Endometrial stromal sarcoma with intracaval extension at initial presentation.

Endometrial stromal sarcoma (ESS) is a rare uterine neoplasm. Tumor involvement of the large vessels is extremely rare. This is a case report of ESS with tumor invasion of the inferior vena cava at initial presentation.

Evaluation of osteopontin and CA125 in detection of epithelial ovarian carcinoma.

The objective of this study was to determine the potential of osteopontin (OPN) and OPN + CA125 (cancer antigen 125) combination in differential diagnosis of the ovarian cancers and non-malignant ovarian disease. Serum and plasma samples were obtained preoperatively from 79 women undergoing surgery for pelvic mass; 48 of them had ovarian carcinoma, and 31 had benign cyst. The samples were analyzed for the levels of OPN and CA 125 (using ELISA and CMIA methods) and then compared with the final pathologic results. The median plasma level of OPN in patients with benign and malignant cysts was 356.33 ng/ml and 865.15 ng/ml, respectively (p < 0.001). Receiver operating characteristic (ROC) analysis for plasma OPN revealed the area under the curve (AUC) of 0.838. At the predefined specificity of 90%, OPN showed sensitivity of 62.5%, whereas the combination of OPN + CA125 reached 74.9% at the same specificity.

Removal of a vaginal leiomyoma presenting as tumor previa allowing vaginal birth.

Leiomyomas of the vagina are very rare tumors of the female genital tract with only 300 cases reported so far. A case of removal of the vaginal leiomyoma presenting as tumor previa in advanced pregnancy is described. Removal of the tumor allowed vaginal birth three weeks after surgery.

Oncology treatment improvement--our experience in Serbia.

OBJECTIVES: To determine weather structural changes by a tumor board made any difference in quality of treatment for oncology patients. MATERIAL AND METHOD: Current management of our hospital initiated structural changes in the tumor board in January 2010 and improvement was measured through comparing the clinical staging of cervical cancer to previous tumor board results. RESULTS: 365 patients were seen by a multidisciplinary tumor board from January to December of 2010. There were 146 cases of cervical cancer. 87 were staged as Ib-IIa for radical surgery, 59 patients were staged as advanced stage of disease and RT was proposed as well as combined radio-chemotherapy in some cases. CONCLUSION: Structural changes in the tumor board have made a significant improvement in the oncology care of our patients, primarily because of a multidisciplinary approach to gynecological malignancies and additional imaging performed in all cases of cervical cancer for better insight in the spread of the disease.

Two cases of immature teratoma with positive reproductive outcomes.

The peak incidence of immature teratoma is in the early reproductive period of a woman's life and fertility preservation is an inevitable topic when discussing treatment options. We present two cases of immature teratoma with positive reproductive outcome. Our experience supports the standpoint that surgery alone is curative in most cases, irrespective of tumor grade. Bearing this in mind, the long-term effect of chemotherapy on ovarian function can be avoided and fertility, an important factor in the overall quality of life, can be preserved.

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis.

This is a case report of twoo patients how have uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis with different clinical manifestations. Progressive abdominal pain after menarche, anuria or obstipation with the existing paravaginal tumor indicates this rare anomaly. Initially, the anomaly remains unrecognized, while patients most frequently refered to surgeons for assistance. The method of choice for diagnosis is clinical examination, ultrasonography and magnetic resonance (MR) imaging. Transvaginal excision of the septum is appropriate mode of treatment.

Refractory metastatic choriocarcinoma treated surgically with polychemotherapy--case report.

The authors present the course of treatment of refractory metastatic choriocarcinoma in a 49-year-old woman was treated surgically by hysterectomy and resection of suprarenal gland metastases. During the treatment the patient received 15 courses of polychemotherapy with different protocols. After five years of treatment and seven years of follow-up there is no evidence of recurency of the disease.

Solitary ovarian metastasis from cutaneous melanoma--case report.

