Ascites, high CA-125 and chronic pelvic pain in an unusual clinical manifestation of Enterobius vermicularis ovarian and sigmoid colon granuloma.

We present a case of a 36-year-old Caucasian woman with ascites, elevated CA-125, an enlarged left ovary and chronic pelvic pain who underwent an unnecessary surgical intervention because of suspected malignant disease. During the operation ovarian and sigmoid colon granulomatous tumors caused by Enterobius vermicularis infestation were revealed. In this case, the presence of Enterobius vermicularis ova in the abdominal cavity appears to have caused a sufficient reaction to produce symptoms and signs of malignancy leading to surgical intervention. Moreover, awareness that such lesions may occur is important since the lesions and clinical signs may be misinterpreted as being malignant with subsequent unnecessary surgical intervention.

Postoperative radiotherapy in stage IB squamous cell cervical cancer.

OBJECTIVE: The purpose of the study was to evaluate postoperative whole pelvic radiation for high-risk patients with FIGO Stage IB cervical cancer. METHODS: One hundred and forty-eight patients with Stage IB squamous cell carcinoma of the cervix underwent radical hysterectomy and pelvic lymphadenectomy. The low-risk group included patients without unfavorable prognostic factors who were treated only by surgery. The high-risk group included women with pelvic node metastases, with positive or close surgical margins, clinical tumor size > 4.0 cm, depth of stromal invasion > 1/3 the cervical wall, grade 3 tumor and presence of lymphovascular space involvement. High-risk patients received whole pelvic radiotherapy between two and four weeks after surgery. RESULTS: Seventy patients (47.3%) were low risk and 78 patients (52.7%) were high risk. Locoregional recurrences were diagnosed in nine cases (12.8%) in the surgery group and in 11 patients (14.1%) assigned to radiotherapy. The incidence of distant metastases was 2.8% in the surgery group and 6.4% in the surgery and radiotherapy group. Overall survival at five years was 88.6% in the low-risk group and 84.7% in the high-risk group. CONCLUSION: Five-year overall survival, locoregional and distant metastases were similar in the low-risk and high-risk groups of patients, thus emphasizing the value of whole pelvic radiation in patients with unfavorable prognostic factors in Stage IB cervical cancer.

Adenosquamous carcinoma of the uterine cervix--adjuvant chemotherapeutic treatment with paclitaxel and carboplatin; a case report.

Adenosquamous carcinoma of the uterine cervix is a rare mixture of malignant glandular and squamous epithelial elements. We present a case of a 56-year-old woman with Stage IV cervical carcinoma treated with paclitaxel and carboplatin chemotherapy after cytoreductive surgery. Solitary liver metastases were treated by ultrasound guided percutaneous sclerotherapy with 95% ethanol. For ten months the patient showed an objective response to the treatment with a good quality of life during that time. A year after the first, the second cytoreductive operation was performed and chemotherapy (paclitaxel, carboplatin, and epirubicin) followed. The patient died 20 months after establishing the diagnosis. Paclitaxel in combination with carboplatin as adjuvant chemotherapeutic treatment could be another promising agent for patients with advanced metastatic cervical adenocarcinoma.

Breast cancer in the elderly.

The study population was derived from 482 patients with breast cancer treated at the Department of Oncology, University Hospital Center Zagreb, between 1992 and 1999. The main purpose of our study was to evaluate differences in breast cancer characteristics and treatment in a population of women with breast cancer older than 65 years compared to younger women group (less than 65 years). We have analyzed disease parameters (stage of the disease, size of primary tumor, tumor differentiation grade and steroid receptor status) and parameters associated to treatment modalities (surgery, radiotherapy, hormonal therapy and chemotherapy) in both age groups. In older women, we found significantly higher rates of tumors grade 1 (p = 0.0049), tumors > 2 cm and tumors with a high steroid receptor status (p = 0.0013). Evaluation of treatment modalities showed that in older women a significantly higher proportion were treated with hormonal therapy (p < 0.001) compared to younger patients. In evaluation of clinical outcome after a median follow-up of 58 months, in older women the cumulative 5-year disease-free survival rate was 65%, while cumulative 5-year survival was 83%, which was not significantly different from the younger women (p > 0.005).

Primary squamous cell carcinoma of endometrium: a case report.

