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Laparoscopic hysterectomy as optimal approach for 5400 grams uterus with associated polycythemia: A case report

World Journal of Clinical Cases 2019年第19期7卷 3027-3032页

作者： Antonio Macciò Giacomo Chiappe Fabrizio Lavra Elisabetta Sanna Romualdo Nieddu Clelia Madeddu Department of gynecologic oncology Azienda Ospedaliera BrotzuCagliari 09100Italy Department of Medical Sciences and Public Health Medical Oncology UnitUniversity of CagliariCagliari 09042Italy

BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is *** is significantly associated with risk of venous thromboembolism(VTE),which is further increased in case of a large pelvic mass and *** we report the surgical challenges in the case of an obese patient with a giant fibromatous uterus and associated *** SUMMARY A 42-year-old obese woman was referred to our department for treatment for a huge fibromatous *** suffered of pelvic pressure and abdominal distension and reported severe dyspnea from several *** analyses including hemoglobin(Hb)19.2 g/dL and hematocrit(Hct)59.7%were indicative of *** blood gas analysis showed arterial oxygen pressure(pO2)of 81.5 *** computed tomography confirmed a giant fibromatous uterus measuring 28.2 cm×17 cm×25 *** reduce the thromboembolic risk,the patient underwent low molecular weight heparin,phlebotomy twice before surgery,and we opted for a laparoscopic *** uterus weighed 5400 g and the histology confirmed a diagnosis of *** did not find increased erythropoietin levels in the supernatant of the myomatous uterine *** were no *** postoperative day 1,the Hb and the Hct levels normalized to 13.3 g/dL and 41.7%,*** blood gas analysis after surgery showed a pO2 of 144.7 *** results suggested the diagnosis of myomatous erythrocytosis *** patient was discharged on the second postoperative day in very good condition with no *** We believe this is the first reported laparoscopic hysterectomy in a patient with a giant uterus,polycythemia and *** VTE risk factors warranted a laparoscopic approach.

关键词： Hysterectomy Laparoscopy Myoma Myomatous erythrocytosis syndrome Polycythemia,huge uterus Total laparoscopic hysterectomy Case report

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Sentinel lymph node mapping of a breast cancer of the vulva: Case report and literature review

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World Journal of Clinical oncology 2015年第2期6卷 16-21页

作者： James Cripe Ramez Eskander Krishnansu Tewari Division of gynecologic oncology Department of Obstetrics and Gynecology the University of CaliforniaIrvine Medical Center

Ectopic breast tissue is rare and typically presents as an axillary mass. Previous reports have identified ectopic breast tissue in the vulva, but malignancy is exceedingly uncommon. We present a 62 years old with locally advanced breast carcinoma arising in the vulva demonstrates the utilization of sentinel lymph node mapping to identify metastatic lymph nodes previously unable to be identified via traditional surgical *** case supports the principles of adjuvant therapy for breast cancer to be applied to ectopic breast cancer arising in the vulva. A literature review highlights common key points in similar cases to guide management.

关键词： Vulvar cancer Ectopic breast Sentinel lymph node Breast cancer Vulvar breast cancer

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Prognostic evaluation of postoperative adjuvant therapy for operable cervical cancer:10 years'experience of National Cancer Center in China

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Chinese Journal of Cancer Research 2017年第6期29卷 510-520页

作者： Tong Shu Dan Zhao Bin Li Yating Wang Shuanghuan Liu Pingping Li Jing Zuo Ping Ba i RongZhang Lingying Wu Department of gynecologic oncology National Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China

