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Even nowadays the diagnostic of ovarian cancer is difficult to be established preoperatively, and therefore a significant number of patients are submitted to a much too extensive or to an incomplete surgical procedure. Therefore attention was focused on identifying more reliable markers which might help the clinician to distinguish between benign and malignant ovarian lesions. The aim of the current paper is to analyze the differences between benign and malignant ovarian tumors based on the preoperative levels of the mean platelet volume.

Ovarian cancer remains one of the most aggressive malignancies which is frequently diagnosed in advanced stages of the disease, when disseminated lesions are already present. In order to maximize the rates of complete debulking surgery, different prognostic markers have been investigated. The aim of the current paper is to investigate the prognostic value of neutrophil to lymphocyte ratio in advanced stage ovarian cancer patients submitted to debulking surgery.

Red cell distribution width [RDW] represents a new prognostic marker which has been widely studied in malignant tumors including ovarian cancer patients. Therefore, it has been stipulated that RDW can be also used as a prognostic marker and a follow up tool for these patients. The aim of the current paper was to analyze the variations of this parameter on a study group of 31 patients diagnosed with advanced stage ovarian cancer and respectively 48 cases with benign ovarian lesions submitted to surgery between 2017-2020 in “Cantacuzino” Clinical Hospital.

Although multiple studies have been conducted so far on the issue of advanced stage ovarian cancer, the overall prognostic of these patients reports a wide variety even in cases in which complete debulking surgery is feasible. Therefore, attention was focused on identifying other prognostic markers which might influence the long term outcomes of these patients. In this paper special attention was focused on studying the impact of mesenteric lymph node involvement in advanced stage ovarian cancer.

Ovarian cancer remains one of the most aggressive gynecological malignancies after cervical and endometrial cancer especially due to the multiple patterns of spread cited so far. Although it has been stated that the peritoneal route is the most dangerous pattern of spread leading to the apparition of disseminated intraabdominal lesions, other pathways such as hematogenous or lymphatic route can be also important, leading to the apparition of abdominal and extra-abdominal metastases. The aim of the current paper is to discuss about the risk of developing axillary metastases from ovarian cancer primaries.

The relationship between diabetes mellitus and ocular complications has been extensively studied by many authors. Diabetic keratopathy has already been well characterized and defined as a clinical entity. This review focuses on exploring corneal epithelial changes in diabetic patients, aiming to provide a pragmatic overview of the existing knowledge on this topic. The paper systematically examines alterations in corneal epithelial structure and their impact on diabetic patients. Advanced imaging techniques are also discussed for their role in precise characterization and improved diagnostics. Additionally, the paper explores the mechanisms behind corneal epithelial changes in diabetes, looking at factors such as hyperglycemia, oxidative stress, and Advanced Glycation End-Products. The impact of altered corneal epithelial integrity on barrier function and susceptibility to external issues is considered, addressing potential links to heightened proteolytic enzyme activities and delayed wound healing observed in diabetic individuals. The review also covers the practical implications of corneal epithelial changes, including the association with corneal erosions, persistent epithelial defects, and an increased risk of dry eye syndrome in diabetic patients.

Gallbladder cancer represents the most commonly encountered malignancy of the biliary tract which becomes symptomatic only in advanced stages of the disease when, in most cases, local invasion in unresectable structures is already present. Another significant problem regarding this pathology is related to the fact a positive diagnostic is difficult to be established preoperatively. The aim of the current paper is to discuss about the possible relationship between the preoperative number of circulating platelets and the overall prognosis in gallbladder cancer patients.

Ovarian cancer is recognized for the high capacity of spread which leads to the apparition of distant metastases via multiple pathways such as peritoneal, hematogenous or lymphatic route. If cases presenting peritoneal dissemination usually present extended but limited to the abdominal cavity lesions, patients with hematogenous or lymphatic spread will lead to the apparition of both intra-abdominal and extra-abdominal lesions. Even though, the presence of extra-abdominal lymphatic metastases is rather a rare event; however, contamination of extra-abdominal lymph nodes and is considered as distant metastazation and considered as stage IV of disease. The aim of the current paper is to review the cases presented so far with histopathological documented supraclavicular metastases originating from ovarian cancer.

