Malignant transformation of mature cystic teratoma of the ovary: a case series.

The aim of this study was to analyze the patients with malignant transformation (MT) arising in mature cystic teratoma of the ovary (MCTO) and evaluate the clinicopathologic features, managements, and prognosis of these cases. The records of the patients with MT arising in MCTO who were treated at our hospital were reviewed retrospectively. The demographic features, presenting symptoms, preoperative ultrasonographic evaluations, surgical treatments, pathological findings, adjuvant therapies, follow-up outcomes, and survival time were examined. Eighteen patients with MT arising in MCTO were detected during the study period. The incidence rate of MT was 0.404% of all MCTO and squamous cell carcinoma was the most common histologic type (66.7%). The median age of the patients was 48 (range, 28-79) and the mean tumor size was 12 cm. Eleven patients (61.1%) were classified as stage IA, 1 (5.6%) as stage IC, 1 (5.6%) as stage IIC, 4 (22.2%) as stage IIIC, and the remaining 1 (5.6%) as stage IV. The overall 5-year survival rate was 66.7%. MT of MCTO is a rare occurrence entity and early detection and complete surgical staging are cardinal for survival. Additionally, this malignancy usually occurs in postmenopausal women and the high tumor diameter may be associated with MT.

Does Lymphadenectomy Improve Survival in Uterine Leiomyosarcoma?

INTRODUCTION: The role of lymphadenectomy in the management of uterine leiomyosarcoma (LMS) is controversial. We aimed to identify whether lymph node dissection (LND) has any survival benefit in uterine LMS. METHODS: Data of 95 patients with histologically proven uterine LMS from 2 tertiary centers (1993 through 2009) were retrospectively analyzed. Kaplan-Meier and Cox proportional hazards regression models were used for analyses. RESULTS: Mean age was 51.5 years. Thirty-six (37.9%) underwent LND. The median lymph node count was 54. Eight (22.2%) patients had lymphatic metastasis. Median follow-up was 26 months. Sixty-two (65%) patients had recurrence and 48 (50.5%) died. Median disease-free survival (DFS) was 19 months for both group of patients who had or did not have LND, and median overall survival (OS) was 29 and 26 months, respectively (P = 0.4). Five-year DFS was 35.9% vs 26.8% (P = 0.4), and 5-year OS was 45.4% vs 43.8% (P = 0.22) for the groups. Multivariate analyses did not reveal a single independent prognostic factor in respect to DFS or OS. CONCLUSION: Higher rate of lymph node metastasis in patients with extrauterine disease indicated the importance of LND in LMS. However, the survival benefit of lymphadenectomy could not be shown.

Lymphadenectomy should be performed up to the renal vein in patients with intermediate-high risk endometrial cancer.

We aimed to evaluate para-aortic metastases relative to the level of inferior mesenteric artery (IMA) and to discuss the clinico-pathological features of these patients. A total of 204 patients who underwent systematic pelvic and para-aortic lymphadenectomy up to the level of renal veins for endometrial cancer between January 2007 and August 2013 were included in this study. Of these 204 patients, 44 (21.6 %) had lymph node involvement. From a total of 27 patients with paraaortic lymph node (PALN) metastasis, 11 had only supramesenteric and 4 had only inframesenteric nodal involvement, while 12 had both supramesenteric and inframesenteric metastases. Supramesenteric lymph node metastases were detected in 85.2 % of patients who have para-aortic metastases and in 11.3 % of all patients. Additionally, 5 patients had only supramesenteric lymphatic metastasis. The surgico-pathological characteristics of patients with isolated supramesenteric and inframesenteric metastasis were similar. However, the patients with lymphatic spread in both regions were found to have pelvic lymphatic metastasis and cervical invasion more commonly compared to patients with only supramesenteric or only inframesenteric metastasis. The site of metastatic lymph nodes wasn't associated with the likelihood and site of recurrence. Lymphadenectomy should be performed up to the level of renal vein in case of the presence of indication for lymphadenectomy in patients with endometrial cancer. Additionally, it is not possible to predict the patients with supramesenteric lymph node involvement by tumor grade, histological type and myometrial invasion.

Analysis of non-squamous vulvar cancer cases: A 21-year experience in a single center.