Objective： The aim of this study was to investigate the prognostic factors and to evaluate the impact of adjuvant therapy on clinical outcome for early-stage cervical cancer. Methods： The clinical-pathological data of all 1,335 patients with the International Federation of Gynecology and Obstetrics （FIGO） Ib-[Ia cervical cancer treated with primary radical surgery at the Chinese National Cancer Center between May 2007 and Dec 2013 were retrospectively reviewed. The median follow-up was 70 months. Results： Of all the patients, 61.6% of the cases received adjuvant therapy, with 5-year disease-free survival （DFS） of 92.1% and 5-year overall survival （OS） of 95.0%. In multivariate analysis, differentiation of G3 （P〈0.05）, lymph node metastasis （LNM, P〈0.05） and lymphovascular space invasion （LVSI, P〈0.05） were independent predictors for OS, while LNM （P〈0.05）, deep stroma invasion （DSI, P〈0.05） and LVSI （P〈0.05） were independent factors for DFS. The samples were stratified by histologic type, and cervical squamous cell carcinoma （SCC） was found to share the same independent factors except for differentiation of OS. As to patients with cervical adenocarcinoma/adenosquamons carcinoma （AC/ASC）, differentiation was the independent predictor of OS （P〈0.05）; and LVSI of DFS （P〈0.05）. Of 236 patients with high-risk factors, there was no significant difference in survival between concurrent chemoradiotherapy （CCRT, n=195）, radiotherapy （RT, n=24）, and chemotherapy （CT, n=17）. Among the 190 patients with LNM who underwent CCRT, 124 cases showed improved DFS after sequential CT （P=0.118）, with a recurrence rate decrease of 14%, though the difference was not statistically significant. Patients with single intermediate-risk factors like DSI or LVSI were found to partially benefit from adjuvant therapy, but the difference was not statistically significant. Conclusions： LNM, LVSI, DSI and differentiation were found to be independent prognostic factors for operable cervical cancer. Ag

关键词： Cervical neoplasm adjuvant therapy prognostic factors DFS OS

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Evolution of radical hysterectomy for cervical cancer along the last two decades: single institution experience

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Chinese Journal of Cancer Research 2016年第2期28卷 215-220页

作者： Claudia Arispe Ana Isabel Pomares Javier De Santiago Ignacio Zapardiel gynecologic oncology Department La Paz University Hospital

Background： The radical hysterectomy （RH） surgical technique has improved along the years. It is used for the treatment of cervical cancer, endometrial cancer when affecting the cervix, and upper vaginal carcinomas. Our aim was to describe the historical evolution of the technique after the introduction of laparoseopy at our institution. Methods： We performed a retrospective review of medical records of patients who underwent RH, grouped in three periods according to the year of surgery： 1990-1999, 2000-2009 and 2010-2013. Patients＇ characteristics, pathologic details, intraoperative and postoperative complications were analyzed and comoared throughout the time periods. Results： A total of 102 cases of RH were performed at our center during the study period. Among all data collected, the presence of necrosis, age, number of lymph nodes, surgery route, operating time, hospital stay, blood loss and transfusion requirement were statistically significant different among groups. Conversion to laparotomy rate was 19% for the second period compared to the absence of cases in the last one. No significant differences （P=0.124） were observed in the adjuvant treatment received among the three different groups. At the time of the last contact the patients free of disease were 12 （85.7%）, 53 （91.3%） and 26 （86.6%） respectively （P=0.406）. Regarding the disease-free interval, we found significant better outcomes in the group of laparotomy compared to laparoscopy （P=0.015）.Conclusions： Laparoscopic RH is an acceptable surgery with advantages like magnified vision of the operation＇s field, lower surgical complications, shorter hospital stay and earlier resumption to daily activities.

关键词： Gynaecological cancer radical hysterectomy (RH) laparoscopy cervical cancer

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Selecting the best strategy of treatment in newly diagnosed advanced-stage ovarian cancer patients

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World Journal of Methodology 2015年第4期5卷 196-202页

作者： Lucas Minig Cristina Zorrero Pablo Padilla Iserte Andres Poveda Gynecology Department Clinical Area of Gynecologic Oncology Valencian Institue of Oncology Medical oncology Department Clinical Area of Gynecologic Oncology Valencian Institue of Oncology

