Comparación histopatológica entre biopsia preoperatoria y debulking luego de la cirugía micrográfica de Mohs en carcinomas cutáneos / Histopathological comparison between preoperative biopsy and debulking after Mohs micrographic surgery in cutaneous carcinomas / Comparação histopatológica entre biópsia pré-operatória e citorredução após cirurgia micrográfica de Mohs em carcinomas cutâneos

Resumen: Introducción: el subtipo histopatológico es uno de los determinantes fundamentales en la clasificación de riesgo de los carcinomas cutáneos. Surge de una biopsia incisional que representa solo un porcentaje de la masa tumoral, siendo la principal preocupación la no detección de un subtipo agresivo. De ahí nace el interés de comparar la similitud entre ésta y la pieza de escisión quirúrgica (debulking) de la cirugía micrográfica de Mohs (CMM). Objetivos: comparar los resultados histopatológicos entre la biopsia incisional y el debulking en los carcinomas cutáneos tratados con CMM en el Servicio de Dermatología del Hospital de Clínicas en el período de noviembre de 2013 a marzo de 2019. Metodología: estudio retrospectivo descriptivo, se analizaron 202 pacientes con carcinomas de piel no melanoma (CPNM) sometidos a CMM en el servicio de Cirugía Dermatológica del Hospital de Clínicas "Dr. Manuel Quintela" entre noviembre de 2013 y marzo de 2019. Resultados: únicamente se consideran los casos donde en el debulking se halló tumor. Del total, la biopsia coincidió con el debulking en 61,39% de los casos. El debulking mostró un subtipo agresivo que no fue detectado en la biopsia en 8,41% de los casos. Conclusiones: el estudio histopatológico del debulking ha demostrado ser relevante, siendo la biopsia incisional parcialmente representativa para determinar el subtipo histopatológico de un CPNM, ya que aproximadamente 1 de cada 10 carcinomas podrían ser subdiagnosticados y tratados de manera insuficiente.

Abstract: Introduction: histological subtype is a vital element in determining the risk of skin cancer. It may be determined by an incisional biopsy which represents just a percentage of the tumor mass, the main concern lying in its potential failure to detect an agressive subtype. Therefore, comparing the results of biopsies with the surgically obtained piece with Mohs micrographic surgery is significantly relevant. Objective: to compare histopathologic evaluation results of incisional biospy and debulking in skin cancer treated with Mohs micrographic surgery at the Dermatology Service of the Clinicas University Hospital, between November, 2013 and March, 2019. Methodology: retrospective, descriptive study analysing 202 non-melanoma carcinomas which were treated with Mohs micrographic surgery the Dermatology Service of the "Dr. Manuel Quintela" Clinicas Hospital, between November, 2013 and March, 2019. Results: the study only considered the cases where bulking identified the tumor. Biopsy matched debulking in 61.39% of cases. Debulking detected an agressive subtype that was not detected in the biopsy in 8.41% of the cases. Conclusions: the hystopathological study of debulking has proved to be relevant, and the incisional biopsy was found to be partially representative in determining the histopathological subtype of non-melanoma carcinomas, since approximately 1 out of 10 carcinomas could be underdiagnosed and not appropriately treated.

Resumo: Introdução: o subtipo histopatológico é um dos determinantes fundamentais na classificação de risco dos carcinomas cutâneos. Identifica-se na biópsia incisional que representa apenas uma porcentagem da massa tumoral, sendo a principal preocupação a não detecção de um subtipo agressivo. Daí o interesse de comparar a semelhança entre esta e o material de excisão cirúrgica (citorreduçao - debulking) da Cirurgia Micrográfica de Mohs (CMM). Objetivos: comparar os resultados histopatológicos entre biópsia incisional e citorredução em carcinomas de pele tratados com CTM no serviço de Dermatologia do Hospital de Clínicas de novembro de 2013 a março de 2019. Metodologia: estudo descritivo retrospectivo onde foram analisados 202 carcinomas de pele não melanoma (NSCLC) submetidos a CCM no serviço de Cirurgia Dermatológica do Hospital de Clínicas "Dr. Manuel Quintela" entre novembro de 2013 e março de 2019. Resultados: foram considerados somente os casos em que um tumor foi encontrado em citorredução. Do total, a biópsia coincidiu com a cirurgia citorredutora em 61,39% dos casos. A citorredução mostrou um subtipo agressivo que não foi detectado na biópsia em 8,41% dos casos.

