Borderline ovarian tumour of mixed seromucinous histology and bilateral presentation: a case report and review of literature

This article reports the case of a 40 year old woman who presented to the gynaecologic outpatient clinic with pain lower abdomen and an abdominopelvic lump. Clinical assessment, biochemical and radiological investigations revealed bilateral complex ovarian masses. Surgical exploration and histology of ovarian masses confirmed a rare bilateral borderline seromucinous cystadenoma. The purpose of this paper is to highlight the importance of thorough examination of women with symptoms of ovarian tumour which can be vague and to emphasize the necessity of a good collaboration between various medical specialties (primary physician/gynaecologist, oncosurgeon, radiologist and histopathologist) for correct diagnosis, optimum care and best outcome. This article also provides overview of the pathology and biology of borderline ovarian tumours, diagnosis, principles of surgical management and to appreciate the value of follow up.

Surgical Staging and Recurrence Management of Ovarian Granulosa Cell Tumor.

Introduction: Ovarian Granulosa Cell Tumors (GCT) is a potentially malignant tumor. Accurate diagnosis requires histological and immunohistochemical study. The treatment of choice is surgical staging and debulking staging according to International Federation of Gynecology and Obstetrics (FIGO) criteria, preferred by laparoscopy. The therapeutic role of adjuvant therapy is unclear. Relapses arefrequent, usually late and insidious. Case Report: we report two cases of Ovarian Granulosa Cell Tumor. First case, a laparoscopic oophorectomy for complex adnexal cyst, intraoperative study does not differentiate between Granulosa Cell Tumor or clear cell carcinoma of the ovary, so we performed a complete staging surgery by laparoscopy. Second case aparaortic recurrence twenty years after first surgery. Non-steroidal anti-androgen therapy was useful to control progression of the disease, finally laparoscopic excision of the lesion. Conclusion: A complete surgery in the management of Granulosa Cell Tumor is recommended. Relapses can occur very late and response to chemotherapy is poor, so it is important to perform a careful initial staging or debulkingprocedure because intraoperative pathological diagnosis is difficult and confusing.

Magnetic resonance imaging in pre‑operative staging of endometrial cancer.

INTRODUCTION: Endometrial cancer (EC) is one of the most common gynecological cancers and the fourth most common cancer in the female. Although clinical evaluation with diagnostic imaging has not yet proved to be accurate enough in the evaluation of tumor extent to replace surgical staging, it may enable optimization of the surgical procedure and a better tailored therapeutic strategy. This study will review the characteristic magnetic resonance imaging (MRI) findings in endometrial carcinomas in the pre‑operative staging of endometrial carcinomas and compare it with the newly revised Federation of Gynecology and Obstetrics (FIGO) staging scheme of 2009 based on post‑operative surgical histopathology. MATERIALS AND METHODS: It is a retrospective analysis of 36 patients diagnosed and treated for endometrial carcinoma in our institute from January 2009 to December 2012. RESULTS: Majority of the patients (61%) were between the age group of 41‑60 years. Most of the patients (72%) were postmenopausal at the time of presentation. Most common histopathology of endometrial carcinoma was endometroid adenocarcinoma (27 patients, 75%). FIGO staging of 12 patients (85.7%) showed concordance with MRI Staging for Stage Ia, with up‑gradation of two patients to Stage Ib. CONCLUSION: The information provided by MRI can define prognosis, help planning the surgical approach and identify those patients requiring neoadjuvant chemotherapy or radiation therapy.

Histopathological and Immunohistochemistry Observations Based Bukhari Grading for Squamous cell carcinoma.

