Gynacological Cancers
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Gynaecological cancers are a group of different malignancies of the female reproductive system. The most common types of gynaecologic malignancies are cervical cancer, ovarian cancer, and endometrial (uterus) cancer. There are other less common gynaecological malignancies including cancer of the vagina, cancer of the vulva, gestational trophoblastic tumours, and fallopian tube cancer. Occasionally skin cancers or sarcomas can also be found in the female genitalia. Generally, most gynaecological cancers are found in women aged over 50, though the incidence rates for younger women have been rising.

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Menu: Gynacological Cancers

Cervical Cancer
Endometrial (Uterus) Cancer
Fallopian Tube Cancer
Gestational Trophoblastic Cancer
Ovarian Cancer
Vaginal Cancer
Vulva Cancer
Uterine Sarcoma
Gynecologic Oncology (specialty)
General Gynacological Cancer Resources
Latest Research Publications

General Gynacological Cancer Resources (15 links)

Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Ashton E, Szutowska M, Shafer A, Hoffman J
Attempted conservative management of a placental site trophoblastic tumor: a case report.
Conn Med. 2014; 78(8):475-7 [PubMed] Related Publications
BACKGROUND: Placental site trophoblastic tumors (PSTTs) are rare malignant forms of gestational trophoblastic neoplasia (GTN). Controversy exists regarding the most important pathologic or radiologic predictors of extent of disease. Consequently, there is limited information as to the best candidates for conservative surgery.
CASE: A 28-year-old female presented 18 months after a term delivery with a biopsy confirmed PSTT. She declined hysterectomy. Imaging revealed a locally limited lesion without myometrial invasion, and no evidence of metastatic disease. She was given two cycles of neoadjuvant etoposide, methrotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA/CO) chemotherapy followed by an attempt at laparoscopically guided hysteroscopic resection. Pathology showed extensive myometrial invasion with positive surgical margin, and our recommendation for hysterectomy with pelvic lymph node dissection was accepted. Postoperatively, she was given two cycles ofpaclitaxel, cisplatin alternating with paclitaxel, etoposide (TP/TE) chemotherapy.
CONCLUSION: Fertility sparing options are desirable and should be considered. However, as our case and much of the literature demonstrates, hysterectomy remains the most successful treatment.

Related: Cisplatin Cyclophosphamide Dactinomycin Etoposide Methotrexate Paclitaxel Vincristine

Abid N, Mnif H, Mellouli M, et al.
Uterine tumour resembling ovarian sex cord tumours presenting as multiple endometrial and cervical uterine polyps: a case report.
Pathologica. 2014; 106(2):73-6 [PubMed] Related Publications
BACKGROUND: Uterine tumours resembling ovarian sex-cord tumours (UTROSCT) are very rare, benign uterine tumours, composed solely of sex cord elements. These tumours have a polyphenotypic immunophentype that favours a derivation from uterine mesenchymal stem cells.
CASE REPORT: A 43-year-old female presented with recurrent vaginal bleeding. On hysteroscopy, she had multiple endometrial and cervical polyps that were removed endoscopically. Histologically, the specimen contained epithelioid cells arranged in tubules, trabeculae and anastomosing cords, without significant cellular atypia or mitotic activity. Immunohistochemical studies were performed. The tumour was found to be diffusely positive for vimentin, calretinin and desmin, focally positive for cytokeratin, CD99 and inhibin and negative for chromogranin and CD10. A subsequent total hysterectomy was performed and revealed neoplastic infiltration of the myometrium.
CONCLUSION: A polyphenotypic immunophenotype is a characteristic feature of UTROSCT, and may be helpful in diagnosis and in exclusion of other lesions. Familiarity with this tumour by gynaecologists and pathologists is essential to avoid misdiagnosis:correct diagnosis of this neoplasm is important in patient management.

Related: Endometrial (Uterus) Cancer Endometrial Cancer Ovarian Cancer Cervical Cancer

Takeshita T, Ninoi T, Maebayashi T, et al.
Diffusion-weighted magnetic resonance imaging findings in a patient with struma ovarii.
Osaka City Med J. 2014; 60(1):45-52 [PubMed] Related Publications
In this report, the magnetic resonance imaging (MRI) appearance of struma ovarii (SO) in a patient who underwent diffusion-weighted imaging (DWI) of the pelvis and subsequent histological analysis is described. The solid portion of SO showed a high apparent diffusion coefficient (ADC) value, indicating unrestricted diffusion, and each loculus of SO showed different ADC values due to the different viscosity of the cyst contents in each loculus. These unique and characteristic DWI findings may serve as a helpful sign in making the correct diagnosis of SO when DWI findings are interpreted in conjunction with conventional MRI findings.

Related: Ovarian Cancer

Shabbir S, Ghayasuddin M, Younus SM, Baloch K
Chronic non puerperal uterine inversion secondary to sub-mucosal fibroid.
J Pak Med Assoc. 2014; 64(5):586-8 [PubMed] Related Publications
Inversion of uterus is a rare clinical condition, if not associated with puerperium or third stage of labour. Non-puerperal uterine inversion usually results secondary to tumour implanted at fundus of the uterus. An unusual case of non-puerperal uterine inversion caused by a large submucosal fundal fibroid is reported where a 39-year-old woman presented with heavy bleeding per vaginum and profuse vaginal discharge. Uterine inversion was corrected abdominally by Haultain's procedure after vaginal myomectomy followed by abdominal hysterectomy. Both the ovaries were conserved.

