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Background: Studies on the long-term risk of treated cervical intraepithelial neoplasia (CIN), have shown that these women have a higher risk of invasive cancer in the remaining cervix or vagina, when compared to the general population. This risk persists, for at least, ten years after initial treatment. Methods: Retrospective cohort study to evaluate the long-term risk of vaginal cancer after treatment of high-grade cervical intraepithelial neoplasia. Results: The data comprised 460 women with high-grade cervical intraepithelial neoplasia treated at our institution, from January 2012 to December 2020. Three women developed vaginal cancer. The rate of invasive cancer during this period was 181 per 100 000 woman-years. The increased risk of developing cancer was noticed during the first 5 years of follow-up, in women older than 50, and with human papillomavirus (HPV) 16 infections. Conclusions: Women previously treated for high-grade lesions, are at an increased risk of developing invasive vaginal cancer. This risk is higher in older women. Follow-up of these women should be based on risk, by a combination of co-testing and clinical evaluation.

Introduction: Granular cell tumor (GCT) is a rare clinical entity derived from Schwann cells of the outer sheath of the peripheral nerves, involving skin and subcutaneous tissue in most cases, but specifically GCT of the vulva is less frequent and labium majus is more prevalent site in vulva. The exact prevalence and pathogenesis of GCT haven’t been determined, but the risk of malignancy has been described at the rate of 2%. The authors report a case of 52-year-old postmenopausal woman, with a 2-year slow growth vulvar mass, without associated symptoms. On physical examination, a hard consistent and nodular subcutaneous mass, with 5 cm and located over the mons pubis was observed. Pelvic magnetic resonance identified a solid mass with irregular borders on subcutaneous tissue, upon mons pubis. An aspiration cytology was performed, suggesting a GCT leading a complete excision. Microscopically, GCT was compatible with a GCT without malignancy characteristics and the margins were negative. Conclusion: This case reports a GCT on the mons pubis, whose rare location have only been reported in three cases. Despites its benign behavior, the unusual size conditioned a more aggressive surgical treatment and a multidisciplinary approach. During follow-up vulva and other anatomical locations should be carefully observed, because of its unusual local or extragenital recurrence.

Introduction/Background The spectrum of Gestational trophoblastic disease (GTD) ranges from pre-malignant conditions of complete (CHM) and partial (PHM) hydatidiform moles to the malignant invasive mole, choriocarcinoma (CC) and very rare placental site trophoblastic tumour/epithelioid trophoblastic tumour (PSTT/ETT). Gestational trophoblastic neoplasia (GTN) are highly responsive to chemotherapy (CT) and with appropriate diagnosis and management a high cure rate (>90%) is observed. In this study we reviewed the outcomes of long term follow up for GTN patients (pts) treated in our centre. Methodology Update of outcomes (clinical records and phone contacts) of patients with GTN tumours treated in our centre between January 2005-December 2014. Results Twenty three GTD pts between 2005–2014: 2 PHM (9%) and 9 CHM (39%), 8 CC (35%), 2 ETT (9%) and 2 PSTT (9%). Median age at diagnosis: 37 years (20–53). Staging: 12 stage I (52%), 9 stage III (39%) and 2 stage IV (9%). Most patients received CT as first treatment (20; 87%), according to prognostic risk score: 10 with methotrexate (MTX) monotherapy (50%) and 10 with EMA-CO (50%). Resistance to first line CT was observed in 5 patients (22%), 2 after MTX monotherapy and 3 after EMA-CO. For those pts, 2nd line CT was as follows: 1- ACT-D; 1 -EMA-CO (after MTX monotherapy) and 3-EMA-EP (after EMA-CO). Surgery was performed in 9 pts: 6 because of residual disease after CT and in 3 cases as the only treatment (1 patient with ETT and 2 patients with PSTT). One patient without criteria for treatment underwent clinical surveillance. Treatment related adverse reactions- Significant CT toxicity was observed in 2 pts (1-pneumonitis, 1- sarcoidosis), both with clinical resolution after specific care. One pt complained of late surgical sequelae (adhesions) and still hasn´t recovered. After a median follow up of 69 months, 2 patients died: 1 due to a second malignancy (glioblastoma), 1- due to acute respiratory failure (extensive lung metastasis in previous chronic lung disease). Five patients maintain FU at our centre and 17 were either referred to their primary care physician (9) or were lost to follow up (7). Second neoplasia was observed in 3 pts:1-glioblastoma, 1- thyroid papillary carcinoma, and 1- gallbladder polyps. Conclusion GTD is a rare diagnosis and duration of follow is controversial. Our data suggests that prompt management of serious CT adverse reactions is important to prevent the late term impact of CT toxicities. Second neoplasia in survivors of GTD deserve further study. Disclosures No disclosures to report.