Background: Increasing incidence of Squamous Cell Carcinoma (SCC) has emphasized the challenges of managing this condition. Traditional microscopic information often fails, especially when based on H & E methods. Immunohistochemistry (IHC) and molecular studies in combination with traditional histopathology may fill this gulf. Aims: The study was conducted to introduce new a grading system based on both histopathological and biological correlation of SCC. Settings and Design: A descriptive study included 180 cases of SCC of the skin (all regions of skin and oral mucosa). Cellular proliferation index (Ki‑67 and p53 expression) was studied in SCC by immunohistochemistry (IHC). This study was carried out in the Department of Pathology from January 2006 to December 2008. Methods and Material: The clinicopathological information regarding age, sex, primary tumor site, tumor size, local recurrence, distance metastasis and follow‑up status was collected for each case. Patient outcome was verified and updated through the medical records. Five micron thick (5μm) sections were cut from archival formalin fixed, paraffin embedded specimens. The first section was stained with haematoxylin and eosin (H&E) for histopathological analysis. Other sections were stained immunohistochemically with p53 and Ki‑67 and then independently scored for the expression of p53 proteins and Ki‑67 index. Results: SCC was designated low, intermediate, and high tirade grades based on the sum of point values assigned to each 4 scores of histological differentiation, staging, expression of p53 protein and Ki‑67 index. Expression of P53 was found to be related to the Ki‑67 and the scores of histology and stages of SCC. A significant correlation was found among the newly assigned grades, stages (Spearman correlation = 0.721, P value = 0.000). The grades were also significantly correlated with other prognostic factors like local invasion, lymph node and distance metastasis (Kendall’s Tau‑b = 0.394;p‑value = 0.00). Tumor recurrence was also significantly based on grades of SCC (Kendall’s Tau–b = 0.966, P value = 0.025). Conclusion: It was concluded that a new grading system is an important prognostic indicator of squamous cell carcinoma. This practical approach has potential to improve clinical evaluation of SCC in understanding the pathological as well as clinical behavior of SCC.

Cáncer de endometrio: experiencia de 10 años en el hospital San Juan de Dios / Endometrial cancer: 10 years experience in the San Juan de Dios hospital

Antecedentes: El cáncer de endometrio es uno de los cánceres ginecológicos más frecuentes. La incidencia de esta enfermedad pudiera ir en aumento dado los cambios epidemiológicos de la población femenina. Objetivo: Evaluar resultados clínicos y características de la población atendida por cáncer de endometrio. Método: Se analizaron las historia clínicas de 100 pacientes tratadas por cáncer de endometrio entre enero de 2000 y diciembre de 2009. En el análisis de los datos se consideró como base la etapificación FIGO 1988. Resultados: La edad promedio fue de 62 años, el 75 por ciento de las pacientes consultaron por hemorragia post menopáusica y en el 64 por ciento de las pacientes el diagnóstico se realizó por dilatación y curetaje. En el 60 por ciento se realizó etapificación completa. El 60 por ciento correspondió a etapa I y el 15 por ciento a etapa II. La sobrevida global en etapa I y II fue del 83 por ciento y 66 por ciento, respectivamente. Conclusión: El cáncer de endometrio se presenta preferentemente en pacientes post menopáusicas en etapas precoces. La mayoría accede a tratamiento quirúrgico con escasas complicaciones y alta sobrevida global.

Background: Endometrial cancer is one of the most frecuent gynecological cancer. The incidence of this disease could arise because of epidemiologycal changes in female population. Aims: To evaluate characteristics and clinical results of atended population with endometrial cancer. Method: Clinical histories of 100 patients treated for endometrial cancer between January 2000 to December 2009 were analized. In the data analysis, the FIGO 1988 staging was considered as base. Results: The age average was 62 years. The 75 percent of patients consulted for postmenopausal hemorrhage in the 64 percent of the patients the diagnosis was made by dilation and curettage. Full staging was made in the 60 percent. Stage I was 60 percent and 15 percent for stage II. Overall survival in stage I and II was 83 percent and 66 percent, respectively. Conclusion: Endometrial cancer presents preferably in early stages in postmenopausal patients. The mayority access to surgical treatment with few complications and a high survival rate.

