RESUMEN
Congenital adrenal hyperplasia (CAH) is an inherited disorder of adrenal steroidogenesis often diagnosed in infancy. Gynecologists may encounter adult patients with CAH due to the clinical effects of increased androgens, e.g. hirsutism, clitoromegaly, oligomenorrhea, or, rarely, pelvic masses. This case report reviews the association of para-ovarian adrenal rest tumors with CAH, and the role of gynecologists in their evaluation and treatment. A 23-year-old woman with CAH (21-hydroxyase deficiency) untreated for the past 5 years presented with a pelvic mass and elevated serum testosterone (1433 ng/dL) and plasma ACTH (1117 pg/mL). Intraoperative findings revealed multiple retroperitoneal masses. Final pathology demonstrated adrenal rest tissue. Para-ovarian and ovarian adrenal rest tumors may present as a rare gynecologic manifestation in patients with untreated CAH.
Asunto(s)
Anexos Uterinos/patología , Enfermedades de los Anexos/patología , Hiperplasia Suprarrenal Congénita/complicaciones , Tumor de Resto Suprarrenal/patología , Neoplasias Retroperitoneales/patología , Enfermedades de los Anexos/diagnóstico por imagen , Enfermedades de los Anexos/etiología , Tumor de Resto Suprarrenal/diagnóstico por imagen , Tumor de Resto Suprarrenal/etiología , Femenino , Humanos , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/etiología , Adulto JovenRESUMEN
OBJECTIVE: Primary cytoreductive surgery is well accepted in the initial management of ovarian cancer with a goal of maximal tumor reduction. The role of cytoreductive surgery at disease recurrence is controversial and guidelines are not standardized. We aimed to review cases of women with recurrent ovarian cancer who were collaboratively managed by two teams of oncologic surgeons with different areas of surgical expertise. METHODS: A list of 616 patients with recurrent ovarian cancer from 1995 to 2009 was generated at a single institution. 20 cases of recurrent ovarian cancer were identified that were managed collaboratively. Data collected included date of diagnosis, initial treatment, recurrence date, location and number of sites of recurrence, secondary cytoreductive procedure performed, residual disease after surgery, pre-operative status, post-operative course, and pathologic findings. RESULTS: Of the 20 cases that fit eligibility criteria, 11 were completely resected, 5 were incompletely resected, and 4 were biopsied only. Median disease-free interval following primary surgery was 18 months (6-147). Median interval from diagnosis to collaborative cytoreduction was 63 months (13-170). Our patients had metastatic disease to the liver (11), lymph nodes (8), the diaphragm (7), other locations including colon, pancreas, lung, adrenal, kidney (9). Two patients had additional miliary disease. All patients underwent joint surgical management by gynecologic and surgical oncologists. There were no deaths in the immediate post-operative period. The 5 year survival rate was 45% following the joint surgical effort, with a median post-collaborative surgery survival duration of 42 months. CONCLUSIONS: Previous studies document survival benefit of surgery for women with recurrent ovarian cancer when there has been a long disease-free interval, localized pelvic or intra-abdominal recurrences and an optimal performance status. Most gynecologic oncologists do not perform extensive liver or diaphragm resections or lymph node excision above the renal vessels; thus, collaboration with a surgical oncologist is a viable option. In this small descriptive study, the feasibility of this reasonably well-tolerated approach, with possible survival benefit, is documented.
Asunto(s)
Procedimientos Quirúrgicos Ginecológicos/normas , Recurrencia Local de Neoplasia/cirugía , Neoplasias Ováricas/cirugía , Adulto , Anciano , Conducta Cooperativa , Supervivencia sin Enfermedad , Femenino , Procedimientos Quirúrgicos Ginecológicos/métodos , Humanos , Oncología Médica/normas , Persona de Mediana Edad , Cuidados Paliativos/normas , Grupo de Atención al Paciente , Estudios RetrospectivosRESUMEN
A proportion of reproductive age women are affected by gynecologic malignancies. This patient population is faced with difficult decisions, related to their cancer care and treatment, as well as future childbearing potential. Therefore, it is important for gynecologists to be familiar with fertility sparing management options in patients with cervical, ovarian, and endometrial cancer. In addition to understanding the surgical approaches available, providers should be able to counsel patients regarding their eligibility for and the indications and limitations of fertility sparing therapy for gynecologic cancer, allowing for appropriate referrals. A comprehensive PUBMED literature search was conducted using the key words "fertility preservation," "cervical cancer," "endometrial cancer," "ovarian cancer," "borderline tumor of the ovary," "germ cell tumor," "obstetrical outcomes," "chemotherapy," and "radiation." The following review summarizes fertility sparing options for patients with cervical, ovarian and endometrial cancer, with an emphasis on appropriate patient selection, oncologic, and obstetric outcomes.