Introduction/Background Sentinel lymph node (SLN) biopsy is the recommended staging method for single vulvar tumors, The vulva has an ample lymphatic system and especially for midline tumors (tumors that cross midline), its drainage can be made to both groins. According to international guidelines, bilateral detection of SLN is recomended for midline tumors and, in case of unilateral detection, inguinofemoral lymphadenectomy should be performed on the opposite groin. In an era of de-escalation surgery, should bilateral groin evaluation be mandatory for midline vulvar tumors? Methodology Retrospective observational study (2005–2018) of midline squamous-cell vulvar tumors, fulfilling criteria for SLN biopsy. In our oncology center, we detect SLN by performing lymphocintigraphy and using dual-mapping technique (radioactive tracer and blue-dye). In case of unilateral detection we do not execute contralateral lymphadenectomy. The aim of the study is to evaluate recurrence on the contralateral groin when SLN was negative. To accomplish this, the study-population was divided into two groups, according to SLN biopsy: 1) unilateral; 2) bilateral. Results We included 34 cases with a median follow-up time of 37,5 (1–111) months. During surgery, the detection rate of the SLN was 100% and always in accordance with the previous lymphocintigraphy. Group 1 included 16 cases (47%) and SLN biopsy was negative in 13 cases (81,3%). There were 2 cases of groin recurrence, one of which on the opposite side of the previous SLN. Group 2 included 18 cases (53%) and SLN biopsy was negative in 13 cases (72,2%). There wasn´t any case of groin recurrence. Conclusion SLN biopsy is a feasible staging technique and should be directed by previous lymphocintigraphy. Because vulvar cancer is rare, few cases were described, but our approach does not seem to increase the groin recurrence rate on the non-evaluated side. More studies are needed. Disclosure Nothing to disclose

Introduction/Background Some authors reported that there are clinicopathological differences between squamous cell carcinoma (SCC) and adenocarcinoma (ADC) of the uterine cervix. On the other hand, current studies have failed finding significant differences in survival between the two groups. Still the controversy remains. The purpose of this study was to compare clinical outcomes of squamous cell carcinoma with those of adenocarcinoma of the cervix in our population. Methodology We conducted a retrospective analysis of all women with a primary diagnose of squamous cell carcinoma and adenocarcinoma of the uterine cervix, from 2013 to 2014, in a Portuguese oncological referral center. Cases were identified by searching for ICD-9 codes and data was collected through electronic medical records. Our main outcome was overall survival (OS) and recurrence-free survival (RFS). Survival was evaluated using the Kaplan-Meier curves and compared with log-rank test before and after propensity score matching (1:1). Results We included a total of 302 cases: 258 (85,4%) of squamous cell carcinoma and 44 (14,6%) of adenocarcinoma. We found differences in patients characteristics between SCC and ADC regarding medium age (61,3 years vs 56,4 years, p=0,02) and initial disease stage (FIGO I–II) at diagnosis (71,2% vs 64,6%, p=0,034). The 5-year OS and RFS in the SCC group and adenocarcinoma group were respectively 86.2 and 77.4% (p=0.005). After matching, OS and RFS for patients with AC did not significantly differ from those with SCC (p=0,06 and p=0,12). Conclusion In our population, both patients with SCC and ADC, with similar baseline characteristics, have no differences in overall and recurrence-free survival. However, it remains controversial if the histologic subtype is an independent prognostic factor. For more conclusive results, more studies focusing adenocarcinoma are needed, in order to understand the differences between these patients and its impact on the natural history of the disease. Disclosure Nothing to disclose.

