Giuseppe Deo’s research while affiliated with University of Cagliari and other places

Low-grade stage I endometrioid endometrial carcinomas should have an excellent prognosis, but a small subset of these cancers can relapse. The search for putative immunohistochemical prognostic markers for relapse in low-risk/low-grade endometrioid endometrial cancers remains open. Among the candidate molecules that may implicate the roles of immunohistochemical risk markers, we focused our attention on human epididymis protein 4 (HE4) after a review of the literature. Few authors have devoted themselves to this topic, and none have found a correlation between the tissue expression of HE4 and the molecular classification of endometrial cancer. Five different variants of HE4 mRNA and multiple protein isoforms of HE4 were identified many years ago, but current HE4 assays only measure the total HE4 expression and do not distinguish the different proteins encoded by different mRNA variants. It is important to have an approach to distinguish specific variants in the future.

Introduction/Background The aim of this preliminary retrospective study was to assess the feasibility and accuracy of Indocyanine Green (ICG) sentinel lymph node (SLN) sampling using a laparoscopic camera during vulvar cancer staging. Methodology Retrospective study. Between 2016 and 2022, 9 women with diagnosis of vulvar cancer underwent radical vulvectomy and inguinofemoral lymphadenectomy; in 2 (22%) selected cases we performed ICG SLN mapping using the IMAGE1 laparoscopic camera combining with Tc99(m)-nanocolloid during open surgery. • Download figure • Open in new tab • Download powerpoint Abstract 2022-RA-1155-ESGO Figure 1 • Download figure • Open in new tab • Download powerpoint Abstract 2022-RA-1155-ESGO Figure 2 Results The median age of patients was 73 (range 84–60) years. Mean operative time 212.5 minutes. The overall detection rate of SLN mapping was 100%. No post-operative short or long-term complications related to the procedure were observed. Conclusion Real-time NIR technology supported by the IMAGE1 S by Storz is a reliable system and represents a consolidated method for SLN mapping in selected cases with vulvar cancer.In our study we confirmed the feasibility of Hand-Assisted Laparoscopy during an open procedure to detect groin SLN with ICG in vulvar cancer. This approach can be used in combination with Tc99(m)-nanocolloid, increasing the detection rate or it can be an appropriate option to detect SLN in those countries where Tc99(m)-nanocolloid is not available or cannot be practiced. The use of laparoscopic camera for ICG SLN mapping seems to be accessible and inexpensive. Further studies are needed to evaluate the accuracy and oncological outcomes.

Introduction/Background Sentinel lymph node (SLN) mapping with indocyanine green (ICG) has become the standard of care in apparent early-stage endometrial cancer. The aim of this study is to evaluate the possible risk factors (RFs) for lymph-nodal metastases, differentiating by the type of metastasis. Methodology This is an observational single-center retrospective study. We reviewed 96 patients with a diagnosis of apparent early-stage endometrial cancer submitted to hysterectomy with salpingo-oophorectomy and SLN mapping from December 2015 to March 2022. Possible RFs for nodal metastasis were considered including clinical (age, BMI), and biochemical (CA125, CA 19.9, HE-4) parameters, anatomopathological characteristics (Myometral invasion – MI, Lymphovascular space invasion (LVSI), grade, histotype) and immunohistochemical findings (L1CAM, Ki67, estrogen receptor – ER, progesterone receptor- PR). Odds ratios (ORs) were calculated, and then RFs were confronted with logistic regression. Results Overall detection rate was 94.8%, 83.3% bilateral, and 11.5% unilateral. We removed 181 suspected SLNs. The preponderance of SLNs was found at the external iliac and interiliac stations (69%). 7 patients had macrometastases, 5 micrometastases, and 7 ITCs. Higher ER percentage resulted in a protective factor (PF) for lymph nodal metastasis. MI more than 50%, LVSI, and p53 positivity resulted in RFs for lymph nodal metastases. Histotype, age, and L1CAM showed a slight, not significant, correlation as possible RFs. The multivariate multinomial analysis didn’t find any statistically significant differences between the RFs and the type of metastasis.View this table: • View inline • View popup • Download powerpoint Abstract 2022-RA-1526-ESGO Table 1 Impact of possible risk factors on model involvement Conclusion Our study shows a good SLN detection rate in line with the literature. The multivariate multinomial analysis shows that there are no differences in the RFs for the different types of metastases suggesting that these entities are a pathological continuum. Further studies are needed.

Introduction/Background In young women with a recurrence of borderline ovarian tumor (BOT) a second conservative treatment for the preservation of reproductive potential and endocrine function should be mandatory. In our study, we reported three cases of ovarian BOT recurrences assessed to oncofertility consultation and underwent fertility sparing surgery (FSS), highlighting the importance of the tailored clinical management in the context of a multidisciplinary meeting. Methodology From July 2020 to April 2022, we managed three cases of young women with controlateral ovarian BOT recurrence after unilateral adnexectomy. Median age at diagnosis was 26 years (I.Q.R 25–28). After multidisciplinary meeting each patient has been addressed to oncofertility consultation with the gynecologic oncologist and the reproductive physician. Two patients had strong desire to conceive furthermore they underwent a controlled ovarian hyperstimulation (COH) with concomitant letrozole and ovarian cryopreservation. In one case the ART (assisted-reproductive-technology) procedures has been performed with tumor onsite. Results Second surgery consisted in unilateral laparoscopic cystectomy in all cases. In those patients who have undergone COH, two and five mature oocytes were cryopreserved, respectively. After 11 months of surgery one patient became pregnant spontaneously and she gave birth at 39 weeks with an excellent obstetrical outcome. In one case the oocytes cryopreservation has been rejected by the patient, but the endocrine function has been preserved. Conclusion In young women, with BOT ovarian recurrence, a second conservative treatment should be always considered and an oncofertility consultation should be recommended. Clinical management must be tailored on a case-by-case basis by a gynecologic oncologist and reproductive physician meeting.

Introduction/Background This report aimed to illustrate the video-guided application of the Keystone perforator island flaps (KPIF) technique in a patient with diagnosis of vulvar cancer. Methodology Eight patients were selected for the study: seven of them underwent radical vulvectomy for vulvar squamous cell carcinoma (SCC), and one underwent vulvar wide excision for Paget disease. The Keystone perforator island flaps technique was adopted for all these vulvar reconstruction. The team approach comprised both a gynecologic oncologist and a plastic surgeon in all procedures. The defects were successfully covered by the Keystone flap technique in all patients. Results Bilateral Keystone flaps were taken from the medial and proximal region of the thigs, with incision lines coinciding with the natural skin folds. When flaps vitality was determined, each one was positioned along the perineal midline for labia majora and vaginal opening reconstruction. Final reconstructive step coincided with skin and vaginal mucosa suture. No post-operative short complications in the described case were observed. Conclusion The Keystone technique is an extremely simple and effective solution, easily applicable and reproducible. KPIF technique warrants an excellent vascular supply and does not require delicate perforator dissection. Additionally, it is associated with minimal morbidity in donor sites, a lower risk of flap necrosis and lower intraoperative and postoperative complications. Keystone flap method also yields good aesthetic and functional results by preserving shape and contour, avoiding differences in skin coloration and preserving sensitivity with an excellent cosmetic outcome in terms of patient satisfaction and postoperative scars and with an acceptable complication rate. Further studies with larger sample size are required to evaluate the efficacy of this technique.