scholarly journals Pulmonary and pleural metastasis mimicking COVID-19 infection in stage IV ovarian cancer: a case report

2020 ◽  
Vol 106 (6) ◽  
pp. NP73-NP75
Author(s):  
Fabiana Carbone ◽  
Innocenza Palaia ◽  
Giusi Santangelo ◽  
Lucia Manganaro ◽  
Giorgia Perniola ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Stage Iv ◽  
Ambient Air ◽  
Final Diagnosis ◽  
Computed Tomographic ◽  
Negative Results ◽  
Gynecology And Obstetrics ◽  
Radiologic Imaging ◽  
Computed Tomographic Scan ◽  
Pleural Metastases

Background: The differential diagnosis of lung and pleural metastases and coronavirus disease 2019 (COVID-19) can be challenging. Case: We report a case of a 41-year-old woman with FIGO (International Federation of Gynecology and Obstetrics) stage IV ovarian cancer with pleural and pulmonary spread. After primary cytoreduction was performed, she developed a high fever and worsening dyspnea with desaturation (92% in ambient air). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was suspected, but three swabs gave negative results. Computed tomographic scan showed radiologic imaging strongly suspect for COVID-19 and the patient was transferred to a COVID-19 ward. The final diagnosis was paraneoplastic fever. Conclusion: Lung and pleural metastases can mimic SARS-CoV-2 infection.

Tumor Residual After Surgical Cytoreduction in Prediction of Clinical Outcome in Stage IV Epithelial Ovarian Cancer: A Gynecologic Oncology Group Study

2008 ◽  
Vol 26 (1) ◽  
pp. 83-89 ◽  
Author(s):  
William E. Winter ◽  
G. Larry Maxwell ◽  
Chunqiao Tian ◽  
Michael J. Sundborg ◽  
G. Scott Rose ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Residual Disease ◽  
Gynecologic Oncology ◽  
Stage Iv ◽  
Gynecologic Oncology Group ◽  
Gynecology And Obstetrics ◽  
Microscopic Residual Disease

Purpose To identify factors predictive of poor prognosis in a similarly treated population of women with stage IV epithelial ovarian cancer (EOC). Patients and Methods A retrospective review of 360 patients with International Federation of Gynecology and Obstetrics stage IV EOC who underwent primary surgery followed by six cycles of intravenous platinum/paclitaxel was performed. A proportional hazards model was used to assess the association of potential prognostic factors with progression-free survival (PFS) and overall survival (OS). Results The median PFS and OS for this group of stage IV ovarian cancer patients was 12 and 29 months, respectively. Multivariate regression analysis revealed that histology, malignant pleural effusion, intraparenchymal liver metastasis, and residual tumor size were significant prognostic variables. Whereas patients with microscopic residual disease had the best outcome, patients with 0.1 to 1.0 cm residual disease and patients with 1.1 to 5.0 cm residual disease had similar PFS and OS. Patients with a residual size more than 5 cm had a diminished PFS and OS when compared with all other groups. Median OS for microscopic, 0.1 to 5.0 cm, and more than 5.0 cm residual disease was 64, 30, and 19 months, respectively. Conclusion Patients with more than 5 cm residual disease have the shortest PFS and OS, whereas patients with 0.1 to 1.0 and 1.1 to 5.0 cm have similar outcome. These findings suggest that ultraradical cytoreductive procedures might be targeted for selected patients in whom microscopic residual disease is achievable. Patients with less than 5.0 cm of disease initially and significant disease and/or comorbidities precluding microscopic cytoreduction may be considered for alternative therapeutic options other than primary cytoreduction.

Natural History of Stage IV Epithelial Ovarian Cancer

1999 ◽  
Vol 17 (3) ◽  
pp. 767-767 ◽  
Author(s):  
H. Bonnefoi ◽  
R. P. A'Hern ◽  
C. Fisher ◽  
V. Macfarlane ◽  
D. Barton ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Natural History ◽  
Epithelial Ovarian Cancer ◽  
Median Overall Survival ◽  
Response Rate ◽  
Residual Disease ◽  
Stage Iv ◽  
Therapeutic Implications ◽  
Gynecology And Obstetrics

