Ovarian cancer: origin and factors involved in carcinogenesis with potential use in diagnosis, treatment and prognosis of the disease.

Ovarian cancer representing the most lethal gynecologic malignancy escapes from the efforts to manage the disease. We reviewed the current state of the research considering three main concepts on origin of ovarian cancer including epithelial-mesenchymal transition, secondary origin from Müllerian system and cancer stem cell hypothesis. Cytogenetic and molecular characteristics of ovarian cancer are focused particularly on microRNA expression studies revealing huge potential in recent years, although other transcriptomic, proteomic, epigenetic, epidemiologic and immunological factors are touched upon, too. Routine and investigated diagnostic and treatment methods are outlined and several factors revealed to be associated with prognosis of the disease. Despite the huge progress on elucidating factors involved in ovarian cancer carcinogenesis, still remains urgent need to improve both the diagnostics as well as the treatment.

[Ultrasound-guided intervention in the treatment of abdomino-pelvic advanced tumors]. / Význam intervencní ultrasonografie v l écbe pokrocilých abdomino-pelvických nádoru.

OBJECTIVE: The goal of this study was to evaluate the accuracy and safety of ultrasound-guided tru-cut biopsy in advanced abdomino-pelvic tumors in a sufficiently large cohort. DESIGN: Prospective study. SETTING: Oncogynecological Center, Department of Obstetrics and Gynecology, General Faculty Hospital of Charles University, Prague. METHODS: Patients indicated for tru-cut biopsy were those with primarily inoperable tumors, with advanced tumors and compromised performance status preventing a primary surgical procedure, and with recurrent pelvic tumors requiring histological verification. All were referred to the Oncogynecological Center between January 2005 and June 2007. Tru-cut biopsy was taken either from pelvic tumor or from its metastatic sites transvaginally or transabdominally under ultrasound guidance. Sample adequacy was evaluated. RESULTS: Altogether, 119 patients were referred for tru-cut biopsy during a study period. Only 4 cases were found unsuitable for tru-cut biopsy and the patients were referred for laparoscopy instead. Samples were obtained transvaginally in 67 patients (58.3%) and transabdominally in 48 patients (41.7%). The biopsy was taken from pelvic tumor in 59 patients (51.3%), omental cake in 14 patients (12.2%), from peritoneal visceral or parietal carcinomatosis in 37 patients (32.2%) and from other localities in 5 patients (4.3 %). The diagnostic adequacy of ultrasound-guided tru-cut biopsy reached 94.8% (95% CI, 94.17-99.40%). There were only two tru-cut biopsy-related complications: The first case involved bleeding from tumor in a patient with mild thrombocytopenia that required laparotomy; in the second case, diagnostic laparoscopy was indicated after a minor bleeding occurred in the biopsy site on ultrasound, however, no significant pelvic bleeding was confirmed by the procedure. CONCLUSION: Ultrasound-guided tru-cut biopsy is a safe, reliable, fast, and cost-effective diagnostic method for histological verification of both advanced primary and recurrent abdomino-pelvic tumors. It can be performed in an outpatient setting without the need for general anesthesia, causing a minimal discomfort to the patient in comparison with laparoscopy or laparotomy. The risk of complications is low and the main advantage is the acquirement of a sample adequate for further immunohistochemical examination, which is a necessary requirement for the choice of optimal oncological treatment.

Genetic alterations in gynecological malignancies.

The aim of the study was to estimate genetic alterations detected in ovarian and cervical cancer cells, in correlation with other available parameters of a histopathological and clinical character and to find the important associations and differences of both these tumor sites with diverse impacts on the cancer's prognosis. Sixty patients presenting with ovarian cancer and twenty patients manifesting cervical cancer were included in the study. The histological type and grade, MIB-1 and p53 were estimated. For genetic testing, both conventional and molecular methods were applied. The results were subjected to statistical evaluation, using analysis of variances and I2 test. Ovarian cancer patients with extensive chromosomal rearrangements were assessed to be significantly younger. The typical findings, different in ovarian and cervical cancer cells have been found, including some less frequent findings (deletion of 22q in 36% of all ovarian cancer samples, as well as amplifications of chromosome 2 and deletions of chromosome 10, 11p and 21q in cervical cancer cells). The expression of proliferation marker MIB-1 was observed to be significantly higher in women with a high p53 HSCORE. The significant importance of genetic alterations and the activity of proliferative markers, including common correlations with an unfavorable outcome with respect to ovarian tumors in younger women were found. Key words: chromosomal rearrangements, genetic alterations, ovarian cancer, cervical cancer, prognostic significance.

