Academic literature on the topic 'Genital Neoplasms, Female, surgery'

Vascular tumors are rare in female genital tract (FGT). The aim of this study was to analyze the distribution of vascular tumors in FGT and to highlight their clinicopathologic features. As a retrospective study, clinical features including imaging studies, gross findings, and microscopic features of cases (ten) diagnosed as having vascular tumors of FGT over 4 years were reviewed. The age range of our cases was 12–52 years. The presenting complaint was abdominal pain/mass, postcoital bleeding, and vaginal and vulval mass. In most cases, duration of symptoms was 6 months to 2 years. Only one case had a long-standing history of 8 years. The vascular tumors occurred most commonly in ovary (six), followed by vulva (two), and one each in cervix and vagina. Clinical diagnoses ranged from cystadenoma in ovarian tumors to endocervical polyp in cervical tumor. Histologically, all were benign vascular neoplasms, ranging from hemangioma (five), lymphangioma (one), lymphangioma circumscriptum (one) to angiomatosis (two) and arteriovenous malformation (one). Thus, we conclude that vascular lesions in FGT can present with symptoms similar to epithelial malignancies and may lead to unwarranted radical surgery. Vascular lesions of cervix and vulvovaginal region pose special problem during pregnancy. Risk of Kasabach–Merritt coagulopathy has to be considered in larger vascular tumors. Most of these cases can be treated by surgery.

Cancer of the external genitals is up to 8 % in the overall structure of the incidence of malignant neoplasms of female genital organs. Under our observation there were 92 patients with vulvar dystrophy and suspected cancer. The effectiveness of treatment of vulvar dystrophy (VIN I-II degree) by the method of photodynamic therapy (PDT) 45.8±4.7%. However, dysplasia II - III degree, sclerotic changes with the formation of pronounced horn scales prevents the full PDT and recurrence of the disease. Reconstructive plastic surgery was performed using cryoapplication and « Harmonic» apparatus to reduce blood loss and duration of lymphorrhoea in the postoperative period. The use of new reconstructive plastic surgery, including with the use of abdominal skin and fascial flap combined with vascularized lower segments of the rectus muscles), have helped to reduce complications, improve cosmetic effect (patent for invention № 2580665 from 11.11.14).

Background / Aim: Functional imaging, including diffusion-weighted magnetic resonance imaging (DWI MRI) and ADC map, provides promising results in discrimination benign from malignant pelvic and inguinal lymph nodes in patients with gynecological malignancies. Aim of the study was to assess diagnostic performances of DWI in differentiation between benign and malignant pelvic and inguinal lymph nodes in patients with gynecological malignancies. Methods: The prospective clinical study was conducted at Clinical Center of Vojvodina from 2013 to 2016, comprising 80 patients with malignant gynecological tumors. Preoperatively, all patients underwent MRI examination, followed by standard surgical treatment with complete pelvic and/or inguinal lymphadenectomy. Histopathological examination of surgically removed material and lymph nodes separated in pelvic and inguinal anatomic groups was performed after the surgery. Results: The total of 2320 of lymph nodes were mapped and histopathologically examined in 80 patients included in the study. Metastases in lymph nodes were histopathologically confirmed in 28 patients (35%). Measured ADC values were significantly lower in metastatic (mean ? SD, ADC: 0.8725 x 10-3 mm2/s ? 0.0125) than benign lymph nodes (mean ? SD, ADC: 1.116 x 10-3 mm2/s ? 0.1848; P=0.001). If ADC value of 0.860 x 10- 3 mm2 / s is determined as a cut off value for discrimination between benign and malignant lymph nodes, DWI sensitivity was 89%, specificity 85% and overall accuracy was 86%. Combination of ADC value criteria and size-based criteria yields MRI the following diagnostic performances in discrimination between benign and malignant lymph nodes: sensitivity 95%, specificity 92%, overall accuracy 92.5%, positive predictive value 46% and negative predictive value 99.6%. Conclusion: DWI MRI sequence is fast, simple, noninvasive method which aids significantly to MRI diagnostic performances in discrimination between benign and malignant pelvic and inguinal lymph nodes.

ObjectiveAngiosarcomas are aggressive, malignant soft tissue neoplasms of endothelial origin and occur rarely in the female genital tract. There is lack of consensus on risk factors for poor outcome and optimal treatment. To this end, we performed a clinicopathologic review and survival analysis.MethodsWe report a case of a woman with an angiosarcoma of the vagina. Published English literature was reviewed for angiosarcomas of the vulva, vagina, uterus, and ovary. Survival was evaluated by using Kaplan-Meier analysis and the effect of clinical and demographic variables on survival by using Cox regression analysis.ResultsA total of 51 patients were identified with a median age of 47 years (range, 17–87 years). Two of the patients had an angiosarcoma of the vulva; 2 had an angiosarcoma of the vagina; 18 had an angiosarcoma of the uterus, and 29 had an angiosarcoma of the ovary. Five-year overall survival was 27% (SE, 8%). Most patients presented with locoregional disease, having surgery as their primary intervention. Overall, adjuvant therapy significantly improved survival (hazards ratio, 0.17; 95% confidence interval, 0.05–0.59; adjusted for age and tumor size). Adjuvant treatment consisted of radiotherapy for angiosarcomas of the vulva, vagina, and uterus and chemotherapy for ovarian angiosarcomas. Subgroup analysis of the female genital tract site was hampered by the small number of cases.ConclusionsThis review supports the use of surgical and adjuvant radiotherapy for angiosarcomas of the vulva, vagina, and uterus. Cytoreductive surgery and adjuvant chemotherapy remain the primary treatment of angiosarcomas of the ovary.

