Federation Internationale De Gynecologie Et d'Obstetrique Research Articles

Successfully completed pregnancy after conservative treatment of nonepithelial ovarian cancer

Introduction. Granulosa cell tumors are rare neoplasms of the ovary with low malignancy potential and late recurrence. They originate from the granulose of the ovary stromal cells and have the ability to produce estrogen. The main treatment is surgical and implies hysterectomy with bilateral salpingooophorectomy, omentectomy, taking peritoneal biopsies, and cytological analysis of the peritoneal washing. When found in young women who have not given birth, a conservative approach can be considered. Fertility sparing surgery is safe only for early FIGO (Federation Internationale de Gynecologie et d?Obstetrique) stages IA tumors ?? IC, where it is necessary to make unilateral salpingo-oophorectomy and complete staging. Case outline. We present a case of young woman with granulosa cell tumor who was accidentally discovered, and after an adequate surgery and chemotherapy she gave a birth to a healthy child. Conclusion. Young women who have not given birth and who have been diagnosed with granulosa cell ovarian tumor can be treated conservatively after adequate disease staging and confirmation that the disease is at an early stage.

Overexpression of Fatty Acid 2-Hydroxylase is Associated with an Increased Sensitivity to Cisplatin by Ovarian Cancer and Better Prognoses

Background: Recent discoveries indicate that the enzyme fatty acid 2-hydroxylase (FA2H) is associated with biological behavior and can be used for outcome prediction in several types of cancers. Such relevancy, however, between FA2H and ovarian cancer is not clear. Therefore, we carried out this study to compare the expression of FA2H with the clinicopathological features of ovarian cancer. Methods: Using the Oncomine database, we examined the expression levels of the FA2H gene in ovarian cancer tissues and their adjacent noncancerous tissues that had been evaluated by quantitative reverse-transcription polymerase chain reaction (PCR) analyses. We performed Kaplan-Meier curve analyses for overall survival and progression-free survival. In addition, relationships between the FA2H expression levels and clinicopathological features of ovarian cancer were analyzed. Finally, FA2H small interfering RNAs (siRNAs) or negative control siRNAs were separately transfected into OVCAR-3 and SKOV-3 cells to explore the downstream effects. From these results, Gli1 expression was tested by real-time PCR, and the effects of FA2H expression levels on the sensitivity of ovarian cancer cells to cisplatin chemotherapy was evaluated using sulforhodamine B assays. Results: Compared with the adjacent tissues, FA2H was expressed at lower levels in the ovarian cancer tissues. In survival analyses, decreased FA2H was significantly associated with poorer survival outcome in multiple subtypes of ovarian cancer. In addition, FA2H expression was significantly associated with Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) stage, differentiation, lymph node involvement, tumor size, ascites, CA125 levels, and pelvic involvement. Knockdown of FA2H expression by siRNAs in the OVCAR-3 and SKOV-3 cell lines reduced their sensitivity to cisplatin, via modulation of GLI Family Zinc Finger 1 (Gli1) gene expression. Conclusion: Our results demonstrate that FA2H is a biomarker for ovarian cancer and it may serve as a useful prognostic factor.

MicroRNA-612 inhibits cervical cancer progression by targeting NOB1.

Recently, many studies have shown that microRNA (miR)‐612 is involved in cancer progression. However, the role of miR‐612 in cervical cancer remains unclear. The present study aims to investigate the biological effects of miR‐612 on cervical cancer. The expression of miR‐612 in cervical cancer tissues and cell lines was analysed by quantitative reverse transcription‐polymerase chain reaction. The effect of miR‐612 cell proliferation, migration, invasion and apoptosis was studied by appropriate methods. Protein expression was determined by Western blot analyses. Bioinformatics analysis and luciferase reporter assays were performed to clarify the relationship between miR‐612 and nin one binding protein (NOB1). A xenograft model was established to examine the role of miR‐612 in vivo tumorigenesis. Cervical cancer tissues and cell lines showed down‐regulation of miR‐612 expression, which was associated with the Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) stage and lymph node metastasis. Functional assays revealed that miR‐612 overexpression significantly suppressed cervical cancer cell proliferation, migration and invasion in vitro and delayed tumour growth in vivo. Mechanically, miR‐612 targeted NOB1 in cervical cancer cells, revealing a negative correlation between miR‐612 and NOB1in cervical cancer samples. NOB1 overexpression partially reversed the inhibitory effects of miR‐612 overexpression in cervical cancer cells. Taken together, these findings indicate that miR‐612 functions as a tumour suppressor in cervical cancer and suggest that miR‐612 may be a potential target in the therapeutic intervention of this malignancy.

