[Lambert-Eaton myasthenic syndrome--a rare manifestation of paraneoplastic syndrome in ovarian cancer--case report].

INTRODUCTION: Paraneoplastic neurological syndromes are rare non-metastatic complications of cancer that have an immune-mediated etiology. The Lambert-Eaton myasthenic syndrome (LEMS) is a neuromuscular disorder, often associated with small cell lung carcinoma (SCLC), which is characterized by reduced quantal release of acetylcholine from the motor nerve terminals. LAMBERT-EATON MYASTHENIC SYNDROME: The Lambert-Eaton Myasthenic Syndrome (LEMS) is characterized by proximal muscle weakness initially affecting gait, autonomic symptoms (dry mouth, constipation, erectile failure) and augmentation of strength during initial voluntary activation. Symptomatic treatment of the junctional disorder is based on cholinergic drugs, immunosuppression, immunomodulation and physical therapy useful in case of unsuccessful antineoplastic therapy. CASE REPORT: A rare case of ovarian cancer with Eaton-Lambert syndrome is reported. A 50-year-old woman was admitted to the gynecologic department, complaining of weakness and pain in her arms and shoulders. Physical therapy resulted in partial improvement. Treatment of paraneoplastic syndrome markedly improves the quality of life of cancer patients. Patients presenting with this syndrome should undergo a careful evaluation for the presence of an occult malignancy.

The role of laparoscopy in gynecologic oncology.

In some patients and when performed by a skillful surgeon, gynecologic oncologist familiar with advanced laparoscopic techniques, laparoscopy results with less surgical trauma, reduced blood loss and hospitalization, and faster recovery. The complication rate has been found to increase as the complexity of the operation rises, but it is not higher than in open surgery. Preliminary studies show that recurrence and survival rates are comparable to those reported for patients treated by a standard abdominal approach. Future randomised trials are necessary to deal with long term recurrences and survival data and benefits of laparoscopy in management of gynecologic malignancies. At our institution 97 cancer patients underwent laparoscopic procedures, without complications: explorative and staging laparoscopies with biopsies of ovaries, peritoneal biopsies, retroperitoneal and mesenteric tumours; second look laparoscopy, ovariectomy, laparoscopic assisted vaginal hysterectomy (LAVH). Advanced ovarian cancer was found in 3 patients and laparotomy was performed. No complications were established.

[Ovarian epithelial carcinoma--a malignant disease sparing no age group]. / Epitelijalni karcinom jajnika--maligna bolest koja ne pita za dob.

INTRODUCTION: Ovarian epithelial carcinoma is one of the most common gynecologic malignancies and the fifth most frequent cause of cancer death in women. Ovarian cancer affects women 65 years of age and older more frequently than younger women. MATERIAL AND METHODS: Four young patients with ovarian epithelial carcinoma were treated at the Institute of Oncology in Sremska Kamenica, Serbia and Montenegro, in the period 1981-2000. The median age at diagnosis was 17.3 years. Final histopathological findings revealed cystadenocarcinoma, either mucinous or serous. The stage of the disease was established using International Federation of Gynecology-Obstetrics (FIGO) Calssification. Spread of the disease dictated the extent of operation and post-operative chemotherapy. Patients were strictly followed-up at the Institute. RESULTS: The first two patients underwent unilateral adnexectomy as initial treatment. Final histopathological examination revealed an epithelial ovarian carcinoma, stage IIIa and IIb. Total hysterectomy with unilateral adnexectomy and total omentectomy were performed in both patients as second treatment with chemotherapy, according to the Cisplatin/Carboplatin and Cyclophos-phamide (CP) protocol following surgery. Another two patients underwent total hysterectomy with bilateral adnexectomy and total omentectomy as initial treatment with chemotherapy, CP protocol, following surgery. Both patients had stage IIc. Despite treatment, in two patients with stage IIIa and IIc, metastases were diagnosed. In 2 patients survival was over five years. One patient lived less than 3 years, and one less than 4 years. DISCUSSION: Ovarian carcinomas are difficult to diagnose at early stage. Histologic confirmation of the diagnosis, surgical staging, and aggressive surgical debulking, when possible, are all part of the initial evaluation and treatment. In most cases, surgery is followed by chemotherapy. The risk increases from 15.7 to 54 per 100,000 in the age group 40-79 years. Our study included 4 patients, medium age 17.3, with epithelial ovarian carcinoma which warns us to think twice when we get an adolescent patient with an adnexal mass. CONCLUSION: Advancing age, the major risk factor for development of ovarian carcinoma is, of course, unalterable. We investigated 4 patients medium age 17.3 years, with epithelial ovarian carcinoma. Pelvic masses found in women of reproductive age, must also be evaluated preoperatively to determine the probability of malignancy.

[Treatment protocol for cervical carcinoma]. / Protokol lecenja karcinoma grlica materice.

INTRODUCTION: Cervical cancer is the second most common cancer in women worldwide and the second cause of cancer death among women. About 95% (90% in developed countries) of invasive carcinomas are of squamous types, and 5% (10% in developed countries) are adenocarcinomas. FIGO classification of cervical carcinomas, based on clinical staging and prognostic factor dictate therapeutic procedures and help in designing treatment protocols. THERAPEUTIC MODALITIES: Surgical therapy includes conization, radical hysterectomy with pelvic lymphadenectomy and palliative operation--urinary diversion and colostomy. Radiotherapy, brachytherapy and teletherapy are most recently combined with chemotherapy as concurrent chemoradiation. DISCUSSION AND CONCLUSION: No change in therapeutic modalities will ever decrease mortality rate of cervical carcinoma as much as education, prevention and early screening. The 5-year survival for locally advanced disease has not improved during the last 40 years as a result of failure to deliver therapy to the paraaortic region. Paraaortic lymph nodes should be evaluated before therapy planning by different imaging procedures, or more exactly by surgical staging: laparoscopy or laparotomy. Radical operations of cervical carcinoma should be performed by experienced surgeons, educated for this type of operation, with sufficient number of cases.