Serous cystadenoma with massive ovarian edema. A case report and review of the literature.

BACKGROUND: Massive ovarian edema is an usual tumour-like condition. It may be confused with an ovarian neoplasm. CASE: A 13-year-old female in premenarchy was referred as emergency case to a local hospital due to acute, severe and persistent hypogastric pain. She had noticed a gradual abdominal enlargement, mainly on the right abdomen during the last months. Ultrasound revealed a mass of a non-echogenic cystic compartment of 13 cm maximum diameter, and an area of mixed echogenicity of 11 cm maximum diameter at the anatomic site of the right ovary. The CA- 125 levels were increased. An unilateral salpingo-oophorectomy was performed. The pathology examination revealed serous cystadenoma with massive ovarian edema. CONCLUSIONS: Conservative treatment and ovarian suspension may be more appropriate, when histology on frozen section suggests a benign lesion.

Immunopathological study of mesonephric lesions of cervix uteri and vagina.

Seventeen cases of mesonephric cervical remnants, four cases of mesonephric cervical carcinoma and nine vaginal Gardner cysts were studied by histochemical and immunohistochemical methods for the presence of mucin, proteoglucans, glucogen, CEA, cytokeratins, secretory component and vimentin. Mesonephric lesions in contrast to endocervical glandular lesions are negative for mucin, glucogen, CEA, and secretory component and positive for vimentin, and broad spectrum cytokeratins. Mesonephric carcinomas present certain immunopathological characteristics that permit their identification and proper treatment.

Tissue polypeptide specific antigen (TPS) throughout normal pregnancy.

AIM: TPS concentrations were measured throughout normal pregnancy in maternal serum (MS) and amniotic fluid (AF), in order to evaluate the usefulness of TPS in the follow-up of pregnancy breast cancer patients. PATIENTS AND METHODS: Following informed consent, 30 pregnant women during the 2nd trimester, 28 during the 3rd and 26 at parturition were included in the study. For comparison, 28 women in the 1st trimester and 28 healthy, non pregnant women (controls) were also studied. Both MS and AF antigen values were measured by an enzyme immunoassay (BEKI Diagnostics). RESULTS: Maternal serum TPS concentrations increased significantly with gestational age (p < 0.0001), being significantly higher in the 3rd trimester and during labor than those in the controls (p < 0.0001). Amniotic fluid TPS values were markedly elevated, compared with those in MS (p < 0.0001, paired-t-test), declining significantly from the 2nd to the 3rd trimester (p < 0.0015) and labor. Both MS and AF TPS values during labor depended on the mode of delivery, being higher in the cases terminated by vaginal delivery, compared to those by elective cesarean section. CONCLUSION: Maternal serum TPS values are influenced significantly by pregnancy, and thus, this antigen, as tumor marker seems to be reliable only during early pregnancy.

Ifosfamide plus oral etoposide salvage chemotherapy for platinum-resistant paclitaxel-pretreated ovarian cancer.

BACKGROUND: The prognosis of platinum resistant ovarian cancer is very poor and the treatment of choice has not been clearly defined. PATIENTS AND METHODS: We conducted a phase II study with the combination of ifosfamide i.v. at 2.25 g/m2 (days 1, 2) and etoposide per os at 100 mg daily (days 1-10) every four weeks. To be eligible for the study patients had to be resistant to platinum and paclitaxel pretreated. RESULTS: Forty-one patients entered the study. The median interval from the previous chemotherapy was 3.9 months. The median number of previous chemotherapeutic regimens was 2. Severe toxicities included neutropenia (41% of patients), leukopenia (29%) and thrombocytopenia (13%). Thirty-five patients are assessable for response. Nine patients responded (22% of the eligible, 26% of the assessable), four of them demonstrated complete response to chemotherapy (10% and 12%, respectively), while three patients demonstrated stabilization of their progressive disease. After a median follow-up of 18 months, time to progression is 3 months (range 0.9-14.4), duration of response is 9 months (2.5-11) and median survival is 13 months (2.5-37.4+). CONCLUSIONS: The combination of ifosfamide with oral etoposide appears to have significant but manageable toxicity and encouraging efficacy in platinum resistant ovarian cancer.

Tumour-associated antigens CEA, CA125, SCC and TPS in gynaecological cancer.