OBJECTIVE: To evaluate the patients with non-squamous cell type of vulvar cancer who were treated in our clinic within 21 years. MATERIALS AND METHODS: We assessed the data of 14 patients who were treated for non-squamous cancer of the vulva between January 1992 and August 2013. The age of patients, histopathological diagnosis of the tumor, tumor size, tumor location, medical or surgical treatment, response to the treatment, recurrence, and survival rates were analyzed. RESULTS: The mean age of the patients was 53 years. The main complaint was vulvar pruritus (71%). Mean tumor size was 2.4 cm (range: 0.5-6 cm). In 65% of cases, the tumor was localized in the labia majora. The histopathologic diagnosis of the patients was as follows: malignant melanoma in 5 patients, basal cell carcinoma in 5 patients, mucinous type adenocarcinoma in 2 patients, apocrine gland carcinoma in one patients, and malign peripheral nerve sheath tumor in 1 patient. For 11 patients, surgery was the primary treatment. Radical vulvectomy and bilateral inguinofemoral lymphadenectomy were performed in 8 patients. Local excision alone without lymphadenectomy was performed in other 3 patients. Five of eight patients (62.5%), who undergone radical surgery, had lymph node metastases. Of these 5 patients, two had bilateral lymph node metastasis. Mean follow-up time was 49.2 months (range 12 to 72 months). Eight (57.1%) patients had suffered first recurrence. In those patients, the mean time to recurrence was 19.5 months (range, 6-48 months). CONCLUSION: Non-squamous cell vulvar cancer is a rare disease and comprises a heterogeneous group of tumors. Malignant melanoma is the most aggressive one. Multicenter prospective studies are necessary in order to standardize the treatment of these rare tumors.

Comparison of advanced stage mucinous epithelial ovarian cancer and serous epithelial ovarian cancer with regard to chemosensitivity and survival outcome: a matched case-control study.

OBJECTIVE: The aim of this study was to compare clinicopathologic characteristics, surgery outcomes and survival outcomes of patients with stage III and IV mucinous epithelial ovarian cancer (mEOC) and serous epithelial ovarian carcinoma (sEOC). METHODS: Patients who had surgery for advanced stage (III or IV) mEOC were evaluated retrospectively and defined as the study group. Women with sEOC who were matched for age and stage of disease were randomly chosen from the database and defined as the control group. The baseline disease characteristics of patients and platinum-based chemotherapy efficacy (response rate, progression-free survival and overall survival [OS]) were compared. RESULTS: A total of 138 women were included in the study: 50 women in the mEOC group and 88 in the sEOC group. Patients in the mEOC group had significantly less grade 3 tumors and CA-125 levels and higher rate of para-aortic and pelvic lymph node metastasis. Patients in the mEOC group had significantly less platinum sensitive disease (57.9% vs. 70.8%; p=0.03) and had significantly poorer OS outcome when compared to the sEOC group (p=0.001). The risk of death for mEOC patients was significantly higher than for sEOC patients (hazard ratio, 2.14; 95% confidence interval, 1.34 to 3.42). CONCLUSION: Advanced stage mEOC patients have more platinum resistance disease and poorer survival outcome when compared to advanced stage sEOC. Therefore, novel chemotherapy strategies are warranted to improve survival outcome in patients with mEOC.

What is the impact of cervical invasion on lymph node metastasis in patients with stage IIIC endometrial cancer?

PURPOSE: The aim of this study was to evaluate whether the presence of cervical invasion has altered the site of lymph node (LN) metastasis in stage IIIC endometrial cancer (EC) patients. METHODS: Fourty-six patients who had systematic pelvic and para-aortic lymphadenectomy surgery for EC and staged as IIIC were included in the study. Patients with cervical invasion were defined as Group A and patients without cervical invasion were defined as Group B. The groups were compared according to surgical-pathologic characteristics. Chi-square and Annova table test were used to examine the effect of cervical invasion on LN metastasis. RESULTS: The mean age of patients was 59 years (range 38-81) and tumor size was 47 mm (range 10-80). Twenty-three patients had cervical involvement (Group A) and 23 had no cervical metastasis (Group B). Groups were not different with regard to cell type, grade, depth of myometrial invasion, tumor size, adnexal involvement, peritoneal metastasis and lymphovascular space invasion. Among 46 patients obturator LN was the most involved site of LN metastasis, however, when there is cervical metastasis external iliac LN was found to be the most involved LN site. Patients without cervical invasion had 21.7% of external iliac LN metastasis while patients with cervical invasion had 60.9% of external iliac LN metastasis. Also, cervical invasion has increased the risk of pelvic LN and obturator LN involvement from 82.6 to 95.7% and 39.1 to 52.2%, respectively. CONCLUSION: Cervical invasion may have an effect on lymphatic spread and change the site of metastatic LNs. Large prospective studies are needed to clarify the alteration of LN metastasis in cervix invaded EC patients.

A prospective evaluation of lymphatic dissemination in endometrial cancer: is it adequate to perform lymph node dissection up to the inferior mesenteric artery?