Hannan A, Awan UE, Siddiqui N, Muzaffar N
Malignant transformations in ovarian teratomas: a report of four cases.
J Pak Med Assoc. 2014; 64(8):946-8 [PubMed] Related Publications
Mature cystic teratoma (MCT) is a common ovarian neoplasm in young females. A secondary malignant transformation occurs rarely in cystic teratomas at an older age. These secondary malignant neoplasms most commonly are squamous cell carcinomas (SCCs). Various mechanisms are reported, but the exact aetiology is unknown. We report three cases of SCC arising in cystic teratoma and one case of papillary thyroid neoplasm as secondary transformation. The SCCs were arising from the cyst wall, while the papillary thyroid malignancy arose from the normal-looking thyroid epithelium. Histologically, all SCC cases were poorly differentiated. Poor prognostic features for secondary transformations include size more than 10 cm, older age and rapid growth. Data is scarce regarding their appropriate treatment. However, surgical debulking is necessary. Platinum-based adjuvant regimens and taxanes are recommended in cases of advanced disease. In this paper we review and share our experience with this rare disorder.

Related: Ovarian Cancer

Brown DS, Poulos C, Johnson FR, et al.
Adolescent girls' preferences for HPV vaccines: a discrete choice experiment.
Adv Health Econ Health Serv Res. 2014; 24:93-121 [PubMed] Related Publications
PURPOSE: To measure adolescent girls' preferences over features of human papillomavirus (HPV) vaccines in order to provide quantitative estimates of the perceived benefits of vaccination and potential vaccine uptake.
DESIGN/METHODOLOGY/APPROACH: A discrete choice experiment (DCE) survey was developed to measure adolescent girls' preferences over features of HPV vaccines. The survey was fielded to a U.S. sample of 307 girls aged 13-17 years who had not yet received an HPV vaccine in June 2008.
FINDINGS: In a latent class logit model, two distinct groups were identified--one with strong preferences against vaccination which largely did not differentiate between vaccine features, and another that was receptive to vaccination and had well-defined preferences over vaccine features. Based on the mean estimates over the entire sample, we estimate that girls' valuation of bivalent and quadrivalent HPV vaccines ranged between $400 and $460 in 2008, measured as willingness-to-pay (WTP). The additional value of genital warts protection was $145, although cervical cancer efficacy was the most preferred feature. We estimate maximum uptake of 54-65%, close to the 53% reported for one dose in 2011 surveillance data, but higher than the 35% for three doses in surveillance data.
RESEARCH LIMITATIONS/IMPLICATIONS: We conclude that adolescent girls do form clear opinions and some place significant value on HPV vaccination, making research on their preferences vital to understanding the determinants of HPV vaccine demand.
ORIGINALITY/VALUE: DCE studies may be used to design more effective vaccine-promotion programs and for reassessing public health recommendations and guidelines as new vaccines are made available.

Related: USA Cervical Cancer Human Papillomavirus (HPV), Vaccination, and Cervical Cancer

Fitzpatrick P, O'Neill S, Mooney T, et al.
Age related influence on screening coverage and satisfaction. with CervicalCheck.
Ir Med J. 2014 Jul-Aug; 107(7):216-7 [PubMed] Related Publications
The aim of this study was to evaluate levels of satisfaction of women attending the CervicalCheck programme and reasons for the age differential in screening uptake. A questionnaire was sent to 5,000 randomly selected attenders with a normal smear test (3,500 aged 25-44, 1,500 aged 45-60). Almost all in both age groups said they would return to CervicalCheck if invited (98.5%; 98.5%) and recommend the service to family/friend (99.6%; 99.5%). The single independent predictor of 'would recommend to family/friend' was willingness to return to CervicalCheck (OR = 31 (5.2-183.7)). Predictors of 'would return if invited' were knowledge of when due to return (OR = 2.5 (1.3-5.0)) and having contacted or having received a letter of invitation from CervicalCheck (OR = 3.1 (1.6-6.1)). Independent predictors of 'knowledge of when due to return' were older age group (OR = 0.5 (0.4-0.7)) and willingness to return to CervicalCheck (OR = 3.2 (1.2-6.3)). The GP is particularly important in informing older women and encouraging attendance.

Related: Cancer Screening and Early Detection Cervical Cancer Cervical Cancer Screening

Teng FF, Kalloger SE, Brotto L, McAlpine JN
Determinants of quality of life in ovarian cancer survivors: a pilot study.
J Obstet Gynaecol Can. 2014; 36(8):708-15 [PubMed] Related Publications
OBJECTIVE: Ovarian cancer treatments and outcomes vary substantially, yielding a diverse group of survivors. Few data exist on quality of life (QoL) concerns and the foremost needs of these patients. Our goal was to conduct a pilot study to determine the QoL needs of ovarian cancer survivors to establish priorities for future interventions.
METHODS: In this cross-sectional study, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ-C30 and OV28) QoL questionnaires and one investigator-derived questionnaire were administered in an outpatient setting. Clinical parameters were abstracted and tested for associations with QoL measures.
RESULTS: A total of 102 women consented to participate and completed all components. Their mean age was 58 years (range 29 to 85), with 80% having epithelial ovarian carcinoma and 66% high-grade serous carcinoma. Women with stage I (28%), II (15%), III (47%), and IV (10%) lesions were represented in the primary treatment (25%), surveillance (46%), recurrent (23%), and palliative (7%) phases of the survivorship continuum. Fifty-one percent characterized their disease burden as "quite a bit" or "very much," and this did not vary by histology or diagnoses. Global QoL did not vary by clinico-pathologic parameters. Cardiovascular and respiratory comorbidities were associated with EORTC scores in physical functioning (P=0.027 for cardiovascular and P=0.041 for respiratory), global QoL (P=0.03 for cardiovascular and P=0.039 for respiratory), and sexual health (P=0.025 for cardiovascular). Task completion/memory/concentration, anxiety, and fatigue were the distress categories given highest priority by respondents.
CONCLUSION: In women with ovarian cancer, clinical factors such as age, stage, and histology did not have a significant impact on QoL. Psychosocial factors have a larger impact on global QoL than physical symptoms.