Background and Objectives. Angioleiomyoma is a benign perivascular neoplasm commonly involving subcutaneous tissue of extremities, head, and trunk region. They rarely involve the female genital tract. This study analyses clinicopathological features of 6 cases of uterine angioleiomyoma. Methods. Routine sections of 6 cases were reviewed and immunohistochemical markers namely muscle-specific actin, h-caldesmon, desmin, CD10, WT-1, HMB-45, and melan-A were done. Results. Of the 6 cases, 4 cases had tumor involving the corpus and 2 cases had tumor in the cervix. Grossly, all tumors had a whorled and congested cut surface. Microscopic examination of all the cases revealed circumscribed neoplasms composed of interlacing fascicles of benign perivascular smooth muscle cells with evenly distributed slit-like blood vessels (solid variant) along with vessels exhibiting thick muscular walls with swirling pattern (venous variant). In only 2 cases many dilated vessels were seen (cavernous variant). Immunohistochemically, all cases were positive for muscle-specific actin, h-caldesmon, and desmin. All cases were negative for CD10 and WT-1 ruling out endometrial stromal tumor and were negative for HMB-45 and melan-A ruling out perivascular epithelioid cell tumor (both endometrial stromal tumor and perivascular epithelioid cell tumor have prominent vessels but have different histomorphology). In all cases, surgical excision was curative and there were no intraoperative or postoperative complications. Follow-up of all the cases has been unremarkable. Conclusion. As the World Health Organization has not included angioleiomyoma in the classification of mesenchymal tumors of uterine corpus and cervix, we recommend that it should be included in the classification.

The involvement of the ovary in lymphomatous processes is rare. However, in the female genital tract, the ovary is a frequent site to be involved by the hematological malignancies. Involvement of the ovary by malignant lymphoma can be primary or secondary and is discovered incidentally during a workup for abdominal or pelvic complaints. Most commonly occurring ovarian lymphoma is diffuse large B cell type, whereas the Precursor B Cell Lymphoblastic Lymphomas are extremely rare and previously only 5 cases have been reported. Here, we report a case of clinically suspected malignant ovarian tumor involving bilateral ovaries, which was diagnosed as a primary precursor B-LBL after surgery in a young female. This case highlights the need for careful evaluation of radiologic and morphologic features along with an extensive immunohistochemical panel to arrive at the correct final diagnosis to guide the chemotherapy. Keywords: Non-Hodgkin Lymphoma; Primary Ovarian Precursor B-Cell Lymphoblastic Lymphoma; Primary ovarian lymphoma; Primary ovarian tumors

Endometrial carcinoma is the most common neoplasia of female genital tract. The prognosis of early stage disease (FIGO I and FIGO II) is excellent: recurrence after surgery is less than 15%, most of which are reported within 3 years after primary treatment. Herein we report a case of late rectal recurrence from FIGO Ib endometrial adenocarcinoma. Patient had also familiar and personal history of colonic adenocarcinoma and previous findings of microsatellite instability (MSI); molecular analysis evidenced heterozygotic somatic mutation in MLH1 gene. Twenty-eight years after hysterectomy and bilateral salpingoovariectomy, a rectal wall mass was detected during routine colonoscopy. Patients underwent CT scan, pelvic MRI, and rectal EUS with FNA: histopathological and immunohistochemical analysis revealed differentiated carcinoma cells of endometrial origin. No neoadjuvant treatment was planned and low rectal anterior resection with protective colostomy was performed; histology confirmed rectal lesion as metastasis from endometrial carcinoma. Recurrence of early stage endometrial carcinoma after a long period from primary surgery is possible. It is important to keep in mind this possibility in order to set a correct diagnostic and therapeutic algorithm, including preoperative immunohistochemical staining, and to plan a prolonged follow-up program.

<p> Female Genital Cosmetic Surgery (FGCS) is a burgeoning area of developing cosmetic surgery in the U.S., Britain, and Australia. Hotly debated, the procedure is caught up in cultural discourses of medicalization, on the one hand (arguing for the necessity of such procedures to correct a &ldquo;defect&rdquo; in female anatomy), and, on the other, condemnations of the practice as yet another market invention to capitalize on women&rsquo;s traditional anxieties regarding beauty, especially with regard to genital anatomy. This dissertation situates FGCS historically and culturally within practices of neoliberal capitalism, new surgical technologies, changes in U.S. healthcare systems, increased bodily surveillance and advances in media technology, and a tradition of the development and use of standardized systems of classification within practices of Western medicine. It then illustrates how these factors work in concert to produce &ldquo;defective&rdquo; bodies and the technologies marketed as necessary to fix them.</p><p>

<p>Between one hundred and one hundred and forty million young girls around the world have reportedly been subjected to some form of genital excision during 2005. Approximately three million young girls are at risk every year of undergoing this harmful procedure (WHO, 2008). Female genital mutilation is reported to occur, and is expected to continue occurring in twenty-eight African countries (London Safeguarding Children Board, 2007). This paper aims to firstly observe the levels of excision in Africa, and then highlight the underlying factors that encourage certain women to continue this dangerous ritual by analysing national datasets, such as the child info database, obtained form the United Nations Children&rsquo<br>s Fund. By calculating and comparing common indicators, the prevailing ones that dominate FGM appreciation can be further analysed. The final objective will be to suggest strategies that can be put in place to encourage the discontinuation of female genital cutting universally.</p>

xiv, 246 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number.<br>This project is a critical and comparative investigation of Western and non-Western practices of body modification. Situated in the realm of feminist political theory, the project engages the literature and debates concerning embodiment, or the symbolic and concrete meanings of women's bodies. I specifically explore two examples of the physical construction of women's bodies: breast implantation in the United States and female genital cutting (FGC) in Senegal. I demonstrate that each of the practices molds bodies into preexisting naturalized forms. For this project, I conducted eighty in-depth, open-ended, and semi-structured interviews with women and men in twelve different locations in Senegal. Then, I carried out sixty-five in-depth, open-ended, and semi-structured interviews with American men and women from twenty-one different cities. I argue that the information that emerges from looking at body normalization comparatively allows me to make two important claims. The first is that the material that originates from interviews in this comparative study disrupts existing hegemonic discourse on sex-based body modifications. In particular, the comparative findings challenge the viewpoint that espouses a "Western women are free, African women are oppressed" binary. Second, examining FGC in Senegal alongside breast implantation in the US can uncover normalization that is invisible within social fields, or in the lives of women and men. Normalization is hard to see when in it, but easier to see if an individual steps outside of herself, her context, and her patriarchy. Thus, though many women do not recognize the normalizing structures within their own lives, they often are able to see these hegemonic structures in the lives of others. Women stepping outside of their own contexts can provide fresh, critical eyes that recognize embedded normalizations and oppression in other contexts. Further, this realization also can push them to return that critical gaze onto their own environment, which is the beginning of locating mechanisms of control within their own field. The construction of sex and the imprinting of gender norms upon bodies are manifestations of regulation and normalization that occur within socio-cultural contexts, and which individuals can potentially locate through a comparative conversation of this type.<br>Committee in charge: Dennis Galvan, Chairperson, Political Science; Julie Novkov, Member, Political Science; Leonard Feldman, Member, Political Science; Stephen Wooten, Outside Member, Anthropology

