The use of post-operative drainage has been a topic of debate for several years. While the trend has increasingly shifted toward avoiding routine drainage, opinions on its necessity remain divided. The main objective of this comprehensive review is to effectively summarize and present the current knowledge and up-to-date evidence on the role of prophylactic drainage in women undergoing obstetric, oncological, or other types of gynecological surgical procedures in terms of the indications, post-operative surgical infections, morbidity recovery, post-operative complications and outcomes. Prophylactic drainage does not seem to decrease morbidity in cases of lymphadenectomy and radical hysterectomy. Debulking surgery does not necessitate prophylactic drainage in the majority of cases; however, its usage should be individualized based on the surgical complexity. Conflicting evidence exists regarding drains’ effectiveness in preventing anastomotic leakage, with high rates of re-operation and abscess formation noted. Despite the fact that vaginal drains may help with hematoma and infectious morbidity, the overall benefit of vaginal and peritoneal drains in preventing post-operative morbidity is questionable. Finally, negative pressure wound therapy may reduce surgical site infection rates in patients undergoing cytoreductive surgery for ovarian cancer. Although there is still a great need for further investigation, the topic has been covered adequately by many prospective trials and the international guidelines have provided clear suggestions to guide physicians in clinical practice. However, need for individualization and personalized strategies is well emphasized by the published evidence in an effort to balance the benefits and risks of drainage usage determined by the type of surgery and patient status.

Cervical cancer (CC) continues to be a significant global public health concern, even with preventive measures in place. In women with early-stage CC, the status of lymph nodes is of paramount importance, not only for final prognosis but also for determining the best therapeutic strategy. According to main international guidelines, pelvic full lymphadenectomy (PLND) is recommended for lymph node staging. However, in these early stages of CC, Sentinel lymph node biopsy (SLNB) has emerged as a precise technique for evaluating lymph node involvement, improving its morbidity profile. We performed a literature review through PubMed articles about progress on the application of SLNB in women with early-stage CC focusing on the comparison with PET/CT and PLND in terms of oncological outcomes and diagnostic accuracy. While the superiority of SLNB is clear compared to radiologic modalities, it demonstrates no clear oncologic inferiority over PLND, given the higher detection rate of positive lymph nodes and predominance of no lymph node recurrences. However, due to a lack of prospective evidence, particularly concerning long-term oncological safety, SLNB is not the current gold standard. With careful patient selection and adherence to straightforward protocols, a low false negative rate can be ensured. The aim of the ongoing prospective trials is to address these issues.

Malignancies of the female upper reproductive tract, especially endometrial and ovarian cancers, generate a significant burden for women worldwide. The possible etiopathogenetic role of chronic human papillomavirus (HPV) infection in the carcinogenesis of the female upper genital tract is neither clearly established not completely understood. Therefore, we performed a literature review, using the PubMed and SCOPUS electronic databases, of the prevalence of HPV DNA in endometrial, primary fallopian tube, ovarian, and primary peritoneal cancers, as well as uterine sarcomas. The present investigation covered 35 studies from different countries on various continents. Overall, the prevalence of HPV was approximately 15% in all the above cancers. HPV DNA was isolated from 11%, 0%, 0%, and 14% of endometrial carcinomas, uterine sarcomas, primary fallopian tube cancers, and ovarian malignant neoplasms, respectively. No relevant studies on primary peritoneal cancers were retrieved. The predominant HPV strain from tumors of the upper female reproductive tract, regardless of the tumor site, was HPV-16, followed by HPV-18. The HPV DNA identified was exclusively from subtypes HPV-6, HPV-11, HPV-16, HPV-18, and HPV-33, which are responsible for the development of not only cervical cancer, but also condylomata acuminata. The findings of the present review indicate that HPV vaccination might prove to be a useful strategy in the prevention of HPV-related carcinomas of the upper genital tract in women.

