Clinical outcome of cystectomy compared with unilateral salpingo-oophorectomy as fertility-sparing treatment of borderline ovarian tumors.

OBJECTIVE: To compare recurrence rates and fertility outcomes of patients with borderline ovarian tumors (BOTs) who underwent unilateral salpingo-oophorectomy with those of patients who underwent cystectomy only. DESIGN: Retrospective study. SETTING: Gynecologic oncology department of a tertiary center. PATIENT(S): Sixty-two patients with BOTs who underwent fertility-preserving surgery. INTERVENTION(S): Unilateral salpingo-oophorectomy (USO, n = 40) or cystectomy only (n = 22). MAIN OUTCOME MEASURE(S): Tumor recurrence rate, incidence of pregnancy. RESULT(S): All 62 patients were alive with no clinical evidence of disease after a mean follow-up of 88 months. There was no statistically significant difference in mean tumor recurrence rates between patients who had undergone cystectomy only and those who had undergone USO (22.7% and 27.5%, respectively). In the cystectomy-treated group, the disease-free interval was shortened (23.6 compared with 41 mo), but the difference was not significant. However, the mean follow-up period for the cystectomy group was significantly shorter than for the USO group. Of the 62 patients, 25 (40.3%) attained 38 pregnancies, resulting in 35 deliveries. CONCLUSION(S): Our results support previous findings that conservative surgery is an acceptable option for women with BOTs who wish to preserve fertility. Cystectomy, like oophorectomy, appears to be an adequate treatment, provided that the patient is willing to undergo careful and prolonged follow-up.

The 471delAAAG mutation and C353T polymorphism in the RNASEL gene in sporadic and inherited cancer in Israel.

The rate of RNASEL 471delAAAG mutation was previously reported to be less than 7% in Ashkenazi prostate cancer patients. It seems plausible that the same mutation may also be involved in breast/ovarian cancer predisposition in Jewish individuals. To evaluate the role of this mutation in cancer predisposition, a total of 1011 individuals including 294 Jewish men with prostate cancer, 61 Ashkenazi women with ovarian cancer and 50 unaffected women, matched for age and ethnicity, were genotyped for sequence anomalies in a single RNASEL gene amplicon using DGGE and sequencing. Additionally, 209 Ashkenazi BRCA1/2 mutation carriers, 205 high-risk non-carriers matched for cancer type and age at diagnosis, and 192 healthy Ashkenazi women were screened, using DHPLC and restriction methods. The 471delAAAG mutation was detected in a single male with prostate cancer (1/294, 0.3%), in two ovarian cancer patients (2/141, 1.4%) and in one of 242 healthy controls (0.41%). An abnormal DHPLC profile identical to the one produced by the 471delAAAG mutation was noted in 23 additional women. The rate of this polymorphism was significantly elevated in high-risk non-carrier women (16/205; 7.8%) than in BRCA1/2 carriers (2/209; 1.0%) and controls (5/192; 2.6%) (chi = 11.670; P < 0.001). Sequence analysis disclosed a silent polymorphism in Valine at codon 118: c.353 C- > T.The 471delAAAG mutation occurs rarely in Israeli prostate and breast/ovarian cancer patients. A silent polymorphism in the RNASEL gene occurs more prevalently in high-risk Ashkenazi breast/ovarian cancer patients without a BRCA1/2 mutation.

Cystectomy for immature teratoma of the ovary.

OBJECTIVES: Most patients with malignant ovarian germ cell tumors (MOGCT) of the ovary are in their reproductive years and wish to preserve fertility. Because of the excellent response to chemotherapy, the standard of care is unilateral salpingo-oophorectomy (USO), but some patients undergo cystectomy only before final pathology. In view of the lack of information concerning the outcome following cystectomy in germ cell tumors, we retrospectively evaluated the clinical outcome of patients who underwent cystectomy only as part of their surgical treatment. METHODS: The clinical and pathological records of 38 patients diagnosed with MOGCT, treated and followed in the department of gynecologic oncology were reviewed. Eight patients underwent cystectomy only at their initial surgery and are the subjects of this study. RESULTS: All the eight patients who underwent cystectomy were diagnosed with immature teratoma (three grade 1, four grade 2, and one grade 3) on final pathology following surgery. All except three patients (two with grade 1 and one with grade 2 disease) received adjuvant chemotherapy. Follow-up was available for all the patients, with a median duration of 4.7 years. No recurrences were observed during this period. Three patients delivered a total of seven babies. CONCLUSIONS: Cystectomy followed by adjuvant chemotherapy appeared satisfactory for apparent early-stage immature teratoma when close follow-up was carried out. It is still unclear whether cystectomy alone will also be safe. Further studies will need to address this issue.

Outcome of fertility-sparing treatment with progestins in young patients with endometrial cancer.

OBJECTIVE: To evaluate the safety of fertility-sparing hormonal therapy for endometrial cancer in young patients. METHODS: We reviewed the clinical and pathologic records of patients diagnosed with endometrial adenocarcinoma before the age of 40, who were treated and followed over a 30-year period in the Division of Gynecologic Oncology. All patients who underwent conservative management with progestins (n = 13) are the subjects of this study. RESULTS: Follow-up was available for all 13 patients, with a mean follow-up of 82 months. All patients responded to treatment within a mean period of 3.5 months, with normal pathology on follow-up endometrial samplings. Six patients had a recurrence within a period extending between 19 and 358 months (median 40 months). Four patients were treated with a second course of progestins, and all had a histologic complete response. As of the time of preparation of this report, nine healthy infants had been born, and all the patients remained without evidence of disease. CONCLUSION: Conservative management of well-differentiated endometrial carcinoma in young patients, combined with assisted reproductive technologies, if needed, does not seem to worsen the prognosis. This approach also provides the possibility of conceiving and carrying a normal pregnancy.