OBJECTIVE: This study aimed to assess para-aortic metastases relative to the inferior mesenteric artery (IMA). In addition, the clinicopathologic features of these patients are discussed. MATERIALS AND METHODS: Between 2007 and 2009, a total of 78 consecutive patients who had open systematic pelvic and para-aortic lymphadenectomy surgery for endometrial cancer extending to the renal vessels and who were treated at the gynecologic oncology department were included in this prospective study. The para-aortic lymph nodes (PALNs) removed from these patients were classified as supramesenteric (between the renal vein and the IMA) or inframesenteric (between the IMA and the presacral). Patients' clinical data, pathologic tumor characteristics, and operative and early postoperative data were recorded after surgery. Descriptive statistics were calculated using the SPSS 17.0 package program. RESULTS: Of these 78 patients, 18 (21.3%) had metastatic nodal involvement. From a total of 12 patients with PALN metastasis, 7 had only supramesenteric and 1 had only inframesenteric nodal involvement, whereas 4 had both supramesenteric and inframesenteric metastases. Of the 5 patients in the inframesenteric±supramesenteric group, none had a grade 1 tumor. On the other hand, of the 7 patients with only supramesenteric metastasis, 57.1% (n=4) had a grade 1 tumor and 42.8% (n=3) had less than half of myometrial invasion. CONCLUSIONS: In the case of well-defined risk factors in which a lymphadenectomy is indicated according to current guidelines from the International Federation of Gynecology and Obstetrics, a PALN dissection should be extended up to the renal vessels. We also conclude that tumor grade, histologic type, and myometrial invasion cannot be used as markers to decide on supramesenteric lymphadenectomy in endometrial cancer.

The effect of cell type on surgico-pathologic risk factors in endometrial cancer.

OBJECTIVE: In this study the effect of histologic subtype as a surgicopathologic risk factor in endometrial cancer is evaluated. MATERIAL AND METHODS: We evaluated 182 patients who underwent systematic lymphadenectomy up to the level of the renal vessels and at least 15 lymph nodes were dissected from the pelvic area and 10 lymph nodes from the para-aortic area. investigation of whether endometrioid and aggressive cell types (serous papillary cell and clear cell) affect the distribution of surgicopathologic risk factors among endometrial cancer cases was carried out. RESULTS: Patients in the aggressive cell type group were older and the tumor size was significantly smaller. There was no difference between the two groups for the total number of dissected lymph nodes except for the external iliac area. Although the difference is not statistically significant, the total number of lymph nodes dissected in the aggressive group was less (54.3 vs 62.9, p=0.067) than that of the endometrioid cell type group. While the incidence of pelvic lymph node metastasis in the aggressive group was 59.1% the incidence was 15.6% in the endometrioid cell type group (p>0.001). The possibility of lymph node metastasis for aggressive cell type endometrial carcinoma in the para-aortic area was twice the endometrioid cell type group. It was found that the presence and type (stromal/glandular) of cervical invasion, depth of myometrial invasion and presence of lymphovascular space invasion were not affected by cell type. CONCLUSION: Aggressive cell types significantly increase the adnexial and lymph node metastasis in endometrial cancer.

Krukenberg tumor mimicking pregnancy luteoma.

BACKGROUND: Pregnancy-associated Krukenberg tumor is very rare, and the diagnosis in pregnancy is even more difficult. Usually symptoms are attributed to pregnancy luteomas, which are hormone-active benign neoplasms. CASE: A 22-year-old female presented at the 28th week of gestation with rapid onset of hirsutism and acne since the 20th week of gestation. Physical and ultrasonographic examinations revealed bilateral ovarian solid masses which were considered as pregnancy luteomas. The patient underwent exploratory laparotomy due to the onset of ascites and elevated tumor markers four months after delivery. Histopathologic examination revealed adenocarcinoma with signet-ring-type cells. CONCLUSION: Krukenberg tumors should be considered in the differential diagnosis of pregnancy luteomas. Otherwise, early diagnosis of the tumor can be delayed.

Routine histopathologic analysis of product of conception following first-trimester spontaneous miscarriages.

AIM: To evaluate the histopathologic findings relating to tissue samples collected at surgical uterine evacuation in first-trimester spontaneous miscarriages. METHODS: In this retrospective study, histopathologic diagnosis of the tissue samples obtained via surgical uterine evacuation in patients who were admitted to the Early Pregnancy Clinic in a 12-month period with the diagnosis of incomplete miscarriage (n = 970), missed miscarriage (n = 406) and anembryonic miscarriage (n = 230) in the first trimester was recorded and compared with the presurgery diagnosis. RESULTS: Uterine evacuation was performed in cases of incomplete miscarriage (n = 970, 60.4%), missed miscarriage (n = 406, 25.2%) and anembryonic miscarriage (n = 230, 14.3%). Histopathologic examination revealed the product of conception in 1119 patients (69.7%), while partial hydatidiform mole was diagnosed in 33 patients (2.1%). Complete hydatidiform mole was detected in only seven cases (0.43%). Exaggerated placental site and placental site trophoblastic nodule was detected in two cases (0.12%). Decidual tissue without chorionic villi was reported in 272 patients (16.9%), raising the suspicion of presence of other pathology. CONCLUSIONS: By routine histopathologic assessment of products of first-trimester spontaneous miscarriages, important pathologies such as molar pregnancy and placental trophoblastic disease can be diagnosed. Histopathological assessment has great value in the identification of an ectopic pregnancy or infection when compared with clinical and laboratory findings.