Dualistic classification of epithelial ovarian cancer: surgical and survival outcomes in a large retrospective series.

BACKGROUND: Ovarian cancers have been recently categorized into types I and II according to a dualistic model of tumorigenesis. Data on the correlation between this classification and clinical outcome are still scarce and controversial. METHODS: A retrospective analysis of patients with ovarian cancer treated from 1998 to 2013 and operated by the same surgeon was conducted. Patients were classified into two groups: type I (125 patients), including low-grade serous, mucinous, endometrioid, and clear cell tumors; and type II (286 patients), including high-grade serous tumors, unspecified adenocarcinomas, and undifferentiated carcinomas. RESULTS: Type II patients had a significantly higher incidence of advanced disease than type I (88.4 vs. 65.6 %, P = 0.0001) and required more aggressive surgical procedures. Rates of optimal tumor debulking were almost similar between groups (92.6 vs. 91.7 %, type I vs. II, P = NS). After a median follow-up of 41 months, 207 patients (50.4 %) were alive and 204 (49.6 %) were dead; 79 type I patients (63.8 %) and 237 type II patients (82.7 %) experienced relapse (P = 0.02). Progression-free survival was significantly different between groups: 25 months for type I vs. 17 months for type II (P = 0.023). Overall survival was not significantly different between groups, with a median overall survival of 75 months for type I vs. 62 months for type II (P = 0.116). CONCLUSIONS: The dualistic histotype-based classification into types I and II of ovarian cancer does not seem to correlate with prognosis. Different molecular characteristics of type I and II tumors may have therapeutic implications and should be deeply investigated.

Minimally invasive surgical approach for treatment of isolated endometrial cancer recurrence in an ultra-morbidly obese patient.

Herein is reported the first published case of an ultra-morbidly obese woman affected by an isolated pelvic recurrence of endometrial cancer, which was successfully treated via minimally invasive vaginal excision.

Antibiotics Prophylaxis for Operative Hysteroscopy.

OBJECTIVE: To evaluate the incidence of infectious complications and effect of prophylactic antibiotic administration during operative hysteroscopic procedures. METHODS: A multicentric randomized controlled trial was conducted between January 2012 and December 2013. Women (n = 180) affected by endometrial hyperplasia, myomas, or endometrial polyps undergoing operative hysteroscopy were randomized to receive cefazolin 2 g intravenously 30 minutes prior to the procedure (n = 91) and no treatment (n = 89). RESULTS: No statistical difference in terms of postoperative fever (2.4% vs 2.3%, P = .99), endometritis (0% vs 0%), pain (6.0% vs 10.4%, P = .40), cervicitis-vaginitis (0% vs 0%), pelvic abscess (0% vs 0%), pelvic inflammatory disease (0% vs 0%), and bleeding (0% vs 0%) was noticed. No statistical difference in terms of side effects attributable to antibiotic prophylaxis such as allergy (0% vs 4.8%, P = .12), nausea (10.7% vs 17.4%, P = .27), vomiting (3.6% vs 4.6%, P = .99), diarrhea (4.8% vs 5.4%, P = .99), cephalea (9.5% vs 3.5%, P = .13), dizziness (4.8% vs 2.3%, P = .44), and meteorism (5.4% vs 3.4%, P = .99) was noticed. CONCLUSION: The results of the current study support the recommendation not to prescribe routine antibiotic prophylaxis prior to operative hysteroscopy.

Solitary gastric recurrence from ovarian carcinoma: a case report and literature review.

BACKGROUND: Isolated gastric recurrence due to ovarian cancer is a rare event and is usually associated with gastrointestinal symptoms. CASE REPORT: We report a case of an isolated gastric recurrence of ovarian carcinoma in an otherwise asymptomatic 42-year-old woman in whom diagnosis was made using the FDG-PET/CT scan followed by laparoscopy. CONCLUSIONS: In rare cases, ovarian cancer can directly recur on the stomach without any symptoms. FDG-PET/CT scan and diagnostic laparoscopy are effective in leading to an early diagnosis of disease recurrence.

Olaparib, PARP1 inhibitor in ovarian cancer.

INTRODUCTION: Ovarian cancer is the most important cause of gynecological cancer-related mortality. Conventional treatments for advanced or recurrent disease offer limited results in terms of long-term responses and survival. Researches have recently focused on target therapies, which represent a new, promising, therapeutic approach, able to maximizing tumor kill and minimizing toxicity. The family of polyadenosine diphosphate-ribose polymerase (PARP) inhibitors is currently one of the most hopeful and investigated alternatives. AREAS COVERED: Preclinical and clinical studies of Olaparib , the most investigated PARP inhibitor in ovarian cancer, are analyzed and discussed. Data were obtained by searching for all English peer-reviewed articles on Medline, on Cochrane Database and all on-going Phase I and II studies registered on National Cancer Institute Clinical Trials; also any related abstracts recently presented on Olaparib at major international congresses will be included. EXPERT OPINION: Bad prognosis and drug resistance usually affect ovarian cancer. Recent trends toward the knowledge of molecular-specific pathways have produced new target drugs. PARP inhibition mediated by Olaparib in BRCA1 (breast cancer 1) and BRCA2 (breast cancer 2)-mutated and in sporadic ovarian cancer represents a promising field of investigation. Further studies are needed to confirm initial exciting results.