Concordancia entre histología pre, intra y postoperatoria en cáncer de endometrio / Concordance between pre and intraoperatory biopsy in endometrial cancer

Antecedentes: En pacientes con cáncer de endometrio se discute la concordancia entre biopsia pre e intraoperatoria versus la definitiva, en grado de diferenciación, tipo histológico y profundidad de mioinvasión. Método: Se determinó sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de: grado de diferenciación bien diferenciado y tipo histológico sólo endometrioide en biopsia preoperatoria; y grado de diferenciación bien diferenciado, tipo histológico sólo endometrioide y profundidad de mioinvasión menor o igual a la mitad interna del miometrio, en biopsia intraoperatoria, para resultados similares en biopsia definitiva en serie clínica de pacientes con cáncer de endometrio clínicamente limitado al útero sometidas a tratamiento quirúrgico primario. Resultados: Biopsia preoperatoria: grado de diferenciación bien diferenciado S: 100 por ciento, E: 77,8 por ciento, VPP: 78,9 por ciento y VPN: 100 por ciento. Tipo histológico sólo endometrioide S: 86,4 por ciento, E: 33,3 por ciento, VPP: 86,4 por ciento y VPN: 33,3 por ciento, para resultado similar en biopsia definitiva. Biopsia intrao-peratoria: grado de diferenciación bien diferenciado S: 91,7 por ciento, E: 94,4 por ciento, VPP: 91,7 por ciento y VPN: 100 por ciento. Tipo histológico sólo endometrioide S: 95,7 por ciento, E: 77,8 por ciento, VPP: 95,7 por ciento y VPN: 70 por ciento. Profundidad de mioinvasión menor o igual a mitad interna del miometrio S: 95,2 por ciento, E: 30 por ciento, VPP: 74,1 por ciento y VPN: 75 por ciento, para resultado similar en la biopsia definitiva. Conclusión: No hubo concordancia absoluta de grado de diferenciación bien diferenciado entre biopsia preoperatoria y biopsia definitiva, ni de grado de diferenciación bien diferenciado ni tipo histológico sólo endometrioide entre biopsia intraoperatoria y biopsia definitiva, por lo que se recomienda etapificación quirúgica independiente de los resultados de las biopsias pre e...

Background: Among patients with endometrial cancer there is discussion about concordance between pre and intraoperatory biopsy and the definitive one, for diferentiation grade, histologyc type and depth of myoinvasion. Method: To determinate sensibility (S), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of: good diferenciated diferentiation grade and only endometrioid histologyc type on preoperatory biopsy, and good diferenciated diferentiation grade, only endometrioid histologyc type and inner half of the miometryum or less myoinvasion depth on intraoperatory biopsy, for similar result on definitive biopsy in a clinical cohort of patients with endometrial cancer clinically limited to uterus treated with primary surgery. Results: Preoperatory biopsy: good diferentiated diferentiation grade S: 100 percent, Sp: 77.8 percent, PPV: 78.9 percent and NPV: 100 percent. Only endometrioid histologyc type S: 86.4 percent, Sp: 33.3 percent, PPV 86.4 percent and NPV 33.3 percent, for similar result on definitive biopsy. Intraoperatory biopsy: Good diferentiated diferentiation grade S: 91.7 percent, Sp: 94.4 percent, PPV: 91.7 percent and NPV 100 percent. Only endometrioid histologyc type S: 95.7 percent, Sp 77.8 percent, PPV 95.7 percent and NPV 70 percent. Inner half of the myometrium or less myoinvasion depth S: 95.2 percent, Sp 30 percent, PPV 74.1 percent and NPV 75 percent, for similar result on definitive biopsy. Conclusion: There wasn't absolute concordance of good diferentiated diferentiation grade between preoperatory and definitive biopsy. Also there weren't absolute concordance of neither good diferentiated diferentiation grade, nor only endometrioid histologyc type, between intraoperatory and definitive biopsy, for that it is recommended surgical staging, independent of results of pre and intraoperatory biopsies.

