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Purpose Uterine carcinosarcomas (UCSs) are aggressive biphasic malignancies, with a carcinomatous/epithelial component and a sarcomatous/mesenchymal counterpart. The aim of this study was to evaluate the impact of the sarcomatous component (homologous vs heterologous) on the overall survival (OS) and progression-free survival (PFS). Methods This is a multicenter observational retrospective study conducted in patients with stage I and II UCSs. Results Ninety-five women with histological diagnosis of early-stage UCSs were retrieved: 60 (63.2%) had tumors with homologous sarcomatous components, and 35 (36.8%) with heterologous. At univariate analysis, a stromal invasion ≥ 50%, the presence of clear cell, serous or undifferentiated carcinomatous component, the heterologous sarcomatous component and FIGO stage IB and II were shown to be variables with a statistically significant negative impact on PFS. Similarly, a depth of invasion ≥ 50%, the heterologous sarcomatous component and FIGO stage IB and II were statistically negative prognostic factors also concerning OS. At multivariate analysis, only the heterologous sarcomatous component was confirmed to be a statistically significant negative prognostic factor both on PFS (HR 2.362, 95% CI 1.207–4.623, p value = 0.012) and on OS (HR 1.950, 95% CI 1.032–3.684, p  = 0.040). Conclusion Carcinomatous and sarcomatous components both played a role in tumor progression and patients’ survival. However, only the sarcomatous component retained a statistical significance at the multivariable model suggesting its preeminent prognostic role in early-stage UCSs.

Introduction/Background*Isolated lymph node recurrence (ILNR) in selected platinum-sensitive recurrent ovarian cancer (psROC) patients is a very infrequent event (12% to 37%) and represent a less aggressive and indolent pattern of ROC. ILNR best treatment is represented by secondary cytoreductive surgery (SCS) with laparotomic or laparoscopic approach, given its non-chemo-sensivity, in particular when occurs in psROC patients in a number of metastatic lymph-nodes ≤3. ILNR favourable prognosis is certified by a median post-relapse survival which is around 37 months and without a certain association with BRCA mutational status. The objective of this video-article is to show the laparoscopic treatment for ILNR.MethodologyResult(s)*A case of 68 years-old patient affected by psROC is reported. The woman previously underwent first line platinum-based chemotherapy and interval debulking surgery, followed by bevacizumab maintenance therapy. Follow-up CT scan revealed isolated lymphadenopathy in the left iliac-obturatory region. The video shows a laparoscopic salvage lymphadenectomy, with complete pelvic and aortic dissection. Obviously, the surgeon should be able to prevent and to manage severe vascular complications. It is mandatory to recognize any anatomical anomalies and expose the surgical field to prevent and repair retroperitoneal injuries. In this sense, a preoperative radiological workup is necessary to better localize the lymph node disease. The patient was discharged in the 2nd post-operative day without any intra/post-operative complication. The final histology revealed ROC in 1/19 pelvic and aortic nodes.Conclusion*Salvage lymphadenectomy for ILNR represent a challenging situation and an accurate preoperative study in different clinical situations is essential according to the PFI, number and site of metastases and to the BRCA mutational status. In selected cases, lymphadenectomy performed in a referral centre for gynaecological oncology, with a minimally invasive laparoscopic approach, is a reliable surgical option and could represent a very good alternative to laparotomy.

Introduction/Background*Uterine carcinosarcomas (UCSs) are aggressive biphasic malignancies, with a high grade carcinomatous/epithelial component and a high grade sarcomatous/mesenchymal counterpart. Several studies identified the carcinomatous part as the main factor affecting the aggressive behaviour of UCSs. However, other studies reported that the sarcomatous component, especially the presence of heterologous elements, was associated with a worse prognosis. The prognostic ‘driving force’ is not completely clear for these kind of tumours. For this reason, the aim of our study was to evaluate the impact of the sarcomatous component (Homologous vs Heterologous) on the overall survival (OS) and progression-free survival (PFS).MethodologyThis is a multicenter observational retrospective study conducted in patients with stage I and II UCSs.Result(s)*Ninety-five women with histological diagnosis of early stage UCSs were retrieved: 60 (63.2%) had tumors with homologous sarcomatous components, and 35 (36.8%) with heterologous. Tumors with a sarcomatous heterologous component were significantly larger than the homologous (T ≥ 50 mm: 82.9% vs 51.7%, p-value=0.002) and presented more often lymph-vascular space invasion (62.9% vs 25.9% respectively in patients with heterologous and homologous component, p-value=0.001). At univariate analysis, a stromal invasion ≥ 50%, the presence of clear cell, serous or undifferentiated carcinomatous component, the heterologous sarcomatous component and the FIGO stage IB and II were shown to be variables with a statistically significant negative impact on PFS. Similarly, a depth of invasion ≥ 50%, the heterologous sarcomatous component and the FIGO stage IB and II were statistically negative prognostic factors also concerning OS. At multivariate analysis, only the heterologous sarcomatous component was confirmed to be a statistically significant negative prognostic factor both on PFS (HR 2.362, 95% CI 1.207-4.623, p-value=0.012) and on OS (HR 1.950, 95% CI 1.032-3.684, p=0.040).Conclusion*In conclusion, in our large series of UCSs, both carcinomatous and sarcomatous components played a role in tumor progression and patients’ survival. However, only the sarcomatous component retained a statistical significance at the multivariable model suggesting its preeminent prognostic role in early stage UCSs.

