Ovarian carcinoma metastatic to the breast.

Breast involvement in ovarian cancer is extremely rare. We report a case of solitary breast metastasis from ovarian carcinoma in a 43-year-old white woman, 3 months following diagnosis of ovarian cancer. The diagnostic, therapeutic and prognostic aspects as well as a review of the literature of this uncommon site of metastasis are discussed.

Combined intrauterine and ovarian pregnancy after in vitro fertilization and embryo transfer: a case report.

We describe the natural course and the management of a very rare combined intrauterine and ovarian pregnancy after IVF/ET. The rarity of heterotopic and ovarian pregnancies, with the etiologic, diagnostic and therapeutic aspects of this rare case are reported.

Successful treatment of cervical and simultaneous cervico-isthmic pregnancy with methotrexate.

OBJECTIVE: To describe the monitoring of a case of cervical and simultaneous cervico-isthmic pregnancy. SETTING: University of Bari (Italy), Department of Obstetrics and Gynecology. PATIENT: A 30-year-old white woman, nulliparous, at 8 weeks of amenorrhoea. INTERVENTION: Methotrexate and folinic acid administered systemically. MAIN OUTCOME MEASURE: Treatment success was defined as elimination of the cervical and cervico-isthmic pregnancy, with non-invasive treatment and preservation of the uterus and normal ovarian activity restored. RESULT: Methotrexate and folinic acid were administered, elimination of a twin pregnancy with declining serum beta-hCG levels and with ultrasound was observed. The patient had only occasional dark vaginal bleeding and temporary movement of the transaminase. CONCLUSION: This case report shows that methotrexate is a valid, conservative and non-invasive treatment for a patient affected by cervical pregnancy who wishes to keep fertility.

Ovarian pregnancy: a case report.

We report a rare case of ovarian pregnancy occurring in a 34-year old woman after natural conception. The natural history, management, and outcome of this rare extrauterine pregnancy are described.

Malignant mixed mullerian tumor of the ovary: report of four cases.

INTRODUCTION: Malignant mixed mullerian tumor (MMMT) of the ovary is an extremely rare gynaecologic neoplasm that represents 1% of the malignances of this organ. Stage I disease is rare because it is asymptomatic in early stage. We describe four cases. CASE REPORTS: In the Department of Obstetrics and Gynecology of the University of Bari four cases of MMMT of the ovary were diagnosed. Three patients were in stage IIIC and one of them was a homologous MMMT; the fourth patient was affected by a heterologous stage IV MMMT. All women were treated with surgery and chemotherapy. Two patients are alive 14 and 12 months after diagnosis. The other two died after 37 months and one month, respectively. CONCLUSIONS: The malignant mixed mullerian tumor (MMMT) of the ovary is a particularly aggressive tumor, especially in advanced stages. The survival rate is very low in spite of surgery, chemotherapy and radiotherapy. The optimal treatment for this neoplasm is unknown because of its rarity. Our experience, when considering survival, seems to confirm the use of cisplatin and ifosfamide and to give new horizons to taxol.

Large-cell variant of small cell carcinoma of the ovary with hypercalcaemia.

A rare case of large-cell variant of hypercalcemic small cell carcinoma of the ovary diagnosed in a 17 year-old girl is presented and discussed. The patient died of disease progression and severe hypercalcemia within 25 months of diagnosis.

Socio-demographic factors and indications in second trimester voluntary abortion.