Comparison of Magnetic Resonance Imaging (MRI) and Positron Emission Tomography-Computed Tomography (PET CT) for Detection of Parametrial Involvement and Lymph Node Metastasis in Patients with Cervical Cancer: A Prospective Study

There are few lacunae in the Federation Internationale de Gynecologie et d’Obstetrique (FIGO) staging system for Carcinoma of cervix, as the patients are not assessed for lymph node as well as distant metastases, though these are important prognostic factors. Magnetic resonance imaging (MRI) as well as Flurodeoxy glucose positron emission tomography/computed tomography (FDG PET/CT) has been used for evaluation of local tumor extent and nodal as well as distant metastasis in case of cervical cancer. To compare the usefulness of MRI and FDG PET/CT for detection of parametrial involvement and lymph node metastasis in increasing the accuracy of staging of patients with cervical cancer. In this prospective hospital-based study, 38 patients with cervical cancer were prospectively enrolled. Patients were studied in two groups; Group A (22 cases) included recently diagnosed cases for initial workup and base line staging (prior to any treatment). Group B (16 cases) included treated cases of cervical cancer, on follow-up, suspected clinically to have recurrence, at 6 months or more after completion of planned standard treatment. MRI and FDG PET/CT scan were performed within 1-week interval of each other for all enrolled patients. The criterion for lymph node metastases on MRI was size > 10 mm in short axis diameter and abnormal signal or contrast enhancement in parametrium for involvement. On FDG PET/CT, only areas with FDG uptake significantly higher than the background and FDG uptake visible on at least two consecutive axial slices were considered as positive for malignancy. MRI and FDG PET/CT findings were compared with histopathologic examination (HPE). Group A: On patient-based analysis, MRI versus FDG PET/CT sensitivity for detection of lymph node metastases was: 57 versus 86%, specificity was 71 versus 71% and diagnostic accuracy was 64 versus 78%, respectively. On lymph node-based analysis, MRI versus FDG PET/CT sensitivity was 50 versus 87%, specificity 98 versus 98 and diagnostic accuracy 97 versus 98%, respectively. The efficacy of MRI for detecting parametrial invasion was (sensitivity = 67%, specificity = 91%, diagnostic accuracy was 86%) and for FDG PET/CT was (sensitivity = 0%, specificity = 91%, diagnostic accuracy = 71%). The FIGO staging was found to be inaccurate in 21% cases. Group B: For local disease recurrence: MRI versus FDG PET/CT, the sensitivity was 83 versus 92%, specificity was 75 versus 75% and accuracy was 81 versus 87%. Sensitivity and accuracy of MRI was better than FDG PET/CT in detection of local disease recurrence. When MRI and FDG PET/CT were compared for detecting nodal recurrence, according to cases, the sensitivity was 83 versus 92%, specificity was 75 versus 75% and accuracy was 81 versus 87%. FDG PET/CT had higher sensitivity and accuracy than MRI in detection of lymph nodal recurrence. FDG PET/CT is superior to MRI in detection of local as well as distant lymph node metastases. FDG PET/CT has ability to detect distant metastases beyond the true pelvis. MRI is superior to PET/CT for detection of early parametrial invasion and local recurrence.