PURPOSE: In this report we present the natural history, prognostic factors, and therapeutic implications of stage IV epithelial ovarian cancer (EOC). PATIENTS AND METHODS: We reviewed 192 patients with stage IV EOC as defined in 1985 by the International Federation of Gynecology and Obstetrics. RESULTS: The site of stage IV–defining disease was cytologically positive pleural effusion in 63 patients, liver in 50 patients, lymph nodes in 26 patients, lung in six patients, other sites in 15 patients, and disease at multiple stage IV–defining metastatic sites in 32 patients. Surgery was performed before chemotherapy in 169 patients; 25 patients (14.8%) were left with only microscopic residual disease or less than 2 cm of macroscopic residual disease. The overall response rate to chemotherapy was 56%; the complete response rate was 18%. The median progression-free survival was 7.1 months, and the median overall survival was 13.4 months. The median overall survival of patients with positive pleural effusions only was 13.4 months as compared with 10.5 months for patients with visceral disease only, but this difference was not statistically significant. The 5-year survival rate was 7.6%, with only six patients surviving more than 5 years. Univariate and multivariate analysis showed that two parameters were associated with a shorter survival time: visceral involvement (lung or liver) and diagnosis before 1984. CONCLUSION: Patients with stage IV EOC initially respond to chemotherapy as often as those with less advanced disease, but the long-term prognosis is very poor. The size of residual disease is not a prognostic factor in this group of patients, and, therefore, the role of debulking surgery in these patients needs to be reconsidered.

Morbidity of Surgery After Neoadjuvant Chemotherapy Including Bevacizumab for Advanced Ovarian Cancer

2013 ◽  
Vol 23 (7) ◽  
pp. 1326-1330 ◽  
Author(s):  
Elisabeth Chéreau ◽  
Eric Lambaudie ◽  
Gilles Houvenaeghel
Keyword(s):  
Ovarian Cancer ◽  
Postoperative Complications ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Ovarian Cancer ◽  
Median Number ◽  
Debulking Surgery ◽  
Surgical Safety ◽  
Computed Tomographic ◽  
Gynecology And Obstetrics ◽  
Grade 3

ObjectiveNeoadjuvant chemotherapy followed by interval debulking surgery is an alternative for the management of advanced ovarian cancer (AOC). Owing to unresectable disease at initial evaluation, some patients received bevacizumab in addition to neoadjuvant chemotherapy. The aim of this study was to evaluate the safety and postoperative course of patients who had received bevacizumab before debulking surgery for AOC.MethodsIn 2012, we identified all patients with AOC who had received neoadjuvant bevacizumab before debulking surgery. We recorded patients’ characteristics, surgical course, and postoperative complications.ResultsFive patients were identified, of whom 80% were International Federation of Gynecology and Obstetrics stage 4 at diagnosis. All patients underwent surgery after 6 courses of neoadjuvant chemotherapy with carboplatin, paclitaxel, and bevacizumab. The median number of bevacizumab injections was 3 (3–4), and the median time between the last injection of bevacizumab and surgery was 54 days (34–110 days). One patient had a grade 3 complication (lymphocyst with puncture under computed tomographic scans).ConclusionIn this preliminary study, debulking surgery after neoadjuvant chemotherapy that included bevacizumab did not increase the rate of postoperative complications when there was a reasonable interval between the last bevacizumab injection and surgery. Larger studies are warranted to assess surgical safety after antiangiogenic treatment in the neoadjuvant setting for advanced ovarian cancer.

Time Trends in Ovarian Cancer Survival in Estonia by Age and Stage

2016 ◽  
Vol 27 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Kristiina Ojamaa ◽  
Piret Veerus ◽  
Aleksei Baburin ◽  
Hele Everaus ◽  
Kaire Innos
Keyword(s):  
Ovarian Cancer ◽  
Older Women ◽  
Early Stage ◽  
Cohort Analysis ◽  
Temporal Trends ◽  
Age Groups ◽  
Stage Iv ◽  
Relative Survival ◽  
Early Stage Disease ◽  
Gynecology And Obstetrics