BACKGROUND: According to Italian Law, second trimester termination of pregnancy is allowed for life threatening conditions or for severe psychological distress, linked or not to prenatal diagnosis of foetal abnormalities. Socio-demographic factors related to this condition have been analysed. METHODS: Clinical records of 330 patients admitted during the years 1988-1997 to the Obstetrics and Gynaecology Department, University of Bari, Italy, for voluntary second trimester abortion, were examined. Maternal psychiatric indications have been given in nearly all of the cases. In 123 cases the indications were secondary to the women suffering a psychiatric disorder due to foetal pathologies. In 205 cases--where poor social conditions were more frequent--the indication was given on the ground of a psychiatric disorder linked to the pregnancy itself. RESULTS: Significantly higher incidence of teenagers (23.3%) and singles (50%) in women who underwent a late abortion. Students were 16.4% in this group. In primary psychiatric indication singles prevail (74.4%) and students represent 23.6% while in secondary psychiatric indication the married were 84.7%, students only 4.8%. In primary psychiatric indication 32.5% of women aged nineteen or less, while in secondary psychiatric indication this percentage was 8%. CONCLUSIONS: Among patients who have a late abortion, teenagers students and singles are prevalent, these patients have significantly more primary psychiatric indications, not linked to foetal abnormalities. The high percentage of teenagers with primary psychiatric indication could depend on inadequate information and social service. Reduction of mid-trimester terminations of pregnancy can be significantly achieved intervening in this group of young women. On the other hand, in secondary indications earlier diagnosis of foetal abnormalities must be encouraged (villocentesis instead of amniocentesis) and abortion discouraged when the foetal pathology is minor, treatable or unlikely to significantly impair the future quality of life.

Primary peritoneal carcinoma: a report of twelve cases and a review of the literature.

Primary peritoneal carcinoma (PPC) is rare tumor histologically identical to epithelial ovarian carcinoma (EOC); it is differentiated from EOC based on the extent of gross ovarian involvement and microscopic invasion of the cortex. We report 12 cases of PPC which were diagnosed in our Department during a 9-year period. Total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy were performed in 9 patients, while 3 underwent only explorative laparotomy with bilateral salpingo-oophorectomy. All patients were treated with postoperative platinum-based chemotherapy. After a median follow-up of 42 months, only 5 patients are alive without disease. PPC is a rare tumor currently managed in the same way as ovarian cancer. Primary debulking surgery and chemotherapy represent the cornerstones of treatment. Considering the limited number of patients with PPC, no definitive conclusion can be drawn concerning the prognostic factors for survival.

[Reconstructive surgery in oncological gynecology. Our experience]. / La chirurgia ricostruttiva in ginecologia oncologica. Nostra esperienza.

BACKGROUND: Personal experience in reconstructive surgery for gynecologic oncology is reported. These techniques are playing, during last years, a leading role since it is necessary to assure a good treatment and top quality lifestyle to oncologic patients. METHODS: A retrospective study was made on 357 major surgical treatments for neoplastic disease at the IInd Clinic of Obstetrics and Gynecology, University of Bari. For each disease the technique, the length of surgery and possible complications have been reported. In total 50 reconstructive procedures on 357 surgical interventions for gynecologic neoplastic disease (14%) were made. RESULTS: There was no rate of mortality, and the complications were found only in 5 patients (10%). CONCLUSIONS: Reconstructive surgery can increase surgical radicality, improve the quality of life of the patients and reduce the postoperative complications.

[Combination of cisplatin and vinorelbin in the neoadjuvant treatment of locally advanced cervical carcinoma. Phase II study]. / Associazione di cisplatino e vinorelbina nel trattamento neoadiuvante del cancro cervicale localmente avanzato. Studio di fase II.

BACKGROUND: Aim of this phase II study is to evaluate the cytoreductive efficacy and the toxicity of a regimen consisting of cisplatin and vinorelbine as neoadjuvant chemotherapy for three cycles every 21 days in patients with locally-advanced cervical carcinoma. METHODS: Between April 1996 and December 1998, 33 untreated patients with locally-advanced cervical carcinoma received neoadjuvant chemotherapy with cisplantino 80 mg/m2 (day 1) plus vinorelbine 25 mg/m2 (day 1 and 8). Within 28 days from completion of chemotherapy patients in complete or partial response were submitted to radical hysterectomy plus pelvic lymphadenectomy. RESULTS: Twenty-six patients (79%) were submitted to radical surgery; four patients were not submitted to surgery because of poor response to treatment, two for anesthesiological contraindications and one refused surgery. The combination of cisplatin plus vinorelbine in this phase II study induced a clinical overall response rate of 90%, with 8 pathologic complete response (24%). CONCLUSIONS: The association of cisplatin and vinorelbine as neoadjuvant chemotherapy in locally-advanced cervical carcinoma showed to be safe and effective with a low cost and poor toxicity.