Related: Ovarian Cancer

Palatyńska-Ulatowska A, Michalska M, Łazarenkow A, et al.
Fibrinogen, bFGF and VEGF levels during antibiotic therapy in gynecologic cancer: a preliminary report.
Indian J Biochem Biophys. 2014; 51(3):230-6 [PubMed] Related Publications
The role of angiogenesis in the development of neoplasia has been identified and characterized. However, antiangiogenic therapeutic intervention still requires more evidence to become recognized and successful. The aim of this study was to evaluate levels of selected proangiogenic factors, such as fibrinogen, vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in serum of patients with the gynecologic cancer on the first, third and sixth day of antibiotic therapy, routinely administered as a perioperative treatment. In addition, serum concentrations of gamma-gamma dimers and alpha-polymers of cross-linked fibrin structure and the degree of bFGF binding with the fibrin network were investigated. Immunohistochemistry staining of the excised tumor tissue was also performed. We observed higher levels of bFGF, VEGF, as well as fibrinogen in patients with gynecologic malignancy, as compared to healthy women. In cancer patients, the concentration of alpha-polymers and gamma-gamma dimers of fibrin network increased. Further only gamma-gamma dimers fraction of fibrin was found to bind to bFGF. Immunohistochemical analysis indicated the presence of bFGF in an excised tumor tissue. In conclusion, the decrease of proangiogenic bFGF and fibrinogen levels in a clinical trial of gynecologic patients may confirm anti-angiogenic properties of selected antibiotic therapy.

Related: FGF2 Angiogenesis and Cancer VEGFA

Haber KM, Seagle BL, Drew B, et al.
Genetic counseling for hereditary breast and gynecologic cancer syndromes at a community hospital.
Conn Med. 2014; 78(7):417-20 [PubMed] Related Publications
Genetic screening and testing has been shown to be medically and emotionally beneficial for patients with a personal history or strong family history of breast, ovarian, and/or colorectal cancer. Gynecologic oncologists increasingly utilize genetic screening to modify their care and treatment plans of patients and their offspring based on inherited susceptibility to cancer. The U.S. Preventive Services Task Force (USPSTF) developed specific criteria that consider the medical, psychosocial, and ethical ramifications of genetic counseling of high-risk individuals. Genetic counseling and screening, along with early intervention, is of benefit to women with family histories suggestive of harboring breast cancer antigen (BRCA) mutations. The Western Connecticut Health Network (WCHN) Hereditary Cancer and Genetic Counseling Program provides a comprehensive cancer risk assessment and offers genetic screening as appropriate. This report describes trends in patient referrals, intake, results of genetic testing, and an expansion of services in a community-based genetic counseling program.

Related: Breast Cancer

Topolovec Z, Mrcela M, Sijanović S, et al.
Primary serous papillary adenocarcinoma of the fallopian tube.
Acta Clin Croat. 2014; 53(2):242-5 [PubMed] Related Publications
Fallopian tube cancer is least common of all gynecologic tumors, with the mean age at onset between 54 and 63 years. This case report presents a 67-year-old female, gravida 1, para 1, with primary adenocarcinoma of the fallopian tube, detected and diagnosed preoperatively in clinical stage IIIc. The patient was asymptomatic, with only mild vaginal discharge of amber color and normal measured value of CA 125. The diagnosis was based on routine clinical and ultrasound examination, followed by surgery, surgical-pathological staging of the disease, and finally paclitaxel and platinum based chemotherapy. The patient has been in remission for nine years now.

Related: Fallopian Tube Cancer

Zhang L, Xue Y, Jiang B, et al.
Multiscale agent-based modelling of ovarian cancer progression under the stimulation of the STAT 3 pathway.
Int J Data Min Bioinform. 2014; 9(3):235-53 [PubMed] Related Publications
This research is developed to simulate ovarian cancer progression with signal transducers and activators of the transcription 3 (STAT 3) pathway. The main focus is on studying how the STAT 3 pathway affects the cancer cells' biomechanical phenotype under the stimulation of the interleukin-6 (IL-6) cytokine and various well-known microscopic factors. The simulated results agreed with recent experimental evidence that ovarian cancer cells with a stimulated STAT 3 pathway have high survival rates and drug resistance. And we discussed how the IL6 and these well-known microscopic factors impacted the cancer progression.