Comparison of laparoscopic versus conventional open surgical staging procedure for endometrial cancer / 부인종양

OBJECTIVE: The aim of this study was to compare the surgical outcomes of laparoscopic surgery and conventional laparotomy for endometrial cancer. METHODS: A total of 104 consecutive patients were non-randomly assigned to either laparoscopic surgery or laparotomy. All patients underwent comprehensive surgical staging procedures including total hysterectomy, bilateral salpingo-oophorectomy, and pelvic/para-aortic lymphadenectomy. The safety, morbidity, and survival rates of the two groups were compared, and the data was retrospectively analyzed. RESULTS: Thirty-four patients received laparoscopic surgery and 70 underwent laparotomy. Operation time for the laparoscopic procedure was 227.0+/-28.8 minutes, which showed significant difference from the 208.1+/-46.4 minutes (p=0.032) of the laparotomy group. The estimated blood loss of patients undergoing laparoscopic surgery was 230.3+/-92.4 mL. This was significantly less than that of the laparotomy group (301.9+/-156.3 mL, p=0.015). The laparoscopic group had an average of 20.8 pelvic and 9.1 para-aortic nodes retrieved, as compared to 17.2 pelvic and 8.5 para-aortic nodes retrieved in the laparotomy group. There was no significant difference (p=0.062, p=0.554). The mean hospitalization duration was significantly greater in the laparotomy group than the laparoscopic group (23.3 and 16.4 days, p<0.001). The incidence of postoperative complications was 15.7% and 11.8% in the laparotomy and laparoscopic groups respectively. No statistically significant difference was found between the two groups in the survival rate. CONCLUSION: Laparoscopic surgical staging operation is a safe and effective therapeutic procedure for management of endometrial cancer with an acceptable morbidity compared to the laparotomic approach, and is characterized by far less blood loss and shorter postoperative hospitalization.

Survival benefit of laparoscopic surgical staging-guided radiation therapy in locally advanced cervical cancer / 부인종양

OBJECTIVE: This study was designed to evaluate the survival benefit of laparoscopic surgical staging (LSS)-guided tailored radiation therapy (RT) in locally advanced cervical cancer (LACC). METHODS: We retrospectively reviewed 89 LACC patients' medical records who primarily received non-surgical treatment, of which pretreatment LSS was performed in 20 (LSS group) and primary chemoradiation therapy (CCRT) without LSS (CCRT group) was carried out in 69 from January 2000 to January 2006. We analyzed clinical characteristics, pretreatment imaging study results and survival outcomes including disease free survival (DFS) and overall survival (OS) to compare them between the two groups. RESULTS: There were as many as eight cases (40%) of LSS related complications. The mean time interval between LSS and RT or CCRT was 26.6 days (+/-18.8 days). Six out of twenty (30%) in LSS group and 10 out of 69 (14.5%) in CCRT group received extended field RT when paraaortic lymph nodes (LNs) were positive based on the pathologic findings after LSS and the results of imaging studies, respectively. Three-year DFS and OS were both better in 33 imaging-negative CCRT group patients than those in 4 imaging-negative/pathology-positive (false negative) patients after LSS (3-year DFS, 50% vs. 87%, p=0.022; 3-year OS, 50% vs. 84%, p=0.033). The 5-year DFS rates were 52% and 55% in LSS group and in CCRT group, respectively (p=0.28). The 5-year OS rates were 68% in LSS group and 62% in CCRT group without significant difference between the two groups (p=0.79). CONCLUSION: We found that LSS-based RT tailoring did not show survival benefit in LACC despite inaccuracy of imaging-based RT tailoring. Further studies are required to find new method to overcome this inaccuracy and improve survival outcomes.

Comparison of surgical approach to staging operation for endometrial cancer including pelvic and paraaortic lymphadenectomy / 대한산부인과학회지

OBJECTIVE: To compare laparoscopic surgery with laparotomy in comprehensive surgical staging of endometrial cancer. METHODS: We retrospectively analyzed the medical records of 272 patients with endometrial adenocarcinoma treated by staging operation including pelvic and paraaortic lymphadenectomy between January, 1996 and December, 2007. RESULTS: There was no significant difference between the two groups in terms of age, body mass index, or histologic type, but in the laparotomy group, grade and surgical stage were significantly higher. All the patients, 182 in the laparotomy and 90 in the laparoscopy group, had lymphadenectomy, and the mean number of pelvic and paraaortic lymph nodes (LNs) obtained were 33.1+/-13.2 and 16.1+/-11.6 in the laparoscopy group, and 32.5+/-14.5 and 19.0+/-12.7 in the laparotomy group, respectively; these differences were not statistically significant. In the laparoscopy group, the operating time and postoperative hospital length of stay were shorter than in the laparotomy group, as were the pre- and post-operative hemoglobin changes. There were no significant differences between the two groups in terms of intra- or post-operative complications, but positive lymph nodal metastasis and conducting of postoperative adjuvant therapy were highter in the laparotomy group. The operative technique did not influence overall or disease-free survival after adjusting for several confounding factors. CONCLUSION: Laparoscopic-assisted surgical staging for endometrial cancer required a shorter operating time, shorter postoperative hospital stay, and lower blood loss compared to traditional laparotomy staging, and can be a good therapeutic option for staging operation including lymphadenectomy of endometrial cancer.