The swedish law against female genital mutilation (FGM) prohibits procedures that removes parts of the female genitalia and thereby makes permanent changes in the body. The problem with the wording of the law is that it may also apply to the western phenomenon cosmetic genital surgery. This paper therefore examines if cosmetic genital surgery should be covered by the swedish law against FGM, by making a critical comparing analysis. The paper begins with comparing FGM with cosmetic genital surgery to prove that there are more similarities than differences between the procedures. By using the theoretical perspectives universalism and postcolonialism, the paper then examines why, particularly in the West, there is a different approach to FGM than to cosmetic genital surgery, regardless of the similarities of the procedures. Further the paper also examines consent and why consent to FGM is seen as illegitimate while consent to cosmetic genital surgery is seen as legitimate. On basis of the critical comparing analysis the paper then argues: that the procedures cosmetic genital surgery and FGM are very much alike; that cosmetic genital surgery is accepted over FGM because it is more familiar in the West and; that consent should be as illegitimate when given to cosmetic genital surgery as when given to FGM. Thus the conclusion of the paper is that cosmetic genital surgery should be covered by the swedish law against FGM.

Trata-se de um estudo qualitativo que teve como objetivo analisar se a sexualidade é uma das dimensões do cuidado de enfermagem nas mulheres com câncer ginecológico e mamário, num hospital universitário. A coleta de dados foi realizada empregando-se como fontes de informação a entrevista individual semiestruturada. Foram entrevistadas 16 profissionais da equipe de enfermagem, sendo nove alocadas na Seção de Enfermagem da Unidade de Ginecologia e sete no Ambulatório de Mastologia e Oncologia Ginecológica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Utilizouse o referencial metodológico da análise de conteúdo, e o suporte teórico de análise dos dados foi a sexualidade como construção sociocultural. Os dados foram codificados, inicialmente, em dois núcleos de sentido. A partir desses dois núcleos de sentido, foram construídas quatro unidades temáticas: \"A doença e a sexualidade da mulher: reconhecendo o problema\"; \"A sexualidade como dimensão do cuidado de enfermagem\"; \"Identificando barreiras na abordagem da sexualidade\" e \"Reconhecendo a necessidade de reestruturação da assistência prestada\". No primeiro núcleo temático, destacaram-se as percepções das profissionais de enfermagem em relação ao comprometimento da sexualidade da mulher acometida pelo câncer ginecológico e mamário. Reconhecendo que a vaidade é inerente ao sexo feminino e que as mulheres dão muita importância para a aparência física, foram discutidas as dificuldades apresentadas em viver com o corpo mutilado, bem como as repercussões dessas alterações físicas nas relações conjugais. No segundo tema, exploraram-se as práticas assistenciais que incluem a temática sexualidade. As profissionais de enfermagem entrevistadas incluem a dimensão da sexualidade no cuidado de forma não sistematizada, o que na maioria das vezes não dá identidade às suas práticas e elas passam a ser descontinuadas. Depreende-se que a abordagem da sexualidade pode ser feita de forma irreverente, bem como pode ser beneficiada por certas condições. O terceiro tema enfoca as barreiras mencionadas como impeditivas da abordagem da sexualidade dentro das práticas adotadas. Essas barreiras dizem respeito ao modelo de saúde, às características da dinâmica institucional e às interpretações sociais da sexualidade, sendo reconhecidas como moduladoras das ações. Na construção do quarto tema, consideraram-se as perspectivas de mudança na assistência prestada, pautadas nas reflexões e propostas mencionadas pelas profissionais de enfermagem. A reestruturação que se almeja passa por mudanças na formação, nos valores pessoais e profissionais, assim como pelo reconhecimento das possibilidades de intervenção. Este estudo apresenta limitações por tratar de um tema complexo como a sexualidade. Entretanto as considerações realizadas, a respeito do cuidado prestado pela equipe de enfermagem, instigam à reflexão e à busca por novos paradigmas assistenciais. As discussões não se esgotam e novos estudos são necessários, inclusive dirigidos à própria mulher acometida pela doença, possibilitando confrontar os pontos de vistas em relação à problemática da sexualidade.<br>This qualitative study aimed to analyze if the sexuality is one of the dimensions of nursing care for women with gynecological and breast cancer assisted at a university hospital. Data collection was performed using semi-structured individual interview as sources of information. 16 professionals of the nursing team were interviewed; being nine allocated in the Nursing Section of the Gynecology Unit and seven in the Mastology and Gynecological Oncology Outpatient Clinic of the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School. The content analysis methodology was used and the theoretical support for data analysis was sexuality as socio-cultural construction. Data were coded initially in two cores of meaning. From these two cores of meaning, four thematic units were built: \"Disease and sexuality of women: recognizing the problem\", \"Sexuality as a dimension of nursing care\", \"Identifying barriers in addressing sexuality\", and \"Recognizing the need for restructuring assistance\". In the first thematic core, the perceptions of nursing staff in relation to impairment of the sexuality of women affected by gynecological and breast cancer were highlighted. Recognizing that vanity is inherent in female nature and that women give much importance to physical appearance, the difficulties faced in living with the mutilated body as well as the impact of these physical changes in marital relations were discussed. In the second theme, the care practices that include sexuality were explored. The nursing professionals, who were interviewed, include the issue of sexuality in care in a nonsystematic manner, which most often does not give identity to their practices that become discontinued. It infers that the approach of sexuality can be irreverent and can be benefited in certain conditions. The third theme focuses on the barriers mentioned as hindering the approach of sexuality within the practices adopted. These barriers relate to the health model, to the characteristics of institutional dynamics and to the social interpretations of sexuality, being recognized as modulators of the actions. In the development of the fourth theme, the perspectives for change in assistance were considered, guided by reflections and proposals mentioned by the nurse professionals. The wanted restructuring go through changes in the development, in the personal and professional values as well as through the recognition of the possibilities of intervention. This study has limitations because it deals with a complex subject such as sexuality. However the considerations made about the care provided by nursing staff instigate the reflection and search for new paradigms of care. The discussions are not limited and further studies are needed, including those directed to the woman affected by the disease, making it possible to confront the views regarding the issue of sexuality.

