A 5-year follow-up of vulval swelling due to extraskeletal myxoid chondrosarcoma: A rare case report (2019)

Type of publication:
Journal article

Author(s):
O’Neill D.; El-Ghobashy A.; Elghobashy M.; Abdelsalam H.; *Metelko M.

Citation:
Molecular and Clinical Oncology; May 2019; vol. 10 (no. 5); p. 483-486

Abstract:
Vulval extraskeletal myxoid chondrosarcoma (EMC) is a rare cause of vulval swelling, reported <10 times in the literature to date. EMC in this location is frequently misdiagnosed due to its rarity, and patients may incur delays in diagnosis and treatment. We herein present the diagnosis and management of the case of vulval EMC in a 42-year-old Caucasian female patient who presented in 2011 with a swelling on the right labium majus. The tumour was initially misdiagnosed as a Bartholin’s cyst and managed conservatively. The tumour was ultimately diagnosed as EMC and treated by radical surgical excision and adjuvant radiotherapy. The aim of the present study was to report the results after a long-terms follow-up period and review the available relevant literature.

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Lymphangioma circumscriptum of the vulva clinical picture and surgical management (2018)

Type of publication:
Journal article

Author(s):
*Papoutsis D.; Haefner H.K

Citation:
Archives of Hellenic Medicine 35(6):809-810 · November 2018

Abstract:
Vulvar lymphangioma circumscriptum is a rare entity that may mimic many other diseases of the vulva. It presents with the non-specific symptoms of persistent vulvar itching and soreness, and the diagnosis is confirmed through vulvar biopsy. Surgical treatment has the lowest recurrence rates compared with other treatment modalities. The case is presented here of a woman diagnosed with lymphangioma circumscriptum of the vulva and its surgical management.

Audit of 2-week wait referrals to the Gynecology Department in District General Hospital and investigating patient awareness of the reasons and importance behind the referral (2018)

Type of publication:
Conference abstract

Author(s):
Wilkinson M.; *Sahu B

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology; Dec 2018; vol. 125 ; p. 48

Abstract:
Introduction Two-week wait referrals to gynecology services are at a premium with pressure on numbers. Referrals can be inappropriate. Patients are often unaware the appointment is for suspected cancer. Methods Two-week wait referrals were examined during a six month period. The gynecologist in clinic collected data. Patients were asked about their 2-week wait referral, gauging awareness around their referral. Clinical symptoms and signs were compared to those in referral. Appropriateness of the referral was assessed by symptoms fitting the 2-week wait criteria or clinical findings on referral not consistent with the presenting symptoms and findings in clinic. Results A total of 172 patients were referred under the 2-week wait criteria; mean age was 58 years, range (17-95). Referrals were from 50 separate primary care practices. Suspected cancer referrals were composed of 111 endometrial, 15 ovarian, 22 cervical, 15 vulva/vaginal and 9 of mixed pathology. There was awareness of referral for cancer in 90 cases (52%), awareness of “2-week wait” in 124 cases (72%) and aware that the appointment could be at either hospital within the trust in 96 cases (56%). The referral was considered appropriate for 2-week wait referral in 123 (72%) of cases. Conclusion The majority of patients were referred correctly. A wide range of pathologies was seen. A significant number could have been referred as routine referrals or advice requested. Patient awareness of it being a referral due to suspected cancer was poor with better appreciation of the urgency of referral.

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The paediatrician and the management of common gynaecological conditions (2018)

Type of publication:
Journal article

Author(s):
*Ritchie, Joanne K; Latthe, Pallavi; Jyothish, Deepthi; Blair, Joanne C

Citation:
Archives of disease in childhood; Jul 2018, 103(7), p. 703-706

Abstract:
Paediatric gynaecology is an emerging discipline. Since 2000, there has been an advanced training programme in paediatric gynaecology available for obstetric and gynaecology trainees; additionally, a set of clinical standards1 for the care of paediatric and adolescent patients has been developed by The British Society of Paediatric and Adolescent Gynaecology (BritSPAG). BritSPAG is a multidisciplinary group of professionals including gynaecologists, paediatricians, paediatric urologists and endocrinologists.Girls with gynaecological conditions are often seen in general paediatric services; it is important that those assessing them are confident in identifying patients who require more specialist care. Despite this, gynaecology does not appear in the Royal College of Paediatrics and Child Health curriculum. This article aims to increase the knowledge base and confidence of paediatricians in dealing with common paediatric and adolescent gynaecological conditions.