GnRH analogue treatment before hysteroscopic resection of submucous myomas: a prospective, randomized, multicenter study.

OBJECTIVE: To evaluate the efficacy of GnRH analogue treatment before hysteroscopic resection of submucous myomas in patients with abnormal uterine bleeding. DESIGN: Multicenter, prospective, randomized, clinical study. SETTING: Tertiary-care university hospitals. PATIENT(S): Thirty-nine consecutive patients with submucous myomas graded as G0 or G1 according to the European Society for Gynecological Endoscopy classification (myoma size 10-35 mm). INTERVENTION(S): Patients were randomized to either direct surgery or 2 months of GnRH analogues before undergoing hysteroscopic resection of the submucous myoma. MAIN OUTCOME MEASURE(S): Operating times, fluid absorption, difficulty of the operation, surgeon satisfaction with the procedure, intra- and postoperative complications, postoperative pain, and patient satisfaction were recorded. RESULT(S): Patients treated with GnRH analogue had significantly shorter operative times (15.9+/-3.1 minutes vs. 21.3+/-4.0 minutes) and significantly reduced fluid absorption (378+/-137 mL vs. 566+/-199 mL) compared with no preoperative medical treatment. Operative difficulty and overall surgeon satisfaction were significantly better in the GnRH analogue group. Patient satisfaction was similar in the two groups. CONCLUSION(S): GnRH analogue treatment before hysteroscopic resection of G0-G1 10-35 mm submucous myomas was effective in reducing operative times, fluid absorption, and difficulty of the procedure.

Early prolapse of a neovagina created with self-dilatation and treated with sacrospinous ligament suspension in a patient with Mayer-Rokitansky-Küster-Hauser syndrome: a case report.

OBJECTIVE: To report a case of a patient who had an early prolapse of the neovagina, while using Frank's dilators method, that was successfully treated with sacrospinous ligament suspension. DESIGN: Case report. SETTING: Tertiary-care university hospital. PATIENT(S): A 22-year-old woman with Mayer-Rokitansky-Küster-Hauser syndrome. INTERVENTION(S): Frank's vaginal dilators method. MAIN OUTCOME MEASURE(S): Vaginal elongation by self-dilatation. Early prolapse of the neovagina. Surgical repair with vaginal sacrospinous ligament suspension. RESULT(S): A few months after the beginning of the treatment the patient had a prolapse of the neovagina. On pelvic examination, the total vaginal length was 5 cm with eversion of the vaginal apex 3 cm beyond the hymen with strain. Vaginal length was not satisfactory for the patient yet; therefore, the vaginal dilation program was continued to reach the prefixed vaginal length. Two months later the total vaginal length was 8 cm with eversion of the vaginal apex 6 cm beyond the hymen with strain. The patient underwent a sacrospinous ligament suspension. Twenty months after surgery, the patient had no symptoms and was highly satisfied with the result. CONCLUSION(S): Prolapse of a neovagina may occur early after conservative treatment. If the initial prefixed goal of vaginal length has not been reached when prolapse develops, the vaginal dilatation program may be continued. In our case vaginal sacrospinous ligament fixation was successful, with good anatomic and functional results.

Vaginoplasty using autologous in vitro cultured vaginal tissue in a patient with Mayer-von-Rokitansky-Kuster-Hauser syndrome.

Mayer-von-Rokitansky-Küster-Hauser syndrome (MRKHS) is characterized by vaginal agenesis with variable Müllerian duct abnormalities. The Abbè-McIndoe technique is considered a valid treatment option for vaginoplasty but no consensus has been reached on what material should be used for the neovagina canal wall lining. We report the first case of autologous vaginal tissue transplantation in a 28-year-old women with MRKHS. The patient was subjected to a 1 cm2 full-thickness mucosal biopsy from the vaginal vestibule. Following enzymatic dissociation, cells were inoculated onto collagen IV-coated plates and cultured for 2 weeks. The patient was subjected to a vaginoplasty with a modified Abbè-McIndoe vaginoplasty with 314 cm2 autologous in vitro cultured vaginal tissue for the canal lining. At 1 month from surgery, the vagina appeared normal in length and depth and a vaginal biopsy revealed normal vaginal tissue. The use of autologous in vitro cultured vaginal tissue to create a neovagina appears as an easy, minimally invasive and useful method.