Beschneidung umfasst einschränkende, genitalverändernde und -normierende Eingriffe. Zu unterscheiden sind unter anderem die Vorhautbeschneidung bei Jungen sowie Genitalbeschneidungen bei Mädchen in christlichen, islamischen und jüdischen Traditionen, medizinisch indizierte Praxen, genitale Schönheitschirurgie und genitalvereinheitlichende Behandlungen intergeschlechtlicher Neugeborener. Letztere sind wie die religiös motivierten Eingriffe Thema anhaltender rechtlicher und ethischer Debatten.

Os sarcomas uterinos são tumores mesodérmicos raros que compreendem cerca de 3% de todos os cânceres nesse órgão. Apresentam diversidade histológica, comportamento agressivo, disseminação precoce e altas taxas mortalidade. Recentemente, os carcinossarcomas (CS) foram reclassificados histologicamente como carcinomas. Neste trabalho, os CS foram incluídos na casuística tanto para fins de comparação de seu componente mesenquimal, como por ainda fazerem parte da maioria dos estudos sobre sarcomas de corpo uterino e também da última classificação da WHO (Word Health Organization). Devido à sua diversidade e raridade, não há consenso relacionado aos fatores de risco para pior prognóstico e tratamento adequados para esses tumores. Informações sobre seus perfis gênicos e proteicos poderiam contribuir na caracterização de marcadores moleculares que auxiliassem no diagnóstico e prognóstico desses tumores, bem como no entendimento de sua biologia e comportamento clínico. Assim, nos propusemos a avaliar a presença de alterações gênicas nesses tumores, utilizando um painel de 409 genes, oncogenes e supressores de tumor, frequentemente mutados em tumores sólidos. Para isso, foram selecionadas 66 amostras, das quais 14 foram sequenciadas, incluindo, 5 carcinossarcomas (CCS), 4 leiomiossarcomas (LMS), 4 sarcomas de estroma endometrial (SEE) e 1 adenossarcoma (ADS). As reações foram realizadas utilizando a plataforma Ion Proton System (ThermoFisher) de Sequenciamento de Nova Geração. Nas 14 amostras encontramos 27 LoF e 40 mutações missenses, numa média de 39 inserções e 52 deleções por amostra, totalizando 70 mutações. Dessas, 25 encontram-se no banco de dados COSMIC. Os genes mais comumente mutados em nossa amostragem foram: TP53 (50%), KMT2D (36%), ATM (29%), DICER1 (21%), PIK3CA (21%), TRRAP (21%). Nosso objetivo principal era encontrar mutações específicas para cada subtipo histológico, porém apenas os SEEs (PDE4DIP) e os CCS (ERBB4 e PIK3CA) tiveram mutações especificas. Em outra análise, observamos que todos os subtipos histológicos compartilham o gene KMT2D. Embora não tenha sido possível estabelecer um perfil mutacional para cada subtipo histológico avaliado, nossos resultados abrem perspectivas para uma nova linha de pesquisa nos sarcomas de corpo do útero e certamente contribuem para um melhor entendimento dessas neoplasias<br>Uterine sarcomas are rare mesodermal tumors that comprise about 3% of all cancers in this organ. They present histological diversity, aggressive behavior, early dissemination and high mortality rates. Recently, carcinosarcomas (CCS) were histological reclassified as carcinomas. Here, we have included them in our series for purposes of comparison of the mesenchymal component and also because these tumors still form part of both the majority of studies and the WHO\'s latest classification for uterine sarcomas (Word Health Organization). Because of their diversity and rarity, there is no consensus regarding the risk factors for poor prognosis and appropriate treatment for these tumors. Thus, information about their gene and protein profiles can help in the diagnosis and prognosis of these tumors, as well as in the understanding of their biology and clinical behavior. We performed the New Generation Sequencing of 14 samples of uterine sarcomas (5 CCS, 4 LMS, 4 SEE and 1 ADS, using the Ion Proton System platform (ThermoFisher).) Among the 14 samples, we found 27 LoF (loss of gene function) and 40 missense mutations, with a mean of 39 insertions and 52 deletions per sample, totaling 70 mutations, 25 described in the COSMIC database. The most commonly mutated genes in our sample were TP53 (50%), KMT2D (36%), ATM (29%), DICER1 (21%), PIK3CA (21%), TRRAP (21%).Our main objective was to find specific mutations for each histological subtype, but only SEEs (PDE4DIP) and CCS (ERBB4 and PIK3CA) had specific mutations. In another analysis, we observed that all the histological subtypes share the KMT2D gene, which will be studied in future analyzes. Others analyzes, using a custom panel, are necessary to understand these mutations and its biological implication in uterine carcinosarcoma and sarcomas