Although it is assumed that the combination of chemotherapy and radical surgery should be indicated in all newly diagnosed advanced-stage ovarian cancer patients, one of the main raised questions is how to select the best strategy of initial treatment in this group of patients, neoadjuvant chemotherapy followed by interval debulking surgery or primary debulking surgery followed by adjuvant chemotherapy. The selection criteria to offer one strategy over the other as well as a stepwise patient selection for initial treatment are described. Selecting the best strategy of treatment in newly diagnosed advanced stage ovarian cancer patients is a multifactorial and multidisciplinary decision. Several factors should be taken into consideration:(1) the disease factor, related to the extension and localization of the disease as well as tumor biology;(2) the patient factor, associated with patient age, poor performance status, and co-morbidities; and(3) institutional infrastructure factor, related to the lack of prolonged operative time, an appropriate surgical armamentarium, as well as well-equipped intensive care units with well-trained personnel.

关键词： Ovarian cancer Advanced stage Primary debulking surgery Neoadjuvant chemotherapy Patients' selection

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Ovarian cancer resistance to PARPi and platinumcontaining chemotherapy

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Cancer Drug Resistance 2022年第3期5卷 637-646页

作者： Rebekah Summey Denise Uyar Department of Obstetrics and Gynecology Division Gynecologic OncologyMedical College of WisconsinMilwaukeeWI 53226USA

Epithelial ovarian cancer remains the most lethal female malignancy despite options for systemic therapy and the emergence of targeted *** initial response to therapy is observed,recurrence and ultimately chemoresistance result in overall therapeutic *** pattern has been evident with platinum therapy since the *** excitement surrounded the approval of poly(ADP-ribose)polymerase inhibition(PARPi)as a novel therapeutic option,especially with the advent of personalized medicine,but resistance has similarly developed to these *** agents are constantly being sought,but if the obstacle of chemoresistance remains,the durability of responses will remain *** the multifactorial mechanisms of platinum and PARPi resistance is increasingly important as a therapeutic failure with current strategies is almost *** greater efforts on expanding the current understanding of the complex nature of platinum and PARPi chemoresistance has tremendous potential to improve clinical outcomes.

关键词： Epithelial ovarian cancer chemoresistance platinum resistance poly(ADP-ribose)polymerase inhibitor resistance tumor microenvironment

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Aberrant DNA methylation in cervical carcinogenesis

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Chinese Journal of Cancer 2013年第1期32卷 42-48页

作者： Hui-Juan Yang Department of gynecologic oncology Fudan University Shanghai Cancer Center

Persistent infection wit h high-risk types of human papillomavirus(HPV) is known to cause cervical cancer;however,additional genetic and epigenetic alterations are required for progression from precancerous disease to invasive *** methylation is an early and frequent molecular alteration in cervical *** this review,we summarize DNA methylation within the HPV genome and human genome and identify its clinical *** of the HPV long control region(LCR) and L1 gene is common during cervical carcinogenesis and increases with the severity of the cervical *** L1 gene of HPV16 and HPV18 is consistently hypermethylated in invasive cervical cancers and can potentially be used as a clinical marker of cancer ***,promoters of tumor suppressor genes(TSGs) involved in many cellular pathways are methylated in cervical precursors and invasive *** are associated with squamous cell carcinomas,and others are associated with *** of methylated TSGs in Pap smear could be an adjuvant test in cervical cancer screening for triage of women with high-risk HPV,atypical squamous cells of undetermined significance,or low grade squamous intraepithelial lesion(LSIL).However,consistent panels must be validated for this approach to be translated to the ***,reversion of methylated TSGs using demethylating drugs may be an alternative anticancer treatment,but demethylating drugs without toxic carcinogenic and mutagenic properties must be identified and validated.

