The female genital tract can be involved as a secondary manifestation of disseminated lymphomas or leukaemia but can rarely be the primary site of so-called extranodal lymphomas. Primary lymphomas of the female genital tract can affect the uterine corpus, uterine cervix, vulva, vagina, or adnexa. Only about 0.008% of all cervical tumours are primary malignant lymphomas. The most common clinical presentation of primary cervical lymphomas is a history of prolonged minor abnormal uterine bleeding, while unstoppable bleeding at presentation is rarely reported in the literature. “B” symptoms related to nodal lymphomas are usually absent. Since vaginal bleeding is a nonspecific symptom, the first diagnostic hypothesis is usually of one of the more common female genital conditions such as cervical or endometrial carcinoma or sarcoma, fibroids, adenomyosis, or endometriosis. Cervical cytology is usually negative. Preoperative diagnosis requires deep cervical biopsy. No guidelines regarding optimal treatment exists; radiotherapy, chemotherapy, and surgery are used in different combinations. Conservative treatment with the combination of surgery and chemotherapy or surgery and radiotherapy has been reported in a few cases with apparent success. With this review, we aim to understand what the best therapeutic approaches for this rare pathology in young and elderly women are. Moreover, we find favorable pregnancy outcome in patients treated with a fertility sparing approach.

International guidelines do not take a clear position regarding the management of patients with “intermediate-risk” cervical cancer, and they remain noncommittal on the necessity of adjuvant therapy following radical hysterectomy. To determine if adjuvant therapy after surgery adds benefit in “intermediate-risk” cervical cancer patients in terms of recurrence rate and mortality rate, we performed a systematic review with meta-analysis on Google Scholar, PubMed, and Scopus. The inclusion criteria were studies with >100 patients with intermediate-risk cervical cancer according to the Sedlis criteria, RCTs, or propensity score-matched cohort studies reporting oncological outcomes and treatment-related toxicity, comparing a surgery-only cohort with an adjuvant therapy cohort. We found 11 studies that met our inclusion criteria, comprising a total of 4011 patients. The mean follow-up was 80.7 months. No statistically significant differences were found for both outcomes, respectively, recurrence rate OR 0.92 (95% CI 0.70–1.20, I² 38%) and mortality rate OR 1.05 (95% CI 0.77–1.46, I² 41%). However, a statistically significant difference was found in the site of recurrence–pelvic OR 0.48 (95% CI 0.23–0.98, p < 0.001, I² 42%) or distant OR 2.10 (95% CI 1.02–4.33, p < 0.001 I² 42%). Treatment-related risk of Grade 3 or 4 toxicity was statistically significant. Our meta-analysis shows that oncological outcomes in this class of patients are similar between the two groups. However, while awaiting the results of new RCTs, it is crucial to define a personalized diagnostic and therapeutic strategy for each patient.

The female genital tract can be involved as a secondary manifestation of disseminated lymphomas or leukemia but can rarely be the primary site of so-called extranodal lymphomas. Primary lymphomas of the female genital tract can affect the uterine corpus, uterine cervix, vulva, vagina or adnexa. Only about 0.008% of all cervical tumors are primary malignant lymphomas. The presenting symptoms are unspecific and also refer to much more common diseases of the female genital tract. Cervical cytology is usually negative. Preoperative diagnosis requires deep cervical biopsy. To date there is no consensus regarding optimal treatment. Radiotherapy, chemotherapy and surgery are used in different association. We report the first case reported in literature managed with an urgent hysteroscopic resection of a primary cervical diffuse large B-cell lymphoma, followed by adjuvant radiotherapy. Relevant literature was reviewed. Our conservative approach needs to be validated in the future, especially for women with pregnancy desire and for those with low performance status. To date, after 24 months from diagnosis, our patient is still disease-free.

Background/Objectives: Vascular complications during ovarian cancer surgery are rare but potentially severe. The objective of this review was to underline the need to standardize and optimize the management of these rare complications within an evidence-based framework. Methods: This review included the literature until 29 December 2024 and finally analyzed 17 studies, with 40 vascular complications reported. Results: Complications primarily occurred intraoperatively and involved both arterial and venous systems. Management approaches involved interdisciplinary collaboration, including vascular surgeons and interventional radiologists. Nevertheless, the collected data do not accurately reflect the reality of vascular complications in ovarian cancer surgery, as more than half of the included studies were case reports or research letters. This highlights the lack of standardized guidelines and limited training in vascular surgery for gynecologic oncologists, the importance of preoperative planning, including detailed imaging, risk stratification, and a multidisciplinary approach to mitigate complications. The authors propose an algorithm emphasizing prevention, timely identification, and effective management of vascular injuries alongside postoperative monitoring. Conclusions: The findings stress the need for treatment in high-volume tertiary centers and advocate advanced surgical training, incorporating virtual reality simulations to address vascular complications. Future research should focus on large multicenter studies to establish evidence-based guidelines for managing vascular complications in ovarian cancer surgery. Innovations in technology and education may further improve outcomes, ensuring optimal care for patients undergoing these complex procedures.