Tumors of female reproductive system

Background. One of the most common complications of breast cancer (BC) surgery is postoperative lymphorrhea. The main issue lies in uncontrolled and unpredictable lymph flow in the axillary region caused by surgical lymphatic disruption.

Aim. Prevention of postoperative lymphorrhea after sentinel lymph node biopsy using intraoperative lipofilling in combination with latex tissue glue in patients with early BC.

Materials and methods. Present single-center prospective randomized trial includes 48 patients with early stage BC. Between September 1, 2024 to December 30, 2024, all patients underwent lumpectomy and sentinel lymph node biopsy. The patients were divided into two groups. The experimental group included 23 patients with autologous fat transplantation in combination with latex tissue glue applicated into the axillary region; the control group included 25 patients who underwent layer-by-layer suturing of the wound in the sentinel lymph node biopsy area without autologous fat grafting and latex tissue glue application. Ultrasound of the axillary region in the postoperative period was used to determine the presence of fluid accumulations on days 2, 7, 14 and 21.

Results. There was a statistically significant difference in the number of punctures performed (3 vs. 12, p = 0.03), and the volume of seroma formed on the 14^th day was 55.8 % less in the experimental group than in the control group (1.9 ± 2.2 ml vs. 4.3 ± 4.9 ml). No statistically significant difference in the number of patients who underwent aspiration puncture was observed (2 vs. 4, p = 0.44).

Conclusion. The combined method (lipofilling along with latex tissue glue) can be effective in the prevention of lymphorrhea after sentinel lymph node biopsy in patients with early BC.

Hormone receptor-positive (luminal) subtypes account for up to 70 % of all breast cancer (BC) cases. Endocrine therapy is the mainstay of treatment for luminal BC. Ovarian function suppression is a type of endocrine therapy that significantly impacts treatment outcomes. Pharmacological ovarian suppression using gonadotropin-releasing hormone agonists, including goserelin, has become firmly established in routine clinical practice. Until recently, monthly drug formulations were preferred in BC treatment, in contrast to prostate cancer therapy. However, numerous comparative efficacy studies have demonstrated that the 3-month long-acting goserelin 10.8 mg formulation is non-inferior to the monthly formulation. Furthermore, it ensures higher patient adherence due to fewer clinic visits and contributes to improved BC outcomes. Additionally, the use of goserelin 10.8 mg enhances the quality of medical care, provides budget savings, and optimizes healthcare system resources.

Aim. To evaluate the clinical effectiveness of Dr. Arabin pessaries in postmenopausal women with different stages of pelvic organ prolapse as an alternative to surgical treatment.

Materials and methods. The study included 300 women aged 60–80 years, divided into three groups according to Pelvic Organ Prolapse Quantification (POP-Q) stage: stage I – 100 patients fitted with a ring pessary (group 1); stages II and III – 100 and 100 patients fitted with a cube pessary (groups 2 and 3, respectively). All participants underwent a full clinical and instrumental assessment, including POP-Q, Baden–Walker scale, pelvic ultrasound (transvaginal and transabdominal), cough test, Valsalva maneuver, and standardized questionnaires (Pelvic Floor Distress Inventory Questionnaire (PFDI-20), Quality of Life (QOL)). Treatment efficacy was evaluated after 6 months.

Results. Baseline anthropometric and somatic characteristics did not differ significantly between groups (p >0.05). Significant differences were identified for obstetric history and social status. After 6 months of pessary use, all groups demonstrated a statistically significant reduction in pelvic pain, dyspareunia, vaginal bulge sensation, urinary disorders, and defecation difficulties. PFDI-20 decreased by 45.8 % in group 1, by 45.7 % in group 2, and by 45.2 % in group 3 (p <0.05). QOL scores improved 1.7–2.3 times. The greatest positive dynamics were observed in patients with stage I–II pelvic organ prolapse, although women with stage III also showed substantial clinical improvement.

Conclusion. Dr. Arabin pessaries represent an effective conservative treatment option for pelvic organ prolapse in older women, significantly reducing symptom severity and improving quality of life. The method is particularly valuable for patients with contraindications to surgery. These findings support the wider implementation of pessary therapy in routine gynecological practice.

Background. In current clinical practice, there are no clear criteria for selecting management strategies for patients with initial, potentially reversible, signs of cervical dysplasia. Considering the known role of small regulatory RNAs (microRNAs) in cervical carcinogenesis, these molecules may serve as prognostic markers.

Aim. To develop and evaluate the prognostic potential of a microRNAs analysis technology based on micro-array polymerase chain reaction.

Materials and methods. Cervical swab material obtained from women of reproductive age, following a cytological diagnosis of LSIL (low-grade squamous intraepithelial lesion), was used in the study. RNA was isolated using spin columns. A semi-quantitative analysis of 24 microRNA molecules was performed using sequential polyadenylation, reverse transcription, and micro-array polymerase chain reaction reactions. To evaluate the results, expression ratios of “reciprocal pairs” of microRNAs were calculated, the statistical significance of observed differences was assessed using the Mann–Whitney test, and ROC analysis was applied to evaluate prognostic significance indicators.