Introduction/Background Inherited germline mutations in BRCA1/BRCA2 increase significantly the risk of developing breast and ovarian cancers. For women in whom a BRCA pathogenic variant is identified, risk-reducing bilateral salpingo-oophorectomy (rrBSO) is recommend by age 35 to 40 years or when childbearing is complete. This procedure is associated with reduction of ovarian cancer risk, reduction in breast cancer, cancer-related mortality and overall mortality. The incidence of unsuspected neoplasia in these women varies in the literature. Methodology We performed a retrospective review of all women undergoing risk-reducing surgery between January 2013 and December 2018, in an oncological referral center - Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal. The purpose of this study was to analyze the results of anatomo-histopathologic examinations and to identify the rate of occult cancer diagnosis in a high-risk population. Results Overall, 83 high-risk women (75 known BRCA1/2 carriers; 8 with unknown mutation status) underwent risk-reducing surgery. The median age at the surgery was 48,76 years and the median body mass index was 25,65 kg/m2. 42,2% (n=35) of these women had personal history of breast cancer. Preoperative CA-125 levels were considered normal in 97,6%(n=81). We performed rrBSO on 22,89%(n=19) of cases and concomitant hysterectomy on 77,1%(n=64). Laparoscopic approach was used in 77,1%(n=64) of procedures. The surgical complication rate was 3.6%(n=3). The anatomopathological analysis of specimens revealed: 5 ovarian serous cystadenoma, 1 adenomatoid tumor of the fallopian tube, 1 ovarian cystic teratoma and 1 ovarian endometrioma. The presence of occult tumor cells, including epithelial ovarian cancer and serous tubal intraepithelial carcinoma, was not reported. Conclusion Risk-reducing surgery is a safe and effective strategy to manage BRCA mutation carriers. Even though our median age at surgery is high, the incidence of unsuspected neoplasia identified in this study was unexpectedly low compared with the current literature. Disclosure Nothing to disclose

Introdução: O carcinossarcoma uterino é uma neoplasia bifásica rara e agressiva e está atualmente incluído no grupo de carcinoma do endométrio de alto risco. Os objetivos deste estudo foram determinar o perfil clinico-patológico, tratamento, padrões de recidiva/progressão, sobrevivência e fatores de prognóstico.Material e Métodos: Estudo retrospetivo de 42 doentes, estadiadas cirurgicamente e vigiadas num centro oncológico, entre 2005 e 2013. Os dados clínicos foram consultados nos processos e as características histopatológicas foram revistas para este estudo.Resultados: A idade mediana das doentes foi de 72 anos (61 - 81) e a maioria apresentava co-morbilidades. A distribuição por estádio foi a seguinte: 13 (31,0%) estádio I; oito (19,0%) estádio II; nove (21,4%) estádio III; e 12 (28,6%) estádio IV. A quimioterapia adjuvante foi instituída em 12 doentes e 21 realizaram radioterapia. A doença progrediu em 16 doentes e recidivou em nove após um intervalo curto. A sobrevivência global mediana foi de 18 meses (6,8 - 40) e a sobrevivência livre de doença mediana de 6 meses (0 - 22,8). O único fator prognóstico independente associado a pior sobrevivência foi a invasão da serosa (p = 0,02; HR ajustado 4,22; IC 95% 1,29 - 13,79).Discussão: Em concordância com outros estudos, o diagnóstico de carcinossarcoma uterino é frequentemente realizado com doença avançada e apresenta elevada taxa de progressão/recidiva. A variável que tem sido consistentemente identificada como principal fator de prognóstico é o estádio inicial, mas neste estudo o único fator independente foi a invasão da serosa.Conclusão: O presente estudo representa a maior série de carcinossarcoma uterino estudada em Portugal e reflete o quadro clínico,características histopatológicas e estádio no momento do diagnóstico e confirma a agressividade deste raro tumor.

Objective The authors describe the 20th known case of cervical cancer with metastasis in an episiotomy scar, being the first case describing an implant of malignant cells in the episiotomy scar associated with glassy cell carcinoma. Materials and methods One case report. Results We describe the case of a 34-year-old woman, with cervical cancer diagnosed 1 month after delivery. Four months later, a radical hysterectomy was performed. During surgery, a nodule at the site of the episiotomy scar was identified and removed. The histologic diagnosis revealed a glassy cell carcinoma of the cervix, with metastasis in the episiotomy scar. After surgery, chemotherapy and radiotherapy were performed. The disease progressed rapidly, and the patient died 9 months after surgery. Conclusions The implantation of neoplastic cells in the perineum is a potential risk of vaginal delivery, with a 40% mortality rate. It thus seems advisable to avoid vaginal delivery as much as possible when cervical cancer is diagnosed during pregnancy. Given the rarity, there are no studies on the most effective treatment in such situations.

