A GCIG international survey: clinical practice patterns of sentinel lymph node biopsies in cervical cancer.

PURPOSE: To evaluate the practice patterns among centers and physicians worldwide regarding sentinel lymph node biopsies (SLNB) in cervical cancer (CC) patients. METHOD: A validated 35-item questionnaire regarding SLNB in CC supported by the Gynecologic Cancer Intergroup (GCIG), and sponsored by the North-Eastern German Society of Gynaecologic-Oncology (NOGGO) was sent to all major gynecological cancer societies across the globe for further distribution from October 2015 and continued for a period of 7 months. RESULTS: One hundred and sixty-one institutions from around the world participated. One hundred and six (66%) of the participants were from university centers and 111 (69%) were gynecologic oncologists. One hundred and fifty-two (97%) performed lymphadenectomy (LNE) and 147 (94%) did so systematically; 97 (60%) used SLNB, due to lower morbidity (73%), reliability (55%) and time-saving (27%). In cases of positive SLNB (pN+), 39% of respondents stopped the operation and sent the patient for chemoradiation (CRT), 45% completed pelvic and paraaortic LNE, whereas 26% went on to perform a radical hysterectomy (RH) and systematic pelvic and paraaortic LNE. In case of negative SLNB (pN0), 39% of institutions still performed a systematic pelvic and paraaortic LNE. CONCLUSION: In this survey worldwide, SLNB adoption is an encouraging 60%, yet ample differences exist regarding strategy, and to a lower extent the techniques used. Lack of experience is the most common reason SLNB is not performed. Efforts to increase surgical education on SLNB technique and multicenter prospective trials providing evidence-based guidelines are warranted.

Surgical staging of low-risk Stage IA endometrioid endometrial cancers.

PURPOSE: Surgical staging in early endometrial cancer is not universally done and lymphadenectomy in early-stage disease is controversial. Aim of the present study was to evaluate surgical staging in patients with endometrioid histology, FIGO Stage IA endometrial cancer. MATERIALS AND METHODS: Eighty-seven patients with FIGO Stage IA, low-risk patients were included in the study. Staging surgery group included patients who had comprehensive surgical staging (hysterectomy, oophorectomy, and pelvic lymph node dissection with or without para-aortic lymph node dissection). Non-staging surgery group included patients who had hysterectomy, and bilateral oophorectomy with or without lymph node sampling. Two groups were compared for lymph node status, occult cervical involvement, other prognostic factors, and outcome were analyzed. RESULTS: In total 17.2% of patients were upstaged in final pathological examination; 12.9% in non-staging surgery group and 24.2% in staging surgery group. Upstaging was due to lymph node involvement (6%), cervical stromal invasion (13.7%), and myometrial invasion greater than 50% (1.1%). Median pelvic lymph node number was 23 and pelvic lymph node metastases was found in 3% of the patients. Median para-aortic lymph node number was 11.5 and there was one isolated para-aortic lymph node metastases (5.8%). CONCLUSION: Of the patients, 17.2% had stage migration. Until the issue is solved by future studies, surgical staging might be considered standard surgery for endometrial cancer.

Uterine tumors resembling ovarian sex cord tumors: a case report with adenomyosis and complex hyperplasia with atypia.

Uterine tumors resembling ovarian sex cord tumors (UTROSCTs) are very rare uterine neoplasms. They mostly behave in a benign fashion but cases were reported with extra-uterine spread. There are less than 50 cases reported in the literature so far according to the present authors' knowledge. We report a case of 45-year-old woman with UTROSCT concurrent with adenomyosis and complex hyperplasia with atypia of endometrium and her three-year follow up.

Prospective Comparison of Loop Excision under Colposcopic Guidance versus Vitom Guidance.

Background: Aim of the study was to compare the quality of loop excision using a colposcope with results using the VITOM system. Results compared included cervical volume removed, intra- and postoperative complications, and positive resection margins. Methods: A total of 200 patients with histologically confirmed high-grade cervical premalignant lesions, persistent atypical cytological results and/or suspicious colposcopic findings, and cytological and histological discrepancies were included in the study. In transformation zone type 1 (T1) only a superficial cone biopsy was done, in zones type 2 and 3 (T2 and T3) a superficial outside cone biopsy or a deeper inside cone biopsy were done respectively, followed by endocervical curettage. Volume of removed tissue, complications, and positive resection margins were compared for the colposcopy and the VITOM groups. Findings: Demographic and reproductive features were similar between groups. In the VITOM group 49 % of patients had zone T1, 30 % had zone T2, and 21 % had zone T3. In the group of patients managed by colposcopy, 48, 45, and 7 % of patients had zone T1, T2 and T3 zone, respectively (p < 0.01). A "top hat" procedure was done in 65 % of patients in the VITOM group and in 38 % of patients in the colposcopy group (p < 0.05). Mean volume of removed cervical tissue measured was similar, with 1.2 cm3 measured in the VITOM group and 1.14 cm3 in the colposcopy group (p > 0.05). There were no significant differences in the type of procedure or the mean volume of removed tissue. Results were similar for both groups with respect to positive resection margins and complications. Conclusion: VITOM is a safe and reliable system. Results using the VITOM system are comparable to those obtained with conventional colposcopy. The potential advantage of VITOM is the broader availability of endoscopic systems in the operating theatre.

