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D Castaigne

Publications and source records attributed to D Castaigne.

At least 55 records · Page 3Linked to original sources
PubMed2001

[Basal cell carcinoma of the vulva: 21 cases].

INTRODUCTION: Basal cell carcinoma (BCC) accounts for 2 to 3 p. 100 of all vulvar malignancies. PATIENTS AND METHODS: We report a retrospective study of 21 cases treated from 1937 to 1999. RESULTS: Vulvar BCC's occurred in elderly patients (average age: 66 years), with mean delay to diagnosis of 5.5 years. Five patients were referred for recurrence. Lesions were located on the external hairy side of the labia majus, except one located on the internal side. In 4 cases a preexisting risk factor was identified: 2 patients had previously received radiation therapy and 2 other patients had multiple disseminated BCC. Mean BCC diameter was 2 cm. Pathological data were similar to skin BCC, with one case of mixed tumor (BCC and squamous cell carcinoma). The treatment was surgical excision for 19 BCCs. Local recurrence risk was high. Only one patient died of visceral dissemination of the disease. DISCUSSION: More than 250 cases of vulvar BCC have been reported in the literature. Clinical, pathological and follow up data are similar to results in the present series. Treatment of choice consists of surgical excision with tumor-free margins. Because of local recurrence risk and possible association with other primary cancers in this age group, long term follow-up is necessary.

Adult↗
PubMed2000

Ovarian transposition for patients with cervical carcinoma treated by radiosurgical combination.

OBJECTIVE: To assess the indications, effectiveness, and complications of ovarian transposition before pelvic irradiation for cervical cancer. DESIGN: Prospective study. SETTING: Gynecologic oncology department at a French cancer center. PATIENT(S): One hundred seven patients treated for cervical cancer. INTERVENTION(S): Ovarian transposition to the paracolic gutters with radical hysterectomy and lymphadenectomy. MAIN OUTCOME MEASURE(S): Clinical and laboratory follow-up tests for ovarian function. RESULT(S): Bilateral ovarian transposition was achieved in 104 patients (98%). Twelve patients were lost to follow-up or excluded because of evolution of the disease. Preservation of ovarian function was achieved in 83% of the patients having follow-up. The rates of ovarian preservation were 100% for patients treated exclusively by surgery, 90% for patients treated by postoperative vaginal brachytherapy, and 60% for patients treated by postoperative external radiation therapy and vaginal brachytherapy. The main risk for ovarian failure was found in patients treated by external radiation therapy. CONCLUSION(S): Ovarian transposition is a safe and effective procedure for preserving ovarian function in patients treated by a radiosurgical combination. This procedure should be performed in patients <40 years of age with a small invasive cervical carcinoma (<3 cm) treated by initial surgery. In such selected cases, the risk of ovarian metastasis is low.

Abdominal Pain↗
PubMed2000

Neuroendocrine small cell carcinoma of the uterine cervix: what disease? What treatment? Report of ten cases and a review of the literature.

Neuroendocrine small cell carcinoma of the uterine cervix (NESCCC) is an entity with very aggressive behaviour. The optimal initial therapeutic approach to this rare disease has not yet been clearly defined. We reviewed our experience of this disease over the past 10 years with regard to chemosensitivity. Since 1988, ten patients (mean age 33 years; range 24-47) have been diagnosed with NESCCC and treated in our institutions. Disease stage at presentation was IA (one), IB (five, two with lymph node involvement), IIB (one), IIIB (one), and IV (two). One patient had metastatic disease at presentation; three developed metastases during initial treatment. Eight patients underwent surgery and eight received radiation therapy. Six patients received pre- or postoperative cisplatinumvepeside (PE) combination chemotherapy, either alone or concurrently with radiation therapy. PE alone as primary chemotherapy led to disease stabilization in the two patients so treated; concurrent PE and radiation therapy resulted in a pathological complete response in one patient. Eight patients relapsed within 16 months and died of their disease within 29 months from the initial diagnosis. Two patients are alive with no evidence of disease at 13 and 53 months. Our series confirms the previously described very poor prognosis of NESCCC, despite initial aggressive multidisciplinary treatment. It may be that the introduction of chemotherapy, especially combined primary chemoradiotherapy, might allow patients to do a little better, although at the moment there is no good evidence one way or the other.

Adult↗
PubMed2000

Isolated para-aortic node involvement in stage IB/II cervical carcinoma.

The aim of this report was to describe exceptional cases of patients treated for stage Ib and II cervical carcinoma with isolated para-aortic node involvement and to deduce therapeutic implications. Between 1985 and 1998, 491 women with stage IB or II cervical carcinoma underwent radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy. Five patients had para-aortic metastatic nodes but no external iliac, obturator or common iliac node involvement. These five patients had a tumor size >3 cm. According to these cases, in patients with bulky cervical carcinoma systematic complete lymphadenectomy should be performed in order to avoid misdiagnosis of para-aortic node involvement.

