Bevacizumab Treatment for Low-Grade Serous Ovarian Cancer: A Systematic Review.

Serous epithelial ovarian cancer, classified as either high-grade (90%) or low-grade (10%), varies in molecular, histological, and clinicopathological presentation. Low-grade serous ovarian cancer (LGSOC) is a rare histologic subtype that lacks disease-specific evidence-based treatment regimens. However, LGSOC is relatively chemo-resistant and has a poor response to traditional treatments. Alternative treatments, including biologic therapies such as bevacizumab, have shown some activity in LGSOC. Thus, the objective of this systematic review is to determine the effect and safety of bevacizumab in the treatment of LGSOC. Following PRISMA guidelines, Medline ALL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase all from the OvidSP platform, ClinicalTrials.gov, International Clinical Trials Registry Platform, International Standard Randomised Controlled Trial Number Registry were searched from inception to February 2022. Articles describing bevacizumab use in patients with LGSOC were included. Article screening, data extraction, and critical appraisal of included studies were completed by two independent reviewers. The effect of bevacizumab on the overall response rate, progression-free survival, overall survival, and adverse effects were summarized. The literature search identified 3064 articles, 6 of which were included in this study. A total of 153 patients were analyzed; the majority had stage IIIC cancer (56.2%). The overall median response rate reported in the studies was 47.5%. Overall, bevacizumab is a promising treatment for LGSOC, with response rates higher than traditional treatment modalities such as conventional chemotherapy, and is often overlooked as a treatment tool. A prospective clinical trial evaluating the use of bevacizumab in LGSOC is necessary to provide greater evidence and support these findings.

Fourier transformation based texture analysis for differentiating between hyperplastic polyps and sessile serrated adenomas.

Colorectal cancer (CRC) is the third most common type of cancer. One major pathway involved in the development of CRC is the serrated pathway. Colorectal polyps can be divided in benign, like small hyperplastic polyps and premalignant polyps, like the sessile serrated adenomas (SSA) that has a significant potential of malignant transformation. The morphological similarity between these types of polyp, not-infrequently raises diagnostic difficulties. This study aimed to morphologically differentiate between hyperplastic polyps (HP) and SSAs by using automated computerized texture analysis of Fourier transformed histological images. Thirty images of HP and 58 images of SSA were analyzed by computerized texture analysis. A fast Fourier transformation was applied to the images. The Fourier frequency plots were further transformed into gray level co-occurrence matrices and four textural variables were extracted: entropy, correlation, contrast, and homogeneity. Our study is the first to combine this type of analysis for automated classification of colonic neoplasia. The results were analyzed using statistical and neural network (NNET) classification models. The predictive values of these classifiers were compared. The statistical regression algorithm presented a sensitivity of 95% to detect the SSA and a specificity of 80% to detect the HP. The NNET analysis was superior to the statistical analysis displaying a classification accuracy of 100%. The results of this study have confirmed the hypothesis that Fourier based texture image analysis is helpful in differentiating between HP and SSA. RESEARCH HIGHLIGHTS: Colorectal polyps can be divided in benign, like hyperplastic polyps (HP) and premalignant, like the sessile serrated adenomas (SSA). There is a high morphologic similarity between these two types of polyp that not-infrequently raises diagnostic difficulties. The results of our morphometric analysis that were used to build a neural network based model of prediction of the polyp types, have a great clinical importance of identifying SSA polyps which have significant potential of malignant progression as compared to HP.

The impact of radiation therapy on vaginal biomechanical properties.