Improved metabolic control and hepatic oxidative biomarkers with the periconception use of Helichrysum plicatum ssp. plicatum.

Our aim was to investigate the hypoglycaemic and antioxidant effects of the Helichrysum plicatum ssp. plicatum (HPsP) plant extract in the streptozotocin-induced type 1 diabetes rat model during pregnancy. Five groups (n = 8, each) were formed: (1) diabetic non-mated control, (2) non-diabetic mated control, (3) diabetic mated control, (4) diabetic non-mated treatment and (5) diabetic mated treatment. The HPsP extract was administered orally for 15 days (250 mg/kg body weight), beginning 3 days before mating. The extract led to decreased blood glucose, increased serum insulin, and decreased serum triglycerides in pregnant and non-pregnant diabetic animals. Liver thiobarbituric acid reactive substances (TBARS) and reduced glutathione (GSH) measurements in extract-treated diabetics were similar to non-diabetic pregnant controls, indicating probable reversal of increased lipid peroxidation in the liver. The mean pup number tended to increase (p = 0.06) with extract administration. In conclusion, the beneficial effects we encountered with the periconception use of the studied herbal extract warrant further investigation.

Immunohistochemical expression of MMP-2, MMP-9 and COX-2 in Stage IA malignant polyps of the endometrium.

OBJECTIVE: To study whether endometrioid type malignant endometrial polyps (MEP) are different from endometrium cancer not associated with polyps (ECNAP) in means of immunohistochemical expressions of MMP-2, MMP-9 and COX-2. METHODS: Archived tissue samples of eight MEP, eight ECNAP and 16 benign endometrial polyps were selected and immunohistochemically analyzed for MMP-2, MMP-9 and COX-2 expression. RESULTS: MMP-2 and MMP-9 were overexpressed in ECNAP compared to MEP and benign endometrial polyps (p < 0.05). MMP-2 and MMP-9 expressions were not different in the malignant part of MEP, benign part of MEP and benign endometrial polyps. COX-2 expression was found to be higher in benign lesions, although this was not statistically significant. CONCLUSION: Similar immunohistochemical expression of MMP-2, MMP-9 and COX-2 within a polyp and with benign polyps may indicate an immunohistochemically indolent characteristic of MEP.

Does the localisation of tumour at stage I endometrial endometrioid adenocarcinoma have an impact on invasion of the tumour and individualisation of the surgical procedure?

OBJECTIVE: To detect whether the localisation of the tumour has an impact on the dissemination of the tumour and whether or not surgical procedures should be individualized according to the localisation of the tumour. MATERIAL METHOD: 106 clinically surgically stage I endometrial endometrioid carcinoma cases treated multi-institutionally at Gulhane Military Medical Academy (GATA) and Dr. Zekai Tahir Burak (ZTB) Women's Health Education and Research Hospital Gynecologic Oncology Units in the last five years were evaluated retrospectively. The tumours localised near the internal cervical os and not invading the cervical canal were accepted as lower uterine segment (LUS) localisation and the corporal location as upper uterine segment (UUS) localisation. RESULTS: Tumour localisation was more frequent in the upper segment than LUS (85.9% vs 14.1%). There was no statistically significant difference between only endometrial and only serous invasion rates. Myometrial invasion less than one-half was significantly higher in the UUS group than the LUS group (p < 0.05). Lymph vascular space involvement rate was significantly higher in the LUS group (60%, 9/15) than the UUS group (23 %, 21/91), (p < 0.01). Positive peritoneal cytology rate was 20% (3/15) in the LUS group and 6.6% (6/91) in the UUS group (p > 0.05). CONCLUSION: Patients with LUS involvement should be considered as high-risk patients. Thus more expanded surgery must be taken into consideration. In this study a limitation was the low number of patients with LUS involvement. Larger prospective studies are necessary to confirm our results.

