Gynecologic Neoplasms Research Articles

Improving communication within the interdisciplinary team monitoring young women with onco-gynecological pathology in Romania.

BackgroundThe quality of medical care, as well as the application of effective treatments in the management of patients with gynecologic neoplasm, is of great importance. Finding new and efficient ways of communication between the doctors involved in the multidisciplinary team for the management of the disease, from the diagnosis to the reintegration into society, would help improve the quality of comprehensive patient care.ObjectiveThe objective of the study was to assess the collaboration of family physicians with specialists treating patients suffering from gynecologic cancer, in order to improve the relationship between them via electronic communication.Study designWe conducted a descriptive, transversal study on 353 family physicians and 37 specialist doctors from Romania, between January and June 2015. For statistical data analysis, R for Data Analysis and Graphics version 3.2.1 was used.ResultsMost of the family physicians and specialist doctors believed that they provided the best care that they could, but consider that a multidisciplinary approach using online communication methods, in which doctors collaborate among each other, is needed.ConclusionsFinding a simple, efficient and modern means of communication is essential in order to increase the efficiency of medical care overall.

PET/CT 18F-FDG en carcinomatosis peritoneal: revisión de la fisiopatología y presentación de dos casos

Peritoneal carcinomatosis is the dissemination or extension in the peritoneal cavity of a cancer originated in some organ or abdominal viscera, generally associated with digestive or gynaecological neoplasms. It can also occur in primary form, as in mesothelioma and primary peritoneal adenocarcinoma. Anatomical images are essential for the evaluation of peritoneal seeding, but small neoplastic implants can be difficult to detect with CT or MR imaging. PET/CT 18F-FDG can improve the detection of peritoneal metastases. It is indicated in patients with elevated tumour markers, with negative or inconclusive anatomical images, and in patients selected for complete debulking. PET/CT 18F-FDG adds to conventional images in the detection and staging of peritoneal carcinomatosis, and is a useful diagnostic tool in monitoring the response to therapy and in long-term follow-up.

Immunohistochemical Expression of Different Subtypes of Cytokeratins by Endometrial Stromal Sarcoma.

Endometrial stromal sarcomas (ESS) are rare and understudied gynecologic mesenchymal neoplasms. These tumors can be confused with many other gynecologic and nongynecologic tumors due to their variegated morphologic appearance and nonspecific immunohistochemical profile. ESS can express cytokeratin (CK) and, therefore, may be misdiagnosed as carcinoma especially in extrauterine locations and when recurrence/metastasis is present. In this study, we investigated the expression of a wide spectrum of CKs consisting of AE1/3, CAM 5.2, HMCK, MNF116, CK5, CK6, CK7, CK8/18, CK14, CK17, CK19, and CK20 in 6 low-grade and 5 high-grade ESS. In addition, staining for estrogen receptor, progesterone receptor, CD10, and cyclin D1 was performed. Our results showed that CKs AE1/3, CAM 5.2, MNF116, and CK8/18 are more expressed in low-grade ESS, whereas high-grade ESS express more AE1/3 and CAM 5.2. In problematic cases, especially in recurrences or metastases, the immunohistochemical panel of antibodies AE1/3, MNF116, CAM 5.2, and CK8/18, together with other classic immunohistochemical markers CD10, cyclin D1, estrogen receptor, and progesterone receptor, may be helpful in the differential diagnosis between ESS and other gynecologic and nongynecologic malignancies.

Linking type 2 diabetes and gynecological cancer: an introductory overview.

Type 2 diabetes (T2D) is a chronic disease with a growing prevalence and a leading cause of death in many countries. Several epidemiological studies observed an association between T2D and increased risk of many types of cancer, such as gynecologic neoplasms (endometrial, cervical, ovarian and vulvar cancer). Insulin resistance, chronic inflammation and high free ovarian steroid hormones are considered the possible mechanisms behind this complex relationship. A higher risk of endometrial cancer was observed in T2D, even though this association largely attenuated after adjusting for obesity. A clear relationship between the incidence of cervical cancer (CC) and T2D has still not be determined; however T2D might have an impact on prognosis in patients with CC. To date, studies on the association between T2D and ovarian cancer (OC) are limited. The effect of pre-existing diabetes on cancer-specific mortality has been evaluated in several studies, with less clear results. Other epidemiological and experimental studies focused on the potential role of diabetes medications, mainly metformin, in cancer development in women. The correct understanding of the link between T2D and gynecologic cancer risk and mortality is currently imperative to possibly modify screening and diagnostic-therapeutic protocols in the future.