A 47-year-old patient with two previous deliveries and three deliberate abortions was admitted to the Institute of Gynecology and Obstetrics, Clinical Center of Serbia with the diagnosis of a uterine myoma and left adnexal mass. Five years previously, she had undergone excision of a malignant melanoma from her left leg. Pelvic exemination disclosed a left adnexal solid mass measuring about 100 x 80 x 80 mm and enlarged uterus 120 x 50 mm in size with myomatosus nodes on the posterior wall. After ultrasound and computed tomography examination, the patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, intracolic omentectomy and selective pelvic lymphonodectomy. The final histopathological diagnosis was metastatic amelanotic malignant melanoma of the left ovary and uterine myomas. After surgery the patient was transferred to the Institute of Oncology and Radiology where she received chemotherapy.

[Acute renal failure after cesarean section as a consequence of hematoma of the retropubic space of Retzius].

Acute renal failure is rare postoperative complication of cesarean section. Postrenal acute renal failure is corectible ant it shoud be done immediately in order to avoid secundary destruction of renal parenchim. Surgical techniques shoud be directed to achieve adequat haemostasis, espetialy at low transverse Pfannenstiel incision, as well as in tender manipuliating with tissues to prevent unnecessery formation of dead space and tissues devitalisation. Authors are presenting the case of acute renal failure after cesarean section as a consequence of hematoma of the retropubic space of Retzius and way of treatment.

Treatment of choriocarcinoma metastases by surgery and polychemotherapy - case report.

Choriocarcinoma is present in one out of every 40,000 pregnancies. There is a great risk for incidence of the disease in women who become pregnant after 45 years of age. The clinical picture may vary and is related to the destruction of tissue and bleeding. New chemo protocols containing etoposide, cisplatin, ifosfamide, together with a resection of the focus resistant to chemotherapy, lead in most cases to the complete recovery.

Placental site trophoblastic tumor: a case report.

Patient K.N., age 30, nulliparous deliveries and with one miscarriage, was admitted to the Institute of Gynecology and Obstetrics, Clinical Center of Serbia, in December 2000 with the following diagnosis: Uterine myoma and adnexal mass.

[Surgical treatment of a 5 month pregnancy in the rudimentary uterine cornu].

Cornual ectopic pregnacy is rare clinical entity with high maternal mortality. In all cases surgical treatment is indicated, and taking care of most important complication--haemorrhagic shock. Therapeutic approach is individual and depending of simptomatplogy, gestational age of pregnancy and condition of the patient in time of diagnosis. Authors are presenting the case of cornual ectopic pregnancy of five months.

Bacterial infections--the cause of preterm delivery.

Within diagnostic procedures protocols in preterm delivery, the objective of the study was to examine bacterial causes of preterm deliveries in relation to term deliveries. The study included 106 patients delivered before term (24 to 37 weeks of gestation) and 126 patients with term delivery after 37 to 42 weeks of gestation. Bacterial analysis included hospital material: cervix smear in patients before the delivery and protective and functional fetal elements.

Perinatal outcome in multiple pregnancies--spontaneous gestation versus.

The purpose of this investigation was to determine if twin pregnancies induced by in vitro fertilization (IVF) are under greater risk of negative perinatal outcome than "spontaneous" twin pregnancies. The study included 240 patients with gemellar pregnancies. Each patient with a gemellar IVF pregnancy (120) was assigned to a pregnant woman with appropriate age, education and parity from the "spontaneous" group as a control. Pregnancies were followed clinically, with laboratory analyses and ultrasonography.

Pancreatic tumor in a pregnant woman: a rare case report.

We have analyzed a case of pancreatic carcinoma in a pregnant woman, 37 years old, in the second trimester of the pregnancy. She had a positive family history of digestive tract carcinoma. The delivery ended surgically and hysterectomy was performed at the same time.

[Primary tumors of the fallopian tubes: retrospective analysis of results in 7 patients]. / Primarni tumori jajovoda: retrospektivna analiza resultata kod sedam bolesnica.

Primary malignant tumours of the Fallopian tube are among the rarest of gynaecological malignancies. Seven patients with primary malignant tumour of the Fallopian tube, treated between 1991 and 1996, were studied. The average age was 60 years, with nulliparity rate of 29 percent and a mean parity of 2.2. The most common symptoms were atypical vaginal bleeding (29 percent), abdominal pain and distention (29 percent), whereas 43 percent of patients had no symptoms. No patient had a correct preoperative diagnosis. Primary surgical treatment was in all patients hysterectomy and bilateral salpingo-oophorotomy with or without omentectomy. Staging was done according to the FIGO classification for Fallopian tube carcinomas. In Stage I 29 percent of patients were classified, 43 percent in Stage II and 29 percent in Stage III. Six patients (86 percent) had adenocarcinoma (1 in G1, 2 in G2, 3 in G3) and 1 had MMMT (malignant mixed tumour-heterology type). All patients received additional postoperative therapy including: chemotherapy (58 percent), radiotherapy (14 percent), hormonotherapy (14 percent) or combination of chemotherapy and hormone therapy (14 percent). Our results are comparable to those of other authors. The time is too short to predict a 5-year survival, but this will be reported in our next paper.

