Detection of endometrial precancer by a targeted gynecologic cancer liquid biopsy.

Endometrial cancer is the most common gynecologic malignancy in industrialized countries, and both its incidence and its associated mortality are increasing. The "liquid biopsy" is becoming an important transformative precision oncology tool, but barriers intrinsic to blood sampling have limited its use in early cancer detection. We hypothesized that using a more targeted sample for analysis-namely, a uterine lavage-should provide a more sensitive and specific diagnostic test for endometrial cancer.

Sentinel Lymph Node Ultra-staging as a Supplement for Endometrial Cancer Intraoperative Frozen Section Deficiencies.

For endometrial cancer (EC), most surgeons rely on intraoperative frozen section (IFS) to determine the risk of nodal metastasis and necessity of lymphadenectomy. IFS remains a weak link in this practice due to its susceptibility to diagnostic errors. As a less invasive alternative, sentinel lymph node (SLN) mapping and ultra-staging have gradually gained acceptance for EC.

Responses of advanced directives by Jehovah's Witnesses on a gynecologic oncology service.

Objectives: To review the responses of advance directives signed by Jehovah's Witness patients prior to undergoing surgery at a gynecologic oncology service.

Study Design: A retrospective chart review of gynecologic oncology patients undergoing surgery at a bloodless surgery center from 1998-2007 was conducted. Demographic, pathologic, and clinical data were recorded.

In vitro analysis of cell salvage blood collection with a laparoscopic suction device.

Study Objective: To determine whether cell salvage blood collection with a laparoscopic suction device is inferior to use of a traditional Yankauer suction device.

Design: Prospective, in vitro study.

Setting: Academic teaching hospital.

Bloodless surgery in gynecologic oncology.

Bloodless medicine and surgery is an evolving field in the practice of medicine designed to avoid allogeneic transfusions. Although this field has largely developed in response to the growing needs of Jehovah's Witness patients refusing transfusions, all patients may potentially benefit from the avoidance of transfusions. The applications of bloodless techniques and strategies in the field of gynecologic oncology have been limited until recently, in part because of the generally large blood loss associated with gynecologic cancer surgeries.

Blood salvage use in gynecologic oncology.

Background: Blood salvage allows for collection and processing of surgical blood loss with the eventual reinfusion of washed red blood cells (RBCs) back to the patient. The use of blood salvage in patients undergoing surgery for malignancy is off-label. Controversy exists as to the risk of potential cancer dissemination resulting from the reinfusion of the processed blood, but no data are available to confirm this risk.

Laparoscopy and ovarian cancer: a paradigm change in the management of ovarian cancer?

A MEDLINE search was conducted using the keywords "laparoscopy ovarian cancer," "laparoscopy and borderline ovarian tumors," "advanced stage ovarian cancer," "laparoscopic cytoreduction ovarian cancer," "laparoscopy intraperitoneal catheter," "port-site metastases," and "carbon dioxide pneumoperitoneum." The publications were further limited to English-language articles, those addressing adnexal mass management, early stage ovarian cancer, and advanced stage ovarian cancer treatments. The articles were divided into 4 broad categories: adnexal masses, low malignant potential tumors, early stage ovarian cancer, and advanced ovarian cancer.

Successful placement of a right ventricular assist device for treatment of a presumed amniotic fluid embolism.

Amniotic fluid embolism is a rare and often fatal complication of pregnancy. We report the successful multidisciplinary management of a woman who developed a coagulopathy from a presumed amniotic fluid embolism after forceps-assisted vaginal delivery requiring recombinant factor VIIa, and pulmonary arterial hypertension requiring a right ventricular assist device.

Bloodless surgery in a Jehovah's Witness patient with a 12.7-kg uterine leiomyosarcoma.

Introduction: Bloodless surgery aims to optimize outcomes in patients undergoing surgical procedures who wish to avoid allogeneic transfusion. Using a series of interventions and management strategies related to this goal, patients who were previously considered extremely high risk or inoperable without a blood transfusion can now undergo complex surgical procedures with acceptable outcomes. The techniques of bloodless surgery have been incorporated in order to care for a patient with a large uterine sarcoma with involvement and invasion into adjacent organs.

Complete surgical resection of a 40-cm leiomyosarcoma of the large bowel mesentery.

Introduction: Leiomyosarcoma of the large bowel mesentery is a rare entity and characteristically behaves in an aggressive fashion. Surgical resection is the mainstay of treatment and offers both symptomatic and therapeutic benefit.

Case: We describe the case of a 55-year-old woman who presented with weight loss, increasing abdominal girth and a large solid inhomogenous mass within the abdomen and pelvis demonstrated on a computed tomography (CT) scan.

Renal artery thrombosis following secondary cytoreduction in a patient with ovarian cancer.

Background: In order to successfully perform aggressive cytoreductive surgery for patients with recurrent epithelial ovarian cancer, resection of retroperitoneal disease in close proximity to major vessels is often required.

Case: We describe a case of a 44-year-old female patient with a history of Stage IV carcinoma of the ovary, who underwent a successful secondary debulking procedure. To remove the left para-aortic tumor implant she required complete mobilization of the left kidney, with skeletonization of the left renal artery and vein.

Total laparoscopic radical hysterectomy and pelvic lymphadenectomy using harmonic shears.

Study Objective: To describe the feasibility and outcome of total laparoscopic radical hysterectomy with or without pelvic lymphadenectomy for patients with stage I cervical cancer or severe pelvic endometriosis using harmonic shears as the sole instrument for dissection, division, and maintenance of hemostasis of all major surgical pedicles.

Design: Retrospective review (Canadian Task Force classification II-2).

Setting: University hospital and affiliate institutions.

Post-transplant lymphoproliferative disorder of the cervix.

Background: Post-transplant lymphoproliferative disorder involving the female genital tract is a rare event.

Case: A 67-year-old female status post orthotopic liver transplant 5 years previously for hepatitis B and sarcoidosis presented with vaginal bleeding. Endometrial biopsy revealed a high-grade malignant tumor with immunologic marker studies consistent with lymphoma.

The incidence of port-site metastases in gynecologic cancers.

Objectives: To determine the incidence of port-site metastases in patients undergoing laparoscopic procedures for gynecologic cancers.

Methods: The charts of patients treated by laparoscopy for diagnosis, treatment, or staging of gynecologic cancers by the academic faculty attending physicians were studied from July 1, 1997 to June 30, 2001. No patient without a histological or cytological diagnosis of cancer from the index procedure were included.

Progestin-induced apoptosis in the Macaque ovarian epithelium: differential regulation of transforming growth factor-beta.

Background: Oral contraceptive (OC) use is associated with a reduced risk of ovarian cancer. An OC component, progestin, induces apoptosis in the primate ovarian epithelium. One regulator of apoptosis is transforming growth factor-beta (TGF-beta).