Preoperative Identification of Synchronous Ovarian and Endometrial Cancers: The Importance of Appropriate Workup

2012 ◽  
Vol 22 (8) ◽  
pp. 1325-1331 ◽  
Author(s):  
Fieke M. E. Broeders ◽  
Anneke A. M. van der Wurff ◽  
Johanna M. A. Pijnenborg ◽  
M. Caroline Vos
Keyword(s):  
Ovarian Cancer ◽  
Adnexal Mass ◽  
Young Patients ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Ca 125 ◽  
Primary Tumors ◽  
Endometrial Cancers ◽  
The Right ◽  
Postoperative Findings

ObjectiveFor treatment of patients with both endometrial and ovarian cancer, it is important to discriminate between 2 primary tumors and metastatic disease. Currently, criteria are based on postoperative findings. The aim of this study was to determine whether clinical parameters can discriminate between these groups preoperatively and whether a practical guideline could improve appropriate workup and treatment.MethodsA total of 45 patients with a diagnosis of both endometrium and ovarian cancer between 1998 and 2009 and were included for analysis. Clinical and pathological data were obtained, and initial CA-125 was registered; patients had a diagnosis of 2 primary tumors or tumors with metastasis. All patients were reclassified according to workup and treatment.ResultsPatients with synchronous primary tumors were significantly younger, presented more often with abnormal uterine bleeding, and had a lower initial CA-125 than both metastatic groups (P < 0.05). With age and CA-125 included in a polytomic logistic regression model, 83.3% of diagnoses could be classified correctly. In 15 of 17 patients presented with adnexal mass, workup was incomplete owing to lack on information of the endometrial status. In patients presenting with abnormal uterine bleeding, 13 of 21 patients had an incomplete workup leading to staging laparotomy secondary to initial surgical treatment in 2 patients.ConclusionsPatients with synchronous endometrial and ovarian cancers are young, often present with abnormal uterine bleeding and have a low initial CA-125. Adequate workup with attention to both ovarian and endometrial status, especially in young patients with a wish to preserve fertility, is important to make the right decision for treatment.

A prospective observational study on the effectiveness of risk of malignancy index score (RMI 3) in a tertiary care centre in Eastern India

2020 ◽  
Vol 11 (5) ◽  
pp. 54-60
Author(s):  
Apurba Mandal ◽  
Shibram Chattopadhyay ◽  
Sushanta Mondal ◽  
Arunava Biswas
Keyword(s):  
Ovarian Cancer ◽  
Adnexal Mass ◽  
Malignant Tumors ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Ca 125 ◽  
Tertiary Care Centre ◽  
Gynecology And Obstetrics ◽  
Risk Of Malignancy ◽  
Malignant Lesions

Background: Adnexal mass is a common presentation in today’s gynecological practice. The incidence of ovarian cancer is increasing day by day and diagnosis is often difficult to be made pre operatively with inadequate surgical exploration is a regular occurrence. Aims and Objectives: To assess and validate the importance of RMI-3 score as pre-operative diagnostic tool of differentiating benign from malignant adnexal mass for starting first line therapy of ovarian cancer and to find out the incidences of ovarian malignancy among study population. Material and Methods: The study was conducted in the Department of Gynecology and Obstetrics on (n=115) patients attending GOPD and indoor with adnexal mass fulfilling the inclusion and exclusion criteria using purposive sampling technique. All the selected cases underwent ultrasonography and serum CA- 125 level estimation necessary for calculating RMI score. A score of >200 was taken as suggestive of malignancy and confirmatory diagnosis was performed by histopathological examination obtained from staging laparotomy of adnexal mass. The individual scores were then correlated with final outcomes with statistical analyses. Results: The study revealed benign ovarian tumors are more under 50 years (78.46%) and patients with normal BMI are diagnosed with maximum of malignancy (n = 28). History of tubal ligation carried less risk of malignancy (p<0.0001). Histologically malignant tumors found mostly in 71.4% postmenopausal group whereas 94.1% benign pathology were present in perimenopausal group and there is no association found between parity and histopathology (p=0.058). Bilateral (p=0.013), multilocular (p=0.000) tumors with solid areas (p<0.0001) and thick papillary projections (p<0.0001) had statistically significant association with malignant lesions. RMI score (>200) had more efficacy than serum CA-125 level (>46) in differentiating malignant lesions from benign one in terms of specificity (96% vs 83.87%) and positive predictive value (95% vs 79.17%). Conclusions: RMI-3 score is a simple, reliable and effective tool in differentiating benign from malignant adnexal masses thereby help in quick referral and management of cases with increase chances of survival of the patients.

