Federation Internationale De Gynecologie 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.

The Discovery of Comorbidity Deviation in the Cervical Cancer Patients Treated by the Intravenous Pyelography Examination and Clinical Examination (Based on Federation International de Gyneclogie et d’Obstetrique).

Objective: The cervical cancer is the most found cancer in the gynecological malignancy. Several cervical cancer cases sometimes are found the result of Intravenous Pyelography examination that is not suitable with the clinical stage that has been examined according to Federation Internationale de Gynecologie et d’Obstetrique. Another deviation that accompanies the cervical cancer cases is very important for clinicians and the patients because of the distinct deviation managements. The utilization of other modalities in supporting the other deviations needs to be considered so that the patient service will be better and more accurate as it is expected by the clinicians and the patients.Aim: This study aims to identify comorbid abnormalities in cervical cancer patients undergoing Intravenous Pyelography examinations and clinical examinations according to FIGO.Method: The retrospective research is applied from the medical records of the cervical cancer patients in stage IA IVB on January until December 2014 and it is analyzed statistically.Result: From 131 samples, it is obtained 77 samples which are qualified the inclusion criteria. There are 48 samples (62,3%) which are resulted to normal IVP and 29 abnormal samples (37,7%). It is also revealed that there are comorbidity deviation in 14 patients (18,2%).Conclusion: From the result of intravenous pyelography examination, it is found that several comorbidity deviations based on the result of BUN/creatinine and clinical examination of Federation Internationale de Gynecologie et d’Obstetrique should not be found any deviation. Regarding these results, the clinicians therefore can consider the next management for the patients.

Molecular Classification of Grade 3 Endometrioid Endometrial Cancers Identifies Distinct Prognostic Subgroups.

Our aim was to investigate whether molecular classification can be used to refine prognosis in grade 3 endometrial endometrioid carcinomas (EECs). Grade 3 EECs were classified into 4 subgroups: p53 abnormal, based on mutant-like immunostaining (p53abn); MMR deficient, based on loss of mismatch repair protein expression (MMRd); presence of POLE exonuclease domain hotspot mutation (POLE); no specific molecular profile (NSMP), in which none of these aberrations were present. Overall survival (OS) and recurrence-free survival (RFS) rates were compared using the Kaplan-Meier method (Log-rank test) and univariable and multivariable Cox proportional hazard models. In total, 381 patients were included. The median age was 66 years (range, 33 to 96 y). Federation Internationale de Gynecologie et d'Obstetrique stages (2009) were as follows: IA, 171 (44.9%); IB, 120 (31.5%); II, 24 (6.3%); III, 50 (13.1%); IV, 11 (2.9%). There were 49 (12.9%) POLE, 79 (20.7%) p53abn, 115 (30.2%) NSMP, and 138 (36.2%) MMRd tumors. Median follow-up of patients was 6.1 years (range, 0.2 to 17.0 y). Compared to patients with NSMP, patients with POLE mutant grade 3 EEC (OS: hazard ratio [HR], 0.36 [95% confidence interval, 0.18-0.70]; P=0.003; RFS: HR, 0.17 [0.05-0.54]; P=0.003) had a significantly better prognosis; patients with p53abn tumors had a significantly worse RFS (HR, 1.73 [1.09-2.74]; P=0.021); patients with MMRd tumors showed a trend toward better RFS. Estimated 5-year OS rates were as follows: POLE 89%, MMRd 75%, NSMP 69%, p53abn 55% (Log rank P=0.001). Five-year RFS rates were as follows: POLE 96%, MMRd 77%, NSMP 64%, p53abn 47% (P=0.000001), respectively. In a multivariable Cox model that included age and Federation Internationale de Gynecologie et d'Obstetrique stage, POLE and MMRd status remained independent prognostic factors for better RFS; p53 status was an independent prognostic factor for worse RFS. Molecular classification of grade 3 EECs reveals that these tumors are a mixture of molecular subtypes of endometrial carcinoma, rather than a homogeneous group. The addition of molecular markers identifies prognostic subgroups, with potential therapeutic implications.

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.

Expression Loss and Revivification of RhoB Gene in Ovary Carcinoma Carcinogenesis and Development