Introduction/BackgroundPrimary vaginal leiomyosarcomas (LMS) are rare, recurrent tumours with an unknown etiology; the prognosis is poor and there is no consensus guideline on their management. A nodular, 25 x 23 x 28 mm-mass, infiltrating the urethra but not the rectovaginal septum, was found in a 58-year-old previously hysterectomized woman. A biopsy showed a LMS of the vagina and an anterior pelvic exenteration was performed.MethodologyThe sample was fixed and prepared for light microscopy, transmission and scanning electron microscopy. An immunohistochemical analysis was performed.ResultsThe results confirmed a LMS of the vagina that was positive for vimentin, alpha-smooth muscle actin, caldesmon, desmin, p16 and p53. Light microscopy revealed that the mass contained a storiform pattern of spindle-shaped cells with blunt-ended nuclei. Cells were arranged in interwoven fascicles within a dense and richly vascularised stroma, suggesting an active neoangiogenesis. The histopathological analysis revealed a coagulative focal necrosis and low to moderate mitotic indexes, about 1–4/10 high power fields (HPF). Scanning Electron Microscopy (SEM) evidenced a dense collagenous stroma with numerous small blood vessels. Transmission Electron Microscopy (TEM) showed invasive neoplastic and pleomorphic cells with complex labyrinthic cytoplasm projections. Tumoral cells contained paranuclear crowds of dilated mitochondria, free ribosomes and a well-developed rough endoplasmic reticulum. There were atypical mitotic figures. Blood vessels were usually lined by a high and reactive endothelium.ConclusionThe histopathological and ultrastructural analyses confirmed the malignancy of this tumor. Best outcomes occur when the tumour is small, localized, and can be removed surgically with wide, clear margins, as in this case. As there are different kinds of malignant mesenchymal tumours, biopsy followed by immunohistochemistry and electron microscopy still represents a good diagnostic choice.DisclosureNothing to disclose

Introduction/BackgroundAFRON Oncology for Africa is an Italian non-profit organization that works for female cancer prevention in the Sub-Saharan area, mainly in Uganda. Although the visual inspection with acetic acid (VIA) is one of the most widespread screening method in African countries, it did not show a high accuracy. The aim of this study is to evaluate the efficacy and usefulness of VIA test combined with the PAP smear in Uganda in order to find possible solutions that may be used in a low-resource setting.MethodologyBetween January 2011 and October 2018, eight screening campaigns were held in Kampala, Kitgum and Karamoja. In the last two campaigns, we decided to try a new approach: we performed the PAP smear before the VIA test and, in case of a positive VIA test, we sent the slide for examination. To compare them, we divided the data collected in two groups: the first five campaigns (2011–2016), in which a standard approach was used, and the last two campaigns (2017–2018), in which the new approach was used.ResultsDuring the study period, 9,780 women were screened (median age 34), of whom 699 were positive at the VIA test. The VIA test showed 584 (83.5%) false positives. In the first group, the VIA test was positive in 516 women, of whom 483 (93%) were referred for further examinations. In the second group, in which the VIA test was positive in 173 women, the PAP smear was positive in 46 of the 173 slides analysed. Thus, only 46 of the 173 (26.5%) women were referred for further examinations.ConclusionCombining the PAP smear, VIA test and slide analysis in positive VIA tests may allow women who need treatment to be selected more effectively, while waiting for other more expensive solutions to become more affordable and suitable for these settings.DisclosureNothing to disclose.

Introduction/BackgroundEndometrial cancer (EC) is mostly diagnosed at an early stage with a favorable overall survival. 5-year survival decreases from 95% for localized disease to less than 20% for metastatic disease. Survival is related to known prognostic factors. Nevertheless, they are not sufficient to predict either outcome or recurrence rate/site: to decipher the underlying aberrant biomolecular pathways seems to be promising, although it is not yet applicable in a clinical setting. In that purpose, to investigate EC recurrence patterns according to ESMO-ESGO-ESTRO risk classes, could be beneficial for an early recurrences detection and treatment with a survival rate improvement.Methodology758 women diagnosed with EC, and a 5-years follow-up, were enrolled: they were divided into the ESMO-ESGO-ESTRO risk classes (low LR, intermediate IR, intermediate-high I-HR, and high risk HR) and surgically treated as recommended, followed by adjuvant therapy, when appropriated.ResultsRecurrences were detected in 19,5%. Higher recurrence rate (RR) was significantly detected (p<0,001) in the HR group (40,3%) compared to LR (9,6%), IR (16,7%) and I-HR (17,1%). Recurrences were detected more frequently at distant sites (64%) compared to pelvic (25,3%) and lymph nodes (10,7%) recurrences (p<0,0001): this trend was evident in all risk classes except for the LR group, where no differences were detected between local and distant recurrences. 5-year distant-free (LR 99%, IR 94%, I-HR 86%, HR 88%) and local-free survivals (LR 99%, IR 100%, I-HR 98%, HR 95%) significantly differ between groups (p<0,0001 and p=0,003, respectively), even when we stratified according to adjuvant therapy (AT) approach. AT did not modify RRs in all risk classes, except for LR group (p=0,01) (85,71% of recurrences occur if no AT was administered).ConclusionThese results strengthen the need to identify biological factors to stratify patients at higher risk of relapse, independently or in addition to their risk class prognosis and current surgical and clinical managements.DisclosureNothing to disclose.