OBJECTIVE: In women with cervical cancer (CC), treatment with radiation causes changes in vaginal biomechanical properties, anatomy and function. The aims of the current study were to objectively assess effects of radiotherapy (RT) on vaginal elasticity, wall mobility and contraction strength; and to evaluate associations of these changes with sexual function. STUDY DESIGN: This prospective cohort study was approved by our Institutional Review Board. Between May 2018 and June 2020, women with CC who were candidates for RT were eligible to participate. Participants underwent vaginal tactile imaging (VTI) evaluation and were asked to fill the Female Sexual Function Index (FSFI) questionnaire at the time of first RT session and at a 6-month post-treatment follow up visit. Women who underwent radical hysterectomy, or had pelvic side-wall, pelvic or distant organ metastasis were not included. RESULTS: A total of 25 women with locally advanced CC were included in the final analysis. The mean age was 39 ± 2.7 years, the mean BMI was 24.8 ± 2.2 kg/m2 and the median parity was 2 (range: 1-5). Following RT, the mean scores for vaginal elasticity and vaginal tightening were significantly lower than at pre-treatment: 11.3 ± 2.5 vs. 28.3 ± 9, P < 0.0001 and 2.6 ± 0.7 vs. 16.7 ± 3, P < 0.0001, respectively. Following RT, significant decreases were demonstrated in vaginal wall mobility and pelvic muscle contraction strength: from 1.77 ± 0.34 to 0.36 ± 0.15, P < 0.0001 and from 2.55 ± 0.48 to 0.52 ± 0.23, P < 0.0001, respectively. Compared to pre-treatment, post-RT vaginal length was significantly shorter (3.30 ± 0.22 vs. 7.64 ± 0.63, P = 0.0023) and sexual intercourse frequency significantly lower: 1 (range 1-2) vs. 2 (range 1-4), P = 0.014). The mean total FSFI score was significantly lower following RT (6.7 ± 1 vs. 14.5 ± 2.7, P < 0.0001). CONCLUSIONS: Women with locally advanced CC who have been treated with RT exhibit persistent vaginal biomechanical changes that compromise sexual activity and result in considerable distress.

In Vitro Fertilization Entails a High Prevalence of Erectile and Male Sexual Dysfunction: A Prospective Case-Control Study.

PURPOSE: We evaluated the effect of in vitro fertilization (IVF) on sexual function in men, particularly for erectile dysfunction. MATERIALS AND METHODS: A prospective case-control study at a tertiary medical center. The study group comprised men of infertile couples that required IVF to conceive. The control group comprised men of couples who conceived spontaneously. The effects of IVF on sexual and erectile function were assessed based on the International Index of Erectile Function (IIEF-15) and the Self-Esteem and Relationship (SEAR) questionnaires. Participants were followed up to 1 year postpartum. RESULTS: Compared to the control group (378), for the IVF group (356), mean IIEF-15 scores were significantly lower: prior to pregnancy (31.7±4.5 vs 64.4±7.2, p <0.0001), at mid-pregnancy (37.3±5.1 vs 66.4±5.5, p <0.0001) and up to one year postpartum (42.3±4.9 vs 68.6±4.3, p <0.0001). Compared to the control group, in the IVF group, mean SEAR scores were significantly lower at these 3 respective time points (29.9±6.3 vs 66.5±8.3; 34.1±5.8 vs 66.9±7.2; and 40.9±6.7 vs 67.3±5.6; p <0.0001). At the 3 time points, for the IVF compared to the control group, the median monthly sexual intercourse rate was lower; and both the use of phosphodiesterase-5 inhibitor and psychologist/sexologist care were higher. CONCLUSIONS: The prevalence of erectile dysfunction among men participating in IVF in order to conceive is significantly higher compared to couples that conceived spontaneously, thus leading to an extremely high rate of phosphodiesterase-5 inhibitor use.

Vaginal Fractional Carbon Dioxide Laser Treatment and Changes in Vaginal Biomechanical Parameters.

