Stage IA Research Articles

Systematic Review of Sublobar Resection for Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer.

Sublobar resection offers a parenchymal-sparing surgical alternative to lobectomy and includes wedge resection and segmentectomy. Sublobar resection has been historically utilized in high-risk patients with compromised lung function; however, the technique is becoming more prevalent for normal-risk patients with peripheral lung tumors < 2 cm. In this article, we summarize the technique of sublobar resection, the importance of surgical margins and lymph node sampling, patient selection, perioperative complications, outcomes, and the impact of sublobar resection on the quality of life. There is limited data on short-term and long-term outcomes after sublobar resection for stage I NSCLC in high-risk patients. Results from randomized clinical trials (RCTs) of sublobar resection have been variable. We have summarized the results of the ACOSOG Z4032 RCT, which compared outcomes in high-risk patients who underwent sublobar resection alone versus sublobar resection with brachytherapy for stage I NSCLC. In addition, we have summarized recent findings of the CALGB/Alliance 140503 RCT comparing sublobar resection and lobectomy, which suggested that disease-free survival after sublobar resection in patients with small (< 2 cm) peripheral NSCLC was non-inferior to lobectomy, and another RCT (JCOG 0802) of segmentectomy vs. lobectomy for small peripheral clinical stage IA NSCLC, where segmentectomy was associated with better overall survival despite a higher local recurrence rate. Sublobar resection is primarily performed with minimally invasive approaches, including robotic assisted and video-assisted thoracoscopic techniques. From an oncologic perspective, obtaining adequate surgical margins and performing an adequate lymph node evaluation are critical for good outcomes after sublobar resection.

Conditional Survival of Patients With Early-Stage Non-Small Cell Lung Cancer Who Undergo Lobectomy, Segmentectomy, or Wedge Resection Using the NCDB.

Randomized clinical trials have shown that sub-lobar resection for clinical stage (cStage) IA non-small cell lung cancer (NSCLC) is non-inferior to lobar resection. We evaluated traditional and conditional survival differences between lobectomy, wedge resection, and segmentectomy in patients with cStage IA NSCLC. The National Cancer Database (2004-2019) was queried for patients with cStage IA (≤ 2 cm) NSCLC who underwent upfront lobectomy, segmentectomy, or wedge resection. Patients were stratified by extent of resection. Propensity-matched traditional (TSA) and conditional (CSA) survival analyses were performed. Propensity score included age, gender, histology, tumor grade, and Charlson-Deyo score. Number of lymph nodes (LN) harvested was also compared between groups. There were 46 395 patients who met the inclusion criteria, of whom 32 599 (70.3%) received lobectomy, 11 181 (24.1%) wedge resection, and 2615 (5.6%) segmentectomy. Following propensity matching, all groups contained 2615 patients. In the TSA, segmentectomy (hazard ratio [HR]: 1.19, 95% confidence interval [CI]: 1.08-1.32) and wedge resection (HR: 1.41, CI: 1.28-1.56) were associated with worse 5-year survival. This remained significant in CSA at 3- and 5-years post-resection in patients who underwent segmentectomy (HR: 1.24, CI: 1.08-1.43 and HR: 1.23, CI: 1.02-1.49, respectively) and wedge resection (HR: 1.42, CI: 1.24-1.63 and HR: 1.33, CI: 1.11-1.59, respectively). Wedge resection and segmentectomy were associated with a lower number of harvested LN (median = 4 and 6, respectively) compared to lobectomy (8, p < 0.001). Analysis of real-world data suggests that lobectomy is associated with improved traditional and conditional 5-year survival as well as LN harvest.