Experiences of pretreatment laparoscopic surgical staging in patients with locally advanced cervical cancer: results of a prospective study / 부인종양

OBJECTIVE: To prospectively evaluate the feasibility, safety, and survival of laparoscopic surgical staging in patients with locally advanced cervical cancer. METHODS: From Oct 2001 to Jul 2006, a total of 83 consecutive patients were eligible for inclusion and underwent laparoscopic surgical staging. RESULTS: Three patients with intraoperative great vessel injury and 1 patient in whom the colpotomizer was unable to be inserted were excluded. Laparoscopic surgical staging was feasible in 95.2% (79/83). Immediate postoperative complications were noted in 12 (15.2%) patients. Prolonged complications directly related to operative procedures numbered 2 (2.5%), and were trocar site metastases. The mean time from surgery to the start of radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) was 11 (5-35) days. All patients tolerated the treatment well and completed scheduled RT or CCRT without disruption of treatment and additional admission. The rate of modification of the radiation field after surgical staging was 8.9% (7/79). Five-year progression-free survival and overall survival (OS) rates were 79% and 89%, respectively. The OS of patients with microscopic lymph node metastases, which were fully resected, were comparable to those of patients without lymph node metastasis. However, the OS of patients with macroscopic lymph node metastases that were fully resected were poorer compared with those of patients without lymph node metastasis. CONCLUSION: Pretreatment laparoscopic surgical staging is a feasible and safe treatment modality. However the survival benefit of debulking lymph nodes or full lymph node dissection is not clear.

A case of successful laparoscopic surgical staging in patient of Sertoli-Leydig cell tumor / 대한산부인과학회지

Sertoli-Leydig cell tumors are rare sex cord-stromal tumors. These tumors account for less than 0.5% of all ovarian tumors. Because these tumors appear predominantly in young women (between the age of 30 and 40) and are bilateral in less than 1% of cases, conservative removal of the tumor and adjacent fallopian tube is justifiable. Recently, we experienced a case of successful laparoscopic surgical staging in patient of Sertoli-Leydig cell tumor which was previously incompletely evaluated in local OBGY clinic. There are no solid data to suggest that usefulness and risk of laparoscopic surgical staging and adjuvant therapy with stage I disease of these tumors until now. So we present it with a brief review of literature.

A clinical study of borderline malignant tumors of the ovary / 부인종양

OBJECTIVE: The purpose of this study was to evaluate the clinical and histopathological features, and to find relationship between treatment modality and prognosis of borderline ovarian tumors. METHODS: Ninety-three cases of borderline ovarian tumors that had been treated were reviewed retrospectively. RESULTS: Histologic types of this study group composed of 67 cases of mucinous borderline tumor, 23 cases of serous borderline tumor, 2 cases of mixed type, and 1 case of Brenner tumor. The mean age was 41.6 years (range 14 to 83), and 41 (44.1%) patients were nullipara. The most common chief complaint was palpable mass (39.8%) and asymptomatic cases were presented in 23 patients (24.7%). The cases of elevated serum CA125 (< or =35 IU/ml) were 25.8% in mucinous type and 61.9% in serous type. Surgical staging was completed in 57 cases and other 36 cases were incompletely staged. 45 cases were managed by conservative surgery. There were 4 cases with recurrence, and all of them were related to conservative surgery. Chemotherapy was given to 40 cases. Mean follow-up period was 27.3 months. One patient expired during follow-up, and overall 5-year survival rate was 95.2%. CONCLUSION: Borderline ovarian tumors have a good prognosis. But recurrence rate was high in conservative surgery. In conclusion, careful preoperative evaluations, complete surgical exploration and long-term follow-up after treatment are needed.