Pretreatment values of CEA, CA125, SCC and TPS were measured in 130 women with 1) ovarian carcinoma (n = 25), 2) breast cancer (n = 20), 3) endometrial cancer (n = 14), 4) cervical squamous cell carcinoma (n = 20), 5) cervical adenocarcinoma (n = 9) and 6) benign gynaecological diseases (n = 42) in order to evaluate the usefulness of multiple markers in diagnosing and monitoring patients with gynaecological cancer. Antigen values were significantly higher in the cancer groups than those in the benign one (p < 0.0001). CEA values were significantly elevated in the 2nd and 5th groups, CA125 in the 1st and 5th, SCC in the 4th and 5th, and TPS in the 1st, 2nd and 5th compared to the remaining groups (p < 0.04-p < 0.0001). In advanced stage diseases, significantly higher antigen values, except for SCC, than those in limited tumours were measured (p < 0.05-p < 0.0001). In conclusion, our results suggest that, multiple markers may be more efficient than the use of single markers in accurately identifying malignant from benign gynaecological diseases and in monitoring cancer patients.

Cytokines in gynecological cancer.

BACKGROUND: Cytokines are considered as part of host defence to infection or injury. MATERIAL AND METHODS: Pretreatment values of TNF and sIL-2R were measured in 132 women with a) ovarian carcinoma (n = 25), b) breast cancer (n = 20), c) endometrial cancer (n = 15), d) cervical squamous cell carcinoma (n = 19), e) cervical adenocarcinoma (n = 11) and f) benign gynecological diseases (n = 42) in order to evaluate whether these cytokines could be useful in the discrimination of malignant from benign gynecological diseases. RESULTS: Both TNF and sIL-2R were significantly higher in all cancer groups together (mean +/- SD: 30 +/- 11 pg/mL and 1293 +/- 465 U/mL respectively), than those in the benign group (16.0 +/- 6 pg/mL and 626 +/- 233 U/mL, respectively; p < 0.0001), while no significant differences were found for TNF and sIL-2R values in the five cancer groups. Significantly higher cytokine values were measured in the advanced stage diseases (33 +/- 11 pg/mL and 1705 +/- 192 U/mL), than those in the limited cancer (26 +/- 12 pg/mL, p < 0.05 and 916(521 U/mL, p < 0.0001). CONCLUSIONS: Our results suggest that, cytokines may be useful in the discrimination of malignant from benign gynecological diseases and in monitoring tumor activity in patients early in the malignancy process.

A comparative study of serum alpha-beta A immunoreactive inhibin and tumor-associated antigens CA125 and CEA in ovarian cancer.

alpha-i.r Inhibin, has been recently proposed as a useful tumor marker for mucinous ovarian carcinomas (Ca), as the widely used tumor marker for ovarian malignancies, CA125 is efficient only in nonmucinous ovarian Ca, and, together with CEA, fails to detect minimal disease and show long half-life in serum after successful surgery. Moreover, conflicting evidence has been reported as to whether inhibin in ovarian malignancies is the biologically active dimer alpha-beta A inhibin or the inactive free alpha-subunits and inhibin precursors. Serum alpha-beta A i.r inhibin. CA125 and CEA were measured preoperatively and 8 days postoperatively in 39 postmenopausal patients with ovarian cancer (13 mucinous, 15 serous and 11 different other ovarian Ca) in comparison with 20 age-matched healthy women (Controls), 18 patients with benign ovarian tumors and 10 patients with nonovarian gynecological malignancies. Serum alpha-beta A i.r inhibin values were very low in controls (0.121 U/ml; 0.060-0.250) while they were greatly elevated in both benign (67% sensitivity) and malignant ovarian tumors (100% sensitivity in mucinous Ca, 80% in serous and 90.9% in other ovarian Ca, taken as cut-off level the maximum value in Controls, 0.250 U/ml). In contrast, in non-ovarian malignancies no increased values of alpha-beta A inhibin were found (0% sensitivity). Our results on the sensitivity of CA125 and CEA are in agreement with previous studies. After successful surgery the very high concentrations of alpha-beta A i.r. inhibin were reduced very rapidly (8 days) to normal postmenopausal values in contrast to those of CA125 and CEA, that remained elevated. Serum alpha-beta A i.r inhibin seems to be very useful in monitoring after treatment the patients with any type of ovarian malignancy and specifically those with mucinous ovarian cancer.

Dysgerminoma. A report of five cases.

We analyzed five cases of pure dysgerminoma following the same schedule for the treatment, which were studied during the period of 1971 to 1983. The age of patients during the period of histological examination ranged from 15 years and 6 months to 28 years. All five patients had already had their "first menstruation". The above cases examined according to the clinical findings, the symptoms, the stage of the disease; the sort of treatment the place, the period and kind of therapy in case of reappearance of the disease and final survival.