Risk factors for the recurrence in patients with early endometrioid endometrial cancer achieving complete remission for fertility-sparing hormonal treatment

ObjectiveThis study aimed to assess the recurrence risk factors in patients with early-stage endometrioid endometrial cancer (EC) who achieved a complete response (CR) through fertility-sparing hormonal treatment (FST). MethodsWe retrospectively analyzed patients who received FST for presumed stage IA and grade 1 endometrioid EC at two institutions. Medroxyprogesterone (MPA)- and levonorgestrel-releasing intrauterine devices (LNG-IUD) were used concurrently. Maintenance therapy involved maintaining the LNG-IUDs in situ for those who did not attempt to conceive immediately after achieving CR. Cox regression analysis was used to identify clinicopathological variables for recurrence-free survival (RFS) following CR. ResultsAmong 178 patients with endometrioid EC who received FST, 142 (79.8 %) achieved CR. The median time to achieve CR and the median FST duration were 10 months (range 1–34) and 14 months (range 3–49), respectively. During the median follow-up period of 44 months (range 6–143), 59.9 % (85/142) of patients had recurrence, with a median RFS of 14 months (range 1–123) after CR. In multivariable analysis, age > 35-years (hazard ratio (HR) 1.892, 95 % confidence interval (CI) 1.224–2.923; P < 0.05) and pregnancy after the first CR (HR 0.203, 95 % CI 0.093–0.444; P < 0.05) were significantly associated with RFS. ConclusionsOlder age and non-pregnancy status may be risk factors for recurrence after CR. Therefore, patients with these conditions should undergo stringent follow-up, including imaging and histological examinations, to detect recurrence after CR.

POLE-mutated uterine carcinosarcomas: a clinicopathologic and molecular study of 11 cases

Uterine carcinosarcomas (UCS) are high-grade biphasic neoplasms with generally poor outcomes. Based on TCGA molecular classification of endometrial carcinomas, the majority of UCS are classified as copy-number high/serous-like (p53 abnormal); however, a small subset represent other molecular subtypes, including those that harbor POLE mutations. We identified 11 POLE-mutated (POLEmut) UCS across three institutions and assessed the clinical, histopathologic, immunohistochemical and molecular features of these tumors. POLEmut UCS occurred in adult women (median age 64 years, range 48 to 79 years) and usually presented as FIGO (2009) clinical stage IA (n = 4) or IB (n=3). Almost all tumors were predominantly carcinomatous (n =10), with most showing endometrioid morphology (n = 7), followed by ambiguous (n=4) and serous (n = 3) histotypes. By immunohistochemistry, 7 tumors showed aberrant or subclonally aberrant expression of p53, 6 of which harbored pathogenic mutations in TP53 by sequencing. Other frequent mutations included PIK3CA (10/11), PTEN (8/11), RB1 (7/11), ARID1A (7/11), ATM (6/11), PIK3RA (5/11) and FBXW7 (4/11). Two tumors demonstrated loss of mismatch repair protein expression and one had subclonal loss. Heterologous differentiation was uncommon and only chondrosarcomatous type (n = 2) was observed. Mean and median follow-up were 24.3 and 14.1 months, respectively (range 1.4 to 61.1 months). Ten patients (91%) had no recurrences or death from disease, though 3 of these had follow-up periods <1 year. One patient, with the subclonal POLE variant, presented with stage IV disease and died 1.4 months after surgery. In conclusion, POLEmut UCS demonstrate unique morphologic and immunohistochemical features compared to their p53-abnormal counterparts and may have significant prognostic differences. Our study supports full molecular classification of UCS. We also raise awareness for potentially assessing POLE mutation allele fraction and clonality in the consideration of classifying a tumor as POLEmut.

Subtype-Specific Detection in Stage Ia Breast Cancer: Integrating Raman Spectroscopy, Machine Learning, andLiquid Biopsy for Personalised Diagnostics.

This study explores the integration of Raman spectroscopy (RS) with machine learning for the early detection and subtyping of breast cancer using blood plasma samples. We performed detailed spectral analyses, identifying significant spectral patterns associated with cancer biomarkers. Our findings demonstrate the potential for classifying the four major subtypes of breast cancer at stage Ia with an average sensitivity and specificity of 90% and 95%, respectively, and a cross-validated macro-averaged area under the curve (AUC) of 0.98. This research highlights efforts to integrate vibrational spectroscopy with machine learning, enhancing cancer diagnostics through a non-invasive, personalised approach for early detection and monitoring disease progression. This study is the first of its kind to utilise RS and machine learning to classify the four major breast cancer subtypes at stage Ia.