Results. The developed method, based on the analysis of six microRNA molecules, allows for the prediction of the development of severe cervical epithelial dysplasia (HSIL) within 4–6 months with a sensitivity of 0.83 and a specificity of 0.83.

Conclusion. The analysis of microRNAs in cervical swab material, conducted using micro-array polymerase chain reaction and the proposed interpretation algorithm, can become a convenient tool for predicting the course of mild cervical epithelial dysplasia.

Background. Surgery is the standard treatment for patients with stage IA–IIA ovarian cancer (OC). In early-stage disease, the operative approach aims at complete removal of the primary tumor and comprehensive surgical staging. Accumulated international data demonstrate differences in the patterns and frequency of metastatic spread depending on the histological subtype of OC, which underscores the relevance of targeted investigation of these features.

Aim. To assess the frequency and pattern of metastatic spread in early-stage ovarian adenocarcinomas according to their histological subtype.

Materials and methods. A retrospective study was conducted including 183 patients with early-stage ovarian cancer (FIGO 2014 stages IA–IIA) who underwent surgery at the N. N. Blokhin National Medical Research Center of Oncology between 2010 and 2024. The analysis included patients after primary surgery (n = 74 (40.4 %)) and restaging procedures (n = 109 (59.6 %)). All patients underwent surgical staging with lymphadenectomy followed by histological and cytological examination. Statistical analysis was performed using the χ² test and nonparametric methods.

Results. Analysis of metastatic patterns showed the following frequency of metastasis detection: in the contralateral ovary – 22 (12 %) cases, fallopian tube – 16 (8.7 %), uterine body – 7 (3.8 %), omentum – 9 (4.9 %), peritoneal biopsies – 7 (3.8 %), pelvic lymph nodes – 5 (2.7 %), para-aortic lymph nodes – 3 (1.7 %), and in both pelvic and para-aortic lymph nodes simultaneously – 1 (0.5 %) case. Tumor cells in peritoneal washings or ascitic fluid were identified in 35 patients (19 %). Postoperative upstaging occurred in 32.7 % (n = 60) of patients, primarily due to the detection of tumor cells in peritoneal washings or ascitic fluid (stage IC3).

Conclusion. Surgical staging is an essential component of treatment for early-stage OC. Nevertheless, further accumulation of clinical data is needed to better characterize the metastatic patterns associated with different histological subtypes of OC, which is crucial for resolving the ongoing debate regarding the optimal extent of surgical staging.

Aim. To identify risk factors for preterm birth and spontaneous miscarriage in pregnant patients with cervical insufficiency (CI).

Materials and methods. The study included 300 patients (aged 20–30 years) with a confirmed diagnosis of CI, who were subsequently divided into three groups: group 1 – patients with spontaneous miscarriage due to CI; group 2 – patients with preterm birth due to CI; group 3 – patients with term delivery and CI. The control group consisted of 100 patients (aged 20–30 years) with term delivery without CI.

Results. Women with CI demonstrated a markedly higher burden of obstetric and gynecological risk factors. A history of CI (up to 29 %), significant cervical shortening by 16 weeks (22.7 ± 2.2 mm vs. 45.7 ± 3.6 mm in controls; p <0.05), a high prevalence of connective tissue dysplasia (up to 48 %), and chronic cervical inflammation (up to 51 %) were strongly associated with spontaneous miscarriage and preterm birth. Obstetric complications, including premature rupture of membranes (up to 12 %), acute fetal hypoxia (up to 7 %), perineal tears (15 %), and macrosomia (12 %), occurred significantly more often. Correlation analysis confirmed strong associations between adverse outcomes and a history of CI (r = 0.85), connective tissue dysplasia (r = 0.78), multiparity (r = 0.80), and cervical length ≤25 mm in the second trimester (r up to 0.70).

Conclusion. CI is a multifactorial condition in which the combination of anatomical, connective tissue, and inflammatory alterations substantially increases the risk of pregnancy loss and preterm birth. The findings highlight the importance of early cervical length monitoring, detailed reproductive history assessment, and individualized preventive strategies for women at high risk.

Peritoneal carcinomatosis is one of the most challenging problems in modern oncology, due to its unfavorable progression pattern for malignant tumors in various locations. It is also a relatively rare occurrence in the progression of cervical cancer and is more common in tumors in other locations.

The prognostic significance of peritoneal involvement in cervical cancer remains unclear. The impact of neoadjuvant chemotherapy on the peritoneal area and tumor spread also remains poorly understood. According to various authors, peritoneal carcinomatosis occurs in 1–6 % of patients with malignant cervical tumors. In this case report, we presented a rare case of peritoneal carcinomatosis associated with recurrent cervical cancer.