Objective Cervical cancer is one of the most common malignancies in pregnancy and one percent of women diagnosed with cervical cancer are pregnant or postpartum at the time of the diagnosis. We discuss how pregnancy will affect the management of cancer, and cancer will affect the management of the pregnancy. Material and methods Three case reports. Results We report three cases, with three different approaches of pregnant patient with cervical carcinoma stage IB1, diagnosed below-20 weeks gestation. In two cases, the patients decided to continue the pregnancy. Conclusions Cervical cancer in pregnancy is a clinical challenge. Once the diagnosis, the stage and the extent of invasive cervical cancer have been established, a multidisciplinary approach is required. Decisions regarding timing of treatment and delivery require careful considerations, as well as the trimester in which the diagnosis is made. Delaying definitive treatment to improve fetal outcome, may carry an additional risk of tumor progression, although a delay in definitive treatment is regarded as feasible. Delayed treatment is safe in patients with small sized, early stage disease, if there is no evidence of disease progression. Neoadjuvant chemotherapy during pregnancy is still controversial. Cesarean delivery followed by radical hysterectomy is recommended. The effect of cervical cancer on pregnancy outcome is still not clear.

Uterine carcinosarcoma is a rare and aggressive biphasic malignancy and is currently included in the high risk endometrial carcinoma group. The aims of this study were to determine the clinicopathological profile, treatment, recurrence/progression patterns, survival and prognostic factors.Retrospective study of 42 patients, surgically staged and followed-up at a cancer centre, between 2005 and 2013. Clinical data was retrieved from records and pathological characteristics were reviewed for this study.Median age was 72 years (61 - 78) and the majority presented comorbid diseases. Stage distribution as follows: 13 (31.0%) stage I; eight (19.0%) stage II; nine (21.4%) stage III; and 12 (28.6%) stage IV. Chemotherapy was instituted in 12 patients and 21 received radiotherapy. Disease progressed in 16 patients and recurred in nine after a short interval. Median overall survival was 18 months (6.8 - 40) and median disease-free survival was 6 months (0 - 22.8). The only independent prognostic factor related with poor survival was serosal invasion (p = 0.02; HR adjusted 4.22; IC 95% 1.29 - 13.79).In accordance to other studies, diagnosis of uterine carcinosarcoma is frequently done with advanced disease and presents a high rate of progression/recurrence. The variable which has been consistently identified as main prognostic factor is stage, but in this study the only independent factor was serosal invasion.The present study represents the larger series of uterine carcinosarcoma studied in Portugal and reflects the clinical presentation, histopathological characteristics and stage at diagnosis and confirms the aggressiveness of this rare tumor.Introdução: O carcinossarcoma uterino é uma neoplasia bifásica rara e agressiva e está atualmente incluído no grupo de carcinoma do endométrio de alto risco. Os objetivos deste estudo foram determinar o perfil clinico-patológico, tratamento, padrões de recidiva/progressão, sobrevivência e fatores de prognóstico. Material e Métodos: Estudo retrospetivo de 42 doentes, estadiadas cirurgicamente e vigiadas num centro oncológico, entre 2005 e 2013. Os dados clínicos foram consultados nos processos e as características histopatológicas foram revistas para este estudo.Resultados: A idade mediana das doentes foi de 72 anos (61 - 81) e a maioria apresentava co-morbilidades. A distribuição por estádio foi a seguinte: 13 (31,0%) estádio I; oito (19,0%) estádio II; nove (21,4%) estádio III; e 12 (28,6%) estádio IV. A quimioterapia adjuvante foi instituída em 12 doentes e 21 realizaram radioterapia. A doença progrediu em 16 doentes e recidivou em nove após um intervalo curto. A sobrevivência global mediana foi de 18 meses (6,8 - 40) e a sobrevivência livre de doença mediana de 6 meses (0 - 22,8). O único fator prognóstico independente associado a pior sobrevivência foi a invasão da serosa (p = 0,02; HR ajustado 4,22; IC 95% 1,29 - 13,79). Discussão: Em concordância com outros estudos, o diagnóstico de carcinossarcoma uterino é frequentemente realizado com doença avançada e apresenta elevada taxa de progressão/recidiva. A variável que tem sido consistentemente identificada como principal fator de prognóstico é o estádio inicial, mas neste estudo o único fator independente foi a invasão da serosa. Conclusão: O presente estudo representa a maior série de carcinossarcoma uterino estudada em Portugal e reflete o quadro clínico,características histopatológicas e estádio no momento do diagnóstico e confirma a agressividade deste raro tumor.

