Gynecologic Oncology - Science topic

Confirmation of Diagnosis: Confirm endometrial polyp through imaging or diagnostic procedures like hysteroscopy or SIS.

Evaluation of Infertility: Assess other factors contributing to infertility in both partners.

Assessment of Hormonal Status: Check hormone levels to understand hormonal imbalances.

Medical Management: Hormonal therapy to regulate cycles and shrink the polyp.

Surgical Removal: Polypectomy via hysteroscopy for large or symptomatic polyps.

Fertility Treatments: Consider IUI or IVF, with or without polyp removal.

Follow-Up: Regular appointments to monitor response, assess recurrence, and evaluate treatment effectiveness.

Address Other Contributing Factors: Identify and address any additional factors affecting infertility.

Lifestyle Modifications: Encourage healthy habits like weight management, stress reduction, and smoking cessation.

Thank you very much for your reply. We look forward to receiving your paper!

Please have a look at this useful PDF attachment.

Thanks

Very helpful

I wonder if this case can tolerate the surgery.?

But we don’t heal the proper mechanism of the microscopic disease , i.e , cell spreading....

Thank you! Sorry for the late answer: I didn't receive any email notifying me of your answer. Will check the article right away!

Think same as Mohammed. Usually the cell morphology is accepted.

Laparoscopic ovarian drilling can be of help. Ofcource she may be advice on weight reduction if she is overweight

Looking at The Human Protein Atlas (proteintlas.org) p53 is mainly located in the nucleoplasm. Some of the cancer TMA´s for p53 in the human protein atlas show some accentuation of p53 staining in the nucleolus. 

I think that we are in front of a case of severe vaginal discharge may be due to chronic infection associated with immune disturbance , vaginal swap and culture may be benificial 

Thank you Dr. Aline C Planello

I agree with explanation given by Antonio Simone Laganà 

LAR

I would not call her M0 until you show that the beast cancer is not in itself a metastasis from another area. That is why IHC staining might be of help in locating a primary. It is likely breast, but there is no proof of that at the moment. 

quite interesting for me Marcel that you start asking such a question to the community with your very well established expertise! in pts of such age we know that the length or shortness of an operation heavily influences outcome, therefore I would prefer the open approach; no requirement to stop aspirin even in major surgery if indicated as in your pat; all the best to you 

I would recommend to follow ENETS Consensus Guidelines for Neuroendocrine Neoplasms of the Appendix (Excluding Goblet Cell Carcinomas): Pape UF, Neuroendocrinology 2016;103:144–152

Dear Dr Reza

i recommend to read this case report:

Aggressive Angiomyxoma of Vulva Which Grew with Pregnancy and Attained a Huge Size Rarely Seen in Literature

Vandana Sinha,corresponding author Kalpana S. Dave, Ronak P. Bhansali, and Ruchi S. Arora

Author information ► Article notes ► Copyright and License information ►

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Introduction

Aggressive Angiomyxoma (AA) of the pelvis and perineum was identified as a distinct clinicopathologic entity in 1983 [1] with less than 250 cases reported since then. The tumor usually arises in women of the reproductive age group with peak incidence in the fourth decade. Few cases of its occurrence outside the pelvis have been reported.

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Case Report

A 43-year-old female came to our OPD with complains of a growth over her private parts for the past 10 years and difficulty in walking for the past few days. She had delivered by Cesarean Section 9 months ago. The tumor increased gradually for 9 years, but grew suddenly during and after her pregnancy.

On examination, there was a huge mass arising from the left labia majora of about 55 × 45 × 45 cm with a broad pedicle (Fig. 1). The skin over the tumor was smooth, intact, and without any obvious nodularity. The right labia majora had multiple warts of 2–12 mm in size, also involving the peri-anal region.

Fig. 1

Fig. 1

Angiomyxoma of vulva arising from left labia majora with multiple warts on right labia majora

Pelvic examination was normal. There were no palpable lymph nodes. Biopsies from the large mass diagnosed angiomyxoma and biopsies from the warts diagnosed them as fibroepithelial polyps.

Her routine investigations, Pap Smear were normal. CT scan showed the presence of 53 × 43 × 46 cm sized heterogeneously enhancing soft tissue density lesion involving the left labia and perineum.