RhoB, a member of small GTPases belonging to the Ras protein superfamily, might have a suppressive activity in cancer progression. Here, expression of RhoB gene was evaluated in human benign, borderline and malignant ovary tumors by immunostaining, with normal ovary tissue as control. Malignant tumors were assessed according to Federation Internationale de Gynecologie Obstetrique (FIGO) guidelines and classified in stage I-IV. Revivification of RhoB gene was investigated by analyzing the effect of histone deacetylase (HDAC) inhibitor trichostatin (TSA) and methyltransferase inhibitor 5-azacytidine (5-Aza) on ovarian cancer cells via RT-PCR and western blot. Apoptosis of ovary cancer cells was detected using flowcytometry and fluorescence microscopy. Subsequently, RhoB expression is detected in normal ovary epithelium, borderline tumors, and decreases significantly or lost in the majority of ovarian cancer specimen (P<0.05). RhoB expression decreases significantly from stage II (71.4%) to stage III (43.5%) to stage IV (18.2%, P<0.05). TSA can both significantly revive the RhoB gene and mediate apoptosis of ovarian cancer cells, but 5-Aza couldn’t. Interference into Revivification of RhoB gene results in reduction of ovary carcinoma cell apoptosis. It is proposed that loss of RhoB expression occurs frequently in ovary carcinogenesis and progression and its expression could be regulated by histone deacetylation but not by promoter hypermethylation, which may serve as a prospective gene treatment target for the patients with ovarian malignancy not responding to standard therapies.

Pediatric Malignant Ovarian Tumors: 15 Years of Experience at a Single Institution

Malignant ovarian tumors in children are relatively rare. We reviewed our 15-year experience to understand their clinical presentations, managements, and prognoses. There were 15 children who were diagnosed to have malignant ovarian tumors from January 1994 to June 2009 in our hospital. The presenting symptoms, treatments, and outcomes were obtained retrospectively from the medical records. The median age at presentation was 13 years. The most common presenting symptom was abdominal pain, occurring in 10 patients (66.7%). The tumors were in the left side in 10 patients (66.7%). The pathologic diagnoses were yolk sac tumors in four patients, immature teratomas in four, dysgerminomas in three, malignant mixed germ cell tumors in three, and carcinosarcoma in one patient. According to the Federation Internationale de Gynecologie Oncologique classification, seven girls had Stage I, one had Stage II, and seven had Stage III disease. Thirteen patients received chemotherapy with platinum-based regimens. Three patients died of their disease: one of yolk sac tumor, one of malignant mixed germ cell tumor, and one of carcinosarcoma. They all had Stage III disease at diagnosis. The 10-year overall survival and disease-free survival rates were 77% and 69%, respectively. Pediatric malignant ovarian tumors were highly curable disease if they were not in the advanced stage at presentation. Earlier consideration of malignant ovarian tumor in the differential diagnosis of young girls with abdominal pain is important.

Concurrent Chemoradiotherapy Incorporating High-Dose Rate Brachytherapy for Locally Advanced Cervical Carcinoma

This is a retrospective study evaluating the survival outcomes, patterns of failure, and prognostic factors of chemoradiotherapy incorporating high-dose rate brachytherapy in the treatment of locally advanced cervical cancer. A review of 120 consecutive patients with Federation Internationale de Gynecologie et d'Obstetrique (FIGO) stages IB2 to IVA cervical cancer treated with concurrent cisplatin-based chemoradiotherapy between April 1999 and January 2005. Overall (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method. The 5-year OS and DFS rates were, respectively, 65.0% (35.0% IB2, 65.7% IIA-B, 71.0% IIIA-B, and 40.0% IVA) and 57.3% (30.0% IB2, 58.2% IIA-B, 64.0% IIIA-B, and 40.0% IVA). Most patients had squamous cell carcinoma (89.2%) and belonged to FIGO stages IIB (40.8%) and IIIB (30.8%). All but 4 patients completed the planned radiotherapy regimen. There were 48 documented recurrences, of which 13 were locoregional only, 26 were distant only, and 9 were both sites. Five patients (4.2%) experienced late grade 3 to 4 gastrointestinal toxicity. On multivariate analysis, a preradiotherapy hemoglobin level of less than 10 g/dL and tumor size of 4 cm or greater or bulky on computed tomography were independently significant variables for OS, whereas a nadir hemoglobin level of less than 10 g/dL and presence of radiologically enlarged pelvic or paraaortic lymph nodes were independently significant variables for DFS. We conclude that this regimen is efficacious and feasible, but the safety profile about concurrent administration of high-dose rate brachytherapy and chemotherapy should be studied further. Finally, for cervical cancer patients selected for nonsurgical treatment, radiological assessment of tumor size and lymph node status can provide valuable prognostic information over and above FIGO staging alone.

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.