MELACARE Nurse-led follow-up after early-stage melanoma: protocol and feasibility.

We developed the Melacare nurse-led intervention, which combines education in skin self-examination as a resource-conscious approach to detecting recurrence and management of fear of cancer recurrence in patients treated for melanoma. This publication presents the Melacare study protocol and evaluates the feasibility and acceptability of Melacare prior to a larger randomised controlled trial. Feasibility and acceptability of Melacare were evaluated in an intervention-only feasibility study, in which patients attended two nurse-led intervention sessions coupled with an educational booklet. Participants completed patient-reported outcome (PRO) questionnaires at baseline and before each session. After the intervention, participants completed a study-specific feedback questionnaire. Feasibility was evaluated in terms of recruitment, adherence, and attendance. Self-reported outcomes from the study-specific questionnaire on intervention effects were also collected. Results of the feasibility study: Fourteen patients (nine stage IA, five stage IB melanoma) participated. Attendance and recruitment rates were 100%, all participants completed the baseline and PRO questionnaires, and 100% read at least half of the educational booklet. In terms of intervention effects, all patients reported improved knowledge of performing skin self-examination and coping with the fear of cancer recurrence. Results indicate that the Melacare nurse-led intervention is highly feasible and acceptable for use with patients treated for early-stage melanoma. Prior to clinical trial commencement, minor refinements include changing the method of recruiting by telephone and offering.

Management of Pregnancy in a Patient with a History of Cervical Cancer: Case Report

Cervical cancer is one of the most common malignancies affecting women of reproductive age. Although surgical procedures such as conization or trachelectomy may offer the possibility of preserving fertility, they may also compromise cervical integrity, thereby increasing the risk of obstetric complications in subsequent pregnancies. This case report presents the management of a pregnant patient with a history of cervical cancer, thyroid dysfunction, and previous obstetric complications. The patient, a 38-year-old woman, conceived naturally after previous in vitro fertilization (IVF) attempts. Despite a complex medical history, including two prior cervical conizations for stage IA1 G1 cervical glandular carcinoma, the patient underwent successful antenatal care, delivery, and postnatal management. This report highlights the multidisciplinary approach and challenges encountered in managing pregnancies in patients with a history of cervical cancer and previous obstetric complications.

Pylorus-preserving pancreatoduodenectomy preserving blood supply for pancreatic cancer with a history of proximal gastrectomy and sigmoidectomy: a case report

BackgroundBlood supply to the remnant stomach should be preserved during pancreatectomy in patients with a history of gastrectomy. Moreover, ischemic complications should be considered when performing pancreatoduodenectomy in patients with celiac axis and superior mesenteric artery (SMA) stenosis. However, whether these surgical procedures can be safely performed remains unclear.Case presentationA 75-year-old man had a history of laparoscopic proximal gastrectomy (PG) with double-flap technique for gastric cancer and laparoscopic sigmoidectomy for sigmoid cancer treated 4 years ago. Follow-up computed tomography (CT) revealed an irregular nodular tumor measuring 13 mm in the pancreatic head. The patient was diagnosed with resectable pancreatic head cancer without lymph node metastasis (cT1cN0M0, cStageIA) according to the Union for International Cancer Control, 8th edition. As a standard pancreatic cancer treatment, two courses of preoperative chemotherapy with gemcitabine plus S-1 were administered. CT after preoperative chemotherapy identified no significant changes in tumor size but revealed SMA stenosis due to atherosclerosis. Blood flow to the left-sided colon was supplied from the middle colic artery via the SMA because of the past sigmoidectomy with inferior mesenteric artery detachment. Therefore, SMA stent placement was performed 1 day preoperatively. Subsequently, pylorus-preserving pancreatoduodenectomy (PPPD) was performed, preserving the remnant stomach with the right gastroepiploic (RGE) artery and vein. After resection, indocyanine green fluorescence imaging confirmed a good blood supply to the remnant stomach. The operation time was 467 min, and the blood lost was 442 mL. Histopathologically, the tumor was diagnosed as moderate adenocarcinoma and pT1cN0M0, Stage IA. The postoperative course was uneventful. The patient was discharged on postoperative day 23. S-1 as adjuvant chemotherapy was administered on postoperative day 63. The patient has been alive without recurrence for 7 months.ConclusionsWe performed PPPD preserving blood supply for pancreatic head cancer in a patient with benign SMA stenosis and a history of PG and sigmoidectomy. Blood supply was preserved through preoperative SMA stent placement and a surgical procedure preserving the RGE vessels. Furthermore, S-1 adjuvant chemotherapy was successfully initiated. These multimodal therapies contributed to a favorable clinical outcome.

