Brett Winter-Roach

Vulvovaginal-gingival syndrome

Vulvovaginal-gingival syndrome is a distinct variant of classic lichen planus frequently associated with mucocutaneous scarring and vaginal stricture formation, therefore early diagnosis and treatment through a multidisciplinary approach is essential. Management is challenging and is characterised by wide variation in treatments and lack of evidence-based therapeutic approaches. Literature review with particular regard to therapeutic approaches is performed with a view towards a cooperative treatment study.

Aggressive angiomyxoma of the vulva and perineum: A case report

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Secondary amenorrhoea associated with an isolated elevated serum leuteinising hormone: An unusual presentation of a granulosa cell tumour

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An unusual case of hematometra in a postmenopausal woman associated with Manchester repair.

Background Hematometra is a rare condition caused by obstruction of the lower female genital tract resulting in an accumulation of menstrual fluid in the uterine cavity. Although most commonly a result of congenital abnormalities, in older women, the obstruction is usually acquired and occurs at the level of the cervix. The Manchester repair procedure, done for uterocervical prolapse as an alternative to vaginal hysterectomy, carries a risk of cervical scarring resulting in stenosis and hematometra. Case Report A 61-year-old woman presenting with acute pelvic pain on a background of chronic pelvic pain and urinary retention was found to have a pelvic mass. She underwent magnetic resonance imaging, and her case was discussed in the gynecologic oncology multidisciplinary meeting. She underwent a midline laparotomy and was found to have hematometra. This was a result of the post–Manchester repair amenorrhea being considered as menopause, leading to a gradually accumulating hematometra. Conclusions Very few Manchester repairs are being carried out these days. Although advocated as a safe alternative to vaginal hysterectomy, clinicians doing this procedure should be aware of long-term complications like cervical stenosis.

Improved Survival from Ovarian Cancer in Patients Treated in Phase III Trial Active Cancer Centres in the UK

AIMS Ovarian cancer is the principal cause of gynaecological cancer death in developed countries, yet overall survival in the UK has been reported as being inferior to that in some Western countries. As there is a range of survival across the UK we hypothesised that in major regional centres, outcomes are equivalent to the best internationally. MATERIALS AND METHODS Data from patients treated in multicentre international and UK-based trials were obtained from three regional cancer centres in the UK; Manchester, University College London and Leeds (MUL). The median progression-free survival (PFS) and overall survival were calculated for each trial and compared with the published trial data. Normalised median survival values and the respective 95% confidence intervals (ratio of pooled MUL data to trial median survival) were calculated to allow inter-trial survival comparisons. This strategy then allowed a comparison of median survival across the UK, in three regional UK centres and in international centres. RESULTS The analysis showed that the trial-reported PFS was the same in the UK, in the MUL centres and in international centres for each of the trials included in the study. Overall survival was, however, 45% better in major regional centre-treated patients (95% confidence interval 9-73%) than the median overall survival reported in UK trials, whereas the median overall survival in MUL centres equated with that achieved in international centres. CONCLUSION The data suggest that international survival statistics are achieved in UK regional cancer centres.

Balloon Cell Urethral Melanoma: Differential Diagnosis and Management.

Introduction. Primary malignant melanoma of the urethra is a rare tumour (0.2% of all melanomas) that most commonly affects the meatus and distal urethra and is three times more common in women than men. Case. A 76-year-old lady presented with vaginal pain and discharge. On examination, a 4 cm mass was noted in the vagina and biopsy confirmed melanoma of a balloon type. Preoperative CT showed no distant metastases and an MRI scan of the pelvis demonstrated no associated lymphadenopathy. She underwent anterior exenterative surgery and vaginectomy also. Histology confirmed a urethral nodular malignant melanoma. Discussion. First-line treatment of melanoma is often surgical. Adjuvant treatment including chemotherapy, radiotherapy, or immunotherapy has also been reported. Even with aggressive management, malignant melanoma of the urogenital tract generally has a poor prognosis. Recurrence rates are high and the mean period between diagnosis and recurrence is 12.5 months. A 5-year survival rate of less than 20% has been reported in balloon cell melanomas along with nearly 20% developing local recurrence. Conclusion. To the best of our knowledge, this case is the first report of balloon cell melanoma arising in the urethra. The presentation and surgical management has been described and a literature review provided.