scholarly journals A Case of Peritoneal-Pelvic Tuberculosis With Elevated CA-125; An Enigma as Ovarian Cancer

2019 ◽  
Vol 18 (2) ◽  
pp. 60-63
Author(s):  
Prakash Raj Oli ◽  
Rosy Vaidya Malla ◽  
Kavita Karmacharya
Keyword(s):  
Ovarian Cancer ◽  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Young Women ◽  
Adnexal Mass ◽  
Elevated Serum ◽  
Young Lady ◽  
Ca 125 ◽  
Rare Form ◽  
Menstrual Irregularities

Peritoneal-pelvic tuberculosis is a rare form of extrapulmonary-TB mainly affecting women of 20-40 years, especially in TB endemic countries. It classically presents with abdominal pain, menstrual irregularities, adnexal mass, and elevated serum CA-125 level, creating confusion with genital malignancy, especially ovarian one leading to difficulty in its management and often leads to devastating surgeries. Here's a case of peritoneal-pelvic TB, a young lady with abdominal pain, radiologic associates and adnexal mass, and elevated serum CA-125 level is presented. So, it should always be one of the differential diagnosis of ovarian cancer especially among young women in TB endemic countries.

Predictors for optimal cytoreduction following neoadjuvant chemotherapy in advanced epithelial ovarian carcinoma

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5512-5512
Author(s):  
D. de Jong ◽  
J. E. Dodge ◽  
O. Freedman ◽  
E. Lo ◽  
B. P. Rosen ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Independent Predictor ◽  
Residual Tumor ◽  
Multivariate Regression Analysis ◽  
Ca 125 ◽  
Advanced Stage ◽  
Optimal Cytoreduction ◽  
Primary Tumors ◽  
Predictive Parameters

5512 Background: Neoadjuvant chemotherapy (NAC) is increasingly used to treat patients (pts) with presumed advanced-stage epithelial ovarian cancer (EOC) who are deemed ineligible for upfront debulking surgery (DS). DS following NAC offers a survival benefit to those pts in whom optimal cytoreduction (< 1 cm residual tumor) is achieved. However, not all women who commence NAC have a subsequent attempt at DS. The aims of this study were to identify, in pts planned for NAC, predictive parameters for attempting DS and for achieving optimal cytoreduction in those undergoing surgery. Methods: Pts with presumed stage IIIC or IV EOC who started NAC between 1998 and 2004 were selected for chart review from our institutional ovarian cancer database. Pts with synchronous primary tumors or final pathology inconsistent with EOC were excluded. Age, presence of ascites, Pre NAC hemoglobin (Hb), platelet count (Pls), and CA-125 were explored as possible predictors of attempting DS and of optimal cytoreduction using Kruskal-Wallis analysis and multivariate regression analysis with backward elimination. Results: 212 pts met inclusion criteria. 164 pts (77.4%) had an attempt at DS after NAC; of these 109 pts (66.4%) were optimally cytoreduced. Age and pre-NAC Pls were independent predictors for attempting DS. Median age of pts undergoing DS was 65 years (range 42–82 yrs) compared to 77 yrs (range 54–89 yrs) in those in whom there was no DS attempt, p < 0.01. Median pre NAC Pls of pts undergoing DS was 398 (range 220–685) *109/L, compared to 298 (178–519) for those not proceeding to DS, p < 0.001. Pre NAC Hb, CA125, and ascites were not predictors of DS. Among pts undergoing DS, age was the only independent predictor of optimal cytoreduction identified: median age of pts (optimal vs. suboptimal cytoreduction) was 57yrs (range 42–73 yrs) vs. 67 yrs (49–82yrs), p < 0.001. Presence of ascites, pre-NAC Hb, pre-NAC Pls, and pre-NAC CA-125 were not predictors of optimal cytoreduction. Conclusions: At our centre, pt age and pre-NAC Pls are independent predictors for attempting DS following NAC for advanced stage EOC. In pts undergoing DS age was the only independent predictor of optimal cytoreduction identified. Further investigation of these findings is warranted. No significant financial relationships to disclose.

scholarly journals Histopathological study of endometrium in dysfunctional uterine bleeding