Adult↗
PubMed2000

Port-site metastasis after laparoscopic surgery for gynecologic cancer. A report of six cases.

BACKGROUND: Port-site metastasis after laparoscopic surgery for gynecologic cancer is a recognized entity. CASES: Five patients underwent laparoscopic peritoneal biopsies for a stage III (n = 4) or IV (n = 1) ovarian cancer with moderate or poor differentiation. The sixth patient underwent a laparoscopic lymphadenectomy for vaginal carcinoma with bulky metastatic pelvic lymph nodes. CONCLUSION: In order to avoid port-site metastasis, patients with an obviously malignant ovarian tumor and ascites should not be treated with laparoscopy using pneumoperitoneum. If a malignant ovarian tumor is discovered during laparoscopy, the interval between initial surgery and complete cytoreductive surgery (with resection of laparoscopic ports) followed by chemotherapy should be as short as possible. For patients with uterine cancer and bulky nodes, laparoscopic lymphadenectomy should be avoided to avoid trocar implantation metastasis.

Adenocarcinoma↗
PubMed1999

Interest of pelvic and paraaortic lymphadenectomy in patients with stage IB and II cervical carcinoma.

OBJECTIVES: The objectives of this study were to evaluate the interest and the potential therapeutic value of systematic pelvic and paraaortic lymphadenectomy in patients with stage Ib and II cervical carcinoma. METHODS: This was a prospective study including 421 patients with cervical cancer treated, from 1985 to 1994, by combined radiation therapy and surgery with systematic pelvic and paraaortic lymphadenectomy. RESULTS: The overall rate of pelvic lymph-node involvement was 26% (106 patients), and the rate of paraaortic metastases was 8% (32 patients). Pelvic nodal involvement was unilateral in 14% (59 patients) and bilateral in 11% (47 patients). Macroscopic positive nodes were found in 12% (52 patients). In a univariate analysis, a young age (<30 years), a tumor size >/=4 cm, stage II disease, and nodal involvement were associated with significantly decreased survival. The nodal status and the characteristics of positive nodes (number and location) were the most significant prognostic factors. In the multivariate analysis, age, the tumor size, and the site of nodal involvement (pelvic or paraaortic) were prognostic factors. Three-year survival was 94% for patients with negative nodes compared to 64% for patients with positive pelvic nodes and 35% for patients with positive paraaortic nodes (P < 0.0001). CONCLUSION: These results confirm the diagnostic and prognostic value of systematic complete lymphadenectomy when planning adjuvant treatment and the therapeutic value of complete removal of bulky positive nodes.

Adult↗
PubMed1999

How can laparoscopic management assist radiation treatment in cervix carcinoma?

PURPOSE: To determine the role of laparoscopic lymphadenectomy (pelvis +/- para-aortic nodes) and laparoscopic hysterectomy in cervical cancer compared to 'classic radical surgery' in patients undergoing surgery in comparison with modern imaging in patients treated with radiotherapy alone. MATERIALS AND METHODS: The limitations of modern imaging are presented as well as how complication rates can be increased when classic laparotomy is followed by radiation therapy. Laparoscopic procedures are described with particular emphasis on how to provide information on lymph node metastases with the risk of overlooking microscopic involvement. A number of clinical experiences are cited to illustrate this problem and show how treatment approaches can be adapted. RESULTS: The role of laparoscopy is evaluated according to different clinical situations and treatment protocols emphasizing the possibilities offered by this method to the radiotherapist. CONCLUSION: When developing laparoscopic techniques for the management of cervical carcinoma, caution must be exercised to ensure that these techniques are not detrimental to the prognosis.

Female↗
PubMed1999

Laparoscopic prophylactic oophorectomy in women with inherited risk of ovarian cancer.

The aim of this study was to specify the surgical procedure most adapted for prophylactic laparoscopic oophorectomy in patients with an inherited risk of ovarian cancer. This prospective study was based on a series of 27 patients who underwent prophylactic bilateral laparoscopic oophorectomy between September 1995 and January 1998. Nine patients underwent an oophorectomy (33%) and 18 patients an adnexectomy (67%). The laparoscopic procedure was converted into a laparotomy in one patient in whom an ovarian adenocarcinoma was detected during the surgical procedure. During final histologic examination of the ovaries, 23 patients were found to have benign atypical histologic alterations, one patient had an ovarian adenocarcinoma and only three patients (11%) had normal ovaries. In women with an inherited risk of ovarian cancer, during the laparoscopic procedure for prophylactic oophorectomy, the abdomino-pelvic cavity should be thoroughly explored with peritoneal cytology and systematic peritoneal biopsies. The laparoscopic procedure could be converted into a laparotomy if an ovarian cancer is discovered.

