Co-Existing Ovarian Mucinous Cystadenocarcinoma with Mature Cystic Teratoma: A Rare Case Report.

Background: Mature cystic teratoma is the most common benign germ cell ovarian tumor. Malignant transformation is uncommon. The pathology is mostly composed of squamous cell carcinoma. Mucinous cystadenocarcinoma should be differentiated between malignant transformation and the coincidental occurrence. Case Report: A case of an early stage mucinous ovarian cancer co-existing with mature cystic teratoma at the same ovarian side was reported. A 57-year-old woman presented with incidental palpable pelvic mass for two weeks. Right ovary consisted of multiloculated cyst and mature cystic teratoma. The patient underwent an exploratory laparotomy for a large ovarian cyst evaluation. Mucinous ovarian cancer was diagnosed as FIGO stage IC3 after operation. Histopathology report showed mucinous cystadenocarcinoma and mature cystic teratoma of the right ovary. There was no additional abdominal abnormality. Immunohistochemistry staining supported the diagnosis of metastatic adenocarcinoma of colon or intestinal type of mucinous ovarian cancer. Further investigation for locating other primary cancer site was then performed. The result was negative. The intestinal-type mucinous ovarian cancer co-existing with mature cystic teratoma of the right ovary was the final histopathological reading. The patient was then started on carboplatin/paclitaxel combination chemotherapy for 6 cycles after surgery. The patient showed complete remission at the end of the chemotherapy treatment. Conclusion: This was a rare case of mucinous ovarian cancer co-existing with mature cystic teratoma. Clinical acumen, immunochemistry staining and metastatic survey investigation played important roles for the final diagnosis.

Bevacizumab, Carboplatin and Paclitaxel Combination Treatment in Advanced Stage Ovarian Cancer: The First Experience in Thammasat University Hospital, Thailand: A Case Report.

BACKGROUND: Bevacizumab, a humanized monoclonal antibody targeting vascular endothelial growthfactor (VEGF), has been approvedfor concurrent treatment with first line chemotherapy in advanced epithelial ovarian cancer. CASE REPORT: A case of an advanced stage epithelial ovarian cancer (EOC) receiving a combination of bevacizumab, carboplatin andpaclitaxel chemotherapy was reported. A 44-year-old woman was presented with abdominal discomfort and distention for 4 months. Bilateral 12 cm diameter ovarian tumors were diagnosed as FIGO stage IIIc after surgical staging operation. Histopathology report showed the mixed type of serous and endometriod adenocarcinoma. The patient was then started on carboplatin/paclitaxel combination chemotherapy for 6 cycles after surgery every 3 weeks. Bevacizumab (7.5 mg/ m2) was concurrently administered with chemotherapy every 3 weeks startingfrom the 2nd cycle. A complete remission was achieved after the end of the chemotherapy treatment. Bevacizumab was continued for one year after the completion of the standard chemotherapy. Bone marrow suppression, hypertension and proteinuria were not found during Bevacizumab treatment. At bevacizumab treatment completion, a platinum-sensitive recurrent ovarian cancer was diagnosed at the two weeks postprogram routine check-up. The patient was counseled to start second line chemotherapy treatment and has yet to come back with her decision. CONCLUSION: Combination of bevacizumab, carboplatin and paclitaxelfor first line chemotherapy in advanced EOC in this case had no serious side effects and need further study.

Maternal acceptance, attitude and knowledge on human papilloma virus vaccination for their daughters.

OBJECTIVE: To compare the basic knowledge scores, attitudes and acceptability to HPV immunization before and after acknowledge about HPV, cervical cancer and vaccine to study group. MATERIAL AND METHOD: An anonymous survey was applied to women attending the outpatient clinic, Thammasat University Hospital from April 2010 to October 2010. Basic knowledge about cervical cancer, HPV, HPV vaccine, attitudes and acceptability to HPV immunization were collected via a self administered questionnaire. RESULTS: A total of 173 mothers completed the survey responses rate of 86.5% (173/200). There is no difference in characteristic and lifestyles of the responders. The basic knowledge scores was higher in the subjects who had higher education level and regular cervical screening history. Most of subjects (> 85%) recognized that HPV is associated with cervical cancer but more than half of them confused about route of transmission. Basic knowledge scores is increased in all acceptability group (strongly agree to strongly disagree) after be informed about HPV and vaccine was observed. Most subjects (78.6%) agree to their daughters' vaccination indicating the high vaccine acceptances. The leading factors to maternal acceptances were free vaccination, negative attitudes such as sexual behavior of daughters and positive attitudes such as vaccine efficacy. DISCUSSION: HPV vaccine acceptance seems to be depended on cost and efficacy than maternal knowledge. The vaccine is not widely used. The cost-effectiveness analysis should be provided by government. Education and communication in public media are aimed for increasing coverage of vaccination in the future. CONCLUSION: Maternal acceptances of vaccine depend on high efficacy and low cost.