Chromosomal rearrangements and their relations to histopathological and clinical parameters in epithelial ovarian cancer.

The aim of the study was to estimate genetic alterations detected in ovarian cancer cells in correlation with other available parameters of histopathological and clinical character and to find important relations with impacts on the cancer prognosis. Additionally, we wanted to compare methods for evaluating genetic changes. Sixty patients with ovarian cancer were included in the study. The histological type and grade were defined, MIB-1 and p53 were estimated using an immunohistochemical method. For genetic testing, both conventional and molecular methods were applied - direct culture and G-banding technique, FISH method with whole chromosome painting probes, and CGH method. The results were submitted to statistical evaluation, using analysis of variances and chi2 test, with Bonnferroni correlations of the significance level. Numerical and structural aberrations have been detected in more than 63 % examined ovarian cancer cases. Patients with extensive chromosomal rearrangements were significantly younger. Specific genetic alterations, including some rare findings such as deletion 22q in 36 % of all ovarian cancer samples, have been found, together with associations between particular prognostic factors.

[Importance of chromosomal changes correlated to prognostic factors in ovarian and cervical malignant tumors]. / Význam chromozomálních zmen ve vztahu k prognostickým faktorum u zhoubných nádoru vajecníku a delozního hrdla.

OBJECTIVE: The aim of the study was to estimate genetic changes detected in ovarian and cervical cancer cells, in correlation with other available clinical and histopathological parameters, with impact upon cancer prognosis. DESIGN: Original article. SETTING: Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University in Prague and General Teaching Hospital, Prague. METHODS: Sixty patients with ovarian cancer and twenty patients with cervical cancer were included in the study. A histopathologist examined the tumor samples in order to define the histological type and grade. MIB-1 and p53 were estimated using an immunohistochemical method. For genetic testing, both conventional and molecular methods were applied (direct culture and a G-banding technique, the FISH method with whole chromosome painting probes, and the CGH method). The results were submitted to statistical evaluation, using analysis of variances and X2 test. RESULTS: Numerical and structural chromosomal aberrations were detected in more than 63% of the examined ovarian cancer cases and 29% of examined cervical cancer cases. Ovarian cancer patients with extensive chromosomal rearrangements were significantly younger. The most typical findings in ovarian cancer cells were amplifications 1q, 3q, 20q; and deletions 4p, 4q, 18p, 18q, 19q. The most typical findings in cervical tumor cells were amplifications 3q, 5p; and deletions 13q and isochromosome 5p. Some of the less frequent findings in our study were deletion 22q in 36% of all ovarian cancer samples, as well as amplifications of chromosome 2 and deletions of chromosome 10, 11p, 21q in cervical cancer cells. The activity of proliferative marker MIB-1 was significantly higher in women with a high p53 HSCORE (p < 0.01). CONCLUSIONS: Chromosomal rearrangements, different for ovarian and cervical cancer, have been found, including several rare findings. The significant importance of genetic alterations and the activity of proliferative markers, including common correlations with an unfavorable outcome in ovarian tumors of younger women were found.

[Inactivation of BRCA1, BRCA2 and p53 genes in sporadic ovarian cancer]. / Inaktivace genu BRCA1, BRCA2 a p53 u sporadického karcinomu vajecníku.

OBJECTIVE: To analyze loss of heterozygosity (LOH), loss of expression and somatic mutations of BRCA1, BRCA2 and p53 genes in sporadic epithelial ovarian cancer samples. DESIGN: Original paper. SETTING: Oncogynecologic center, Clinic of Obstetrics and gynecology, First Faculty of Medicine, Charles University in Prague and General Teaching Hospital, Prague. MATERIAL AND METHODS: We used genomic DNA and total RNA from peripheral blood and fresh frozen tumor as a template for LOH, loss-of-expression and mutation analyses. RESULTS: LOH in at least one region was found in 60% of tumors. Majority of these alterations occurred not solely, but in conjunction with other region deletions. CONCLUSION: Our study confirms high frequency of somatic alteration of BRCA1, BRCA2 and p53 genes in sporadic epithelial ovarian cancer.

[Detection of HPV DNA in lymph nodes in early stages cervical cancers]. / Stanovení DNA HPV v lymfatických uzlinách u casných stadií karcinomu delozního hrdla.

