The role of second look laparotomy and tumor markers in the follow-up of endodermal sinus tumor of the ovary. A case report and review of the literature.

Endodermal sinus tumor (EST) of the ovary is extremely rare and little information exists about therapy and the role of second-look laparotomy in the management of this entity. A case of EST of the ovary in a 21 year old woman is reported. She received conservative surgery and six courses of combination therapy consisting of Vincristine, Actinomycin D and Cyclophosphamide before second-look laparotomy. Due to progression of the disease second-line polychemotherapy with Vinblastine, Bleomycin and Cisplatin was administered. This new regimen reduced the alpha-fetoprotein to normal levels although the patient was not free of disease on second-look laparotomy. Precise guidelines for the management of this disease, especially in advanced stages, are still lacking.

Cisplatin-containing versus cisplatin-free adjuvant chemotherapy in ovarian carcinoma. Results after second-look laparotomy.

In 1980, second-look laparotomy was introduced simultaneously into the treatment regimen for ovarian carcinoma at the two main referral centers of northern Spain. First-line chemotherapy after initial surgery was, however, different at both hospitals. At one of them (Bilbao), a combination involving the use of cisplatin was employed (cyclophosphamide 600 mg/m2, Adriamycin 45 mg/m2, and cisplatin 80 mg/m2 i.v. on day 1), whereas the patients of the other hospital were treated mainly with single-agent chemotherapy (melphalan 0.2 mg/kg p.o. on days 1-5) and never with a cisplatin combination as first-line therapy in any case. In all, 92 patients (42 stage I, 14 stage II, 33 stage III, and 3 stage IV) could be treated during the study period with optimal surgery (complete tumor excision or largest residual tumor less than 2 cm in diameter). This was followed by adjuvant chemotherapy for 12-18 months in all cases, except for 18 patients with a stage Ia borderline or G1 tumor. The latter were merely kept under observation until their second-look laparotomy after 1 year of negative follow-up. All of the 74 patients who received adjuvant chemotherapy, of whom 36 with cisplatin and 38 without, were clinically disease free after at least twelve courses of treatment and had a second-look laparotomy performed. This was positive in 33.3% of the cases after cisplatin-containing therapy and in 26.3% of the cases after cisplatin-free therapy. This difference is not statistically significant. The mean follow-up period after negative second-look was 34 months. The long-term results of both patient groups were comparable as far as rate of positive second-look laparotomies and survival rate, overall and stage for stage are concerned. The use of cisplatin did not result in any significant therapeutic improvement. It was uniformly bad tolerated by the patients and carried higher cost, since all patients had to be hospitalized for treatment.

Serum CA 125, CA 15.3 and CA 19.9 levels and surgical findings in patients undergoing second look operations for ovarian carcinomas.

Sera from 52 ovarian cancer patients undergoing chemotherapy and second look operation were studied. CA 125, CA 15.3 and CA 19.9 assays were performed during chemotherapy and prior to relaparotomy. Twenty-six patients (50%) had no evidence of disease whereas 2 (3.8%) and 24 (46.1%) had microscopic and macroscopic disease. In general although the predictive value of an elevated CA 125 or CA 15.3 level is excellent, a normal value (less than 35 U/ml) has limited significance. Moreover, we found no improvement in negative predictive and positive predictive value by adding the determination of CA 19.9.

Simultaneous appearance of ovarian and endometrial carcinoma: a therapeutic challenge.

We have analyzed 37 cases of simultaneous appearance of carcinoma in the ovary and endometrium. This paper deals with the question of whether they should be considered stage III endometrial carcinomas, stage II ovarian carcinomas or independent primary tumors. The cases were grouped according to their histology as endometrioid ovarian carcinomas with endometrial carcinoma (group A), same carcinoma, but not of endometrial origin in both organs (group B) and histologically different concomitant carcinomas of ovary and endometrium (group C). Although our series was small, the survival was better than could have been expected either for stage III endometrial carcinoma, or stage II ovarian carcinoma. This supports the view that many of those tumors should be considered independent stage I carcinomas. Another fact in favour of this hypothesis is the strong correlation between myometrial invasion and prognosis in these cases, which is comparable to that found in endometrial carcinoma alone.

[The therapeutic value of second-look laparotomy in advanced ovarian carcinoma]. / Zur Problematik des therapeutischen Wertes der Second-look-Laparotomie beim fortgeschrittenen Ovarialkarzinom.

42 patients with advanced epithelial ovarian carcinoma who were clinically free of disease after completed postoperative chemotherapy were submitted to second-look laparotomy at the University clinics of Bilbao and Santander, in Northern Spain, between 1980 and 1987. Tumor was demonstrated in 22 of the cases (52.3%). This paper deals with the question of whether this knowledge and the ensuing change in therapy resulted in a longterm benefit for the patients or not. In our experience, this was not the case. All second-look-positive patients either died during the follow-up period, or showed tumor progression if they survived more than 6 months. Survival sank to 50% after only 24 months, and steadily thereafter to 0% after 78 months. The therapeutical value of second-look laparotomy is heavily questioned by these results.

Hydatidiform mole following successful gonadotropin ovulation induction and donor artificial insemination.

A case of successful gonadotropins ovulation induction and donor artificial insemination (AID) followed by a complication of hydatidiform mole is presented. A review of the published papers related to this topic are commented. The organization of a world registry of AID depending on the World Health Organization is encouraged.