Morphological Pattern of Ovarian Tumour : Experience in a Tertiary Level Hospital

Background: Ovarian tumor is a common type of gynecological neoplasm and accounts for 15-25% of all gynecological malignancies. It is associated with high mortality and an accurate histological diagnosis is essential for management of patient.Objective: The study was performed to find out the morphological pattern, nature and age distribution of ovarian tumour in our hospital.Material and methods: It was a prospective study,conducted in the Department of Histopathology and Cytopathology, BIRDEM General Hospital, Dhaka for a period of two years from Jan 2014 to Dec 2015. This study included 186 cases of ovarian tumors sent in the Department of Pathology for histopathological evaluation. Non-neoplastic lesions and tumour-like conditions were excluded from the study. Histological diagnosis, age and laterality of ovary were recorded. Morphological pattern, nature and age distribution of ovarian neoplasms were calculated.Result: 84.95% cases of ovarian tumour were benign, 1.61% cases were borderline and 13.44% cases were malignant. ORIGINAL ARTICLES Surface epithelial tumour was the commonest type of tumour (61.83%), according to the histogenesis , followed by germ cell tumour. Benign serous tumour was the most common type of benign tumor (37.98% cases), followed by mature cystic teratoma (33.55% cases). Serous cystadenocarcinoma was the most common type of malignant tumour (36.0%), followed by endometrioid carcinoma (28.0%). Benign tumours were more frequent in all age group. The incidence of malignant ovarian tumour increased with age and was most frequent in >50 years age group. Benign tumours were commonly cystic, whereas malignant tumours were commonly solid and cystic. 11.23% cases of ovarian tumours were bilateral.Conclusion: Benign ovarian neoplasms were more common than malignant ones and benign serous tumour was the commonest type of benign neoplasm whereas serous cystdenocarcinoma was the commonest type of malignant neoplasm. The pattern and age distribution of ovarian tumour of our study were quite similar with other studies with some variation.J Bangladesh Coll Phys Surg 2018; 36(1): 5-10

Cervical Cancer Markers: Epigenetics and microRNAs.

Gynecologic malignant neoplasms are a severe health problem among female patients, of which cervical cancer (CC), in particular, is a common disease leading to high mortality rates. Despite extensive attempts by researchers to solve the molecular mystery of CC, the mechanisms of its pathogenesis remain unclear. Tumor markers used in the clinical laboratory, such as squamous cell carcinoma (SCC), cancer antigen (CA)-125, and CA19-9, provide some help in diagnosing patients with CC. However, finding new molecular markers with high sensitivity and specificity is necessary. This review focuses on the role of epigenetic changes, particularly microRNAs (miRNAs), to CC. Several miRNAs that associated with CC potentially have the advantage of being early biomarkers. Moreover, altered serum miRNAs or single nucleotide polymorphisms in miRNA patterns may predict disease progression.

Current landscape and future perspective of sentinel node mapping in endometrial cancer.

Endometrial cancer (EC) represents the most common gynecological neoplasm in developed countries. Surgery is the mainstay of treatment for EC. Although EC is characterized by a high prevalence several features regarding its management are still unclear. In particular the execution of lymphadenectomy is controversial. The recent introduction of sentinel node mapping represents the mid-way between the execution and omission of node dissection in EC patients. In the present review we discuss the emerging role of sentinel node mapping in EC. In addition, we discussed how type of tracers utilized and site of injection impacted on sentinel node detection rates. Future perspective regarding EC management are also discussed.

Invasive Paget Disease of the Vulva.

