552 Uterine serous carcinoma mimicking advanced ovarian cancer. Are there clues to pre-operative diagnostic differentiation? A mini case series

ObjectiveOvarian cancer is the deadliest of gynecologic cancers. In recent years, International Federation of Gynecology and Obstetrics (FIGO) and the World Health Organization (WHO) classifications were revised. We compared the major changes between the classifications and examined the effects on the therapy and prognosis of the ovarian, fallopian tubes, and peritoneum cancer in our series according to both classifications.Methods/MaterialsWe performed an observational descriptive study of 210 patients who were diagnosed with a malignant ovarian tumor from 2010 to 2016. The accepted FIGO and WHO classifications at each point in time were registered. We reclassified both data, obtaining both classifications for each patient. The changes in the therapeutic management and prognosis were examined.ResultsIn both FIGO classifications of our case series, most patients with ovarian cancer were in FIGO stage III. We found that 4.2% of the previous stage IIIC patients have changed to stage IIIA2 or stage IIIB, with better prognosis and survival rate. In the new WHO classification, the main change, in our case series, was the increase in the high-grade serous carcinoma percentage. According to the current recommendations, we observed 7.56% more patients in early ovarian cancer stages treated with platinum and taxane. In both early and advanced ovarian cancer group, high-grade serous carcinoma tumors were predominant.ConclusionsThe newly created WHO and FIGO classifications have improved the ability to predict the prognosis and consequently to change the therapeutic managements of patients with ovarian cancer.

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Total Infragastric Omentectomy Including the Vascular Perigastric Arcade in Patients With Advanced Serous Ovarian Tumors

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000832 ◽

2017 ◽

Vol 27 (2) ◽

pp. 252-257

Author(s):

Gloria Cordeiro Vidal ◽

Sabrina Croce ◽

Frédéric Guyon ◽

Guillaume Babin ◽

Denis Querleu

Keyword(s):

Ovarian Cancer ◽

Advanced Ovarian Cancer ◽

Ovarian Tumors ◽

Serous Carcinoma ◽

Pathological Examination ◽

Low Grade ◽

Debulking Surgery ◽

Macroscopic Appearance ◽

Primary Debulking Surgery ◽

Interval Debulking Surgery

ObjectiveThe aim of this study was to document the need of including the perigastric area when performing omentectomy in patients with stage III to IV serous epithelial ovarian tumors.Patients and MethodsPatients undergoing omentectomy in the setting of surgery for advanced epithelial serous ovarian cancer between February and September 2015 were included. Patients with macroscopic involvement of the perigastric area, nonepithelial serous tumors, and recurrences of ovarian cancer were excluded. The perigastric area was isolated and comprehensively processed for pathological examination.ResultsTwenty-four patients were included. Six patients underwent primary debulking surgery, and 18 patients underwent an interval debulking surgery. The mean number of pathologic blocks in the perigastric area was 24 (range, 8–41). Microscopic involvement of the perigastric omentum area was found in 62.5% of the cases. One patient had a low-grade serous carcinoma, with microscopic involvement of the perigastric area. Among the 23 patients with a high-grade serous carcinoma, 10 (83%) of 12 patients with a gross involvement of the rest of the omentum had a microscopic involvement of the perigastric area. The presence of microscopic disease in the perigastric arcade was found in 4 (36.3%) of 11 patients with a macroscopically normal omentum.ConclusionsIn this study, evidence is given that total omentectomy including the perigastric area is a necessary component of complete cytoreductive surgery in advanced ovarian cancer, whatever the macroscopic appearance of the omentum.

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Preservation of pregnancy in a patient with advanced ovarian cancer at 20 weeks of gestation: case report and literature review

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.00917.x ◽

2007 ◽

Vol 17 (5) ◽

pp. 1140-1143 ◽

Cited By ~ 34

Author(s):

M Modares Gilani ◽

M Karimi Zarchi ◽

N. Behtash ◽

F. Ghaemmaghami ◽

A. S. Mousavi ◽

...

