literature review by searching in the PubMed and Cochrane databases for relevant information regarding the technique of endometrial scratching. The technique of endometrial scratching is not complex, but choosing an optimal period in the menstrual cycle seems to produce the desired effects for the successful implantation of the embryo. Pregnancy rates obtained through assisted human reproduction techniques have been improved due to endometrial scratching techniques.

Management of uterine perforation

Uterine perforation, although extremely rare, can have lifelong consequences. Any procedure that can cause perforation has to take into account the risk of damage to the uterine wall. As this is a blind method, adequate training and certification is necessary, before trainees can performed hysteroscopy, D&C (dilatation and curettage), coil insertion independently.

Multiple ovulations between ovarian stimulation treatment and primary ovarian insufficiency

The release of several oocytes during the same menstrual cycle can occur both physiologically and iatrogenic, following ovarian stimulation treatments. Ovarian induction can be achieved either by mild stimulation, in the case of anovulatory or dysovulatory patients, or by controlled ovarian hyperstimulation, to obtain a large number of follicles in the In Vitro Fertilization procedure. At this time, the ideal ovarian stimulation treatment is to suppress the pituitary release of gonadotrophin-releasing hormone (GnRH), a co-opted regimen with high doses of exogenous follicle-stimulating hormone (FSH). The physiological process of multiple ovulations can lead to superfertilization (SF). SF is a biological process by which two eggs are fertilized successively, at intervals of a few days apart, both eggs coming from the same ovulation. Among the factors that can lead to superfertilization are mentioned: family history of dizygotic pregnancies (DZ), increased parity, advanced age, high stature of women, a high weight index, the use of oral contraceptives and folic acid. The premenopausal period is characterized by elevated levels of FSH and a low ovarian reserve, both conditions contributing to the development of multiple follicular and DZ pregnancies.

Triple metachronous primary malignancy – case report and literature review

Multiple primary malignancies (MPMs) are defined as more than two synchronous or metachronous cancers in the same individual. Common risk factors for multiple primaries are represented by inherited predisposition to cancer, cancer-promoting aspects of lifestyle, hormonal and environmental factors, history of previously treated primary cancer and increased lifespan of cancer survivors. Herein, we report a single case of a 68-year-old woman with triple metachronous primary neoplasms of the breast, colon and endometrium with three distinct histological patterns. The patient was initially submitted to a supero-external quadrant sectorectomy and axillary lymph node dissection in May 2016, followed by radical sigmoidectomy for perforated sigmoid malignant lesion in December 2018 and respectively by total hysterectomy with adnexectomy and pelvic lymph node dissection for endometrial cancer in September 2021. The histopathological studies confirmed the different histopathological origins for the three lesions. In conclusion, once the lifespan of cancer survivors increased, multiple metachronous malignancies are to be expected.

Minimum invasive sentinel lymph nodes dissection in cervical, endometrial and vulvar cancers

Genital cancer in women is an ongoing challenge. A correct diagnosis together with a correct staging can lead to a favorable oncological or surgical conduct with an improvement of the prognosis. A literature review was performed to find relevant information regarding the sentinel node mapping in uterine and vulvar cancer. Different dyes are available, but the bioavailability and toxicity of green indocyanine are factors that seem to bring superiority to this tracer. Tracing the sentinel node with green indocyanine is a method that involves special equipment, but the benefits are visible.

Surgical strategies in uterine adenomyosis

Uterine adenomyosis is defined by the presence of heterotopic endometrial glands and stroma at the myometrial level. Although imagistic studies improved, the incidence of adenomyosis is still underestimated, in a significant number of cases the final diagnostic of adenomyosis being established on the histopathological specimen of hysterectomy. The aim of the current paper is to discuss about the most efficient therapeutic strategies in adenomyosis.

Improving laparoscopic myomectomy outcomes

In the field of benign gynecology, laparoscopic myomectomy has clear advantages, although learning curve is longer. Our study aims to review the factors that improve the technique of laparoscopic myomectomies. For women with symptomatic fibroids who wish to maintain their fertility minimally invasive myomectomy is in most cases the best option. Therefore, laparoscopic approach is associated with shorter hospital stay, faster recovery, less postoperative pain, and reduced adhesion formation. Standardization of laparoscopic techniques could help to reduce the learning curve. The costs are higher compared with open myomectomy, but when we take into account the numerous advantages that laparoscopy has, including shorter operative time, less blood loss, shorter hospital stay and a more rapid recovery time, laparoscopy is more cost-efficient.

