Hooman Soleymani majd

• MD, DFFP, MRCOG
• Honorary Senior Clinical Lecturer in Gynaecological Oncology surgery Obstetrician and Gynaecologist / Sub-Specialist in gynaecological oncology at University of Oxford

Smoking remains a significant public health issue in Europe, with elective surgery offering a key opportunity for intervention. Knowledge gaps exist around its prevalence and the optimal timing for preoperative cessation to improve outcomes, despite current guidelines recommend smoking cessation up to six weeks prior to surgery. This study aims to...

Members of the EuroSurg Collaborative and the STARSurg Collaborative are co-authors of this study and are listed under the heading Collaborators. Abstract Background: There is low-certainty evidence on the impact of extended pharmacological prophylaxis on venous thromboembolism-associated morbidity and mortality. The aim of this study was to determ...

Background: ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) has brought about the publication of the FIGO 2023 staging system with a significant impact in practice for endometrial cancer (EC). Methods: In this comparative study, we investigated the need for adjuvant treatment according to FIGO 2023, for each FIGO 2009 stage. We...

Retroperitoneal lipomas are exceptionally rare tumors that mimic liposarcomas. We present a case of a woman in her 30s undergoing fertility investigations, with an incidental finding of a retroperitoneal tumor on MRI. PET and MRI scans suggested this may be a liposarcoma, with widespread effects on the surrounding iliac vessels. Collaboration betwe...

Background/Objectives: Uterine carcinosarcoma (UCS) refers to a rare high-grade aggressive epithelial non-endometrioid endometrial carcinoma, with tumour cells demonstrating epithelial–mesenchymal metaplastic transition and composed of both carcinomatous epithelial and sarcomatous (homologous or heterologous) components. Methods: The aim of this st...

Background Ovarian cancer (OC) is one of the most lethal malignancies in women, primarily due to the absence of reliable predictive biomarkers and effective therapies. The complex role of immunogenic cell death (ICD) in OC remains poorly understood, despite its critical implications for enhancing immune responses against tumors. We are committed to...

https://tcr.amegroups.org/article/view/95615/html#video1 Metastases to the lesser sac (also known as the omental bursa) and its contents are frequently seen in advanced ovarian cancer. This would require a thorough and meticulous intra-operative surgical exploration and mapping for patients requiring radical supracolic omentectomy requiring sacrif...

Cancer screening and diagnosis with the utilization of innovative Artificial Intelligence tools improved the treatment strategies and patients’ survival. With the rapid development of imaging technologies and the rise of artificial intelligence (AI), there is a significant opportunity to improve cancer diagnostics through the combination of image a...

Background: Although grade is a well-recognised prognostic factor for endometrioid endometrial cancer (EEC), in more studies grade 1 (G1) and grade 2 (G2) EEC are combined and compared together with grade 3 (G3) tumours. The aim of our study is to separately investigate the outcomes, prognostic factors and recurrence patterns of G2 EEC and whether...

Synopsis Comparing a novel transverse abdominal entry technique to midline laparotomy for managing severe placenta accreta spectrum, demonstrating excellent long‐term outcome and improved patient satisfaction.

Cervical cancer remains a significant global health concern, ranking as the third most prevalent malignancy and the second leading cause of cancer-related mortality among women in the United States. Early-stage cervical cancer is typically managed with radical hysterectomy, traditionally performed via open abdominal or vaginal approaches. Minimally...

Cervical decidual reaction in pregnancy is a common finding. In rare cases, these changes can mimic the appearance of invasive cervical cancers. We are presenting a case of a pregnant woman with a large cervical mass. Whilst magnetic resonance imaging (MRI) supported a diagnosis of cervical cancer, cervical tissue biopsies showed decidual reaction...

Introduction Our recent pilot study indicated that South Asian ethnicity, young-age, and fertility-sparing surgery were risk factors for poor prognosis in primary mucinous ovarian cancer. This national multicentre study further investigates the prognostic impact of these factors. Methods A retrospective study of women treated at 5 UK gynaecologica...

Background and objective: Krukenberg tumours (KTs) are metastatic signet ring cell (SRC) adenocarcinomas of the ovary, arising from the stomach in most cases (70%). Other common primary sites are the colon, appendix and breast. The use of the term "Krukenberg tumour" is inconsistent in the literature which makes data interpretation difficult. Prog...

Background Open surgical procedures for gynecological malignancies have a potential risk of post-operative complications and hence prolonged hospitalization, despite adherence to an Enhanced Recovery After Surgery (ERAS) protocol. Primary Objective To investigate the relationship between non-compliance to an ERAS protocol in the post-operative set...

