Background: Vulvar neuroendocrine neoplasms are extremely rare and reported only in case reports. Diagnosis and treatment are difficult because of the rarity of these tumors. This report describes a rare case of vulvar neuroendocrine carcinoma (NEC) and reviews the available literature on neuroendocrine neoplasms of the vulva to inform the clinical management of this rare tumor. Compared with similar cases that also with vulvar NEC, our patient received only vulvar wide local excision with no postoperative therapy and had good outcome until the next 17 months follow-up time. Case Description: A 47-year-old woman presented to a local hospital with a 1-month history of a vulvar mass that had progressively enlarged over the preceding 2 months. She underwent vulvar wide local excision at the hospital. The pathological results showed high-grade NEC. The patient then sought treatment at our hospital. We performed vulvar wide local excision. The second pathological examination showed no residual tumor. The patient did not receive any postoperative therapy and was alive with no recurrence 17 months after the surgery. We describe the clinical characteristics of the 29 cases identified in the literature using a Pubmed search. Conclusions: In summary, vulvar NEC is a rare disease. Our case and the reviewed cases further our understanding of the clinical presentation, diagnosis, and treatment of this rare disease. Due to the limited number of available studies with a sufficient follow-up period and large patient sample, more cases should be included in the future to help establish new treatment guidelines.
{"title":"Vulvar neuroendocrine carcinoma: a case report and literature review","authors":"Yanping Yin, Ling Chen, J. Ruan, Ai Zheng","doi":"10.21037/gpm-21-62","DOIUrl":"https://doi.org/10.21037/gpm-21-62","url":null,"abstract":"Background: Vulvar neuroendocrine neoplasms are extremely rare and reported only in case reports. Diagnosis and treatment are difficult because of the rarity of these tumors. This report describes a rare case of vulvar neuroendocrine carcinoma (NEC) and reviews the available literature on neuroendocrine neoplasms of the vulva to inform the clinical management of this rare tumor. Compared with similar cases that also with vulvar NEC, our patient received only vulvar wide local excision with no postoperative therapy and had good outcome until the next 17 months follow-up time. Case Description: A 47-year-old woman presented to a local hospital with a 1-month history of a vulvar mass that had progressively enlarged over the preceding 2 months. She underwent vulvar wide local excision at the hospital. The pathological results showed high-grade NEC. The patient then sought treatment at our hospital. We performed vulvar wide local excision. The second pathological examination showed no residual tumor. The patient did not receive any postoperative therapy and was alive with no recurrence 17 months after the surgery. We describe the clinical characteristics of the 29 cases identified in the literature using a Pubmed search. Conclusions: In summary, vulvar NEC is a rare disease. Our case and the reviewed cases further our understanding of the clinical presentation, diagnosis, and treatment of this rare disease. Due to the limited number of available studies with a sufficient follow-up period and large patient sample, more cases should be included in the future to help establish new treatment guidelines.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41919125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tingting Li, Wenli Zhang, Jingwen Huang, Yangmei Shen, T. Cui, A. Giannini, O. Tapisiz, R. Lasmar, B. Lasmar
Teratoma usually forms plates on or encompasses the ovaries and/or adnexa; however, teratomas of the omentum are so rare that only up to 46 cases have been described in nearly 200 years. Here, we report the case of a 47-year-old woman admitted to hospital with intermittent distending pain and discomfort. At the admission, an ultrasonic examination revealed an irregular cystic space–occupying lesion on the bilateral adnexa area. Laparoscopic ovarian cystectomy was selected as the treatment option. However, coexistence of multiple teratomas on the greater omentum and 2 giant, fused bilateral ovarian teratomas measuring over 20 cm were found during operation, thus needing laparotomy, hysterectomy, bilateral salpingooophenrectomy, omentectomy, appendicectomy, and enterolysis. Three years after the operation, no recurrence has yet been found. We report a rare case with multiple teratomas of the omentum and giant fused teratomas of the bilateral ovaries. Histopathological studies confirmed the diagnosis of teratomas, and surgery completely resolved the original symptoms. There are no standard diagnostic criteria or operative options for teratomas of the omentum, which increases the likelihood of misdiagnosis and of insufficient preoperative planning for the appropriate procedures. Ultrasound, CT, MRI and possibly also the PET may aid in the diagnosis. A definitive diagnosis is possible following histopathological examination, which must differentiate between mature and immature teratoma. Although, malignant transformation (MT) of the omentum teratoma has been described, the risk is very rare. Surgical excision of omentum teratoma is the treatment of choice, and most surgeons perform laparoscopy with tumor dissection. The surgical technique remains particularly important especially in young women, in whom the most conservative approach is crucial, to preserving fertility and minimizing surgical morbidity. The management depends upon the maturity of the teratoma. For mature teratoma, complete excision is curative and no further treatment is required. Immature teratomas are potentially malignant, so the patient may require chemotherapy and