Tamoxifen and giant endometrial polyp.

We present the case of a woman with a giant endometrial polyp of uncommon dimension who was receiving adjuvant tamoxifen for breast cancer. In her gynecologic examination, she had a mass measuring 3 x 4 x 4 cm protruding from the cervical os. The mass was extirpated under general anesthesia. The mass originated from the endometrial cavity. The endometrial polyp measured 10 x 6 x 3 cm macroscopically and was found to be benign under microscopic examination. We conclude that physicians should be aware of the confounding effects of tamoxifen on the histological and ultrasonographic appearance of the endometrium.

Giant bladder leiomyoma presenting as a pelvic mass: a case report.

We present a rare case of bladder leiomyoma with an unusual presentation as a pelvic mass. Bladder leiomyomas are very rare tumors, compromising less than 0.43% of all bladder tumors. Magnetic resonance imaging showed a 16 x 13 cm mass covering the entire pelvis and extending up to the umbilicus. There was a 20 x 20 x 11 cm immobile mass originating from the bladder at laparotomy. The mass was removed by bladder-sparing surgery and was reported to be leiomyoma. We conclude that bladder leiomyomas should be preoperatively recognized as a cause of pelvic mass in order to make the possible diagnosis.

Ovarian gonodoblastoma with yolk sac tumor in a young 46, XX female: case report.

BACKGROUND: Gonodoblastomas with ovarian germ cell tumors (OGCTs) other than dysgerminoma are very unusual. This is the first case report of a pure endodermal sinus tumor of the ovary with gonodoblastoma in a 46 XX, female. CASE: A 19-year-old female was admitted to our hospital with an abdominal mass and pain. She had elevated levels of CA-125 and AFP. Fertility sparing surgery was undertaken and revealed a Stage IA endodermal sinus tumor and gonodoblastoma in the same ovary. The patient refused chemotherapy and was followed-up for six months without disease. CONCLUSION: Gonodoblastomas may occur in conjunction with OGCTs. Tumor markers and immunohistochemical examination may help in the diagnosis of these OGCTs with gonodoblastoma.

Ovarian hemangioma with elevated CA125 and ascites mimicking ovarian cancer.

We report a case of a very rare tumor of the ovary with an unusual presentation; an ovarian hemangioma with massive ascites and elevated CA125. A 57-year-old woman presenting with elevated CA125, massive ascites and a left solid adnexal mass of 60 x 47 mm, with calcification and increased blood flow at Doppler examination, was submitted to laparotomy. Frozen section was inconclusive and a staging procedure which complicated the patient was performed. Pathologic examination revealed cavernous hemangioma which is an extremely rare tumor of the ovary. Although it is very unusual, an ovarian hemangioma may present with ascites and elevated CA125 and the differential diagnosis from ovarian cancer should be considered.

Primary giant leiomyoma of the ovary--case report.

Primary leiomyoma of the ovary, which is of unknown origin, is an extremely rare tumor of ovary. We report a rare case of giant primary ovarian leiomyoma with an unusual presentation, ascites, elevated CA125 and discuss the preoperative imaging findings. A 45-year-old woman was referred for evaluation of an adnexal mass of 8 x 9 cm with ascites and elevated CA125 levels. Preoperative imaging studies were in accordance with fibroma/thecoma. At laparotomy total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Histological and immunhistochemical examination revealed primary ovarian leiomyoma.

Maternal serum levels of dehydroepiandrosterone sulfate and labor induction in postterm pregnancies.

OBJECTIVES: To study the relationship between maternal endogenous dehydroepiandrosterone sulfate (DHEAS) levels, success of labor induction, and Bishop scores in postterm pregnancies. METHODS: There were 65 postterm pregnancies. Group 1 consisted of women spontaneously in the active phase of labor, and group 2 of women with hypotonic uterine contractions whose labor was inducted by oxytocin. Levels of DHEAS were studied from venous blood samples. Demographic data and Bishop scores were recorded. RESULTS: The demographic characteristics of patients were similar, but DHEAS levels were higher in group 1 than in group 2 (P<0.001). Linear regression analysis showed a significant relationship between DHEAS and Bishop scores. DHEAS levels in women delivered vaginally were significantly higher than in women delivered by cesarean section. From the receiver operating characteristics (ROC) curve, DHEAS levels might determine the mode of delivery and success of labor induction; however, Bishop scores do not. CONCLUSIONS: DHEAS levels may be an important factor influencing the efficiency of labor and the success of labor induction in postterm pregnancies.