Abdominal incisions in gynecology

Wound infection post-surgery contributes extensively at the healthcare cost, translated not only by the direct care, but also for the medical leave that most patients request it. Every step is essential for achieving a successful surgery. A suitable incision is most helpful for both patient and surgeon alike. This review focuses on the multiple types of incisions used in gynecological field.

Is routine appendectomy justified in mucinous borderline ovarian cancer?

Mucinous borderline ovarian tumors represent up to one half of cases diagnosed with borderline lesions and are usually associated with favourable outcomes. When it comes to the therapeutic options in these cases, the initial trend was to adopt the same strategy as in cases presenting invasive mucinous lesions. However, studies conducted so far cam to demonstrate that the appendix presented tumoral infiltration in an extremely low number of cases especially if a normal macroscopical aspect was present and therefore routine appendectomy was no longer recommended. The aim of the current paper is to investigate in which cases appendectomy should still be part of the therapeutic strategy in mucinous borderline ovarian tumors.

Uncommon malignancy arising within mature ovarian teratoma: Case report and literature review

Background. Clear cell carcinoma of the ovary developing in the background of an ovarian teratoma represents an extremely rare entity of the gynecologic tract. Giving the rarity of this entity, the histologic challenges, prognosis and the adequate treatment is still uncertain. Methods. We herein present a case of clear cell carcinoma coexisting with a teratoma, accompanied by a scrutinous literature review. The authors have reviewed all case reports published in the literature (1978-2021), adding our new case, in order to enrich current literature data. Results. A thorough search of the PubMed/MEDLINE and Google Scholar databases has revealed 7 cases of clear cell carcinoma of the ovary developing in association with a teratoma. Out of the 7 cases, 4 were part of a more complex tumor, including other malignancies (e.g. angiosarcoma, endometrioid carcinoma). The mean size of the tumors was 16 cm and most patients died of disease or suffered multiple recurrences. Additionally, we report a case of a 54-year-old patient who presented with an ovarian tumor and which upon microscopic examination featured a cystic structure lined by squamous keratinizing epithelium and sebaceous glands. Inside the wall of the cyst, a small nodule made out of tubules and papillae lined by clear cells, which invaded the surrounding stroma was identified. Four months later, the patient developed a small nodule in the liver and she has subsequently received adjuvant chemotherapy. Conclusion. Clear cell carcinoma of the ovary developing in association with a teratoma is an extremely rare entity, that requires thorough sampling of the cyst and which is usually associated with a relatively poor prognosis.

Microvascular surgery for upper limb lymphedema treatment

Although the necessity of performing radical mastectomy has significantly decreased over the last decades there are still cases in which this procedure is required, predisposing the patient to the development of long-term complications such as upper limb lymphedema. Meanwhile, due to the increased implementation of indocyanine green usage, the rates of this complication have decreased, preservation of the lymphatic vessels of the arm being more and more possible. Even though, upper limb lymphedema can be still encountered, in such cases vascular surgical procedures such as lymphovenous anastomoses might be performed in order to treat this complication. This is a literature review regarding the usage and effectiveness of indocyanine green administration in the upper limb lymphedema treatment.

Obesity in gynecological surgery

Despite the effort made by authorities, obesity is rising worldwide. Together with the multiple issues that obesity is bringing with it, the surgical outcome can be influenced significantly. In case of morbid obesity, preoperative assessment of the cardiopulmonary and respiratory system is vital as the compromise of either might be fatal. Obese patients tend to develop hemodynamic instability, hypoxia intolerance, deep venous thrombosis, wound infection and decreased drug clearance. This review aims to underline obesity risks as well as their management.

Hysteroscopic sterilisation

A patient requesting sterilization envisages an easy to perform, safe cheap and reversible method. Despite best efforts of researchers and pharma companies, such a device has not been produced yet. Female sterilization is one of the most common procedures and encompasses tubal ligation, laparoscopic salpingectomy or hysteroscopic sterilization. This short review focuses on role of hysteroscopy on sterilization and informed consent as sterilization is a legacy for the rest of a woman life.

Is laparoscopic sclerotherapy justified in the management of endometriomas?

Endometriomas represent a common finding among women at fertile age and usually associated with pelvic pain, infertility, heavy menstrual periods and dyspareunia. For a long period of time surgical resection has been considered the golden standard in such cases. However, although resection aims to take off only the cyst, in certain cases a decrease of the ovarian reserve and secondarily, to a decrease of the fertility is observed. Due to this reason, attention was focused on creating other methods for cyst destroying without impeding the ovarian reserve. The aim of the current paper is to discuss about the effectiveness and safety of sclerotherapy as part of the therapeutic strategy for endometriomas.