Introduction/BackgroundThe majority of women who undergo radical hysterectomy for endometrial cancer (EC) are obese and they may benefit from robotic surgery. The aim of this study is to compare robotic single-site hysterectomies (RSSH) and robotic multiport hysterectomies (RMPH) for EC in obese patients.MethodologyThis study compares RSSH with RMPH in obese patients with EC and FIGO stage I or II. Data were collected from July 2010 to October 2018 in four Italian institutes: Regina Elena National Cancer Institute of Rome, Fondazione Policlinico San Matteo and University of Pavia, Santa Chiara Hospital of Trento and University of Pisa. According to their BMI, patients were divided in 3 classes: A from 30 to 34.9 kg/m2, B from 35 to 39.9 kg/m2 and C 40 kg/m2 or higher.ResultsWe included 225 patients: 76 in the RSSH group divided, respectively, in 53, 18 and 5 in the A, B and C classes; 149 in the RMPH group divided, respectively, in 76, 37 and 36 in the A, B and C classes. In the RSSH group, the median operation time (OT) and blood loss (BL) were, respectively, 139 min and 50 ml in the A class, 142.5 min and 50 ml in the B class and 165 min and 100 ml in the class C. In the RMPH group, the median OT and the median BL were, respectively, 195 min and 100 ml in the class A, 170 min and 50 ml in the class B and 122.5 min and 75 ml in the class C. The conversion rate increased in the 3 classes, especially in the RSSH group (in the A, B and C classes, respectively, 1.8%, 5.5% and 60%).ConclusionTechnical difficulties in single-site surgery increase with the patients‘ BMI and when the BMI is 40 kg/m2 or higher this technique is most of the times unfeasible.DisclosureNothing to disclose.

Objective: The aim of our study was to investigate the role of the excised vaginal cuff length as a prognostic factor in terms of DFS and recurrence rate/site, in low-risk endometrial cancer (EC) patients. Moreover, we correlated the recurrence with the expression of L1CAM. Material and Methods: From March 2001 to November 2016, a retrospective data collection was conducted of women undergoing surgical treatment for low-risk EC according to ESMO-ESGO-ESTRO consensus guidelines. Patients were divided into three groups according to their vaginal cuff length: V0 without vaginal cuff, V1 with a vaginal cuff shorter than 1.5 cm and V2 with a vaginal cuff longer than or equal to 1.5 cm. Results: 344 patients were included in the study: 100 in the V0 group, 179 in the V1 group and 65 in the V2 group. The total recurrence rate was 6.1%: the number of patients with recurrence was 8 (8%), 10 (5.6%) and 3 (4.6%), in the V0, V1 and V2 group, respectively. No statistically significant difference was found in the recurrence rate among the three groups. Although the DFS was higher in the V2 group, the result was not significant. L1CAM was positive in 71.4% of recurrences and in 82% of the distant recurrences. Conclusions: The rate of recurrence in patients with EC at low risk of recurrence does not decrease as the length of the vaginal cuff removed increases. Furthermore, the size of the removed vaginal cuff does not affect either the site of recurrence or the likelihood of survival.

IntroductionThe aim of this study is to revise the experience of two reference centers for vulvar cancer treatment during the last 2 years, evaluating the ECT procedure in terms of clinical outcome and side effects profile.MethodsData were retrospectively collected from November 2017 to November 2019 in two Italian oncologic Institutes: Regina Elena Institute and Fondazione Policlinico Universitario Agostino Gemelli. ECT was offered in a palliative setting to patients with a primary or recurrent vulvar cancer diagnosis unsuitable for surgery or any other treatment, because of poor performance status or previous delivered treatments. All patients underwent general anaesthesia. Intravenous Bleomycin was administered. Follow-up examinations were performed at 1, 3 and 6 months.Results15 patients were included in the study. No intra-procedure complications occurred. 1 patient had pneumonia during post-operative stay. 1-month overall response rate (2 CR and 10 PR) was 80%. At 3-month follow-up, 3 patients (20%) showed PD, 3 patients (20%) died from the ongoing disease, 1 patients (6.7%) died for other reasons, whereas the other patients maintained their 1-month clinical response. 8 out of 13 patients (61.5%) were alive at 6-month follow-up, whereas 6 out of 12 patients (50%) were alive at 1-year follow-up.Abstract 435 Figure 1ConclusionECT has proven to be a feasible, easy to perform, reproducible and repeatable procedure. For these reasons, it may have a role in the management of VC, especially as palliative treatment when other therapies are no longer applicable.