OBJECTIVE: Review recent knowledge concerning significance of detection of DNA HPV in regional lymph nodes in cervical cancer patients. TYPE OF THE STUDY: Literature review. SETTING: Department of Obstetrics and Gyneacology, 1st Faculty of Medicine, Charles University and General Teaching Hospital, Prague. RESULTS: Metastatic involvement of pelvic lymph nodes is the most important prognostic parameter in early stages cervical cancer. Still, almost 20% of patients with negative pelvic nodes experience recurrence. Detection of HPV DNA in lymph nodes might be a marker of occult metastatic involvement. However, published data are limited, mostly due to inconsistent methodology. Only 3 prospective studies evaluating HPV from fresh or frozen tissue were published till now, all other retrospective studies extracted HPV DNA from paraffin embedded samples. A few papers showed correlation between HPV DNA and metastatic involvement of pelvic lymph nodes. DNA HPV identification in histopatology-negative nodes was considered as a risk factor for recurrence. Presence of DNA HPV 18 in histopathology-negative pelvic nodes was described as a poor prognostic factor; however prognostic significance of individual genotype is still unclear. CONCLUSION: Detection of high risk HPV DNA in regional lymph nodes is a good candidate for prognostic parameter in early stages cervical cancers. The group of women with both absence of metastatic involvement and negative HPV DNA evaluation of regional lymph node should represent a cohort of patients with particularly good prognosis.

[Contribution of neoadjuvant chemotherapy for operability of cancers of the uterine cervix]. / Prínos neoadjuvantní chemoterapie pro operabilitu zhoubných nádoru delozního hrdla.

OBJECTIVE: To compare per-operative and post-operative morbidity in patients undergoing radical surgery for carcinoma of the uterine cervix after administration of a neoadjuvant chemotherapy, and for primarily small cervical tumour. TYPE OF THE STUDY: A retrospective case-control study. SETTING: Department of Obstetrics and Gyneacology, 1st Faculty of Medicine, Charles University and General Teaching Hospital, Prague. METHODS: The study included 24 patients with squamous cell carcinoma of the uterine cervix who underwent radical hysterectomy including systematic pelvic lymphadenectomy after previous administration of neoadjuvant chemotherapy (NACT) during the period between 1/2004 and 6/2006. The control group of 24 patients was selected retrospectively from the population of women after radical surgery carried out in the same period, nevertheless, the controls underwent the surgery for primarily small carcinoma of the uterine cervix, stages IA2 or IB1. The tumour size consistent with the reduced tumour after NACT administration was the criterion for selection of the control group. The following parameters were monitored in both groups--duration of the surgery, blood loss objectivised by a difference in pre-operative and post-operative haemoglobin and haematocrit values, the need of blood transfusion, per-operative complications, early post-operative complications (up to 6 weeks after the surgery), duration of hospitalization and retaining the inserted epicystotostomy due to hypotonic bladder after discharge. RESULTS: A therapeutic response allowing the radical surgery was achieved in 92% patients after NACT. After NACT the original tumour volume was reduced by 70% on the average (58% - 100%). No significant differences between the group of patients treated with NACT and undergoing subsequent radical hysterectomy and the control group were reported in terms of duration of the surgery (165 min. vs. 160 min.), blood loss (the difference in pre-operative and post-operative haemoglobin values 18 g/l vs. 19 g/l, the difference in pre-operative and post-operative haematocrit values 0.056 vs. 0.064), administration of blood transfusion (25% vs. 21%) and duration of hospitalization (9.5 days vs. 9.6 days). A significant difference was reported only in the need to retain the inserted epi-cystostomy after discharge (67% vs. 47%). CONCLUSION: There were no significant differences in the evaluated parameters of per-operative and postoperative morbidity in patients after NACT and in control patients, except for the necessary duration of artificial urine derivation in patients after NACT due to the fact that their surgery was more radical in the parametria. Administration of NACT regimen involving ifosfamide/cisplatin (IP) improved surgical conditions in the bulky squamous cell carcinoma of the uterine cervix.

[Prognostic factors of ovarian cancer]. / Prognostické faktory ovariálního karcinomu.

OBJECTIVE: To sum up the knowledge about prognostic factors of ovarian cancer. TYPE OF STUDY: Review article. SETTING: Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague. METHODS: Compilation of data from scientific litarature. CONCLUSIONS: Prognostic factors represent a complex of information with clinical, social, histopathological, biochemical, genetic and molecular biological characteristics. They are integral part of the predictive oncology, with perspective advantage in prevention, screening, prediction, prognosis and monitoring of the tumor disease activity. The prognostic factors of ovarian cancer are discussed from several points of view in the presented review, included their possible implementation into the clinical practice.

