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

Simultaneous Measurement of two Serum Markers [CA-125 and HE-4] while diagnosing malignant ovarian epithelial tumors

To evaluate the benefits of simultaneous measurement of CA-125 and HE-4 markers while diagnosing malignant epithelial tumors in the ovary. By this, the combined measurement of serum markers will possibly add to the accuracy of diagnosing such ovarian tumor. Performing a cross- sectional study on 87 women with ovarian mass, serum levels of CA125 and HE4 markers were measured before surgery or biopsy. In the wake of the surgery or biopsy, the results obtained from these tests were compared and analyzed with pathological report. The average serum level of CA-125 and HE-4 serum was notably higher in women with ovarian malignancy than in those with benignancy [CA-125: 502 vs. 19.3 v/ml, P < 0.001- HE4: 195 vs. 15.8 P mol/L, P < 0.001]. As the disease stage rises, the level of these markers increases significantly. The two markers were also directly proportionate. [r = 0.85 and P < 0.001]. There is also a meaningful difference between the levels of markers, specifically HE-4, in epithelial and non-epithelial tumors of ovary [HE-4: 195 vs. 93 P mol/L P < 0.001]. The simultaneous measurement of CA-125 and HE-4 increases the sensitivity and specificity of diagnosing malignant epithelial tumors in ovary, compared with one- by- one measurement guideline. The sensitivity and specificity of simultaneous measurement of CA125 and HE4 for diagnosing epithelial ovarian cancer were calculated to be 99.5% and 100%, respectively. Simultaneous measurement of CA-125 and HE-4 increases the sensitivity and keep the specificity still high in diagnosing malignant epithelial tumors in ovary, compared with one-by-one measurement system

Major surgeries performed for gestational trophoblastic neoplasms in a teaching hospital in Tehran, Iran / 부인종양

OBJECTIVE: This study aim was to evaluate indications and outcomes of surgical interventions performed in patients with gestational trophoblastic neoplasm. METHODS: During January 1995 to December 2005, 110 patients with a diagnosis of persistent gestational trophoblastic neoplasm were treated in our Gynecologic Oncologic Department. Risk score calculation was carried out based on the revised FIGO 2000 scoring system for gestational trophoblastic neoplasm. Data from the patients' records and pathologic reports were analyzed by the chi-square and Fisher's exact tests and logistic regression. The Kaplan-Meier method including the log rank test was used to compare survival and recurrence. RESULTS: Eight patients did not complete their treatment and were excluded from the study. We evaluated treatment responses and outcomes in 102 patients. Seventy-nine patients (77.5%) responded fully to chemotherapy while 23 patients (22.5%) required surgery. Among 23 patients who underwent surgery, 10 cases (43.5%) had bleeding, and 13 cases (56.5%) had drug resistance. Several factors were found to be significantly different between the groups who responded to chemotherapy and those who needed surgery, including age (p=0.001), antecedent non-molar pregnancy (0.028), tumor stage (p=0.009), and pre-treatment risk scores (p=0.008). But, the total courses of chemotherapy (p=0.521), need to salvage chemotherapy (p=0.074), survival rates (p=0.714), and disease free survival rates (p=0.206) were not significantly different. CONCLUSION: The data suggest that age, antecedent non-molar pregnancy, tumor stage and the prognostic score are clinical predictors of need for surgery. But, it dose not seem that surgery have any effect on the total course of chemotherapy, need for salvage chemotherapy, and patient prognosis.

A favorable maternal and neonatal outcome following chemotherapy with etoposide, bleomycin, and cisplatin for management of grade 3 immature teratoma of the ovary / 부인종양

Ovarian cancer rarely complicates pregnancy. Usually these malignancies consist of germ cell tumors. Preserving maternal safety along with favorable neonatal outcome is a subject of debate in the management of ovarian cancer during pregnancy. In this report, the authors describe a 25-year-old primigravid woman who was diagnosed to with an ovarian immature teratoma which was diagnosed at 13th weeks of pregnancy during a routine sonography. She underwent oophorectomy at week 21 of her gestation. Then she received three cycles of BEP regimen (bleomycin, etoposide, and cisplatin) during her pregnancy until week 37 of gestation. At 36 weeks she delivered a male baby with mild glandular hypospadia who was otherwise normal. Management of immature teratoma after the first trimester of pregnancy is similar to non-pregnant patients and is safe for both the mother and the fetus.

Long term oral etoposide as second-line therapy in recurrent epithelial carcinoma of the ovary

The activity and toxicity of etoposide in women with recurrent ovarian cancer was evaluated in a case series of women with recurrent ovarian cancer who had measurable disease.All patients had prior platinum-based chemotherapy and developed progressive disease. Etoposide was given as 50mg/day for 21 days every 4 weeks until progression of disease or prohibitive toxicity. Between December 1999 and January 2004, 32 patients were enrolled in this study.30 patients received a total of 133 cycles of etoposide. Median age was 49 years [range, 19 to 75]. The median number of etoposide cycles was 4 [range, 1 to 12]. There were 5 partial responses [16.6%]. The mean response duration was 4.8 months [range, 3.5 to 6], median progression-free interval [PFI] was 7 months [range, 3 to 13], and median survival time was 12.5 months [range, 1.3 to 36].The major toxicity was leukopenia. One patient required red blood cell transfusions, and the main non-hematologic toxicity was nausea and vomiting. There were no treatment-related mortalities. Although etoposide appears to exhibit modest activity in recurrent ovarian cancer after platinum-based therapy, response and survival durations are short