关键词： DNA甲基化子宫颈癌人类基因组 HPV16 乳头状瘤病毒异常抑癌基因肿瘤抑制基因

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PROGNOSIS OF EPITHELIAL OVARIAN CANCER RELATED TO ITS ASCITES

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Chinese Journal of Cancer Research 2001年第2期13卷 151-154页

作者：宋水勤张国楠吴艳丽周红赵素兰谢方陈毅男 Fushan City Hospital of Gynecoogy and Pediatrics Guangdong Province Department of gynecologic oncology Si-chuan Province Cancer Hospital

Objective: To investigate the relationship between the prognosis of Epithelial Ovarian Cancer (EOC) and its ascites. Methods: Retrospectively analysis is performed for the clinical, pathological and followed up data of 101 in-patients suffering from epithelial ovarian cancer and operated with tumor debulking surgery in our hospital from January 1986 to December 1993. The patients was divided into two groups based upon the first laparotomy finding with ascites(62) or without(39). Age average, cell type, advanced proportion and survival rate of the patients are evaluated by a χ2 test. Results: For age average and cell type, no statistical difference was noted. However, there were more advanced cases in ascites group than in the other (P<0.01). The 3-, 4- and 5-year survival in the no-ascites group were 87.02%, 73.42%, 57.10% respectively compared with 65.02%, 38.66%, 28.12% in the ascites group. The 5-year survival rate of stage I, II,III, IV patients in no-ascites group are 77%, 70%, 41.1%, 0 respectively, compared with that of 60%, 56.8%, 15.46%, 0 respectively in the ascites group. The results shows that 3-, 4-, and 5-year survival in no-ascites group were significantly higher than those in ascites group(P<0.01). Conclusion: Presence of ascites is a factor of poor prognosis for EOC.

关键词： Ovarian neoplasms Ascites Prognosis

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Fatal risk in hysteroscopic surgery that should not be overlooked:Uterine artery pseudoaneurysm

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World Journal of Clinical Cases 2025年第8期13卷 53-56页

作者： Mi-Si He Ke-Xiao Yu Chen Wang Department of gynecologic oncology Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer HospitalChongqing 400030China Department of Orthopedics Chongqing Hospital of Traditional Chinese MedicineChongqing 400021China

This article provides a detailed account of the diagnosis and treatment of a case involving a uterine artery pseudoaneurysm(UAP),as well as an analysis of UAP *** finding emphasizes that UAP should be considered in patients presenting with abnormal genital bleeding after hysteroscopy and offers valuable insights and lessons for gynecologists in hysteroscopic *** patient underwent timely relevant examinations to confirm the diagnosis,allowing for crucial time required for her *** this study,the primary cause of UAP formation in the patient was attributed to a prior hysteroscopic surgical procedure conducted at another medical facility,suggesting that the selection and imple-mentation of dilatation catheters are some of the predisposing factors for *** conclusion,this case study offers a comprehensive analysis of the etiology of UAP and effectively provides timely diagnosis and treatment,offering valuable in-sights for the clinical diagnosis and management of UAP.

关键词： Editorial Uterine artery pseudoaneurysm Case report Hysteroscopic surgery Uterine arteriovenous malformations

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Ovarian cancer recurrence:is the definition of platinum sensitivity modified by PARPi,bevacizumab or other intervening treatments?:a clinical perspective

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Cancer Drug Resistance 2022年第2期5卷 415-423页

作者： Peter G.Rose Section of gynecologic oncology Women’s Health InstituteCleveland ClinicClevelandOhio 44195USA.

In view of the high risk of recurrent disease in stage III and IV ovarian cancer following primary first-line chemotherapy,a variety of maintenance and consolidation treatment strategies have been *** have included:radiation,intravenous or intraperitoneal chemotherapy,targeted therapies,and *** at this time is the use of Poly-adenosine ribose polymerase(PARP)inhibitors and bevacizumab as maintenance *** effect these maintenance or consolidation therapies have on subsequent response to therapy,specifically platinum-based chemotherapy,is only beginning to be *** this manuscript,we review the impact of PARP inhibitors and bevacizumab as well as radiation and maintenance chemotherapy on subsequent response to *** use of bevacizumab does not appear to adversely affect subsequent response to platinum-based chemotherapy or platinum-based chemotherapy with *** therapy with PARP inhibitors induces platinum resistance to subsequent platinum-based therapy and negates classic predictors of response such as platinum-free interval and breast cancer susceptibility gene(BRCA)mutational status.

关键词： Maintenance consolidation PARP inhibitors bevacizumab radiation chemotherapy

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