Background and Objective: Krukenberg tumours (KTs) are metastatic signet ring cell (SRC) adenocarcinomas of the ovary, arising from the stomach in most cases (70%). Other common primary sites are the colon, appendix and breast. The use of the term “Krukenberg tumour” is inconsistent in the literature which makes data interpretation difficult. Prognosis of KTs is dismal and, in the absence of randomised controlled trials, the best treatment strategies remain controversial. Evidence from retrospective studies suggests that metastectomy is associated with improved survival. Our narrative literature review set out to determine which patients gain maximal survival benefit from surgical management. Methods: A comprehensive literature search was performed using PubMed and Google Scholar databases, from 1 January 2000 to 15 July 2024, with the terms ‘Krukenberg’, ‘metastatic mucinous adenocarcinoma of ovary’. This search identified 20 full-text manuscripts, including data on 1,815 patients. Key Content and Findings: We found that the overall prognosis of these patients remains poor, with a median overall survival (mOS) ranging between 9 and 50 months. Metastectomy is associated with survival benefit only when all visible disease is removed (R0): mOS in patients with microscopic residual disease (R1) or gross residual disease (R2) is similar to mOS in unresected patients (11 vs. 10 months). The following other factors have been identified as independent prognostic factors for survival in multivariate analyses: heated intraperitoneal chemotherapy (HIPEC), adjuvant chemotherapy, curative surgery for the primary tumour, i.e., gastrectomy, no ascites, non-gastric origin, a good performance status, less extensive metastatic disease, i.e., no extra-ovarian disease or no extra-pelvic disease, no peritoneal carcinomatosis or a low Peritoneal Cancer Index (PCI), smaller size of lesion, no SRC features, expression of oestrogen receptor-β (ER-β) and progesterone receptors (PR), metachronous tumours, linitis plastica, tumour grade. Conclusions: Multiple retrospective analyses have demonstrated that metastectomy is associated with a survival benefit in patients with metastatic mucinous ovarian adenocarcinomas. However, patients with poor prognostic factors are less likely to benefit from surgery and should be counselled accordingly. Diagnostic laparoscopy could be considered before debulking surgery, to assess resectability of disease and to avoid a futile exploratory laparotomy. HIPEC after cytoreductive surgery (CRS) remains controversial, with possible survival benefit for KTs of gastric origin, particularly when peritoneal dissemination is present but the PCI is low.

Key Clinical Message: A surgical MDT approach to high‐complexity surgeries can allow maximal resection in order to achieve disease control and excellent functional outcomes, as demonstrated here for a case of hidradenitis suppurativa in a patient with Crohn's disease. Hidradenitis suppurativa is an autoimmune disease characterized by abscess and fistula formation with purulent discharge in intertriginous zones, and is associated with inflammatory bowel disease. We present the case of a patient with severe ongoing hidradenitis suppurativa causing osteomyelitis and affecting the perineum, on a background of Crohn's disease previously treated with panprotocolectomy and permanent ileostomy. The hidradenitis suppurativa was having a severe impact on the patient's quality of life, and she had failed to respond to conservative management. The patient opted for a radical two‐step procedure: first her coccyx and sacrum were removed. The second step was a radical bilateral anterior vulvectomy and posterior vaginectomy, with preservation of the uterine body and cervix. An anterolateral thigh flap was used to reconstruct the perineum. This complex procedure required the expertise of multiple surgical specialties, including plastic, general, spinal, and gynecological oncology surgeons to achieve maximal disease resection, minimizing the risk of recurrence.