Related: Apoptosis Ovarian Cancer

Kuhs KA, Porras C, Schiller JT, et al.
Effect of different human papillomavirus serological and DNA criteria on vaccine efficacy estimates.
Am J Epidemiol. 2014; 180(6):599-607 [PubMed] Article available free on PMC after 15/09/2015 Related Publications
Two trials of clinically approved human papillomavirus (HPV) vaccines, Females United to Unilaterally Reduce Endo/Ectocervical Disease (FUTURE I/II) and the Papilloma Trial Against Cancer in Young Adults (PATRICIA), reported a 22% difference in vaccine efficacy (VE) against cervical intraepithelial neoplasia grade 2 or worse in HPV-naïve subcohorts; however, serological testing methods and the HPV DNA criteria used to define HPV-unexposed women differed between the studies. We applied previously described methods to simulate these HPV-naïve subcohorts within the Costa Rica HPV16/18 Vaccine Trial and assessed how these criteria affect the estimation of VE. We applied 2 enzyme-linked immunosorbent assay (ELISA) thresholds for HPV16 and HPV18 seropositivity (8 and 7 ELISA units/mL, respectively, for PATRICIA; 54 and 65 ELISA units/mL, respectively, for FUTURE I/II (to approximate the competitive Luminex immunoassay)) and 2 criteria for HPV DNA positivity (12 oncogenic HPV types, plus HPV66 and 68/73 for PATRICIA; or plus HPV6 and 11 for FUTURE I/II). VE was computed in the 2 naïve subcohorts. Using the FUTURE I/II and PATRICIA criteria, VE estimates against cervical intraepithelial neoplasia grade 2 or worse, regardless of HPV type, were 69.0% (95% confidence interval: 40.3%, 84.9%) and 80.8% (95% confidence interval: 52.6%, 93.5%), respectively (P = 0.1). Although the application of FUTURE I/II criteria to our cohort resulted in the inclusion of more sexually experienced women, methodological differences did not fully explain the VE differences.

Related: Cervical Cancer Human Papillomavirus (HPV), Vaccination, and Cervical Cancer

Alptekin H, Efe D
Effectiveness of pericervical tourniquet by Foley catheter reducing blood loss at abdominal myomectomy.
Clin Exp Obstet Gynecol. 2014; 41(4):440-4 [PubMed] Related Publications
OBJECTIVE: To evaluate effectivenes of pericervical tourniquet by Foley catheter reducing blood loss at abdominal myomectomy.
MATERIALS AND METHODS: Retrospective chart review of 67 cases, with symptomatic myoma uteri and undertaken abdominal myomectomy, was performed. Myomectomy was performed in Group 1 (n = 34) by Foley catheter tourniquet around both uterin vessels and in Group 2 (n = 33) the tourniquet was not performed.
RESULTS: The average blood loss during myomectomy was 286.4 +/- 137.5 ml for the tourniquet group and 673.8 +/- 172.3 ml for the control group. Postoperative blood transfusion was necessary in two patients from the control group. Technique significantly reduced the intraoperative blood loss and postoperative hemoglobin fall in patients. No serious complications occured on account of the tourniquet technique.
CONCLUSIONS: The pericervical tourniquet by Foley catheter is a safe and effective method for reducing blood loss during abdominal myomectomy, although it should be evaluated in a randomized controlled trial.

Chao WR, Lee MY, Lin WL, et al.
Assessing the HER2 status in mucinous epithelial ovarian cancer on the basis of the 2013 ASCO/CAP guideline update.
Am J Surg Pathol. 2014; 38(9):1227-34 [PubMed] Related Publications
Her2 gene amplification and protein overexpression are important factors in predicting clinical sensitivity to anti-HER2 monoclonal antibody therapy in breast, gastric, or gastro-esophageal junction cancer patients. The purpose of this study was to evaluate the HER2 status in the mucinous epithelial ovarian cancer (EOC). Adopting the 2013 American Society for Clinical Oncology and the College of American Pathologists guideline update for HER2 testing, 49 tissue microarray samples of mucinous EOC were analyzed by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) tests. The prevalence of HER2 positivity in Asian mucinous EOC was 9 of 49 Asian women (18.37%). The overall concordance was 100% between IHC and FISH results. Her2 gene copies before chromosome-17 correction increased significantly in a stepwise order through the negative, equivocal, and positive IHC result categories (P<0.001), as did the Her2 gene copies after chromosome-17 correction (P<0.001). Of the Taiwanese cohort (n=21), HER2 heterogeneity was 4.76% (1/21) in all but 14.26% (1/7) in HER2-positive cancer. In conclusion, we demonstrated that the prevalence of HER2 positivity in both Asian and white women was comparable; complete HER2 concordance existed between IHC and FISH tests for the Her2 gene copies per tumor cell either before or after correction of chromosome-17, and this can be applied as a potentially valuable tool to analyze the HER2 status. Polysomy-17 was absent under the CEP17 cutoff ≥3. The existence of HER2 heterogeneity can be discerned in certain HER2-expressed primary mucinous EOC in Taiwanese women.