A Single-Center, Retrospective Study of Bevacizumab-Containing Neoadjuvant Chemotherapy followed by Interval Debulking Surgery for Ovarian Cancer

PURPOSE: We evaluated whether adding bevacizumab to current platinum-based chemotherapy could improve clinical outcomes without affecting safety.MATERIALS AND METHODS: We retrospectively reviewed medical records of patients with pathologically confirmed ovarian cancer who received neoadjuvant chemotherapy (NAC) at Yonsei Cancer Hospital. We divided the patients into groups based on the use of bevacizumab for NAC (CP group: carboplatin+paclitaxel vs. BCP group: bevacizumab+carboplatin+paclitaxel) and compared patient characteristics, responses to NAC, and surgical and survival outcomes between the two groups. Overall, 88 patients in the CP group and 16 patients in the BCP group received NAC. The primary endpoint was survival outcomes. Complete resection rate after interval debulking surgery (IDS), cancer antigen 125 (CA-125) normalization after NAC, and chemotherapy response score were secondary endpoints.RESULTS: After NAC treatment, all patients underwent IDS. There were no significant differences in adverse events during NAC or postoperative complications between the two groups (p=0.293 and p=0.485, respectively). There were also no significant differences in CA-125 normalization after NAC (42.0% vs. 43.8%, p=0.899) or complete resection rate after IDS (47.7% vs. 56.3%, p=0.530). However, although the BCP group did not show longer overall survival (OS) (log-rank p=0.854), they had significantly longer progression-free survival (PFS) than the CP group (log-rank p=0.048).CONCLUSION: Bevacizumab-containing NAC might be safe and provide longer PFS than chemotherapy alone in patients with advanced ovarian cancer. However, further study is necessary to investigate the impact of bevacizumab-containing NAC on OS.

Clinical and surgical outcomes of 3 cycles versus 6 cycles of neoadjuvant chemotherapy in advanced ovarian carcinoma

Background: Epithelial cancers are the most common ovarian malignancy accounting for 90% of all type of ovarian cancer. Objective of this study was to evaluate the surgical morbidity and to study clinical outcomes of 3 cycles versus 6 cycles of neoadjuvant chemotherapy.Methods: A total 30 women with diagnosis of advanced epithelial ovarian cancer were randomly divided equally to receive either 3 cycles (Group 1) or 6 cycles (Group 2) of neoadjuvant chemotherapy. End points noted were duration of surgery, extent of surgery, perioperative complications and length of stay.Results: Both groups had comparable demographic profile. Surgery was more difficult in early IDS group with lesser percentage of patients achieving minimum intended surgery in early IDS (61.53% versus 80. 47%) peri-operative complications were seen more commonly in early IDS group compared to late IDS group (26.66% versus 69.2%). However mean duration of surgery was similar in both groups. Mean duration of stay in hospital was 5.4 days in late IDS group and 7.6 days in early IDS group. The mean follow-up period in late IDS was 7 months and in early IDS was 5 months. Survival in both groups when patients were followed up till the end of study period (12 months) was similar (p=0.186).Conclusions: Authors conclude that late IDS may be used as a treatment option in the high-risk group of patients. Though there was no significant difference at 6 months follow up, higher percent of women were disease free in late IDS.