Extramammary Paget disease of the vulva (EPDV) is a rare occurrence with an indolent and relapsing course. Progression to invasion occurs in 4% to 19% of cases. The aim of this study is to report clinical-pathological features and outcomes of patients treated for invasive EPDV. Data of consecutive patients treated between 2000 and 2017 for invasive EPDV were reviewed. Among 79 patients with EPDV, 10 (12.7%) presented a microinvasive or invasive form at first diagnosis or during follow-up. All of them underwent upfront radical surgery; 7 (70%) received subsequent radiotherapy, chemotherapy, or both. The mortality rate was 40%. The recurrence rate after treatment for invasive forms was 60%, with a mean time to first recurrence of 20 (range, 5-36) months. Our study confirms that invasive EPDV remains a rare gynecological neoplasm with a poor prognosis. Multicentre trials or well-organized prospective data collection could improve the knowledge about the management of invasive EPDV.

Massive pelvic recurrence of uterine leiomyomatosis with intracaval-intracardiac extension: video case report and literature review

BackgroundUterine leiomyomas represent the gynecological neoplasm with the highest prevalence worldwide. This apparently benign pathological entity may permeate into the venous system causing the so-called intravenous leiomyomatosis of the uterus (IVL). IVL may seldom extend to large caliber veins and reach the right cardiac chambers or pulmonary arteries and cause signs of right sided congestive heart failure and sudden death. Due to its low incidence, however, IVL with intracardiac extension is often misdiagnosed resulting in deferred treatment. No consensus has been obtained regarding the standard surgical approach to be used for this rare condition. We describe the case of a massive pelvic recurrence of uterine leiomyomatosis with intracardiac extension and provide a review of the literature, analyzing management and surgical outcomes.Case presentationWe present the case of a 46-year-old premenopausal woman presenting with lower-extremity edema, recurrent syncopes and a history of subtotal hysterectomy for multiple uterine fibroids. She was diagnosed with pelvic recurrence of uterine leiomyomatosis and IVL with cardiac involvement. A two-stage surgical excision of the intracardiac-intracaval mass and pelvic leiomyomatosis was performed. The patient had an uneventful recovery and no evidence of recurrence was observed on follow-up.ConclusionsBy virtue of the rarity of the present pathology, awareness is widely scarce and diagnosis is often delayed. Early recognition is difficult due to initial aspecific and subtle clinical manifestations. Nevertheless, suspicion should be held high in premenopausal women with known history of uterine leiomyomata, presenting with cardiovascular symptoms and evidence of a free-floating mass within the right cardiac chambers. In-depth imaging is crucial for defining its anatomical origin and relations. Prompt surgical treatment with radical excision of pelvic and intravenous leiomyomatosis guarantees favorable outcomes and excellent prognosis with low rates of recurrence, whereas delayed diagnosis and treatment exposes to increased risk of congestive heart failure and sudden death.

Risk factors for lower extremity lymphedema following treatment of gynecologic cancers: a meta-analysis

Objective To investigate the multiple risk factors for lower extremity lymphedema in patients following treatment of common gynecologic cancers by meta-analysis for systematic analysis and comprehensive quantitative study. Methods Clinical trials published up until August 2016 were retrieved from PubMed, Embase, and the Cochrane Library. The quality of the included studies was assessed by the Newcastle-Ottawa Scale, and data analysis was performed using Stata 14.0 and RevMan 5.3. The strength of the associations between risk factors and gynecologic cancer-related lower extremity lymphedema was described as odds ratio (OR) and 95% confidence intervals (CI). Results Eighteen studies were included in the meta-analysis, and 8 relevant factors were identified. The risk factors for lower extremity lymphedema after treatment of gynecologic cancer mainly included radiotherapy (OR=2.45, 95%CI: 2.05-2.95, P=0.000), FIGO stage (OR=2.29, 95%CI: 1.66-3.14, P=0.000), and pelvic lymph node dissection (OR=2.00, 95%CI: 1.02-3.91, P=0.040). Conclusions Radiotherapy, FIGO stage, and pelvic lymph node dissection are the main risk factors for lower extremity lymphedema after treatment of gynecologic cancers. Key words: Gynaecological neoplasms; Lower extremity lymphedema; Risk factors

EFFECT OF COGNITIVE BEHAVIORAL THERAPY FOR SEROTONIN LEVEL, DEPRESSION SCORE AND QUALITY OF LIFE IN CERVICAL CANCER PATIENTS