ObjectiveThe objective of the study was to examine temporal trends in ovarian cancer (OC) survival in Estonia during 1995 to 2009 in relation to age and stage.Materials and MethodsEstonian Cancer Registry data on all adult cases of primary OC diagnosed during 1995 to 2009 and followed up for vital status until 2014 were used to estimate relative survival ratios (RSRs). Cohort analysis was used to estimate 1-, 2-, and 5-year RSRs for patients diagnosed in 1995 to 1999, 2000 to 2004, and 2005 to 2009. Analysis was performed by age at diagnosis (<50; 50–59; 60–69; 70+ years) and stage (International Federation of Gynecology and Obstetrics 1988).ResultsAmong 2296 women included in the study, the age-adjusted 5-year RSR improved from 27% in 1995 to 1999 to 38% in 2005 to 2009. Survival increase of 10% units from 1995 to 1999 to 2005 to 2009 was seen for women aged 50 to 59 and 60 to 69 years. Among younger and older women, the respective changes were smaller. In 1995 to 1999, the difference in survival between the youngest and oldest age groups was 41% units. This decreased over the study period to 37% units. From 1995 to 1999 to 2005 to 2009, the 5-year RSR increased from 82% to 91% for stage I patients; from 48% to 67% for stage II patients; from 25% to 35% for stage III patients; and from 11% to 16% for stage IV patients.ConclusionsThe study showed an improvement of OC survival in Estonia in all age and stage groups, but particularly among younger women and those with early stage disease. Slower progress among older women is of great concern.

scholarly journals Papillary squamotransitional cell carcinoma of the uterine cervix: a case report and review of the literature

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Georgios Gitas ◽  
Kubilay Ertan ◽  
Achim Rody ◽  
Sascha Baum ◽  
Dimitrios Tsolakidis ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Case Report ◽  
Cell Carcinoma ◽  
Cervical Carcinoma ◽  
Uterine Cervix ◽  
Vaginal Bleeding ◽  
Tumor Stage ◽  
Gynecology And Obstetrics ◽  
Radiologic Imaging ◽  
The Right

Abstract Background Papillary squamotransitional cell carcinoma of the uterine cervix is a rare neoplasm, a subtype of transitional cervical carcinoma that appears to be a variation of squamous cervical carcinoma. It has a disposition toward metastasis at an advanced stage and local recurrence. Owing to the difficulty of illustrating the invasion histologically, misdiagnosis is likely to affect the patient’s prognosis. Case presentation We present a case report of an 81-year-old Caucasian patient with squamotransitional cell carcinoma with unusual clinical behavior that was primarily thought to be ovarian cancer. According to the clinical examination and radiologic imaging, the patient had no vaginal bleeding and a normal cervix. Nevertheless, the tumor was already metastasized at the retroperitoneal tissue and at the right ovary. Computed tomography-guided biopsy of the right adnexa gave no further clarification. Although the tumor resembled urothelial cancer, this diagnosis was dismissed because of the results of immunohistochemistry analysis with CK7+, CK5+, and CK20−. Because of the differential diagnosis of ovarian cancer, we decided in favor of an exploratory surgical approach. Hysterectomy with bilateral adnexectomy, extensive retroperitoneal tumor debulking, and infragastric omentectomy was performed by laparotomy. Histopathology revealed a squamotransitional cervical cancer as the primary tumor with a tumor stage of pT3b, pN1 (1/2), V0, RX, G2, corresponding to International Federation of Gynecology and Obstetrics stage IIIB. Conclusions As far as we are aware, this is the first report of papillary squamotransitional cell carcinoma of the uterine cervix metastatic to the ovary without vaginal bleeding and with a clinically and radiologically unsuspicious cervix. Physicians should always contemplate papillary squamotransitional cell carcinoma of the uterine cervix in unclear cases with ovarian metastasis, especially if the histology indicates a transitional cancer (CK7+ and CK20−), before proceeding with treatment. More cases are needed to illuminate the clinical characteristics and categorization of papillary squamotransitional cell carcinoma of the uterine cervix.

scholarly journals Preoperative prediction of surgical outcome in advanced ovarian cancer by computed tomographic scan and Eastern Cooperative Oncology Group-performance status