The presence of thrombocytosis has been widely associated with poor prognostic in patients diagnosed with ovarian cancer at the time of the initial diagnostic. Once this fact has been widely accepted, attention was focused on studying whether this biological parameter could be also a diagnostic tool for identifying patients with poorer outcomes at the time of secondary cytoreduction. Therefore the most commonly encountered questions are whether patients presenting thrombocytosis at the time of primary cytoreduction are expected to have also thrombocytosis at the time of relapse and if thrombocytosis at the time relapse is corelated with lower disease free intervals, with higher rates of incomplete debulking and with poorer rates of overall survival respectively. This is a literature review of the most relevant studies conducted on this issue.

Neutrophil to lymphocyte ratio represents a novel prognostic marker which is usually associated with the presence of proinflammatory conditions such as obesity, metabolic syndrome or certain benign and even malignant diseases. Moreover, in cases in which a malignant condition is present, the value of the neutrophil to lymphocyte ratio also seems to be positively correlated with the biological agressivity of the tumor. The aim of the current paper is to discuss about the most relevant studies which discuss about the role of this parameter as a new biological marker in ovarian cancer patients.

The presence of an increased number of platelets has been demonstrated to be significantly associated with the presence of different types of malignancies, especially when it comes to gynecological cancers and seems to be associated with a poorer prognosis. This fact has been widely studied in order to better understand the physiopathology of the phenomenon, the impact on the overall outcomes and to validate new therapeutic lines for such cases. The aim of the current paper is to review the most important studies conducted on this issue.

Defined as the loss of the muscular mass, sarcopenia is a common finding in neoplastic patients, multiple mechanisms such as nutritional deficiency, proinflammatory tumoral related status or physical inactivity being cited. However, the loss of the muscular mass in such cases is associated with significant impact in regard to the type of treatment in such cases; in consequence, as expected the disease-free survival and overall survival might be influenced. The aim of the current paper is to discuss about the most important mechanisms leading to sarcopenia in ovarian cancer patients as well as the impact on the long-term outcomes.

In the last decades understanding the relationship between the circulating platelets and the biological aggressivity of ovarian cancer gave the opportunity to researchers to introduce new therapeutic lines in ovarian cancer patients with promising results. Therefore, this subject has become intensively studied and surprising correlation ships have been observed. One of the most recently investigated issues regards the influence of circulating platelets on epithelial ovarian cancer refers to the platelets’ ability to induce the epithelial to mesenchymal transition. The current paper aims to discuss about this subject and about the clinical implications of the process.

Despite progress reported in terms of paraclinical tests and imagistic studies, ovarian cancer represents one of the most lethal malignancies affecting women worldwide. Therefore attention was focused on identifying new prognostic markers in order to better identify candidates for primary cytoreductive surgery versus interval debulking surgery. Moreover, the wide introduction of the concept of personalized medicine gave the opportunity to benefit from more targeted treatments according to each patient needs and particularities. This is a literature review of the current status of ovarian cancer worldwide.

Breast cancer represents the most commonly encountered malignancy in women worldwide. In the last decades, due to the improvement of the imagistic techniques and to the wide implementation of screening tests, a significant number of cases are suitable for conservative surgery therefore improving the quality of life. Although the postoperative morbidity after breast conservative surgery is reduced, the procedure can still be associated with certain complications such as breast lymphedema, or wound difficult healing. The aim of the current paper is to discuss the possibility of prevention and treatment of breast lymphedema by using innovative techniques such as indocyanine green.

Inflammatory pseudotumors of the liver are rare entities, only few cases being reported so far, pathogenesis of these lesions being scarcely understood. However since now multiple mechanisms have been proposed in order to explain the development of these lesions, the knowledge of their pathogenesis being mandatory in order to further orientate the therapeutic strategy. The current paper is a literature review of the largest studies which aimed to discuss the etiopathogenesis of the inflammatory pseudotumors of the liver.

Pancreatic cancer remains one of the most aggressive neoplasms affecting people worldwide, with lower than one year rates of survival, especially if metastatic disease is encountered. In such cases palliative chemotherapy has been proposed, but the overall prognostic remains extremely poor. Meanwhile, in certain cases, spectacular response to chemotherapy has been observed, with significant reduction and even disappearance of the liver lesions. In this respect, attention was focused on establishing whether surgery might improve the outcomes in such cases. This is a literature review of the largest studies conducted on this issue.

