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    Uterine Rupture in Patient with Prior Cesarean Section, Environmental Influence on Its Occurring - Case Report
    (Medical Faculty, Ss Cyril and Methodius University in Skopje, 2020)
    Zlateska, Sofija
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    Zlateska, Aleksandra
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    SUCCOR quality: validation of ESGO quality indicators for surgical treatment of cervical cancer
    (2022-10-03)
    Boria, Felix
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    Chiva, Luis
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    Chacon, Enrique
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    Zanagnolo, Vanna
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    Fagotti, Anna
    Abstract Objective: To evaluate whether compliance with European Society of Gynaecological Oncology (ESGO) surgery quality indicators impacts disease-free survival in patients undergoing radical hysterectomy for cervical cancer. Methods: In this retrospective cohort study, 15 ESGO quality indicators were assessed in the SUCCOR database (patients who underwent radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage 2009 IB1, FIGO 2018 IB1, and IB2 cervical cancer between January 2013 and December 2014), and the final score ranged between 0 and 16 points. Centers with more than 13 points were classified as high-quality indicator compliance centers. We constructed a weighted cohort using inverse probability weighting to adjust for the variables. We compared disease-free survival and overall survival using Cox proportional hazards regression analysis in the weighted cohort. Results: A total of 838 patients were included in the study. The mean number of quality indicators compliance in this cohort was 13.6 (SD 1.45). A total of 479 (57.2%) patients were operated on at high compliance centers and 359 (42.8%) patients at low compliance centers. High compliance centers performed more open surgeries (58.4% vs 36.7%, p<0.01). Women who were operated on at centers with high compliance with quality indicators had a significantly lower risk of relapse (HR=0.39; 95% CI 0.25 to 0.61; p<0.001). The association was reduced, but remained significant, after further adjustment for conization, surgical approach, and use of manipulator surgery (HR=0.48; 95% CI 0.30 to 0.75; p=0.001) and adjustment for adjuvant therapy (HR=0.47; 95% CI 0.30 to 0.74; p=0.001). Risk of death from disease was significantly lower in women operated on at centers with high adherence to quality indicators (HR=0.43; 95% CI 0.19 to 0.97; p=0.041). However, the association was not significant after adjustment for conization, surgical approach, use of manipulator surgery, and adjuvant therapy. Conclusions: Patients with early cervical cancer who underwent radical hysterectomy in centers with high compliance with ESGO quality indicators had a lower risk of recurrence and death.
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    Serous adenocarcinoma of the fallopian tube: a case report
    (Macedonian Association of Pathology, 2016-09)
    Trajkovska, Elizabeta
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    Objective: Primary serous adenocarcinoma of the fallopian tube (PSAFT) is a rare tumor which histologically and clinically resembles epithelial ovarian cancers. Although it has been postulated that both ovarian and tubal high-grade serous carcinomas actually share common histogenesis, PSAFT has a worse prognosis than ovarian cancer. We report a case of PSAFT that presented clinically as hydrosalpinx. Material and Methods: A 62-year-old patient with complaints of a low abdominal pain and vaginal discharge was admitted at the gynecological department. During the diagnostic procedure, the ultrasound examination revealed uterine fibroid and a right-sided hydrosalpinx. The patient underwent hysterectomy with bilateral adnexectomy. Due to the clinical assessment of benign disease, no tumor markers were required preoperatively, nor biopsy from the omentum and parietal peritoneum, as well as peritoneal washing, were obtained intraoperatively. The operative material was routinely dissected and a standard procedure for histology and immunohistochemistry was performed. Results: The right tube was tortuous, 17 cm in length, having 5 cm long dilatation in the proximal third. In the dilated part, few exophytic, neoplastic, white-grayish soft lesions were found. The histopathologic examination revealed areas of in situ as well as high-grade PSAFT with lamina propria involvement. The malignant cells were positive for CK7 and WT1. The tumor did not infiltrate the muscle layer, so it was defined as FIGO stage IA. The leiomyoma previously diagnosed by ultrasound was histologically confirmed, while the left adnexa and right ovary revealed regular morphology and were free of tumor. Two months after the operation the patient is in good health and diseasefree. Conclusions: PSAFT should be distinguished as a different clinical entity from primary ovarian epithelial neoplasms so that the patient could receive adequate therapy and follow-up.