Mitotically active cellular luteinized thecoma of the ovary and luteinized thecomatosis associated with sclerosing peritonitis: case studies, comparison, and review of the literature.

In this study, we distinguish two clinical and pathological entities that are similarly named: luteinized thecoma and luteinized thecoma associated with sclerosing peritonitis. Ovarian luteinized thecoma lacks definitive criteria for malignancy. Based on our case study of a mitotically active neoplasm without nuclear atypia in which the patient was living and well 19 years after operation and comparison with prior studies of luteinized thecoma and the closely related entity of cellular fibroma, we propose presumptive criteria for malignancy for this rare neoplasm. Increased mitotic activity in luteinized thecoma without significant nuclear atypia is not an indication of malignant behavior, and such cases should therefore be referred to as mitotically active cellular luteinized thecoma. We also contrast neoplasms in the luteinized thecoma category with the entity originally reported as luteinized thecoma associated with sclerosing peritonitis. In the latter, the ovarian stromal proliferations are typically bilateral, can have an exceedingly high mitotic rate as was seen in our illustrative case, often incorporate non-neoplastic ovarian structures at their periphery, and are responsive to medical therapy. In our patient with sclerosing peritonitis, both the ovarian masses and peritoneal sclerosis underwent complete regression following treatment with gonadotropin-releasing hormone agonist and high doses of steroids, and an ovarian biopsy taken 2 months after therapy showed a histologically normal ovary. The patient subsequently became pregnant and delivered a normal infant. This is, to our knowledge, the first case of successful medically conservative treatment of a young patient with this entity that led to complete relief of symptoms and allowed preservation of fertility. Because recent observations support the non-neoplastic nature of the ovarian stromal proliferations, we advocate use of the previously proposed term luteinized thecomatosis associated with sclerosing peritonitis for this entity.

Clinical effectiveness of transcervical polyp resection in women with endometrial polyps: randomized controlled trial.

STUDY OBJECTIVE: To estimate the clinical effectiveness of transcervical resection of endometrial polyps. DESIGN: Randomized controlled trial (Canadian Task Force classification I). SETTING: University teaching hospital. PATIENTS: One hundred fifty premenopausal women with endometrial polyps. INTERVENTIONS: Either transcervical resection of the polyp or observation for 6 months. MEASUREMENTS AND MAIN RESULTS: There was no difference in periodic blood loss measured using the Pictorial Blood Assessment Chart between the study groups at 6-month follow-up. A significant difference between the groups was observed in favor of the intervention group for 2 secondary outcome measures: mean difference of periodic blood loss measured using a visual analog scale (score, 0.7; 95% confidence interval, 0.11-1.30; p = .02) and occurrence of gynecologic symptoms at follow-up (7 of 75 patients [9.3%] vs 28 of 75 [37.3%]; p <.001). Data were analyzed according to the principle of intention to treat. CONCLUSION: Transcervical resection of endometrial polyps seems to have minimal effect on periodic blood loss; however, the procedure seems to relieve symptoms such as intermenstrual bleeding in most premenopausal women.

Assessment of endoglin and calprotectin as potential biomarkers in ovarian carcinoma and borderline tumors of the ovary.

OBJECTIVE: The objective of the study was to analyze circulating endoglin concentration in ovarian carcinoma and evaluate a prognostic role for calprotectin and endoglin in effusions in advanced-stage disease. STUDY DESIGN: Preoperative plasma concentration of endoglin from women with benign ovarian tumors (n = 71), borderline ovarian tumors (BOT, n = 39), and ovarian carcinomas (n = 89) was analyzed with an enzyme-linked immunosorbent assay, as were endoglin and calprotectin concentrations in effusions from 164 women with advanced-stage ovarian carcinoma. RESULTS: Median endoglin plasma concentration was higher in the BOT group as compared with both control and invasive carcinoma groups (4.9 vs 4.5 and 4.3 ng/mL, P = .04 and P = .02), whereas the difference between the control and invasive group was not statistically significant (4.5 vs 4.3 ng/mL, P = .08). Endoglin and calprotectin effusion concentrations did not correlate with survival. CONCLUSION: Circulating endoglin is not elevated in advanced ovarian carcinoma. This is in contrast to the situation in breast and gastric cancer.

Circulating calprotectin in ovarian carcinomas and borderline tumors of the ovary.