Keyword(s):

Ovarian Cancer ◽

Combination Chemotherapy ◽

Advanced Ovarian Cancer ◽

Figo Stage ◽

Serous Carcinoma ◽

Healthy Baby ◽

Resistant Disease ◽

Papillary Serous Carcinoma ◽

Initial Combination

To report a case of FIGO stage III papillary serous carcinoma of ovary, diagnosed during pregnancy at 20 weeks of gestation and treated with unilateral salpingo-oophorectomy and surgical staging, then initial combination chemotherapy while preserving the pregnancy. The patient underwent cesarean section at 35 weeks after four courses of taxol plus carboplatin. She delivered a healthy baby. After that total hysterectomy, omentectomy, pelvic and para-aortic lymphadenectomies were carried out. The surgical resection was complete and no macroscopic residual diseases were seen. During histologic examination, traces of resistant disease were found. The patient underwent three postoperative courses of chemotherapy (carboplatin plus paclitaxel regimen). After 6 months follow-up, the patient remained in complete remission and the child's development was normal. Combination chemotherapy during pregnancy with preservation of the fetus could be considered, and should be discussed with caution in case of epithelial ovarian cancer diagnosed during the second trimester of the pregnancy.

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A Phase I/II trial comparing autologous dendritic cell vaccine pulsed either with personalized peptides (PEP-DC) or with tumor lysate (OC-DC) in patients with advanced high-grade ovarian serous carcinoma

Journal of Translational Medicine ◽

10.1186/s12967-019-02133-w ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 9

Author(s):

Apostolos Sarivalasis ◽

Caroline Boudousquié ◽

Klara Balint ◽

Brian J. Stevenson ◽

Philippe O. Gannon ◽

...

Keyword(s):

Ovarian Cancer ◽

Immune Response ◽

Phase I ◽

Advanced Ovarian Cancer ◽

Serous Carcinoma ◽

Patient Specific ◽

Tumor Lysate ◽

Dc Vaccine ◽

Wide Range ◽

Care Surgery

Abstract Background Most ovarian cancer patients are diagnosed at a late stage with 85% of them relapsing after surgery and standard chemotherapy; for this reason, new treatments are urgently needed. Ovarian cancer has become a candidate for immunotherapy by reason of their expression of shared tumor-associated antigens (TAAs) and private mutated neoantigens (NeoAgs) and the recognition of the tumor by the immune system. Additionally, the presence of intraepithelial tumor infiltrating lymphocytes (TILs) is associated with improved progression-free and overall survival of patients with ovarian cancer. The aim of active immunotherapy, including vaccination, is to generate a new anti-tumor response and amplify an existing immune response. Recently developed NeoAgs-based cancer vaccines have the advantage of being more tumor specific, reducing the potential for immunological tolerance, and inducing robust immunogenicity. Methods We propose a randomized phase I/II study in patients with advanced ovarian cancer to compare the immunogenicity and to assess safety and feasibility of two personalized DC vaccines. After standard of care surgery and chemotherapy, patients will receive either a novel vaccine consisting of autologous DCs pulsed with up to ten peptides (PEP-DC), selected using an agnostic, yet personalized, epitope discovery algorithm, or a sequential combination of a DC vaccine loaded with autologous oxidized tumor lysate (OC-DC) prior to an equivalent PEP-DC vaccine. All vaccines will be administered in combination with low-dose cyclophosphamide. This study is the first attempt to compare the two approaches and to use NeoAgs-based vaccines in ovarian cancer in the adjuvant setting. Discussion The proposed treatment takes advantage of the beneficial effects of pre-treatment with OC-DC prior to PEP-DC vaccination, prompting immune response induction against a wide range of patient-specific antigens, and amplification of pre-existing NeoAgs-specific T cell clones. Trial registration This trial is already approved by Swissmedic (Ref.: 2019TpP1004) and will be registered at http://www.clinicaltrials.gov before enrollment opens.

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Modified posterior pelvic exenteration and rectosigmoid anastomosis for advance epithelial ovarian cancer: A safe cytoreductive procedure

10.1055/s-0039-1685294 ◽

2016 ◽

Author(s):

