Simplifying the preevacuation testing strategy for patients with molar pregnancy.

OBJECTIVE: To review our institution's preevacuation testing strategy for suspected molar pregnancy to determine whether a simplified approach might be indicated. STUDY DESIGN: Patients diagnosed with molar pregnancy from 1999 to 2004 were identified. Clinical data were retrospectively extracted from medical records. RESULTS: One hundred fifty-eight women diagnosed (mean age, 24 years) underwent dilatation and curettage. Molar pregnancy was suspected at presentation in 111 (70%); 47 (30%) cases were presumed miscarriages, and the diagnosis was confirmed only after histologic evaluation of the specimen. Initial testing included complete blood count (CBC) (87%), liver function tests (LFT) (63%), thyroid-stimulating hormone (TSH) level (72%), clotting function studies (26%) and chest radiograph (84%). One patient with right upper quadrant pain had elevated LFTs and a coagulopathy that resolved after evacuation. One woman with a palpably enlarged goiter and elevated TSH level was diagnosed with thyroid carcinoma. No chest radiograph demonstrated metastatic disease. CONCLUSION: We advocate a simplified approach to preevacuation testing for suspected molar pregnancy that includes a CBC and blood type with antibody screen. Clinical assessment should prompt additional evaluation in the rare patient with suspicious signs and symptoms.

Retrospective cohort study of surgical staging for ovarian low malignant potential tumors.

OBJECTIVE: The purpose of this study was to determine the benefit of surgically staging ovarian low malignant potential tumors. STUDY DESIGN: This was a retrospective cohort study of all ovarian low malignant potential tumors that were diagnosed by frozen section or final pathologic review from 2003 to 2005. RESULTS: Twenty-two of 32 patients (69%) were staged surgically. Sixteen low malignant potential tumors were stage I by final pathologic review, and 4 tumors were upstaged to stage II-III disease. Two other patients had early invasive ovarian carcinoma, despite a frozen section that suggested low malignant potential; 1 patient received adjuvant chemotherapy. The tumors of 10 women (31%) were unstaged. Frozen section suspicion of low malignant potential (P = .003) and surgery by a gynecologic oncologist (P < .001) correlated with staging. Preoperative CA-125, intraoperative blood loss, and postoperative hospitalization were increased in patients with staged disease (each P < .05). Two women who underwent fertility-sparing surgery experienced a recurrence in the contralateral ovary. CONCLUSION: Surgical staging of ovarian low malignant potential tumors has limited value for most patients, unless invasive carcinoma is diagnosed by final pathologic review.

Adenocarcinoma of the cervix.

Cervical adenocarcinomas are increasing in incidence each year, comprising up to 25% of all cervical cancers diagnosed in the United States. This increase largely reflects the inherent difficulty in detecting glandular precursor lesions using current screening practices. However, there also appears to be a recent shift in the epidemiology of the disease process with younger women being diagnosed more frequently. Fertility-sparing surgery is an option for selected patients with adenocarcinoma in situ or stage IA(1) cervical adenocarcinoma. Simple hysterectomy should be performed at the completion of childbearing or when preserving fertility is not an issue. The treatment of choice for most women with stage IA(2) to IB(1) disease is radical hysterectomy. Fewer than 20% of patients will need adjuvant therapy and the cure rate is excellent. Primary radiation with weekly cisplatin may be the best option for patients with stage IB(2) to IIA cervical adenocarcinoma. Patients treated initially by primary radical surgery will almost certainly require postoperative chemoradiation because of high-risk surgical-pathologic features. Patients with stage IIB to IVA disease should also receive primary radiation with weekly cisplatin. Management of recurrence should be individualized, depending on the location of disease and the type of previous therapy.