Risk factors and significance of lymph node involvement in serous borderline ovarian tumors

Borderline ovarian tumors represent a particular category of ovarian neoplasms characterized by a more favourable outcome, lower risk of recurrence and association of long term survival rates. Although in up to one third of cases lymph node metastases are present, they seem that they do not affect significantly the survival. The aim of the current paper is to identify the most important risk factors for lymph node invasion in serous borderline ovarian tumors and to study their influence on survival.

Indocyanine green utility in prevention and treatment of upper limb lymphedema

Although screening tests have been widely implemented globally, there are still cases diagnosed with breast cancer in which radical mastectomy and axillary lymph node dissection remains the option of choice. In such cases significant alteration of the quality of life can occur especially in cases in which upper limb lymphedema develops. Therefore, attention was focused on determining the causes related to upper limb lymphedema as well as the therapeutic options in such cases. Special attention was given to the utility of indocyanine green for upper limb lymphatic preservation as well as for the utility of the method in treating this complication. This is a literature review regarding the possibilities of prevention and treatment of upper limb lymphedema by using indocyanine green.

Programmed cell death pathway in epithelial ovarian cancer: Brief review of a novel immunotherapeutic perspective

During the past several decades, ovarian carcinoma has remained the leading cause of death among gynecologic malignancies. The current therapeutic guidelines recommend, in most cases, a combination of surgery and chemotherapy based on platinum agents and taxanes. Despite the increasing usage of newer drug categories, such as bevacizumab and PARP inhibitors, and the expansion of patient groups for these drugs, ovarian cancer is characterized by multiple recurrences, particularly in the form of peritoneal implants. In this article, we perform a short incursion into the programmed cell death pathway in epithelial ovarian cancer and conduct a brief review of literature regarding this novel immunotherapeutic perspective.

Management of interstitial (cornual) pregnancy

Cornual pregnancy is an infrequent event. Goal of cornual pregnancy treatment is the expulsion of the pregnancy and haemostasis in case of haemorrhagic rupture. Treatment involves the removal of the pregnancy and hemostasis of the cornus if required by hemorrhagic rupture. New ultrasound techniques have brought an additional tool in the early diagnosis, which is vital in preserving fertility and enabling medical (methotrexate treatment).

Utility of indocyanine green in the administration of cytotoxic drugs in breast cancer patients

Indocyanine green has been widely introduced in breast cancer protocol for sentinel node detection, for upper limb lymphedema prevention and for breast reconstruction. However, more recent studies came to demonstrate that these particles can be also used in order to provide an efficient intraoperative detection of metastatic deposits as well as for a more targeted delivery of cytotoxic drugs. The current paper aims to investigate the mechanisms of action, the principles and the benefits of indocyanine green as a therapeutic tool, part of the medical oncologic treatment of breast cancer patients.

The role of novel poly (ADP-ribose) inhibitors in the treatment of locally advanced and metastatic Her-2/neu negative breast cancer with inherited germline BRCA1/2 mutations. A review of the literature

The use of the PARP inhibitors (PARPi) in the treatment of breast cancer (BC) with germine mutations has evolved over the years, and further research has been done in order to broaden the horizon of this treatment strategy. Therefore the aim of this paper is to review the efficiency of PARPi in the treatment of BRCA 1/2-mutated locally advanced and metastatic Her-2/net negative BC mentioning their side effects, mechanism of resistance and future directions. Inhibition of PARP transforms single-strand breaks into double-strand breaks (DBS), the accumulation of the latter causing cell death (cell apoptosis). The Olympia AD phase III trial demonstrated a statistically significant progression-free survival rate (PFS) when using the PARPi olaparib in metastatic BC with germline BRCA1/2 mutations without any benefit of the overall survival rate. PARPi therapy is associated with acceptable responsive rates and progression-free survival rates in locally advanced and metastatic BRCA1/2 associated BC through mechanisms that enhance and increase the sensitivity to chemotherapeutic or target agents as they induce a synthetic lethality and cell apoptosis. The side effects are not significant, the most adverse effects being related to the hematological and gastrointestinal systems. Olaparib is currently approved in the first-line treatment of BRCA1/2 mutated Her-2/neu negative metastatic BC at an oral dose of 300 mg twice daily, while Talazoparib represents a category one recommendation in locally advanced and metastatic Her-2/neu negative BC in women with central nervous system metastases.