Splenic involvement in ovarian cancer. Description of three cases.

Metastatic involvement of the spleen in patients with ovarian cancer is unusual. Solitary splenic metastasis in the absence of disseminated disease are rare. Three cases of advanced ovarian cancer with splenic involvement are reported. The splenectomy was adopted in two patients.

Aggressive angiomyxoma of the pelvis. A case report.

Aggressive angiomyxoma is a locally mesenchymal, benign, and rare neoplasm. The vulva, perineum, and pelvis are the most common sites of involvement. The preoperative diagnosis is postulated by CT, sonography, MR image and angiography. The immunohistochemical study reveals the definitive diagnosis. The therapy is only surgical, and because of its tendency to recur locally, the excision has to be as complete as possible.

Prognostic factors and selective use of vaginal hysterectomy in early stage endometrial carcinoma.

INTRODUCTION: Endometrial cancer represents the fourth most frequent malignancy in women of any age, tending to become the most common gynaecological tumor in developed Countries. A retrospective analysis has been conducted on the prognostic factors of endometrial neoplasm during 15-years experience (1977-1991). MATERIAL AND METHODS: 321 patients affected by stage I and II endometrial carcinoma have been treated surgically first hand. Surgical-pathological staging and prognostic factors were reviewed and related to follow-up and 5-year survival rate. RESULTS: The age-peak of patients was 50-70 years; prevalent histologic type was adenocarcinoma (95.6%); 269 patients were in stage I and 52 in stage II. In stage I disease overall 5-year survival rate resulted to be 81.4%, while in stage II it fell to 59.6%. DISCUSSION: Myometrial involvement by adenocarcinomatous cells is probably the most important prognostic factor, considering its reliability and non-contradictory evaluation. Our data confirm there is no difference in impact on 5-year survival between abdominal and vaginal routes in clinical stage I and occult stage II endometrial carcinoma.

Endometrial stromal sarcoma: a clinicopathologic study.

BACKGROUND: This study is a clinicopathologic evaluation of five patients with endometrial stromal sarcoma. PATIENTS AND METHODS: Over a period of 9 years 5 cases of ESS were observed in our Unit. The patients were retrospectively staged according to the FIGO staging system for endometrial cancer. The neoplasm was divided into two groups based on mitotic activity. Patients underwent endouterine curettage, surgery therapy and, except one of them, chemotherapy. RESULTS: Two patients had low-grade ESS stage Ib and Ic. The other three had high-grade ESS, and were in stage IIIa. Treatment was surgery for all patients, and adjuvant chemotherapy for 4 out of 5. Both patients in stage I are alive, clinically free from the disease, 25 and 36 months after diagnosis. In stage III all patients died 14, 25 and 36 months after diagnosis. CONCLUSION: ESS is a rare uterine neoplasm. Histologic grade is the most important prognostic factor.

Hypersensitivity reactions in ovarian cancer patients receiving paclitaxel.