A wide excision of the tumor with adequate tumor-free margins and primary closure was done. There was no significant blood loss during the surgery. Histopathologic examination of the excised mass confirmed angiomyxoma, which was further confirmed by immunohistochemistry. The tumor was an infiltrating, diffuse, very low cellular spindle cell tumor with extensive myxoid areas and thick and thin blood vessels with foci of lymphocytes around the blood vessels. The base of the resection was free of tumor. She is symptom free for the past 8 months.

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Discussion

Aggressive Angiomyxomas are benign tumors. The term “aggressive” refers to the tumor’s locally infiltrative and recurrent nature, but with rare distant metastases [2].

In our case, AA showed the typical insidious growth pattern. Patients can present with an asymptomatic perineal nodule or a pelvic mass diagnosed on imaging studies. Our case also reflects the possible hormone dependence of this tumor as its growth was pregnancy related. Estrogen receptor positivity was also seen in the immunohistochemistry.

Pre-operative diagnosis helps in planning the extent of excision and patient counseling. However, the rarity of these neoplasms and a lack of typical features make it a difficult pre-operative diagnosis. They are misdiagnosed as labial, Bartholin’s, or Gartner’s Cyst and are diagnosed histologically after surgical excision.

Magnetic Resonance Imaging accurately detects the trans-levator spread and relation of the mass with the anal sphincter, urethra, bladder, and pelvic side-wall.

Tumor recurrences are high and can be seen even within 6 months from initial resection. There is no proven therapy for recurrences. Radiotherapy, selective angiographic embolism, hormone antagonists like tamoxifen, or GnRH analogs are also treatment options, but their role is still unclear.

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Conclusion

Angiomyxomas are rare tumors. Complete surgical excision is necessary to prevent recurrence. Patient counseling, individualization of each case, and long-term follow-up are essential.

Best wishes

Dear Dr.Batista. its regarding the removal of lymphnodes after NACT, prophyactically lymphadenectomy  is required if the tumour mass is more than of 2cm size in the pelvic region.

The screening process has been methodical with extensive screening for STI's , Diabetes and  immune compromise undertaken. Repeat antifungals x 6 administered. Barriers are in use: Penis-vaginal transmission ruled out.

Is there another source for the vaginitis? gut and oral sources come to mind. Any information on whether cunnilingus and /or fellatio is practiced. Source/pool Identification

Suggest a medication break, diet change -try yogurt alternate day as a meal item or snack , avoid antibiotic use. How about some pro-biotics?  

I think a partial pericardiectomy and biopsy will both help symptomatically and will probably give the diagnosis.  Malignancy should be high in the differential especially sonce the last effusion was bloody. You can also do a mammography and a thorough skin examination. Please let us know of the progress. 

Hi there!  Please check out this bioprotocol for details on how to dissociate endometrial biopsies into single cell suspensions, preserving viability for endometrial stromal cells, epithelial cells, leukocytes, and stem cells. 

Also check out this paper for cryopreservation of endometrial epithelial cells for epithelial cell culture models.

Good luck!

Joe

If we use FIGO staging, it clearly states that any distant metastasis means stage IVB. SO, ovarian metastasis is IVB. 

If we use TNM, then of course M1

Dear Dr Ramawad

we had similar patients and we inject TC radio tracer  and blue dye (isosulfan blue) subdermaly at the ends of scar .

Probably this recent paper is very appropriate in your research... have a look:

J Oncol Pract. 2014 Dec 30. pii: JOP.2014.000786. [Epub ahead of print]

If You Did Not Document It, It Did Not Happen: Rates of Documentation of Discussion of Infertility Risk in Adolescent and Young Adult Oncology Patients' Medical Records.

Quinn GP1, Block RG2, Clayman ML2, Kelvin J2, Arvey SR2, Lee JH2, Reinecke J2, Sehovic I2, Jacobsen PB2, Reed D2, Gonzalez L2, Vadaparampil ST2, Laronga C2, Lee MC2, Pow-Sang J2, Eggly S2, Franklin A2, Shah B2, Fulp WJ2, Hayes-Lattin B2.

sir Asharaf tumours histopathology report came as Benign ovarian tumour.patient went home attending school.

Murat,

as Nadia and Nelson already said it, yes, high risk HPV is seen more frequently in cervical cancers than low risk counterparts.

About the cut-off level of low-risk to high-risk: the main difference between the two types is the presence (low) or not (high) of transcription factor E2, a protein that suppresses E6 and E7 (the main oncoproteins) expression. High-risk HPVs often lose E2 during viral DNA integration into host genome. See attached file for more details.

regards.