BACKGROUND AND OBJECTIVES: Vaginal fractional carbon dioxide (CO2 ) laser treatment has emerged in the past two decades as a non-surgical option for vaginal tightening. Mounting evidence supports the effectiveness and safety of this treatment for female sexual dysfunction. A newly developed vaginal tactile imaging (VTI) technique accurately evaluates the biomechanical parameters of the female pelvic floor and vagina, including tissue elasticity, pelvic support, and pelvic muscle function in high definition. In the current study, we evaluated changes in objective biomechanical parameters using VTI, following vaginal CO2 laser treatment for vaginal tightening and sexual dysfunction. STUDY DESIGN/MATERIALS AND METHODS: We conducted a prospective cohort between June 2018 and January 2020. Inclusion criteria were vaginal looseness, decreased local sensation during sexual intercourse, and sexual dysfunction. All the participants were treated with a vaginal carbon dioxide laser. They underwent a gynecological evaluation based on the Vaginal Health Index (VHI) and sexual function assessment according to the Female Sexual Function Index (FSFI). Vaginal biomechanical parameters were assessed by VTI. Initial evaluations were performed at the pre-treatment consult visit, 1 week prior to the first treatment and at a 6-month post-treatment follow-up visit. RESULTS: Twenty-five women were included in the final analysis. Compared with baseline, the post-treatment mean scores for vaginal elasticity and tightening were higher (54.8 ± 5.2 vs. 41.5 ± 6.3, P = 0.0027 and 1.97 ± 0.25 vs. 1.32 ± 0.31, P = 0.0014, respectively). Post-treatment increases were demonstrated in pelvic muscle contraction strength (25.9 ± 3.5 vs. 16.5 ± 4.2, P = 0.0011) and in reflex pelvic muscle contraction (2.93 ± 0.44 vs. 2.12 ± 0.47, P = 0.0022); the mean FSFI and VHI scores were higher following treatment (28.47 ± 1.73 vs. 21.12 ± 1.58, P = 0.036 and 19.15 ± 1.27 vs. 11.6 ± 0.97, P = 0.0032). CONCLUSIONS: The quantification of vaginal biomechanical parameters using VTI technology offers objective evidence of the beneficial effect of vaginal CO2 laser treatment. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Advanced maternal age and perinatal outcome in twin pregnancies: a meta-analysis.

Objective: The current meta-analysis evaluates the perinatal outcomes of twin pregnancies in pregnant women 35 years or older (advanced maternal age) compared with less than 35 years at the time of delivery.Study design: A search was conducted up to March 2018. Electronic databases that were used in our research included; Embase (NO Medline), Ovid Medline, Cochrane Central Register of Controlled Trials, and Web of Science. Inclusion criteria were twin pregnancies; a comparison between pregnant women aged ≥35 years versus <35 years at the time of delivery and reported perinatal outcomes. Review articles, case reports, and case series were excluded. Data analysis was performed using the Cochrane's Review Manager 5.3 software. Pooled odds ratio for dichotomous outcomes or mean difference for continuous outcomes were calculated using a random effects model. I2 test was performed to assess heterogeneity. The quality of each accepted article was assessed using the Newcastle-Ottawa Scale.Results: Our search yielded 1622 publications, of which 25 were assessed for eligibility. A total of 13 studies met our final inclusion criteria. In twin pregnancies, advanced maternal age was associated with a lower incidence of preterm birth prior to 37 weeks' gestation (OR 0.89 [95% CI 0.83-0.95]) compared with women under 35 years at the time of delivery. Gestational diabetes (OR 1.57 [95% CI 1.24-1.98]) and cesarean deliveries (OR 1.69 [95% CI 1.52-1.87]) were significantly higher among women in the advanced maternal age group. All other measured outcomes, such as preterm delivery before 32 weeks' gestation, hypertension disorders, small for gestational age, birth weight under 2500 or 1500 g, need for neonatal intensive care admission and perinatal death were comparable between the groups.Conclusions: This meta-analysis implies that advanced maternal age mothers in the setting of twin pregnancy is associated with comparable outcomes to nonadvanced maternal age mothers. The only outstanding differences were higher rates of GDM and cesarean deliveries in the advanced maternal age (AMA) group.

A Case of Recurrent Vulvar Carcinoma With Cardiac Metastasis: Case Report and Review of the Literature.