Introduction. Ovarian cancer is characterized by a high capacity of relapse, even in cases in whom cytoreductive surgery with curative intent followed by platinum and taxanes-based chemotherapy were performed. In such cases, attention was focused on determining if iterative cytoreduction might improve the long-term outcomes and how far these boundaries can be pushed. While for secondary cytoreduction multiple studies have been conducted, for tertiary and quaternary cytoreduction data are significantly scarcer. The objective of the study. This paper aims to realize a systematic review of the studies published so far on the theme of quaternary cytoreduction. Methodology. We searched medical journals in English language published from January 2010 to December 2019. Results. Six studies involving 110 patients submitted to quaternary cytoreduction met the inclusion criteria. Data reported in the above mentioned studies demonstrate that quaternary cytoreduction can be safely performed both at the level of the lower and the upper abdomen, in order to maximize the debulking effort. However, a significantly lower number of cases will be considered candidates for this type of procedure, when compared to secondary or even tertiary cytoreduction, an adequate selection process being mandatory in order to minimize the postoperative risks. Conclusions. Although it is less frequently feasible when compared to secondary or tertiary cytoreduction, quaternary cytoreduction might be beneficial in selected cases.

Krukenberg tumors are ovarian metastases from different malignancies, most often originating from the gastrointestinal tract. However, in rare cases, other primary tumors, even with extra-abdominal location, might lead to the development of such lesions. Neither the mechanism of development, prognostic significance or therapeutic strategy are not clearly defined so far. It seems that these lesions are more frequently encountered in patients with BRCA1/2 mutations. Most often, Krukenberg tumors are bilateral lesions associated with ascites and with firm areas at the level of the ovarian surface. This paper aims to review existing data regarding Krukenberg tumors from breast cancer.

Gastric cancer remains one of the most aggressive malignancies which is frequently diagnosed in advanced stages of the disease. Therefore, the long term prognostic is extremely poor especially if surgery with curative intent is no longer feasible. When it comes to the predilection sites of metastatic disease with gastric origin, it seems that liver has a central role. The aim of this paper is to analyse the largest studies which investigated the potential benefit of gastric cancer liver metastases resection.

The aim of this study is to analyze the feasibility and safety of left upper abdominal resections as part of debulking surgery. Case series presentation. Between January 2015 and August 2019, 32 patients were submitted to left upper abdominal resections. Left upper abdominal resections were performed as part of primary cytoreduction in 22 cases, as part of secondary cytoreduction in eight cases, and respectively as part of tertiary cytoreduction in two cases. The complexity of the resection increased from primary to secondary and tertiary cytoreduction; in the meantime, the rates of postoperative complications also increased with the attempt of cytoreduction. Therefore the postoperative morbidity rate was of 27% at the time of primary cytoreduction, 37.5% at the time of secondary cytoreduction and 50% at the time of tertiary cytoreduction. However, association of left upper abdominal resections leaded to a complete resection rate of 77% at the time of primary cytoreduction, 62.5% at the time of secondary cytoreduction and 50% at the time of tertiary cytoreduction. Conclusions. Left upper abdominal resections might increase the rates of complete debulking in the setting of advanced stage or relapsed ovarian cancer. However the complexity of procedures and the risk of postoperative complications increase with the number of attempts of debulking.

Uterine neuroendocrine tumors are extremely rare malignancies which are usually diagnosed in advanced stages of the disease and are associated with poor prognostic. Due to their rarity a standard therapeutic strategy as well as a standard diagnostic protocol is still missing, these patients being rather diagnosed and treated by extrapolation of the present guidelines for other types of neuroendocrine tumors. This is a literature review of the most relevant studies conducted on the issue of diagnostic and management of uterine neuroendocrine tumors.

Ureteral endometriosis is characterized by the development of deep infiltrating islets of endometrial tissue affecting the ureter, the optimal management in such cases being still poorly defined. Once the techniques of laparoscopic surgery improved, this minimally invasive approach has been proposed with encouraging results in treating such cases. When it comes to the types of surgical procedure which are needed in such cases, they are chosen accordingly to the degree, extent and localization of the endometrial tissue. This is a literature review of the largest studies which were conducted on the theme of the laparoscopic management of ureteral endometriosis; the main analyzed parameters refer to the efficacy and safety of the procedure.