Clinical significance of surgical staging and lymphadenectomy in patients with borderline ovarian tumors / 부인종양

OBJECTIVE: To compare the outcome of patients with borderline ovarian tumors who had been surgically staged with those who were not staged. METHODS: Between 1997 and 2004, there were 204 patients who underwent surgery and were diagnosed as borderline ovarian tumors. A retrospective review was performed. Two groups were identified: patients who underwent surgical staging (n=98) versus those who were not staged (n=106). Clinical outcomes were compared between the two groups. RESULTS: Between the two groups, there were no differences of the mean age of the time of diagnosis, parity, BMI, family history, pretreatment CA 125 level, tumor size, and disease recurrence, but were significant differences of FIGO stage (p=0.04), histologic types (p<0.01), operation time (p<0.01), length of hospital stay (p<0.01), and adjuvant chemotherapy (p<0.01). The lymph node positivity rate were 3.5% and 7.1% in patients with pelvic and para-aortic lymphadenectomy respectively. All patients with postive lymph nodes showed the micropapillary serous carcinoma. The 5 year disease-free survival rate was 90%. The overall disease-free survival was significantly found to be decreased in patients with advanced FIGO stage (p<0.01). There was no significant difference of overall disease-free survival regard to pretreatment CA 125 level (p=0.72), histologic types (p=0.78), adjuvant chemotherapy (p=0.45), and surgical staging with lymphadenectomy (p=0.79). CONCLUSION: Disease-free survival was not significantly different between staged and unstaged patients who had surgery with borderline ovarian tumors. It seems that routine pelvic and para-aortic lymphadenectomy is not necessary in the majority of women with borderline ovarian tumors.

Ultrasonographic Evaluation of Osteosarcomas / 华中科技大学学报（医学）（英德文版）

The ultrasonographic appearances of osteosarcomas and the roles of ultrasonography in the diagnosis and surgical staging of osteosarcomas were investigated. A comparative study was performed on 45 cases of osteosarcomas by ultrasonography and radiography. Bony changes, periosteal reaction and soft tissue mass were evaluated for each lesion. The results showed that ultrasonography revealed a solid mass around bone in 42 patients, bone destruction in 24 patients and periosteal reaction in 16 patients. Plain radiographs showed bony changes in 44 patients and no bony change in remaining one patient, shadowing of soft tissue swelling in 30 patients, and pulmonary metastases in 3patients. Surgical biopsy and pathological examination confirmed osteosarcoma in all 45 patients.Soft tissue mass was confirmed in 42 patients surgically. The diagnostic accuracy of soft tissue masses by ultrasonography and radiography was 100 % (42/42) and 71.4 % (30/42), respectively. The positive rate of ultrasonography and radiography in displaying bony changes was 53.3 % (24/45) and 97.8 % (44/45), respectively. In conclusion, in the detection of soft tissue mass of osteosarcoma, ultrasonography is superior to radiography, and in displaying bony changes of osteosarcomas, radiography is superior to ultrasonography. So it may come to a conclusion that plain radiography combined with ultrasonography can completely display the bony and soft tissue lesion of osteosarcomas.

The role of lymphadenectomy in surgical staging of endometrial cancer / 부인종양

A review of the role of lymph nodes dissection for patients with endometrial cancer was performed. The prognostic value of node status for endometrial cancer patients has been recognized, and lymph nodes dissection performed by experienced surgeons has acceptable morbidity. Multiple series have suggested that significantly less external beam radiation is given to patients with known negative nodes. In 1988 FIGO established the surgical staging system for endometrial cancer, ever since the decreased use of postoperative whole pelvic radiation has potential cost savings. However a survival advantage for lymph nodes dissection has not yet been proven in a randomized clinical trial. The interim result of ASTEC study showed that there is no survival advantage for endometrial cancer patients who undergo lymph nodes dissection. Although the morbidity, potential cost savings,and prognostic impact of node status are well accepted, it remains controversial as to whether lymph nodes dissection provides a survival advantage.

