Ovarian cancer in pregnancy: a clinicopathologic analysis of 22 cases and review of the literature.

The aim of this study was to summarize our experience of ovarian cancer diagnosed during pregnancy, to review the literature concerned, and to discuss the rationale for therapy. Twenty-two patients of ovarian malignancies complicating pregnancy were treated at Peking Union Medical College Hospital between 1985 and 2003. Data on treatment and follow-up were reviewed, and their outcomes were analyzed by survival analysis. The incidence of ovarian carcinoma complicating pregnancy in the series was 0.073/1000 pregnancies. Nine (40.9%) were found with ovarian malignant germ cell tumors, six (27.3%) with low malignant potential tumors, five (22.7%) with invasive epithelial tumors, and two (9.1%) with sex cord stromal tumors. Sixteen (72.7%) of the patients were diagnosed in stage I and had achieved complete remission. Four of the five in advanced stage died. Ascites presenting at diagnosis implies advanced disease and gloomy prognosis. The mean follow-up was 47.8 months. The prognosis was significantly related with stage and histologic type (P < 0.05). Thirteen healthy live babies were recorded in this group, and one premature newborn died of respiratory distress syndrome. The clinical characters and prognosis of ovarian cancers complicating pregnancy are similar to those of nonpregnant, reproductive-age women. Management depends on histology of the tumor, stage of the tumor, and the term of the pregnancy. In most of cases, conservative surgical treatment could be performed with adequate staging and debulking equal to the treatment of nonpregnant women. Chemotherapy is not contraindicated during the second or third trimester, but the choice of couple must be considered.

Ovarian sex cord tumor with annular tubules: a report of six cases.

Six patients suffering from ovarian sex cord tumor with annular tubules (SCTAT) were reported in this article with special reference to the clinical features, histological characteristics, sex hormone profile, and management of disease. SCTAT was documented to be a estrogen-progesterone-secreting tumor based on the observations of glandular atrophy and decidual change of stroma in the endometrium and assays of steroid hormone. Menometrorrhagia followed by persistent amenorrhea and pelvic mass were presented as important clinical features. This tumor was considered as a tumor with low-grade malignancy, and retroperitoneal lymphatic metastasis was thought to be an important pathway of spread. Unilateral salpingo-oophorectomy together with ipsilateral pelvic and para-aortic lymphadenectomy were suggested as an effective treatment for SCTAT. Radiotherapy can be used for local recurrence and distant metastases.

[CA125 and radioimmunoimaging in monitoring of epithelial ovarian carcinoma].

Serum CA125 was measured by monoclonal antibody-OC125 in 50 primary and 29 suspected recurrent ovarian cancer patients. Among the later, RII examination by using 131I labelled polyclonal antibody-OCOV3 was carried out in 16 cases at the same time. For the suspected recurrent cases, the results, as checked by surgico-pathological findings, revealed a corroborative rate of 79.3% for CA125 assay and 87.5% for RII technique. The positive predictive value of both CA125 assay and RII were 100%, while the negative predictive value was only 25% for CA125 assay and 50% for RII technique. However, for each individual case if the results of the two tests were combined, the negative predictive value was also 100%. Preoperative CA125 level had no significant relationship with the prognosis in primary cases. But the two year survival rate for recurrent cases with a preoperative CA125 less than or equal to 35,000 U/L was much higher than those with CA125 greater than 35,000 U/L.

Treatment of malignant ovarian germ cell tumors with preservation of fertility: a report of 28 cases.

Preservation of fertility was carried out in 28 young patients with malignant germ cell tumors of the ovary from 1962 through 1987. The pathologic diagnosis was immature teratoma in 16, endodermal sinus tumor in 7, dysgerminoma in 2, and germ cell tumor of mixed type in 3. At laparotomy, 16 patients were proved to have stage I disease, 1 had stage II disease, 9 had stage III disease, and 2 had stage IV disease. The tumor was confined to one ovary in all 22 cases treated for the first time, and the preserved ovary and uterus were normal in all 6 referred cases with recurrent diseases. Postoperative chemotherapy was given to all patients except two with stage I immature teratoma. Persistent remission was achieved in 22 patients; 5 patients died and 1 was lost to follow-up. The duration of follow-up was more than 1 year for all surviving patients, more than 3 years in 16 cases (72.7%), and more than 5 years in 13 cases (59.1%). The menstrual periods were normal in all except 3 cases, of whom 2 were below the age of 12 and one failed to menstruate at the age of 21 with a hypoplastic uterus and underdeveloped secondary sex characters. Among 12 married patients, 7 of 10 desirous of child-birth became pregnant during follow-up. Of these, 6 had a normal term delivery and 1 is currently pregnant. The preliminary conclusion is that preservation of fertility for young patients with malignant germ cell tumors of the ovary, regardless of the stage of the disease, is a safe and practicable procedure in the absence of involvement of the contralateral ovary and uterus.

Intestinal metastasis and operation in ovarian cancer: a report on 62 cases.

