Risk strata-based therapy and outcome in stage Ib-IIa carcinoma cervix: single-centre ten-year experience.

AIM: To review the outcome of stage (Ib, IIa), cervical cancer patients were primarily treated with radical hysterectomy and risk-based postoperative therapy. MATERIAL AND METHODS: Between January 2001 and December 2011, 601 cases underwent surgery followed by tailored therapy. Patients were classified into low risk (pelvic lymph node negative, tumour less than 4 cm, no evidence of lympho-vascular invasion, less than one-third of thickness of surgical stoma involved), intermediate risk (positive lympho-vascular space invasion, tumour size more than 4 cm, and deep invasion of cervical stroma), and high risk (pelvic lymph node involved, positive parametrial, or vaginal margins) groups. Postoperative adju-vant therapy in the form of radiotherapy alone to those with intermediate risk and chemo-radiotherapy to those with high risk was given to patients. The median follow-up was 60 months. RESULTS: The majority of patients had intermediate risk. The overall event-free survival (EFS) at five years was 74.37%, with EFS of 86.5% in those from the low-risk group, 73% in those from the intermediate-risk group, and 64% in those from the high-risk group. In conclusion, risk strata-based adjuvant postoperative therapy is able to provide a favourable outcome in patients with stage Ib-IIa cervical cancer with a nearly 11% improvement in survival compared with historical control.

A clinical update on massive ovarian oedema - a pseudotumour?

OBJECTIVE: Benign massive ovarian oedema is a rare clinical entity arising from the ovaries, and it poses a significant clinical challenge as it can be easily mistaken for neoplasm. Due to the lack of pathognomonic clinical features or characteristic hallmarks on non-invasive diagnostic modalities and the dependence on the final histopathology, the efforts of the surgeon have been deviated from performing fertility-sparing surgery on young women. The lack of standardised guidelines due to the rarity of this condition calls for a review of the literature to enable the clinician to formulate treatment guidelines. METHODS AND MATERIAL: A Medline search on the PubMed database for literature published in English from 1969 to 2011 was done using the keywords 'massive ovarian oedema, massive ovarian oedema case report or case series, and pseudotumour of ovary'. A total of 177 women who had undergone a variety of treatments were retrieved. We also report the management options we used for four women presenting to us between August 2000 and October 2011, as well as a review of the literature. RESULT: A total of 177 cases of massive ovarian oedema were identified. Out of these cases 151 (85.3%) were primary massive ovarian oedema; secondary massive ovarian oedema was identified in 26 (14.7%) cases. A salpingo-oophorectomy was done in 145 (81.9%) cases, 12 (6.8%) cases had an abdominal hysterectomy with bilateral salpingo-oophorectomy. A total of 76 (42.9%) cases intraoperatively were found to have ovarian torsions, and one patient with primary massive ovarian oedema had ascites. Conservative treatment was carried out in 20 (11.3%) patients; 14 of these had a wedge biopsy with frozen section and with or without ovarian suspension, one patient had diagnostic laparotomy, and five cases had only ultrasonographic or magnetic resonance imaging monitoring and symptomatic treatment. The four cases treated at the regional cancer institute from 2000 to 2011 revealed that the first three cases had salpingo-oophorectomy and the fourth case received a successful conservative treatment. CONCLUSION: The majority of massive ovarian oedemas will respond to judicious use of intraoperative wedge resection and frozen section for the confirmation of diagnosis. The detorsion and transfixation of the ovary or partial debulking and drainage of fluid accumulated in the cyst may be more appropriate to preserve hormonal function and fertility in these young women.

Malignant mixed Mullerian tumour of the uterus.

BACKGROUND: A malignant mixed Mullerian tumour (MMMT) of the uterine corpus is an extremely rare and aggressive malignancy. There are very few studies regarding the outcome of MMMT patients in India. Hence, we conducted the present study to analyse the outcome of MMMTs at our institute. OBJECTIVE: To study the clinical profile, prognostic features, and treatment outcome of MMMT with multimodal therapy. METHOD: A five-year retrospective study of the MMMT cases diagnosed and treated at our centre was conducted. Twenty patients with pathological proven diagnosis of MMMT treated at our institute from January 2007 to May 2012 were analysed. These patients underwent comprehensive surgical staging followed by adjuvant therapy in the form of chemotherapy alone or chemoradiotherapy. These patients were analysed for event-free survival (EFS), and their outcomes were correlated with histology, therapy, myometrial invasion, and the stage of disease. RESULTS: A majority of these patients presented with postmenopausal bleeding. Endometrial biopsy was diagnostic in only 20% of the patients. Of the 20 patients who underwent surgery, 18 patients received adjuvant therapy. At median follow-up of 16 months (range 3-30 months), the EFS was 30%. No difference in outcome was noted based on tumour histology (heterologous versus homologous). Concurrent chemoradiation improves local control and may delay recurrence but has shown little survival advantage. CONCLUSION: MMMT is an aggressive tumour of the uterine corpus. A negative endometrial biopsy does not rule out the diagnosis. Poor outcome is noted in patients with advanced-stage disease and myometrial invasion. The optimal adjuvant treatment for this uncommon disease is yet to be established, highlighting the need for larger multicentric studies on MMMTs.

A rare case of plasmacytoma of the ovary: a case report and literature review.

OBJECTIVE: Extramedullary plasmacytomas are rare. Ovarian plasmacytomas, for which treatment options vary, are more unique and even more rare. We will consider the option of optimal cytoreductive surgery followed by adjuvant chemotherapy consisting of carboplatin (AUC-2) to prevent massive ascites and pleural effusion. CASE REPORT: We report a case of ovarian plasmacytoma in a 35-year-old woman presenting with abdominal pain due to the mass. She underwent optimal cytoreductive surgery. A post-operative histopathologic diagnosis of ovarian plasmacytoma was confirmed. She was assigned stage IIC disease. She received three cycles of single agent carboplatin for rapidly refilling ascites and pleural effusion. Her response was dramatic. There is no evidence of recurrence clinically for more than 14 months. The patient is receiving follow-up care. CONCLUSION: Multimodality treatment comprising of optimal cytoreductive surgery followed by carboplatin-based chemotherapy is a novel observation and may be an option for the treatment of these rare tumours. This options needs to be further researched.

Primary ovarian adenosarcoma with elevated Ca-125 levels and normal ascitic fluid cytology: a case report and review of literature.

OBJECTIVE: Ovarian adenosarcoma is a very rare tumour for which treatment options vary. We will consider the option of optimal cytoreductive surgery followed by adjuvant chemotherapy consisting of ifosamide (mesna) and adriamycin to prevent systemic metastasis, and will observe the role of serial CA-125 levels as a follow-up marker. CASE REPORT: We report a case of ovarian adenosarcoma in a 38-year-old woman presenting with abdominal pain, distention due to massive ascites. She had undergone total abdominal hysterectomy 8 months previously for abnormal uterine bleeding. She underwent paracentesis followed by optimal cytoreductive surgery. A post-operative histopathologic diagnosis of primary adenosarcoma was confirmed. She was assigned a stage III C cancer. She received five cycles of ifosamise (mesna) and adriamycin and is on follow-up with serial CA-125 levels. There is no evidence of recurrence clinically, biochemically, or radiologically for more than 12 months. CONCLUSION: Multimodality treatment comprising optimal cytoreductive surgery followed by ifosamide (mesna) and adriamycin-based chemotherapy may be an option for treatment of these aggressive tumours. Follow-up with serial CA-125 values in advanced stage adenosarcoma of the ovary is a novel observation which needs to be researched.