Asunto(s)
Fertilidad , Neoplasias de los Genitales Femeninos/patología , Neoplasias de los Genitales Femeninos/terapia , Infertilidad Femenina/prevención & control , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Terapia Combinada , Neoplasias Endometriales/patología , Neoplasias Endometriales/terapia , Femenino , Procedimientos Quirúrgicos Ginecológicos/métodos , Humanos , Histerectomía/métodos , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Neoplasias Ováricas/patología , Neoplasias Ováricas/terapia , Ovariectomía/métodos , Pronóstico , Radioterapia Adyuvante , Medición de Riesgo , Resultado del Tratamiento , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/terapia , Neoplasias Uterinas/patología , Neoplasias Uterinas/terapiaRESUMEN
OBJECTIVE: Uterine papillary serous carcinoma (UPSC) is an aggressive subtype of endometrial cancer. We studied survival outcomes in patients with stages I/II UPSC. MATERIALS: A retrospective, multi-institutional study of patients with stages I/II UPSC was conducted. Patients underwent surgical staging followed by observation, adjuvant platinum-based chemotherapy (CT), or radiation therapy (RT). Continuous variables were compared via Wilcoxon rank sum test; Fisher exact test was used for the unordered categorical variables. Kaplan-Meier curves were used to estimate survival. RESULTS: Thirty-nine women were diagnosed with stage I (n = 30) or II (n = 9) UPSC, with a median follow-up of 52 months. Of the 26 patients who did not receive adjuvant CT, 9 developed recurrences and 8 died of their disease. Of the 10 patients with no myometrial invasion who did not receive adjuvant CT, 3 developed recurrences and died. Of the 7 patients who underwent RT, 2 developed distant recurrences and died. Of the 13 patients who underwent CT, 1 developed vaginal recurrence. The 5-year overall (OS) and progression-free survival (PFS) rates for the adjuvant CT group were 100% and 92%, respectively, compared with 69% and 65% for those who did not receive CT (P = 0.002 OS, P = 0.002 PFS). The 5-year OS and PFS rates for RT group were both 71%. CONCLUSIONS: Patients with stages I/II UPSC are at significant risk for distant recurrence and poor survival. Platinum-based adjuvant CT may decrease recurrence rate and improve survival in women with early and well-staged UPSC.
Asunto(s)
Antineoplásicos/uso terapéutico , Carboplatino/uso terapéutico , Cistadenocarcinoma Papilar/tratamiento farmacológico , Recurrencia Local de Neoplasia/epidemiología , Paclitaxel/uso terapéutico , Neoplasias Uterinas/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , California/epidemiología , Quimioterapia Adyuvante , Cistadenocarcinoma Papilar/mortalidad , Cistadenocarcinoma Papilar/cirugía , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Uterinas/mortalidad , Neoplasias Uterinas/cirugíaRESUMEN
Wound reconstruction surgeries are at high risk for failure. Outpatient wound reconstruction (OWR) describes these procedures performed in the outpatient setting under local anesthesia. The use of closed incision negative pressure therapy (ciNPT) has been shown to protect the incision and help minimize the risk of postoperative complications. To date, this has not been readily adopted in the outpatient setting. The authors report their initial experience with 3 cases of OWR with ciNPT used by the application of disposable negative pressure wound therapy (dNPWT) to the closed, postsurgical incision. The results of these 3 cases were favorable. While more data are needed, the authors believe the use of dNPWT with OWR will help optimize surgical outcomes and serve as an alternative to surgery with acute hospitalization.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Terapia de Presión Negativa para Heridas , Procedimientos de Cirugía Plástica , Herida Quirúrgica/cirugía , Adulto , Procedimientos Quirúrgicos Ambulatorios/métodos , Equipos Desechables , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia de Presión Negativa para Heridas/instrumentación , Terapia de Presión Negativa para Heridas/métodos , Procedimientos de Cirugía Plástica/métodos , Herida Quirúrgica/terapia , Cicatrización de HeridasRESUMEN
Primary clitoral malignancies are rare and most are invasive squamous cell carcinomas. Microcystic adnexal carcinoma (MAC) is an indolent, rare dermatologic carcinoma that typically affects the head and neck region. A 23-year-old nulligravid Hispanic female presented with a 9-month history of an enlarging periclitoral mass. After surgical resection, the mass was diagnosed as a MAC. MAC is a cutaneous carcinoma rarely found on the vulva. It is a slow growing but locally aggressive carcinoma that is best treated with surgical resection. Sclerosing ductal carcinomas may have MAC-like features, and the diagnosis and management of one case is provided here.