[Radical hysterectomy with pelvic lymphadenectomy in patients with carcinoma of the uterine cervix--3 years' experience]. / Radikalna histerektomija s pelvisnom lymfadenektomijom kod bolesnica s karcinomom grlica maternice--trogodisnje iskustvo.

INTRODUCTION: Almost all patients with invasive cervical carcinoma can be treated with either primary irradiation therapy or primary surgery. Some patients are appropriately treated with the combination of irradiation and surgery. Chemotherapy is not effective as primary treatment of invasive cervical cancer but may be used as additional therapy and when the disease is recurrent or persistent. There are some important advantages of primary extensive surgery over irradiation. The findings at operation and that from the careful pathologic examination of surgical specimens can be very helpful in selection of patients for supplementary postoperation irradiation therapy or chemotherapy, or both [1-6]. AIM OF THE STUDY: The aim of the study was to compare pretreatment clinical evaluations with surgical and postsurgical pathohistological findings. METHODS: Extensive hysterectomy and bilateral pelvic lymphadenectomy were used in the treatment of 251 patients with early invasive cervical cancer. The patients were treated at the Department of Obstetrics and Gynaecology of the Clinical Centre of Serbia in Belgrade, between 1993 and 1995. Cervical cancer was detected by clinical examination, colposcopic and cytologic (Pap smear) findings, colposcopically directed biopsy or conisation and pathological findings, sonography, chest radiography, blood and urine analyses. In some cases we had to make other examinations (cystography, cystoscopy, intravenous pyelography, sygmoidoscopy, rectoscopy, CT scanning and magnetic resonance). The surgical treatment of invasive carcinoma of the cervix was limited to those patients in whom the disease was confined to the cervix or vaginal fornix (stage Ia, stage Ib or stage IIa), and who were in high surgical risk. RESULTS: Over a three year period (1993-1995) there were 251 patients with invasive cervical cancer, treated by primary surgery (radical hysterectomy and bilateral pelvic lymphadenectomy sec. Werthein-Meigs), average age 42 years. Most of the patients demonstrated invasive cervical cancer, clinically classified in Ib st. (81.67%). Some characteristics of pathologic findings, such as parametric width, number of removed lymph nodes, percentage of lymph nodes metastases and correlation with clinical stage of invasive cervical cancer, histologic grade of cervical cancer with lymph node metastasis, pathologic findings after surgical treatment, correlation between clinical and surgical staging, were already presented in tables. DISCUSSION: In the last decades the incidence of invasive cervical cancer and death rate have been decreased. Progress in reducing mortality is primarily attributed to the introduction of cervical cancer screening as part of regular gynaecologic examinations. Regular testing with Papanicolaou (Pap) smear and colposcopy have an important role in this problem [1]. Extensive hysterectomy and bilateral pelvic lymphadenectomy were used in the treatment of 251 patients with early invasive cervical cancer. We found that the clinical diagnosis of disease extent was correct in 67.7% of patients who underwent extensive surgery for early invasive cervical cancer. Sensitivity of clinical findings was 75.8% and positive predictive value was 86.2%. Lymph node metastasis was detected in 17% patients. Brodman at al. [14] found that clinical examinations, including CT scanning and magnetic resonance, were correct in only 62.5% of cases. It is very difficult to detect parametric involvement and lymph node metastasis by clinical examinations. Irradiation therapy was used in the postoperative period as additional treatment of extensive hysterectomy and bilateral pelvic lymphadenectomy in 89.7% of patients. CONCLUSION: The findings at operation and that from the careful pathologic examination of surgical specimens are absolutely irreplaceable and important in grading invasive cervical cancer and selection of patients for supplementary postoperate irradiation therapy.