Deep infiltrating endometriosis is a debilitating disease which usually affects young women and significantly impacts on the quality of life. Due to the fact that it remains a benign condition which usually affects patients at the reproductive age, an aggressive, radical surgical procedure might be considered as a too mutilating one by certain cases. In consequence, attention was focused on treating these patients in a less invasive manner, procedures like rectal shaving or full thickness local excision being proposed. In the meantime, once the minimally invasive techniques evolved, laparoscopic surgery has been widely proposed in the last decade in order to treat this pathology. The current paper is a literature review of the largest studies which investigated and compared the outcomes after minimally invasive approach for deep infiltrating colorectal endometriosis.

Described for the first time in 1982, intraductal papillary mucinous neoplasms have been widely studied so far. According to the site of origin and location, it seems that these tumors have a specific risk of malignisation and therefore their type of treatment as well as the moment in which it should be applied should be carefully tailored. In this respect, multiple therapeutic strategies have been proposed, ranging from follow up and limited excision to total pancreatectomy. The current paper is a literature review of the largest studies conducted on the theme of the therapeutic strategies in intraductal papillary mucinous neoplasms.

Anatomical liver resection guided by segmental portal inflow compression proved to be an efficient tool in order to maximize the curative surgical treatment in hepatocellular carcinoma. In this respect, in the last decades, once the concept of indocyanine guided surgery gained more field, the method has been also implemented in hepatic surgery. Therefore it seems that intravenous injection followed by portal pedicle clamping and liver inspection in infrared light inspection might delimitate the segments of the liver and might successfully guide the gesture of anatomical liver resection. The current paper is a literature review of the studies which analyzed the efficacy and safety of indocyanine green guided liver surgery.

Indocyanine green guided surgery has gained significant popularity in the last decade in different areas including colorectal, gynecological or even hepatic surgery. Moreover, recently published papers came to demonstrate the utility of the method in pancreatic surgery, providing a better identification of pancreatic lesions and bringing significant information regarding the local anatomy. The current paper represents a literature review of the most relevant studies published so far on this issue.

Although it represents a benign condition, endometriosis is an important and sometimes debilitating health problem affecting women worldwide, associated with a high capacity of relapse. While the correlation between different endometrial pathologies, obesity and metabolic syndrome has been clearly demonstrated lately, the relationship between endometriosis and metabolic syndrome is far to be understood. The aim of this paper is to review the most relevant studies conducted on this issue.

Uterine leiomyoma represent a common finding in women at fertile age, being usually responsible for the apparition of metrorhagia and pelvic pain; in certain cases presenting large uterine fibroids, tumoral masses can be encountered at the clinical abdominal exam. However, in certain cases they can be responsible for the apparition of urinary signs such dysuria and pollakiuria due to their compression on the urinary bladder. The aim of this paper is to report the case of a 56-year-old patient who presented for oligo-anuria and bilateral ureteral hydronephrosis and who was diagnosed with a large intra-istmic leiomyoma with vaginal development which induced the development of acute urinary retention. The patient was submitted to surgery, a total hysterectomy with bilateral adnexectomy being performed.

With wide implementation of screening tests for the Human Papilloma Virus, the number of diagnosed cases of premalignant or early stages of cervical cancer has increased considerably. As a consequence, surgeons’ attention has focused on determining how best to limit the surgical procedure so the benefits of the procedure will not be surpassed by postoperative morbidity. In this respect, extended lymph node dissection, routinely associated so far with cervical cancer patients, has in the last decades been replaced with sentinel node detection and biopsy. Initially performed through radiocolloid injection, this method has undergone permanent changes in order to maximize its efficacy and safety. Although the laparoscopic approach had been widely used in the past, a new method has been proposed, i.e., the use of indocyanine green injection, which has yielded promising results for sentinel node detection in the early stages of cervical carcinoma. This paper reviews the literature of the most relevant studies conducted on this topic.

Ovarian cancer remains one of the most aggressive biological malignancies which is characterised by a high capacity of relapse even in cases in which a curative intent treatment is performed. In such cases the therapeutic options are rather limited, especially in platinum resistant lesions. The aim of this paper is to analyse the reported results after performing intraperitoneal heated chemotherapy in such cases.