Among numerous sites of metastasis in ovarian cancer, the most common and serious one is the intestinal tract. However, reports on ovarian malignancy with special reference to intestinal metastasis and its surgical treatment have been few. This paper is a retrospective analysis of cases of ovarian cancer with intestinal metastasis treated at the Peking Union Medical College Hospital. Sixty-two cases of ovarian cancer with intestinal metastatic tumours larger than 2 cm in diameter were treated between January 1982 and October 1987, accounting for 28.2% of a total of 221 cases of ovarian cancer admitted during the same period. Twenty-seven patients were operated on for the first time, 24 were referred from other hospitals where the cancer was considered 'inoperable' during the initial surgery, and 11 were recurrent cases. Of the 62 cases, 51 had epithelial cancer and 11 had germ-cell tumours. Metastasis to the large intestine was observed in all 62 cases, of which the rectosigmoid was involved in 59 (95.2%). Metastasis to the small bowel was observed in 26 cases (41.9%). Superficial or serosal invasion occurred in 40 cases (64.5%), and deep invasion, in which the muscularis or both muscularis and mucosa were involved, occurred in 22 cases. A complete or optimal resection of the intraperitoneal tumours was achieved in 46 cases (74.2%). Resection of metastatic tumours of the intestine was performed in 40 cases, of which a repair of the perforated intestinal wall was required in 19. Resection of the bowel was carried out in 22 cases, and a colostomy was done in 6. Postoperatively, all patients were followed up for at least 6 months. During follow-up, 17 patients (27.4%) survived, 39 died and 6 had recurrent disease. The mean survival time for 17 patients achieving complete remission was 30.3 months. Of these, ten have survived for more than 2 years, and seven for more than 3 years. The survival rate was higher in patients with germ-cell tumours and in those having superficial invasion of the intestinal wall, optimal cytoreduction of tumour and relatively sufficient postoperative chemotherapy. However, only the latter two prognostic factors were found to bear statistical significance. The role and feasibility of bowel surgery in ovarian cancer are discussed.

Lymph node metastasis and retroperitoneal lymphadenectomy in ovarian cancer.

While clinicians are devoting themselves to the study of the behaviour of ovarian cancer as well as to the search for more effective therapeutic modalities, little attention has been paid to an important route of metastasis in this group of diseases: retroperitoneal spread through the lymphatic pathway. The purpose of this report is to present a 5-year experience of a prospective study on lymph node metastasis in patients with ovarian cancer through retroperitoneal lymphadenectomy at the Peking Union Medical College Hospital. From June 1982 through May 1987, retroperitoneal lymph node dissection was performed in 105 cases of ovarian cancer. Seventy-seven (73.3%) were histologically diagnosed as cancer of epithelial origin, and 28 (26.7%) as germ-cell tumours. The overall incidence of retroperitoneal positive nodes was 54.3% (57/105). The incidence of positive pelvic nodes was 46.7% (49/105), and that of positive para-aortic nodes was 37.5% (30/80). In 69 patients who underwent systemic lymphadenectomy, 39 were found to have glandular involvement; in these 39 patients both aortic and pelvic nodes were positive in 19 cases (48.7%), aortic nodes were positive and pelvic nodes negative in 7 cases (18.0%), and pelvic nodes were positive and aortic nodes negative in 13 cases (33.3%). Preoperative lymphography was performed in 30 cases. The positive and negative correspondence rates with the pathological findings were both 83.3%. In 38 cases in which the primary cancer originated in the left ovary, 17 (44.7%) were found to have positive pelvic nodes, whereas in 25 cases with primary cancer arising in the right ovary only 2 (8%) had metastasis of the ipsilateral pelvic nodes. The lymph nodes obtained from 22 patients with positive nodes and sufficient preoperative chemotherapy were carefully examined under the microscope for the effects of the drugs. Some cellular degeneration of the lymph node metastasis was observed in only one of the 15 cases of epithelial cancer, and no response at all was noted in three cases of immature teratoma. Cellular degeneration accompanied by extensive necrosis was demonstrated in the metastatic tumours of the lymph nodes in all four cases of endodermal sinus tumour. Seventy-two patients were followed-up for at least 2 1/2 years. The rate of complete remission was 46.7% (14/30) in patients with negative nodes, but only 33.3% (14/42) in those with positive nodes. However, the difference was not statistically significant.

Lymph node metastasis of ovarian cancer: a preliminary survey of 74 cases of lymphadenectomy.

Retroperitoneal lymph node dissection was performed in 74 cases of various types of ovarian malignancies. Fifty-three (71.6%) were histologically confirmed as cancer of epithelial origin and 19 (25.7%) as germ cell tumors. The results indicate that lymphatic metastasis is an exceedingly important route of spreading of this group of malignant diseases. The overall incidence of retroperitoneal positive nodes was 56.8% (42/74). In 49 cases undergoing systemic lymphadenectomy 32 were found to have glandular involvement, of which both aortic and pelvic nodes were positive in 17 cases (53.1%), aortic nodes positive but pelvic negative in six (18.8%), and pelvic nodes positive but aortic negative in nine (28.1%). In 32 cases with primary cancer that originated from the left ovary, 17 (53.1%) were found to have positive pelvic nodes, whereas in 19 cases with cancer arising from the right ovary, only one (5.3%) had metastasis of ipsilateral pelvic nodes. The routes of lymphatic spreading and the significance of lymphadenectomy in ovarian cancer are discussed.