Background Ovarian clear cell carcinoma (OCCC) is a rare and distinct subtype of epithelial ovarian cancer (EOC). It is unique in several biological aspects. This study analyzes the clinicopathological features and survival outcome of patients with OCCC, aiming to identify factors affecting recurrence, progression-free survival (PFS) and overall su...

Key Clinical Message Cardiophrenic metastasis is typically a late stage manifestation of ovarian high grade serous carcinoma. Here we present a case where this was the sole presentation of this disease. This case challenges our current understanding of the natural course of ovarian high grade serous carcinoma. Abstract Ovarian cancer is typically...

Uterine sarcomas are rare and aggressive gynecological malignancies. We evaluated the epidemiology, treatment outcomes and survival rates in uterine sarcoma patients managed in our institute. The medical records of women with histology proven uterine sarcoma, including leiomyosarcoma (LMS), adenosarcoma (ADS), and endometrial stromal sarcoma (ESS),...

Simple Summary The sexual well-being of women with hereditary breast and ovarian cancer (HBOC) syndrome is often overlooked by clinicians. The aim of the study is to analyze the correlation between HBOC syndrome itself and the potential risk of sexual dysfunction. Understanding this link could help improve clinical practices and the management and...

Key Clinical Message A surgical MDT approach to high‐complexity surgeries can allow maximal resection in order to achieve disease control and excellent functional outcomes, as demonstrated here for a case of hidradenitis suppurativa in a patient with Crohn's disease. Abstract Hidradenitis suppurativa is an autoimmune disease characterized by absce...

Objectives Iatrogenic ureteral injury is a severe surgical complication, with a highest incidence of 1.5% in gynecological surgeries. The purpose of this report is to document our initial experience with using methylene blue (MB) to label the ureter in gynecological laparoscopic surgeries and to explore its effectiveness and safety. This is also a...

Aims We aimed to audit the effect of the 2023 International Federation of Obstetrics and Gynaecology (FIGO) staging guidelines on the clinicopathological characteristics of Uterine Serous Papillary Carcinoma (UPSC) Background UPSC is a subtype of endometrial cancer that accounts for a disproportionately high rate of endometrial-cancer-related-death...

Aims • To determine the link between endometriosis and Mullerian adenosarcoma • To contribute to literature concerning the optimal management of adenosarcoma of the uterine cervix, including fertility-preserving treatments Background Mullerian adenosarcomas are rare tumours characterised by benign epithelial and malignant stromal elements, with 10%...

Key Clinical Message Endometrioid ovarian adenocarcinoma is a common subtype of epithelial ovarian cancer that can arise on a background of endometriosis. Maximal cytoreductive effort with an aim to remove all macroscopic disease (achieve R0) is the single independent prognostic factor for survival. Complex multidisciplinary surgeries may be requir...

Background Pulmonary complications are the most common cause of death after surgery. This study aimed to derive and externally validate a novel prognostic model that can be used before elective surgery to estimate the risk of postoperative pulmonary complications and to support resource allocation and prioritisation during pandemic recovery. Method...

Key Clinical Message Endometriosis may contribute to Mullerian adenosarcoma development but makes diagnosis challenging given similar symptoms. Survival benefit has not been definitively shown for chemotherapy, hormonal therapy, or radiotherapy, consolidating surgery as the mainstay treatment. Local excision may be a treatment option for patients w...

Background Multimorbidity poses a global challenge to healthcare delivery. This study aimed to describe the prevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort of patients undergoing major abdominal surgery. Methods This was a pre-planned analysis of a prospective, multicentre, international study investi...

Background: Lymph node metastasis in vulvar cancer is a critical prognostic factor associated with higher recurrence and decreased survival. A survival benefit is reported with adjuvant radiotherapy but with potential significant morbidity. We aim to clarify whether there is high-quality evidence to support the use of adjuvant radiotherapy in this...

Objectives: Enhanced recovery after surgery (ERAS) protocols provide well-known benefits in the immediate recovery with a shorter length of stay (LOS) also in gynecological surgery. However, the impact of ERAS has not been clearly showed yet regarding long-term consequences and health-related quality of life (HRQL). The aim of this study is to inv...

Introduction/Background Uterine sarcomas are rare and aggressive gynaecological malignancies. The aim of this study is to evaluate the epidemiology, treatment outcomes and survival rates of uterine sarcoma patients managed at our institute. Methodology The medical records of patients with histology-proven uterine sarcoma, including leiomyosarcoma...

