Lymphovascular space invasion (LVSI) is an isolated poor prognostic factor for recurrence and survival among women with intermediate- to high-risk early-stage endometrioid endometrial cancer.

OBJECTIVES: Whereas previous studies have shown that lymphovascular space invasion (LVSI) is associated with an increased risk for recurrent endometrioid endometrial cancer and worse survival, the magnitude of this risk in relationship to the other high-risk features is poorly understood. Our aim was to study the impact of LVSI in comparison with the other high-risk features in recurrence and survival. MATERIALS AND METHODS: Women with stage I or II endometrial cancer were included in this study if they had LVSI, International Federation of Gynecology and Obstetrics grade 2 or 3 histology, or outer-half myometrial invasion. We performed multivariate regression analyses to identify prognostic factors for recurrence. We performed Kaplan-Meier survival curve predictions of progression-free survival (PFS), overall survival (OS), and disease-specific survival; and Cox proportional hazard models to adjust for other variables. RESULTS: Three hundred eighty-eight patients met the inclusion criteria; their median follow-up was 59 months. The rates of recurrence were the following: overall, 17%; pelvic, 11%; vaginal cuff, 8%, and distant, 11%. Twenty-six percent of the patients died during follow-up. After adjusting for age, body mass index, grade, depth of invasion, cervical invasion, lymphadenectomy, and adjuvant treatment(s), LVSI was the only significant independent risk factor for total (odds ratio, 2.6) and distant (odds ratio, 3.3) recurrences and was also a risk factor for local and vaginal recurrences. Lymphovascular space invasion was also a significant poor prognostic factor for PFS (hazard ratio [HR], 2.8), OS (HR, 2.8), and disease-specific survival (HR, 7.0). Among the other risk factors, age was significantly associated with worse PFS and OS, whereas grade 3 histology was significantly associated with worse OS. CONCLUSION: In our study, LVSI is the only significant and consistent poor prognostic factor for all the outcomes studied: recurrences and survival. Lymphovascular space invasion seems to be a better predictor than the other risk factors. This suggests a potential role for adjuvant systemic therapies in patients with LVSI, even in the absence of other high-risk features.

Survival and reproductive outcomes in women treated for malignant ovarian germ cell tumors.

OBJECTIVE: The objective of this study is to review all malignant germ-cell tumors (MOGCTs) treated at our institution, focusing on reproductive outcomes and menstrual function of patients treated with fertility-sparing surgery and adjuvant chemotherapy. METHODS: We performed a retrospective chart review of patients treated for MOGCTs between January 1, 1979 and March 31, 2008. Charts of identified patients were abstracted and data were collected. Patients who had fertility-sparing surgery were contacted and a telephone questionnaire was performed to gather reproductive and menstrual history. RESULTS: Forty patients were treated for MOGCTs at our institution. Mean age at the time of diagnosis was 26.5years (range, 10-48years). Histologic subtypes were: immature teratoma (52.5%), dysgerminoma (27.5%), yolk sac tumor (10.0%), mixed germ cell tumor (7.5%), and choriocarcinoma (2.5%). Thirty-five percent of tumors were FIGO stages II-IV. Twenty-seven patients (67.5%) were treated with chemotherapy postoperatively, 23 (85%) of whom received bleomycin, etoposide and cisplatin (BEP). There were three recurrences, but no deaths. Fertility-sparing surgery was performed in 22 patients (55%), 16 of whom received adjuvant chemotherapy. Fourteen of these patients were contacted. Of the 10 remaining patients desiring pregnancy, 8 (80%) had 11 successful spontaneous pregnancies, one required in-vitro fertilization, and the other required donor egg in-vitro fertilization, resulting in 14 live births. All 14 patients had normal menstrual cycles within one year of completing chemotherapy. CONCLUSIONS: Overall survival was 100% among patients with both local and advanced MOGCTs, including those who underwent fertility-sparing surgery. Fertility-sparing surgery plus adjuvant chemotherapy appeared to have little or no effect on fertility or menstrual cycles.

Severe hydramnios and preterm delivery in association with transient maternal diabetes insipidus.

BACKGROUND: Diabetes insipidus is rare in pregnancy. It is characterized by hypoosmolar polyuria and may be central, nephrogenic, or transient in etiology; the latter is presumably related to excess placental vasopresinase production. In theory, fetal effects of this endocrine condition may include hydramnios secondary to fetal polyuria. CASE: A pregnant patient developed rapid-onset second-trimester hydramnios that prompted a thorough fetal and maternal evaluation. She ultimately was diagnosed with transient diabetes insipidus of pregnancy because of an abrupt change in her voiding pattern at 20 weeks of gestation, significant polydipsia, and laboratory studies that revealed a hypoosmolar polyuria with normal serum and urine electrolytes. Transient neonatal polyuria also was confirmed in association with this unique maternal endocrine syndrome. CONCLUSION: The most likely cause of hydramnios in this case is transient maternal diabetes insipidus of pregnancy from excessive secretion of placental vasopressinase resulting in fetal polyuria. In cases of hydramnios of unknown etiology, if a history of maternal polyuria is elicited and confirmed, diabetes insipidus of pregnancy may play a role in some cases.

The role of neoadjuvant chemotherapy in treating advanced epithelial ovarian cancer.

The current management of advanced ovarian cancer consists of aggressive primary cytoreductive surgery (PCS) followed by combination platinum based chemotherapy. Recent studies have suggested that platinum-based chemotherapy may be of benefit in patients with advanced ovarian cancer prior to cytoreductive surgery (neoadjuvant chemotherapy, NACT). The concept of NACT has not been completely validated in the treatment of ovarian cancer. This review will discuss the role of NACT in patients with advanced epithelial ovarian cancer.