{"title":"Rare multiple teratomas of the omentum and giant fused teratomas of the bilateral ovaries: a case report and review of the literature","authors":"Tingting Li, Wenli Zhang, Jingwen Huang, Yangmei Shen, T. Cui, A. Giannini, O. Tapisiz, R. Lasmar, B. Lasmar","doi":"10.21037/gpm-21-35","DOIUrl":"https://doi.org/10.21037/gpm-21-35","url":null,"abstract":"Teratoma usually forms plates on or encompasses the ovaries and/or adnexa; however, teratomas of the omentum are so rare that only up to 46 cases have been described in nearly 200 years. Here, we report the case of a 47-year-old woman admitted to hospital with intermittent distending pain and discomfort. At the admission, an ultrasonic examination revealed an irregular cystic space–occupying lesion on the bilateral adnexa area. Laparoscopic ovarian cystectomy was selected as the treatment option. However, coexistence of multiple teratomas on the greater omentum and 2 giant, fused bilateral ovarian teratomas measuring over 20 cm were found during operation, thus needing laparotomy, hysterectomy, bilateral salpingooophenrectomy, omentectomy, appendicectomy, and enterolysis. Three years after the operation, no recurrence has yet been found. We report a rare case with multiple teratomas of the omentum and giant fused teratomas of the bilateral ovaries. Histopathological studies confirmed the diagnosis of teratomas, and surgery completely resolved the original symptoms. There are no standard diagnostic criteria or operative options for teratomas of the omentum, which increases the likelihood of misdiagnosis and of insufficient preoperative planning for the appropriate procedures. Ultrasound, CT, MRI and possibly also the PET may aid in the diagnosis. A definitive diagnosis is possible following histopathological examination, which must differentiate between mature and immature teratoma. Although, malignant transformation (MT) of the omentum teratoma has been described, the risk is very rare. Surgical excision of omentum teratoma is the treatment of choice, and most surgeons perform laparoscopy with tumor dissection. The surgical technique remains particularly important especially in young women, in whom the most conservative approach is crucial, to preserving fertility and minimizing surgical morbidity. The management depends upon the maturity of the teratoma. For mature teratoma, complete excision is curative and no further treatment is required. Immature teratomas are potentially malignant, so the patient may require chemotherapy and","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44791970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Endometriosis surgery: a long controversial challenge","authors":"A. Tinelli","doi":"10.21037/gpm-21-37","DOIUrl":"https://doi.org/10.21037/gpm-21-37","url":null,"abstract":"","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48452206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Leopold, J. Klebanoff, S. Rahman, S. Bendifallah, J. Ayoubi, G. Moawad
: Endometriosis is an all too common benign inflammatory condition that impacts the lives of countless women around the world. Not only is there typically a delay in diagnosis of this devastating condition, but women are often mismanaged until they reach a provider with expertise in the condition. Endometriosis can be associated with a multitude of different symptoms most common cyclical pelvic pain, painful intercourse, pain with urination or defecation, and chronic pelvic pain. First line therapy for this condition is often hormonal therapy, however, surgery may be indicated for the appropriate patient. Deeply infiltrating endometriosis is often refractory to medical therapy and usually surgery is the only reasonable treatment approach. Deeply infiltrating disease can involve sensory nerves in the pelvis believed to be attributed to many symptoms. Furthermore, inadvertent or unrecognized damage to these nerves during surgery can lead to many unwanted complications following surgery for endometriosis. Nerve sparing surgery for endometriosis has been well defined and is associated with improved functional outcomes for women. Appropriate training and understanding of pelvic neuroanatomy are needed to perform these nerve sparing procedures and this review serves to highlight the benefits of nerve sparing procedures on functional urinary outcomes following surgery.