Duodenal carcinoma remains a very rare pathology, the most efficient therapeutic strategy remaining intensively debatable. However, it seems that the most appropriate therapeutic approach for each case can be established depending on the dimensions and stage of the tumor and according to the tumoral localization. Although initially it has been proposed that in all cases in which resection is feasible a duodenopancreatectomy should be performed, nowadays the therapeutic strategy has been submitted to permanent changes, more conservative approaches such as endoscopic full thickness resection or pancreas preserving duodenal resection being proposed with encouraging results. This is a literature review of the largest studies which investigated the feasibility of duodenal resections for duodenal malignant tumors.

Due to the permanent discordance between the number of available liver grafts and the number of cases on the waiting lists, attention was focused on developing different solutions in order to increase the number of grafts. Once the technique of living donor has been proposed, the number of grafts increased but the gap between the number of available grafts and the cases on the waiting list is still significant. Therefore attention was focused on finding out other solutions such as splitting the graft or performing a domino liver transplant. The procedure of domino transplant consists of harvesting a graft from a young patient with metabolic disorders in which a healthy graft will be used and implants it to a marginal receiver. The method seems to associate minimal risks for the marginal donor to develop the metabolic disorder especially if the donor suffers from familial amyloid polyneuropathy; however, ethical issues in such cases are obvious. The aim of this paper is to analyse both the benefits of domino liver transplant and the ethical issues of the procedure.

Ex vivo liver surgery techniques have been proposed almost two decades ago in order to extend the indications and feasibility of liver resections for large, but not absolutely unresectable liver lesions. However, the procedure remains a demanding one, being associated with high risks of postoperative complications; therefore it should be performed only in specialized centers. This is a literature review of the largest studies conducted on the theme of ex vivo liver resection for tumoral pathology.

Gastric cancer has been for a long period of time one of the most aggressive malignancies due to the fact that it was usually diagnosed in advanced stages of the disease. However, in the last decades, introduction of upper digestive endoscopy on a wider scale led to a higher detection of this malignancy in earlier stages. Therefore, surgery with curative intent and, in consequence, better long-term outcomes, has been reported. In order to maximize the effect of surgery and to minimize the postoperative complication rates, in the Eastern studies the concept of sentinel lymph node biopsy has been implemented with satisfactory results. This is a literature review of the studies conducted so far on the theme of sentinel lymph node detection in gastric cancer patients.

Anal cancer is a rare digestive malignancy with high propensity to spread via lymphatic route, leading to the apparition of metastases at the level of superficial inguinal and perirectal stations. However, prophylactic irradiation of all these fields is not recommended due to the inacceptable high risks of complications when compared to the rates of metastases. Therefore, sentinel lymph node biopsy has been routinely associated in order to determine which cases present lymphatic metastases and could benefit most after irradiation. This is a literature review of the largest studies conducted on the subject of sentinel lymph node biopsy in anal cancer patients.

Pancreatic adenocarcinoma remains one of the most aggressive malignancies worldwide which is unfortunately associated with very poor long-term survival. However, it seems that the only option in order to improve the outcomes of these patients remains radical surgery consisting of in block resection of the tumor and the surrounding tissues. When it comes to the extent of the lymph node dissection, a permanent debate still exists between the eastern and the western countries; while the Western countries consider that an extended lymph node dissection increases the postoperative complication worthwhile, the Eastern countries consider that this should be the treatment of choice as long as these tumors usually disseminate on the lymphatic route. In order to establish what patients could benefit most from an extended lymph node dissection, certain authors proposed performing the sentinel lymph node biopsy technique. This is a literature review of the largest studies conducted on this theme.

Colorectal cancer represents one of the most common malignancies reported worldwide, associated with an increased risk of hepatic metastases development. Historically, the development of liver metastases from colorectal cancer has been associated with extremely poor rates in terms of survival. Improvement of the surgical techniques, as well as of the perioperative outcomes, in association with the development of new chemotherapeutic agents lead to a better survival; however, in certain cases with unresectable liver metastases, association of chemotherapy and resection can be no longer feasible due to the extent of the disease. In such cases liver transplantation has been proposed with promising results. However, this therapeutic strategy is only indicated when the absence of extrahepatic disease is documented. This is a literature review of the largest studies which focused on the topic of liver transplantation for unresectable liver metastases from colorectal cancer.