Negative peritoneal washing cytology during interval debulking surgery predicts overall survival after neoadjuvant chemotherapy for ovarian cancer / 부인종양

OBJECTIVE: Optimal debulking in interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) has been reported as a prognostic factor for patients with ovarian cancer. However, the identification of microscopic residual disease (MRD) using visualization and palpation is subjective. Peritoneal washing cytology (PWC) during IDS is an easy-to-implement, objective approach for assessing disease status, although its clinical relevance and association with MRD is not known. The aim of this study was to evaluate the efficacy of PWC during IDS. METHODS: In total, 164 patients diagnosed with ovarian cancer at our institution were retrospectively evaluated, including 64 who had received NAC. Seventeen patients had undergone an exploratory laparotomy followed by NAC, while the remaining patients were diagnosed based on imaging, peritoneal cytology, and tumor markers. The PWC was performed before intraperitoneal observation at laparotomy during IDS. RESULTS: NAC-treated patients had stage III–IV disease. IDS was performed in 78.1% of NAC-treated patients. Seventeen patients (26.6%) were PWC-negative and 33 patients (51.6%) were PWC-positive. Fourteen patients (21.9%) had progressive disease and were ineligible for IDS. The median overall survival of the PWC-negative, PWC-positive, and non-IDS groups was 47, 18, and 5 months, respectively. The differences were significant (p < 0.01). PWC was an independent prognostic factor in the multivariate Cox regression analysis (p < 0.001). CONCLUSION: PWC during IDS may be a prognostic factor for NAC-treated patients with ovarian cancer. PWC may be more useful than visualization and palpation in IDS for determining the presence of MRD.

Clinical treatment progress of pseudomyxoma peritonei syndrome / 肿瘤研究与临床

Pseudomyxoma peritonei syndrome (PMP) is characterized by a gradual expansion of mucoid tumour and fluid at specific sites within abdominopelvic regions as a result of a perforated appendiceal adenoma. The standard therapy for PMP is combining cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy. Maximal tumor debulking surgery (MTD) may be beneficial in patients in whom complete cytoreductive surgery (CCRS) cannot be achieved. It is now recognized that CCRS is one of the strongest predictors of long term survival in patients with PMP. The 5-year survival rate in patients who underwent CCRS was 80.0 %-87.4 %, however the rate in patients who underwent MTD was only 24.0 %-39.2 %.This article reviews the pathological classification,diagnosis and treatment of PMP.

External validation of chemotherapy response score system for histopathological assessment of tumor regression after neoadjuvant chemotherapy in tubo-ovarian high-grade serous carcinoma / 부인종양

OBJECTIVE: The chemotherapy response score (CRS) system based on histopathological examination has been recently proposed for tubo-ovarian high-grade serous carcinoma (HGSC) to assess response to neoadjuvant chemotherapy (NAC). This study was aimed at validating the CRS system in an external cohort of tubo-ovarian HGSC patients. METHODS: This study included 110 tubo-ovarian HGSC patients who underwent NAC followed by interval debulking surgery. The 3-tiered CRS of the omental and adnexal tissue sections was determined by 3 independent pathologists. Differences in patient outcomes according to CRS were analyzed. RESULTS: The CRS system was highly reproducible among the 3 pathologists. Fleiss' kappa value and Kendall's coefficient of concordance for the omental CRS were 0.656 and 0.669, respectively. The omental CRS significantly predicted progression-free survival (PFS). The median PFS of patients whose tumors exhibited the omental CRS 1–2 (15 months) was significantly shorter than that of patients with an omental CRS of 3 (19 months; p=0.016). In addition, after adjusting for age, stage, and debulking status, the omental CRS was an independent prognostic factor for PFS of tubo-ovarian HGSC patients who were treated with NAC (adjusted hazard ratio [HR]=1.74; 95% confidence interval [CI]=1.05–2.87). CONCLUSION: The CRS system for assessing NAC response was a reproducible prognostic tool in our cohort. The application of the CRS system after NAC can improve survival estimation in HGSC patients.

