Background/Objectives: Rarely, primary (PriCs) or metastatic (metECs) carcinomas occur in the episiotomy site.Methods: A systematic literature review of metECs was carried out. We reviewed the PRISMA guidelines and the Scopus, Pubmed, and Web of Science databases.Results: We found 21 carcinomas; all of them were cervical carcinomas (11 squamous, SCC; 6 adenocarcinomas; 3 adenosquamous; 1 SCC or adenocarcinoma) diagnosed during pregnancy (38%) or 0.25–8 months postpartum (57%). SCCs were larger (mean size: 4.8 cm). At presentation, only two cases were pN+, and no distant metastases were found, excluding four episiotomy metastases (one anticipating the cervical cancer diagnosis); the remaining episiotomy metastases (mean size: 3 cm; one multifocal) were found at follow-up (these were first metastases in 86% of cases). The time range from the episiotomy/last delivery to first episiotomy metastasis was 1–66 (mean, 12.3) months. Treatment was variable: hysterectomy (71%) ± lymphadenectomy (67%) and/or adjuvant treatment (19%); chemoradiation/radiotherapy alone (24%). A total of 90% of cases recurred after 18 days to 66 months (mean, 12 months). At last follow-up, ten patients (48%) were disease-free after 12–120 (mean, 63.5) months, two patients (10%) were alive with disease, and nine (42%) patients died of disease after 6–36 (mean, 12.5) months (including two never-cleared/progressing cases).Conclusions: PriCs and metECs are rare. Iatrogenic/obstetric implantation or vascular dissemination of cervical cancer at the site of episiotomy may occur. For episiotomy lesions, accurate gynecological/perineal examination is required, and biopsy can be considered. Larger studies are required in order to determine treatment guidelines. Compared to PriCs, metECs occurred in younger (premenopausal) patients, were not associated with endometriosis, and demonstrated slightly smaller size and shorter mean time from episiotomy to episiotomy metastases, with a higher likelihood of a less favorable prognosis.
背景/目的：原发性（PriCs）或转移性（metECs）癌在会阴切开部位的发生较为罕见。方法：对metECs进行了系统性文献综述。我们依据PRISMA指南，检索了Scopus、PubMed及Web of Science数据库。结果：共发现21例癌变，均为宫颈癌（11例鳞状细胞癌，SCC；6例腺癌；3例腺鳞癌；1例SCC或腺癌），诊断于妊娠期（38%）或产后0.25–8个月（57%）。SCC体积较大（平均大小：4.8厘米）。就诊时，仅两例为淋巴结阳性（pN+），未发现远处转移，但除外四例会阴切开部位转移（其中一例早于宫颈癌诊断）；其余会阴切开部位转移（平均大小：3厘米；一例为多灶性）均在随访中发现（其中86%的病例为首发转移灶）。从会阴切开/末次分娩至首次会阴切开转移的时间范围为1–66个月（平均12.3个月）。治疗方案多样：子宫切除术（71%）±淋巴结清扫术（67%）和/或辅助治疗（19%）；单纯放化疗/放疗（24%）。总计90%的病例在18天至66个月（平均12个月）内复发。末次随访时，十例患者（48%）在12–120个月（平均63.5个月）内无病生存，两例患者（10%）带病生存，九例患者（42%）在6–36个月（平均12.5个月）内死于该病（包括两例病情持续未缓解/进展的病例）。结论：PriCs与metECs均属罕见。宫颈癌可能通过医源性/产科种植或血管播散至会阴切开部位。对于会阴切开部位病变，需进行精确的妇科/会阴检查，并可考虑活检。需开展更大规模研究以制定治疗指南。与PriCs相比，metECs患者更年轻（绝经前），与子宫内膜异位症无关，肿瘤体积略小，从会阴切开至发生转移的平均时间更短，且预后不良的可能性更高。
Metastatic Carcinomas at the Episiotomy Site: A Systematic Literature Review
肿瘤(癌症)患者之家