Modified Fletcher's 3-channel brachytherapy system with vaginal line source loading versus uterine tandem and vaginal cylinder system in Stage IIIA cervical cancer

PurposeThe uterine tandem with open-ended vaginal cylinder is the most commonly used brachytherapy system for Federation Internationale de Gynecologie et d'Obstetrique (FIGO) Stage IIIA cervix cancer at the National Cancer Centre, Singapore. Without the 3-channel ovoid system, the dose to the parametrium is often compromised. In this study, a vaginal cylinder that could potentially be incorporated with the 3-channel system was developed, hence addressing the problem of treating both the vaginal disease extension and the parametrium.Methods and materialsA hollow cylinder of 3 cm in diameter was incorporated with the Fletcher's 3-channel tandem and ovoid system. Treatment plans were generated with the single tandem line source with a vaginal cylinder applicator and the modified Fletcher's system using the Abacus version 3 brachytherapy treatment planning software. A nominal dose of 5 Gy was prescribed to point H for both plans. The perpendicular distance of the 5 Gy isodose line from the uterine tandem plane at the centre of the ovoid and the vaginal cylinder plane 1 cm below the os guard were then compared.ResultsThe 5 Gy isodose line was 1.7 cm from the uterine tandem source at the location lateral through the centre of the ovoids on the plan with the uterine tandem and vaginal cylinder system as compared to a distance of 3.3 cm using the modified 3-channel Fletcher system. The 5 Gy isodose line was 2 cm lateral to the central source at the vaginal cylinder plane 1 cm below the os guard on the uterine tandem and vaginal cylinder system as compared to a distance of 2.5 cm on the Modified-Fletcher system. This corresponds to an increase of 1.6 cm and 0.5 cm depth of treated parametrium on the uterine tandem plane and vaginal cylinder plane respectively with the modified Fletcher's applicator as compared with the single line source cylinder system.ConclusionAs compared with the single uterine tandem and open-ended vaginal cylinder system, an addition of 1.6 cm of the parametrium was covered within the 5Gy isodose on the uterine tandem plane and 0.5 cm on the vaginal cylinder plane with the modified Fletcher's applicator. A feasibility study was started to address the ease of insertion of this modified Fletcher system into patients.

Synchronous and Metachronous Endocervical and Ovarian Neoplasms

The vast majority of endocervical adenocarcinomas are high-risk human papillomavirus (HPV)-related neoplasms, characterized by p16 expression and frequent loss of hormone receptor expression, which infrequently metastasize to the ovaries. We report 10 cases of endocervical adenocarcinomas with ovarian metastases in which the ovarian tumors simulated primary ovarian surface epithelial neoplasms. The presence of HPV DNA was assessed to determine whether the ovarian neoplasms were metastases or independent neoplasms. Immunohistochemistry for hormone receptors and p16 was also performed. The ovarian metastases presented concurrently with the primary endocervical tumors in 5 cases, subsequent to the endocervical tumors in 3 cases, and prior to diagnosis of the endocervical tumors in 2 cases. The ovarian tumors ranged in size from 2 to 30 cm, with tumors in 7 cases measuring 10 cm or greater. The ovarian tumors were unilateral in 8 cases and bilateral in 2. In all cases, the ovarian tumors were initially diagnosed as or thought to represent independent primary ovarian surface epithelial tumors (atypical proliferative [borderline] tumors or well-differentiated carcinomas of endometrioid or mucinous type). The endocervical tumors ranged in size from microscopic foci to 3 cm, with depth of invasion ranging from 0.2 to 1.5 cm; in 2 cases, the invasive foci qualified as microinvasive according to Federation Internationale de Gynecologie et d'Obstetrique staging criteria for cervical carcinoma. Adenocarcinoma in situ was identified in all tumors. In all cases, the paired endocervical and ovarian tumors contained identical HPV types. All evaluable tumors were diffusely positive for p16; and in 8 cases, there was absent or only limited expression of hormone receptors. Two of the minimally invasive endocervical tumors were initially interpreted as adenocarcinoma in situ and not recognized as unequivocally invasive even when evaluated in conjunction with the histologically identical ovarian tumors. HPV DNA detection in the ovarian tumors of 2 patients without known cervical disease led to discovery of occult cervical adenocarcinomas in those patients. Endocervical adenocarcinomas, including some qualifying as microinvasive, can metastasize to the ovaries and simulate primary ovarian surface epithelial neoplasms. The presence of HPV DNA in these ovarian tumors confirms that they are metastatic endocervical adenocarcinomas.

After FIGO 2003

After FIGO 2003

Relation between socioeconomic status and tumour stage in patients with breast, colorectal, ovarian, and lung cancer: results from four national, population based studies

Although there is evidence that patients with cancer from deprived communities in Scotland might present with more advanced disease,1–3 this finding has not been replicated in every study.4 Using data...