UVOD: Maligni tumori reproduktivnih organa nalaze se među vodećim uzrocima obolevanja i umiranja od malignih bolesti žena, kako u svetu, tako i u Srbiji. Jedan od najvažnijih puteva &scaron;irenja ovih bolesti je limfogeni, a konvencionalna radiolo&scaron;ka dijagnostika limfnih čvorova kod ovih pacijentkinja je neprecizna. Funkcionalna radiolo&scaron;ka dijagnostika, uključujući i magnentno rezonantnu sekvencu difuzionog kretanja (DWI) i iz nje izvedenu ADC mapu koja omogućava kvantitativnu analizu difuzionih osobina unutar limfnog čvora, daju obećavajuće rezultate u mogućnosti razlikovanja benignih od maligno izmenjenih limfnih čvorova male karlice i ingvinuma kod pacijentkinja obolelih od malignih tumora ženskih polnih organa. CILJ: Cilj studije je 1. utvrđivanje dijagnostičkih mogućnosti magnetnorezonantne sekvence difuzionog kretanja (DWI) u razlikovanju benignih od maligno izmenjenih limfnih čvorova male karlice i ingvinuma kod pacijentkinja obolelih od malignih tumora ženskih polnih organa, poređenjem preoperativno načinjenog magnetnorezonantnog pregleda i postoperativnog patohistolo&scaron;kog nalaza; 2. analiza povezanosti osobina metastatski izmenjenih limfnih čvorova na sekvenci difuzionog kretanja (DWI) i gradusa primarnog tumora, i 3. utvrđivanje uticaja tehničkih karakteristika sekvenci difuzinonog kretanja (DWI) na magnetnorezonantu procenu metastatske infiltracije karličnih i ingvinalnih limfnih čvorova i postoperativnog patohistolo&scaron;kog nalaza. MATERIJAL I METODE: Istraživanje je sprovedeno u periodu od 2013. do 2016.godine, kao prospektivna klinička studija u Centru za radiologiju, na Operativnom odeljenju Zavoda za ginekologiju, Klinike za ginekologiju i aku&scaron;erstvo i u Zavodu za patologiju Kliničkog Centra Vojvodine u Novom Sadu. Studija je obuhvatila 80 pacijentkinja obolelih od malignih tumora vulve, vagine, grlića materice, tela materice i jajnika. Na osnovu lokalizacije malignog tumora sve ispitanice su razvrstane u 5 grupa: grupa A- 3 žene obolele od carcinoma vulve, grupa B- 1 žena obolela od karcinoma vagine, grupa C-32 pacijentkinje obolele od karcinoma grlića materice, grupa D- 30 pacijentkinja obolelih od malignih tumora tela materice i grupa E- 14 žena obolelih od malignih tumora jajnika. Procena stadijuma bolesti definitivno je izvr&scaron;ena posle operacije na osnovu histopatolo&scaron;kog pregleda kompletnog hirur&scaron;kog materijala uključujući i pregled uklonjenih limfnih čvorova na osnovu aktuelne FIGO klasifikacije stadijuma bolesti zasebno za svaku pojedinačnu lokalizaciju malignog tumora. Svim pacijentkinjama je preoperativno načinjen magnetnorezonantni pregled male karlice na uređaju za magnetnu rezonancu 1.5 T General Electric Signa HDx u Centru za radiologiju, Kliničkog centra Vojvodine. Kod istih pacijentkinja naknadno je sprovedeno standardno hirur&scaron;ko lečenje po protokolu hirur&scaron;kog lečenja za dato maligno ginekolo&scaron;ko oboljenje sa karličnom i/ili ingvinalnom limfadenektomijom. Postoperativno je izvr&scaron;ena patohistolo&scaron;ka analiza hirur&scaron;ki uklonjenog materijala i limfnih čvorova razdvojenih po anatomskim grupama u karlici i ingvinalnoj regiji. REZULTATI: Ukupno 2320 limfnih čvorova je mapirano i patohistolo&scaron;ki pregledano kod 80 pacijenata. Metastaze u limfnim čvorovima patohistolo&scaron;ki su verifikovane kod 28 pacijenata (35%). Kod ovih 28 (35%) pacijentkinja, 152 (27,28%) od ukupno 557 limfnih čvorova bilo je metastatski izmenjeno na patohistolo&scaron;kom pregledu. Metastaze u limfnim čvorovima utvrđene su kod 2 pacijentkinje (7,14%) sa karcinomom vulve, 11 (39,28%) sa karcinomom cerviksa, 9 (32,14%) sa tumorima tela materice, te 6 (21,42%) sa tumorima jajnika. Od 28 pacijentkinja kod kojih su utvrđeni pozitivni limfni čvorovi, 14 pacijentkinja (50%) imalo je dobro diferentovan primarni tumor, 8 (28,57%) srednje diferentovan, dok je 6 (21,42%) imalo lo&scaron;e diferentovan primarni tumor. Od ukupno 152 metastatski izmenjena limfna čvora u na&scaron;oj studiji, 8 limfnih čvorova (5,26%) pripadalo je ingvinalnoj grupi od čega 5 (3,289%) povr&scaron;noj ingvinalnoj, a 3 ( 1,97%) dubokoj ingvinalnoj grupi, 8 (5,26%) parametrijalnoj grupi, 48 (31,58%) opturatornoj grupi, 40 (26,31%) spolja&scaron;njoj ilijačnoj grupi, 36 (23,684%) unutra&scaron;njoj ilijačnoj grupi, dok je 12 (7,89%) pripadalo zajedničkoj ilijačnoj grupi karličnih limfnih čvorova. Kraći prečnik limfnog čvora nije pokazao značajnu razliku između metastatskih ( mean &plusmn; SD, 8,3 &plusmn; 5.4 mm, raspon , 4.5-30 mm ) i limfnih čvorova koji nisu bili metastatski izmenjeni ( 6,3 mm &plusmn; 1,5 , 4,5-9,6 mm ; P= 0,191 ). Izmerena ADC vrednost bila je značajno niža kod metastatski izmenjenih limfnih čvorova (mean &plusmn; SD , ADC: 0,8725 x 10-3 mm2/s &plusmn; 0,0125) nego kod limfnih čvorova koji nisu bili metastatski izmenjeni (mean &plusmn; SD, ADC: 1,116 x 10- 3 mm2/s &plusmn; 0,1848; P=0,001). Prosečne vrednosti ADC kod b =800 s/mm2 i b =1200 s/mm2 nisu se značajno razlikovale između metastaski izmenjenih limfnih čvorova (mean &plusmn; SD, ADC: 0,8575 &plusmn; 0,0125 x 10-3 mm2/s, ADC:0,8859 &plusmn; 0,0125 x 10-3 mm2/s) i limfnih čvorova koji nisu metastatski izmenjeni (mean &plusmn; SD, ADC:1,0345 &plusmn; 0,1222 x 10-3 mm2/s, ADC:1,1125 &plusmn; 1638 x 10-3 mm2/s; P =0,657 i P = 0,877). Ako se koristi vrednost ADC od 0,860 x 10- 3 mm2 / s kao kritična vrednost za razlikovanje metastatskih od limfnih čvorova koji nisu metastatski izmenjeni, senzitivnost DWI MR iznosila je 89%, specifičnost 85% i ukupna tačnost 86%. Pozitivna prediktivna vrednost (PPV) DWI MR u detekciji limfnih metastaza u karličnoj i ingvinalnoj regiji iznosila je 30%. Negativna prediktivna vrednost (NPV) testa iznosila je 99%. Pozitivna prediktivna vrednost (PPV) MR zasnovana na kriterijumu ADC vrednosti značajno je veća u odnosu na sve kriterijuma veličine (P &lt; 0,001). Negativna prediktivna vrednost MR zasnovanoj na kriterijumima veličine limfnog čvora i na ACD vrednosti nisu se međusobno statistički značajno razlikovali (P&lt;0,05). Performanse dijagnostičke metode (MR) bile su značajno bolje za minimalnu ADC vrednost od svih kriterijuma baziranih na veličini limfnih čvorova ( P=0.001 za minimalnu ADC vrednost u odnosu na sve druge kriterijume). MRI na osnovu definisanog modela koji kombinuje kriterijum ADC vrednosti sa kriterijumom veličine ima sledeće dijagnostičke performanse za diferencijaciju malignih od benignih limfnih čvorova: senzitivnost od 95%, specifičnost 92%, sveukupna tačnost od 92,5%, pozitivnu prediktivnu vrednost od 46% i negativnu prediktivnu vrednost od 99.6%. ZAKLJUČAK: Kriterijum veličine limfnog čvora nije dovoljno precizan pokazatelj metastatske invazije limfnih čvorova. Sekvenca difuzionog kretanja (DWI) uvek se mora analizirati zajedno sa ADC mapom i visoko rezolutivnim T1 i T2 otežanim magnetnorezonantnim sekvencama. Studijom je dokazan visok stepen povezanosti između preoperativnog određivanja metastaske infiltracije karličnih i ingvinalnih limfnih čvorova malignih tumora ženskih polnih organa primenom sekvence difuzionog kretanja (DWI) i postoperativnog patohistolo&scaron;kog nalaza. Uz graničnu ADC vrednost od 0,860 x 10-3 mm2/ s, senzitivnost MRI DWI u otkrivanju metastatskih limfnih čvorova iznosi 89%, a specifičnost 85%. Kombinacija ADC vrednosti i morfolo&scaron;kih karakteristika limfnih čvorova konvencionalnim magnentno rezonantnim pregledom je najprecizniji prediktor postojanja metastatske infiltracije karličnih i ingvinalnih limfnih čvorova kod pacijentkinja sa malignim tumorima ženskih polnih organa. Tehničke karakteristike sekvenci difuzionog kretanja (DWI) u smislu razlike u visokim b vrednostima ne utiču na magnentno rezonantnu procenu metastatske infiltracije karličnih i ingvinalnih limfnih čvorova kod pacijentkinja sa malignim tumorima ženskih polnih organa. Studijom nije utvrđena statistički značajna razlika između preoperativno utvrđenih ADC vrednosti metastatski izmenjenih limfnih čvorova i stepena histolo&scaron;ke diferencijacije ovih tumora. Sekvenca difuzionog kretanja (DWI) je brza, jednostavna, neinvazivna metoda koja značajno doprinosi dijagnostičkim mogućnostima magnetne rezonance u razlikovanju benignih od malignih limfnih čvorova male karlice i ingvinuma.