Megestrol acetate plus metformin for fertility-sparing treatment of atypical endometrial hyperplasia and early-stage endometrial adenocarcinoma: a prospective study

To evaluate the efficacy of medroxyprogesterone acetate (MA) plus metformin as the primary fertility-sparing treatment for atypical endometrial hyperplasia (AEH) and early-stage grade 1 endometrial adenocarcinoma (G1 EAC) and the recurrence rate after treatment. Sixty patients (aged 20-42 years) with AEH and/or grade 1 EAC limited to the endometrium were enrolled prospectively and randomized into two groups (n=30) to receive oral MA treatment at the daily dose of 160 mg (control) or MA plus oral metformin (850 mg, twice a day) for at least 6 months. The treatment could extend to 12 months until a complete response (CR) was achieved, and follow-up hysteroscopy and curettage were performed every 3 months. For all the patients who achieved CR, endometrial expressions of IGFBP-rP1, p-Akt and p-AMPK were detected immunohistochemically. A total of 58 patients completed the treatment. After 9 months of treatment, 23 (76.7%) patients in the combined treatment group and 20 (71.4%) in the control group achieved CR; two patients in the control group achieved CR after converting to the combined treatment. The recurrence rate did not differ significantly between the control group and combined treatment group (30.0% vs 22.7%, P>0.05). Ten (35.7%) patients in the control group experienced significant weight gain of 5.7±6.1 kg, while none of the patients receiving the combined treatment exhibited significant body weight changes. Compared with the control group, the patients receiving the combined treatment showed enhanced endometrial expressions of IGFBP-rP1 and p-AMPK with lowered p-Akt expression. Metformin combined with MA may provide an effective option for fertility-sparing treatment of AEH and grade 1 stage IA EAC, and the clinical benefits of metformin for controlling MA-induced weight gain and promoting endometrial expressions of IGFBP-rP1 and p-AMPK while inhibiting p-Akt expression warrants further study.

Clinical stage IA non-small cell lung cancer with occult pathologic N1 and N2 disease after segmentectomy: does a completion lobectomy justify?

When final pathology shows pathologic N1 or N2 disease after a pulmonary segmentectomy for early stage non-small cell lung cancer (NSCLC), completion of lobectomy could be considered and recommended as an option for treatment. We explored outcomes after segmentectomy for clinical stage IA NSCLC with occult pN1 or pN2 disease. We identified clinical stage IA NSCLC undergoing segmentectomy or lobectomy from the National Cancer Database (NCDB) between 2010 and 2020. We categorized patients by pathologic N diseases (pN0/pN1/pN2). We compared segmentectomy to lobectomy adjusting for patient and clinical characteristics. We explored survival using time-varied Cox regression, 30-day, 90-day mortality, and unplanned 30-day readmission using logistic regression, and length-of-stay using Poisson regression. Of 123,085 clinical IA NSCLC, 7.9% underwent segmentectomy. Pathology showed 2.8% pN1 and 1.9% pN2 after segmentectomy, and 6.5% pN1 and 3.7% pN2 after lobectomy. For pN1, segmentectomy conferred 33% better survival within 2 years (aHR = 0.67, p = 0.03), but similar survival after 2 years (aHR = 1.06, p = 0.7). For pN2, segmentectomy had similar survival with lobectomy (aHR = 0.96, p = 0.7). For all clinical IA NSCLC, segmentectomy was associated with lower 30-day mortality (aOR = 0.55, p < 0.001), 90-day mortality (aOR = 0.57, p < 0.001), readmission (aOR = 0.86, p = 0.01), and shorter length-of-stay (aRR = 0.76, p < 0.001) than lobectomy. Outcomes after segmentectomy for clinical stage IA NSCLC may be associated with better short-term mortality, readmission rate and length-of-stay. Survival with occult pN1 and pN2 after segmentectomy are at least equivalent to lobectomy in completely resected clinical stage IA patients. A completion lobectomy may not be needed after pN1 and N2 findings after the permanent pathology was released.