Ovarian squamous cell carcinoma (SCC) is a rare entity among primary ovarian cancers. This type of cancer typically originates from the transformation of mature cystic teratomas, commonly known as dermoid cysts, and occasionally from associations with endometriosis or Brenner’s tumors. The typical clinical scenario involves presentation in postmenopausal women, with symptoms arising from tumor growth or metastasis. Herein, we present a case study of SCC arising from a dermoid cyst in the right ovary. Alongside this, we offer a concise review covering the histogenesis, diagnostic approaches, current therapeutic modalities, and prognosis associated with this condition. A 62-year-old woman presented with abdominal pain and fever. Imaging revealed a large mass originating from the right ovary, suspected to be ovarian serous cystadenocarcinoma. Elevated CA 19-9 levels indicated malignancy. The case was discussed in a multidisciplinary tumor board (MTB), leading to diagnostic laparoscopy. Despite initial biopsy results suggesting no malignancy, PET-CT indicated possible ovarian malignancy. Further exploration via exploratory laparotomy confirmed the malignancy through fast-track biopsy. As a result, intraoperatively, a primary debulking surgery was decided. The final diagnosis was primary moderately differentiated squamous ovarian carcinoma, stage IIB, originating from a dermoid cyst. The patient was referred for chemotherapy and is currently under follow-up care. This case underscores the complexity of ovarian cancer diagnosis and the importance of multidisciplinary approaches in treatment decisions. As of now, there are no established treatment guidelines for the effective management of this histotype. More research specifically tailored to this aim, involving global contribution and extended follow-up periods, are essential to establish the best management strategies.

Endometrial osseous metaplasia is a rare histopathological condition characterized by the presence of ectopic bone tissue within the endometrium. Although most commonly reported in women of reproductive age presenting with secondary infertility and menstrual abnormalities, it may occasionally occur in asymptomatic postmenopausal women. A 55‑year‑old postmenopausal woman with a history of invasive ductal breast carcinoma treated with surgery, radiotherapy, chemotherapy and 10 years of tamoxifen therapy was referred for evaluation of incidentally detected endometrial thickening (12 mm) on routine ultrasonography. Transvaginal ultrasound demonstrated a suspected endometrial polyp with posterior acoustic shadowing. Diagnostic hysteroscopy revealed osseous tissue and bone marrow within the endometrial cavity, raising concern for carcinosarcoma or another mesenchymal malignancy. Following multidisciplinary tumour board discussion, operative hysteroscopy with resectoscopy was performed, confirming the presence of osseous tissue; however, malignancy could not be definitively excluded. The patient subsequently underwent total hysterectomy with bilateral salpingo‑oophorectomy. Final histopathological examination demonstrated atrophic endometrium containing two microscopic foci of bony tissue with degenerative and necrotic changes, confirming endometrial osseous metaplasia without evidence of malignancy. Notably, the patient had undergone pharmacologically induced abortion followed by dilation and curettage 35 years before diagnosis, suggesting that retained foetal bone fragments or trauma‑induced metaplastic transformation may persist for decades and remain clinically silent before being detected incidentally. The present case highlights the importance of considering endometrial osseous metaplasia in the differential diagnosis of hyperechoic endometrial lesions, particularly in women with a history of pregnancy termination or uterine instrumentation. Transvaginal ultrasonography is a useful initial diagnostic modality, whereas hysteroscopy remains the gold standard for both diagnosis and treatment. Integration of clinical history, imaging findings and histopathological examination is essential to exclude malignancy and guide appropriate management.

Malignancies of the female upper reproductive tract, especially endometrial and ovarian cancers, consist a significant burden for women worldwide. The possible etiopathogenetic role of chronic human papillomavirus (HPV) infection in the female upper genital tract carcinogenesis is neither clearly established not completely understood. Therefore, we performed a literature review through PubMed and SCOPUS electronic databases about the prevalence of HPV DNA in endometrial, primary fallopian tube, ovarian and primary peritoneal cancers, as well as uterine sarcomas. The present investigation covered 35 studies from different countries of various continents. Overall, HPV prevalence was approximately 15% in all the above cancers. HPV DNA was isolated from 11%, 0%, 0% and 14% of endometrial carcinomas, uterine sarcomas, primary fallopian tube cancers and ovarian malignant neoplasms, respectively. No relevant studies on primary peritoneal cancers were retrieved. The predominant HPV strain from all tumors of the upper female reproductive tract, regardless of the tumor site, was mostly HPV-16, followed by HPV-18. HPV DNA was identified exclusively from subtypes HPV-6, HPV-11, HPV-16, HPV-18, and HPV-33, which are responsible for the development of not only cervical cancer, but also of condylomata acuminata. The findings of the present review indicate that HPV vaccination might prove to be a useful strategy in the prevention HPV-related carcinomas of the upper genital tract in women.