2018 ◽  
Vol 7 (9) ◽  
pp. 3497
Author(s):  
Malarvizhi Loganathan ◽  
Meera Krishnakumar
Keyword(s):  
Abnormal Uterine Bleeding ◽  
Histological Change ◽  
Uterine Bleeding ◽  
Histopathological Study ◽  
Age Group ◽  
Dysfunctional Uterine Bleeding ◽  
Medical College ◽  
Histopathological Studies ◽  
The Right ◽  
Secretory Endometrium

Background: This study was undertaken to study the endometrial histology in patients presenting with abnormal uterine bleeding in the absence of palpable pelvic pathology, which helps in choosing the right modality of treatment in a particular age group with a specific histological change. The study of endometrium in dysfunctional uterine bleeding was undertaken to correlate clinical presentations with histopathological studies and to correlate the distribution of histopathological findings in various age groups.Methods: The present study was conducted in the Department of Obstetrics and Gynaecology at Govt. Dharmapuri Medical College and Hospital during the period 01.07.2017 to 31.05.2018. Patients presenting to Govt. Dharmapuri Medical College and Hospital with abnormal uterine bleeding form the material of this study. Cases have been selected by using purposive sampling technique.Results: An ovulatory cycles were more common than ovulatory cycles in all age group. However, in patients with menorrhagia and polymenorrhagia majority had secretory endometrium (ovulatory cycles).Conclusions: Majority of the patients were found in the reproduction age group with the maximum percentage in multiparous women. Menorrhagia was the commonest mode of presentation in all age group. Most of the patients with proliferative and secretory endometrium had normal sized uterus and normal looking endometrium.

γ-synuclein expression in ovarian cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5574-5574
Author(s):  
Kristina Mori ◽  
Stacey Akers ◽  
Wiam Bshara ◽  
Barbara Buttin ◽  
Peter J. Frederick ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Progression Free Survival ◽  
Tissue Microarrays ◽  
Figo Stage ◽  
Ca 125 ◽  
Categorical Variables ◽  
Chemotherapy Response ◽  
Primary Tumors ◽  
Peritoneal Cancer ◽  
Significant Difference

5574 Background: γ-synuclein (SNCG) expression is associated with advanced disease and chemo-resistance in multiple solid tumors. Our goal was to determine if SNCG expression in ovarian cancer was correlated with clinicopathologic variables and patient outcomes. Methods: Tissue microarrays from primary tumors of 358 ovarian, fallopian tube, and primary peritoneal cancer patients, who underwent primary surgery at Roswell Park Cancer Institute between 1995 and 2007 were constructed and stained for SNCG. A blinded pathologist scored tumors as positive if ≥10% of the sample stained. Medical records were reviewed for clinicopathologic and demographic variables. Between the positive and negative groups, Wilcoxon rank-sum test was used to compare the median ages and Fisher’s exact test was used to compare groups in categorical variables. Cox proportional hazard models were used to determine associations between SNCG and overall (OS) and progression-free survival (PFS). Results: The median follow-up was 36 months, median OS was 39 months, and median PFS was 18 months. SNCG presence was significant in patients with serous histology, grade 3 disease, suboptimal debulking, ascites at surgery, FIGO stage III-IV cancer, or initial CA-125 level >485. There was no significant difference in OS (HR 1.06 95% CI 0.81-1.39 P 0.69) or PFS (HR 1.16 95% CI 0.89-1.50 P 0.28) for patients with SNCG expression. Conclusions: SNCG expression in ovarian cancer is more frequent in patients with high-risk features, but it does not correlate with chemotherapy response, OS, or PFS. [Table: see text]

Management of patients with abnormal uterine bleeding puberty in the outpatient setting (experience MCDC “Yuventa”)

2015 ◽  
Vol 6 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Irina Nikolaevna Gogotadze ◽  
Pavel Naumovich Krotin ◽  
Tat’yana Yur’yevna Kozhukhovskaya ◽  
Elena Magometovna Bogatyreva
Keyword(s):  
Clinical Effect ◽  
Dynamic Assessment ◽  
Young Patients ◽  
Abnormal Uterine Bleeding ◽  
Outpatient Setting ◽  
Uterine Bleeding ◽  
Recurrent Bleeding ◽  
Day Hospital ◽  
Diagnostic Center ◽  
Hemostatic Therapy