Asunto(s)
Carcinoma Ductal/patología , Carcinoma Ductal/cirugía , Clítoris/patología , Clítoris/cirugía , Neoplasias de los Genitales Femeninos/patología , Neoplasias de los Genitales Femeninos/cirugía , Adulto , Femenino , Hispánicos o Latinos , HumanosRESUMEN
OBJECTIVE: To estimate the accuracy of 3-dimensional (3D) vascular ultrasound in the preoperative assessment of pelvic masses for malignancy. METHODS: We performed a chart review of 66 patients who underwent 3D ultrasound for pelvic masses. Each mass was preoperatively judged to be benign or malignant based upon a study of vascularity within an ovarian mass using 3D ultrasound. Masses with orderly vascular architecture were categorized as probably benign, and masses with chaotic vascular patterns were categorized as malignant. The predictive value of 3D vascular ultrasound was compared with that of 2-dimensional ultrasound and cancer antigen 125 as a predictor of malignancy. RESULTS: Among the 66 patients examined, 34 underwent a documented surgical intervention. Of those 34 patients, 10 had primary malignant neoplasms including 2 with low-malignant potential tumors. Suspicious 3D vascular ultrasound findings predicted malignant neoplasm in 10 patients. Two patients had recurrent cancer; however, only 1 had a suspicious ultrasound finding. There was 1 case of a low-malignant potential tumor without a suspicious ultrasound finding. Excluding the recurrent cancers and the observed patients, the positive predictive value (PPV) and the negative predictive value (NPV) of 3D vascular ultrasound were 100% and 95%, respectively. The PPV and the NPV of 2-dimensional ultrasound in predicting malignancy were 37% and 100%, respectively. An abnormal level of cancer antigen 125 had a PPV and an NPV of 73% and 83%, respectively, in this patient population. CONCLUSIONS: In this preliminary and observational study, 3D ultrasound examination of vascular architecture was discriminatory in distinguishing benign ovarian masses from malignancy. Chaotic vascular architecture correlated with malignancy in this group of high-risk patients.