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A national colposcopy survey comparing destructive versus excisional treatment for CIN (2016)

Type of publication:
Conference abstract

Author(s):
Parry-Smith W., *Papoutsis D., Parris D., *Panikkar J., Redman C., *Underwood M.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, June 2016, vol./is. 123/(99)

Abstract:
Introduction Women found to have high grade CIN should be offered either ablative treatment or large loop excision of the transformation zone with appropriate biopsy. Objective 1) To learn if a trial of ablative versus excisional treatment would be supported by fellow colposcopists in the UK 2) To investigate the current practice amongst colposcopists with regards to ablative treatment for high grade CIN 3) To gain an understanding of aspects of practice such as use of local anaesthetic during punch biopsies Methods An electronic questionnaire was sent to all registered colposcopists in the United Kingdom (total = 1677). Of these, 325 responded (19%). The study was granted ethical approval by the council of the British Society for Colposcopy and Cervical Pathology (BSCCP). Results The majority of colposcopists n = 248 (76%) felt that a study investigating the morbidity and Test of Cure outcomes comparing excisional and destructive treatments was needed. A reduced complication and morbidity rate would be the greatest factor to encourage colposcopists to use destructive treatments more often n = 250 (76.92%). If a destructive treatment were found to have a significantly reduced complication, morbidity, and equal or higher patient satisfaction rate during the procedure, but resulted in a slightly higher need for further treatment 5%, this was acceptable to n = 140 (43.1%) of those surveyed. However, a further treatment rate of 2.5% was acceptable to n = 196 (60.1%). The majority n = 182 (56%) of colposcopists did not perform destructive treatments for high grade disease; For those who did not perform destructive treatments the main reason was that they were not aware of sufficient evidence for its use n = 98 (30.2%) and had no experience nor training n = 33 (10.25%). Cold coagulation was the most common destructive treatment n = 100 (31%) that colposcopists could perform, with diathermy n = 70 (22%), laser n = 11 (3.4%) and cryotherapy n = 10 (3.1%) being less prevalent. The majority of colposcopists took two punch biopsies per patient n = 190 (58.5%), with only n = 45 (13.8%) taking three or more biopsies. Silver nitrate was the most favoured haemostatic technique following punch biopsy n = 217 (66.7%), with n = 269 (87.1%) using no local analgesia. Conclusion A study investigating morbidity and Test of Cure of excisional compared with destructive treatments for high grade CIN would be supported by most participating colposcopists. Variation in practice regarding both treatment and diagnosis exists. This has quality assurance implications for a standardised national screening programme.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201606002-00174&LSLINK=80&D=ovft

Haematocolpos. A 20-year review of cases at a District General Hospital (2016)

Type of publication:
Conference abstract

Author(s):
*Oates S.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, June 2016, vol./is. 123/(24)

Abstract:
Introduction Paediatric and Adolescent care is now more structured within the gynaecology department and will often be undertaken by only one or two individuals. It would be useful to know the outcome after uncommon procedures to provide advice and reassurance to both the girls and their parents. Haematocolpos is a simple adolescent surgical intervention although the underlying pathology can be variable. Methods This was a retrospective study of 23 cases of haematocolpos identified using ICD codes, theatre records and theatre diaries at the Shrewsbury and Telford Hospitals trust over a 20 year period. More than half of the cases had been managed by the author. Results The age range of the girls was 11-17 years and those presenting with delayed menarche were aged 16 or 17 years at diagnosis. The commonest symptom was pain in 17 (74%) and then delayed menarche in 3 (13%) and urinary retention or difficult micturition in 3 (13%). There were three cases of Uterus Didelyphys and in these cases the girls had had menarche 1, 2 or 3 years before. Two cases of Transverse Vaginal Septum were identified and these girls required more extensive and repeated surgery to correct their problem following referral to a tertiary centre. The follow-up period for these patients is between 6 months to 20 years. Of the 23 cases identified 4 patients were lost to follow-up but all the others remain local. Five (22%) have gone on to successful pregnancies without difficulty. A further two cases have tried for pregnancies but one lady is awaiting a kidney transplant due to chronic renal failure and the other has a partner with sperm dysfunction and her BMI precludes her from infertility treatment at present. The remaining 12 do not appear to have any contact with maternity services yet or have a referral for infertility issues. There is no evidence that any of these women have endometriosis although two have had further surgery to open up their tight hymen and two have had vaginal dilators to stretch the hymen. Conclusion The management of heamatocolpos is relatively simple but follow-up of the cases highlights the variable out comes.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201606002-00037&LSLINK=80&D=ovft

Gynaecological laparoscopic injuries: a 10-year retrospective review at a District General Hospital NHS Trust (2016)

Type of publication:
Journal article

Author(s):
*Moores K.L., *Bentick B.

