Outcomes and Prognostic Factors of Patients with Platinum- Resistant or Refractory Epithelial Ovarian Cancer, Fallopian Tube Cancer and Peritoneal Cancer.

OBJECTIVE: To determine the survival outcomes and prognostic factors of the patients with recurrent platinumresistant and refractory epithelial ovarian cancer (EOC), tubal, and peritoneal cancer. METHODS: Women with recurrent platinum-resistant and refractory EOC, tubal and peritoneal cancer who received treatment at the HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC) between January 2010 and December 2019 were included. Demographic data, serum marker, surgical factors, pathological factors and response of treatment were reviewed. Kaplan-Meier was used to calculate survival outcome. RESULT: Forty patients were recruited in this study (platinum-resistant 24 patients and refractory 16 patients). The median survival times were 19 and 21 months in and platinum-resistant and platinumrefractory patients, respectively. There were no significant differences in overall survival according to age, comorbidity, tumor grading, primary treatment, and secondary surgery. However, histology of clear cell carcinoma may associate with increased risk of death. The median overall survival of patients with clear cell carcinoma, serous carcinoma, and others were 14.4, 22.9, and 32.2, respectively (p = 0.003). CONCLUSION: Almost 10 years, the survival rate of the patients in these group has not increased despite new treatments option. Novel strategies should be considered in National policy of the treatment for ovarian cancer in our country.

Clear cell adenocarcinoma of the cervix in second generation young women who are without maternal exposure to diethylstilbestrol: A case report.

Clear cell adenocarcinoma of the cervix (CCAC) is a rare type of gynecological cancer. The risk factors and pathogenesis have yet to be clearly determined. This is a case report of a 19-year-old woman, who was never exposed to DES from her mother, who had gone for an examination for vaginal bleeding. A polypoid mass measured at 3 cm presenting in her cervix was discovered. Histological diagnosis following cervical biopsy proved the tumor to be a clear cell carcinoma. The patient was then referred to our hospital. A loop electrosurgical excision procedure (LEEP) was done and the pathological diagnosis was confirmed for clear cell carcinoma with a positive endocervical margin. Radical hysterectomy, pelvic lymphadenectomy and incidental appendectomy were achieved without any complications. The microscopic findings had revealed no residual tumor. The patient did not require adjuvant treatment. No sign of recurrence has been detected throughout 6 months of follow-up. We have performed the literature review on the clinical presentation, pathogenesis, pathology, diagnosis, treatment, and prognosis of this unusual tumor.

Pelvic Retroperitoneal Cellular Leiomyoma: A Case Report.

Leiomyomas are common benign gynecological tumors and usually arise in the uterus. The retroperitoneal cellular leiomyoma, one of the unusual manifestations, is a rare tumor. Diagnosis and treatment are challenges. We report a case of 65-year-old women presented with an asymptomatic mass beneath the right posterior vaginal mucosa. CT imaging revealed heterogeneous mass 6 cm in the pelvic cavity abutted lower segment of uterus, cervix, and vagina. The provisional diagnosis was subserosal cervical leiomyoma. She underwent exploratory laparotomy. Intra-operative, a normal size uterus was found separately from retroperitoneal pelvic mass at the level of internal os. Histological report confirmed cellular leiomyoma later Total hysterectomy, bilateral salpingoophorectomy and completely excision of tumor were achieved with good outcome. Our patient represents the rare case of retroperitoneal cellular leiomyoma, which is hardly identified from internal examination and preoperative imaging. Surgical removal is essential for pathological diagnosis and treatment.

See-and-treat approach to cervical intraepithelial lesions in HRH Princess Maha Chakri Sirindhorn Medical Center.

BACKGROUND: To evaluate the overtreatment rate with the see and treat approach in the management of women with abnormal cervical cytology. MATERIALS AND METHODS: A retrospective review of patients with abnormal cervical cytology who underwent S and T at MSMC between January 2008 and December 2012 was conducted. Loop electrosurgical excision procedure (LEEP), histological results, cytology and colposcopic impression were analyzed to evaluate overtreatment rate, cyto-histologic correlation and related factors. RESULTS: Average age of S and T cases was 42 years. Ninety seven percents were referred from affiliated health care providers. The study revealed 83.2% patients had HSIL or higher from cervical cytology. Correlation between HSIL and final histology was relatively low at 75% compared to other studies. Overtreatment rate was 28%. CONCLUSIONS: S and T was done in 197 patients in a tertiary care health facility with patient satisfaction. Overtreatment occurred, but the rate can be reduced with appropriate recommendations. HSIL Pap smears should be reexamined before S and T while low grade and lesser colposcopic impression groups should obtain conventional colposcopic approach for patient future reproductive benefit.