Asunto(s)
Adenocarcinoma de Células Claras/diagnóstico por imagen , Carcinoma Papilar/diagnóstico por imagen , Cistadenocarcinoma Seroso/diagnóstico por imagen , Neoplasias Endometriales/diagnóstico por imagen , Neoplasias Ováricas/diagnóstico por imagen , Adenocarcinoma de Células Claras/secundario , Adenocarcinoma de Células Claras/cirugía , Adolescente , Adulto , Anciano , Carcinoma Papilar/secundario , Carcinoma Papilar/cirugía , Cistadenocarcinoma Seroso/secundario , Cistadenocarcinoma Seroso/cirugía , Neoplasias Endometriales/secundario , Neoplasias Endometriales/cirugía , Femenino , Humanos , Imagenología Tridimensional , Persona de Mediana Edad , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Cuidados Preoperatorios , Pronóstico , Estudios Retrospectivos , Ultrasonografía Doppler en Color , Adulto JovenRESUMEN
PURPOSE: To determine the efficacy of adjuvant therapy in patients with early-stage uterine papillary serous carcinoma. METHODS AND MATERIALS: Data were collected on all surgically staged Stage I-II uterine papillary serous carcinoma patients. Statistical analyses were performed using the Kaplan-Meier and Cox proportional hazards regression methods. RESULTS: Of 68 patients, 50 had Stage I and 18 had Stage II disease; 35 underwent adjuvant treatment, including radiotherapy in 26, chemotherapy in 7, and combined RT and chemotherapy in 2. The remaining 33 were treated expectantly. The median follow-up was 56 months (range 1-173). The 5-year overall survival rate was 69%. Of 19 patients with disease limited to the endometrium, 10 received no additional therapy, 3 of whom developed recurrence. However, all 9 women who underwent adjuvant treatment remained free of disease. Patients receiving adjuvant therapy with chemotherapy or radiotherapy had a prolonged 5-year overall and disease-free survival compared with those who were treated expectantly (85% vs. 54%, p = 0.002 for overall survival and 85% vs. 49%, p = 0.01 for disease-free survival). In multivariate analysis, adjuvant therapy (p = 0.035) and the absence of lymphovascular space invasion (p = 0.001) remained as independent prognostic factors for improved survival. CONCLUSION: Adjuvant therapy with chemotherapy or radiotherapy improves the survival of women with early-stage uterine papillary serous carcinoma.
Asunto(s)
Cistadenocarcinoma Papilar/tratamiento farmacológico , Cistadenocarcinoma Papilar/radioterapia , Neoplasias Endometriales/tratamiento farmacológico , Neoplasias Endometriales/radioterapia , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carboplatino/administración & dosificación , Quimioterapia Adyuvante , Cistadenocarcinoma Papilar/patología , Doxorrubicina/administración & dosificación , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias/métodos , Paclitaxel/administración & dosificación , Radioterapia Adyuvante , Análisis de Regresión , Tasa de SupervivenciaRESUMEN
OBJECTIVE: Guidelines for referring women with pelvic masses suspicious for ovarian cancers to gynecologic oncologists have been published jointly by Society of Gynecologic Oncologists (SGO) and the American College of Obstetricians and Gynecologists (ACOG). They are based on patient age, CA 125 level, physical findings, imaging study results, and family history. Although the guidelines are evidence-based, their predictive value in distinguishing cancers from benign masses is unknown. METHODS: Chart review for factors included in the guidelines of surgically evaluated women with pelvic masses at 7 tertiary care centers during a 12-month interval was performed. This information was used to estimate the predictive values of the SGO and ACOG guidelines in identifying patients with malignant pelvic masses. RESULTS: A total of 1,035 patients were identified, including 318 (30.7%) with primary malignancies of the ovary, fallopian tube, or peritoneum. Seventy-seven were younger than 50 years old (premenopausal group), and 240 were 50 years old or older (postmenopausal group). Fifty additional patients (4.8%) had cancers metastatic to the ovaries, and the remaining 667 (64.4%) had benign masses. The referral guidelines captured 70% of the ovarian cancers in the premenopausal group and 94% of the ovarian cancers in the postmenopausal group. The positive predictive value was 33.8% for the premenopausal group and 59.5% for the postmenopausal group, whereas the negative predictive values were more than 90% for both groups. Elevated CA 125 level was the single best predictor of malignancy in both groups. CONCLUSION: The SGO and ACOG referral guidelines effectively separate women with pelvic masses into 2 risk categories for malignancy. This distinction permits a rational approach for referring high-risk patients to a gynecologic oncologist for management.