A case of primary squamous cell carcinoma of the endometrium (PSCCE) in a virgin treated with surgery--abdominal hysterectomy and bilateral salpingo-oophorectomy, and followed by whole pelvic radiation is presented. The tumor recurred 12 months later and the patient then underwent relaparotomy and excision of recurrent tumor of the pelvis; right hemicolectomy and rectosigmoidectomy were done due to recurrence and metastasis of the primary tumor. After re-operation, six courses of cisplatin and 5-fluorouracil were given intravenously for cytotoxic effects at 3-week intervals. The patient's disease progressed despite therapy, and she died three months after the last cycle or 21 months after the first diagnosis was made.

Adnexal masses in pregnancy: a review of eight cases undergoing surgical management.

OBJECTIVE: Our purpose was to determine maternal and foetal outcome in patients undergoing surgery for a pelvic mass in pregnancy. STUDY DESIGN: Maternal and foetal records (outcomes) of eight cases of adnexal masses associated with intrauterine pregnancy that required laparotomy or aspiration or that were diagnosed incidentally at the time of caesarean section were reviewed. The review was performed on patients who were seen with an adnexal mass in pregnancy from January 1994 to February 2001. We included patients with simple or complex masses > or = 6 cm that were persistent on ultrasonographic evaluation and patients with adnexal masses with complications (torsion, haemorrhage). We excluded cysts that spontaneously resolved by 16 weeks' gestation. RESULTS: Eight patients of 16,472 deliveries were identified with adnexal masses that satisfied the above criteria. Six patients underwent laparotomy in the first and/or the second trimester of pregnancy. In two of them emergency laparotomy were done due to torsion or haemorrhage as a complication of the adnexal masses. In all patients benign ovarian tumors were found. Two patients underwent transvaginal aspiration of simplex cysts due to subtorsion in the first trimester of gestation (negative results on cytological study). All of these eight patients had term deliveries. Two patients, due to obstetrical reasons, underwent caesarean section. CONCLUSION: The incidence of an adnexal mass during pregnancy in our population is consistent with what has been reported in the literature. We emphasize that transvaginal aspiration and drainage of symptomatic simplex cysts in the first trimester and percutaneous cysts in the second trimester can avert laparotomy. Our data support a randomised clinical study to determine optimal management of an adnexal mass in pregnancy.

Postoperative radiotherapy in stage I endometrial adenocarcinoma.

OBJECTIVE: To evaluate postoperative whole pelvic radiation for high-risk patients with Stage I endometrial adenocarcinoma. METHODS: One hunderd and twenty-two patients with irregular premenopausal or postmenopausal haemorrhage were included into the study. Fractional curettage was performed in all cases. When the pathohistological report confirmed endometrial adenocarcinoma, abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Low-risk patients include women with Stage IA tumours and Stage IB grade 1 or 2 histology. High-risk group include patients with Stage IB grade 3 tumours and Stage IC carcinomas. High-risk patients received whole pelvic radiotherapy between two and four weeks after surgery. RESULTS: Eighty-two patients (67.21%) were low-risk and forty patients (32.79%) were high-risk. In the low-risk group of patients, CA-125 was negative in ten cases and positive in 72 patients with a mean value of 30.12 +/- 12.42 U/ml serum. In the high-risk group of the patients, CA-125 was negative in two cases and positive in 38 patients with a mean value of 60, 48 +/- 20, 14 U/ml serum. Locoregional recurrences were diagnosed in four patients (4.87%) in the surgery group and in two patients (5.00%) assigned to radiotherapy. The incidence of distant metastases was 2.43% in the surgery group and 2.50% in the radiotherapy group. Overall survival at five years was 90.25% in the low-risk group and 87.50% in the high-risk group of patients. CONCLUSION: Five-year overall survival, locoregional and distant metastasis were similar in the low-risk and high-risk groups of patients. That emphasizes the value of whole pelvic radiation in patients with unfavourable prognostic factors in Stage I endometrial cancer.

Serum CA-125 tumor marker in endometrial adenocarcinoma.

One hundred and seventy-four patients, mean age 61.23 +/- 9.41 years old, with irregular perimenopausal haemorrhage were included in the study. Fractional curettage was performed in all patients. When the pathohistologic findings were adenocarcinoma the concentration of CA-125 tumor marker was determined. Hysterectomy with bilateral salpingo-oophorectomy was determined. In 142 cases carcinoma was restricted to the uterus and in 32 patients extrauterine metastatic disease was found. In the former group CA-125 was positive in 130 patients with a mean value of 64.12 +/- 22.41 U/ml serum. In the latter group the cancer antigen was positive in 29 patients with a mean value of 244.82 +/- 68.11 U/ml. High production is associated with increased metastatic potential.