Rashmi Rekha Bora

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Pelvic Exenteration ◽

Residual Disease ◽

Circular Stapler ◽

Advanced Ovarian Cancer ◽

Length Of Hospital Stay ◽

Serous Carcinoma ◽

Retroperitoneal Lymph Node Dissection ◽

Bowel Movements

Introduction: Surgery plays an important role in the management of advanced stage ovarian cancer and is complex involving surgical procedures including peritonectomy, splenectomy, diaphragmatic stripping, retroperitoneal lymph node dissection and bowel resection including resection of recto-sigmoid. Objective: To assess the safety and efficacy of the patients undergoing modified posterior pelvic exenteration and rectosigmoid anastomosis achieving in optimal cytoreduction. Methods: Between June 2011 and June 2014 a total of 100 patients underwent surgical cytoreduction for advanced epithelial ovarian cancer of which 20 patients had undergone modified posterior pelvic exenteration with rectosigmoid anastomosis. The present study includes a retrospective analysis of these 20 patients. Rectosigmoid anastomosis was done using circular stapler in these patients. All patients had a PS score of 1 or 2. Results: The median age of patients was 50 years. The optimal status of no macroscopic residual disease was achieved in all patients. Modified posterior pelvic exenteration with rectosigmoid anastomosis was carried out to achieve optimal status of surgical cytoreduction in 20 patients out of which fifteen patients had primary surgical cytoreduction, three patients had interval surgical cytoreduction surgery after receiving three cycles of neoadjuvant chemotherapy with paclitaxel & carboplatin while two patients had this procedure as a part of secondary surgical cytoreduction. The most common histology was papillary serous carcinoma. Average blood loss was 500 ml. Mean operative time was 6 hours. There were no intra operative complications. Bowel movements returned to normal in 3 to 5 days. The median length of hospital stay was 7 days. The median time to start postoperative chemotherapy was 32 days. There was no major morbidity and mortality. Conclusion: Modified posterior pelvic exenteration with rectosigmoid anastomosis should be performed when indicated as a part of cytoreduction. In our experience this is a safe and effective procedure to achieve optimal status in advanced ovarian cancer.

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The role of omentectomy during the surgical staging of uterine serous carcinoma

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200303000-00019 ◽

2003 ◽

Vol 13 (2) ◽

pp. 212-215 ◽

Cited By ~ 4

Author(s):

P. A. Gehrig ◽

L. Van Le ◽

W. C. Fowler

Keyword(s):

Ovarian Cancer ◽

Surgical Procedures ◽

Surgical Staging ◽

Serous Carcinoma ◽

Exact Test ◽

Uterine Serous Carcinoma ◽

Stage Ivb ◽

Sensitivity Specificity ◽

Omental Metastasis

Uterine serous carcinoma (USC) has a propensity for extrauterine spread, and some suggest that this disease be staged as an ovarian cancer, and thus include omental sampling. However, given the primary organ involved, the staging recommendations do not include omental sampling. The aim of this study is to evaluate the role of omental sampling during the surgical staging of USC. We retrospectively identified cases of USC at our institution from January 1990 to June 2000 and abstracted surgical procedures, stage, and sites of metastasis. Fisher's exact test was used to calculate sensitivity, specificity, and positive and negative predictive value. We identified 65 women with USC, of which 52 underwent omental evaluation. Thirty four of the omentums were visually normal and benign on histologic review. Two were visually negative and histologically positive for metastatic serous carcinoma. The remaining 16 specimens were grossly involved with histologic confirmation of disease. The sensitivity of a visually negative omentum is 0.89 (P < 0.0001). Microscopic omental metastasis from USC is rare. When the omentum is involved, thereby upstaging the patient to stage IVB disease, the disease is generally diagnosed by gross visualization. We conclude that omental sampling does not need to be included in the routine surgical staging of USC.

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Is a More Comprehensive Surgery Necessary in Patients With Uterine Serous Carcinoma?

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000488 ◽

2015 ◽

Vol 25 (7) ◽

pp. 1266-1270 ◽

Cited By ~ 5

Author(s):

Omar Touhami ◽

Xuan-Bich Trinh ◽

Jean Gregoire ◽

Alexandra Sebastianelli ◽

Marie-Claude Renaud ◽

...

Keyword(s):

Ovarian Cancer ◽

Endometrial Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Clinical Stage ◽

Sentinel Lymph Node Mapping ◽

Serous Carcinoma ◽

Lymph Node Mapping ◽

Uterine Serous Carcinoma ◽

Extensive Surgery

ObjectiveUterine serous carcinoma (USC) is an aggressive histologic subtype of endometrial cancer that shares similarities to serous ovarian cancer, with a propensity for spread to the upper abdomen, a high recurrence rate, and a poor prognosis. The aim of this study was to determine whether the traditional surgical staging procedure for endometrial cancer was adequate for USC or whether a more extensive surgery, similar to the staging procedure for ovarian cancer, needs to be performed. Specifically, the roles of omentectomy and sentinel lymph node (SLN) mapping were evaluated.MethodsWe retrospectively identified cases of presumed clinical stage I USC at our institution from April 2005 to March 2014. Medical records were reviewed for the following information: age at diagnosis, preoperative imaging, operative findings, surgical procedure, and final histology with definitive International Federation of Gynecology and Obstetrics stage.ResultsA total of 39 patients with presumed clinical stage I USC were identified. According to the final pathology report, the surgical stage was as follows: 17 stage IA (44%), 8 stage IB (20%), 3 stage II (8%), 2 stage IIIA (5%), 6 stage IIIC1 (15%), 1 IIIC2 (3%), and 2 stage IVB (5%). Therefore, 14 patients (36%) were surgically upstaged, but none of the patients had their clinical disease upstaged by virtue of finding microscopic metastatic disease in an otherwise normal-looking omentum. Sentinel lymph node mapping was performed in 19 patients (42%). Sensitivity and negative predictive value of SLN mapping were 100% when at least 1 SLN was identified.ConclusionsThe detection of microscopic disease in radiologically and clinically normal-appearing omentum seems to be rare in USC. Sentinel lymph node mapping seems to be valuable in the serous subtype of endometrial cancer. A less extensive surgery may be possible in patients with USC as it seems to provide the same information as a more extensive surgery.