Related: Chromosome 17 FISH Ovarian Cancer

Sciallis AP, Bedroske PP, Schoolmeester JK, et al.
High-grade endometrial stromal sarcomas: a clinicopathologic study of a group of tumors with heterogenous morphologic and genetic features.
Am J Surg Pathol. 2014; 38(9):1161-72 [PubMed] Related Publications
The existence of a "high-grade endometrial stromal sarcoma" category of tumors has been a controversial subject owing to, among other things, the difficulty in establishing consistent diagnostic criteria. Currently, the recommended classification for such tumors is undifferentiated uterine/endometrial sarcoma. Interest in this subject has recently increased markedly with the identification of recurrent molecular genetic abnormalities. At Mayo Clinic, a group of neoplasms has been observed that morphologically resemble, either cytologically or architecturally, classic "low-grade" endometrial stromal sarcoma but feature obvious deviations, specifically, 17 tumors with unequivocally high-grade morphology. These high-grade tumors displayed 3 morphologic themes: (1) tumors with a component that is identical to low-grade ESS that transitions abruptly into an obviously higher-grade component; (2) tumors composed exclusively of high-grade cells with uniform nuclear features but with a permeative pattern of infiltration; (3) tumors similar to the second group but with a different, yet characteristic, cytomorphology featuring enlarged round to ovoid cells (larger than those found in low-grade ESS) with smooth nuclear membranes and distinct chromatin clearing but lacking prominent nucleoli. We collected clinicopathologic data, applied immunohistochemical studies, and also tested tumors by fluorescence in situ hybridization for abnormalities in JAZF1, PHF1, YWHAE, and CCND1. Tumors from these 3 groups were found to be immunohistochemically and genetically distinct from one another. Most notable was the fact that category 3 contained all the cases that tested positive for YWHAE rearrangement, did not show any classic translocations for JAZF1, PHF1, or CCND1, often presented at a high stage, and behaved aggressively. This study demonstrates the morphologic, immunophenotypic, and molecular genetic heterogeneity that exists within "undifferentiated endometrial sarcomas" as currently defined and lends credence to the effort of subclassifying some tumors as truly "high-grade endometrial stromal sarcomas." Our study also shows that, in the context of undifferentiated endometrial sarcomas, recognition of cytomorphologic features on routine hematoxylin and eosin-stained sections may be used to select tumors with specific molecular genetic changes-that is, translocations involving YWHAE. Our conclusions will help further efforts towards proper sub-classification of these tumors which will aid in diagnosis and potentially affect clinical management.

Related: Endometrial (Uterus) Cancer Endometrial Cancer FISH

Saito S, Kajiyama H, Miwa Y, et al.
Unexpected ovarian malignancy found after laparoscopic surgery in patients with adnexal masses--a single institutional experience.
Nagoya J Med Sci. 2014; 76(1-2):83-90 [PubMed] Related Publications
Laparoscopy has become the standard surgery for the treatment of benign ovarian tumors. The aim of this study was to evaluate the appropriateness of laparoscopy for ovarian tumors, including those with malignant potential. A total of 487 patients with adnexal masses underwent laparoscopic surgery in Social Insurance Chukyo Hospital from January 2000 to December 2012. We reviewed 471 cases that fulfilled the criteria set for this study, and examined 10 cases with unexpected ovarian malignancy to analyze their preoperative diagnosis, second surgery, postoperative chemotherapy, and prognosis. The ages of the 471 patients ranged from 13 to 50 years, with a median of 31. Nulliparous patients numbered 321(68.1%). Of all, 436 patients mostly consisted of those with endometrioma, benign ovarian neoplasm or functional cyst. In all, we histologically identified 10 women with malignancy: 6 with borderline ovarian tumors (BOT), 2 with ovarian cancer, and 2 with histologically rare tumors (immature teratoma and granulosa cell tumor). All patients with BOT were diagnosed with a mucinous histology. Two patients underwent both second radical surgery (hysterectomy and contra- or bilateral salpingo-oophorectomy) and chemotherapies that consisted of CBDCA and PTX or DTX. Thus, 2 patients underwent staging procedures, but the remaining 8 cases did not. None of them had evidence of recurrences. With accurate staging and careful postoperative follow-up, laparoscopic surgery could be a feasible initial operation for patients with adnexal masses including early-stage ovarian malignancy.

Related: Ovarian Cancer

Itoh Y, Ikeda M, Hirasawa N, et al.
Retrospective case series of 15 patients treated with chemoradiation using 5-FU and nedaplatin for gynecological malignancy: with regard to hemotoxicity.
Nagoya J Med Sci. 2014; 76(1-2):11-6 [PubMed] Related Publications
We conducted a retrospective comparison of the hemotoxicity of the sequential administration of 5-Fluorouracil (5-FU) prior to Nedaplatin (NDP) (FN therapy) and that of its reverse sequence (NF therapy) for gynecological malignancy. From February 2002 to November 2004, a total of 15 gynecological malignancy patients were treated with radiation therapy combined with NDP and 5-FU. Of these 15 patients, 5 were treated with NF therapy, and 10 were treated with FN therapy. No significant differences were detected between the FN and NF groups with regard to white blood cell count (WBC), hemoglobin level (Hb), and platelet count. The results of this study do not show that the FN group has a lesser degree of hemotoxicity than the NF group.