Predictive factors for residual disease in the uterine cervix after large loop excision of the transformation zone in patients with cervical intraepithelial neoplasia III.

OBJECTIVE: To determine predictive factors for residual disease in uterine cervix after large loop excision of the transformation zone (LLETZ) in patients with cervical intraepithelial neoplasia III (CIN III). MATERIAL AND METHOD: Medical records of patients who underwent LLETZ with CIN III between September 1, 1992 and December 31, 2001 in Ramathibodi Hospital were reviewed. Demographic data, colposcopic findings, and pathologic parameters were analyzed to identify the predictive factors for residual disease in uterine cervix. RESULTS: The total of 541 cases were enrolled in this study. Managements after LLETZ are 1) repeated LLETZ, 2) hysterectomy, and 3) Papanicolaou smear. Residual disease was detected in a total of 156 patients (28.84%), there were 21 cases of CIN I (13.46%), 22 cases of CIN II (14.10%), 107 cases of CIN III (68.59%), and 6 (3.85%) cases of microinvasive squamous cell carcinoma of cervix. 1) Age > or = 50 years old was significant factor associated with residual disease. The incidence of residual disease was 50.00%. 2) Unsatisfactory colposcopy was significant factor associated with residual disease with 38.44% incidence of residual disease. 3) Margins involvement of LLETZ specimen was the only pathological predictive factor identified. The incidence of residual disease with clear margin, endocervical margin, ectocervical margin, and both margins involvement were 14.74, 52.63, 57.14, and 74.19% respectively. Other parameters, including gravidity, parity, menopausal status, cervical gland involvement, and number of quadrants involvement were not predictive of residual disease. CONCLUSION: 1) Age > or = 50 years old, 2) unsatisfactory colposcopy, and 3) margins involvement of LLETZ specimens were the predictive factors for residual disease in uterine cervix.

Laparoscopic management of 53 cases of cornual ectopic pregnancy.

OBJECTIVE: To present our experience of laparoscopic management of cornual ectopic pregnancy. DESIGN: Retrospective review of 53 cases of cornual pregnancy treated laparoscopically. SETTING: K.K. Women's and Children's Hospital, Singapore. PATIENT(S): Patients who were treated for cornual pregnancy via laparoscopic surgery from 2001 to 2006. INTERVENTION(S): Laparoscopic surgery as a treatment modality for cornual pregnancy. MAIN OUTCOME MEASURE(S): Success rate of laparoscopic surgery and future reproductive outcome. RESULT(S): Fifty-two cases were managed by laparoscopy, and one was converted to laparotomy. Laparoscopic wedge resection was carried out in 33 patients, cornuostomy in 13 patients, and salpingectomy in 7 patients. Nine patients received methotrexate injection after surgery because of persistently high serum beta-hCG. Eighteen patients became pregnant, four had early miscarriages, and ten had pregnancies beyond 24 weeks' gestation. Five delivered vaginally, and three had cesarean section at term. Two patients traveled back to their native countries for delivery. There were no cases of uterine rupture or dehiscence reported. CONCLUSION(S): Laparoscopic treatment of cornual pregnancy can be safely carried out with good results in an institution with trained laparoscopist and adequate facilities.

Implanon failure.

A 28-year old woman, P1-0-1-1 presented with 5-month amenorrhea after having had single--rod 68 mg--etonorgestrel contraceptive implant (Implanon) for 18 months. Pregnancy was diagnosed by physical examination and confirmed by ultrasonography. At first, she wanted to have her pregnancy terminated because of a financial problem and anxiety about fetal anomaly as well as pregnancy complication. However, after counseling, she decided to continue her pregnancy and had a normal male infant delivered by cesarean section. This pregnancy is considered as product failure, which is very rare and is the first report in Thailand. Clinical counseling on medical risk of pregnancy and fetal anomaly can reduce the mother's anxiety and assure her to carry on her pregnancy as done in this case.