A 67-yr-old female patient was diagnosed with squamous cell vulvar carcinoma and treated with a radical vulvectomy and bilateral sentinel lymphadenectomy. Three months after the surgery, the patient presented with local recurrence and underwent surgical excision of the mass, followed by chemotherapy. Eight months later, the patient was admitted due to weakness and pleural effusion. The patient underwent a chest computed tomography and echocardiogram, which revealed a large mass in the right ventricle penetrating into the pericardium and an additional mass residing on the tricuspid valve. She underwent a pericardial biopsy, and the pathology revealed a moderately differentiated squamous cell carcinoma metastasis. The patient was admitted thereafter in the oncological department for additional chemotherapy treatment. Because of a rapid deterioration in the patient's condition, only palliative treatment was given, and the patient died shortly after. Secondary cardiac tumors are very rare and have not been extensively studied in oncology. Therefore, optimal management is not entirely clear. It is extremely rare for vulvar cancer to metastasize to the heart, and only a handful of cases have been reported in the literature.

Mixed neuroendocrine tumor of the common bile duct.

CONTEXT: Mixed adenoendocrine tumors of the extrahepatic bile ducts are exceedingly rare and most of those who are rarely diagnosed are adenocarcinomas. Neuroendorine tumors accounts for only 0.2-2%. CASE REPORT: We report a case of mixed adenoneuroendo-carcinoma of the common bile duct in an 82-year-old male. CONCLUSION: Clinical experience suggests that the neuroendocrine component of mixed tumors behave more aggressively than the regular biliary adenocarcinoma component. This clinical behavior may have an important role in the management of this clinical entity.

[4-dimensional computed tomography for localization of parathyroid adenoma].

INTRODUCTION: In about 85% of patients with primary hyperparathyroidism (pHPT) only a single parathyroid gland is diseased. The operation of choice in this group of patients is minimally invasive parathyroidectomy (MIP). In order to perform an MIP, the diseased gland should be identified prior to surgery. This is not always possible with the routine imaging studies including parathyroid sestamibi scan and ultrasound. Four-dimensional computed tomography (4D-CT) scanning was developed in order to identify an enlarged parathyroid gland. Several characteristics make it possible to identify glands of this type and to differentiate it from other neck nodes. PURPOSE: To evaLuate the accuracy of 4D-CT in the identification of parathyroid adenoma/s in order to perform an MIP. METHODS: A total of 69 patients underwent parathyroidectomy for pHPT during the period July 2010 to June 2012. The 4D-CT was performed on 27 patients. Data were retrospectively extracted from the patients' charts including imaging studies, operative notes, number and LocaLization of glands excised and pathological reports. RESULTS: The 4D-CT was positive for a single adenoma in 26 patients confirmed in surgery. In 4 of those patients, one or two additional glands were found enlarged during surgery. Sixteen patients underwent an MIP, 3 patients had a unilateraL exploration and in 8 cases a biLateraL exploration was performed. The 4D-CT had a sensitivity of 81.4% and a positive predictive value of 100% in this group of patients. CONCLUSIONS: The 4D-CT is another tool for the identification of enlarged parathyroid gLand/s before surgery. Further study is needed to determine its place in the current armamentarium of pre-operative localization studies.

Hypervascular lesion in the head of the pancreas. Preoperative angiography and selective embolization results in bloodless operation.

CONTEXT: Pancreatic neuroendocrine tumors (PNETs) are rare tumors. These tumors are hypervascular in nature. Their surgical management is well described and practiced. Although hypervascular in their nature, preoperative angioembolization of the primary tumor is usually not indicated. CASE REPORT: We describe a case of an extremely hypervascular PNET in the head of the pancreas that was managed with preoperative angioembolization that was followed by a Whipple operation that resulted in excellent recovery. DISCUSSION: Pre-operative angioembolization of pancreatic tumors, although previously reported, is exceedingly rare. The use of this technique prior to surgery is feasible and may result in bloodless surgery and better outcome.

Cecal fibromatosis (desmoid tumor) mimicking periappendicular abscess: a case report.

A 32-year-old man presented to our department with abdominal pain and fever. In an earlier hospitalization he was diagnosed with periappendicular abscess and treated with antibiotics. Due to fever and 'non-resolution' of the abscess and due to its deep location in the lower abdomen, which excluded percutaneous drainage, we elected to operate the patient. A large mass in the cecum accompanied with an abscess resulted in a right hemicolectomy. The pathological examination revealed a desmoid tumor of the cecum. The patient's recovery was uneventful.