OBJECTIVE: Recent studies indicate that circulating calprotectin may serve as a biomarker in some cancers. We investigated whether this is the case for ovarian neoplasms. STUDY DESIGN: Calprotectin was analyzed with an enzyme-linked immunosorbent assay in EDTA-plasma collected prior to surgery from women with ovarian carcinomas (n = 89), borderline ovarian tumors (BOT, n = 39), and benign ovarian tumors (n = 71). Serum CA 125 was analyzed in the same study population. RESULTS: Median plasma calprotectin concentration was elevated in ovarian carcinoma, compared with controls, as well as compared with BOT (both P < .001). A positive correlation was found between CA 125 and calprotectin concentrations in ovarian carcinoma. Receiver operating characteristic curves demonstrated a larger area under the curve for CA 125 (0.85) as compared with calprotectin (0.70). CONCLUSION: Plasma calprotectin is elevated in invasive ovarian cancer, but when used as a tumor marker, it is inferior to CA 125.

Surgery of borderline tumors of the ovary: retrospective comparison of short-term outcome after laparoscopy or laparotomy.

BACKGROUND: Laparoscopic management of borderline ovarian tumors is controversial. OBJECTIVE: To retrospectively compare outcome after surgery by laparoscopy or laparotomy for borderline tumors. METHODS: Ovarian tumors from all women operated at Ullevål University Hospital during a five-year period were re-evaluated histologically. Patients with borderline FIGO (International Federation of Gynaecology and Obstetrics) stage I tumors were retrospectively compared regarding surgery outcome following laparoscopy or laparotomy. RESULTS: Histological re-evaluation revealed only 3 misclassifications in 608 patients. Borderline tumors represented 36% of epithelial ovarian malignancies. The 107 borderline stage I included 52 serous, 53 mucinous, and 2 endometrioid tumors. Thirty-eight patients were operated on primarily by laparoscopy and 69 by laparotomy (including 14 women starting with laparoscopy). In the laparoscopy group, more women were premenopausal (63% versus 35%, p=0.01) and median tumor diameter was smaller (8.6 versus 16.4 cm, p<0.001) as compared to the laparotomy group. When tumor diameter exceeded 10 cm, intraoperative tumor rupture was significantly more frequent during laparoscopy than during laparotomy (p=0.01). Less postoperative complications were seen after laparoscopic operations (p=0.034), but laparoscopic surgeries were less extensive, without hysterectomy, as compared to laparotomy. During the 14-78 months follow-up time, no relapse occurred in either group. After fertility-sparing surgery, there was no statistical significant difference regarding successful pregnancies between the two groups. CONCLUSIONS: Laparoscopic treatment of borderline ovarian tumors is feasible if tumor is of moderate size (diameter below 10 cm), gives fewer complications, and shorter hospital stay. Long-term follow-up of larger materials is needed to determine the ultimate recurrence risk as well as fertility rates.

Imprint cytology of sentinel lymph nodes in breast cancer. Experience with rapid, intraoperative diagnosis and primary screening by cytotechnologists.

OBJECTIVE: To evaluate the intraoperative imprint diagnoses of smears from sentinel lymph nodes that had been primary screened by cytotechnologists and to assess the most important causes of false negative (FN) imprint diagnoses. STUDY DESIGN: Material consisted of 429 imprints from sentinel lymph nodes in 211 breast cancer patients that were sent for frozen section examination over 13 months. RESULTS: The mean number of imprints/lymph nodes per patient was 2.02. The mean screening time per imprint was 3.6 minutes. Sixty-six sentinel nodes (16%) from 51 women (24%) were metastatic. Imprints and/or frozen sections were positive in 54 nodes (82%). Imprints were positive in 38 nodes, representing 70% of intraoperative positive nodes and 58% of the total number of positive nodes. Twenty-six of 28 (93%) FN imprints were due to suboptimal sampling. Four of 9 FN macrometastases did not contain diagnostic or suspicious cells/cell groups even on rescreening, whereas a few, and then only 1 diagnostic group were identified in 2/9. There were no false positives. CONCLUSION: Primary screening by experienced cytotechnologists is both rapid and reliable and enabled the diagnosing pathologist to concentrate on the frozen section. The major cause of false negative imprints is sampling, even in macrometastases.