High neutrophil-to-lymphocyte ratio at Helicobacter pylori eradication increases the risk of eradication failure and post-eradication gastric cancer

Introduction Vonoprazan has been known to have a high Helicobacter pylori (H. pylori) eradication rate since its launch in 2015. Yet, the risk factors for eradication failure and development of post-eradication gastric cancer (GC) using VPZ regimen remain unclear. Methods This single-center cohort study included 934 consecutive patients who underwent H. pylori eradication using VPZ between February 2015 and June 2017 and were followed up for five years by the end of 2022. We examined several indicators of systemic immune, inflammatory, and nutritional status at the time of eradication to identify those indicators could predict eradication success, risk of post-eradication GC development, and long-term prognosis. Results The successful eradication rates were 92.6% (intention-to-treat) and 98.7% (per-protocol). Multivariate analysis showed that only a high peripheral blood neutrophil-to-lymphocyte ratio (NLR) was significantly associated with eradication failure. The 5-year GC incidence rate was 1.67%, and all GCs were stage IA. The mean (standard deviation [SD]) time from eradication to diagnosis was 40.5 (6.1) months. Multivariate analysis showed that high NLR and history of GC and hypertension were significantly associated with GC development. Patients with elevated NLR post-eradication had a higher risk of newly developed GC. Twelve patients died during the study period, and a high NLR was associated with a significantly higher mortality rate. Conclusions NLR has the potential to be a biomarker that predicts the failure of eradication and development of post-eradication GC. High NLR was also associated with poor long-term prognosis after H. pylori eradication.

Does High Standard Uptake Value on Positron Emission Tomography Preclude Sublobar Resection in Stage IA Non-Small Cell Lung Cancer ≤2cm?

Recent randomized trials have shown equivalent survival after sublobar resection (SLR) versus lobectomy in patients with clinical stage IA non-small cell lung cancer (NSCLC)≤2cm. High SUVmax is a known risk factor in NSCLC, yet limited data exists on whether a high SUV should preclude a SLR. This study aims to determine if there is an association between SUVmax and survival based on the extent of parenchymal resection. A retrospective review of a prospectively maintained institutional database was conducted to identify patients with clinical stage IA NSCLC≤2cm (2011-2020) treated with SLR or lobectomy. The primary outcome was cancer-specific survival (CSS). Secondary outcomes were overall survival (OS) and disease-free survival (DFS). 543 patients were identified; 36.8% had SLR and 63.2% had lobectomy. Baseline characteristics were similar. Patients who had SLR had significantly worse ECOG performance status and higher rates of comorbidities. 5-year CSS, OS, and DFS for the whole cohort were similar between SLR and lobectomy. A receiver operating characteristic curve estimated the SUVmax cutoff point to be 4.15. For the whole cohort, patients with SUVmax>4.15 had worse CSS compared to SUVmax≤4.15. However, there was no significant difference in 5-year CSS after SLR versus lobectomy in patients with SUVmax≤4.15 (98% in both groups; P=0.77) or patients with SUVmax>4.15 (90% versus 94% respectively; P=0.12). SUVmax may not be a useful clinical determinant of the extent of parenchymal resection in patients with cT1N0 NSCLC≤2cm. Patients treated by SLR had comparable survival to lobectomy, irrespective of PET avidity.