Cervical cancer is the most common cause of death among gynaecological neoplasms. Management of advanced cervical cancer currently has not been able to improve the prognosis. Standard intervention therapy, chemotherapy and radiotherapy, as well as the emerging pain could lead to psychological stress till depression, thus reduce patients’ quality of life. CBT for psychological stress and depression is expected to improve the fruitfulness of standard therapy. Serotonin is a neurotransmitter which plays a role in the patophysiology of depression. The aim of this study is to analyze the effect of cognitive behavioral therapy on serotonin level, depression score and quality of life in advanced cervical cancer patient with experimental quasi pre and post test design methods. The samples are 15 subjects in both intervention and control groups. Intervention group was given CBT and standard therapy, while control group was given standard therapy only. Study was held in Department of Obstetric and Gynecologic Dr. Moewardi Hospital Surakarta and Prodia Laboratory, in January to March 2015. Independent variable was advanced cervical cancer patients underwent CBT intervention and dependent variables were serotonin level, depression score and quality of life score. The result, serotonin level and quality of life scores were higher after intervention compared with control, (219.43±33,42 vs 89.57±23.23) and (85.13±14.62 vs 41.86±7.24), respectively. Depression score was lower after intervention than without CBT intervention (11.20±4.94 vs 17.00±4.86) and statistically significant (p < 0.05). So, there were effects of cognitive behavioural therapy on serotonin level, depression score and quality of life score in cervical cancer patients and were statistically significant.

Abstract LB-166: Risk of anal cancer in women with human papillomavirus-related gynecological neoplasm: Puerto Rico 1987-2013

Abstract Objective: This study aimed to: 1) describe age-adjusted incidences for invasive cervical, vulvar, vaginal, and anal cancer cases reported from 1987 to 2013 in Puerto Rico (PR); 2) to estimate the Standardized Incidence Ratio (SIR) of secondary anal cancer among women with HPV-related gynecological neoplasms (cervical, vulvar or vaginal) during 1987-2013; and 3) to estimate the magnitude of these associations, adjusting for age. Methods: We identified 9,489 women who had been diagnosed with a primary cervical, vaginal or vulvar tumor during 1987-2013 in PR. To describe the trends of cervical, vulvar, vaginal, and anal cancer, the age-standardized incidences were estimated using the direct method (2000 US Std Pop). SIRs (observed/expected) were computed using the indirect standardization method; expected cases were calculated using age-specific rates of anal cancer in women from the general population of PR. The ratio of SIRs was estimated using the Poisson regression model to estimate the magnitude of the association between secondary anal cancer and HPV-related gynecological neoplasms. Results: A significant increase in the incidence trend for anal cancer was observed from 1987 to 2013 (APC=1.1; p-value<0.05), whereas from 2004 to 2013, a significant increase was observed for cervical cancer incidence (APC=3.3; p-value<0.05). Women with HPV-related gynecological cancers had three times the risk of developing anal cancer in comparison with women with non-HPV-related gynecological cancers (RR: 3.27; 95%CI: 1.37, 7.79). Conclusion: Anal cancer is increasing among women in PR. Women with gynecological HPV-related tumors are at increased risk of anal cancer as compared to women from the general population and to those with various other primary tumors. Further investigation on the public health implications of this association is needed, as well as appropriate screening guidelines for anal cancer in these populations. Citation Format: Adrianna Isabel Acevedo-Fontanez, Erick Suarez, Carlos R. Torres-Cintron, Ana Patricia Ortiz. Risk of anal cancer in women with human papillomavirus-related gynecological neoplasm: Puerto Rico 1987-2013 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr LB-166. doi:10.1158/1538-7445.AM2017-LB-166

Platinum-containing compound platinum pyrithione suppresses ovarian tumor proliferation through proteasome inhibition

