[ effect of consolidation treatment with intraperitoneal carboplatin in advanced epithelial ovarian cancers]

Background: The aim of this study was to assess the role of consolidative intraperitoneal chemotherapy with carboplatin in decreasing relapse and increasing survival in advanced epithelial ovarian cancers, as well as evaluation of its toxicity

Methods: In this clinical trial 30 patients with epithelial ovarian cancer in stages II-IV who had complete surgery [optimal debulking surgery] received six standard cycles of intravenous carboplatin and paclitaxel. They were enrolled through non-random sequential selection

The control patients were similar to case group in stage [II-IV] and pathology [epithelial ovarian cancer]

The control group was evaluated retrospectively through hospital files. This clinical trial performed in Gynecology Oncology department in Tehran Valiasr University Hospital, during 2005-2010. They including 18 cases as the intervention group receiving intraperitoneal chemotherapy and 12 patients as the control group with only retrospective follow-up. The cases received 3 cycles of 400 mg/m[2] intraperitoneal carboplatin every 21 days following intravenous chemotherapy. Relapse of disease was diagnosed as increasing or even doubling CA125 serum titer during one month, or any CA125 above 100 IU, or an abdominal or pelvic mass in ultrasound or physical exam. Mean survival of two and five years, progression-free interval [PFI], overall survival [OS], relapse, demographic parameters, drug toxicities, pathologic types of cancers in two groups were coded and compared using SPSS 14. Any PO.05 was considered as a significant difference

Results: The mean ages of cases and controls were 52.4+/-8.6 and 55.1+/-11.5 years. The mean duration of relapse-free survival was 13+/-8.6 months for the cases and 9.5+/-4.3 months for the control patients [not statistically different, P>0.05]

The mean overall survival for cases and controls were 39+/-16.5 and 30.8+/-16.2 months, respectively [no significant difference, P>0.05]

The frequency of drug toxicities in the cases was 5.6%, and consisted of mild-to-moderate abdominal pain, nausea and vomiting

Conclusion: It seems that consolidation therapy with intraperitoneal carboplatin may not increase overall survival, reduce relapse rate or decrease mortality, though it does not induce considerable side effects. Since the mean survival in the intervention group was nine months more than controls, this difference may be clinically significant

[Concomitant mucin-producing tumors of ovary and adenocarcinoma of cervix: a case report]

Ovarian mucinous borderline tumors are divided into two morphologic groups: endocervical-like and intestinal type. Most endocervical adenocarcinomas exhibit mucinous and/or endometrioid differentiation, they infrequently metastasize to the ovaries but may simulate primary ovarian tumors [both atypical proliferative or borderline and carcinoma]. In patients with mucinous adenocarcinoma in the abdominal cavity, caution should be exercised in interpreting the possible primary site of the tumor on the basis of the immunohistochemical profiles. The presence of human papillomavirus [HPV] DNA is assessed to determine whether the ovarian neoplasms were metastases or primary independent neoplasm. Approximately 90% of endocervical adenocarcinomas are related to high-risk human papillomavirus [hr-HPV] with the remainder being unrelated to HPV. Both types metastasize to the ovaries very infrequently. Ovarian endocervical-type [mullerian] mucinous tumors and tumors composed of a mixture of endocervical-type mucinous, serous endometrioid, squamous, and indifferent cells with abundant eosinophilic cytoplasm reported to date have been primarily limited to borderline and micro invasive types. We report a-36-yr old woman with adenocarcinomas of uterine cervix who also had ovarian mucinous borderline tumor. The patient presented with abnormal uterine bleeding and lower abdominal pain. She had a history of uterine cervix polyps. Pelvic ultrasound showed a right adnexal mass and a large cervical size. Histological diagnosis in uterine cervix biopsy revealed adenocarcinoma of cervix. Radical hysterectomy type III with bilateral salpingo-oophorectomy was performed. Histological finding in adnexal mass revealed borderline mucinous tissue of ovarian tumor. Testing for HPV DNA in the tumoral tissue was negative. This confirms that the ovarian tumor is not metastatic from endocervical adenocarcinoma. We conclude that in a patient with tumors that involve two organs, complete diagnostic investigation should be done to distinguish the primary origin. The factors that affect cell proliferation, can probably have synchronous effects on the two similar cells.

Long-term disease free and successful pregnancy in a woman with gonadal dysgenesis and malignant germ cell tumor

To report a case of long-term disease free and successful pregnancy after fertility sparing staging surgery with adjuvant chemotherapy in a 46,Xy gonadal dysgenetic with malignant germ cell tumor. A case report from a university hospital about a 19-year-old female with 46,XY karyotype [Swyer syndrome]. The patient underwent bilateral gonadectomy and staging with uterus preservation. Six course adjuvant chemotherapy with VBP [Vinblastin, Bleomycin, Cisplatin] was given. The case got pregnant through IVF- embryo donation. Disease free period and successful pregnancy is reported. After treatment the patient is free of the disease after 11 years follow-up. She underwent in vitro fertilization treatment with oocyte donation and gave birth to a healthy ch. Improved multimodality treatment, allowance for consideration of fertility options for some women with gynecologic cancers. Since major concern in women with XY gonadal dysgenesis is ovarian malignancy, even with stage II dysgerminoma hysterectomy may not be required in some cases considering the opportunity for childbearing with the use of embryo transfer

Low grade endometrial stromal sarcoma of uterine: review of 17 cases

Endometrial stromal sarcomas [ESS] are the second most common uterine sarcomas. Endometrial stromal sarcomas account for 0.25% of all uterine malignancies. Uterine sarcomas most often affect postmenopausal women. The aim of this retrospective study was to review the experience in the treatment and clinical outcome of low grade malignant endometrial stromal sarcoma. Seventeen patients with histologically proven low grade ESS in department of Gynecologic Oncology of the Vali-e-Asr Hospital, Tehran-Iran, between 1999 and 2008 were included in the analysis. Demographics, pathology, treatment, time to recurrence, salvage therapy and survival information was collected. The median age of our patients was 45.35 +/- 6.8 [range 36-61]. The median parity of the patients was 5 [range 0-8]. Most patients were diagnosed at FIGO stage I. The mean survival for patients with stage I and II was 73.5 +/- 35.09 and 57.6 +/- 5.37 months, respectively, with mortality rate of 5.9% through a median follow-up time of 68.82 +/- 30 months. Of 17 patients, seven cases [35.29%] were disease free at 6 years after hysterectomy. Radiotherapy was administered to four patients [23.53%]. Only one patient recurred at 10th month after surgery. Surgeries not preserving ovarian function were helpful to decrease the risk of recurrence compared with those sparing ovarian function

Sarcoma botryoides (embryonal rhabdomyosarcoma) of the uterine cervix in sisters / 부인종양

Sarcoma botryoides (embryonal rhabdomyosarcoma) rarely arises in the uterine cervix. We report a case of a 14-year-old female with sarcoma botryoides who presented with prolonged vaginal bleeding and cervical polyp. The biopsy specimen confirmed sarcoma botryoides. The patient underwent radical surgery of the tumor and hysterectomy without adjuvant chemotherapy. The sister of the patient had died previously due to the same diagnosis at the age of 17. We achieved a satisfactory outcome in short-term period with radical surgery and hysterectomy. Presence of sarcoma botryoides of the cervix in two sisters in the family highlights the possible role of genetic factors in the development of sarcoma botryoides.