2018 ◽  
Vol 7 (9) ◽  
pp. 3672
Author(s):  
Nithya S. ◽  
Jayalakshmi D. ◽  
Deepak Barathi ◽  
Biswajit Dubashi
Keyword(s):  
Ovarian Cancer ◽  
Lymph Nodes ◽  
Surgical Outcome ◽  
Group Performance ◽  
Performance Status ◽  
Advanced Ovarian Cancer ◽  
Computed Tomographic ◽  
Preoperative Prediction ◽  
Computed Tomographic Scan ◽  
Ecog Ps

Background: Ovarian cancer represents the sixth most common cancer in women with almost 2 lakh new cases diagnosed every year. Present study was done to investigate the role of preoperative Computed Tomographic scan (CT) and Eastern Cooperative Group Performance Status (ECOG-PS) in the prediction of surgical outcome in advanced ovarian cancer.Methods: It is a Prospective cohort study of 41 cases of advanced ovarian cancer. Patients fulfilling the inclusion criteria were included after obtaining informed consent. A detailed history with general examination of the patient and relevant preoperative investigations were carried out. A preoperative Contrast Enhanced Computerised Tomography scan (CECT) was obtained and relevant CT parameters were analysed by a senior radiologist. Surgical outcome and its correlation with the CT scan findings and ECOG-PS were calculated by statistical analysis.Results: Among the 41 patients 23(56%) had optimal cytoreduction. Among the CT parameters, omental extension to spleen, stomach, lesser sac (specificity-100%, PPV-100%, NPV-60.5%), suprarenal lymph nodes >1 cm (specificity-100%, PPV-100%, NPV-59%), infrarenal lymph nodes >2 cm (specificity-95.7%%, PPV-66.7%, NPV-59.7%) were found as better predictors for suboptimal cytoreduction. ECOG-PS didn’t have a statistically significant association with surgical outcome.Conclusions: Presence of omental extension to adjacent structures and suprarenal lymphnodes on CT scan predicted suboptimal cytoreduction with 100% specificity. Though CT served as a valid tool in the preoperative prediction of surgical outcome in advanced ovarian malignancy, these results cannot be extrapolated to the general population nor can this be universally applied in determining the mode of treatment. Future studies are required to validate the findings of the present study on a larger scale.

Screening for Familial Ovarian Cancer: Failure of Current Protocols to Detect Ovarian Cancer at an Early Stage According to the International Federation of Gynecology and Obstetrics System

2005 ◽  
Vol 23 (24) ◽  
pp. 5588-5596 ◽  
Author(s):  
Diane Stirling ◽  
D. Gareth R. Evans ◽  
Gabriella Pichert ◽  
Andrew Shenton ◽  
Elaine N. Kirk ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Early Stage ◽  
Transvaginal Ultrasound ◽  
Stage Iv ◽  
International Federation ◽  
Lifetime Risk ◽  
Stage Iii ◽  
Ca 125 ◽  
Gynecology And Obstetrics ◽  
Increased Risk

PurposeTo assess the effectiveness of annual ovarian cancer screening (transvaginal ultrasound and serum CA-125 estimation) in detecting presymptomatic ovarian cancer in women at increased genetic risk.Patients and MethodsA cohort of 1,110 women at increased risk of ovarian cancer were screened between January 1991 and March 2004; 553 were moderate-risk individuals (4% to 10% lifetime risk) and 557 were high-risk individuals (> 10% lifetime risk). Outcome measurements include the number and stage of screen-detected cancers, the number and stage of cancers not detected at screening, the number of equivocal screening results requiring recall/repetition, and the number of women undergoing surgery for benign disease.ResultsThirteen epithelial ovarian malignancies (12 invasive and one borderline), developed in the cohort. Ten tumors were detected at screening: three International Federation of Gynecology and Obstetrics (FIGO) stage I (including borderline), two stage II, four stage III, and one stage IV. Of the three cancers not detected by screening, two were stage III and one was stage IV; 29 women underwent diagnostic surgery but were found not to have ovarian cancer.ConclusionAnnual surveillance by transvaginal ultrasound scanning and serum CA-125 measurement in women at increased familial risk of ovarian cancer is ineffective in detecting tumors at a sufficiently early stage to influence prognosis. With a positive predictive value of 17% and a sensitivity of less than 50%, the performance of ultrasound does not satisfy the WHO screening standards. In addition, the combined protocol has a particularly high false-positive rate in premenopausal women, leading to unnecessary surgical intervention.

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.

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