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Analysis of the outcome of patients with stage IV uterine serous carcinoma mimicking ovarian cancer

10.1101/19002410 ◽

2019 ◽

Author(s):

Murad Al-Aker ◽

Karen Sanday ◽

James Nicklin

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Neoadjuvant Chemotherapy ◽

Cytoreductive Surgery ◽

Stage Iv ◽

Serous Carcinoma ◽

Optimal Cytoreduction ◽

Uterine Serous Carcinoma ◽

Interval Cytoreduction

ABSTRACTObjectivesTo identify clinicopathological factors that might influence survival in patients with stage IV uterine serous carcinoma, and to compare survival outcomes in patients with stage IV uterine serous carcinoma managed with neoadjuvant chemotherapy followed by interval cytoreduction (with or without adjuvant chemotherapy), primary cytoreductive surgery followed by adjuvant chemotherapy.MethodsA retrospective cohort study of all patients with stage IV Uterine serous carcinoma treated between 2005 and 2015 within a regional cancer centre. Progression-free and overall survival rates were calculated using the Kaplan–Meier method.ResultsOf 50 women with stage IV uterine serous carcinoma who met inclusion criteria, 37 underwent primary cytoreductive surgery, nine received neoadjuvant chemotherapy with planned interval cytoreductive surgery and four received palliative care only. A pre-treatment diagnosis of stage IV uterine serous carcinoma was made for only 45.9% of the primary cytoreductive surgery group and 56.6% of the neoadjuvant chemotherapy group, with advanced ovarian cancer the most common preoperative misdiagnosis. Median follow up was 19 months. Median overall survival was 27 months for the primary cytoreductive surgery group, 20 months for the neoadjuvant chemotherapy group and two months for the palliative care group. Optimal cytoreduction was achieved in 67.6% of the primary cytoreductive surgery group and 87.5% of the neoadjuvant chemotherapy group who underwent interval cytoreduction. Optimal cytoreduction was associated with improvement in overall survival, compared with suboptimal cytoreduction (36 versus 15 months; P=0.16). Adjuvant chemotherapy was associated with significantly higher overall survival compared with no adjuvant chemotherapy (36 versus four months; P<0.05). Median overall survival was 16 months for those with pure uterine serous carcinoma (n=40), compared with 32 months for those with mixed histopathology (n=10).ConclusionStage IV uterine serous carcinoma can mimic advanced ovarian cancer. It carries a poor prognosis, which is worse for pure uterine serous carcinoma than for mixed-type endometrial adenocarcinoma. Neoadjuvant chemotherapy followed by interval cytoreduction and adjuvant chemotherapy seems to be a safe option, with an increased rate of optimal cytoreduction and comparable overall survival, compared with primary cytoreductive surgery. Adjuvant chemotherapy significantly improves survival in all groups.Primary objectiveTo analyse the clinicopathological factors that might influence the progression-free survival and overall survival in patients with stage IV uterine serous carcinoma treated at Queensland Centre for Gynecological cancer.Secondary objectiveTo compare the survival outcomes of patients with stage IV uterine serous carcinoma treated with neoadjuvant chemotherapy and interval cytoreduction, with those treated with primary cytoreductive surgery followed by adjuvant chemotherapy and patients who received palliative care only.PRECISOptimal cytoreduction and adjuvant chemotherapy improved survival in stage IV uterine serous carcinoma. Neoadjuvant chemotherapy was feasible and safe. Patients with microscopic disease have similar poor prognosis.HIGHLIGHTSPure uterine serous carcinoma carries a worse prognosis compared to mixed uterine serous carcinomaOptimal cytoreduction and adjuvant chemotherapy improve survival in Stage IV uterine serous carcinomaNeoadjuvant chemotherapy is feasible and a safe option in the management of stage IV uterine serous carcinoma

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