{"title":"A narrative review on the impact of nerve sparing surgery on urinary function in pelvic surgery for endometriosis","authors":"B. Leopold, J. Klebanoff, S. Rahman, S. Bendifallah, J. Ayoubi, G. Moawad","doi":"10.21037/GPM-20-52","DOIUrl":"https://doi.org/10.21037/GPM-20-52","url":null,"abstract":": Endometriosis is an all too common benign inflammatory condition that impacts the lives of countless women around the world. Not only is there typically a delay in diagnosis of this devastating condition, but women are often mismanaged until they reach a provider with expertise in the condition. Endometriosis can be associated with a multitude of different symptoms most common cyclical pelvic pain, painful intercourse, pain with urination or defecation, and chronic pelvic pain. First line therapy for this condition is often hormonal therapy, however, surgery may be indicated for the appropriate patient. Deeply infiltrating endometriosis is often refractory to medical therapy and usually surgery is the only reasonable treatment approach. Deeply infiltrating disease can involve sensory nerves in the pelvis believed to be attributed to many symptoms. Furthermore, inadvertent or unrecognized damage to these nerves during surgery can lead to many unwanted complications following surgery for endometriosis. Nerve sparing surgery for endometriosis has been well defined and is associated with improved functional outcomes for women. Appropriate training and understanding of pelvic neuroanatomy are needed to perform these nerve sparing procedures and this review serves to highlight the benefits of nerve sparing procedures on functional urinary outcomes following surgery.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48039174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adenosarcoma is a rare subtype of uterine sarcoma, composed by a combination of a benign epithelial and a malignant, but generally low grade, mesenchymal component and it is considered the least aggressive form of its epithelial counterpart, uterine carcinosarcoma. The presence of myometrial invasion and the extent of disease outside the uterus determines the stage of disease, while the presence of sarcomatous overgrowth represents the most important histological prognostic factor, correlating with the grade of disease. Management of localized uterine adenosarcoma (UAS) is based on complete surgical removal. Cytotoxic chemotherapy with doxorubicin-based regimens, gemcitabine/docetaxel, trabectedin or platinum-based regimens remains the standard of care for the advanced stage, recurrent or metastatic adenosarcoma, although an integrated approach of surgery and medical therapy should also be considered in this setting. Hormone therapy represents a potential therapeutic option for estrogen receptor (ER) and progesterone receptor (PR) positive low grade adenosarcoma. Because of the extreme rarity of UAS, most available literature data arise from retrospective case series and reports, while uniform clinical guidelines are still lacking. The aim of this updated literature review is to better define the multidisciplinary management of this rare neoplasm, focusing on the role of surgical and medical treatment and proposing a treatment flow sheets that could help to guide our clinical practice.