Concentrations of CA-125 tumor marker in endometrial carcinoma.

Thirty-eight patients with irregular perimenopausal hemorrhage in whom carcinoma of the endometrium had been diagnosed by fractional curettage were included in the study. In all patients, the concentration of CA-125 tumor marker was determined preoperatively. Findings were compared to the depth of penetration of stage I adenocarcinoma into the endometrium. A statistically significantly higher CA-125 value was recorded when the tumor had penetrated more than one-third of the uterine wall. This method could be successfully combined with other techniques in therapy planning.

[Ultrasound grading of placental maturity and fetal lung maturity]. / Ultrazvucno stupnjevanje zrelosti posteljice i fetalna plucna zrelost.

In 126 pregnant women of the gestational age from the 28th to the 44th gestational week, the biparietal diameter, the abdomen diameter, and the placental maturity after Granum et al. were determined. Amniocentesis was performed for obstetric indication. Also the L/S ratio and the cytological estimation of the gestational age were recorded. The first degree of the placental maturity was found in 37, the second degree in 3, and the third degree in 36 pregnant women. In the first group, BPP was 8.38 +/- 0.75, the abdomen diameter 8.30 +/- 0.63, and pulmonary maturity in 73% of women according to the L/S ratio and in 91.9% according to cytological estimation. In the second group, BPP was 9.15 +/- 0.65, the abdomen diameter 9.03 +/- 0.83, and in 77.9% of women the L/S ratio was higher than 2 but in 56.6% of women, according to cytological estimation, there was a good pulmonary maturity. At the third degree of placental maturity, BPP was 9.49 +/- 0.60, the abdomen diameter 9.63 +/- 0.92, and a good pulmonary maturity in 94.4% of women. The RDS was not observed in 5.6% of newborns with the L/S ratio below 2. According to cytological estimation, BPP below 9.15 was found in pre-term labour and higher than 9.15 in at-term births when in 94% of women the L/S ratio was higher than 2.

[Transvaginal sclerosing therapy of cystic ovarian lesions with alcohol]. / Die transvaginale Behandlung von Ovarialzysten mittels Alkoholsklerosierung.

AIM: Description of puncture technique for conservative treatment of cystic ovarian lesions. METHOD: The cyst should be unilocular, sonolucent, with a smooth inner wall of the capsule, without septa and neovascularisation on transvaginal colour Doppler. Serum CA-125 levels must be lower than 35 U/ml. The capsule of the cyst was punctured with a 18 gauge needle, sonographically guided with a 5 MHz transvaginal probe. After complete emptying of the cyst, (cytological examination of the cystic fluid was negative), we injected an amount of sterile 96 % alcohol equalling 50 % of the volume of the cyst. The alcohol remained in the cyst for 5 minutes and was then aspirated completely. RESULTS: 152 patients aged 18 to 60 with an ovarian cyst volume between 40 and 140 ml were treated. Five of the patients (3.3 %) had intensive pelvic pain and therefore received intravenous analgesics. After three months, relapse appeared in 8 patients (5.3 %), in most of whom the volume of the cyst had been more than 100 ml. CONCLUSION: The proposed puncture technique is simple and easily performed. Treatment with 96 % alcohol showed good results. In cases where the cyst volume exceeds 100 ml, we advise surgical treatment by laparoscopy or laparotomy.

Transabdominal placental biopsy in the second and third trimester of pregnancy.

Transabdominal placental biopsy under ultrasound guidance was carried out in 260 cases in the second trimester and 50 cases in the third trimester of pregnancy. Placental tissue was aspirated using an 18 or 20 gauge needle. In a total of 310 placental biopsies in the second and third trimester, 100 were performed because of suspicious ultrasonographic findings. Placental biopsy is simple in the presence of severe oligohydramnios where fetal blood sampling is usually more difficult. Oligohydramnios and polyhydramnios were the ultrasonographic findings in 50% of cases and were found to be associated with 30% of abnormal chromosomal findings. There was one (0.3%) abortion within two weeks following placental biopsy. Placental biopsy did not affect the outcome of the pregnancy.

[Evacuation of a hydatidiform mole with ultrasonic guidance]. / Evakuacija hidatidne mole uz ultrazvucni nadzor.

In addition to being the best method for the diagnosis of the hydatidiform mole, ultrasound is also used in the surgical treatment of the mole. The procedure of the evacuation of the complete hydatidiform mole by vacuum suction and continuous ultrasonic monitoring is described. The method is illustrated by three cases.