Ovarian cancer: lymph node metastases.

PURPOSE OF INVESTIGATION: To analyze pelvic and paraaortic lymph node involvement in epithelial ovarian cancer. METHODS: Between 1995 and 2006, 60 patients with FIGO Stages II, III, IV epithelial ovarian cancer underwent surgical treatment, including systematic pelvic and paraaortic lymphadenectomy. RESULTS: Aortic lymph node metastases were documented in 45 (75%) patients and pelvic nodal metastases in 42 (70%). The incidence of paraaortic nodal involvement was 20% (12/60) in the absence of positive pelvic nodes while the incidence of pelvic nodal involvement was 15% (9/60) in the absence of paraaortic disease; both pelvic and paraaortic lymph node involvement occurred in 55% of patients. The most frequent groups for nodal metastases are paracaval (56%), externaliliac (60%), and obturator (55%). CONCLUSION: The rate of nodal involvement is important in ovarian cancer and there is a high prevalence of both pelvic and paraaortic lymph node metastases. For this reason bilateral pelvic and paraaortic lymphadenectomy is necessary for staging and as treatment for micrometastases, also in patients with unilateral tumors.

Double laparotomy wound recurrence of endometrial carcinoma.

INTRODUCTION: Abdominal scar recurrence of endometrial carcinoma after abdominal total hysterectomy is very rare. We report a case of a 65-year-old woman who had two recurrences in the abdominal incisional scar after total hysterectomy. CASE REPORT: A 65-year-old woman underwent total hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy because of well-differentiated endometrial adenocarcinoma (Stage IIB). Thus, the patient was treated by external beam radiotherapy. She developed two recurrences in the abdominal incisional scar two and three years after total hysterectomy, respectively. Surgery plus chemotherapy and surgery plus hormonal therapy were used for treatment of the first and second scar recurrence, respectively. CONCLUSIONS: It is a very intriguing and controversial biologic question how neoplastic cells can implant and grow in an abdominal scar without other concomitant metastases. We report a review of the literature and the possible mechanism of recurrences in laparotomy wounds.

Vascular endothelial growth factor (VEGF): can we use it as prognostic factor in endometrial cancer?

AIM: The aim of the study was to investigate if VEGF levels reflect the severity of endometrial cancer and the clinic relationship between microvasal density (MVD) and concentration of VEGF in tumor. METHODS: The study was conducted on 22 patients affected by endometrial cancer who were submitted to total abdominal radical hysterectomy plus bilateral salpingo-ophorectomy. VEGF (pg/mL) and MVD values were measured on histologic specimens of endometrial cancer obtained during the surgical treatment. The means and standard deviations of estimated values were calculated and a statistical comparison was effected by student t test for not coupled data. Pearson correlation test was used to analyze the eventual correlation among VEGF and MVD values in overall patients. RESULTS: We have documented that VEGF expression and MVD change according to FIGO stage, lympho-vascular infiltration and lymph node involvement. Pearson correlation test shows a good linear positive correlation in overall patients between VEGF and MVD values. CONCLUSIONS: Results obtained show a possible use of VEGF as prognostic factor in endometrial cancer. Confirmation of these data may permit both to identify high-risk patients, who must be treated with a more aggressive treatment, and to use an angiogenic therapy in endometrial cancer.