{"title":"Current status on treatment of uterine adenosarcoma: updated literature review","authors":"M. C. Nigro, M. Nannini, A. Rizzo, M. Pantaleo","doi":"10.21037/GPM-20-81","DOIUrl":"https://doi.org/10.21037/GPM-20-81","url":null,"abstract":"Adenosarcoma is a rare subtype of uterine sarcoma, composed by a combination of a benign epithelial and a malignant, but generally low grade, mesenchymal component and it is considered the least aggressive form of its epithelial counterpart, uterine carcinosarcoma. The presence of myometrial invasion and the extent of disease outside the uterus determines the stage of disease, while the presence of sarcomatous overgrowth represents the most important histological prognostic factor, correlating with the grade of disease. Management of localized uterine adenosarcoma (UAS) is based on complete surgical removal. Cytotoxic chemotherapy with doxorubicin-based regimens, gemcitabine/docetaxel, trabectedin or platinum-based regimens remains the standard of care for the advanced stage, recurrent or metastatic adenosarcoma, although an integrated approach of surgery and medical therapy should also be considered in this setting. Hormone therapy represents a potential therapeutic option for estrogen receptor (ER) and progesterone receptor (PR) positive low grade adenosarcoma. Because of the extreme rarity of UAS, most available literature data arise from retrospective case series and reports, while uniform clinical guidelines are still lacking. The aim of this updated literature review is to better define the multidisciplinary management of this rare neoplasm, focusing on the role of surgical and medical treatment and proposing a treatment flow sheets that could help to guide our clinical practice.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43864794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Pérez-López, M. T. López-Baena, G. Pérez-Roncero
The aim of this review is to explore relevant aspects of prolactin physiology and the conditions associated with hyperprolactinemia in women. PubMed and Google Scholar were queried using pertinent keywords to retrieve relevant studies with a particular focus on prolactin physiology, hyperprolactinemia, macroprolactinemia, prolactinoma, and general conditions that may displays alterations of prolactin secretion. Circulating prolactin displays a circadian cycle that disappears during pregnancy, hyperprolactinemia, and prolactinoma. Prolactin is under dopaminergic control and the influence of estrogens during reproductive years. Physical activity is a powerful stimulus for the pituitary release of prolactin. During pregnancy circulating prolactin increases and is present in the amniotic fluid. During lactation, the principal stimulus for prolactin secretion is breast suckling. Hyperprolactinemia may be related to functional causes or due to the presence of tumors producing prolactin (prolactinoma). Hyperprolactinemia may correspond to excessive production of normal (monomeric) prolactin or polymeric molecules (macroprolactinemia). The use of polyethylene glycol may differentiate the presence of those forms of prolactin. Functional hyperprolactinemia may be treated with dopaminergic agents like bromocriptine or cabergoline. The majority of cases of hyperprolactinemia associated with pituitary tumors correspond to microprolactinomas that may be treated with the same drugs. Macroprolactinoma may be treated with the same compounds, although surgical excision may be needed in some cases. These drugs should be interrupted during pregnancy unless prolactinoma grows or expand out of the sella turcica. A prolactin fragment has been related to the rare peripartum cardiomyopathy that appears during the last month of pregnancy or within the initial five months after delivery. Hyperprolactinemia has been also associated with an increased risk of subclinical atherosclerosis.