[Glandular premalignant lesions of the uterine cervix]. / Adenoprekancerózy delozního hrdla.

OBJECTIVE: Review of diagnostical and therapeutical methods in glandular premalignant lesions of the uterine cervix. DESIGN: Review article. SETTING: Department of Obstetrics and Gyneacology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. RESULTS: The incidence of invasive adenocarcinomas of the uterine cervix is increasing. Incidence ratio between adenocarcinomas and spinocellular carcinomas is approximately 1:5; however ratio of premalignant lesions reaches only about 1:80. Glandular premalignant disease is usually found in the specimen taken for squamous disease. The coincidence of both types of premalignant lesions, so called "mixed lesion", is revealed in about 46-72%. PAP-smear of AGC-NOS/-NEO or adenocarcinoma in situ (AIS) in combination with typical colposcopic appearance raise a suspicion of glandular lesion. Direct biopsy must be always performed to get definite diagnosis. Optimum biopsy technique requires cylindrical excision. A woman can be carefully followed if desires pregnancy and specimen margins are negative. Hysterectomy is indicated if reproductive plans are completed. CONCLUSION: Diagnosis of glandular premalignat lesion of the uterine cervix is more complicated in comparison to spinocellular one, however it is getting more significant due to increasing incidence. Colposcopy and cytology are less reliable. Any suspicion on glandular premalignat leasion requires more active approach and radical procedure (hysterectomy) if possible.

[Radical parametrectomy in women with invasive cervix cancer after previous simple hysterectomy]. / Radikální parametrektomie u zen s invazivním karcinomem delozního hrdla po piredchozí prosté hysterektomii.

OBJECTIVE: Evaluate technique, indications and limits of surgical procedure in the treatment of cervical cancer diagnosed from uterus specimen from simple hysterectomy. DESIGN: Retrospective observational study, review of literature. SETTINGS: Department of Obstetrics and Gynecology, 1st Medical Faculty and General Faculty Hospital, Charles University, Prague, Czech Republic. METHODS: Women following radical parametrectomy with upper vaginectomy and pelvic lymphadenectomy were enrolled to the study. In all patients unexpected invasive cervical cancer was found from the uterus specimen after simple hysterectomy. RESULTS: Together 10 patients were enrolled to the study. CIN was the indication for primary hysterectomy in all but two patients. There were two operative complications, cystostomy in both cases, treated properly during surgery. In the specimen from radical procedure residual tumor in parametria was found in 2 cases, and metastasis to pelvic nodes in 4 cases. There was no postoperative complication. Adjuvant radiotherapy was recommended in 4 patients due to positive lymph nodes, in one case due to residual tumor in parametria, and in one case for both reasons. CONCLUSIONS: Radical parametrectomy with upper vaginectomy and pelvic lymphadenectomy should be considered as an alternative solution in patients following simple hysterectomy with unexpected finding of invasive cervical cancer. Morbidity of the procedure is higher in comparison to standard radical hysterectomy, however majority of complications are easy to repair. The most significant criteria for patient's selection for surgical approach is a depth of invasion to cervical stroma. In our group radical procedure obviated the need for radiotherapy in half of the patients.

[Genetic aspects of malignant epithelial ovarian tumours]. / Genetické aspekty maligních epiteliálních nádoru ovaria.

OBJECTIVE: To sum up the knowledge about genetic aspects of ovarian cancer. TYPE OF STUDY: Review article. SETTING: Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague, Prague. METHODS: Compilation of data from scientific literature. CONCLUSIONS: Ovarian cancer represents the most lethal malignancy among gynecological tumours. Etiology is still largely unknown. Multistep process, with accumulation of genetic alterations concerning factors with key role in cell regulation - oncogenes, tumor-supressor genes and mismatch-repair genes is supposed. Cytogenetic and molecular-genetic characteristics, in correlation with other molecular-biological parameters extend information of carcinogenesis. The final aim is to create a predictive model for clinical use.

[Pelvic exenteration]. / Exenterace pánve.

