Ovarian tissue cryopreservation in a patient with breast cancer during pregnancy: a case report

Background Fertility preservation using ovarian tissue cryopreservation (OTC) in patients with certain diseases, especially those needing chemo- or radiotherapy, is becoming routine in various Western countries. Our hospital is the first and until now the only centre in China to use this method. The question of whether treatment of breast cancer during pregnancy (PrBC) should be similar to non-pregnant young patients with breast cancer is controversial. To our knowledge, this is the first report worldwide to use OTC as fertility preservation for PrBC. Case presentation During the 29th week of pregnancy, a 24-year-old woman underwent needle aspiration cytology of a left breast tumour. Ultrasound and cytology revealed BI-RADS 4a grade. Oncologists recommended termination of the pregnancy. Caesarean section was performed at week 32, and ovarian tissue samples were collected for OTC to preserve fertility and ovarian endocrine function. Twenty-three ovarian cortex slices were cryopreserved. It is estimated that 13,000 follicles were cryopreserved. Breast nodules and sentinel lymph node biopsy suggested invasive micropapillary carcinoma. Neoadjuvant chemotherapy was started within 1 week after diagnosis. After six courses of neoadjuvant chemotherapy, targeted drug therapy and goserelin acetate, left mastectomy and left axillary lymph node dissection were performed. In total, 23 doses of radiotherapy, eight trastuzumab targeted therapy treatments, and 17 pertuzumab + trastuzumab double targeted therapy treatments were performed after breast cancer surgery. Until now, more than 2 years after delivery, the ovarian function still is good, and no signs of a negative impact of OTC have been observed. Goserelin acetate injections, administered every 28 days, are planned to last for the next 5 years. In addition, endocrine therapy with anastrozole was started after breast cancer surgery and also is scheduled for 5 years. Conclusion OTC for fertility preservation in patients with PrBC does not delay breast surgery, radiotherapy or chemotherapy, which is essential for effective treatment of breast cancer. We assess this method as a promising fertility preservation method which was used here for the first time worldwide in a patient who developed breast cancer during pregnancy.

Hemorrhagic ascites endometriosis could be a cause: a case report

Background Endometriosis is a condition in which tissue similar to the lining inside the uterus (called “the endometrium”) is found outside the uterus, where it induces a chronic inflammatory reaction that may result in scar tissue. Endometriosis with massive ascites causing abdominal distension and other symptoms simulating malignancy has been described in the literature. Case presentation A case of a 27-year-old woman who presented to the Ascites Study Group Tropical Medicine department Ain Shams University in collaboration with the Egyption Club of Ascites (ECA) with increased central abdominal contour, shifting dullness, and hemorrhagic transudate hypocellular ascites with no malignant cells and bilateral ovarian cysts. A long stepwise approach was conducted to the patient, and after exclusion of other causes of hemorrhagic ascites, the patient was prepared for laparoscopy. The diagnosis of endometriosis was made. The patient was discharged on goserelin acetate subcutaneous injection every 28 days with good response, and she regularly follows up with our study group on scheduled visits monthly according to her clinical status. Conclusions Endometriosis could be a possible cause of massive hemorrhagic obscured ascites. The unexplained infertility should increase the probability of the endometriosis.

A Cohort Study of the Efficacy of the Dienogest and the Gonadotropin-Releasing Hormone Agonist in Women with Adenomyosis

Purpose: To study the efficacy and safety of the dienogest and the Gonadotropin-Releasing Hormone agonist (GnRH-a) in symptomatic females with uterine adenomyosis. Methods: A total of 127 patients with adenomyosis with a chief complaint of dysmenorrhea were recruited. The first group received 2mg of Dienogest (DNG) daily, whereas the second group received Goserelin Acetate (GS) (3.6mg/4 weeks) for 12 weeks. Outpatient follow-up was undertaken after 12 weeks. Results: Among 127 women, 56/63 (87.5%) patients completed the treatment in the DNG group, whereas 62/64 (96.9%) patients completed the treatment in the GS group. A significant decrease in dysmenorrhea symptoms as measured by the Visual Analog Scale (VAS) and Carcinoma Antigen125 (CA125) after 12 weeks of treatment was observed in both groups (P<0.001). The hemoglobin of anemic patients did not significantly improve after 12 weeks of treatment (P=0.21) and the uterine volume slightly increased without statistical significance (P=0.10) in the DNG group. Simultaneously, the hemoglobin of anemic patients significantly improved (P<0.001) and the uterine volume significantly decreased (P<0.001) in the GS group. Conclusions: Dienogest effectively alleviates the symptoms of dysmenorrhea in patients with adenomyosis, but it cannot improve the anemia or reduce the size of the uterus. GnRH-a is more effective in improving anemia and reducing the uterine volume in patients with adenomyosis.