BackgroundOvarian carcinoma is one of the most aggressive gynecological malignant neoplasms and makes up 25–30% of all cancer cases of the female genital tract. Currently, resistance to traditional chemotherapy is a great challenge for patients with Epithelial ovarian cancer (EOC). Therefore, identifying novel agents for EOC treatment is essential and urgent.MethodMTS assay was used to analyze the cell viability and proliferation of cancer cells. Flow cytometry was employed to analyze cell cycle distribution and cell apoptosis. Protein signaling pathways were detected by western blot and immunohistochemical staining. Nude mouse experiment was performed to test the in vivo effect of platinum pyrithione (PtPT).ResultsPtPT is a chemically well-characterized synthetic complex of platinum that potently inhibits proteasome-associated deubiquitinases USP14 and UCHL5 activity and shows selective cytotoxicity to multiple cancer cells without damaging DNA. We found that PtPT significantly accumulated ubquitinated-proteins and suppressed the proliferation of multiple EOC cells. Additionally, PtPT induced G2 phase arrest and apoptosis in both A2780 and SKOV3 cells. More importantly, animal experiments showed that PtPT dramatically suppressed the growth of EOC xenografts without obvious side effects.ConclusionThese results suggest that through proteasome inhibition, PtPT significantly suppressed the proliferation of EOC in vitro and in vivo and could be developed as a novel agent for EOC treatment in the future.

Uterine Adenosarcoma in Obese/Overweight Patients; A Report of Two Cases

Uterine adenosarcomas are an uncommon gynecological neoplasm consisting of benign epithelial and malignant mesenchymal components and usually presenting as a polypoid mass. We report herein two cases of uterine adenosarcoma. Both of the patients were obese/overweight (body mass index 32 kg/m2 and 27 kg/m2, respectively), and controlling obesity and metabolic disorders seemed to be the key to prevent their post-operative tumor recurrence. You can submit your Manuscripts at: https://symbiosisonlinepublishing.com/submitManuscript.php

Evaluation of the indications for performing magnetic resonance imaging of the female pelvis at a referral center for cancer, according to the American College of Radiology criteria.

ObjectiveTo evaluate the indications for performing magnetic resonance imaging of the female pelvis at a referral center for cancer.Materials and MethodsThis was a retrospective, single-center study, conducted by reviewing medical records and imaging reports. We included 1060 female patients who underwent magnetic resonance imaging of the pelvis at a cancer center between January 2013 and June 2014. The indications for performing the examination were classified according to the American College of Radiology (ACR) criteria.ResultsThe mean age of the patients was 52.6 ± 14.8 years, and 49.8% were perimenopausal or postmenopausal. The majority (63.9%) had a history of cancer, which was gynecologic in 29.5% and nongynecologic in 34.4%. Of the patients evaluated, 44.0% had clinical complaints, the most common being pelvic pain (in 11.5%) and bleeding (in 9.8%), and 34.7% of patients had previously had abnormal findings on ultrasound. Most (76.7%) of the patients met the criteria for undergoing magnetic resonance imaging, according to the ACR guidelines. The main indications were evaluation of tumor recurrence after surgical resection (in 25.9%); detection and staging of gynecologic neoplasms (in 23.3%); and evaluation of pelvic pain or of a mass (in 17.1%).ConclusionIn the majority of the cases evaluated, magnetic resonance imaging was clearly indicated according to the ACR criteria. The main indication was local recurrence after surgical treatment of pelvic malignancies, which is consistent with the routine protocols at cancer centers.

Lack of HPV in Benign and Malignant Epithelial Ovarian Tumors in Iran

Background:Ovarian epithelial tumors one of the most common gynecological neoplasms; we here evaluated the presence of HPV in benign and malignant examples.Methods:In this cross-sectional study the records of 105 patients with epithelial ovarian tumors (benign and malignant) referred to Imam Hossein University Hospital from 2012 to 2015 were evaluated along with assessment of the presence of the HPV infection using PCR.Results:Among 105 patients, comprising 26 (24.8%) with malignant and 79 (75.2%) with benign lesions, the factors found to impact on malignancy were age at diagnosis, age at first pregnancy, number of pregnancies and hormonal status. However, malignancies was not related to abortion, late menopause, and early menarche. In none of the ovarian tissues (benign and malignant) was HPV DNA found.Conclusion:In this study HPV DNA could not be found in any epithelial ovarian tumors (benign and malignant) removed from 105 women; more studies with larger sample size are needed for a definite conclusion.