Prevalence of abnormal cervical cytology by liquid based cytology in the antenatal care clinic, Thammasat University Hospital.

OBJECTIVE: To determine the prevalence of abnormal cervical cytology by liquid based cytology (LBC) in pregnant women who attended the antenatal care clinic at Thammasat University Hospital. MATERIAL AND METHOD: LBC was performed on specimens from the collecting vial containing preserved cell solution (Cytyc, Boxborough, MA) in pregnant women who attended antenatal care at the antenatal care clinic, Thammasat University Hospital between March and July 2010. One hundred forty three pregnant women were recruited in the present study. All cytological reports were reviewed by senior cytopathologists for accurate diagnosis using the Bethesda System 2001 criteria. Patients with abnormal results as "abnormal squamous/glandular cells of undetermined significant" or more over were referred for colposcopic examination. RESULTS: One hundred forty three pregnant women participated in the present study. The average age was 27.09 years. There were 10 abnormal Pap smear results with four, five, and one cases of ASC-US, LSIL and HSIL respectively The prevalence of abnormal cervical cytology in this investigation was 7% with 0.7% high-grade cervical intraepithelial neoplacia. Only 6% of participants had the correct understanding of the necessity of Pap smear testing. Thirty-one percent of multiparous pregnant women in the present study had no previous Pap smear screening. The majority of participants had coitarche before the age of 20. CONCLUSION: The prevalence of abnormal cervical cytology in pregnant patients attending the antenatal care clinic at Thammasat University Hospital was 7%. The cervical cytology and related education were highly recommended in antenatal care clinic to increase cervical cancer screening coverage among reproductive age women.

A 1-year experience with liquid-based and conventional papanicolaou smear in Thammasat University Hospital.

OBJECTIVE: The aim of the present study was to evaluate the prevalence of abnormal Pap smears as detected by liquid-based (LBP) and conventional (CPP) techniques in women who were patients in the gynecologic clinic, Thammasat University Hospital. MATERIAL AND METHOD: Retrospective analysis of cervical cancer screening, histopathological findings and operative procedures was done between January 2009 and December 2009. Of the 6,332 participants who underwent gynecological examination and cervical screening and had a Pap smear result as atypical squamous cells of undetermined significance or worse would be performed a further colposcopic examination. RESULTS: A total of 6,332 women were screened for cervical cancer in the one year period. A total of 169 abnormal Pap smears were found. Of 497 (8%) and 5,835 (92%) women were screened by LBP and CPP, respectively. The mean age of patients was 39.45 years old (14-90) and 1,550 (24.5%) women were post menopausal. The Prevalence of abnormal Pap smears was 4.0 and 2.6% in the LBP and CPP groups, respectively. Among LBP group, patients with atypical smear and LSIL (low grade squamous intraepithelial lesion) were 11 (2.29%) and 9 (1.8%), respectively. While CPP group, patient with atypical smear, LSIL, HSIL (high grade squamous intraepithelial lesion) and cancer were 73 (1.25%), 49 (0.84%), 25 (0.43%) and 2 (0.03%), respectively. CONCLUSION: The prevalence of abnormal Pap smear in women who attended gynecologic clinic of Thammasat University Hospital was 4.0% and 2.6 % per LBP and CPP group, respectively. There was no significant difference in the incidence of atypical smear and false positive result between LBP and CPP.

Failed conservative treatment of synchronous primary cancer of endometrium and ovary in a young Thai woman: a case report.

A case of well differentiated endometriod adenocarcinoma of the endometrium with a synchronous endometriod and clear cell adenocarcinoma of both ovaries was reported. Recently, a 28-year-old woman presented with vaginal bleeding was diagnosed to have only FIGO stage IaG1 (FIGO 2000) cancer of the endometrium. After 3 months of high dose progestin treatment, 15 cm bilateral ovarian tumors later diagnosed as FIGO stage IIIa ovarian cancer (mixed endometriod and clear cell adenocarcinoma) were detected, and later surgically removed. The patient then was started on Placitaxel/Carboplatin combination chemotherapy for 6 cycles after surgery. The synchronous cancers of endometrium and ovary are usually presented in woman with median age of 50 with obesity, diabetes, and hypertension. These low grade tumors and better prognosis are the norm in contrast to the authors' case with clear cell component and higher stage of ovarian cancer in young lean Thai woman.