{"title":"Prolactin secretion in women: narrative review","authors":"F. Pérez-López, M. T. López-Baena, G. Pérez-Roncero","doi":"10.21037/GPM-21-4","DOIUrl":"https://doi.org/10.21037/GPM-21-4","url":null,"abstract":"The aim of this review is to explore relevant aspects of prolactin physiology and the conditions associated with hyperprolactinemia in women. PubMed and Google Scholar were queried using pertinent keywords to retrieve relevant studies with a particular focus on prolactin physiology, hyperprolactinemia, macroprolactinemia, prolactinoma, and general conditions that may displays alterations of prolactin secretion. Circulating prolactin displays a circadian cycle that disappears during pregnancy, hyperprolactinemia, and prolactinoma. Prolactin is under dopaminergic control and the influence of estrogens during reproductive years. Physical activity is a powerful stimulus for the pituitary release of prolactin. During pregnancy circulating prolactin increases and is present in the amniotic fluid. During lactation, the principal stimulus for prolactin secretion is breast suckling. Hyperprolactinemia may be related to functional causes or due to the presence of tumors producing prolactin (prolactinoma). Hyperprolactinemia may correspond to excessive production of normal (monomeric) prolactin or polymeric molecules (macroprolactinemia). The use of polyethylene glycol may differentiate the presence of those forms of prolactin. Functional hyperprolactinemia may be treated with dopaminergic agents like bromocriptine or cabergoline. The majority of cases of hyperprolactinemia associated with pituitary tumors correspond to microprolactinomas that may be treated with the same drugs. Macroprolactinoma may be treated with the same compounds, although surgical excision may be needed in some cases. These drugs should be interrupted during pregnancy unless prolactinoma grows or expand out of the sella turcica. A prolactin fragment has been related to the rare peripartum cardiomyopathy that appears during the last month of pregnancy or within the initial five months after delivery. Hyperprolactinemia has been also associated with an increased risk of subclinical atherosclerosis.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44962117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A-M Schütz, N. Taumberger, P. Pautier, Joly Florence, G. Ferron, J. Classe, E. Pujade-Lauraine, B. Asselain, F. Lécuru
: The initial treatment of ovarian cancer consists of a combined approach of surgery and platinum-based chemotherapy. Complete resection of the tumor should be aimed for, if not manageable, neoadjuvant chemotherapy (NAC) followed by interval debulking is recommended. Until recently, treatment strategies for the recurrent setting were mainly focusing on systemic therapies. Currently published trials including DESKTOP III, GOG 213 and SOC 1 did randomize patients with first platinum-sensitive recurrence to either surgery, aiming for complete cytoreduction, followed by platinum-based chemotherapy or chemotherapy alone. All three trials did report a benefit for the surgery arm in terms of progression free survival (PFS), while two of the studies did also show an improved overall survival (OS), this was not the case in the GOG 213 trial, with better result in terms of OS for the chemotherapy + bevacizumab arm. All the above-mentioned studies confirmed that only interventions leading to complete resection provided a benefit, highlighting the need to carefully select the patients who will be offered surgery. A score can be a useful tool but should not be the only basis of the final decision. Noteworthy, these results were obtained in trained centers. Apart from that, the homologous recombination deficiency (HRD) and BRCA status of the patient needs to be taken into consideration. In case of an indication for anti-angiogenic treatment in the event of a relapse and if not given initially, surgery is debatable. The role of maintenance therapy with PARP inhibitor alone or in combination is also an alternative.
{"title":"Surgery for recurrent ovarian cancer: expert point of view","authors":"A-M Schütz, N. Taumberger, P. Pautier, Joly Florence, G. Ferron, J. Classe, E. Pujade-Lauraine, B. Asselain, F. Lécuru","doi":"10.21037/GPM-2020-13","DOIUrl":"https://doi.org/10.21037/GPM-2020-13","url":null,"abstract":": The initial treatment of ovarian cancer consists of a combined approach of surgery and platinum-based chemotherapy. Complete resection of the tumor should be aimed for, if not manageable, neoadjuvant chemotherapy (NAC) followed by interval debulking is recommended. Until recently, treatment strategies for the recurrent setting were mainly focusing on systemic therapies. Currently published trials including DESKTOP III, GOG 213 and SOC 1 