OBJECTIVE: Review of literature concerning pelvic exenterative procedures. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Charles University, Prague. METHODS: Review and critical assessment of published data. CONCLUSION: Pelvic exenterations are standard procedures in oncogynecology which have no alternative in certain indications. The most frequent indications are recurrences or progressions of cervical, vulva or vaginal cancers. Exenterative procedures might be used in primary treatment in some cases of locally advanced tumors. Mortality of current procedures reaches 5% to 10%, early and late postoperative morbidity is frequent (40-60%). Recently explorative laparoscopy is used in preoperative staging to decrease the number of aborted procedures due to distant metastasis or pelvic tumor inoperability. The procedure with high morbidity, causing impairment of quality of life, is justified due to good follow-up results--5-years overall survival is about 50-60%. It should be emphasized that with no treatment in these patients median of survival reaches about 6 months.

[Possibilities of increased radicality in pelvic exenteration]. / Moznosti zvýsené radikality u exenterací pánve.

OBJECTIVE: Review of advanced radicality in pelvic exenterations. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, General Faculty Hospital and Ist Medical Faculty of the Charles University, Prague. METHODS: Review and critical assessment of published data. CONCLUSIONS: More extensive radicality in pelvic exenterations make possible to use surgical treatment in some cases of lateral recurrences or central recurrences with the attachment to the pelvic side wall. One possible technique is a combination of en bloc exenteration with pelvic bone resection, most frequently sacrum. Experiences in gynecological tumours are so far limited. Laterally extended resection was described in lateral infrailiac pelvic wall recurrences. The only one presented paper related to laterally extended procedures showed a reasonable overall survival of patients; however follow-up is limited.

[Teratogens during pregnancy]. / Teratogeny v tehotenství.

OBJECTIVE: To sum up the knowledge of the influence of substances in the external environment on the development of the human embryo/fetus during exposure at various periods of intrauterine life. TYPE OF STUDY: Summary. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University, Prague. METHODS: Compilation of data from scientific literature. RESULTS: An overview of the main groups of teratogenic substances among the physical, chemical, biological and metabolic teratogens. Their relationship to morphological malformations, anomalies and functional defects are described. CONCLUSION: A summary of the principles/basics of care of a pregnant woman using medication before or during pregnancy and the possibility of evaluating the individual reproductive risk during preconception and prenatal exposure to teratogenic substances.

[Vulvar carcinoma--retrospective study of 47 cases (epidemiology, etiology and long-term results]. / Karcinom vulvy--retrospektivní studie 47 prípadu (epidemiologie, etiologie a dlouhodobé výsledky).

OBJECTIVE: To evaluate the incidence of vulvar carcinoma, epidemiological signs and therapeutic results in patients with vulvar malignancies during the stated time period. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague. METHOD: An analysis of the available clinical documentation of the patients of the oncological outpatient service of the Department of Obstetrics and Gynaecology. RESULTS: Vulvar carcinoma represents 4% of all malignant tumours of female genital tract. It concerns predominantly elder women (the average age is 74.2 years). The overall 5-year survival, with no regard to the stage of the disease, is 39.1% in our group. This low figure is due to the high age of the group and to the inappropriate therapeutic approach owed to the internal comorbidity, advanced age and the fact that the majority of cases are diagnosed in advanced stage. CONCLUSION: In spite of good access, the introduction of screening program is unlikely due to the age distribution, biological behaviour and difficulties in diagnostic of premalignant lesions. With regard to the increasing incidence of in situ carcinoma whose ethiopathogenesis is affected by HPV infection, it is necessary to pay more attention to vulva lesions in terms of an early histopathological verification. The treatment of the external genital tract malignancies should be concentrated to the centers with the greatest experience of their management.

[Borderline ovarian tumors--10-year clinical series and literature review]. / Borderline nádory vajecníku--10letý klinický soubor a literární prehled.