The role of sentinel lymph node detection was clearly demonstrated in patients diagnosed with gynecologic malignancies such as breast, endometrial, cervical or vulvar cancer. Therefore, the method provides an adequate staging of the disease with minimal postoperative complications when compared to classical extended lymphadenectomy. Recently, the method has been successfully reported in vaginal cancer patients. This is a literature review of the current papers published so far on the issue of sentinel lymph node detection in vaginal cancer patients. Although only few cases have been reported so far, it seems that sentinel lymph node biopsy in vaginal cancer patients represents a safe, effective and feasible method to diminish the rates of unnecessary extended lymph node dissection in vaginal cancer patients. However, due to the rarity of the disease in association with the low number of cases reported so far, the method is not part of the therapeutic standard protocol for this disease, larger studies still being needed.

Performing radical surgery for locally advanced vulvar cancer is usually associated with the occurrence of large perineal defects. In order to provide a better healing process of the perineal wound, different reconstructive techniques have been proposed. We present the case of a 63-year-old female patient diagnosed with locally advanced vulvar cancer for which a left hemivulvectomy with bilateral inguinal lymph node dissection was performed. After completion of the resection phase, the reconstruction with gracilis myocutaneous flap was performed. The patient developed a non-union of the flap. However, it slowly healed without any surgical re-intervention. Gracilis myocutaneous flap seems to be an effective and feasible method of perineal reconstruction after extended perineal resection for gynecological malignancies, including vulvar cancer. The method appears effective even in pre-irradiated patients with larger perineal wounds resulting after total pelvic exenteration for locally advanced gynecological malignancies.

Cholangiocarcinoma represents an extremely aggressive digestive malignancy associated with very poor survival rates in the absence of a treatment with curative intent. Moreover, an important per cent of patients are diagnosed in advanced stages of the disease, when resection with curative intent is no longer feasible. When it comes to cases which can be submitted to surgery, radical resection, including lymph node dissection, seems to be one of the most important therapeutic strategies in order to improve survival. This is a literature review of the most relevant studies which were focused on analyzing the impact of lymph node status on the overall survival of surgically treated hilar cholangiocarcinomas

Merkel cell carcinoma represents an aggressive histopathological subtype of skin cancer with a high propensity to spread via lymphatic route. Once the benefits of the sentinel lymph node detection have been proven in malignant melanoma, the effectiveness of the method was investigated further on in Merkel cell carcinoma, as long as the two tumoral subtypes seem to have a common embryological origin. Surprisingly, the results reported so far in Merkel cell carcinoma are rather confusing, the method not being so far associated as part of the standard therapeutic protocol. However, it seems that the method plays a certain role in identifying the high risk patients and further tailoring the therapeutic strategy. This is a literature review of the most eloquent studies conducted on this theme.

Thyroid cancer has been usually treated by total or near total thyroidectomy in association with cervical lymph node dissection and followed by adjuvant oncological and endocrinological treatment. In order to maximize the effect of the surgical approach and to minimize the perioperative rates of complications, certain authors proposed the introduction of the sentinel node detection; however, the method has certain particularities due to the complex lymphatic anatomy of the cervical region. This is a literature review of the more significant studies conducted so far on this theme.

Colorectal cancer represents one of the most encountered malignancies worldwide, with a high capacity of lymphatic spread. Therefore, the lymph node status plays a crucial role in order to tailor the adjuvant treatment and to decrease the recurrence rates. In consequence, performing the sentinel lymph node detection in colorectal cancer patients should orientate the surgeon’s attention on the lymphatic basins of drainage and, furthermore to orientate the lymph node dissection. However, the method has certain particularities in colorectal patients depending on the location of tumor, on the size and on the type of associated neoadjuvant therapy. This is a literature review of the most relevant studies conducted on this theme.

Although the exact incidence of cervical cancer cases in pregnant women is not known, undoubtedly is the most common gynecological malignancy diagnosed during pregnancy. Association between the two entities does not seem to influence the oncological outcomes. However, the management of these cases remains a real challenge for the obstetrician and for the onco-gynecologist, fighting for two lives being necessary. Moreover, due to the rarity of cases, there are no standard guidelines, the therapeutic strategy being influenced only by small case series and observational studies. This is a literature review of the current therapeutic options available for the management of such cases.

