Ultrasound features and clinical outcome of patients with malignant ovarian masses diagnosed during pregnancy: experience of a gynecological oncology ultrasound center.

OBJECTIVE: The number of women diagnosed with ovarian masses during pregnancy has increased in recent years and the management of these women can be controversial. We aim to describe ultrasound characteristics and clinical outcomes of patients with malignant ovarian masses diagnosed during pregnancy. METHODS: Patients with a histological diagnosis of malignant ovarian mass detected during pregnancy who underwent pre-operative ultrasound by experienced ultrasound examiners between December 2000 and November 2017 were included in this retrospective observational study. Ultrasound characteristics of the masses were described using International Ovarian Tumor Analysis terminology. Patients with ovarian masses but without histopathological reports were excluded. Results are presented as absolute frequency (percentage) for nominal variables and as median (range) for continuous variables. Results A total of 22 patients were included in the analysis. The median age was 32.5 (range 23-42) years and median gestational age at diagnosis was 13.5 (range 4-30) weeks. Eight (36.4%) patients had a serous/endocervical-type borderline tumor, seven (31.8%) patients had a primary epithelial ovarian carcinoma, five (22.8%) patients had a metastatic tumor to the ovary, and two (9%) patients had a mucinous borderline tumor. At ultrasound, mucinous borderline tumors were multilocular (1/2, 50%) or multilocular-solid (1/2, 50%) lesions. Serous/endocervical-type borderline tumors were unilocular-solid (3/8, 37.5%) or multilocular-solid (5/8, 62.5%) masses and all had papillary projections. Most invasive epithelial ovarian cancers were multilocular-solid masses (5/7, 71.4%). All metastatic tumors appeared as solid masses. No patients with borderline tumors had a cesarean section due to disease, whereas most patients with epithelial ovarian carcinomas (4/7, 57.2%) and with ovarian metastases (3/5, 60%) had a cesarean section due to disease. No neonatal complication was reported for patients with borderline tumors or epithelial ovarian carcinomas, whereas two of three newborns of patients with metastatic tumor died of the disease. CONCLUSION: At ultrasound, morphological features of malignant ovarian masses detected during pregnancy are similar to those described in non-pregnant patients. The likelihood of undergoing cesarean section increases with malignant disease in the ovary.

[Intestinal obstruction from undiagnosed rectal and ileal endometriosis. Two clinical cases and review of the most recent literature]. / Sub-occlusione intestinale da insospettata endometriosi rettale ed ileale. Due casi clinici e revisione della più recente letteratura.

Deep endometriosis is a subserosal growth (for more than 5 mm) of funzional endometrial tissue outside the uterine cavity. Authors report two clinical cases of intestinal endometriosis localized in the anterior wall of the rectum and in the last ileal loop. Both cases were characterized by sub-occlusive symptoms, diagnosis performed by laparoscopy and surgical resection. Authors focus the various pathogenetic theories and dwell itself on the symptomatology often characterized by nonspecific abdominal symptoms such as chronic abdominal pain, sometimes in relation to the menstrual cycle, and intestinal disorders. If rectal bleeding is rare, more frequent are dysmenorrhea, dyspareunia and infertility may occur in up to 50% of patients. The diagnosis of intestinal endometriosis is very difficult and can be made by radiological methods (CT or MRI) or by endoscopic ultrasound only for the rectal localization but nowadays often the diagnosis is due to laparoscopic techniques. In the absence of guidelines the surgical therapy is not well defined. When is not necessary surgical emergency, according to the depth of endometriotic infiltration, elective surgery includes several surgical techniques both conservative and extensive such as segmental intestinal resection with hysterectomy and ovariectomy. In the most recent literature, finally, are reported over 50% of pregnancies after surgery

Adjuvant chemotherapy after primary treatments for cervical cancer: a critical point of view and review of the literature.

Cervical cancer is the second most frequent female malignancy worldwide. Concurrent chemoradiotherapy represents the standard of care for patients with advanced stage cervical cancer, while radical surgery (RS) and radiotherapy is widely used for treating early stage cervical cancer. However, the poor control of micrometastasis, declining operability, the lack of radiotherapy departments and the high incidence of long-term complications due to radiotherapy have brought about the development of different therapeutic approaches such as neoadjuvant chemotherapy followed by RS. Unfortunately, treatment results are still unsatisfactory due to a high recurrence rate and several authors have studied the possibility to add an adjuvant treatment to primary therapy. We reviewed the literature concerning the role of adjuvant chemotherapy in advanced cervical cancer after neoadjuvant chemotherapy followed by RS and after chemoradiotherapy.