Analysis of the effectiveness of primary treatment of stage IA–IIA ovarian cancer. Siberian Journal of Oncology

Aim: to determine the effectiveness of primary treatment of patients with ovarian cancer of stages IA–IIA.Material and Methods. The study included 336 (100 %) patients with histologically confrmed ovarian cancer of stages IA–IIA, who were treated at the Primorsky Regional Oncology Center from 2004 to 2021. The overall survival (s) and progression-free survival (PFS) were analyzed depending on clinical and morphological factors: histological type of cancer, BRCA1/2 mutation, profle of the clinic where surgical treatment was performed, surgical staging and chemotherapy option. The examination for a mutation in the BRCA1/2 gene was performed by a new generation sequencing method. The data were statistically processed using the IBM SPSS Statistics 26 program.Results. The average age of patients with stage IA–IIA ovarian cancer was 52.12 ± 12.13 years. Statistically signifcantly higher survival rates were in patients with histological tumor type low-grade serous carcinoma compared with high-grade serous carcinoma (S: p=0.010 and IBP: p=0.020), with surgical treatment in specialized hospitals compared with patients operated in gynecological hospitals (s: p=0.040 and IBP: p=0.020), during adequate surgical staging (OV: p=0.008 and IBP: p=0.010), during treatment with platinum and taxanes (OV: p=0.001 and IBP: p=0.001).Conclusion. It was shown that about 30 % of patients with stage IA–IIA ovarian cancer in Primorsky Krai received primary surgical treatment in non-specialized hospitals, which increased the risk of progression and death by 1.7 times. A low percentage of adequate surgical staging was noted (12.5 %). Adjuvant chemotherapy with platinum and non-oxane agents worsened the prognosis of the disease. Patients with low-grade serous carcinoma had a more favorable prognosis (by 60 %). There was no statistically signifcant effect of the presence of a mutation in the BRCA1/2 genes on survival rates.

Pembrolizumab Induced Recall Dermatitis Occurring 5 Years After Radiotherapy

Background and Clinical Significance: Radiation recall dermatitis (RRD) following immune checkpoint inhibitor (ICI) therapy has been infrequently reported. Case Presentation: We present a 47-year-old female patient who developed RRD of the breast following three doses of pembrolizumab administered as an adjuvant treatment post-nephrectomy for Stage III renal cell carcinoma (RCC). Notably, the affected breast had previously undergone external beam radiotherapy 247 weeks earlier for Stage IA invasive ductal carcinoma. She had received no prior chemotherapy at any point. RRD manifested as breast induration, erythema, and peau d’orange, and contraction of breast volume was noted following three cycles of pembrolizumab on week 17 (400 mg dose every 6 weeks). The dermatitis responded rapidly to systemic corticosteroids and no treatment interruption was needed. Conclusion: To date, this is the longest reported interval from completion of radiotherapy to RRD. A literature search underscores the variability in presentation and management of ICI-associated RRD.

Evaluation of physical function and quality of life before and after non-radical surgical therapy (extra fascial hysterectomy or cone biopsy with pelvic lymphadenectomy) for stage IA1 (LVSI+) and IA2–IB1 cervical cancer (GOG-278)

Evaluation of physical function and quality of life before and after non-radical surgical therapy (extra fascial hysterectomy or cone biopsy with pelvic lymphadenectomy) for stage IA1 (LVSI+) and IA2–IB1 cervical cancer (GOG-278)

Evaluation of efficacy and fertility after non-radical surgical therapy (extra fascial hysterectomy or cone biopsy with pelvic lymphadenectomy) for stage IA1 (LVSI+) and IA2–IB1 (GOG-278) cervical cancer

Evaluation of efficacy and fertility after non-radical surgical therapy (extra fascial hysterectomy or cone biopsy with pelvic lymphadenectomy) for stage IA1 (LVSI+) and IA2–IB1 (GOG-278) cervical cancer

The challenge of ovarian cancer care in the oldest old.