Aim: PCS is the standard of care for aOC but NACT and interval debulking surgery (IDS) are acceptable treatment options for patients (pts) with stages IIIC and IV OC. Our aims are to characterize OC pts treated with PCS or NACT in our centre and to analyse decision criteria and efficacy outcomes of both strategies. Methods: All pts with ovarian tumours registered at the Southern Portuguese Cancer Registry (ROR-Sul) between 2006-2011 were reviewed for age at diagnosis, histology, FIGO stage, treatment (none, surgery and/or CT), progression free survival (PFS), overall survival (OS), criteria for NACT, number of platinum based CT cycles and residual macroscopic disease. Results: From 345 pts registered with ovarian tumours, 258 were epithelial ovarian cancers (EOC) (75%). EOC pts had a median age of 62 yrs (10-90); 64 (25%) were treated with surgery alone, 53 (21%) with NACT (stages IIIB-3, IIIC-15, IV-29) and 94 (37%) with PCS (25% stages IA-IC; 23% IIA-IIIA; 51% IIIB-IV).Other pts (17%) were not treated at our centre (only pathology review, multidisciplinary decision or death before treatment). For similar stages (IIIB-IV), median age was higher for NACT pts (64 yrs, 36-90) vs 59 yrs (33-82); median number of CT cycles was 8 (NACT) and 6 (PCS). Nine pts in the NACT group progressed and died before IDS. Complete resection of macroscopic disease was achieved in 24 (55%) of NACT pts and in 17 (36%) of PCS pts. Median OS and PFS were 29,2 and 8,1 months (NACT) and 38,1 months and 10,6 months (PCS). Bad prognosis pathology (mucinous/clear cell) was observed in 10 pts (3 NACT, 7 PCS). NACT decision was based on radiological criteria (74% of cases) such as implants >2cm outside the pelvis, lymphadenopathies above renal hilum, pre-sacred retroperitoneal disease or liver metastasis. In 14 pts (26%), comorbidities contraindicated upfront surgery. Conclusions: NACT was mostly decided for older pts with contraindications for upfront surgery and/or with radiologically determined unresectable disease. Observed OS was similar to that observed in trials with more fit pts. OS for the PDS group is in line with previous reports of single centre studies with experience in OC treatment. Disclosure: All authors have declared no conflicts of interest.

A implementação dos programas de rastreio tem conduzido à redução da incidência do carcinoma do colo do útero e à sua detecção em estádios mais precoces. Contudo, esta continua a ser uma patologia frequente, nomeadamente em Portugal, constituindo a neoplasia maligna ginecológica mais frequente no grupo etário abaixo dos 50 anos e levantando a premente questão da preservação da fertilidade. A Traquelectomia radical é uma técnica cirúrgica recente, já realizada em Portugal e exequível nos casos de tumor invasivo em fase precoce (estádio IB1). Consiste na remoção do colo do útero, de um segmento proximal contíguo dos paramétrios e da cúpula vaginal, associado a um procedimento de linfadenectomia pélvica, sendo realizada uma anastomose corpo ou istmo-vaginal que permite a manutenção da fertilidade. Em termos de prognóstico e taxa de recidiva, a literatura não mostra diferenças significativas face à histerectomia radical. Cabe ao radiologista um contributo importante no correcto estadiamento, sobretudo quanto à extensão local da doença, para adequada decisão terapêutica e selecção das doentes jovens com desejo de preservação da fertilidade que irão beneficiar da realização de traquelectomia. The implemented screening programs have been responsible for a reduction in the cervical cancer incidence and detection in earlier stages. However, it is still a prevalent disease, particularly in Portugal and represents the most frequent gynecologic malignancy in women with less than 50 years of age, what raises the fertility problematic. Radical Trachelectomy is a recent option, just beginning to be performed in Portugal, which can be performed in the IB1 stage (early invasive cancer). It consists in removal of the cervix, its contiguous parametrium and vaginal cuff, in addition to a pelvic lymphadenectomy, with a vaginoisthmic anastomosis allowing fertility preservation. In terms of prognosis and recurrence rate, this operative technique is comparable to radical hysterectomy in literature review data. An important contribute concerning the accurate stage assessment relies on the Radiologist, particularly in relation to local tumor extent, to determine the best therapeutic option and correctly select the young patients that desire to preserve their fertility.