Introduction/Background Mullerian adenosarcomas are rare tumours characterised by benign epithelial and malignant stromal elements, with 10% of these tumours being of cervical origin.They present in pre-menopausal women with lower abdominal pain or abnormal vaginal bleeding, including menorrhagia and dysmenorrhoea. Methodology We present the case...

Introduction/Background Grade 1 (G1) endometrial cancer (EC) are well differentiated cells which at diagnosis, most are confined to the uterine corpus and ovary (stage 1), hence mainly treated with surgery alone and often in benign gynaecology service.The aim of this study is to evaluate the independent risk factors for recurrence and mortality and...

Introduction/Background Vulval cancer is a rare gynaecological malignancy. HPV infection and lichen sclerosis are responsible for premalignant lesions. Recurrence occurs in 12–37% of cases. Around 40–80% of recurrences occur within the first two years.We aimed to examine the recurrence patterns and survival outcomes of vulval SCC in our cancer cent...

Introduction/Background Although grade is a well-recognised prognostic factor for endometrioid endometrial cancer, in more studies grade I (G1EEC) and grade II (G2EEC) endometrioid endometrial carcinomas are combined and compared together with grade III (G3EEC) tumours. The aim of our study is to investigate separately the outcomes of grade II endo...

Introduction/Background Primary surgery by total hysterectomy and bilateral oophorectomy is the widely accepted treatment for low grade (Grade 1; G1) low stage endometrial cancer (EC) worldwide.Although surgical lymph node staging is unanimously agreed for higher risk ECs for targeted therapy, there is no universal protocol regarding lymph node dis...

Introduction/Background This report details the cases of two women – one in her 70s and one in her 80s - who developed unexplained cerebellar symptoms, which eventually led to the investigation and discovery of underlying gynaecologic malignancy in one, while the investigations for the second are still ongoing. Paraneoplastic Neurological Syndrome...

Abstract Cardiovascular complications after major surgery are associated with increases in morbidity and mortality. There is confusion over definitions of cardiac injury or complications, and variability in the assessment and management of patients. This international prospective cohort study aimed to define the incidence and timing of these compl...

Large loop excision of the transformation zone is an extremely common procedure routinely carried out in a gynaecology or colposcopy outpatient setting under local anaesthetic. Here, we present a rare case resulting in emergency hysterectomy. A healthy para 3, who had been diagnosed with microscopic cancer of the cervix, attended colposcopy for rep...

Chronic, severe Crohn's disease in a young female patient can result in surgical complexity. The rarity of the presentation of intractable pelvic abscesses within this etiology with additional considerations given to fertility concerns and hence requirement for input from a multi‐disciplinary team makes this a vital case in building a consensus for...

Mixed endometrial carcinoma (MEEC) refers to rare endometrial tumours that are composed of two or more distinct histotypes, at least one of which is serous or clear cell. The aim of this study was to evaluate the epidemiology, treatment outcomes and survival rates of patients with mixed endometrial carcinoma. The medical records of 34 patients diag...

Background: Mucinous ovarian carcinomas (MOCs) are rare ovarian tumours accounting for 3% ofall epithelial ovarian carcinomas (EOCs). They are either expansile or infiltrative, based on the tumour’shistological pattern of invasion. MOCs have a distinct molecular profile, natural history, chemo-sensitivity,and prognosis compared to other EOCs. The a...

Introduction/Background High grade endometrioid endometrial cancer (HGEEC) is a heterogeneous group of tumors with unclear prognostic features. The aim of the present study is to evaluate the independent risk factors for recurrence and mortality and to describe the recurrence patterns of HGEEC. Methodology Ninety-six consecutive cases of HGEEC tre...

Introduction/Background Mixed endometrial carcinoma refers to rare endometrial tumours that are comprised of two or more distinct histotypes, at least one of which is serous or clear cell. Limited data is available on the recurrence rates for mixed epithelial endometrial carcinoma, as it comrises a relatively understudied subtype of endometrial can...

BACKGROUND: The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during th...

Key Clinical Message Radical gynecology oncology surgeries are feasible in patients refusing blood transfusion, when performed with careful preoperative (with hemoglobin optimization and patients' counseling), intraoperative (with hemostasis and stepwise devascularization, hemodilution, and autologous cell salvage) and postoperative (considering ir...

