Ines Zemni

Lymph node ratio as an indicator of nodal status in the assessment of survival and recurrence in vulvar cancer: A cohort study

Background: Inguinal lymph node (LN) metastasis and particularly the number of metastatic lymph nodes (NMLN) represent a determinant prognostic factor in vulvar squamous cell carcinoma (VSCC). However, the NMLN may be related to the number of removed LNs. Therefore, the lymph node ratio (LNR) reflects not only the burden of LN involvement but also the quality and extent of lymphadenectomy. Objectives: To investigate the value of the LNR and the count of LN on overall survival (OS) and recurrence-free survival (RFS). Design: This study is a retrospective, longitudinal, institution-based study. Methods: This study included 192 patients treated for VSCC at the Salah Azaiez Institute between 1994 and 2022. Clinical, pathological, and evolutionary data were reported. Survival curves were generated by the Kaplan–Meier method, and predictive factors of outcome were analyzed using Cox proportional hazards models. Results: Surgery consisted of a radical vulvectomy, hemivulvectomy, and pelvic exenteration in, respectively, 96.4%, 2.1%, and 1.6% of cases followed by adjuvant radiotherapy in 38.5% of cases. LN dissection was bilateral in 88.5% of cases. LNR = 0, LNR = 0–0.2, and LNR ⩾0.2 were recorded in, respectively, 64.7%, 22.1%, and 13.2% of cases. With a mean follow-up time of 35 ± 42.06 months, the 5-year OS was 52.5% and the 5-year RFS was 55.8%. On multivariate analysis, the independent prognostic factors of OS were the LNR (hazard ratio (HR) = 5.702; 95% confidence interval (CI) = 2.282–14.245; p < 0.0001), Federation of Gynecology and Obstetrics (FIGO) stage (HR = 2.089; 95% CI = 1.028–4.277; p = 0.042), and free margins (HR = 2.247; 95% CI = 1.215–4.155; p = 0.01). Recurrences were recorded in 37.5% of cases. Independent prognostic factors of RFS were the LNR (HR = 2.911; 95% CI = 1.468–5.779; p = 0.002), FIGO stage (HR = 1.835; 95% CI = 1.071–3.141; p = 0.027), and free margins (HR = 2.091; 95% CI = 1.286–3.999; p = 0.003). Conclusion: Surgical margin, FIGO stage, and LNR represent the independent prognostic factors of survival and LNR showed superior prognostic predictive accuracy compared with the revised 2021 FIGO staging system for predicting OS and RFS in VSCC.

Ovarian carcinoma and peritoneal tuberculosis: A rare coexistence with challenging diagnosis, a case report and literature review

Peritoneal tuberculosis is one of the most challenging forms of extrapulmonary tuberculosis to diagnose, especially, in women as it often mimics an advanced ovarian carcinoma. Many authors had documented cases where peritoneal tuberculosis was initially misdiagnosed as advanced ovarian carcinoma, but only four cases had reported the coexistence of both conditions. We present the fifth case in the literature of concurrent peritoneal tuberculosis and serous cystadenocarcinoma of the ovary. A 61-year-old female patient presented with diffuse abdominal tenderness. Physical examination revealed an abdominal distension. Computed tomography scan showed a heterogeneous, poorly defined right latero-uterine mass associated with ascites and nodular peritoneal infiltration. The level of cancer antigen 125 was elevated. Therefore, a diagnosis of advanced ovarian carcinoma was highly suspected. A diagnostic laparoscopy was performed. Peritoneal biopsy confirmed the diagnosis of peritoneal tuberculosis without any histological evidence of malignancy. The patient subsequently underwent a right adnexectomy, which revealed serous cystadenocarcinoma of the ovary. She received 6 months of antituberculosis treatment complicated with renal dysfunction. Computed tomography scan control showed no abnormalities. Tumor markers levels decreased to the normal range. The patient refused further surgery and chemotherapy was recommended. Female patients presenting with ascites, adnexal masses, and elevated levels of cancer antigen 125 are usually presumed to have advanced ovarian carcinoma. There are a few discriminating features that suggest the diagnosis of peritoneal tuberculosis rather than peritoneal carcinomatosis of an advanced ovarian carcinoma. Eventually, their coexistence should be considered as a differential diagnosis, particularly in developing countries where tuberculosis is still endemic as it is the case of Tunisia.