<br>INTRODUCTION: Malignant tumors of reproductive organs are among the leading causes of morbidity and mortality in women, both in Serbia and worldwide. Lymphatic spread is one of the most important pathways of tumor dissemination. However, conventional lymph node imaging in these patients is imprecise. Functional imaging, including diffusion-weighted magnetic resonance imaging (DWI MRI) and derived ADC map which allows quantitative analysis of diffusion parameters within a lymph node, provide promising results in discrimination benign from malignant pelvic and inguinal lymph nodes in patients with gynecological malignancies. AIM: Aim of the study was: 1. To assess diagnostic performances of DWI MRI in differentiation between benign and malignant pelvic and inguinal lymph nodes in patients with gynecological malignancies, by comparison of preoperative magnetic resonance and postoperative histopathological findings. 2. To analyze correlation between DWI characteristics of metastatic lymph nodes and grade of the primary tumor, and 3. To evaluate the influence of technical characteristics of DWI sequences on MR assessment of metastatic pelvic and inguinal lymph node and postoperative histopathological findings. MATERIAL and METHODS: The prospective clinical study was conducted in Center for Radiology, Surgery Department of Clinic for Gynecology and Obstetrics and Pathology Department of Clinical Center of Vojvodina from 2013 to 2016. It comprised 80 patients with malignant tumors of vulva, vagina, uterine cervix and body and ovaries. Based on the localization of the tumor, all patients were divided into 5 groups: group A-3 patients with vulvar cancer, group B- 1 patient with vaginal cancer, group C- 32 patients with cervical cancer, group D- 30 patients with uterine body tumors and group E- 14 patients with malignant ovarian tumors. Staging of the disease was performed after surgery based on histopathological examination of complete surgical specimen, including examination of removed lymph nodes, based on current FIGO classification separately for each primary tumor location. Preoperatively, all patients underwent MRI examination (1.5 T General Electric Signa HDx) at Center for Radiology, Clinical Center of Vojvodina. The same patients underwent standard surgical treatment according to the treatment protocol regarding the tumor type and stage, with complete pelvic and/or inguinal lymphadenectomy. Histopathological examination of surgically removed material and lymph nodes separated in pelvic and inguinal anatomic groups was performed after the surgery. RESULTS: The total of 2320 of lymph nodes were mapped and histopathologically examined in 80 patients included in the study. Metastases in lymph nodes were histopathologically confirmed in 28 patients (35%). In these 28(35%) patients, in 152 (27,28%) out of 557 lymph nodes histopathological examination confirmed metastases. Lymph node metastases were confirmed in 2 patients (7.14%) with vulvar cancer, 11 (39.28%) with cervical cancer, 9 (32.14%) with uterine body tumors and 6 (21.42%)patients with ovarian tumors. In 28 patients with positive lymph nodes, 14 patients (50%) had well differentiated primary tumor, 8 (28.57%) moderately differentiated, while 6 (21.42%) patients had poorly differentiated primary tumor. Out of 152 metastatic lymph nodes in our study, 8 lymph nodes (5.26%) were inguinal ( 5 (3.289%) superficial inguinal and 3 ( 1.97%) deep inguinal group), 8 (5.26%) were parametrial, 48 (31. 58%) obturatory, 40 (26.31%) external iliac, 36 (23.684%) internal iliac, while 12 (7. 89%) belonged to common iliac pelvic lymph nodes group. Shorter lymph node axis did not show significant difference between metastatic ( mean &plusmn; SD, 8.3 &plusmn; 5.4 mm, range , 4.5-30 mm ) and benign lymph nodes ( 6.3 mm &plusmn; 1.5 , 4.5-9.6 mm ; P= 0.191 ). Measured ADC values were significantly lower in metastatic (mean &plusmn; SD , ADC: 0.8725 x 10-3 mm2/s &plusmn; 0.0125) than benign lymph nodes (mean &plusmn; SD, ADC: 1.116 x 10-3 mm2/s &plusmn; 0.1848; P=0.001). Mean ADC values at b =800 s/mm2 and b =1200 s/mm2 did not differ significantly between metastatic (mean &plusmn; SD, ADC: 0.8575 &plusmn; 0.0125 x 10-3 mm2/s, ADC:0.8859 &plusmn; 0,0125 x 10-3 mm2/s) and benign lymph nodes (mean &plusmn; SD, ADC:1.0345 &plusmn; 0.1222 x 10-3 mm2/s, ADC:1.1125 &plusmn; 1638 x 10-3 mm2/s; P =0.657 i P = 0.877). If ADC value of 0.860 x 10- 3 mm2 / s is determined as a cut off value for discrimination of benign and malignant lymph nodes, DWI MRI sensitivity was 89%, specificity 85% and overall accuracy was 86%. Positive predictive value (PPV) of DWI MR in detection of pelvic and inguinal lymph node metastases was 30%. Negative predictive value (NPV) of the test was 99%. MRI PPV based on ADC value criteria was significantly higher compared to all size-based criteria (P &lt; 0,001). MRI NPV based on size based and ADC values criteria did not differ significantly (P&lt;0,05). Performances of diagnostic method (MRI) were significantly better for minimal ADC value compared to all lymph node size-based criteria ( P=0.001 for minimal ADC value compared to all other criteria). Combination of ADC value criteria and size-based criteria yields MRI the following diagnostic performances in discrimination between benign and malignant lymph nodes: sensitivity 95%, specificity 92%, overall accuracy 92.5%, positive predictive value 46% and negative predictive value 99.6%. CONCLUSION: Lymph node size is not sufficiently precise criteria for determination of metastatic lymph node involvement. DWI sequence always needs to be evaluated together with ADC map and high resolution T1W and T2W magnetic resonance sequences. The study shows high correlation between preoperative assessment of pelvic and inguinal lymph node metastases from gynecological malignancies using MRI DWI and postoperative histopathological findings. With a cut off ADC value of 0.860 x 10-3 mm2/ s, sensitivity of MRI DWI in metastatic lymph node detection is 89%, while specificity is 85%. Combination of ADC values and morphological lymph nodes characteristics assessed by conventional MRI is the most precise predictor of metastatic pelvic and inguinal lymph node invasion in patients with gynecological malignancies. Technical characteristics of DWI i.e. different high b-values do not influence MR assessment of metastatic pelvic and inguinal lymph node involvement in patients with gynecological malignancies. The study did not confirm statistically significant difference between preoperatively measured ADC valued of metastatic lymph nodes and histological grade of primary tumors. DWI MRI sequence is fast, simple, noninvasive method which aids significantly to MRI diagnostic performances in discrimination between benign and malignant pelvic and inguinal lymph nodes.