Background: Mesonephric adenocarcinoma (MA) of the vagina is a rare tumor that arises from mesonephric remnants (Wolffian) in the female genital tract. It is a neoplasm with no significant evidence about its diagnosis, treatment, follow-up and prognosis. Methods: Systematic research of the literature was conducted in Scopus, PubMed/MEDLINE, Scie...

Although minimal invasive approach has been established as the standard surgical treatment in early stage endometrial cancer, the oncological safety of laparoscopy when cervix is involved is not based on strong evidence. Our retrospective analysis aims to investigate whether there is any difference on overall and cancer specific survival between pa...

The prognostic characteristics and recurrence patterns of High Grade Endometrioid Endometrial Cancer: A retrospective analysis of 96 consecutive cases sharing the experience of a large tertiary Center over 10 years.

Objectives: We present an educational technique for the safe completion of complete cytoreduction of diaphragmatic disease for the management of advanced ovarian malignancy. Methods: We demonstrated these steps with attention to anatomical landmarks and surgical approaches, considering intraoperative and postoperative morbidity and mortality. R...

BGCS 28-30 June 2023 annual meeting Poster

Aims We present a complex case of uterine carcinosarcoma and suspicious para-aortic lymph nodes at the level of the renal vessels, complicated by a previous history of multiple laparotomies and radiotherapy for anal carcinoma. Background Successful surgical excision required considerable multidisciplinary teamwork between gynae-oncology, colorectal...

Aims Holistic care is found at the heart of every oncology patient's journey, but perhaps nowhere more pivotal than in the case of concurrent pregnancy. We present this rare case in recognition of the onerous effect of the covid-19 pandemic with a focus on the emotional burden of such difficult circumstances. Background A 33-year-old primiparous fe...

Appendiceal mucinous neoplasms are often misdiagnosed due to presenting similarly to appendicitis or other more common retroperitoneal malignancies. This case is an uncommon presentation, but notably, there are ambiguities brought about by the initial investigations, indicative instead of an ovarian malignancy, which complicated the diagnostic thin...

Aims and Background Recurrent mucinous cystadenoma is rare, with few cases of retroperitoneal and only one of primary peritoneal mucinous cystadenocarcinoma reported in the literature. We discuss distinct pathology associations and acknowledge challenges faced regarding case management. Methods Our 32-year-old female patient previously underwent le...

Aims This report aims to highlight optimum surgical management of the gynaecological sequelae of severe Crohns disease. Background Chronic, severe Crohn’s disease in a young patient creates surgical complexity with fertility considerations. The rarity of the presentation of intractable pelvic abscesses within this aetiology and their requirement...

Aims This report details the cases of two women – one in her 70s and one in her 80s - who developed unexplained cerebellar symptoms, which eventually led to the investigation and discovery of underlying gynecologic malignancy in one, while the investigations for the second are still ongoing. Background Paraneoplastic Neurological Syndromes (PNS)...

LEER in dessiminated leiomyomatosis mimicking low-grade sarcoma in a solitary kidney patient

Leiomyomas are common benign uterine smooth muscle tumours. Rarer subsets may demonstrate aggressive extrauterine growth which mimic metastatic disease. We discuss the case of a female patient in her 40s, with a long-standing atrophic right kidney, presenting with a 17 cm uterine mass demonstrating bilateral para-aortic and pelvic sidewall spread....

Adamantinoma is a rare primary low-grade malignant tumour of the appendicular skeleton most commonly found in the tibia. It has an indolent course, with local recurrences and lung metastases occurring over a protracted duration. There have been several suggestions pertaining to a vascular origin in the literature, however, histogenesis remains uncl...

A 69-year-old woman was referred to the gynaecological oncology team due to vague abdominal pain, lethargy, and appetite loss over the previous month. Tumour markers of carcinoembryonic antigen (CEA) 3.3 micrograms (normal), cancer antigen (CA) 19-9 3U (normal), and CA-125 91 IU/mL (raised) were most suggestive of ovarian malignancy. A computerised...

Evolutions in the management of advanced ovarian cancer Advanced ovarian cancer has the lowest survival rates and cure rates remain dismal; as a result it remains the most challenging gynaecological cancer to manage. All multidisciplinary specialities involved in the management of advanced ovarian cancer are fighting tirelessly to expedite evolutio...

Objective: To describe a suggested version of the Clavien-Dindo morbidity classification specific to obstetrics and employ it to build a cumulative morbidity score which fully reflects the ‘patient experience’. To demonstrate the utility of this novel system in a cohort of women with Placenta Accreta Spectrum (PAS). Design: Delphi consensus and ret...

