Robotic surgery - prevention of the risk of cytokine storm in women with endometrial cancer

Background Endometrial carcinoma is frequently diagnosed gynecologic neoplasm all over the world. Most often, women aged between 50 and 70 are affected by it. One third of the diagnosed patients pertain to a younger age group. The data of Bulgarian National Cancer Registry show that uterine body cancer accounts for 8,3% of all oncologic diseases of women. Methods 97 women with endometrial carcinoma, Ist stage, with clarified diagnosis for one year (2020) and already operated in UMHAT “Dr.G.Stranski”- Pleven, have been tested. 62 of these patients had undergone robotic surgery and 35 - conventional surgery. The immunologic parameters were tested before the surgical intervention, at the 3rd hour and on the 3rd day via Human ELISA-Diaclone. Statistic processing is with STATGRAF. Results The comparative survey between the robotic surgery patients and open surgery patients demonstrated that in the early post-operation period the open surgery patients had considerably increased serum cytokine level compared to the robotic surgery patients. The minimal invasive surgery demonstrates a reduced acute-phase response and a better preservation of cellular immune mechanisms compared to the open surgery. Conclusions The acceptance and implementation of mini-invasive surgical system Da Vinci in Bulgaria for treatment of endometrial carcinoma (Ist stage) reduces the cytokine explosion, decreases the post-surgical risk as well as the reanimation care days and hospital stay. Psychological stress and hospitalization time are reduced, quality of life is improved. Key messages Surveying the robotic surgery role in the treatment of women with endometrial carcinoma, Its stage via cytokine profile determination. Through Da Vinci, the hemorrhage and post-surgical complications are minimal, the psychological stress and hospital stay are reduced, the treatment cost is diminished and life quality is improved.

Enlarged uterine fibroid forming uterine diverticulum during pregnancy: a case report

Background Although uterine fibroids are a common gynecologic neoplasm, uterine diverticulum accompanied by a uterine fibroid is unique. In addition, pregnancy complicated with uterine diverticulum is extremely rare. We experienced a case of a uterine fibroid that was associated with a uterine diverticulum that enlarged during pregnancy and puerperium. Case presentation A 25-year-old nulligravida woman had an abnormal uterine cavity surrounded by myomatous mass. After natural conception, the mass and pouch had enlarged during pregnancy. Six months after elective cesarean delivery, she underwent laparotomy because of abdominal pain caused by the myomatous mass and the fluid inside. The tumor was connected to the midline of the posterior wall of the normal uterus. The resected tumor was pathologically diagnosed as leiomyoma and diverticulum. Conclusions Pregnancy can stimulate uterine fibroids to form uterine diverticula. Resection of the diverticulum and fibroid is a useful option for symptomatic patients with desired future fertility.

Female Adnexal Tumor of Probable Wolffian Origin: A Review

Context.— Female adnexal tumor of probable Wolffian origin (FATWO) is an extremely rare gynecologic neoplasm of low malignant potential. Fewer than 90 cases of this entity have been described in the English-language literature. It is presumed to be derived from mesonephric (Wolffian) duct remnants in the upper female genital tract. We provide a literature review to increase awareness of this extremely uncommon entity. Objectives.— To review the clinical and pathologic findings of FATWO and to discuss common entities in the differential diagnosis. Data Sources.— The study involved PubMed (National Center for Biotechnology Information, Bethesda, Maryland) searches, including multiple review articles, case reports, retrospective studies, selected book chapters, and University of Mississippi Medical Center cases. Conclusions.— FATWO can affect patients from a wide age range and present with a nonspecific clinical presentation. It typically presents as solid tumors with occasional nodular, lobulated, or cystic appearances. FATWO can show a variety of histologic patterns which may result in diagnostic difficulties for pathologists. There is no single specific immunohistochemical stain for FATWO, and the pathogenesis and molecular alterations are not yet well understood. Although it is generally considered a benign entity, recurrent and metastatic cases have been reported. There are no current recommendations regarding the optimal clinical management of FATWO.

Improving communication within the interdisciplinary team monitoring young women with onco-gynecological pathology in Romania

Background. The quality of medical care, as well as the application of effective treatments in the management of patients with gynecologic neoplasm, is of great importance. Finding new and efficient ways of communication between the doctors involved in the multidisciplinary team for the management of the disease, from the diagnosis to the reintegration into society, would help improve the quality of comprehensive patient care.Objective. The objective of the study was to assess the collaboration of family physicians with specialists treating patients suffering from gynecologic cancer, in order to improve the relationship between them via electronic communication.Study design. We conducted a descriptive, transversal study on 353 family physicians and 37 specialist doctors from Romania, between January and June 2015. For statistical data analysis, R for Data Analysis and Graphics version 3.2.1 was used.Results. Most of the family physicians and specialist doctors believed that they provided the best care that they could, but consider that a multidisciplinary approach using online communication methods, in which doctors collaborate among each other, is needed. Conclusions. Finding a simple, efficient and modern means of communication is essential in order to increase the efficiency of medical care overall.

High grade unclassified sarcoma of the broad ligament: A case report and literature review

20536 Background: The incidence of primary sarcoma of the broad ligament is very rare. From the first reported finding in 1968, there are only 17 documented cases worldwide of this very progressive and highly malignant gynecologic neoplasm. We present the 18th case of this aggressive tumor to add to the scarce knowledge about this disease and to contribute in characterizing its behavior and its reasonable management. Methods: Case report and case review/series Results: This is the 18th case of broad ligament sarcoma found on routine physical examination in a woman who had previous hysterectomy for benign leiomyoma. Treatment consisted of resection of the broad ligament mass, bilateral salpingo-oophorectomy, omental and peritoneal biopsies with pelvic cytology. She is disease-free on strict clinical surveillance. An updated extensive review of previous reports was done as well. Conclusions: The scarcity of the cases of leiosarcoma of the broad ligament prevents the understanding of its biologic nature. Thus, there were different approaches on its staging, surgical management and adjuvant therapy, and tumor surveillance producing unpredictable prognosis. It appears TAH-BSO with rigid disease follow-up and subsequent chemotherapy or radiotherapy prolongs survival. No significant financial relationships to disclose.