Asunto(s)
Neoplasias Pélvicas/cirugía , Derivación y Consulta/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/análisis , Antígeno Ca-125/análisis , Femenino , Ginecología , Humanos , Oncología Médica , Persona de Mediana Edad , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/cirugía , Neoplasias Pélvicas/diagnóstico , Posmenopausia , Guías de Práctica Clínica como Asunto , PremenopausiaRESUMEN
PURPOSE: The purpose of this study was to determine whether differences in molecular markers might explain the better prognosis of women < or =45 years of age versus women >45 years of age diagnosed with ovarian cancers. EXPERIMENTAL DESIGN: Tissue sections from women with stage III-IV ovarian cancers were examined for expression of CD34, p53, and HER2. The Kaplan-Meier method and Cox Proportional Hazard analyses were used to identify predictors for outcome. RESULTS: Fifty-two women < or =45 years of age were matched with 52 women who were >45 years old. Of the 46 available tissue sections, 24 were from the younger age group (mean age, 41 years), and 22 were from the older age group (mean age, 61 years). Based on CD34 expression, tumors from women >45 years of age had lower microvessel density (MVD) compared with tumors of younger women (10.3 versus 16.1 microvessels per x400 field; P = 0.03). Lower MVD (< or =11 microvessels per x400 field) predicted for a worse prognosis than higher MVD (>11 microvessels per x400 field) in the overall study group (P = 0.001) and within the older subgroup (P = 0.03). The expressions of p53 (P = 0.13) and HER2 (P = 0.49) did not vary between the two age groups. The median survivals of those with tumors that overexpressed p53 and HER2 were 28.6 and 23.9 months compared with 51.7 and 38.6 months in those with cancers that underexpressed these markers, respectively (P = 0.09 for p53, P = 0.15 for HER2). CONCLUSIONS: Ovarian cancers in women >45 years of age had lower MVD compared with those in women < or =45 years of age. Lower MVD was an independent prognostic factor for decreased survival. Lower frequency of neovascularization in these cancers may contribute to the decreased survival observed in women >45 years of age.
Asunto(s)
Antígenos CD34/metabolismo , Biomarcadores de Tumor/metabolismo , Neoplasias Ováricas/metabolismo , Receptor ErbB-2/metabolismo , Proteína p53 Supresora de Tumor/metabolismo , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Microcirculación , Persona de Mediana Edad , Neovascularización Patológica/metabolismo , Neovascularización Patológica/patología , Neoplasias Ováricas/irrigación sanguínea , Neoplasias Ováricas/diagnóstico , Pronóstico , Tasa de SupervivenciaRESUMEN
OBJECTIVE: To assess whether circulating insulin-like growth factor-1 (IGF-1), IGF-2, insulin-like growth factor-binding protein-1 (IGFBP-1), or IGFBP-3 were associated with endometrial cancer in postmenopausal women. STUDY DESIGN: Between 1987 and 1990, we conducted a case-control study of 405 women with endometrial cancer and 297 matched population-based controls. This analysis included 174 postmenopausal cases and 136 controls. RESULTS: In logistic regression models adjusted for potential confounders, higher IGF-1 levels were not positively associated with endometrial cancer: odds ratio (OR) for the highest tertile versus the lowest tertile = 0.63, 95% confidence interval (CI) = 0.30-1.32. Endometrial cancer was inversely associated with IGF-2 (OR for the highest tertile = 0.35, 95% CI = 0.18-0.69) and IGFBP-3 (OR for the highest tertile = 0.40, 95% CI = 0.21-0.77), and not associated with IGFBP-1. CONCLUSION: Serum IGF-1, IGF-2, and IGFBP-3, but not IGFBP-1, were inversely associated with endometrial cancer in postmenopausal women. These associations and the potential role of the IGF system in endometrial proliferation and carcinogenesis warrant further research.
Asunto(s)
Neoplasias Endometriales/sangre , Neoplasias Endometriales/epidemiología , Adulto , Anciano , Estudios de Casos y Controles , Neoplasias Endometriales/etiología , Femenino , Humanos , Proteína 1 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Proteínas de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Factor I del Crecimiento Similar a la Insulina/metabolismo , Factor II del Crecimiento Similar a la Insulina/metabolismo , Modelos Logísticos , Persona de Mediana Edad , Posmenopausia , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Struma ovarii is a rare form of ovarian neoplasm, composed entirely or predominantly of thyroid tissue. This tumor is generally benign, although malignant transformation has been reported. CASE: We report an unusual presentation of a postmenopausal woman with benign struma ovarii associated with a large amount of ascites, a markedly elevated CA 125 serum level, and a large complex pelvic mass thereby mimicking an ovarian cancer. CONCLUSION: This case serves to remind clinicians that clinical features highly suspicious for ovarian cancer do not necessarily confirm a malignancy.
