SERVİKS SKUAMÖZ HÜCRELİ KANSERİN ÖVERE METASTAZI VE TRAKELEKTOMİ İŞLEMİNİN LİTERATÜR EŞLİĞİNDE DEĞERLENDİRİLMESİ

Abstract

Amaç: Kliniğimizde 6 yıl önce uygulamış olduğumuz trakelektomi operasyonunun uzun dönem takip sonuçlarını literatür eşliğinde değerlendirmeyi ve nadir görülen bir vaka olan serviksin övere sküamöz hücreli metastaz durumunun bildirilmesi amaçlanmıştır. Olgu: Hastanemizde 6 yıl önce evre 1A2 serviks kanseri nedeniyle trakelektomi yapılan hasta operasyondan 7 ay sonrasında servikal stenoz nedeniyle ikinci kez operasyona alınmış ve dilatasyon & drenaj işlemleri uygulanmıştır. Postoperatif uzun dönem takiplerinde ise 1 yıl sonrasında 3-4 cm’lik adneksiyal kitle gelişmesi ve malignite düşünülmesi nedeniyle üçüncü kez operasyon uygulanmıştır. Frozen sonucunda malignite saptanan hastaya total histerektomi ve bilateral salpingooferektomi yapılmıştır. Kesin patoloji sonucunda serviksin övere skuamöz hücreli tümör metastazı olarak belirlenmiştir. Hastanın 6 yıl sonrasında şuan nüks tümörü veya başka bir patolojisi bulunmamaktadır. Sonuç: Radikal trakelektomi günümüze kadar yapılan araştırmalar sonucunda etkinliğini ve uygun bir seçenek olduğunu ispatlamaktadır. Bu nedenle uygun hasta grubunda tanı sağlandıktan sonra bu tekniğin düşünülmesi ve deneyimli bir merkezde uygulanması en doğru yaklaşım olacaktır. Serviksin skuamöz hücreli kanserlerinin nadiren de olsa överlere metastaz yapabileceği unutulmamalı, hastanın takiplerinde bu durum göz ardı edilmemelidir.

Keywords

• Serviks kanseri, konservatif yaklaşım, fertilite koruyucu cerrahi.

OVARIAN METASTASIS OF CERVIX SQUAMOUS CELL CARCINOMA AND EVALUATION OF THE LITERATURE ABOUT TRACHELECTOMY PROCESS

Abstract

Objective: Evaluation of the literature about the long term follow-up of trachelectomy operation and to notify the rare situation of cervical squamous cell carcinoma metastasis to the ovaries. Case: We have done a trachelectomy operation 6 years ago for stage 1A2 cervix carcinoma. 7 months after the operation a cervical stenosis was diagnosed and a second operation was done for dilatation-drainage. 1 year later a 3-4 cm adnexal mass occurred. And it had malignancy suspicion. The patient had the third operation for the adnexal mass and in the frozen examination malignancy was detected. She had total abdominal hysterectomy and bilateral salpingoopherectomy because of that. After the exact pathologic examinations cervix squamous cell carcinoma metastasis to the ovaries was seen. After 6 years she does not have any recurrence or other any pathology. Conclusion: As a result of the researches radical trachelectomy proves that it is an effective and appropriate option. Therefore it must be considered in suitable patients and implemented in experienced centers will be the right approach. And it should be noted that cervix squamous cell carcinoma can make metastasis to the ovaries and patient’s follow-ups should not be ignored in this case.

Keywords

• Cervical cancer, Conservative approach, Fertility-sparing surgery.

References

1. 1. Gien LT, Covens A. Fertility-sparing options for early stage cervical cancer. Gynecol Oncol 2010;117:350-357.
2. 2. Covens A, Rosen B, Murphy J et al. Changes in the demographics and perioperative care of stage Ia(2)/Ib(l) cervical cancer over the past 16 years. Gynecol Oncol 2001;81:133-137.
3. 3. Dursun P1, LeBlanc E, Nogueira MC. Radical vaginal trachelectomy (Dargent’s operation): a critical review of the literature. Eur J Surg Oncol. 2007;33(8):933-41.
4. 4. Sato S1, Aoki D, Kobayashi H, Saito T, Nishimura R, Nagano T, Yaegashi N, Enomoto T, Kigawa J. Questionnaire survey of the current status of radical trachelectomy in Japan. Int J Clin Oncol. 2011;16(2):141-4.
5. 5. Smith JR, Boyle DCM, Corless DJ, et al. Abdominal radical trachelectomy: a new surgieal teelmique for the conservative management ofcervieal carcinoma. Br J Obstet Gynaeeol. 1997;104(10):1196-200.
6. 6. Rodriguez M, Guimares O, Rose PG. Radical abdominal trachelectomy and pelvic lymphadenectomy with uterine conservation and subsequent pregnancy in the treatment of early invasive cervical cancer. Am J Ob stet Gynecol 2001; 185:370.
7. 7. Palfalvi L, Ungar L, Boyle DC, Del Priore G, Smith JR. Announcement of healthy baby boy bom following abdominal radical traehelectomy. Int J Gynecol Caneer 2003; 13:250.
8. 8. Nishio H, Fujii T, Kameyama K et al. Abdominal radical trachelectomy as a fertility-sparing procedure in women with early-stage cervical cancer in a series of 61 women. Gynecol Oncol 2009;115:51-55.