Usefulness of preoperative CA 125 level in decision making of lymphadenectomy in endometrial cancer patients / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate whether the preoperative serum level of CA 125 in patients with endometrial cancer could provide an additional information on determining the extent of surgical staging and which cutoff value might be optimal in this respect. METHODS: CA 125 levels were measured in 42 patients with endometrial carcinoma who underwent surgery at our institution between March 2000 and December 2004. Operative and postoperative pathologic findings were then correlated with preoperative CA 125 values. Statistical analysis was performed using Mann-Whitney U test, Kruskal-Wallis test, chi-square test and logistic regression model to evaluate the association of preoperative CA 125 levels with various factors. Receiver operating characteristic (ROC) curve was used to determine which cutoff value of the preoperative CA 125 was optimal. RESULTS: Univariate analyses showed that elevated CA 125 levels were significantly correlated with an advanced stage, larger tumor size, increasing depth of the myometrial invasion, extrauterine disease, and lymph node metastasis (P30 U/mL whereas lymph node metastasis can be predicted at the CA 125 level of >50 U/mL.

Importancia de aa linfadenectomia pelvica y lumoaortica en la etapificacion quuirurgica del cancer de endometrio

Se reportan 40 pacientes con cáncer de endometrio sin evidencia clínica de diseminación extrauterina, tratadas en la Unidad de Oncología Ginecológica del Hospital de Carabineros entre enero de 1992 y enero de 2001, que fueron sometidas a etapificación quirúrgica como tratamiento primario. En 16 pacientes (40%) se efectuó linfadenectomía pélvica y lumboaórtica más histerectomía total, anexectomía bilateral, omentectomía y citología peritoneal. Este grupo se catalogó como con etapificación quirúrgica completa (EQC). En 24 pacientes (60%) sólo se efectuó disección parcial de los ganglios retroperitoneales, o no se efectuó, catalogándose este grupo como con etapificación quirúrgica incompleta (EQI). Recibieron radioterapia postoperatoria en el grupo con EQC 3 pacientes (18,75%) y en el grupo con EQI 13 pacientes (54,17%) (p < 0,05). El grupo total tuvo una sobrevida global de 75% y una sobrevida libre de enfermedad de 72,5%, con una mediana de seguimiento de 38,5 meses. La sobrevida global fue 87,5% y 66,7% para el grupo con EQC y EQI respectivamente (p NS). La sobrevida sin evidencia de enfermedad fue 87,5% y EQI 62,5% para el grupo con EQC y EQI respectivamente (p < 0,05). La sobrevida sin evidencia de enfermedad fue 77,8% y 30% para los subgrupos con factores quirúrgico-patológicos de alto riesgo sometidos a EQC y EQI respectivamente (p < 0,05). La sobrevida sin evidencia de enfermedad fue 60% y 0 para los subgrupos con enfermedad extrauterina sometidos a EQC y EQI respectivamente (p < 0,025). La sobrevida sin evidencia de enfermedad fue 33% y 0 para los subgrupos con metástasis linfonodales sometidos a EQC y EQI respectivamente (p < 0,025). Conclusión: La linfadenectomía pelviana y lumboaórtica como componente esencial de la etapificación quirúrgica primaria en cáncer de endometrio, sería beneficiosa para la paciente al asociarse con menor necesidad de radioterapia postoperatoria y mejor sobrevida.