Peritoneal carcinomatosis with breast cancer origin is an uncommon situation, which usually develops late during the evolution of the disease. The development of such lesions is commonly associated with an aggressive histology (such as lobular carcinoma) and advanced stage at diagnostic and is usually associated with a poor outcome. The positive diagnostic of peritoneal carcinomatosis with breast cancer origin can be sustained only if a biopsy from the tumoral nodules demonstrates the mammary origin of the lesions. In order to improve the outcome of these patients cytoreductive surgery alone or in association with hyperthermic intraperitoneal chemotherapy has been proposed. However, more studies are still needed in order to include the method as part of the therapeutic strategy of these patients.

Central cholangiocarcinoma represents a very aggressive malignancy associated with poor survival rats especially due to the fact that most patients are diagnosed in advanced stages of the disease when curative resection is no longer feasible. In order to try improving the long-term outcomes of these patients, especially in unresectable cases liver transplantation has been proposed with promising results. This is a literature review of the largest studies focused on this subject. Cholangiocarcinomas remain aggressive tumors with poor outcomes whenever surgery with curative intent is not feasible. Currently, the largest experience accumulated consists of neoadjuvant external beam radiotherapy in association with beam radiation, 5 fluorouracil and capecitabine followed by orthotopic liver transplantation. Following this therapeutic protocol excellent long-term outcomes have been reported even if vascular involvement is present.

Although sentinel lymph node mapping has been widely implemented in gynecological malignancies in order to minimize the number of unnecessary lymph node dissections and to diminish postoperative morbidity rate, little is known about ovarian cancer sentinel lymph node mapping. This article presents a literature review regarding the effectiveness, safety and benefits of this method. Sentinel lymph node detection in early stage ovarian cancer seems to be a safe and effective method, able to minimize the rate of patients submitted to unnecessary lymph node dissection. The second goal of the procedure, to minimize the risk of missing involved lymph nodes, seems also to have been achieved, most studies reporting a very small number of cases diagnosed with positive non-sentinel lymph nodes. Considering all these data we can note that this procedure is not yet included as part of the standard therapeutic protocol, so that further studies would be necessary to include it as a common therapeutic approach in the case of patients with early stage ovarian cancer.

Background/Aim: Synchronous gynecological malignancies are rarely encountered, and most often these cases are represented by synchronous ovarian and endometrial cancer. The aim of this paper is to present the case of a 53-year-old patient who was diagnosed with synchronous cervical and ovarian cancer. Case presentation: The patient had been initially investigated for vaginal bleeding and was submitted to a biopsy confirming the presence of a cervical adenocarcinoma. Once the diagnostic of malignancy was confirmed, the patient was submitted to a computed tomography which revealed the presence of large abdominal tumoral nodules of peritoneal carcinomatosis and was submitted to palliative chemotherapy with poor response. Eighteen months later she developed intestinal obstruction and was submitted to surgery. At that moment, synchronous ovarian and cervical tumors were diagnosed. Total radical hysterectomy with bilateral adnexectomy, pelvic and para-aortic lymph node dissection, omentectomy, and pelvic peritonectomy was performed; in the meantime, the histopathological studies confirmed the presence of two synchronous malignancies. Conclusion: Although synchronous lesions are rarely encountered, this eventuality should not be omitted. In such cases, surgery should be taken in consideration and the intent of radicality should regard both lesions.

Background and objectives: To identify the risk factors for para-aortic lymph node metastases in cases with presumed early stage ovarian cancer. Materials and methods: Between 2014 and 2019, 48 patients with apparent early stage ovarian cancer were submitted to surgery. In all cases, pelvic and para-aortic lymph node dissection was performed for staging purposes. Results: Among the 48 cases we identified nine cases with positive pelvic lymph nodes and 11 cases with positive para-aortic lymph nodes. The positivity of the retrieved lymph nodes was significantly correlated with the histopathological subtype represented by serous histology (p = 0.02), as well as with the degree of differentiation (p = 0.004). Conclusion: Patients with serous ovarian carcinomas in association with a poorer degree of differentiation are at risk of associated lymph node metastases even in presumed early stages of the disease. Therefore, lymph node dissection should be performed in such cases in order to provide adequate staging and tailoring of further treatment.