Bilateral ovarian well-differentiated Sertoli-Leydig cell tumors with heterologous elements associated with unilateral serous cystadenoma--a case report.

Bilateral Sertoli-Leydig cell tumors (SLCTs) of the ovary, especially in association with a cystadenoma, are exceedingly rare. Some SLCTs, usually of poor differentiation, show heterologous elements. We present a case of a 61-year-old woman with bilateral well-differentiated SLCTs in which the Sertoli-Leydig cell component showed leiomyogenic (heterologous) differentiation. Furthermore, on the left side it also was associated with a serous cystadenoma.

Breast metastasis 56 months before the diagnosis of primary ovarian cancer: a case study.

BACKGROUND: Breast metastasis of ovarian cancer is rare. A patient with a breast tumor which turned out to be a metastasis as the first clinical manifestation of a primary ovarian cancer diagnosed 56 months later is described. CASE REPORT: A 72-year-old patient presented with a palpable mass in the right breast. Lumpectomy was performed and primary breast cancer was excluded. Histology confirmed a poorly differentiated adenocarcinoma. However, further examination showed no evidence of extramammary primary malignancy. Fifty-six months later, a multicystic pelvic lesion with irregular septa was found. Laparotomy showed a tumor of the right adnexa. The final pathology confirmed the diagnosis of a primary serous ovarian carcinoma. The paraffin blocks of both tumors were reevaluated and showed that the cytological atypia and the immunohistochemical profiles [cytokeratin (CK) 5/6, CK 17, gross cystic disease fluid protein (GCDFP)-15 / BRST-2, estrogen- and progesterone receptor, cancer antigen (CA)125, Wilms tumor (WT-1), tumorsuppressor gene p53, MIB-1 (proliferation marker)] were similar in both the breast and the ovarian specimens. CONCLUSION: To our knowledge, this is the first report of a breast metastasis preceding the diagnosis of primary ovarian cancer by several years.

Inguinal lymph node metastasis as the presenting symptom of endometrial cancer: a case report.

BACKGROUND: Less than 5% of patients with endometrial cancer present with stage IV disease and among these inguinal metastasis is rare. CASE: A 54-year-old patient presented with a palpable, 5x3 cm right inguinal mass. Histopathology showed bulky lymph nodes with mucinous adenocarcinoma. Hysteroscopy and curettage revealed well-differentiated endometrioid adenocarcinoma. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy and systematic pelvic and paraaortic lymphadenectomy were performed. Final histopathology showed an endometrioid adenocarcinoma with infiltration of the inner half of the myometrium. Metastases up to 2.3 cm in diameter were found in 11 out of 76 pelvic, and 17 out of 51 paraaortic lymph node CONCLUSION: Inguinal lymph node metastasis can occur in patients with endometrial cancer and may be the presenting symptom in patients with occult endometrial disease.

Outcome of pregnancies after non-amniocentesis-induced premature rupture of membranes at 14 to 23 weeks' gestation.

OBJECTIVE: To evaluate the outcome of singleton pregnancies after non-amniocentesis-induced premature rupture of membranes (PROM) at 14 to 23 weeks' gestation. STUDY DESIGN: We reviewed the hospital records of 53 consecutive pregnant women with PROM at 14 to 23 weeks' gestation at our institution from 1991 to 1996; the pregnancies were not associated with amniocentesis or multiple gestation. RESULTS: The median interval between PROM and delivery was 1 day (range 0-90; mean 5.2 days). Fifty-two (98%) of the 53 neonates were stillborn or died within 4 days. One neonate (2%), a 720-gram male delivered vaginally at 23 weeks' gestation, survived. The infant had Apgar scores of 6 at 1 minute and 2 at 5 minutes, and showed normal physical and neurological development at age 5 months. CONCLUSION: The outcome of pregnancies with non-amniocentesis-induced PROM at 14 to 23 weeks' gestation is almost uniformly poor.

Multivisceral cytoreductive surgery in FIGO stages IIIC and IV epithelial ovarian cancer: results and 5-year follow-up.

OBJECTIVE: The present study reviews our 5-year results with extensive, multivisceral cytoreduction in patients with FIGO stages IIIC and IV ovarian cancer. METHODS: During the five-year period from January 1995 to December 1999, 101 patients with primary epithelial ovarian cancer FIGO stages IIIC and IV had extensive multivisceral cytoreductive surgery at our department. Patients' history, surgery data, staging, recurrence and survival data were abstracted from the patients' records. RESULTS: Eighty-four (83%) patients had no gross residual disease after the complete surgical procedure. Mean follow-up was 46 months (range, 1-130). Eight patients died within 6 months postoperatively. Seventy-six of our one hundred one patients (75%) had disease progression or recurrence after a mean of 28 months (range, 4-110). Seventeen (17%) patients are alive without disease. Median survival was 47 months and five-year survival was 33% for all 101 patients. CONCLUSION: This series indicates that in the majority of patients with advanced ovarian cancer, primary surgery can lead to complete gross cytoreduction with substantial subsequent rates of disease-free and overall survival.