OBJECTIVE: Analysis of 10-year clinical series of borderline ovarian tumors (BLT) and literature review. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. METHODS: Analysis of 38 patients from years 1994-2003 regarding age, histological types, tumor duplicities, role of frozen section, Ca125 levels, operation methods, adjuvant treatment, relaps occurrence, follow-up and survival. RESULTS: Median follow-up was 18.5 months (3-122), median age 51 (16-78). HISTOLOGY: 23 serous, 12 mucinous (1 microinvasion), 2 cystadenofibromas and 1 endosalpingiosis. 26 patients of stage IA, 3 of IB, 6 of IC, 1 of IIA, 1 of IIC and 1 IIIB. 3 cases were underestimated by frozen section. 6 tumor duplicities were revealed. Ca125 marker was elevated in 10/23 (43.5%) cases. 12 patients underwent conservative surgery, 3 of them with complete staging including lymphadenectomy. 26 patients had radical operation, 9 of them with full staging. No one lymphonode was positive. 7 patients had primary laparoscopic approach, 6 had more than one operation. Adjuvant chemotherapy was indicated in 3 cases: PTX-CBDCA (IC and IIC) and CBDCA-CFA (IC). 4 patients were lost of evidence. 2/34 evaluated patients (5.9%) had a frank carcinoma recurrence after 3 and 7 years. Both relapsed patients and all 34 evaluable patients live without evidence of disease at present. Our results as well as literature date generate some controversies. Do we need staging lymphadenectomy in all cases (inclusive T1a)? Which parameters identify high-risk group and which patients will benefit from adjuvant (and which one) therapy? Are there not recurrencies of BLT rather second primary malignancies? CONCLUSION: In spite of 2 recurrences in a group of 34 evaluated cases all patients live without evidence of disease at present. Some management questions are therefore raised.

[Granulosa cell tumor--clinical group and literature review]. / Nádor z bunek granulózy--klinický soubor a literární prehled.

OBJECTIVE: To present a review of literature and to analyse a clinical retrospective series of patients with granulosa cell tumor. DESIGN: Retrospective study and review. SETTING: Department of Obstetrics and Gynaecology, First Faculty of Medicine, Prague, Czech Republic. METHODS: Retrospective analysis of age, stage, surgery, radiotherapy and chemotherapy, survival curve, number of recurrences and time to recurrence. Literature and information database (Medline 1997-1999) review. RESULTS: In a group of 43 patients the median of age was 53.5 years. 83.7% of cases were in a stage I. There were two duplicate tumors in a series. Conservative surgery was performed in 9/43 cases, 5 of them were reoperated on. The most frequent chemotherapy regimens were platinum-cyclophoshamide and BEP (bleomycin, etoposide, platinum). The 5-year overall survival was 86% and specific survival 90.7%. There were 3/43 recurrences, median time to recurrence was 22 months. CONCLUSION: A good prognosis of a patient with granulosa cell tumor requires a precise histopathologic examination, an adequate surgery and a comprehensive clinical analysis of a case to evaluate an indication of adjuvant therapy. Concentration of patients in oncogynaecological centres is advisable. A careful follow-up because of a risk of late recurrences is necessary.

[Gynecologic operations in patients after kidney and liver transplantation--case report]. / Gynekologické operace u pacientek po transplantaci ledviny a jater--kazuistiky.

OBJECTIVE: To give an overview of the complications associated with the post-transplantation period which thus presents an increased risk for subsequent gynecological surgery and also for the postoperative period. To determine the criteria and conditions under which these operations may be performed with relative safety. TYPE OF STUDY: Case report. SUBJECT OF STUDY: Described surgical treatment of gynecological diseases in three patients after liver and kidney transplantation. CONCLUSION: A summary of the principles/basics of patient care after surgery for gynecological indications with a prior organ transplant in ther patient's history. These patients should undergo surgery in hospitals with a high quality of professional care as well as high quality equipment and cooperation among the specialists from the various medical fields involved.

[Prophylactic adnexectomy]. / Profylaktická adnexektomie.

OBJECTIVE: Analysis of the issue of prophylactic bilateral salpingo-oophorectomy (BSO): a) during pelvic surgery for benign diagnosis; b) in women with hereditary risk of ovarian cancer. DESIGN: Review article. SETTING: Department of Obstetric and Gynecology, Charles University. METHODS: Critical review of published data. CONCLUSION: During pelvic surgery for benign diagnosis a prophylactic BSO is indicated of the age over 45, in younger women an individual approach is required, considering many aspects, including history of ovarian and breast cancer. Another indication for BSO is an increased risk of familial ovarian cancer. The surgery significantly diminished the risk of epithelial cancer of ovary, fallopian tube, and simultaneously the risk of breast cancer. There is a continuing increased risk of peritoneal cancer following the surgery. Bilateral oophorectomy together with bilateral salpingectomy is recommended. The age limit for surgery is about 35 years after careful consideration of individual risk, reproductive plans, type of mutation and age at malignant disease manifestation in previous generation. Potential alternative for women who do not accept prophylactic surgery is tubal ligation. Screening of risk group or chemoprevention by oral contraceptives are not equivalent alternatives to prophylactic surgery.