BACKGROUND

Primary invasive mucinous epithelial ovarian carcinoma (MOC) is a rare subtype of epithelial ovarian carcinoma (EOC). According to the 2020 World Health Organization (WHO) classification, the invasive patterns of MOC are classified into two categories: Infiltrative and expansile invasion. Studies examining the relationship between expansile and infiltrative primary MOCs are limited. In our local setting, there are no published studies to determine the impact of classifying primary MOCs between the two subtypes to treatment outcomes. This study, therefore, aims to determine the prevalence of primary MOC subtypes, their clinical and demographic characteristics, and clinical outcomes.

This is a retrospective study of patients diagnosed with MOCs for a 5-year period from January 2013 to December 2017 in a public end-referral tertiary hospital. A pathological review was conducted using the 2020 WHO classification to determine the pattern of invasion. Demographic data were obtained and the treatment outcome of infiltrative invasion and expansile invasion of ovarian mucinous carcinoma were compared. Log–rank test was used to determine the overall survival (OS) with the specific type of MOCs.

A total of 29 cases were included in this study wherein 79.3% were expansile MOC type and 20.7% were infiltrative. Most of the patients had International Federation of Gynecology and Obstetrics Stage IA (27.6%). All patients had laparotomy and half of the patients received adjuvant therapy, 47.8% and 50% in expansile and infiltrative type, respectively. The factors associated with overall mortality were MOC type: expansile, hazard ratio (HR) = 0.3, 95% confidence interval (CI) = 0.07–0.91, P = 0.047, and infiltrative, HR = 3.3, 95% CI = 1.1–13.5, P = 0.047. Median OS was significantly higher in patients with expansile compared to infiltrative type (42 vs. 25 months, P = 0.039).

Infiltrative invasion was observed to be a prognostic factor showing worse outcomes for ovarian mucinous carcinoma compared to expansile invasion.

INTRODUCTION

The conventional teaching of laparoscopic surgery in academic centers in the apprentice/mentor model is highly subjective. The Gynecological Endoscopic Surgical Education and Assessment is a well-structured education program proposed by the European Society for Gynaecological Endoscopy (ESGE). This program uses the Laparoscopic Skills Training and Testing (LASTT) kit, an objective, validated, and measurable test to evaluate an individual’s competence level in basic laparoscopic psychomotor skills. The LASTT kit may be used to assess the basic laparoscopic psychomotor skills of Filipino doctors, guide surgical training recruitment, and improve the local minimally invasive surgery curriculum.

The study will describe the implementation of the LASTT kit in evaluating the psychomotor skills of Filipino physicians in training and assess the feasibility and user acceptance of the kit.

A descriptive cross-sectional research design was used. A total of 34 trainees (19 medical interns and 15 surgical residents) were included. All trainees underwent the LASTT test to have the baseline data for comparison of each cohort. A posttest questionnaire for the feasibility and user acceptance of the kit was accomplished.

A majority of participants were right-handed, and female, with 0–30 laparoscopic assists. The mean age of surgical residents was higher than medical interns. Surgical residents showed a significantly shorter time to accomplish the exercises than medical interns. Finally, it showed that the kit was clear and understandable, easy to use, and represented a realistic model of the actual laparoscopic surgery.

The surgical residents were superior to medical interns in laparoscopic psychomotor skills, which supports that hands-on training and exposure to procedures improve skill proficiency. Furthermore, the LASTT kit was well accepted and would greatly aid in recruitment and skills training in the Philippines.

We report a case of a 33-years old, nulligravid, diagnosed with mullerian adenosarcoma with sarcomatous overgrowth (MASO), who presented with vaginal bleeding and recurrent endometrial polyp. MASO is a rare type of uterine sarcomas, it is a variant of adenosarcomas with poor prognosis. The index patient underwent primary surgical management with lymphadenectomy with a final stage of IC. Histologic diagnosis was Mulllerian adenosarcoma with sarcomatous overgrowth. A panel of immunostaining for estrogen receptors, progesterone receptors and CD 10 showed diffused positivity for the hormones with loss of CD 10 which is consistent with MASO. The rarity of MASO has a distinctive histologic features which merits meticulous sectioning as the clinical course and management vary. It has a poor prognosis due to its short and fast course of the disease.
Adenosarcoma ; Sarcoma ; Uterine Neoplasms ; Soft Tissue Neoplasms

A 35-year-old woman underwent laparoscopic radical hysterectomy, pelvic lymphadenectomy and ovarian transposition for stage IB2 cervical adenocarcinoma. She received adjuvant concurrent chemoradiation for poor pathologic risk factors but had tumor recurrence 20 months after the surgery. Transposed ovaries were uninvolved in the recurrence and progression. Salvage chemotherapy and radiotherapy were given. Despite systemic chemotherapy and repeat pelvic radiotherapy, the patient was able to maintain ovarian function. Ovarian transposition in cervical cancer is an easily performed procedure that does not alter the prognosis of the disease in some cases. Present recommendations for its use should be reevaluated so that more premenopausal cancer patients may benefit from this underutilized procedure.
Adenocarcinoma ; Female ; Humans ; Hysterectomy ; Laparoscopy ; Lymph Node Excision ; Ovary ; Prognosis ; Quality of Life ; Recurrence ; Risk Factors ; Uterine Cervical Neoplasms