Asunto(s)
Neoplasias Ováricas/diagnóstico , Estruma Ovárico/diagnóstico , Anciano , Anciano de 80 o más Años , Ascitis/sangre , Antígeno Ca-125/sangre , Femenino , HumanosRESUMEN
BACKGROUND: Primary endometrial stromal sarcomas of the ovary are rare gynecologic malignancies. We report a disseminated case of this tumor arising from ovarian endometriosis. CASE: A 45-year-old woman presented with an abdominal pelvic mass and an elevated CA 125. Exploration showed extensive tumor spread from the ovaries to the upper abdomen. Surgery included a total hysterectomy, bilateral salpingo-oophorectomy, splenectomy, partial gastrectomy, partial pancreatectomy, transverse colectomy, appendectomy, and omentectomy. Final pathology showed a low-grade endometrial stromal sarcoma of the ovary arising from foci of endometriosis. Megestrol acetate was initiated, and she is currently without evidence of disease. CONCLUSION: This is an advanced case of a primary low-grade endometrial stromal sarcoma of the ovary arising from endometriosis managed by total resection and progestational therapy.
Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Acetato de Megestrol/uso terapéutico , Neoplasias Ováricas/terapia , Sarcoma Estromático Endometrial/terapia , Terapia Combinada , Endometriosis/patología , Femenino , Humanos , Persona de Mediana Edad , Enfermedades del Ovario/patología , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Ovario/patología , Sarcoma Estromático Endometrial/tratamiento farmacológico , Sarcoma Estromático Endometrial/patología , Sarcoma Estromático Endometrial/cirugíaRESUMEN
Despite effective screening methods for detecting pre- malignant diseases of the cervix, cervical cancer remains a leading cause of cancer mortality in women globally. There has been a dramatic decline in the age adjusted death rate from cervical cancer in the United States, where cervical cancer has declined from the leading cause of cancer mortality in women prior to 1940 to a point where it is a relatively uncommon cause of cancer mortality today. Despite these advances in screening and early detection reported in the United States, intraepithelial disease detection rates in many non-industrialized countries remain low because screening programs are generally lacking. As a result most cancers detected in many underdeveloped areas of the world are advanced at diagnosis. Furthermore, in such countries there may be inadequacies in physicians trained in the most effective means of treating cervical cancer, technical support required for the effective delivery of radiation therapy or the administration of chemotherapy, and modern equipment required for optimal treatment with radiation therapy. Thus cure rates for women with cervical cancers in many areas of the world remain low.
Asunto(s)
Neoplasias del Cuello Uterino/terapia , Ensayos Clínicos como Asunto , Terapia Combinada , Femenino , HumanosRESUMEN
OBJECTIVE: To evaluate the fertility and survival outcomes in young women with borderline ovarian tumors treated with fertility-sparing surgery. STUDY DESIGN: From 1985 to 2002, 25 women with borderline ovarian cancers surgically managed with preservation of the uterus and at least a portion of 1 ovary were identified from tumor registry databases at 2 southern California hospitals. Data for analysis were collected from hospital charts, office records and tumor registry files. RESULTS: Twenty-five patients (median age, 29 years) with borderline ovarian tumors, including 10 with stage IA, 3 with stage IC, 1 with stage IIIA and 11 with unstaged disease, underwent fertility-sparing surgery, consisting of unilateral adnexectomy in 19, unilateral adnexectomy with contralateral cystectomy in 5 and unilateral cystectomy in 1. No disease recurred, providing an overall survival of 100%. Fertility status was available on 15 patients 4-157 months after surgery; 6 of them attempted to become pregnant. Five women had successful pregnancies, with a total of 5 live births. One woman underwent assisted reproductive techniques, became pregnant but aborted. The median follow-up was 80 months (range, 4-157). CONCLUSION: Conservative surgery for borderline ovarian tumors should be considered for women in the reproductive age group who desire preservation of fertility.