Citation:
Gynecological Surgery, May 2016, vol./is. 13/2(125-130)

Abstract:
Worldwide, increasingly complex surgery is being performed laparoscopically; thus, laparoscopic complication rates may be increasing. Reported risks from all complications of laparoscopic surgery are between 1 and 12.5/1000 cases and serious complications in 1/1000 cases. Accurate complication rates of surgery are difficult to obtain as most data are from retrospective studies and may be incomplete. This paper is a 10-year retrospective review of gynaecological laparoscopic complications from 1 January 2003 to 31 December 2012. Data sources are SEMAHELIX Hospital Database, Gynaecology Complications Register, Clinical Governance Records, Complaints and Legal Cases. Recorded complications were classified as diagnostic, sterilisations and therapeutic laparoscopies. Further classifications are as follows: major complications and type of injury (bowel, urological, vascular, other), minor complications and failed sterilisations. Twenty-nine complications were identified from 5128 laparoscopies; total complication rate is 5.7/1000 procedures. Major complication rates are as follows: diagnostic, 2.2/1000; sterilisations, 3.3/1000; and therapeutic, 3.1/1000, subcategorised into bowel 1.4/1000, urological 0.2/1000 and vascular 1.2/1000. Our total complication rate lies within published national rates. Compared to published standards of major complications, diagnostic laparoscopy and laparoscopic sterilisation rates were comparable. Conversely, our therapeutic laparoscopy complication rate was much lower. The highest complication rate was in the failed sterilisation group; however, this rate is within published sterilisation failure rates. Bowel and vascular complications were comparable; minor complication rates were low in all groups.

Does the number of tissue fragments removed from the cervix with excisional treatment for CIN pathology affect the completeness of excision and cytology recurrence at follow-up? An observational cohort study (2016)

Type of publication:
Journal article

Author(s):
*Papoutsis D., *Panikkar J., *Gornall A., *Blundell S.

Citation:
Journal of Obstetrics and Gynaecology, February 2016, vol./is. 36/2(251-256)

Abstract:
The objective of our study was to determine whether removing multiple pieces of cervical tissue during large loop excision of the transformation zone (LLETZ) reduced the margin positivity of excision and cytology recurrence rates at follow-up. We conducted an observational cohort study and identified 462 women having had a single LLETZ treatment for cervical intraepithelial neoplasia (CIN) over a two-year period. Women with previous cervical treatment, cervical cancer on the excised tissue or missing follow-up data were excluded. Multiple regression analysis showed that removal of cervical tissue in multiple pieces did not offer any benefit in removing more disease and less recurrence rates. When multiple pieces were taken there was a four-fold increased risk for inconclusive excision margins as reported by the histopathologist. Removal of multiple pieces led to significantly more tissue being removed which may expose the patient to an increased risk of preterm delivery in a future pregnancy.

Cytological follow-up after hysterectomy: is vaginal vault cytology sampling a clinical governance problem? The University Hospital of North Staffordshire approach (2015)

Type of publication:
Journal article

Author(s):
Parry-Smith W., Thorpe D., Ogboro-Okor L., *Underwood M., Ismaili E., Kodampur M., Todd R., Douce G., Redman C.W.E.

Citation:
Cytopathology, June 2015, vol./is. 26/3(188-193)

Abstract:
Objectives: Vaginal vault cytology sampling following hysterectomy is recommended for specific indications in national guidelines. However, clinical governance issues surround compliance with guidance. Our first study objective was to quantify how many patients undergoing hysterectomy at the University Hospital of North Staffordshire (UHNS) had vault cytology advice in their histology report and, if indicated, whether it was arranged. The second was to devise a vault cytology protocol based on local experience and national guidance. Methods: The local cancer registry was searched. Clinical, clerical and histological data for all patients undergoing hysterectomy were collected. Results: In total, 271 patients were identified from both the gynae-oncology and benign gynaecology teams. Of these, 24% (65/271) were gynae-oncology patients with a mean age of 69 years. The benign gynaecology team had 76% (206/271) of patients with a mean age of 55 years. Subsequently, 94% (256/271) had cytology follow-up advice in their histopathology report. Ultimately, from both cohorts, 39% (18/46) had follow-up cytology performed when indicated. Conclusion: A high proportion of cases complied with national guidance. However, a disappointingly high number did not have vault cytology sampling when this was indicated. This is probably a result of the complex guidance that is misunderstood in both primary and secondary care. Vault follow-up of patients after hysterectomy rests with the team performing the surgery. Vault cytology, if indicated, should be performed in secondary care and follow-up should be planned. The protocol set out in this article should be followed to avoid unnecessary clinical governance failings.