Inguinal lymph node presenting as the delayed site of metastasis in early stage endometrial carcinoma: Case report

A Radiological Review of the Unusual Contents of Inguinal Region

Background  The inguinal region is an area of complex anatomy that could contain diverse uncommon contents in routine clinical practice. Although inguinal hernia repair is one of the commonest surgeries done routinely, thorough preoperative imaging has a significant impact on the outcome of the surgery, by revealing the presence of unusual contents in the inguinal region. Aim  The aim of this article is to review the differential diagnosis of the uncommon inguinal pathologies, which can simulate an inguinal hernia, to determine, and to simplify the treatment approach. Conclusions  A profound understanding of the imaging characteristics of uncommon inguinal pathologies is crucial for both the radiologists (to prevent misdiagnosis) and the treating physicians (to avoid surgical complications) and ensure optimal management.

The role of oncovascular surgery in gynecologic oncology surgery

Oncovascular surgery is a new term used to define tumor resection with simultaneous reconstruction of the great vessels when the tumor infiltrates or firmly adheres to such vessels. The benefit of oncovascular surgery has been widely described in patients with hepato-biliary-pancreatic cancers, retroperitoneal soft tissue sarcoma, and in other areas of gynecologic oncology, such as the lateral compartment of the pelvis, retroperitoneum, and hepato-biliary-pancreatic region, with an increase in complete resections and without increasing the morbidity and mortality rates. In the latter decades of the past century, several advances and accumulating scientific evidence led gynecologic oncologists to perform more thorough cytoreductive surgeries that included multivisceral resections. But to our knowledge, published studies on the frequency and relevance of vascular surgery in gynecological oncology are scarce. Gynecologic oncologists still do not receive formal training in vascular surgery and additionally, with the current reduction in experience with pelvic and para-aortic lymphadenectomy, as well as other types of radical abdominal and pelvic surgeries, trainees will encounter fewer vascular injuries and the opportunity to deal with a variety of management types required. Well-organized collaboration between each subspecialty with a multidisciplinary approach and adequate pre-operative planning are pivotal. The aim of this review is to pave the way towards the understanding that patients with suspicion of great vessels' infiltration or encasement by tumor require personalized and specialized treatment with the need to form an oncovascular surgery team, and that it is necessary for gynecologic oncology surgeons to take a step forward in surgical training.

Endometrioid endometrial cancer "recurring" as high-grade serous adenocarcinoma in the inguinal lymph nodes in a patient with germline MLH1 mutated Lynch syndrome: consequence or coincidence?

Background

Inguinal metastasis of endometrial cancer (EC) is rare. The aims of the study were to identify whether the inguinal metastatic tumor was originated from EC and to present the management of the disease.

Methods

The clinical data of a case of endometrioid EC "recurring" as serous adenocarcinoma in the inguinal lymph nodes were collected and analyzed. Paired samples of primary and metastatic tumors were used for exome sequencing to determine whether the tumors are same origination and to identify potential gene mutations associated with the relapse.

Results

The patient presented with right inguinal lymphadenopathy and histopathology revealed metastatic serous adenocarcinoma. A germline MLH1 mutation was identified. A combination of bioinformatical methods and cancer-related gene exome sequencing assay identified that only 17 (0.1%) somatic gene mutations were shared by the primary EC and the metastatic inguinal tumor, suggesting that the metastasis did not originate from the primary EC. Postoperative radiation therapy followed by a combination of chemotherapy were performed. Thirty-four months after that, the patient was doing well without any evidence of recurrence.

Conclusions

This is the first case of metastatic inguinal serous adenocarcinoma in a woman with Lynch syndrome shortly after surgical treatment of stage I endometrioid EC.

Dacarbazine nanoparticle topical delivery system for the treatment of melanoma

Dacarbazine (DZ) is poorly soluble in water with the short half-life in blood circulation, low rate of response with the toxic effect which ultimately limits its utilization of the treatment of skin cancer. In view of this background current study was designed for development of dacarbazine laden nanoparticle (DZNP) and dacarbazine laden nanocream (DZNC) topical delivery system for the treatment of melanoma. Firstly DZNP was prepared. By using DZNP its cream formulation prepared for topic drug delivery for melanoma. Dacarbazine nanoparticle and its cream were evaluated for morphology, drug load capacity, efficiency of nanoencapsulation and size of particle and zeta potential, Transmission Electron Microscopy (TEM), determination of pH, spreadability and viscosity, in vitro drug release capacity and its cytotoxic potential. The particle size of DZNP and DZNC was 16.3 ± 8.1 nm and 16.9 ± 7.8 nm respectively. pH value and spreadability of nanoparticle cream were found to be 6.7 ± 0.14 g cm/sec and 55.23 ± 3.13 g cm/sec respectively. Nanoencapsulation efficiency and Drug loading capacity were 67.4 ± 3.5% and 6.73 mg/10 mg respectively. IC50 of dacarbazine nanoparticle was 0.19 mg/ml while it was 0.63 mg/ml for nanoparticle cream. It can be concluded that DZNP and its cream can be effectively used as a topical formulation for the treatment of melanoma.