Asunto(s)
Conización/métodos , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/cirugía , Adenocarcinoma Mucinoso/mortalidad , Adenocarcinoma Mucinoso/patología , Adenocarcinoma Mucinoso/cirugía , Adulto , California/epidemiología , Cistadenocarcinoma Seroso/mortalidad , Cistadenocarcinoma Seroso/patología , Cistadenocarcinoma Seroso/cirugía , Femenino , Fertilidad , Humanos , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Neoplasias Ováricas/patología , Embarazo , Índice de Embarazo , Sistema de Registros , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoAsunto(s)
Quimioterapia Adyuvante/efectos adversos , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Neoplasias Peritoneales/patología , Síndrome de Lisis Tumoral/etiología , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Ascitis/diagnóstico , Ascitis/etiología , Quimioterapia Adyuvante/métodos , Terapia Combinada , Progresión de la Enfermedad , Resultado Fatal , Femenino , Humanos , Histerectomía/métodos , Laparotomía/métodos , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Neoplasias Primarias Múltiples/tratamiento farmacológico , Neoplasias Primarias Múltiples/cirugía , Neoplasias Ováricas/tratamiento farmacológico , Ovariectomía/métodos , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/cirugía , Tomografía Computarizada por Rayos X , Síndrome de Lisis Tumoral/terapiaRESUMEN
OBJECTIVES: To determine the importance of margin status and other prognostic factors associated with the recurrence and survival of patients with squamous cell vulvar carcinoma. METHODS: Data were analyzed using Kaplan-Meier methods and Cox proportional hazards regression. All slides were re-reviewed by two gynecologic pathologists. RESULTS: Ninety patients (median age: 69) were treated for vulvar carcinoma from 1984 to 2002, including 28 FIGO stage I, 20 stage II, 26 stage III and 16 with stage IV disease. Sixty-three (70%) patients underwent complete radical vulvectomies and 27 (30%) had modified radical vulvectomies. Nineteen (20%) patients received adjuvant radiotherapy. Five-year disease-specific survival rates were 100%, 100%, 86% and 29% for stages I-IV, respectively. None of the 30 patients with a pathologic margin distance >8 mm had local recurrence. Of the 53 women with tumor-free pathologic margin of <8 mm, 12 (23%) had a local recurrence. Moreover, women with >2 positive groin nodes had significantly higher recurrence risk compared to those with <2 metastatic groin nodes (p<0.001). On multivariate analysis, positive groin nodes and margin distance were important prognostic factors for recurrence. Moreover, stage, tumor size, margin distance, and depth of invasion were significant independent predictors for disease-specific survival. The median follow-up was 58 months (range: 2-188). CONCLUSIONS: Pathologic margin distance is an important predictor of local vulvar recurrence. Our data suggest that a > or =8-mm pathologic margin clearance leads to a high rate of loco-regional control.
Asunto(s)
Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Neoplasias de la Vulva/patología , Neoplasias de la Vulva/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/radioterapia , Supervivencia sin Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Radioterapia Adyuvante , Neoplasias de la Vulva/radioterapiaRESUMEN
OBJECTIVES: To compare the outcomes of stage III and IV uterine papillary serous carcinoma (UPSC) patients treated with platinum-based chemotherapy (PC) versus whole abdominopelvic irradiation (WAPI) after optimal cytoreductive surgery. METHODS: Surgically staged patients with advanced stage UPSC diagnosed between 1981 and 2002 were identified from tumor registry databases at four hospitals. Survival analyses and predictors of outcome were analyzed using Kaplan-Meier methods. RESULTS: Of the 40 patients with advanced UPSC (median age: 64.5), 84% were Caucasian, 8% were African American, and 8% were Asian. The majority of patients (85%) presented with vaginal bleeding. Twenty-seven had stage III and 13 had stage IV disease. All patients were optimally debulked; 21 patients received adjuvant PC while 19 underwent WAPI. The median follow-up was 27 months (range: 5-209). The 3-year overall survival (OS) and progression-free survival (PFS) for the patients with stage III disease were 49% and 37% compared to 37% and 31% in those with stage IV disease (P = 0.23 for OS; P = 0.41 for PFS). Women who received PC had a 3-year OS and PFS of 43% and 31% compared to 45% and 41% in those receiving WAPI, respectively (P = 0.40 for OS; P = 0.84 for PFS). CONCLUSION: Platinum-based chemotherapy or whole abdominopelvic irradiation resulted in similar survival in this series of women with optimally cytoreduced UPSC. Given the overall poor prognosis of these patients, new treatment modalities are warranted.