Related: Fluorouracil Nedaplatin

Kongnyuy EJ, Wiysonge CS
Interventions to reduce haemorrhage during myomectomy for fibroids.
Cochrane Database Syst Rev. 2014; 8:CD005355 [PubMed] Related Publications
BACKGROUND: Benign smooth muscle tumours of the uterus, known as fibroids or myomas, are often symptomless. However, about one-third of women with fibroids will present with symptoms that are severe enough to warrant treatment. The standard treatment of symptomatic fibroids is hysterectomy (that is surgical removal of the uterus) for women who have completed childbearing, and myomectomy for women who desire future childbearing or simply want to preserve their uterus. Myomectomy, the surgical removal of myomas, can be associated with life-threatening bleeding. Excessive bleeding can necessitate emergency blood transfusion. Knowledge of the effectiveness of the interventions to reduce bleeding during myomectomy is essential to enable evidence-based clinical decisions. This is an update of the review published in The Cochrane Library (2011, Issue 11).
OBJECTIVES: To assess the effectiveness, safety, tolerability and costs of interventions to reduce blood loss during myomectomy.
SEARCH METHODS: In June 2014, we conducted electronic searches in the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL and PsycINFO, and trial registers for ongoing and registered trials.
SELECTION CRITERIA: We selected randomised controlled trials (RCTs) that compared potential interventions to reduce blood loss during myomectomy to placebo or no treatment.
DATA COLLECTION AND ANALYSIS: The two authors independently selected RCTs for inclusion, assessed the risk of bias and extracted data from the included RCTs. The primary review outcomes were blood loss and need for blood transfusion. We expressed study results as mean differences (MD) for continuous data and odds ratios for dichotomous data, with 95% confidence intervals (CI). We assessed the quality of evidence using GRADE methods.
MAIN RESULTS: Eighteen RCTs with 1250 participants met our inclusion criteria. The studies were conducted in hospital settings in low, middle and high income countries.Blood lossWe found significant reductions in blood loss with the following interventions: vaginal misoprostol (2 RCTs, 89 women: MD -97.88 ml, 95% CI -125.52 to -70.24; I(2) = 43%; moderate-quality evidence); intramyometrial vasopressin (3 RCTs, 128 women: MD -245.87 ml, 95% CI -434.58 to -57.16; I(2) = 98%; moderate-quality evidence); intramyometrial bupivacaine plus epinephrine (1 RCT, 60 women: MD -68.60 ml, 95% CI -93.69 to -43.51; low-quality evidence); intravenous tranexamic acid (1 RCT, 100 women: MD -243 ml, 95% CI -460.02 to -25.98; low-quality evidence); gelatin-thrombin matrix (1 RCT, 50 women: MD -545.00 ml, 95% CI -593.26 to -496.74; low-quality evidence); intravenous ascorbic acid (1 RCT, 102 women: MD -411.46 ml, 95% CI -502.58 to -320.34; low-quality evidence); vaginal dinoprostone (1 RCT, 108 women: MD -131.60 ml, 95% CI -253.42 to -9.78; low-quality evidence); loop ligation of the myoma pseudocapsule (1 RCT, 70 women: MD -305.01 ml, 95% CI -354.83 to -255.19; low-quality evidence); and a fibrin sealant patch (1 RCT, 70 women: MD -26.50 ml, 95% CI -44.47 to -8.53; low-quality evidence). We found evidence of significant reductions in blood loss with a polyglactin suture (1 RCT, 28 women: MD -1870.0 ml, 95% CI -2547.16 to 1192.84) or a Foley catheter (1 RCT, 93 women: MD -240.70 ml, 95% CI -359.61 to -121.79) tied around the cervix. However, pooling data from these peri-cervical tourniquet RCTs revealed significant heterogeneity of the effects (2 RCTs, 121 women: MD (random) -1019.85 ml, 95% CI -2615.02 to 575.32; I(2) = 95%; low-quality evidence). There was no good evidence of an effect on blood loss with oxytocin, morcellation or clipping of the uterine artery.Need for blood transfusion We found significant reductions in the need for blood transfusion with vasopressin (2 RCTs, 90 women: OR 0.15, 95% CI 0.03 to 0.74; I(2) = 0%; moderate-quality evidence); peri-cervical tourniquet (2 RCTs, 121 women: OR 0.09, 95% CI 0.01 to 0.84; I(2) = 69%; low-quality evidence); gelatin-thrombin matrix (1 RCT, 100 women: OR 0.01, 95% CI 0.00 to 0.10; low-quality evidence) and dinoprostone (1 RCT, 108 women: OR 0.17, 95% CI 0.04 to 0.81; low-quality evidence), but no evidence of effect on the need for blood transfusion with misoprostol, oxytocin, tranexamic acid, ascorbic acid, loop ligation of the myoma pseudocapsule and a fibrin sealant patch.There were insufficient data on the adverse effects and costs of the different interventions.
AUTHORS' CONCLUSIONS: At present there is moderate-quality evidence that misoprostol may reduce bleeding during myomectomy, and low-quality evidence that bupivacaine plus epinephrine, tranexamic acid, gelatin-thrombin matrix, a peri-cervical tourniquet, ascorbic acid, dinoprostone, loop ligation and a fibrin sealant patch may reduce bleeding during myomectomy. There is no evidence that oxytocin, morcellation and temporary clipping of the uterine artery reduce blood loss. Further well designed studies are required to establish the effectiveness, safety and costs of different interventions for reducing blood loss during myomectomy.

Li P, Zhou L, Liu X, et al.
Mitotic DNA damages induced by carbon-ion radiation incur additional chromosomal breaks in polyploidy.
Toxicol Lett. 2014; 230(1):36-47 [PubMed] Related Publications
Compared with low linear energy transfer (LET) radiation, carbon-ion radiation has been proved to induce high frequency of more complex DNA damages, including DNA double strands (DSBs) and non-DSB clustered DNA lesions. Chemotherapeutic drug doxorubicin has been reported to elicit additional H2AX phosphorylation in polyploidy. Here, we investigated whether mitotic DNA damage induced by high-LET carbon-ion radiation could play the same role. We demonstrate that impairment of post-mitotic G1 and S arrest and abrogation of post-mitotic G2-M checkpoint failed to prevent mis-replication of damaged DNA and mis-separation of chromosomes. Meanwhile, mitotic slippage only nocodazole-related, cytokinesis failure and cell fusion collectively contributed to the formation of binucleated cells. Chk1 and Cdh1 activation was inhibited when polyploidy emerged in force, both of which are critical components for mitotic exit and cytokinesis. Carbon-ion radiation irrelevant of nocodazole incurred additional DNA breaks in polyploidy, manifesting as structural and numerical karyotype changes. The proliferation of cells given pre-synchronization and radiation was completely inhibited and cells were intensely apoptotic. Since increased chromosomal damage resulted in extensive H2AX phosphorylation during polyploidy, we propose that the additional γ-H2AX during polyploidy incurred by carbon-ion radiation provides a final opportunity for these dangerous and chromosomally unstable cells to be eliminated.