Questions of the effectiveness of therapy of abnormal uterine bleeding puberty, prevention of recurrence and restore of normal menstrual and fertility are extremely important in the future. Diagnosis of abnormal uterine bleeding puberty often is an absolute indication for hospitalization. However, the experience Saint Petersburg Municipal consultive and diagnostic center “Juventa” patients can receive medical treatment in a day hospital with good clinical effect, if they haven’t anemia and heavy bleeding. Аccording to Juventa clinic, dysfunctional uterine bleedings of the pubertal period iconsist 4 % in the structure of the gynaecological diseases among the young girls. 75-89 % of young patients with bleedings do not require hospitalization with 24 hour observation and can get medical care in the outpatient settings with good clinical effect. In 2/3 of patients could receive the hemostatic effect when using a non-hormonal therapy. In 1/3 of patients require hormone therapy. All of the patients need further medical supervision and therapy for prevention of recurrent bleeding. The effectiveness of conservative hemostatic therapy conducted in a day hospital was 97.8 %. Important conditions for a good clinical effect were: patient selection, which can be performed outpatient treatment, the use of complex therapy, dynamic assessment of the effectiveness of the therapy, timely correction of the treatment regimen with the addition of hormone hemostatic therapy.

scholarly journals Pedunculated Fibroid Mimicking an Ovarian Cancer

2019 ◽  
Vol 14 (1) ◽  
pp. 56-58
Author(s):  
Kabin Bhattachan ◽  
Aruna Karki ◽  
Ganesh Dangal ◽  
Hema Kumari Pradhan ◽  
Ranjana Shrestha
Keyword(s):  
Ovarian Cancer ◽  
Blood Supply ◽  
Adnexal Mass ◽  
Degenerative Change ◽  
Menstrual Period ◽  
Radiological Diagnosis ◽  
Ca 125 ◽  
Cystic Degeneration ◽  
Radiological Imaging ◽  
Ovarian Mass

Large myoma may show various type of degenerative change and have alteration of radiological view. Subserosal or pedunculated fibroid with cystic degeneration may mimic complex ovarian mass on radiological imaging. A 34 year female, para one, with normal menstrual period presented with radiological diagnosis of complex adnexal mass and CA 125 value  100 u/ml. Postoperative finding revealed cystic degeneration of pedunculated subserosal fibroid receiving blood supply from adherent omentum. Keywords:  Cystic degeneration, pedunculated fibroid, complex ovarian mass.  

Management of a patient diagnosed with ovarian cancer during pregnancy

2021 ◽  
Vol 70 (3) ◽  
pp. 135-141
Author(s):  
Anna E. Protasova ◽  
Irina E. Zazerskaya ◽  
Anna A. Tsypurdeyeva ◽  
Ekaterina S. Shelepova ◽  
Elena D. Vyshedkevich ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Histological Examination ◽  
Pain Syndrome ◽  
Pregnant Patient ◽  
Ca 125 ◽  
Cystic Neoplasm ◽  
Resonance Imaging ◽  
Midline Laparotomy ◽  
Left Fallopian Tube ◽  
The Right

Insufficient diagnosis of ovarian tumors during pregnancy and decreased oncological alertness constitute huge problems that can subsequently have an unfavorable outcome for both the pregnant woman and the fetus. The difficulties of diagnosing and treating ovarian cancer during pregnancy were demonstrated on the following clinical case example. In pregnant patient A. at 19-20 weeks of pregnancy, a lesion was found in the area of the right appendages (100.9 55.4 93.4 mm, V = 273 cm3), with many tissue partitions and parietal tissue inclusions. The growth of the neoplasm was noted (CA-125 884 U / ml) and the pain syndrome occurred in the patient at 23-24 weeks of pregnancy. Magnetic resonance imaging revealed a solid-cystic neoplasm of the right ovary (cystadenoma?) and surgery was performed in November 2019. Based on the results of histological examination, a high-grade serous ovarian cancer was diagnosed without signs of microsatellite instability MSI-H/dMMR (in the right ovary, in the biopsy of the left fallopian tube). The patient. received two cycles of polychemotherapy (TC scheme). The treatment was tolerated satisfactorily (CA-125 287.3 U / ml). At a gestational age of 34 6/7 weeks (January 2020), a simultaneous operation was performed, including a lower midline laparotomy, a lower uterine segment caesarean section, extirpation of the uterus with appendages, and an omentectomy. A boy was born (weight 2280 g, height 44 cm) with the Apgar score of 7/7 points, with no complications noticed in the postpartum period. Postoperative histological examination showed metastasis of carcinoma in the left ovary with signs of therapeutic pathomorphosis. The treatment was completed in March 2020 after six cycles of polychemotherapy.