Background and Objective: The field of Gynaecological Oncology (GO) has undergone a paradigm shift over recent decades, shaped by advancements in prevention, molecular therapeutics, and surgical innovation. We explore how the management of gynaecological malignancies has transformed in the past 25 years. Methods: A structured narrative review of landmark publications and guideline updates published between 2000 and 2025 was undertaken. Key developments in the management of cervical, ovarian, endometrial, vulvar, and vaginal cancers were critically analysed, with particular focus on prevention strategies, surgical evolution, and integration of targeted and immune therapies. Key Content and Findings: In cervical cancer, population-level human papillomavirus (HPV) vaccination has dramatically reduced incidence, while the LACC and SHAPE trials prompted a return to open and less radical surgery, respectively. Sentinel node biopsy is supplanting systematic lymphadenectomy, and combined chemoradiotherapy (CRT) with immunotherapy is improving survival in locally advanced disease. For ovarian cancer, optimal cytoreduction remains key, with TRUST highlighting surgical quality, while heated intraperitoneal chemotherapy (HIPEC) and poly-ADP ribose polymerase (PARP) inhibitors—alone or combined with immunotherapy—extend progression-free survival (PFS). Endometrial cancer management is now driven by molecular classification [The Cancer Genome Atlas (TCGA)/Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE)], with immunotherapy and targeted therapy transforming outcomes. In vulvar and vaginal cancers, GROINSS-V (Groin Sentinel Node Trial in Vulvar Cancer) and related studies underpin de-escalated and minimally invasive nodal surgery, while immunotherapy emerges for advanced disease. Conclusions: Modern GO is defined by prevention, precision, and personalisation. The contemporary Gynaecological Oncologist now integrates molecular insight, function-preserving surgery, and multidisciplinary collaboration to deliver optimised, patient-centred care.

Retroperitoneal lipomas are exceptionally rare tumors that mimic liposarcomas. We present a case of a woman in her 30s undergoing fertility investigations, with an incidental finding of a retroperitoneal tumor on MRI. PET and MRI scans suggested this may be a liposarcoma, with widespread effects on the surrounding iliac vessels. Collaboration between the orthopedic sarcoma service, gynecological oncology, and vascular surgery was required to excise the tumor without damaging the surrounding vessels. The patient underwent an exploratory midline laparotomy, with mobilization of the ascending colon along the Toldt line to gain access to the tumor. The morbid adherence of the tumor to neurovascular structures added significant complexity to this procedure; however, complete tumor resection was achieved with mobilization and excision of the obturator nerve only. The initial histological diagnosis was well‐differentiated liposarcoma; however, subsequent molecular analysis showed no evidence of MDM2 amplification, suggesting a final diagnosis of benign lipoma. This case exemplifies diagnostic challenges in lipomatous retroperitoneal tumors, as well as the importance of inter‐disciplinary collaboration in surgery to achieve the best surgical and oncological outcomes.

Background/Objectives: Although the binarism between type I and II endometrial cancer was dismissed and substituted with molecular classification, histopathological features remain of paramount importance. Hence, analysing survival outcomes according to histological type, our aim is to clarify whether the morphological features of the tumour retain prognostic relevance in the context of advanced disease. Methods: This is a retrospective analysis led within the Thames Valley Cancer Alliance Network. Results: We include 148 FIGO 2009 stage III–IV patients affected by endometrioid endometrial cancer (EEC) G1, G2, and G3, carcinosarcoma (CS), serous carcinoma (SC), and clear cell carcinoma (CCC) of the uterus. Five year overall survival (OS) is distinct among the histological groups (p-value < 0.001), being 73.3% for G2 endometrioid, 49.2% for G3 endometrioid, 8.3% for CS, and 28.4% for SC. The divergence was marked also for 5 year progression-free survival (PFS) (p-value < 0.001) as follows: for G2 endometrioid, was 76.4%; for G3 endometrioid, 52.7%; and for carcinosarcoma, 5.9%. PFS after 18 months for serous carcinoma was 5.7%. The multivariate analysis found G3 endometrioid (HR 2.91, 95% CI 1.20–7.11, p-value 0.018), carcinosarcoma (HR 12.15, 95% CI 5.07–29.11, p-value < 0.001), and serous carcinoma (HR 4.84, 95% CI 2.16–10.83, p-value < 0.001) as independent predictors of poor survival, as well as cervical invasion (HR 1.83, 95% CI 1.10–3.05, p-value 0.020) as the only histopathological feature confirmed. Regarding progression-free only carcinosarcoma (HR 14.91, 95% CI 5.28–41.11) and serous carcinoma (HR 17.68, 95% CI 6.41–48.75) were associated with an increased risk of recurrence. Conclusions: Our findings testify that, beyond the disease stage, histological subtype remains a major determinant of survival outcome. Cervical involvement is associated with a more aggressive disease, possibly correlated to death beyond relapse. Prospective trials involving advanced stage endometrial cancer, stratified by histological subtype and integrated with the molecular classification, are required.