We do not use Ova-1 to monitor ovarian cancer.  OVA-1 is only used in women  who have already been evaluated and for whom surgery is planned. OVA-1 rather  than CA 125 is used to decide whether a patient who is planned for surgical evaluation for an adnexal mass should be referred to a gynecologic oncologist. 

No experience in Obstetrics and Gynaecology at the postgraduate level. I am a community Health Physician. However from my little experience in O&G, it is not common, I did not see any case.

Tamoxifen causes Endometrial hyperplasia because of its weak Estrogenic agonist activity.In the advanced cases of carcinoma Endometrium tamoxifen can be used to stimulate the synthesis of the  receptorse which will help for the effective use of the progesterone therapy.

I belive most of the time in cases of carcinoma of vulva they come in late stages with enlarged palpable lymphnodes then the approach of open eill be easier,but if the cases of early cases can go with endoscopic removal of  inguinal lymph nodes.

Oh  it is difficult procedure with  high  failure rate.

I  belief that  it will  not succeed 

In Addition: Malingering and Pseudopathie

In ovarian Epithelial ovarian tumours we wont use Immunotherapy as its not necessary.i fully agree with Marialuigina Fruscella.

In our institute WE Give 6 cycles of  neoadjuvent chemotherapy by keeping a watch on the toxicity of chemotherapy.

46 XY

I have an animal trial related to the subject and title of my article is: THE EFFECT OF A LEVONORGESTREL-RELEASING INTRAUTERINE

DEVICE ON OVARIECTOMIZED RAT ENDOMETRIUM UNDER

ESTROGEN REPLACEMENT THERAPY

You can find it as open access in google as an english written paper

Did you ever check the protein amount that you are loading if it is equal or not? I am working with HTR-8/SVneo cells, so these are trophoblastic cells and I never faced a problem by using beta-actin. But finally this depends on the question you're working on or which pathways you affect during your cell treatment.

GAPDH would be a very classical protein people are generally using in research.

The trials of the vaccines, and more important the follow up studies in field use in various countries show that risk of harm is very small (unless you know of studies that I am unaware of). However, so far the outcome studies of cancer reduction are not long enough to be confident about how effective the vaccine will be: 70%? 90%? 98%? At what level would you say we can stop cervical screening? In particular, the trials and population cohort studies cannot yet show the long term effect in the peak age group for the cancer: 40-60. Until we know that, it is difficult to recommend cutting down on cervical screening: a preventive activity that we know works. Further, if the vaccine reduces minor abnormalities, LSIL, HSIL ASCUS that are found on screening but mostly resolve without treatment, it will reduce the harms that arise when colposcopists feel obliged to treat these, and thereby cause cervical damage that may lead to pregnancy complications. We already know that the vaccine reduces these abnormalities in the younger age groups, so gives us greater confidence not to screen young women under 25. Thus at present, the vaccine should reduce the harms of screening, and in the distant future we will know how well it reduces cancer.

Based on systematic reviews and metanylisis and taking account some facts:

1. Among those newly diagnosed with cervical cancer, 30–60 % have never had a screening test. (1)

2. Up to 15 % have had inadequate follow up after an abnormal Pap smear.(1)

3. 60 to 80 % of women diagnosed with advanced cervical cancer have not had a screening test within the past 5 years. (1)

4. The population-level impact of screening (i.e., reduction in the incidence and mortality of cervical cancer) was most influenced by the level of coverage. (2).

It is evident that due to the already established relationship between high-risk oncogenic HPV and cervical cancer, the possibility of primary screening using HPV DNA test, specially in places where cytology has not been used or where, for some reason , has not been adopted appropriately is very cost-effective. (3)

1- Glick et al, 2012

2- Goldie et al, 2006

3- Luhn ; Wetzensen, 2013

Dear Branka, the stategy should be to perform 2-3 cycles of neoadjuvant platinum based chemotherapy and to deliver the baby above 30 weeks of gestation; this should be done in a center for gynecologic oncology and for perinatal medecine. Certainly we would also offer to support you and your patient in Essen, Germany: however, Vesna Kesic may give you some additional advice as incoming president of ESGO and well connected to the "cancer in pregnancy" task force of Frederic Amant in Leuven/Belgium.

Sincerely Yours

Rainer

very interesting!, I will take your suggestion on board. Have you come across literature on this by any chance? ATCC does mention Karyotipical instability observed in C33a through different passages, but its not referenced appropriately...