Asunto(s)
Cistadenocarcinoma Papilar/tratamiento farmacológico , Cistadenocarcinoma Papilar/radioterapia , Cistadenocarcinoma Seroso/tratamiento farmacológico , Cistadenocarcinoma Seroso/radioterapia , Neoplasias Uterinas/tratamiento farmacológico , Neoplasias Uterinas/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Adyuvante , Cistadenocarcinoma Papilar/cirugía , Cistadenocarcinoma Seroso/cirugía , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Radioterapia Adyuvante , Estudios Retrospectivos , Tasa de Supervivencia , Neoplasias Uterinas/cirugíaRESUMEN
OBJECTIVE: Primary lymphoma of the uterine cervix is rare, with less than 60 cases reported. We present a series of 6 patients with cervical lymphoma and review the literature. STUDY DESIGN: Between 1988 and 2003, we identified 6 women with primary lymphoma of the uterine cervix treated at our institutions. Data for analysis were obtained from hospital charts, office records, and tumor registry files. We also reviewed 20 published reports on cervical lymphoma, providing information on 58 additional patients. RESULTS: The median age at diagnosis was 52 years (range 40-76). Three patients had an abnormal Papanicolaou test within 6 months of the diagnosis. Mean tumor size was 8.3 cm (range 3-14 cm). On the basis of the Ann Arbor system of staging where "E" denotes extranodal tumor origin, 2 patients had stage IE, 1 had stage IIIE, and 3 had stage IVE disease. The median follow-up for these 6 women was 33 months (range 12-120). Adding the 6 patients in our series to the 58 patients obtained from published reports, 43 had stage IE, 14 had stage IIE, 2 had stage IIIE, and 5 had stage IVE disease. There was no consistent pattern of treatment identified from our literature review. CONCLUSION: Primary lymphoma of the uterine cervix is a rare malignancy. Most patients present with stage IE disease. Women with localized disease typically respond to various combinations of surgery, chemotherapy, and radiotherapy. Combination chemotherapy with tailored radiotherapy appears to be the preferred treatment option in women with advanced disease.
Asunto(s)
Linfoma/patología , Neoplasias del Cuello Uterino/patología , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclofosfamida/uso terapéutico , Doxorrubicina/uso terapéutico , Femenino , Humanos , Linfoma/diagnóstico , Linfoma/tratamiento farmacológico , Linfoma/cirugía , Persona de Mediana Edad , Estadificación de Neoplasias , Ovariectomía , Prueba de Papanicolaou , Prednisona/uso terapéutico , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/tratamiento farmacológico , Neoplasias del Cuello Uterino/cirugía , Hemorragia Uterina/etiología , Frotis Vaginal , Vincristina/uso terapéuticoRESUMEN
PURPOSE: To compare the in vitro drug resistance profiles of advanced stage primary and recurrent epithelial ovarian cancer specimens using the tritiated thymidine uptake assay. METHODS: Extreme drug resistance (EDR) to cisplatin, paclitaxel, 4-hydroxycyclophosphamide, and topotecan was determined for an unselected population of primary and metastatic malignant ovarian tissues, synchronous tumors (primary and metastatic tissues obtained from the same patient at diagnosis), and metachronous lesions (specimens from the same patient before and after chemotherapy). RESULTS: For the large unselected population of malignant tissues (total, N = 6990; primary ovarian, N = 2031; metastatic ovarian, N = 4959), no statistically significant differences were discovered between primary tissues and metastatic lesions when a comparison was made between the percentage of tumors from each group that exhibited extreme drug resistance to the agents assayed. From the library of 6990 specimens, 119 synchronous pairings were identified. These synchronous lesions did not differ significantly in the %EDR between primary and metastatic sites in the same patient; approximately 10% shifted between low drug resistance and EDR. A total of 334 metachronous pairings were identified and the percentage of tissues that exhibited EDR also failed to show a significant difference when primary tumors were compared with matched recurrences in the same patient. CONCLUSIONS: For the agents studied, acquired resistance was not a function of disease site. In vitro drug resistance observed at recurrence was not influenced significantly by intervening therapy. It is possible that assay results at diagnosis could be used to guide subsequent therapy at relapse, especially when recurrent tissue is not available for analysis.