Serum Selenium Concentration in Cervical Cancer Patients: Preliminary Study and Literature Review

Objective: To analyze the role of selenium and glutathione peroxidase (GPx) in cervical cancer. Methods: Serum selenium concentrations and GPx activities of 19 women with cervical cancer along with their healthy counterparts (control group) were obtained. Selenium concentration were measured fluorometrically and GPx activities were measured spectrophotometrically based on the quantity of NADPH used in the reduction of glutathione. Results: The mean of serum selenium concentrations in cervical cancer group was significantly lower than that in the control group, 67.24±15 ng/mL and 77.05±12 ng/mL (p=0.03), respectively. The mean GPx activity in the cervical cancer group was also significantly lower than that in the control group, 128.18±38 ∆mmol NADPH/min/L and 148.9±23 ∆mmol NADPH/min/L (p=0.04), respectively. Multivariate analysis in the cervical cancer patients showed that the Federation Internationale de Gynecologie et d’Obstetrique (FIGO) staging score (early vs. advanced) was inversely correlated with serum selenium concentration (p=0.027). Conclusions: Serum selenium concentration and GPx activity was significantly lower in the cervical cancer patients. Our results demonstrate that selenium and GPx activity may have an important role in the carcinogenesis of cervical cancer. Keywords: Cervical cancer, glutathione peroxidase activity, selenium DOI: 10.15850/ijihs.v4n2.833

The Prognosis and Risk Stratification Based on Pelvic Lymph Node Characteristics in Patients With Locally Advanced Cervical Squamous Cell Carcinoma Treated With Concurrent Chemoradiotherapy.

The purpose of this study is to determine the prognostic significance of pelvic lymph node (PLN) characteristics and perform risk stratification in patients undergoing concurrent chemoradiotherapy for locally advanced cervical squamous cell carcinoma. We retrospectively reviewed the records of 609 patients with Federation Internationale de Gynecologie et d'Obstetrique (FIGO) stage II to IVa who underwent concurrent chemoradiotherapy, compared overall survival (OS), distant metastasis-free survival (DMFS), and pelvic recurrence-free survival between patients with or without PLN involvement. We further analyzed prognostic factors for OS and DMFS including FIGO stage, tumor volume, and lymph node (LN) characteristics in 300 patients with PLN involvement. The 3-year OS rate was 81.7% versus 92.8% (P = 0.002) and the 3-year DMFS rate was 79.3% versus 92.7% (P = 0.006) in patients with or without PLN involvement, respectively. With univariable analysis, FIGO stage, LN-volume, LN-number, LN-diameter, and matted/necrotic LN affected both OS and DMFS. Based on multivariable analysis, we created a risk stratification model. For OS, the independent risk factors were FIGO stage III or IVa, LN-volume of 3 cm or more, LN-diameter of 1.5 cm or more, and matted/necrotic LN. The low-risk group (no risk factors), mid-risk group (1 or 2 risk factors), and high-risk group (3 or 4 risk factors) had a 3-year OS of 96.6%, 84.9%, and 64.7%, respectively (P = 0.005). For DMFS, LN-diameter of 1.5 cm or more, LN-number of 3 or more, and matted/necrotic LN were the independent risk factors. The subgroups for DMFS were the low-risk group (no risk factors), the mid-risk group (1 risk factor), and the high-risk group (2 or 3 risk factors), and the 3-year DMFS was 92.4%, 76.2%, and 64.6%, respectively (P = 0.001). The prognosis was significantly poorer for patients with high-risk lymph node characteristics. Using this risk stratification, we should select the most appropriate and individualized treatment modality to improve outcomes in those patients with a poorer prognosis.

Staging for vaginal cancer

Vaginal cancer is a rare cancer comprising about 3% of all gynecologic cancers. Primary vaginal cancer should be carefully assigned as spread from cervix, vulva, and other metastatic tumors to vagina can occur. Although vaginal cancer traditionally occurs in older postmenopausal women, the incidence of high-risk human papillomavirus (HPV)-induced cancers is increasing in younger women. Squamous cell carcinoma is still the most common histopathologic type followed by adenocarcinoma. With decreasing use of diethylstilbestrol in pregnancy, non-diethylstilbestrol-associated cancers are described. The Federation Internationale de Gynecologie et d'Obstetrique (FIGO) staging of vaginal cancer (2009) follows the same rules as cervical cancer; it is clinically staged and allows the use of routine investigative modalities for staging. Although FIGO encourages the use of advanced imaging modalities, such as computed tomography, magnetic resonance imaging (MRI), and positron emission tomography (PET), to guide therapy, the imaging findings may not be used to change or reassign the stage. TNM staging is the pathologic staging system proposed by the American Joint Committee on Cancer, and information available from examination of the resected specimen, including pelvic and inguinal lymph nodes, may be used for staging.