Ovarian cancer: Autologous immunotherapy optimized by remote adjuvancy of a silicate-induced granuloma

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 12515-12515
Author(s):  
E. Garcia-Giralt ◽  
E. Lasalvia-Prisco ◽  
S. Cucchi ◽  
E. Lasalvia-Galante ◽  
J. Vazquez ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Tumor Growth ◽  
Performance Status ◽  
Advanced Ovarian Cancer ◽  
Ca 125 ◽  
Tumor Growth Inhibition ◽  
Primary Tumors ◽  
Group Iii ◽  
Group I ◽  
Group Ii

12515 Background: Advanced ovarian cancer has been included in several studies about an immunotherapy procedure using an Autologous Thermostable Hemoderivative Vaccine (ATHV) with anti-progressive tumor effect in metastatic malignant disease from different primary tumors (Cancer Biol Ther 2003). Like in most cancer vaccines, the net anti-tumoral effect of ATHV has low intensity despite the addition of several adjuvant steps: immune response enhancement by GM-CSF, immune tolerance break by cyclophosphamide or interference with CD4+CD25+ regulatory cells (E. Lasalvia-Prisco et al. ASCO 2003–2005). The inclusion of another adjuvant immunomodulatory step to ATHV in patients with advanced ovarian cancer was explored in this study. The tested adjuvancy was the local and remote immune-stimulation elicited by a subcutaneous silicate-granuloma (SSG), a phenomenon well proven in preclinical models (RM Fauve et al. Immune Lett 1987; E Fontan et al Proc Nat Acad of Sci 1983). Methods: Twenty four metastasic ovarian cancer patients, chemotherapy resistant, performance status ≤ 2 and CA-125 progressing serum level, were included in this institutional-IRB approved phase I/II trial. The patients were 3-group randomized, submitted to 3 different treatments: I only sympthomatic; II the previously reported ATHV and III ATHV + SSG. Tumor Growth was assessed in each case by the tumor size increase (RECIST measured). Mean difference in the 3 groups was statistically assessed (Student’s test). Results: Tumor Growth was slower in Group II and III than in Group I (p<0.02, p<0.005). Tumor growth was slower in Group III than in Group II (p<0.02). No relevant toxicities were detected. Conclusions: The results support that in advanced ovarian cancer an additional subcutaneous silicate granuloma as adjuvant agent optimizes the tumor growth inhibition through immunotherapy with an autologous thermostable hemoderivative vaccine. The bypass of the immune-ignorance could be discussed as its mechanism of action. No significant financial relationships to disclose.

scholarly journals Coexistence of genital tuberculosis and ovarian serous cystadenofibroma in a young female patient: a case report

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052094941
Author(s):  
Shaoyan Yang ◽  
Zhengjuan Yang ◽  
Suxian Zhang ◽  
Tianyan Len ◽  
Lihua Yang
Keyword(s):  
Adnexal Mass ◽  
Young Patients ◽  
Granulomatous Inflammation ◽  
Young Female ◽  
Fallopian Tubes ◽  
Genital Tuberculosis ◽  
Tb Treatment ◽  
Laparoscopic Biopsy ◽  
Female Genital Tuberculosis ◽  
The Right

Most cases of female genital tuberculosis (TB) are asymptomatic and are thus difficult to diagnose. Coexistence of genital TB and ovarian serous cystadenofibroma (OSCAF) is rare and easily ignored or misdiagnosed. We report a 26-year-old woman with coexistence of genital TB and OSCAF, and with an adnexal mass detected by B-ultrasound. Laparoscopic biopsy of diffuse miliary white nodules was performed on the surface of the peritoneum and both fallopian tubes. Right ovarian cystectomy was performed. Postoperative pathology showed that the right ovarian mass was a benign serous cystadenofibroma, and both fallopian tubes and miliary white nodules on the surface of pelvic organs showed chronic granulomatous inflammation. Polymerase chain reaction for Mycobacterium tuberculosis and acid-fast bacilli culture were positive in biopsies of the fallopian tubes, omentum, and peritoneum. The patient received anti-TB treatment after surgery. Six months after the operation, the patient had no abdominal pain and no major changes in menstruation. Our findings suggest that a timely operation is required for patients with an adnexal mass. During surgery, even if the lesion is similar to a malignant tumor, the surgical approach needs to be cautiously chosen for young patients without children. The patient’s postoperative fertility must be taken into consideration.

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