Related: Apoptosis Cervical Cancer

Pichatechaiyoot A, Buhachat R, Boonyapipat S, Kanjanapradit K
Radiation, chemotherapy or combined modality therapy in adjuvant treatment for stage III endometrial carcinoma in lower southern Thailand: disease recurrence and overall survival.
J Med Assoc Thai. 2014; 97(3):274-82 [PubMed] Related Publications
OBJECTIVE: To survey disease-free survival (DFS) and overall survival (OS) of patients with stage III endometrial carcinoma treated with post-operative radiation and/or chemotherapy
MATERIAL AND METHOD: The medical records of patients with surgical stage III endometrial carcinoma, and receiving adjuvant treatment between January 2003 and December 2012 were reviewed DFS and OS were analyzed using the Kaplan-Meier method and Cox proportional hazards model.
RESULTS: Of the 54 eligible patients, 61% underwent radiation, 19% chemotherapy, and 20% chemotherapy with radiation. The median DFS was 36.7 months. The 3-year DFS and OS was 51.9% (95% CI 36.3-74.1%) and 70.6% (95% CI 57.4-86.8%), respectively. There was no significant difference in DFS and OS among treatment groups. Cox regression analysis showed grade 2-3 tumors and menopause were associated with poor DFS and OS.
CONCLUSION: The DFS and OS in stage III endometrial carcinoma receiving postoperative adjuvant therapy were quite good and were not different among radiation therapy, chemotherapy, and combined treatment groups. The multi-center randomized prospective study was needed to determine the standard modality.

Related: Endometrial (Uterus) Cancer Endometrial Cancer Thailand

Fernandez-Vega I, Santos-Juanes J, García-Pravia C
Bilateral Sertoli cell adenoma in gonads, associated with serous cystadenoma.
Pol J Pathol. 2014; 65(2):154-6 [PubMed] Related Publications
Complete androgen insensitivity syndrome is an extremely infrequent disease. The patients exhibit female phenotype because of insensitivity to the androgen receptor and may develop tumors, especially in their undescended gonads. We report a case of bilateral Sertoli cell adenoma in gonads with unilateral serous cystadenoma, in an elderly phenotypic woman with primary amenorrhea. We also provide radiological and pathological studies.

Related: Ovarian Cancer

Miyata H, Tsuji N, Jimi T, et al.
Adenosarcoma of the uterine body initially presenting as an interstitial small tumor of the uterus: a case report.
Eur J Gynaecol Oncol. 2014; 35(4):473-6 [PubMed] Related Publications
Adenosarcoma of the uterine body is a rare mixed tumor in which a benign epithelial component is mixed with a malignant stromal element. It has been considered that this tumor originates from the endometrium and its most common finding of imaging is a polypoid tumor occupying the uterine cavity. The authors herein present a case of 37-year-old female with a complaint of abnormal vaginal bleeding. At the first visit, transvaginal ultrasound and magnetic resonance imaging (MRI) showed a round mass with a diameter of one cm in the uterine wall. No malignant pathological finding was detected. The patient visited the authors again one year later, because of continuous bleeding. At that time, they found a polypoid tumor in the uterine cavity, which turned out to be adenosarcoma with sarcomatous overgrowth. The round mass in the uterus detected at first time seems to have been incipience of adenosarcoma. Prodromal sign of adenosarcoma has not been reported previously.

Park CM, Kim SY
Rupture of an endometrioma with extremely high serum CA-125 level (> 10,000 IU/ml) and ascites resembling ovarian cancer.
Eur J Gynaecol Oncol. 2014; 35(4):469-72 [PubMed] Related Publications
Carbohydate antigen 125 (CA-125) is a type of cell surface glycoproteins present in more than 80% of non-mucinous epithelial ovarian carcinomas; however, benign gynecologic conditions commonly cause a smaller increase in CA-125 level. This report presents the details regarding a 44-year-old woman with extremely high serum CA-125 level and ascites. She complained of having abdominal pain and abdominal distension. Her serum CA-125 level had been markedly elevated (> 10,000 IU!ml) and computed tomograpgy (CT) revealed an ovarian tumor and massive ascites. The cytological analysis showed no evidence of malignancy, however, the positron emission CT (PET-CT) scan suggested ovarian malignancy with peritoneal carcinomatosis. Under the impression that the patient had ovarian cancer, the present surgical team carried out an explorative laparotomy and discovered the ruptured bilateral ovarian endometriomas. In this study, it is suggested that clinicians carrying out differential diagnosis of pelvic mass with high serum CA-125 level and ascites should consider not only ovarian cancer but also ruptured endometrioma.

Related: Ovarian Cancer

Ki EY, Park JS, Lee A, Hur SY
Aggressive angiomyxoma of the female genital tract: report of two cases.
Eur J Gynaecol Oncol. 2014; 35(4):465-8 [PubMed] Related Publications
Aggressive angiomyxoma (AA) was identified in 1983 and 250 cases of this rare tumor have since been reported in the literature. It is characterized by a locally infiltrative and recurrent nature; however, it rarely shows distant metastasis. Surgical managements can successfully treat AA patients but may result in a significant morbidity due to the large size and infiltration of the tumor. Less radical surgeries have recently been recommended in the treatment of this tumor, but adjuvant therapies have not yet been fully established. The authors report here two AA cases that were treated at their hospital, with a brief review of the literature.