We report 40 patients with endometrial cancer without clinical evidence of extrauterine disemination, treated in the Gynecologic Oncology Unit of the Carabineros Hospital between January 1992 and january 2001, managed with surgical staging as primary treatment. In 16 patients (40%) it consisted of pelvic and lumboaortic lymphadenectomy with total hysterectomy, bilateral adnexectomy, omentectomy and peritoneal citology. This group was classified as complete surgical staging (CSS). In 24 patients (60%) retroperitoneal lymphonodes disection was only partial, or not at all being classified as incomplete surgical staging (ISS). In the CSS group 3 patients received postoperatory radiotherapy (18.75%) and in the ISS group 13 patients did (54.17%) (p < 0.05). The global survival of the total group was 75% and the free of disease survival was 72.5%, with a median follow up of 38.5 months. The global survival was 87.5% and 66.7% for the CSS and ISS groups respectively (p NS). The free of disease survival was 87.5% and 62.5% for the CSS and ISS groups respectively (p < 0.05). The free of disease survival was 77.8% and 30% for the subgroups with high risk surgical-pathological factors with. CSS and ISS respectively (p < 0.05). The free of disease survival was 60% and 0 for the subgroups with extrauterine disease with CSS and ISS respectively (p < 0.025). The free of disease survival was 33% and 0 for the subgroups with lymphonodal metastases with CSS and ISS respectively (p < 0.025). Conclusion: The pelvic and lumboaortic lymphadenectomy as esential component of primary surgical staging of endometrial cancer, could be beneficious for the patient through its association with less need of postoperatory radiotherapy and better.

Laparoscopically assisted surgical staging in endometrial cancer / 대한산부인과학회잡지

This paper reports our experiences in laparoscopically assisted surgical staging (LASS) to manage the patients with early-stage endometrial cancer. From March 1996 to March 1999, we performed LASS in 6 patients with clincal stage I adenocarcinoma of the endometrium. We performed laparoscopic-assisted vaginal hysterectomy (LAVH) with bilateral salpingo-oophorectomy (BSO) and intraoperative frozen-section (IFS) diagnosis. The depth of myometrial invasion, tumor differentiation, histologic types, cervical invasion, and adnexal involvement were determined by IFS diagnosis. Laparoscopic pelvic and/or para-aortic lymphadenectomies were performed based on the grade of the tumor and depth of myometrial invasion. One patient was discovered to have tumor metastases in pelvic peritoneum and uterosacral ligaments, and underwent only para-aortic lymphadenectomy for determining field of radiation therapy. 2 out of 5 patients only underwent LAVH with BSO and peroitoneal washing cytology. Three other patients underwent LAVH with BSO, peritoneal washing cytology and pelvic lymphadenectomy because they were identified by IFS diagnosis as intermediate risk group for nodal metastasis. The mean age of the patients was 46.4 years. Total length of the operation time ranged from 100 minutes to 305 minutes and the mean was 187.5 minutes. The mean hemoglobin decrement after the surgery was 0.9 gm/dl. No one recieved blood transfusion. The average number of pelvic and para-aortic lymph nodes removed were 16.7 and 18, respectively. After the surgery, the patients passed gas after an average of 2.0 days and urinated urine after an average of 3.8 days. No one had complication after LASS. Based on our experiences, LASS might be an alternative to the traditional surgical approach in patients with early-stage endometrial carcinoma.

Clinical Profile and Prognostic Factor of Endometrial Cancer / 대한부인종양콜포스코피학회잡지

OBJECTIVE: The importance of surgico-pathologic staging in endometrial cancer to identify risk factors of the therapeutic and prognostic value has been recognized only recently. Recognition of subsets of patients should minimize treatment related morbidity and mortality for those patients with a good prognosis, while identifying patients who are at high risk for recurrence and therefore likely to benefit from adjuvant therapy. METHODS: This rettospective study was based on clinical review of 76 patients with endometrial cancer from 1983 through 1994 who underwent surgical treatment in Department of Obstettics and Gynecology at Seoul National University Hospital. All cases were restaged using the newly adopted FIGO surgical staging. Univariate and multivariate analysis were carried to compare the importance of prognostic variables. RESULTS: Significant prognostic factors in endometrial cancer were histologic subtype, depth of myometrial invasion, cervical invasion, parametrial invasion, adnexa metastasis, lymph node metastasis and peritoneal cytology(p0.05). Multivariate analysis showed that surgical stage and depth of myometrial invasion were important factors that predict recurrence(p<0.05). CONCLUSION: This study has yielded important information for therapeutic approach to endometrial cancer.