Adult↗
PubMed1999

[Indications and results of extemporaneous examination of pelvic lymph nodes in the surgical strategy of stage Ib or II cancers of the cervix uteri].

The aim of this study was to evaluate the accuracy of frozen section examination of lymph nodes and its place in the surgical management of early stage cervical cancer. This study was based on 80 patients with stage Ib (n = 76) or IIa (n = 4) invasive cervical carcinoma, with tumor size < 3 cm, treated by radical hysterectomy with pelvic lymphadenectomy with frozen section examination of pelvic lymph nodes. A total of 718 nodes were submitted to frozen section examination. Only one case of false-negative result was found (micrometastases). The sensitivity of frozen section examination in detecting metastatic nodes was 92.3%, its specificity was 100% and its negative predictive value was 97%. Frozen section diagnosis of pelvic nodes is a reliable procedure and should be carried out on obturator, external iliac and common iliac nodes. It should, therefore be performed in patients with early cervical carcinoma to avoid routine para-aortic lymphadenectomy.

Adenocarcinoma↗
PubMed1999

Frozen section of lymph nodes in uterine cervical carcinoma.

UNLABELLED: The aim of this study was to evaluate the accuracy of frozen section examination of lymph nodes in cervical cancer. METHODS: This retrospective study was based on 55 patients with stage Ib or IIa invasive cervical carcinoma treated by surgery followed by irradiation. All patients underwent a pelvic lymphadenectomy with frozen section analysis of lymph nodes. RESULTS: A total of 1249 nodes were removed (23 per patient) and 501 nodes (40%) were examined during the frozen section analysis. The sensitivity of frozen sections analysis in detecting metastatic nodes was 89%, its specificity and positive predictive value was 100% and its negative predictive value was 97%. CONCLUSIONS: The frozen section diagnosis of pelvic nodes should be performed in patients with a small cervical carcinoma to avoid systematic para-aortic lymphadenectomy. This is an accurate procedure and should be carried out on obturator, external iliac and common iliac nodes.

Adenocarcinoma↗
PubMed1998

Primary yolk sac tumor of the endometrium: a case report and review of the literature.

A 49-year-old woman was admitted with abnormal vaginal bleeding of 5 months duration. Hysteroscopy showed polypoid formations in the uterine cavity. Biopsy of a polyp revealed an anaplastic malignant tumor. A total hysterectomy with bilateral salpingo-oophorectomy and iliac lymphadenectomy were performed. A polypoid soft white-yellowish tumor originated from the endometrium. The biopsies plus sections of the operative specimen were histologically similar and displayed typical features of yolk sac tumor (YST) with tubulo-papillary pattern. Schiller-Duval bodies and PAS-positive, diastase-resistant, hyaline droplets were present. There was no neoplastic involvement of the cervix, ovaries, and iliac lymph nodes. Tumor cells and hyaline globules were strongly immunoreactive with alpha-fetoprotein antibody. The patient refused chemotherapy and was subsequently treated by external radiotherapy. The patient remained free of disease 28 months after surgery. There are only four additional cases of primary YST of the endometrium reported in literature. On the basis of the small number of cases reported, such tumors appear to have clinical and pathological features similar to their ovarian counterparts.

Biomarkers, Tumor↗
PubMed1998

Laparoscopic ovarian transposition for pelvic malignancies: indications and functional outcomes.

OBJECTIVE: To assess the indications and effectiveness of laparoscopic ovarian transposition before pelvic irradiation for a gynecologic cancer. DESIGN: Prospective study. SETTING: A gynecologic oncology department in a French anti-cancer center. PATIENT(S): Twenty-four patients treated for pelvic cancer. INTERVENTION(S): Laparoscopic ovarian transposition to paracolic gutters. Uterine conservation in 18 patients. MAIN OUTCOME MEASURE(S): Clinical and laboratory follow-up tests of ovarian function. RESULT(S): Bilateral laparoscopic ovarian transposition was achieved in 22 patients (94%). Twelve patients were treated for clear cell adenocarcinoma of the cervix and/or upper vagina, 6 patients for invasive squamous cervical carcinoma, 3 patients for pelvic sarcoma, 1 patient for recurrent cervical cancer to the upper vagina, 1 patient for ependymoma of the cauda equina, and 1 patient for ovarian dysgerminoma. Ovarian preservation was achieved in 79%. Three pregnancies were obtained. CONCLUSION(S): Laparoscopic ovarian transposition is a safe and effective procedure for preserving ovarian function. Bilateral ovarian transposition should be performed. The main indications for laparoscopic ovarian transposition are a patient with a small invasive cervical carcinoma (<2 cm) in a patient <40 years of age who is treated by initial laparoscopically assisted vaginal radical hysterectomy and a patient with a clear cell adenocarcinoma of the cervix and upper vagina.

