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Purpose: Mozambique is a country with a very high prevalence of gynecological cancer and, until 2018 had no training program in gynecologic oncology and no gynecologic oncology specialists. Through the International Gynecologic Cancer Society (IGCS) global fellowship program, three gynecologists in Mozambique were trained to become gynecologic oncologists and completed training in October 2020. Methods: The training program pairs specialists in gynecologic oncology with gynecologists in countries without a formal training program in gynecologic oncology. In Mozambique, fellows were paired with specialists from Brazil and the United States, due to a common language with Brazilians and pre-existing partnerships. Over a 2.5 year period, fellows performed self-study using an on-line curriculum, received training in clinical practice and surgery with specialist mentors who traveled to Mozambique 3-4 times/year, attended monthly tumor boards and other regular virtual meetings, and visited the mentors' hospitals in Brazil for a 3 month observership. All surgical cases were logged in REDCap. after completing all requirements, the fellows successfully completed a final exam and received a certificate of successful completion of training. Results: During the training, each fellow participated on average of 251 surgical procedures where they performed: 69 radical hysterectomies, 80 simple hysterectomies, 92 salpingo-oophorectomies, 73 pelvic lymphadenectomies, 2 para-aortic lymphadenectomies, 14 radical vulvectomies, 19 inguinal lymphadenectomies, 34 cold knife conizations and 38 loop electrosurgical excision procedures (LEEPs). At the conclusion of the fellowship, the fellows were performing these procedures independently. Conclusion: The IGCS program and international mentors supported the training of physicians in Mozambique, a country without formal gynecologic oncology training, facilitating the acquisition of the knowledge and skills to effectively care for women with gynecologic cancers. Citation Format: Ricardina Rangeiro, Dercia Changule, Siro Daud, Magda Ribeiro, Elvira Luis, Flora Mabota, Georgia Cintra, Renato Moretti-Marques, Andre Lopes, Marcelo Vieira, Mila Salcedo, Ellen Baker, Cesaltina Lorenzoni, Kathleen Schemeler. IGCS Fellowship Program in Mozambique: the Results [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 91.

Background to evaluate the intraobserver and interobserver reproducibility of cervical cytopathology according to previous knowledge of whether patients received radiotherapy (RT) treatment or not. Methods The study analyzed a sample of 95 cervix cytological slides; 24 with cytological abnormalities (CA) and presence of RT; 21 without CA and presence of RT; 25 without CA and without previous RT; 25 with CA and without previous RT. Two cytopathology (CP) evaluations of the slides were carried out. For the first CP re-evaluation, the cytotechnologist was blinded for the information of previous RT. For the second CP re-evaluation, the cytotechnologist was informed about previous RT. The results were analyzed through inter and intraobserver agreement using the unweighted and weighted kappa. Results Post radiotherapy effects were identified in 44.4% of cases that undergone previous pelvic RT. The agreement for RT status was 66.32% (unweighted K = 0.31, 95%CI: 0.13; 0.49, moderate agreement). The intraobserver agreement, regarding the cytological diagnoses, regardless of radiotherapy status, was 80.32% (weighted K = 0.52, 95%CI: 0.34; 0.68). In no RT group, the intraobserver agreement was 70% (weighted K = 0.47, 95%CI: 0.27;0.65) and in patients that received RT, the intraobserver agreement was 84.09% (unweighted K = 0.37, 95%CI: 0.01;0.74). The interobserver agreement between cytopathology result (abnormal or normal) in the group with RT, considering normal and abnormal CP diagnosis was 14.0% and 12.5%, respectively. There was no association between the cytological alterations and the median time between the end of RT and the cytological diagnosis. Conclusion This study showed that RT has an important impact in CP diagnosis because the agreement, also in interobserver and intraobserver analysis, had high discrepancy in patients that received RT. Also, demonstrated that it is difficult to recognize the presence of RT in cytological slides when this information is not provided. Electronic supplementary material The online version of this article (10.1186/s12907-018-0078-z) contains supplementary material, which is available to authorized users.

More than 85% of cervical cancer cases occur in low and middle income countries where there are not enough medical specialists to provide prevention, screening, and treatment services. Numerous cancer patients around the world are victims of the scarcity of institutional organization structure and

The patient is placed in gynecological position, with arms along the body, in Allen stirrups, and with intermittent pneumatic compression to prevent thromboembolism. After a systematic survey for extrauterine disease, the patient is placed in steep Trendelenburg position (Fig. 28.1).

Epithelioid sarcoma is a distinct sarcoma type with specific morphology and immunophenotype. An epithelioid sarcoma of the vulva is an extremely rare and aggressive tumor and most commonly occurs on the labia majora in women of reproductive age. Only few cases have been reported, especially with the presence of focal myxoid changes. Early diagnosis is difficult because of its benign appearance as a painless subcutaneous nodule. Optimal treatment is not well established due to its rarity. We report a successfully approached case of vulvar epithelioid sarcoma that occurred in a 34-year-old female patient, treated with wide local excision, and review of the current medical literature.

Study Objective To demonstrate a laparoscopic vaginal-assisted nerve-sparing radical trachelectomy. Design An edited educational video, including a step-by-step description of the procedure. Setting Radical trachelectomy is the main surgical indication for selected cases of initial cervical cancer with a fertility-sparing approach. Although transvaginal access is the most traditional route, this technique has not gained widespread acceptance because of the complexity of the ureteral dissection and the limited amount of resected parametrial tissue. This video describes a laparoscopic technique including an adequate parametrial resection with autonomic preservation (C1 level) and a standard laparoscopic ureteric dissection under direct visualization. All parametrial dissections were performed by laparoscopy using a nerve-sparing technique. The uterine vessels were well dissected and transected at their origin. The colpotomy was performed by laparoscopy with a 1-cm vaginal margin using a monopolar energy hook. To achieve an adequate endocervical margin and to avoid thermal injury to the endocervix, the cervical section was performed transvaginally with a cold knife. The specimen was then retrieved, and a segment of the remaining cervix was removed for frozen section analysis. If the margin was free of tumor, the cervical-vaginal anastomosis was performed transvaginally. An endocervical device was placed to avoid postoperative cervical stenosis. Interventions Laparoscopic vaginal-assisted nerve-sparing radical trachelectomy. Conclusion This video demonstrates a reproducible laparoscopic technique for radical trachelectomy with a nerve-sparing technique. The vaginal route was used at the moment of sectioning the cervix/isthmus to permit adequate margin evaluation.