did randomize patients with first platinum-sensitive recurrence to either surgery, aiming for complete cytoreduction, followed by platinum-based chemotherapy or chemotherapy alone. All three trials did report a benefit for the surgery arm in terms of progression free survival (PFS), while two of the studies did also show an improved overall survival (OS), this was not the case in the GOG 213 trial, with better result in terms of OS for the chemotherapy + bevacizumab arm. All the above-mentioned studies confirmed that only interventions leading to complete resection provided a benefit, highlighting the need to carefully select the patients who will be offered surgery. A score can be a useful tool but should not be the only basis of the final decision. Noteworthy, these results were obtained in trained centers. Apart from that, the homologous recombination deficiency (HRD) and BRCA status of the patient needs to be taken into consideration. In case of an indication for anti-angiogenic treatment in the event of a relapse and if not given initially, surgery is debatable. The role of maintenance therapy with PARP inhibitor alone or in combination is also an alternative.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49613422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A rectovaginal fistula (RVF) is an abnormal formation of an epithelialized tract between the rectum and vagina (1,2). In the United States, between 1979 and 2006, a total of 81,735 women underwent surgical repair of a RVF (3). There are different approaches to the repair of the RVF. In patients who develop a fistula as a result of an obstetric complication, conservative management with regular sitz baths for 3–6 months, along with stool bulking and perineal care may be sufficient (4). In patients who require further intervention, a local approach may be taken with the use of Original Article
{"title":"Perioperative adverse events in women undergoing rectovaginal fistula repair in the United States","authors":"O. Chang, C. Bretschneider, C. Ferrando","doi":"10.21037/GPM-20-38","DOIUrl":"https://doi.org/10.21037/GPM-20-38","url":null,"abstract":"A rectovaginal fistula (RVF) is an abnormal formation of an epithelialized tract between the rectum and vagina (1,2). In the United States, between 1979 and 2006, a total of 81,735 women underwent surgical repair of a RVF (3). There are different approaches to the repair of the RVF. In patients who develop a fistula as a result of an obstetric complication, conservative management with regular sitz baths for 3–6 months, along with stool bulking and perineal care may be sufficient (4). In patients who require further intervention, a local approach may be taken with the use of Original Article","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47022265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: For over 30 years cytotoxic chemotherapy has been used to treat epithelial ovarian cancer. Type of platinum agents, scheduling of chemotherapy and the use of neoadjuvant have been extensively studied. However, in the past decade understanding of the biology of epithelial ovarian cancer and advances in molecular diagnostics have helped to identify new molecular pathways and design small molecules and antibodies which can transform treatment of this deadly disease. Such advances have enabled us to pursue new strategies in order to enhance the efficacy of chemotherapeutic agents, delay recurrence, overcome resistance to platinum or treat platinum resistant disease. In this section we review recent advances leading to approval of new agents, and the current efforts in developing new chemotherapeutic drugs. We discuss the role of antiangiogenic agents including vascular endothelial growth factor (VEGF) antibodies, VEGF receptor (VEGFR) tyrosine kinase inhibitors and Tie-Ang inhibitors. We also review new developments that have led to the approval of poly(ADP-ribose) polymerase (PARP) inhibitors as maintenance therapy in frontline and recurrent epithelial ovarian cancer and discuss new DNA repair targeting agents such as ataxia telangiectasia-mutated and Rad3-related (ATR) and cell cycle checkpoint inhibitors. Finally, we review the study data related to the most recent therapeutic strategies such as antibody drug conjugates. The role of immunotherapy in ovarian cancer has already been discussed in the previous article “The role of immunotherapy in ovarian cancer” in this special series. 12 tubulin-targeting DM4 through a cleavable linker. Following binding to the FR α , antigen mediated endocytosis results in an DM4 acts as anti-tubulin The tolerability preliminary of mirvetuximab This study platinum-resistant or platinum-refractory disease. Investigators reported partial response in 8/24 patients (33% of patients).