Newly and relapsed epithelial ovarian carcinoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up

Surgical staging requires a median laparotomy with a thorough examination of the abdominal cavity according to Federation Internationale de Gynecologie et d’Obstetrique (FIGO) classification guidelines. If disease appears confined to the ovary, biopsy of the diaphragmatic peritoneum, paracolic gutters, pelvic peritoneum, an infracolic omentectomy and sampling or dissection of para-aortic and pelvic nodes are required in addition to peritoneal washings. Surgery should be performed by an appropriately trained gynaecologic oncologist with experience in the management of ovarian cancer [III, B]. Staging is described using the FIGO and American Joint Committee on Cancer (AJCC) classification as in Table I. Established favorable prognostic factors besides surgical stage are: small tumor volume (before and after surgery), younger age, good performance status, cell type other than mucinous or clear cell, well-differentiated tumor and absence of ascites. Low grade, absence of dense adhesions, minimal ascites, subgroups a/b versus c and cell type other than clear cell are considered good prognostic factors for patients with stage I disease. Before surgery and/or chemotherapy, patients should have a CT scan of the abdomen and pelvis, chest X-ray, serum CA125, complete blood count and differential, and biochemistry for renal and hepatic function. The routine use of FDG-PET–CT for initial staging is not recommended.

Epithelial ovarian carcinoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up

Surgical staging requires a median laparotomy with a thorough examination of the abdominal cavity according to Federation Internationale de Gynecologie et d’Obstetrique (FIGO) classification guidelines. If disease appears confined to the ovary, biopsy of the diaphragmatic peritoneum, paracolic gutters, pelvic peritoneum and an infracolic omentectomy, and sampling or dissection of para-aortic and pelvic nodes are required in addition to peritoneal washings. Surgery should be performed by an appropriately trained gynaecologic oncologist with experience in the management of ovarian cancer [III, B]. Staging is described using the FIGO and American Joint Committee on Cancer (AJCC) classification and FIGO as in the table below. Established favorable prognostic factors besides surgical stage are: small tumor volume (before and after surgery), younger age, good performance status, cell type other than mucinous or clear cell, well-differentiated tumor and absence of ascites. Low grade, absence of dense adhesions, minimal ascites, subgroups a/b versus c and cell type other than clear cell are considered good prognostic factors for patients with stage I disease. Before surgery and/or chemotherapy, patients should have an abdomino-pelvic CT scan, chest X-ray, serum CA125, complete blood count and differential, and biochemistry for renal and hepatic function.

A questionnaire survey on current surgical procedures for endometrial cancer in Japan.

The current standards for surgical procedures and lymph node dissection of endometrial cancer in Japan were investigated using a questionnaire survey. The estimated clinical stages used in the questionnaire were predicted from preoperative diagnostic imaging, histopathology of endometrial biopsies and intraoperative findings using a new classification, Federation Internationale de Gynecologie et d'Obstetrique (FIGO) in 1988. Questionnaires were mailed to 235 institutions, and 212 institutions (90.2%) responded. As a standard surgery for endometrial cancer, institutions performed simple total hysterectomy or semiradical hysterectomy and bilateral adnexectomy, which accounted for 86% of all respondents. For stage I carcinoma, simple (44%) or semi-radical (47%) hysterectomy was carried out in 91% of institutions, while radical hysterectomy was selected in 84% of institutions when stage II carcinoma was diagnosed clinically. The consensus of this survey was that dissection of both the para-aortic and pelvic lymph nodes can be omitted in G1 cases showing lesions confined to the endometrium, and that pelvic lymph nodes should be dissected, but para-aortic lymph node dissection could be omitted in G1 or G2 cases demonstrating myometrial invasion of 1/2 or less. Moreover, findings from this survey suggest that biopsy or dissection of the para-aortic lymph nodes was required in G3 cases, or in those patients diagnosed with myometrial invasion more than 1/2.