Extraperitoneal lymph node dissection in locally advanced cervical cancer; the prognostic factors associated with survival.

OBJECTIVE: Surgical staging was recently recommended for the decision of treatment in locally advanced cervical cancer. We aimed to investigate clinical outcomes as well as factors associated with overall survival (OS) in patients with locally advanced cervical cancer who had undergone extraperitoneal lymph node dissection and were managed according to their lymph node status. MATERIAL AND METHODS: The medical records of 233 women with stage IIb-IVa cervical cancer who were clinically staged and underwent extraperitoneal lymph node dissection were retrospectively reviewed. Paraaortic lymph node status determined the appropriate radiotherapeutic treatment field. Surgery-related complications and clinical outcomes were evaluated. RESULTS: The median age of the patients was 52 years (range, 26-88 years) and the median follow-up time was 28.4 months (range, 3-141 months). Thirty-one patients had laparoscopic extraperitoneal lymph node dissection and 202 patients underwent laparotomy. The number of paraaortic lymph nodes extracted was similar for both techniques. Sixty-two (27%) of the 233 patients had paraaortic lymph node metastases. The 3-year and 5-year OS rates were 55.1% and 46.5%, respectively. The stage of disease, number of metastatic paraaortic lymph nodes, tumor type, and paraaortic lymph node status were associated with OS. In multivariate Cox regression analyses, tumor type, stage, and presence of paraaortic lymph node metastases were the independent prognostic factors of OS. CONCLUSION: Paraaortic lymph node metastasis is the most important prognostic factor affecting survival. Surgery would give hints about the prognosis and treatment planning of the patient.

Vanishing endometrial carcinoma in hysterectomy specimens: probable implications for fertility sparing management

Background/aim: The vanishing cancer phenomenon was first reported in radical prostatectomy specimens in the absence of neo-adjuvant treatment. Reported cases are mostly well-differentiated and low-volume tumors. A similar entity was described for hysterectomy specimens of patients with biopsy proven endometrial cancer (EC). In this study, we discuss the probable reasons for vanishing EC and long-term follow-up results of EC patients without residual tumors in hysterectomy specimens. Materials and methods: This study was carried at two institutions in Ankara, Turkey, in a retrospective design. The computerized databases of both institutions were searched for endometrioid type EC patients whose final pathological specimens failed to show any residual tumor. Results: We evaluated 38 endometrial biopsy confirmed EC patients with no residual tumor detected in the hysterectomy specimens among a total of 224 women (17%) with the disease confined to the endometrium. During the follow-up period, no recurrences were noted among the patients. Conclusion: It can be suggested that premenopausal women with FIGO grade 1 endometrioid type EC with MRI proven "absent myometrial invasion" would have a significant probability of having no residual tumor after endometrial biopsy without any further medical treatment.

Mucinous borderline ovarian tumors: Analysis of 75 patients from a single center.

OBJECTIVE: To analyze the clinicopathologic features, recurrence and survival rates, reproductive history, and treatment of patients with mucinous borderline ovarian tumors (mBOTs). MATERIAL AND METHODS: Patients with a diagnosis of mBOT were evaluated retrospectively. Patients with borderline ovarian tumors other than mucinous type and concomitant invasive cancer were excluded. RESULTS: A total of 75 patients were identified. Median age was 38 years. The most common symptom was pain (42.7%). Median CA-125 level was 23.5 IU/mL (range, 1-809 IU/mL). Median tumor size was 200 mm (range, 40-400 mm), and 6.7% of mBOTs were bilateral. Thirty-six (48%) patients underwent staging surgery. Two patients (5.9%) had nodal involvement. One patient received platinum-based adjuvant chemotherapy. One (1.3%) patient had recurrence. None of the patients died because of the ovarian tumor. A total of 43 patients had conservative surgery. CONCLUSION: Prognosis of mBOTs is excellent, and fertility-sparing surgery should be considered in the reproductive age group. Furthermore, the necessity of staging surgery is controversial.

Amphricrine carcinoma of the cervix-adeno neuroendocrine tumor: A case report.

Adenoneuroendocrine carcinoma is a very rare form of cervical carcinoma that includes both endocrine and exocrine components. In general terms, these carcinomas progress aggressively and show early metastases due to the neuroendocrine component. The most important criteria related to prognosis is the stage of the disease. Without clearly determined therapeutic protocols this carcinoma is generally seen at earlier ages and causes high mortality. Many radiotherapy and multidrug chemotherapy protocols are used after surgical intervention. Detection of the neuroendocrine component of cervical tumors is achieved through immunohistochemical staining. Herein, we present a woman aged 50 years who was admitted to the hospital with abdominal pain and postmenopausal vaginal bleeding whose examination revealed a cervical tumor. A pathologic examination after surgery resulted as "adenocarcinoma and large cell neuroendocrine carcinoma." Afterwards, a combined chemotherapy regimen (cisplatin + etoposid) was administered to the patient and 6 months of progress is evaluated in this report.

Malignant transformation of mature cystic teratoma of the ovary: a case series.

The aim of this study was to analyze the patients with malignant transformation (MT) arising in mature cystic teratoma of the ovary (MCTO) and evaluate the clinicopathologic features, managements, and prognosis of these cases. The records of the patients with MT arising in MCTO who were treated at our hospital were reviewed retrospectively. The demographic features, presenting symptoms, preoperative ultrasonographic evaluations, surgical treatments, pathological findings, adjuvant therapies, follow-up outcomes, and survival time were examined. Eighteen patients with MT arising in MCTO were detected during the study period. The incidence rate of MT was 0.404% of all MCTO and squamous cell carcinoma was the most common histologic type (66.7%). The median age of the patients was 48 (range, 28-79) and the mean tumor size was 12 cm. Eleven patients (61.1%) were classified as stage IA, 1 (5.6%) as stage IC, 1 (5.6%) as stage IIC, 4 (22.2%) as stage IIIC, and the remaining 1 (5.6%) as stage IV. The overall 5-year survival rate was 66.7%. MT of MCTO is a rare occurrence entity and early detection and complete surgical staging are cardinal for survival. Additionally, this malignancy usually occurs in postmenopausal women and the high tumor diameter may be associated with MT.