Beschneidung umfasst einschränkende, genitalverändernde und -normierende Eingriffe. Zu unterscheiden sind unter anderem die Vorhautbeschneidung bei Jungen sowie Genitalbeschneidungen bei Mädchen in christlichen, islamischen und jüdischen Traditionen, medizinisch indizierte Praxen, genitale Schönheitschirurgie und genitalvereinheitlichende Behandlungen intergeschlechtlicher Neugeborener. Letztere sind wie die religiös motivierten Eingriffe Thema anhaltender rechtlicher und ethischer Debatten.

Genital tract and breast are two most common sites of malignancy in females. Out of the genital tract malignancies, carcinoma cervix is so far found to be the commonest followed by ovary and endometrium. In developed countries, carcinoma cervix incidence is comparatively quite low due to good regular screening of females. One year review of patients was done, who underwent definitive/debulking surgery for a diagnosed malignant pathology of the genital tract, in obstetrics and gynaecology department of Govt medical College and Hospital, Chandigarh. Total 62 patients were operated, most common indication was carcinoma ovary, followed by endometrial cancer, cancer cervix and gestational trophoblastic neoplasia. 166 patients underwent biopsies for suspicious symptoms or the abnormal findings on examination and the patients with final malignancy report were either operated as described above and the inoperable cases were referred to oncotherapy department for further management.