Adolescent↗
PubMed1998

Lymphatic spread in stage Ib and II cervical carcinoma: anatomy and surgical implications.

OBJECTIVE: To determine the frequency and topography of pelvic and para-aortic node involvement in cervical carcinoma and to identify the appropriate level for resection of the lymphatic chains. METHODS: Between 1985 and 1994, 421 women with stage Ib or II cervical carcinoma were treated by surgery in combination with irradiation. Each underwent a radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy. RESULTS: A median of 34 lymph nodes were removed per patient. The overall frequency of lymph node involvement was 26%, and the frequency of para-aortic metastases was 8%. The frequency of lymph node metastasis was associated significantly with stage (chi(2) = 7.8; P < .02), tumor size (chi(2) = 14.8; P < .001), and patient age (chi(2) = 5.9; P < .05). The frequency of para-aortic involvement was below 3% in patients with small tumors (under 2 cm). When pelvic nodes were involved, the obturator group was concerned in 76 cases (18%) and the external iliac group in 48 patients (11%). When para-aortic nodes were involved, the left para-aortic chain was the most frequently concerned (23 patients [5%]). In eight of these patients, nodal involvement was found only above the level of the inferior mesenteric artery. Among 106 patients with pelvic positive nodes, 28 (26%) also had para-aortic metastatic nodes. CONCLUSION: Para-aortic lymphadenectomy should remove all of the left para-aortic chain (inframesenteric and supramesenteric) and so should be performed up to the level of the left renal vein. According to the low frequency of para-aortic involvement when tumor size is below 2 cm, such a procedure could be avoided in patients with small tumors.

Adult↗
PubMed1998

Tumour size in cancer of the cervix.

In a randomized trial comprising 204 patients with operable cervical carcinomas stages I and II, two low-dose rates in gynaecological brachytherapy were compared. Treatment consisted of Cs-137 uterovaginal application followed by surgery (either immediate or delayed). The results for the two dose rates have been published previously. The present paper concerns the correlation between outcome and tumour size. Tumour size was carefully estimated in two ways: by clinical examination under general anaesthesia and by measurements on the customized vaginal mould used for the brachytherapy. Ninety-one patients (45%) were classified as stage I, and 113 were classified as stage II proximal. The mean tumour size was 39 mm (range 15-64 mm). Cox's multivariate analysis indicated that the factors with a poor prognostic value were for survival: node involvement (N +) (p < 0.001), large tumour size (T +) (p < 0.001) and involvement of the endocervix (E +) (p <0.01); for event-free survival: N + (p <0.001), T + (p < 0.001); for local control; N + (p = 0.0001); for metastasis and regional relapse: N + (p < 0.001) and T + (p < 0.001). Stage was not a prognostic factor over the present range in either univariate or multivariate analysis. In this series tumour size is a powerful independent prognostic factor. It is therefore suggested that for the classification of cervical cancer and the indications for surgical staging and adjuvant treatment, tumour size should be taken into account.

Adult↗
PubMed1998

Fertility results after ovarian transposition for pelvic malignancies treated by external irradiation or brachytherapy.

The aim of this study was to assess the fertility outcome after ovarian transposition with uterine conservation and pelvic irradiation therapy for pelvic cancer. A total of 37 consecutive cases were reviewed. Of these, 27 patients were treated for a clear cell adenocarcinoma of the vagina and/or the cervix (group 1), nine for an ovarian pure dysgerminoma and one for a para-uterine soft tissue sarcoma (group 2). The pregnancy rate was 15% (4/27) in group 1 and 80% (8/10) in group 2 (P=0.01). A total of 18 pregnancies was observed in 12 patients. Of these, 16 pregnancies were obtained spontaneously and two after in-vitro fertilization. Of the spontaneous pregnancies, 12 (75%) were observed with ovaries still in the abdominal cavity (not repositioned). These results show that the prognosis for fertility is excellent after ovarian transposition and irradiation in patients with morphologically normal genital tracts (group 2). The prognosis is not as good for patients treated for a clear cell adenocarcinoma of the vagina and/or the cervix who may have morphological and/ or functional anomalies of the genital tract, following exposure to diethylstilboestrol and brachytherapy (group 1). Furthermore, these results show that repositioning of the ovary is not essential to achieve pregnancy.

Adenocarcinoma, Clear Cell↗
PubMed1998

[Prognostic factors of cancer of the endometrium and therapeutic implications].

Tumor differentiation, myometrial invasion and lymph node metastasis are the most important prognostic factors in endometrial carcinoma. Tumor stage, positive peritoneal cytology, obesity and race seems to be also prognostic factors. The surgical treatment of stage I and II endometrial carcinoma is hysterectomy with bilateral adnexectomy and pelvic lymphadenectomy (obturator group). This procedure can be performed by laparotomy or laparoscopy.

Age Factors↗