Related: Vulva Cancer

Seki T, Yanaihara N, Hirata Y, et al.
Uterine endometrial carcinoma with trophoblastic differentiation: a case report with literature review.
Eur J Gynaecol Oncol. 2014; 35(4):461-4 [PubMed] Related Publications
Choriocarcinoma is categorized as either gestational or nongestational depending on its origin. Nongestational choriocarcinoma originated in the trophoblastic differentiation is a rare but an aggressive tumor. This article reports a nongestational case of a uterine endometrial carcinoma with trophoblastic differentiation. A 54-year-old woman with a history of atypical genital bleeding that underwent semi-radical hysterectomy, bilateral salpingo-oophrectomy, and pelvic lymph nodes dissection. Pathological investigation showed that the tumor had endometrioid adenocarcinoma and choriocarcinomatous components. Although a series of multimodality treatments including craniotomy were performed, she died of aggressive lung and brain metastases one year after the primary surgery.

Related: Endometrial (Uterus) Cancer Endometrial Cancer

Grigore M, Ilea C, Terinte C, et al.
Heterologous type of malignant mixed Müllerian tumor of the uterus presenting as a vulvar mass.
Eur J Gynaecol Oncol. 2014; 35(4):458-60 [PubMed] Related Publications
Carcinosarcoma is a rare, extremely aggressive tumor of the uterus with a poor prognosis. The authors describe a case of a 78-year-old woman who presented with a giant mass protruding through the cervix, vagina, and vulva. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The histopathological examination of the surgical specimen revealed a malignant mixed Müllerian tumor. The clinical and pathological features, molecular data, and prognosis of this aggressive neoplasm are discussed. Although uterine carcinosarcomas are extremely rare, when a postmenopausal woman with a vulvar mass is admitted to the gynecology clinic, the physician should consider that the mass may be a carcinosarcoma.

Stukan M, Dudziak M
Successful treatment of a large symptomatic lymphocyst with percutaneus drainage and repeated iodopovidone sclerotherapy.
Eur J Gynaecol Oncol. 2014; 35(4):456-7 [PubMed] Related Publications
The objective of the case report was to present an easy and safe method for treatment of a large, persistent lymphocyst, through a procedure performed in an ambulatory setting. The patient diagnosed with large (1,800 mi), symptomatic (pains, renal insufficiency) lymphocyst after lymphadenectomy for cervical cancer, was successfully treated with percutaneous drainage (using vascular drains) and five sessions of sclerotherapy with 10% iodopovidone, performed in ambulatory settings. The method was minimally invasive, safe, and effective in management of symptomatic lymphocyst.

Related: Cervical Cancer

Yoon BS, Seong SJ, Song T, et al.
Rectus abdominis muscle resection and fascial reconstruction for the treatment of uterine leiomyosarcoma invading the abdominal wall: a case report.
Eur J Gynaecol Oncol. 2014; 35(4):449-51 [PubMed] Related Publications
The authors present a case of intra-abdominal recurrent leiomyosarcoma invading a large area of the abdominal wall. The patient underwent cytoreductive surgery, including resection of the rectus abdominis muscle, followed by reconstruction of the defect using synthetic mesh. The tumor was surgically removed by en bloc resection, including most of the rectus abdominis muscle and ileum. The abdominal wall defect was repaired using synthetic mesh. The patient underwent radiotherapy and chemotherapy after the surgery and was healthy one year later.

Ishikawa M, Nakayama K, Rahman MT, et al.
Therapy-related myelodysplastic syndrome and acute myeloid leukemia following chemotherapy (paclitaxel and carboplatin) and radiation therapy in ovarian cancer: a case report.
Eur J Gynaecol Oncol. 2014; 35(4):443-8 [PubMed] Related Publications
In recent years, the incidence of therapy-related myelodysplastic syndrome (t-MDS) and therapy-related acute myeloid leukemia (t-AML) that occur during chemotherapy for ovarian cancer has increased. While alkylating agents and topoisomerase II inhibitors are particularly mutagenic and have strong leukemogenic potential, paclitaxel and combination chemotherapy/radiation therapy also appear to induce t-MDS. The present authors report a case of t-MDS that developed during chemotherapy and radiation therapy for ovarian cancer. The patient was a 75-year-old woman who received six courses of cyclophosphamide/doxorubicin/cisplatin (CAP) therapy after initial surgery for Stage IIIc grade ovarian cancer in 1995. Beginning in February 2005, the patient experienced multiple recurrences due to sternal metastasis. Chemotherapy, including paclitaxel and carboplatin (TC), was administered intermittently and was combined with radiation therapy to a sternal metastatic lesion. Pancytopenia was observed in December 2008, and she was diagnosed with t-MDS (WHO subtype, refractory cytopenias with multilineage dysplasia [RCMD]): the time from first chemotherapy to t-MDS onset was 106 months. Without evidence of blast crisis, the recurrent lesions continued to grow and caused multiple cerebral infarctions, from which she eventually died. The cumulative doses of paclitaxel and carboplatin administered to this patient were 1,968 mg and 6,480 mg, respectively.

Related: Carboplatin Acute Myeloid Leukemia (AML) Ovarian Cancer Paclitaxel

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