Juvenile granulosa cell ovarian tumor: clinicopathological evaluation of ten patients.

OBJECTIVE: We aimed to analyze the clinical characteristics and management of ten patients who were diagnosed with juvenile granulosa cell ovarian tumor (JGCOT). MATERIAL AND METHODS: The records of 10 patients diagnosed with JGCOT between April 1995 and January 2014 in the Gynecological Oncology Clinic of our institution were retrospectively evaluated. RESULTS: The median age of the patients was 21.5 years (range; 13-36). Nine patients had stage IA disease and one had stage IC disease according to the International Federation of Gynecology and Obstetrics (FIGO) criteria. Five patients underwent pelvic and para-aortic lymph node dissection. None of them had lymph node involvement. All but two patients underwent unilateral salpingo-oophorectomy. One of the other two patients had cystectomy and the other had total abdominal hysterectomy and bilateral salpingo-oophorectomy. Three patients had adjuvant therapy after surgery. Two of these patients took chemotherapy and the other took radiotherapy. Four of the five patients who desired pregnancy achieved five term pregnancies. The median follow-up time of the patients was 58 months (range; 3-113). No recurrence was observed in the follow up period. CONCLUSION: JGCOT generally occurs during childhood. The primary management of JGCOT is through surgery. The role of adjuvant therapy is controversial. Because survival is long at early stages and most of the patients are young, fertility sparing surgery could be safely suggested to these patients.

Case report: Methotrexate-induced pericardial effusion.

We report a case of pericardial effusion induced by methotrexate in a patient with low risk gestational trophoblastic neoplasia, who had been taking the first course of sequential methotrexate-folinic acid treatment. After aspiration of pericardial effusion another methotrexate-folinic acid course was given and the pericardial effusion did not relapse.

Chylous ascites: analysis of 24 patients.

OBJECTIVES: Chylous ascites is the pathologic accumulation of lymphatic fluid in the peritoneal cavity. Patients who underwent surgery for gynecologic malignancy and had postoperative chylous ascites were evaluated retrospectively. METHODS: We reviewed 1514 patients who had staging surgery for gynecologic malignancy at our institution from January 2003 to February 2012. We analyze the patients who develop chylous ascites and who didn't. RESULTS: Twenty-four (2%) patients had postoperative chylous ascites. In the patients with chylous ascites, the median number of removed para-aortic lymph nodes was 26 (range 8-54), while this number was 17 (range 1-76) for the patients who didn't develop chylous ascites (p=0.001). Among the patients with chylous ascites, nine patients took chylous diet and 15 patients took TPN as the initial treatment. Totally seven (29%) patients required surgical correction, since 17 (71%) responded to conservative treatment. In the TPN group, the time from staging surgery to the diagnosis of chylous ascites was significantly longer in the group who required surgery compared with the group who did not (20 days vs 8 days, p:0.037). In addition this time wasn't statistically different from the patients' time in the diet group who didn't require surgery. CONCLUSION: The aggressiveness of para-aortic lymphadenectomy should be individualized and the lymphatics should be controlled with suture ligation or hemoclips, since the extent and method of para-aortic lymphadenectomy has a determinative role in the development of chylous ascites. It may be logical to treat chylous ascites with diet rather than TPN initially in case the symptoms occur later.

Peritoneal tuberculosis mimicking advanced ovarian cancer: a retrospective review of 22 cases.

OBJECTIVE: To evaluate the clinical, laboratory and diagnostic features in women with peritoneal tuberculosis that resembled advanced ovarian malignancy. METHODS: A retrospective review of women with peritoneal tuberculosis who were managed at TCSB Ankara Etlik Maternity and Women's Health Teaching and Research Hospital from July 1992 to November 2004 was undertaken. RESULTS: Among the 1,826 women treated during the study period, 22 women with peritoneal tuberculosis (1.2%) were identified. The mean age was 36.9 years (range 21-68 years); the mean Ca125 level was 564.95 U/ml (3-2021 U/ml). All patients with peritoneal tuberculosis had ascites, 20 patients (90.91%) had elevated CA125 levels and 17 patients (77.27%) had detectable pelvic masses in the preoperative period. During preoperative diagnostic work-up, pulmonary tuberculosis was diagnosed and antituberculosis therapy had begun in two of 22 patients (9.09%). Among 20 patients, 11 (55%), 8 (40%) and 1 (5%) underwent exploratory laparotomy, diagnostic laparoscopy and laparoscopy converted to laparotomy due to dense pelvic adhesions, respectively. Since frozen section was not available during the surgery in 5 of 20, 3 patients (10%) underwent extended surgery. Frozen section was performed in 15 patients and revealed chronic granulomatous changes and final pathological examination confirmed the diagnosis. CONCLUSION: Our data indicate that the majority of the cases with peritoneal tuberculosis can be diagnosed intraoperatively through the use of frozen section in conjunction with clinical features. Ascites and high levels of Ca125 do not necessarily indicate that the clinical picture is malignant in reproductive women. Laparoscopic tissue biopsy may be a fundamental tool in the management of such cases to avoid extended surgery.