IntroductionOvarian cancer (OC) is the eighth most common cancer in women, with a poor prognosis, particularly in older women. The aim of this study was to describe an octogenarian population with OC and to examine the differences in net survival (NS) according to age. Material and methodsIn this retrospective observational population-based study from a gynecological cancer registry, patients aged > 18 years with an identified epithelial ovarian cancer stage IA to IVB diagnosed between 1998 and 2018 were included. Patients with non-available FIGO stage were excluded. Patients were stratified into three age groups: <70, 70-79 and ≥80 years, then by OC stage (FIGO I-II, IIIA-IIIB, IIIC-IV). Sociodemographic and cancer-related variables were compared using univariate test (Khi²). The 5-year NS was calculated using the Pohar-Perme method. ResultsAmong the 721 patients included: 462 (64.1%) were younger than 70 years, 176 (24.4%) were aged between 70 and 79 years, and 83 (11.85%) were aged 80 years or older. Patients ≥80 years had a trend for lower rate of serous carcinoma than the other age subgroups. As age increased, patients were less likely to undergo surgery and chemotherapy. While 73% of women <70 years received a combination of surgery and chemotherapy, the rate was 62% among women 70-79 years and 27% among women ≥80 years (p<.0001). When focusing on FIGO IIIC-IV stages, the 5-year NS rate for women <70 years was 45.1% (95% CI 39.1-52.0). For women 70-79 years, it was 25.9% (95% CI 18.6-36.1), and for those ≥80 years, it was 19.5% (95% CI 10.0-38.0) (p<.005). DiscussionThe oldest patients had less optimal treatment and a lower NS compared to patients in their seventies or younger. Frailty should be carefully assessed to optimize care in the oldest patients with OC.

Limiting adjuvant chemotherapy in stage IA uterine papillary serous carcinoma

Limiting adjuvant chemotherapy in stage IA uterine papillary serous carcinoma

Granulosa cell tumor – Different faces of one neoplasm. A case series

IntroductionGranulosa cell tumor (GCT) accounts for 3–5 % of all ovarian malignancies, being the most common among those originating from the sex cords and ovarian stroma. GCTs can be divided into juvenile and adult types, with the latter occurring mostly in perimenopausal women. These hormonally active tumors present diverse clinical manifestations, primarily related to elevated estrogen levels. The treatment is primarily surgical; other methods, mainly chemotherapy, are also used. Presentation of casesThree cases highlight the heterogeneity of GCTs. Case 1 involved a 34-year-old woman diagnosed with ovarian tumor during routine gynecological follow-up. Stage IA GCT was diagnosed. Fertility-sparing surgery followed by chemotherapy led to a favorable outcome, including two pregnancies. Case 2 involved a postmenopausal woman with a large pelvic mass. Surgery revealed a Stage IA GCT. Chemotherapy was stopped early due to complications. Case 3 featured a 47-year-old with acute abdominal symptoms caused by a ruptured GCT, leading to emergency surgery and subsequent radical treatment. DiscussionGCTs are hormonally active, causing symptoms such as abnormal bleeding or abdominal discomfort. Prognosis is generally favorable, especially in early-stage cases. Long-term surveillance is essential due to the potential for late recurrences. Fertility-sparing surgery is feasible in young patients, while chemotherapy is mainly used for advanced disease or recurrence. ConclusionGCTs, in addition to being rare, present with a wide range of clinical manifestations. Individualized treatment based on patient age, tumor stage, and fertility plans is crucial for favorable outcomes. Long-term monitoring is recommended due to the risk of late recurrence.

Usefulness of pelvic lymphadenectomy in staging of ovarian dysgerminoma.

To determine the usefulness of pelvic lymphadenectomy in the staging of ovarian dysgerminoma. Patients with a histopathological diagnosis of ovarian dysgerminoma who were staged between January 1995 and December 2013 were retrospectively studied. We found 39 cases, the mean age was 23.5 years. Histologically, 34 were pure dysgerminomas and 5 were mixed associated with endodermal sinus tumors. According to FIGO, we found stage IA in 15 patients, stage IB in 1 patient, stage IC in 8 patients, stage IIB in 1 patient, stage IIIA in 1 patient, and stage IIIC in 13 patients. Pelvic nodes with metastases were not documented in any of the patients studied. The lymphatic spread pattern in ovarian dysgerminomas is always towards the retroperitoneal nodes, both paracaval and paraaortic, but there is no spread towards the pelvic lymph nodes. Therefore, we recommend not performing pelvic lymphadenectomy in surgical staging in these patients.