Chylaskos as a presentation of serous papillary adenocarcinoma of the endometrium: a case report

A 77-year-old female was presented to the emergency department with intense anorexia, weight loss despite progressive abdominal distension, and dyspnea. Abdomen imaging studies revealed moderate-volume ascites and a hepatic space-occupying lesion. Diagnostic paracentesis allowed the drainage of a chylous effusion and cytology analysis identified adenocarcinoma cells. Hepatic metastasis of papillary serous adenocarcinoma of the endometrium was confirmed after tomography-guided biopsy. Endometrial carcinoma is the most common malignant gynecological neoplasm in developed countries and is often classified in type I with endometrioid histology (estrogen-dependent) and non endometrioid type II (non-estrogen-dependent). Chylous ascites or chylaskos is a rare presentation on hospital admission. Several etiologies have been described. In adults, solid malignancy is expected to be identified in less than 20% of the cases. Currently only one case of endometrial carcinoma presenting with chylous ascites was described in a systematic review

Circulating miRNA landscape identifies miR-1246 as promising diagnostic biomarker in high-grade serous ovarian carcinoma: A validation across two independent cohorts

High-grade serous ovarian carcinoma (HGSOC) is the most lethal gynecologic neoplasm, with five-year survival rate below 30%. Early disease detection is of utmost importance to improve HGSOC cure rate.Sera from 168 HGSOC patients and 65 healthy controls were gathered together from two independent collections and stratified into a training set, for miRNA marker identification, and a validation set, for data validation. An innovative statistical approach for microarray data normalization was developed to identify differentially expressed miRNAs. Signature validation in both the training and validation sets was performed by quantitative Real Time PCR (RT-qPCR).In both the training and validation sets, miR-1246, miR-595 and miR-2278 emerged significantly over expressed in the sera of HGSOC patients compared to healthy controls. Receiver Operating Characteristic curve analysis revealed miR-1246 as the best diagnostic biomarker, with a sensitivity of 87%, a specificity of 77% and an accuracy of 84%.This study is the first step in the identification of circulating miRNAs with diagnostic relevance for HGSOC. According to its specificity and sensitivity, circulating miR-1246 levels are worthy to be further investigated as potential diagnostic biomarker for HGSOC.

Systematic assessment of HER2/neu in gynecologic neoplasms, an institutional experience.

BackgroundHER2/neu overexpression and/or amplification has been widely studied in a number of solid tumors, primarily in the breast. In gynecologic neoplasms, determination of HER2/neu status has not been well studied as a predictive biomarker in anti-HER2/neu treatment.MethodsWe systematically evaluated the HER2/neu reactions by immunohistochemistry and fluorescent in situ hybridization in malignant gynecologic neoplasms as experienced in our institution.ResultsThe HER2/neu overexpression or amplification occurred in 8 % of the cancers of the gynecological organs in our series. Majority of the HER2/neu overexpression and/or amplification occurred in clear cell (27 %) and serous (11 %) carcinomas. HER2/neu positivity was also seen in undifferentiated as well as in mixed clear cell and serous carcinomas. Discordant IHC and FISH results (positive by FISH but not IHC) was seen in 2 cases. Majority of the HER2/neu overexpression and/or amplification occurs in the endometrium rather than the ovary. Heterogeneity of the HER2/neu by IHC staining was in < 2 % of the tumors in our series.ConclusionsWe recommend the HER2/neu studies on Müllerian carcinomas of clear cell, serous, and undifferentiated types, particularly when they arise in the endometrium. Since there are some discordant IHC/FISH results, we also propose performing the HER2/neu testing by FISH when the IHC score is less than 3 + .

Syndrome de Muir-Torre chez un patient atteint de maladie de Waldenström

Muir-Torre syndrome (MTS), a cutaneous variant of Lynch syndrome, consists of hereditary predisposition to cutaneous tumours and gastrointestinal and gynaecological neoplasms, with autosomal dominant transmission. It is associated with mutations in genes coding for proteins in the DNA mismatch repair system. Herein, we report a case of a male patient presenting Waldenstrom's macroglobulinemia since the age of 50 and which, after the age of 65 years, developed into sebaceous tumours (5 sebaceous adenomas, 1 sebaceoma, 1 sebaceous carcinoma) and colonic lesions (4 adenomas). The clinical phenotype was consistent with MTS. Somatic analysis carried out on one sebaceous tumour showed instability of the microsatellites with loss of expression of MSH2 and MSH6 although constitutional genetic analysis showed no germline mutations known to be harmful. This noteworthy case raises a number of questions, including the possibility of association between STM and Waldenstrom's macroglobulinemia, which is discussed herein.