Malignant Ovarian Tumors in Children: 22 Years of Experience at a Single Institution

Malignant ovarian tumors of childhood are relatively rare and thus, management is still unclear. We reviewed our experience with these tumors to evaluate their histopathologic characteristics, treatment, and outcome. From January 1975 to December 1997, 56 patients had their malignant ovarian tumors diagnosed, treated, and followed-up in our institution. All tumors were completely excised when possible; otherwise, biopsy was performed. Staging was made according to Federation Internationale de Gynecologie Oncologique classification. Chemotherapy was recommended for all patients. Twelve cases were treated with vincristine, actinomycin, cyclophosphamide (VAC) before 1986; 12 with cisplatin, vinblastine, and bleomycin (PVB) from 1986 to 1989; and 23 with the bleomycin, etoposide, and cisplatin (BEP) regimen from 1989 to present. The Kaplan-Meier survival method was used to calculate the survival. The log-rank test was used to compare groups with respect to survival. Age range was 0 to 16 years (median 11 yrs; average 9.8 yrs). Only two patients were younger than 1 year. The most common presenting symptom was abdominal pain, occurring in 27 patients (48.2%). Thirty-three patients (60%) had total one-sided salpingo-oophorectomy and three patients had bilateral salpingo-oophorectomy. Nineteen patients had stage I, 15 had stage II, 19 had stage III, and 3 had stage IV disease. Dysgerminoma was the most common type. Overall survival (OAS) and event-free survival were 68% (median follow-up time: 71 mos) and 57%, respectively, after 22 years. Histopathology was not correlated with survival. Two important predictors for survival are age (P < 0.0001) and treatment protocol (P = 0.013). The BEP protocol was superior to the other regimens. The OAS was 74.6% in BEP, 55% in PVB, and 63.6% in VAC regimens. Although age at diagnosis and treatment with BEP regimen have major roles in determining prognosis of the ovarian tumors in childhood, for patients with advanced ovarian germ cell tumors, intensification of chemotherapy or the development of new approaches is necessary.

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.

Prognostic factors for local and distant recurrence in Stage I and II cervical carcinoma

Purpose : The effects of tumor size, parametrial involvement, and other variables on treatment outcome for patients with Federation Internationale de Gynecologie et d'Obsterique (FIGO) Stage I or II cervical carcinoma, as well as treatment complications, were analyzed retrospectively. Methods and Materials : Records of 125 patients with FIGO Stage I or II carcinoma of the uterine cervix selected for curative radiotherapy between January 1980 and December 1990 were reviewed. Twelve patients (9.9%) underwent adjuvant extrafascial hyterectomy and 8 patients (6.4%) received chemotherapy. Median age was 55 years. Median follow-up time was 40 months, and minimum follow-up time was 24 months. The data were analyzed for site of first relapse, survival, overall incidence of complications, and incidence of grade 4 complications. Results : The overall 5-year was: Stage IA: 100%, Stage IB: 72%, Stage IIA: 90%, and Stage IIB: 72%. The 5-year survival with no evidence of disease (NED) was: Stage IA: 100%, Stage IB: 67%, Stage IIA: 90%, and Stage IIB: 50%. Patients with bulky (> 5 cm) tumors had a shorter overall and NED survival than patients with nonbulky tumors (53% vs. 83%; p = 0.0008 and 44% vs. 78%; p = 0.0001, respectively). Thirty-nine tumor recurrences (39 out of 125 = 31%) occurred and were scored as local (23 out of 125 = 18.3%), if initial failure had a local component, or distant (16 out of 125 = 12.7%), if initial failure was distant only. Patients with bulky (more than 5 cm) tumors (32 out of 125) were more likelyto experience a recurrence (18 out of 32 = 56%) than patients with nonbulky tumors (21 out 93 = 22%; p = 0.0004). The initial site of recurrence was more likely to be local for bulky tumors (14 out of 18 = 78%) than for nonbulky tumors (9 out of 21 = 43%; p = 0.03). The profitability of a recurrence increased with the number of involved parametria (none: 20 out of 78 = 25%; one: 12 out 34 = 35%; two 7 out of 13 = 54%; p = 0.04 for linear trend), as did the probability that the initial failure was distant rather than local (none: 4 out of 20 = 20%; one: 7 out of 12 = 58%; two: 5 out of 7 = 71%; p = 0.01 for linear trend). Positive lymph nodes, vessel invasion, and low hemoglobin level all correlated with an increased risk of a recurrence (RR 2.41, p = 0.004; RR 2.20, p = 0.01; OR 2.02, p = 0.01, respectively). There were 46 complications among 37 (29%) patients. The incidence of grade 4 complications was 8.8% (11 out of 125). History of pelvic surgery and bulky tumor were significantly predictors of a grade 4 complications ( p < 0.0001 and 0.021, respectively). Also, a dose rate to point A of > 0.6 Gy/h increased the chance of a grade 4 complication ( p = 0.007). Conclusion : For patients with FIGO Stage I or II cervical carcinoma, tumor size was more predictive of local recurrence than was overall stage, and the extent of parametrical involvement was strongly predictive of distant recurrence, as was the stage. These findings suggest that tumor size and extent of parametrial involvement should be incorporated into the stagling system. Patients with bulky tumors had a shorter survival and were more likely to experience a grade 4 toxicity of therapy. Dose rate to point A of > 0.6 Gy/h was associated with the increased risk of grade 4 complications.