9. 9. Karateke A1, Kabaca C. Radical abdominal trachelectomy is a safe and fertility preserving option for women with early stage cervical cancer. Eur J Gynaecol Oncol. 2012;33(2):200-3.
10. 10. David N. Are they really asymptomatic? Int J STD AIDS 2008;19:575.
11. 11. Burnett AF, Roman LD, O’Meara AT, Morrow CP. Radical vaginal trachelectomy and pelvic lymphadenectomy for preservation of fertility in early cervical carcinoma. Gynecol Oncol 2003;88:419-23.
12. 12. Marchiole P, Benchaib M, Buenerd A, Lazlo E, Dargent D, Mathevet P. Oncological safety of laparoscopic-assisted vaginal radical trachelectomy (LARVT or Dargent’s operation): a comparative study with laparoscopic-assisted vaginal radical hysterectomy (LARVH). Gynecol Oncol 2007;106:132- 41.
13. 13. Kim JH1, Park JY, Kim DY, Kim YM, Kim YT, Nam JH. Fertility-sparing laparoscopic radical trachelectomy for young women with early stage cervical cancer. BJOG. 2010;117(3)340-7.
14. 14. Diaz JP, Sonoda Y, Leitao MM, Zivanovic O, Brown CL, Chi DS, et al. Oncologic outcome of fertility-sparing radical trachelectomy versus radical hysterectomy for stage IB1 cervical carcinoma. Gynecol Oncol. 2008;111:255-60.
15. 15. Beiner ME, Hauspy J, Rosen B, Murphy J, Laframboise S, Nofech-Mozes S, et al. Radical vaginal trachelectomy vs. radical hysterectomy for small early stage cervical cancer: a matched case-control study. Gynecol Oncol. 2008;110:168-71.
16. 16. Shepherd JH1, Spencer C, Herod J, Ind TE. Radical vaginal trachelectomy as afertility-sparing procedure in women with early-stage cervicalcancer-cumulative pregnancy rate in a series of 123 women. BJOG. 2006;113(6):719-24.
17. 17. Wong I1, Justin W, Gangooly S, Sabatini L, Al-Shawaf T, Davis C, et al. Assisted conception following radical trachelectomy. Hum Reprod. 2009;24(4):876-9.
18. 18. Jackson KS, Das N, Naik R, Lopes AD, Godfrey KA, Hatem MH, et al. Laparoscopically assisted radical vaginal hysterectomy versus radical abdominal hysterectomy for cervical cancer: a match controlled study. Gynecol Oncol 2004;95:655-61.
19. 19. Xu L1, Sun FQ, Wang ZH. Radical trachelectomy versus radical hysterectomy for the treatment of early cervical cancer: asystematic review. Acta Ob stet Gynecol Scand. 2011;90(11)1200-9.
20. 20. Carter J, Smirnova S. A personal experience with radical abdominal trachelectomy for the conservative management ofi nvasive cervical cancer. Aust NZ J Ob stet Gynaecol. 2011;51(2):177-82.
21. 21. Gottschalk E, Mangler M, Schneider A, Koehler C, Lanowska M. Pregnancy after lymphadenectomy and neoadjuvant chemotherapy followed by radical vaginal trachelectomy inFIGO stage IB1 cervical cancer. Fertil Steril. 2011;95:2431. e5 -7.
22. 22. Jaiman S, Surampudi K, Gundabattula SR1, Garg D. Bilateral ovarian metastatic squamous cell carcinoma arising from the uterine cervix and eluding the Mullerian mucosa. Diagn Pathol. 2014;9:109. 322