{"title":"Narrative review of novel chemotherapeutic agents in management of ovarian cancer","authors":"S. Rafii","doi":"10.21037/GPM-20-58","DOIUrl":"https://doi.org/10.21037/GPM-20-58","url":null,"abstract":": For over 30 years cytotoxic chemotherapy has been used to treat epithelial ovarian cancer. Type of platinum agents, scheduling of chemotherapy and the use of neoadjuvant have been extensively studied. However, in the past decade understanding of the biology of epithelial ovarian cancer and advances in molecular diagnostics have helped to identify new molecular pathways and design small molecules and antibodies which can transform treatment of this deadly disease. Such advances have enabled us to pursue new strategies in order to enhance the efficacy of chemotherapeutic agents, delay recurrence, overcome resistance to platinum or treat platinum resistant disease. In this section we review recent advances leading to approval of new agents, and the current efforts in developing new chemotherapeutic drugs. We discuss the role of antiangiogenic agents including vascular endothelial growth factor (VEGF) antibodies, VEGF receptor (VEGFR) tyrosine kinase inhibitors and Tie-Ang inhibitors. We also review new developments that have led to the approval of poly(ADP-ribose) polymerase (PARP) inhibitors as maintenance therapy in frontline and recurrent epithelial ovarian cancer and discuss new DNA repair targeting agents such as ataxia telangiectasia-mutated and Rad3-related (ATR) and cell cycle checkpoint inhibitors. Finally, we review the study data related to the most recent therapeutic strategies such as antibody drug conjugates. The role of immunotherapy in ovarian cancer has already been discussed in the previous article “The role of immunotherapy in ovarian cancer” in this special series. 12 tubulin-targeting DM4 through a cleavable linker. Following binding to the FR α , antigen mediated endocytosis results in an DM4 acts as anti-tubulin The tolerability preliminary of mirvetuximab This study platinum-resistant or platinum-refractory disease. Investigators reported partial response in 8/24 patients (33% of patients).","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46805913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Pinelli, Rocco Guerrisi, C. Brusadelli, V. Artuso, H. S. Majd, G. Bogani, F. Ghezzi, J. Casarin
: Ovarian cancer is the most fatal gynecological malignancy in developed areas. More than two-thirds of women with ovarian cancer have advanced disease at diagnosis. The standard treatment for advanced stage has been primary debulking surgery (PDS), aimed to achieve the complete resection of macroscopic disease, followed by platinum-based chemotherapy. The absence of residual tumor after surgical cytoreduction represents the most significant prognostic factor. The feasibility of complete cytoreduction depends on the resectability of the tumor and the operability of patients, respectively related to the extension of disease and patients’ comorbidities. For cases where PDS is not feasible for these reasons, an alternative strategy was developed in the last decades, the so called interval debulking surgery (IDS). This pathway consists of three or four courses of neoadjuvant platinum-based chemotherapy followed by IDS and a completion of other three courses of platinum-based chemotherapy. Actually, it represents an effective option to improve the rate of women who could benefit of a cytoreductive surgery. In this review we critically explore the current literature and report the evidence about the role of IDS in the management of advanced ovarian cancer, focusing on pros and cons of both strategies (PDS and IDS) and patients’ selection process.
{"title":"Interval debulking surgery for advanced ovarian cancer: when, how and why?","authors":"C. Pinelli, Rocco Guerrisi, C. Brusadelli, V. Artuso, H. S. Majd, G. Bogani, F. Ghezzi, J. Casarin","doi":"10.21037/GPM-20-61","DOIUrl":"https://doi.org/10.21037/GPM-20-61","url":null,"abstract":": Ovarian cancer is the most fatal gynecological malignancy in developed areas. More than two-thirds of women with ovarian cancer have advanced disease at diagnosis. The standard treatment for advanced stage has been primary debulking surgery (PDS), aimed to achieve the complete resection of macroscopic disease, followed by platinum-based chemotherapy. The absence of residual tumor after surgical cytoreduction represents the most significant prognostic factor. The feasibility of complete cytoreduction depends on the resectability of the tumor and the operability of patients, respectively related to the extension of disease and patients’ comorbidities. For cases where PDS is not feasible for these reasons, an alternative strategy was developed in the last decades, the so called interval debulking surgery (IDS). This pathway consists of three or four courses of neoadjuvant platinum-based chemotherapy followed by IDS and a completion of other three courses of platinum-based chemotherapy. Actually, it represents an effective option to improve the rate of women who could benefit of a cytoreductive surgery. In this review we critically explore the current literature and report the evidence about the role of IDS in the management of advanced ovarian cancer, focusing on pros and cons of both strategies (PDS and IDS) and patients’ selection process.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48786410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：