Genital tract and breast are two most common sites of malignancy in females. Out of the genital tract malignancies, carcinoma cervix is so far found to be the commonest followed by ovary and endometrium. In developed countries, carcinoma cervix incidence is comparatively quite low due to good regular screening of females. One year review of patients was done, who underwent definitive/debulking surgery for a diagnosed malignant pathology of the genital tract, in obstetrics and gynaecology department of Govt. medical College and Hospital, Chandigarh. Total 62 patients were operated, most common indication was carcinoma ovary, followed by endometrial cancer, cancer cervix and gestational trophoblastic neoplasia. 166 patients underwent biopsies for suspicious symptoms or the abnormal findings on examination and the patients with final malignancy report were either operated as described above and the inoperable cases were referred to oncotherapy department for further management.

Background: Synchronous primary malignancies of the female genital tract constitute 1.7% of all genital malignancies. Case: A 45-year-old para 5 woman presented with loss of appetite and abdominal distention. Provisional diagnosis of ovarian malignancy was made. Final histopathology of the specimen revealed ovarian papillary serous cystadenocacinoma with cervical leiomyosarcoma. She received chemotherapy. Results: Patient is on regular follow-up. Conclusion: The coexistence of primary neoplasms in the ovary and cervix are rare. A normal appearing organ may have a hidden malignancy. So, every surgical specimen should be subjected to detailed histopathological examination. Also, the possibility of synchronous malignancy elsewhere in body should be kept in mind while working on a genital malignancy.

Ovarian carcinoma usually presents at an advanced stage with diffuse intra abdominal manifestations. Inguinal lymph node metastasis is rare event in ovarian cancer. We report 7 cases who presented with inguinal lymphadenopathy as the initial manifestation between January 2014 to January 2016. All patients underwent tru-cut biopsy from inguinal area. Morphology and IHC were suggestive of ovarian origin or female genital Tract origin. Two patients underwent primary debulking surgery while four patients were managed by neo-adjuvant chemotherapy followed by interval cytoreductive surgery owing to relatively poor performance status at presentation. One patient underwent secondary debulking in which inguinal Lymph node was positive for metastatic deposits.

Haemangiomas of the ovary are very rare neoplasms with a wide age range and present with pain lower abdomen and adenexal mass. Many a times this is an incidental finding on surgery. These neoplasms should be considered in the differential diagnosis of haemorragic ovarian lesion. A 48 yr old female presented to us with pain lower abdomen and adenexal mass. Her routine investigations were normal. Her tumour markers were S. LDH 213, CEA 1.72, CA 125 was 2.3. Ultrasound findings showed a well defined echogenic mass in left ovary measuring 6 x 3.4 cm with no ascitis. Her cervical cytological findings were with in normal limits. Staging laprotomy was done and a bilobed solid ovarian mass was identified on left side. TAH with BSO was done and specimen saved for histopathology that finally showed cavernous haemangioma of ovary. Post op recovery was uneventful with subsequent relief of pain.

Aims: Extra ovarian granulosa cell tumor (GCT) is extremely rare tumor, assumed to arise from the ectopic gonadal tissue along the embryonal route of the genital ridge. A case of extra ovarian granulosa cell tumor of omentum in a 69 year old female presented here. Materials and Methods: A 69 years old postmenopausal, hypertensive female presented with complaints of pain in right lumber and iliac region of one month duration. Pain was off and on and intermittent. The patient had a history of hysterectomy 12 years ago for fibroid uterus. Results: Ultrasound examination of abdomen showed a hypoechoic lesion of size 78.1 mm x 57.3 mm in right iliac fossa with mild thickening of surrounding omentum. Another hypoechoic lesion of size 36.7 mm x 22.9 mm was seen in retroperitoneal region in supero-medial aspect of right kidney. CECT abdomen showed heterogeneously enhanced nodular lesion of size 6.6 x 6.8 cm in right lumbar region, mild thickening of surrounded omentum also seen however there was no evidence of infiltration to bowel loop seen. Uterus was not visualized. PET CT whole body revealed mildly metabolically active enlarged nodes in the bilateral level ib an ii, metabolically active large lobulated heterogeneously enhancing soft tissue density lesion in right lumbar region with non enhancing areas of necrosis. The lesion is closely abutting the anterior abdominal wall musculature antero laterally and small bowel loop medially surrounding mesenty shows increased vascularity and haziness. Colonoscopy findings were normal. Trucut biopsy of mass right lumbar region was positive for malignancy likely Round cell Sarcoma. A provisional diagnosis of retroperitoneal sarcoma of right lumbar region was made. She underwent exploratory laparotomy with excision of tumor. As per Operative findings there was approximately 8 x 7 cm, firm, omental mass present right to midline, arising from under surface of greater omentum. Ovaries were normal. Gross examination of omental mass showed nodular mass measuring 8 x 5 x 6 cm. External surface was multinodular and cut surface was grey brown to grey yellow with solid cystic areas and areas of necrosis. Microscopic examination of specimen showed Extraovarian Adult granulosa cell tumor/metastasis from occult granulose cell tumor. On IHC Vimentin, CK, SMA, Inhibin were positive, Ki67:15%, ER/PR were also positive and are negative for calretinin, thromobomodulin. Extensive necrosis was seen. After that she underwent rexploration and total omenectomy. HPE showed fat necrosis in omentum. All investigation showed no evidence of tumor in ovaries and at any other primary site then the patient finally diagnosed as having Granulosa cell tumor involving only omentum post op stage III C. Then patient was given six courses of chemotherapy with Inj Paclitaxel and Inj Carboplatin three weekly. Now patient is on regular follow up and disease free. Conclusion: Extra ovarian adult granulosa cell tumor of omentum is rare tumor. Multimodal treatment approaches including surgery, multi-agent chemotherapy may provide a survival benefit for patients.