High grade endometrioid endometrial cancer (HGEEC) is a heterogeneous group of tumors with unclear prognostic features. The aim of the present study is to evaluate the independent risk factors for recurrence and mortality and to describe the recurrence patterns of HGEEC. Ninety-six consecutive cases of HGEEC treated with primary surgery in a single...

Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published i...

A retrospective study including 49 women with ovarian clear cell carcinoma between January 2009 and December 2021 at Oxford cancer centre was done. The mean age was 63 years, with 78% post-menopausal. All women underwent cytoreductive surgery with no residual disease (R0) in 39 women. The follow-up time ranged between 12-144 months, with mean of 10...

Introduction/Background This report details the cases of two women – one in her 70s and one in her 80s - who developed unexplained cerebellar symptoms, which eventually led to the investigation and discovery of underlying gynaecologic malignancy in one, while the investigations for the second are still ongoing.Paraneoplastic Neurological Syndromes...

The COVID-19 pandemic exposed the fragility of electivesurgical and anaesthesia services, resulting in millions ofoperations being cancelled across the world1. As healthsystems plan post-COVID recovery of elective surgicalservices, they should identify potential future external risksto surgical services2. Extreme weather events resulting fromclimat...

Objective: The incidence of placenta accreta spectrum (PAS) is rising rapidly due to the global surge in Caesarean delivery. It is associated with significant maternal morbidity and mortality. It is usually managed with Caesarean hysterectomy. However, uterine preserving surgeries can have advantages over Caesarean hysterectomy and intentional pla...

Background: A recent randomized trial showed that laparoscopy had poorer outcomes compared with open surgery for early-stage cervical cancer. Whether this is of concern in endometrial cancer, when the cervix is involved has received little attention. This study aimed to investigate whether there is any difference on overall and cancer specific sur...

We describe the case of a Jehovah’s witness patient undergoing pelvic exenteration for recurrent endometrial carcinoma, focusing on the preoperative, intraoperative and postoperative measures that allowed uncomplicated surgeries. Our case shows that pelvic exenteration is feasible in patients refusing blood products, if performed with a multidiscip...

Leiomyomas are uncommon vulvar neoplasms often misdiagnosed as other Bartholin gland pathology. This case report describes a case of accelerating growth of a vulvar mass, initially diagnosed as Bartholin cyst. Surgical excision led to a histopathologic diagnosis of vulvar leiomyoma. The postoperative recovery was complicated by secondary hematoma a...

Objectives The advantages of the enhanced recovery after surgery (ERAS) protocols application in all surgical branches have been largely demonstrated, even though there is a lack of a strong evidence from randomized trial and the evidence regarding the multimodality treatments is of low grade. Moreover, the problem of the barriers to the implementa...

Background: Bartholin's gland carcinoma (BGC) accounts for approximately 5% of all vulval malignancies-making it an extremely rare malignancy of the female genital tract. It commonly manifests as a painless unilateral mass, near the introitus. BGC more commonly occurs in post-menopausal women. Unfortunately, over half of cases are associated with...

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index...

Introduction: Cervical cancer is currently the fourth most common cancer in women and in the poorest countries this neoplasia still represents a widespread and potentially lethal disease. We present a rare case of cervical cancer in pregnancy, analyzing the historical changes behind the procedure of radical hysterectomy for cervical cancer and dis...

A patient in her 60s was referred to be investigated for an incidental large uterus with a history of renal cell carcinoma and melanoma. Uterine biopsy revealed features of perivascular epithelioid cell tumours (PEComas) and she underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Final histology confirmed PEComa with maligna...

Uterine carcinosarcomas are aggressive gynaecological cancers comprising less than 5% of uterine malignancies. We present the case of a woman in her 70s with a complicated history of advanced anal carcinoma treated with pelvic radiotherapy and multiple laparotomies, who was referred to gynae-oncology following MRI surveillance imaging showing evide...

The logistic strain on the health care system during the COVID-19 pandemic disproportionally affected women with gynecologic cancers and surgical care delivery. Surgeries were being delayed or replaced by systemic or palliative care options with less favorable outcomes. The true impact of pandemic-related modifications to clinical management of sur...

Gorham-Stout disease (GSD) is thought to be due to uncontrolled proliferation of vascular and lymphatic structures within bone tissue causing destruction and osteolysis of bone. We present a patient in her mid-40s who reported chronic shoulder pain, a pleural effusion and irregular periods. Investigations showed osteolysis of her ribs, pleural effu...