OBJECTIVE: The aim of this study was to describe a rapid retreatment strategy in patients with paclitaxel hypersensitivity reactions. METHODS: A retrospective review of all patients receiving standard 3-hour infusion paclitaxel-based chemotherapy after proper premedication at the Department of Gynecologic Oncology, University of Bari between 1995 and 1998, was performed. All patients who developed hypersensitivity reactions to paclitaxel were identified and their treatment course and outcome were reviewed. A review of the literature on this subject is also presented. RESULTS: Eighty-six women were treated with 461 cycles of paclitaxel-based chemotherapy at our Unit. Twelve patients (14%) developed hypersensitivity reactions. All had received standard premedication consisting of corticosteroids and hystamine blockers. Hypersensitivity reactions consisted of isolated face flushes (3 patients), dyspnea and chest tightness (4 patients) or bronchospasm (5 patients). Eleven patients were rechallenged with the original paclitaxel solution starting at a slower rate after a second premedication with a double dosage of steroids. None of these patients had reactions in subsequent courses. Only one patient (the first of this series treated in February 1995), was retreated 5 days later under strict monitoring in intensive care unit. CONCLUSIONS: Retreatment with the original paclitaxel solution is safe in almost all patients with hypersensitivity reactions. The drug should be administered within the next 24 hours with a new premedication protocol.

[Chemotherapy in the treatment of ovarian carcinosarcoma]. / La chemioterapia nel trattamento del carcinosarcoma dell'ovaio.

Carcinosarcoma of the ovary is a rare neoplasm representing 1% of this organ malignancies. The disease appears almost exclusively in advanced stage having an unfavourable prognosis. Three patients affected by carcinosarcoma (MMMT) of the ovary admitted to our Operative Unit have been treated. All patients underwent surgery and subsequently chemotherapy. Two patients were affected by heterologous MMMT and were stage IV and IIIc respectively, the other one, affected by homologous MMMT, was stage IIIc. Stage IV patient was submitted to 6 cycles of CARBO + IFX + CDDP, second look and further 6 cycles of TAX. After 23 months she was submitted to colostomy for intestine occlusion. At the 35 months she died for cachexia and intestine occlusion. Stage IIIc heterologous patient was submitted to 6 cycles of CDDP + EPI + IFX + MESNA for 3 days; at 6 months from diagnosis she did not present any sign of disease. Stage IIIc homologous patient, affected by chronic renal insufficiency and submitted to dialysis, underwent 5 cycles of TAX and at 11 months from diagnosis presented partial response. Carcinosarcoma of the ovary, because of its rarity, and of the poor record of cases in the literature, is a much debated topic in particularitis complementary therapy. Opinions of the several authors are in contrast regarding the use of CHT + RT at the same time. Only RT after surgery does not seem to improve the survival of these patients. Personal experience, with the reported outlines, compared with survival, seems to confirm the use of CDDP and of IFX and to give new horizons to TAX, waiting for further findings.

Pure lipoma of the uterus in association with endometrial carcinoma.

Pure lipoma of the uterus is a very rare entity, with few cases described in the English literature. We report the case of a 71-year-old woman, with pure lipoma of the uterus and coexistent endometrial carcinoma and discuss the possible relationship between these pathologic entities.

[Acute urinary retention in uterine myoma: description of a case]. / Ritenzione urinaria acuta da mioma uterino: descrizione di un caso.

We report the case of a 50-year-old woman admitted to our Unit with the diagnosis of acute urinary retention due to huge uterine leiomyoma. Total abdominal hysterectomy resulted in resolution of the urologic symptomatology.

Prolonged survival of stage IV malignant mixed Müllerian tumor of the ovary after carboplatin, mesna, ifosfamide, and cis-platin chemotherapy: case report.

Malignant mixed müllerian tumors (MMMT) of the ovary are rare, aggressive and rapidly progressive tumors. According to the available literature, the presence of metastatic disease rarely permits long term survival. We report on a 64-year old patient with stage IV ovarian MMMT who achieved a surgically-documented complete response (CR) after 6 cycles of carboplatin, mesna, ifosfamide, cis-platin. Pelvic recurrence was diagnosed 14 months later; the patient received 6 cycles of the same regimen used as first-line chemotherapy which resulted in a second complete response lasting for 4 months. The patient died 37 months after initial diagnosis due to intestinal occlusion. In the current case Ca 125 was significantly increased at clinical presentation of disease but not at the time of recurrence.