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Rhabdomyosarcoma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Gideon Sandler, Andrea Hayes-Jordan
Vaginal, vulval, and uterine rhabdomyosarcoma are usually botryoidal and present with vaginal discharge, bleeding, or prolapse of a polypoid mass (Figure 61.5), which may be primarily resectable. Diagnosis is made by vaginoscopic or open incisional or excisional biopsy. Eighty-five per cent of patients require biopsy only followed by chemotherapy and RT or brachytherapy, with little if any surgical intervention and excellent outcomes (5-year FFS 92%). If surgery is required, an R1 resection with adjuvant RT is preferable to radical surgery. Hysterectomy, vulvectomy, partial vaginectomy, or sleeve resection are only indicated for persistent or recurrent disease. Bladder salvage is almost always possible even with locally advanced tumors. Oophorectomy should only be considered if there is direct ovarian involvement. Pelvic and retroperitoneal lymphatic metastases are uncommon and lymph node evaluation is not routinely performed. The details of hysterectomy, sleeve-vaginectomy, vulvectomy, and oophorectomy are beyond the scope of this chapter.
Menopause transition
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
For methodological precision, the changes which women undergo during their transition to menopause are best considered in discrete phases. These have been described in several studies during the past thirty years5,8,9 and are well known. Women are considered premenopausal if they report no changes to menstrual frequency or flow during the prior months; any changes to flow and/or frequency during the same time span is classified as perimenopausal; and 12 consecutive months of amenorrhea is the internationally accepted definition of postmenopause. Women who undergo surgical removal of the uterus with or without oophorectomy are designated as surgically menopausal.
Oncology
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Surgical treatment options for excision of breast cancer include mastectomy (radical, extensive radical, modified radical, simple [total], or subcutaneous), and lumpectomy (tylectomy). Oophorectomy (removal of the ovaries) is another surgical procedure sometimes used to reduce the level of endogenous ovarian hormones and temporarily regress hormone-dependent tumors. Adrenalectomy and hypophysectomy (excision of the adrenal and pituitary glands, respectively) are also utilized to decrease hormone secretions. Radiation therapy has been used for all types of breast cancer as primary, adjuvant, and palliative treatment. A number of chemotherapeutic agents are used successfully in treatment, particularly in multidrug regimens. Hormonal manipulation has also been a significant addition to treatment options. Use is determined by the presence of estrogen receptor protein (ERP) in the tumor tissue.
Incidentally detected steroid cell tumour presenting with abnormal uterine bleeding: a rare case report with review of literature
Published in Journal of Obstetrics and Gynaecology, 2022
Priyanka Yadav, Navpreet Kaur, Shramana Mandal, Nita Khurana, Ashok Kumar
These are benign tumours, however 30–45% cases are reported to be malignant. Distant metastasis is the most direct evidence of malignancy. Criteria for malignancy has been described as equal to or greater mitosis 2 mitoses per 10 high-power fields, vascular invasion, grade II or III nuclear atypia, and necrosis or haemorrhage with a diameter greater than 7 cm on gross pathologic specimen (Hayes and Shully 1987). In the present case no necrosis, haemorrhage, nuclear atypia was noted. Surgery is the mainstay of treatment, in steroid cell tumours NOS, as is with other ovarian stromal tumours. For early stage tumours, conservative surgery with unilateral oophorectomy may be done if there is a desire to maintain the fertility. Those who have completed their family, total hysterectomy, bilateral salpingo-oophorectomy, and complete staging are indicated. In our patient total abdominal hysterectomy with unilateral salpingooophorectomy was performed. Radiation or adjuvant chemotherapy should be carried out if the neoplasms proved to be malignant or distant metastasis is reported (Zang et al. 2017). There is no consensus on the adjuvant therapy for metastatic or malignant steroid cell tumours NOS. The Gynaecologic Oncology Group has shown that BEP is effective as the first line treatment for malignant ovarian stromal tumours. The use of GnRH-agonists as primary adjuvant therapy for sex cord stromal tumours including steroid cell tumours has also been advocated. Testosterone levels needs to be monitored for disease progression or recurrence (Lee et al. 2016).
When is it too late? Ovarian preservation and duration of symptoms in ovarian torsion
Published in Journal of Obstetrics and Gynaecology, 2022
Katherine Adams, Emma Ballard, Akwasi Amoako, Akram Khalil, David Baartz, Kevin Chu, Keisuke Tanaka
The management of ovarian torsion has progressed over the last 30 years, from complete removal of the ovary to more conservative preservation using ovarian detorsion (White and Stella 2005; Wang et al. 2019). This is on the background knowledge that ovarian tissue has the ability to re-perfuse, subsequently preserving fertility despite its ischemic-hemorrhagic appearance (Göçmen et al. 2008; Coskun et al. 2009). Oophorectomy or removal of the ovary is required where the ovary is deemed not viable (Damigos et al. 2012). Leaving the ovary in situ in these situations increases the risk of infection, gangrene and peritonitis (Huchon et al. 2010; Gerscovich et al. 2014; Wang et al. 2019). If the ovary is untwisted and the ovary is judged to be viable, management depends on the cause of the torsion (Damigos et al. 2012). In cases where an ovarian cyst is present, cystectomy aims to reduce the risk of recurrence by decreasing the weight of the ovary (Damigos et al. 2012). An oophoropexy is usually reserved for a situation in which the ovary appears normal however recurrent ovarian torsion has occurred or the ovarian ligament is found to be long (Fuchs et al. 2010; Damigos et al. 2012; Resapu et al. 2019). Oophoropexy is performed by anchoring the ovary to the lateral or posterior pelvic wall, the posterior aspect of the uterus, or by plication of the utero-ovarian ligament to reduce the chance of recurrence (Fuchs et al. 2010; Damigos et al. 2012; Hosny 2017; Hartley et al. 2018).
A rare case of recurrences of multiple ovarian fibrothecoma
Published in Journal of Obstetrics and Gynaecology, 2021
Gianluca Raffaello Damiani, Mario Villa, Giulio Licchetta, Maria Cristina Cesana, Edoardo Dinaro, Matteo Loverro, Giuseppe Muzzupapa, Antonio Pellegrino
Surgery is the treatment of choice. Based on the size, on the nature, on the location of the tumour and on the patient’s age, it is possible to perform a tumorectomy, especially in fertility-sparing treatment, a salpingo-ophorectomy or a radical hysterectomy in a case of tumour of multiple locations or uterine symptoms. In the last surgery, we performed a radical hysterectomy type b1 with salpingo-ophorectomy and removal of all the lesions. Despite the recurrence, no malignant histological features were found in the lesions. The Ca125 was higher than normal and it probably depends on the largest lesions. In the literature, recurrent ovarian fibroma is associated with Gorlin syndrome and has rarely occurred in non-syndromic patients (Rybalka 1967; Karck et al. 1991; Obeidat et al. 2019). The surgical effort must be maximal and based on this. On the histological finding, adjuvant therapy could be administered. The role of oophorectomy in our case was essential due to the recurrences on the ovary, but this option can be evaluated from the surgeon, based on medical history and previous surgeries and the localisation of relapses.