Is intraoperative frozen section analysis of pelvic lymph nodes accurate after neoadjuvant chemotherapy in patients with cervical cancer?

OBJECTIVE: Intraoperative frozen section examination of pelvic lymph nodes is frequently used in patients with cervical cancer, some of whom have received neoadjuvant chemotherapy (NACT). However, NACT can cause necrosis, fibrosis, or keratinization of tumor deposits in extirpated lymph nodes, and it is unclear whether intraoperative frozen section analysis of extirpated nodes is accurate after NACT. We analyzed the accuracy of frozen section examination of pelvic lymph nodes in patients after NACT for cervical cancer. METHODS: We reviewed 134 patients with invasive cervical cancer who underwent surgery including systematic pelvic lymphadenectomy with intraoperative frozen section examination of pelvic lymph nodes. Results of frozen section examination were related to definitive histology and compared between patient groups of NACT and primary surgery. RESULTS: A total of 1670 pelvic lymph nodes were evaluated intraoperatively by frozen section examination, and 6689 pelvic lymph nodes were analyzed by final histopathology. Overall frozen section analysis had nine false negative results among 53 patients with positive lymph nodes (false negative rate, 16.9%). After NACT, there were two false negative diagnoses in twelve patients with node metastases (false negative rate, 16.7%). No false positive cases were noted. The sensitivity and negative predictive value of frozen section examination were 83% and 82%, respectively, in patients after NACT, and 83% and 91% at primary surgery. CONCLUSION: NACT does not appear to compromise the diagnostic accuracy of intraoperative frozen section examination of pelvic lymph nodes in patients with cervical cancer.

Accuracy of frozen section examination of pelvic lymph nodes in patients with FIGO stage IB1 to IIB cervical cancer.

OBJECTIVE: We evaluated the accuracy of intraoperative frozen section histology of pelvic lymph nodes in patients with FIGO stage IB1 to IIB cervical cancer. METHODS: A total of 96 patients with cervical cancer FIGO stage IB1 to IIB had surgery including systematic pelvic or pelvic and paraaortic lymphadenectomy and intraoperative frozen section examination of pelvic lymph nodes at our department between January 1997 and October 2001. The results of frozen section were compared with those of final histology. RESULTS: A total of 1044 pelvic lymph nodes underwent intraoperative frozen section examination and node metastases were found in 29 patients (30%). Final histopathology yielded a total of 5042 lymph nodes and identified an additional seven patients with node metastases for a false negative rate of 19%. The specificity and the positive predictive value of frozen section examination were 100%; the negative predictive value was 90% (60/67). CONCLUSION: The diagnostic accuracy of frozen section analysis of pelvic lymph nodes should be considered when intraoperative decisions are based on its results.

Fibrin application for preventing lymphocysts after retroperitoneal lymphadenectomy in patients with gynecologic malignancies.

OBJECTIVE: We performed a randomized, prospective trial to assess the impact of fibrin glue on the incidence of lymphocysts after systematic pelvic or pelvic and paraaortic lymphadenectomy in patients with gynecologic malignancies. METHODS: Ninety-three consecutive patients with gynecologic pelvic malignancies who underwent surgery including pelvic or pelvic and paraaortic lymphadenectomy were randomized during surgery to be treated with fibrin glue or not. Serial computed tomography (CT) scans were performed during follow-up. CT findings of a smooth and thin-walled cavity filled with a water-equivalent fluid, sharply demarcated from its surroundings and without signs of infiltration were interpreted as lymphocysts. RESULTS: Forty-seven patients (51%) were treated with fibrin glue and 46 (49%) were not. All 93 patients underwent pelvic lymphadenectomy; 15 patients (32%) of the fibrin group and 12 (26%) of the controls also underwent paraaortic lymphadenectomy. We found no significant differences between patients who received fibrin glue and those who did not. CONCLUSION: Intraoperative application of fibrin glue did not reduce the rate of postoperative lymphocysts after lymphadenectomy and had no impact on any follow-up parameter. Its use seems not to be indicated in systematic gynecologic pelvic or pelvic and paraaortic lymphadenectomy.