Impact of systematic retroperitoneal lymphadenectomy during primary debulking surgery on prognosis in patients with advanced ovarian cancer / 实用医学杂志

Objective To explore the impact of systematic retroperitoneal lymphadenectomy (SL) in patients with advanced ovarian cancer. Methods The data on 188 patients with FIGO stageⅢC epithelial ovarian cancer were retrospectively analyzed. All the patients underwent primary debulking surgery and then received platinum-based chemotherapy. The patients were divided into SL group and non-systematic lymphadenectomy (USL) group. Progression free survival (PFS) and overall survival (OS) times were analyzed. Results PFS and OS were higher in SL group than in USL group (36 versus 17 months and P = 0.022; 58 versus 52 months and P = 0.041). Univariate analysis showed that both SL and optimal debulking surgery were the independent prognostic factors , but multivariate analysis indicated that optimal debulking surgery was the only independent prognostic factor. However , for 143 patients without enlarged retroperitoneal lymph nodes , multivariate analysis showed that either SL or optimal debulking surgery were the independent prognostic factor (P = 0.040 and P = 0.014). Conclusions Optimal debulking surgery is helpful in improvement of the survival in patients with advanced ovarian cancer. For patients without enlarged retroperitoneal lymph nodes, SL still has a positive effect on the prognosis.

A Case of Sphenoidal Sinus Carcinoma Associated with Partial Oculomotor and Abducens Nerve Palsy

PURPOSE: To report a rare case of a patient with diplopia due to a mass in the sphenoidal sinus, histologically diagnosed as carcinoma. CASE SUMMARY: A 57-year-old male visited our clinic complaining of diplopia and ptosis for 10 days. He had esotropia 45 prism diopters in the primary position, markedly limited abduction, and a 4 mm dilated pupil in the right eye compared with a 2 mm pupil in the left eye. Enhanced magnetic resonance imaging revealed a sphenoidal sinus mass extended into the pituitary gland and sella turcica with homogeneous intense enhancement. Metastatic workups, including CT of the head, neck, chest, and abdomen were unremarkable. He underwent a transsphenoidal approach mass debulking surgery followed by radiotherapy for 6 weeks. Histological findings were compatible with carcinoma. Six weeks after radiotherapy he had esotropia of 20 prism diopters in the primary position. Abduction limitation was partially recovered postoperatively. CONCLUSIONS: Diplopia may develop as a result of multiple cranial nerve palsy due to carcinoma in the sphenoidal sinus and may be improved by debulking surgery and radiation treatment.

Recurrent ovarian steroid cell tumor, not otherwise specified managed with debulking surgery, radiofrequency ablation, and adjuvant chemotherapy

Steroid cell tumors, not otherwise specified, are infrequently encountered ovarian neoplasms, which constitute <0.1% of all ovarian tumors. Most of these tumors are unilateral, and almost one-third of all cases are reportedly malignant. However, because most of these tumors are diagnosed in the early stage, and do not recur or metastasize, little is known about their response to therapies such as chemotherapy or radiation. Here, we present a rare case of recurrent steroid cell tumor, not otherwise specified that showed a complete response after debulking surgery, radiofrequency ablation, and adjuvant chemotherapy.

Current status of application of the secondary cytoreductive surgery for patients with epithelial ovarian carcinomas / 대한산부인과학회지

Recurrent ovarian cancer has been considered as a difficult disease to treat despite the rapid development of various chemotherapeutic agents and surgical techniques for several decades. Many investigators tried to establish the optimal triage for treat recurrent or persistent disease applying not only salvage regimen but also debulking surgery. We reviewed many literature concerning the surgical approaches for patients with primary treatment failure to outline the treatment scheme. Most of authors agrees that optimal or even maximal cytoreduction enables survival benefit of patients with refractory disease while the biologic characteristics of tumor may not affect the prognosis.