Gambaran Pasien yang Menggunakan Suplemen Kalsium di Poliklinik Sub Spesialis Bedah Onkologi RSUD Ulin Banjarmasin

Suplemen kalsium banyak digunakan oleh pasien yang menderita kanker dengan terapi hormonal di poliklinik sub spesialis bedah onkologi RSUD Ulin Banjarmasin. Penelitian ini bertujuan mendeskripsikan karakteristik berupa umur dan jenis kelamin pasien yang menerima suplemen kalsium, jenis kanker, obat lain yang diberikan bersama pemberian kalsium, jenis suplemen kalsium, frekuensi pemberian kalsium, lama pemberian kalsium dan penggunaan suplemen kalsium dari lama pemberian kalsium dan obat terapi hormonal yang digunakan di poliklinik sub spesialis bedah onkologi RSUD Ulin Banjarmasin. eksperimental deskriptif adalah jenis penelitiannya serta pengambilan datanya dengan retrospektif menggunakan sumber cacatan medik pada tahun 2018. Data Populasi digunakan dengan kriteria inklusi adalah pasien kanker usia >18 tahun, menerima suplemen kalsium dan kriteria eksklusi yaitu penderita kanker dengan informasi catatan medik yang kurang lengkap/tak ditemukan. Total jumlah populasi yang digunakan adalah 55 pasien. Hasil dan kesimpulan penelitian didapatkan karakteristik berdasarkan usia pada rentang 26-35 tahun (1,81%), 36-45 tahun (10,91%), 46-65 tahun (43,64%), 56-65 tahun (40,00%) dan >65 tahun (3,64%); jenis kelamin perempuan (100%); jenis kanker berupa kanker payudara (98,18%) dan kanker tiroid (1,82%); obat lain yang diberikan bersama pemberian kalsium adalah obat golongan hormonal, kemoterapi sitotoksik, analgesik, H2 Blocker, ACE Inhibitor, Antihistamin, Bifosfonat, Analog vitamin D serta multivitamin lainnya; jenis suplemen kalsium yang didapat yaitu kalsium karbonat (100%); frekuensi pemberian kalsium 1x sehari 500 mg (100%); lama pemberian kalsium selama 7 hari (1,82%), 15 hari (1,82%), 20 hari (1,82%), 21 hari (1,82%), 30 hari (92,72%) dan penggunaan suplemen kalsium dari lama pemberian kalsium dan obat terapi hormonal yang digunakan adalah 7, 15, 20 dan 21 hari dengan jumlah pasien masing-masing 1 pasien terapi hormonal yang digunakan yaitu letrozole dan 30 hari dengan jumlah pasien 51 terapi hormonal yang digunakan yaitu letrozole, anasrozole, tamoxifen, goserelin acetate, megestrol acetate, dan levothyroxine. Kata Kunci: Suplemen, Kalsium, Onkologi, Hormonal, Kanker Calcium supplements are widely used by patients who suffer cancer with hormonal therapy at oncology surgery sub specialist polyclinic at Ulin Regional Public Hospital Banjarmasin. The research aims to describe the characteristics of the age and gender of patiens who receive calcium supplements, types of cancer, other drugs given with calcium, types of calcium supplements, frequency of calcium administration, duration of calcium administration and the use of calcium supplements from the duration of calcium administration and hormonal therapy drugs used at oncology surgery sub specialist polyclinic at Ulin Regional Public Hospital Banjarmasin. The research type is non-experimental descriptive and the data retrieval is taken restropective by using medical record as the source in 2018. The population data used with inclusion criteria are patients who suffer cancer with the age of > 18 years old, consumed calcium supplements and the exclusion criteria are patients with incomplete / not found medical record. The total population used are 55 patients. The research result and conclusion shows that the characteristics based on age is between 26-35 years old (1,81%), 36-45 years old (10,91%), 46-65 years old (43,64%), 56-65 years old (40,00%) and > 65 years old (3,64%); female (100%); types of cancer in the form of breast cancer (98,18%) and thyroid cancer (1,82%); other drugs given with calcium are hormonal medicine groups, cytotoxic chemotherapy, analgesic, H2 Blocker, ACE Inhibitor, Antihistamine, Bisphosphonates, Vitamin analogues D and other multivitamins; types of calcium supplements obtained is calcium carbonate (100%); frequency of calcium administration is 1 x 500 mg (100%) each day and duration of calcium administration is 7 days (1,82%), 15 days (1,82%), 20 days (1,82%), 21 days (1,82%), 30 days (92,72%) and the use of calcium supplements from the duration of calcium administration and hormonal therapy drugs used were 7,15,20 and 21 days with 1 patient each of hormonal therapy used letrozole and 30 days with 51 patients using hormonal therapy letrozole, anasrozole, tamoxifen, goserelin acetate, megestrol acetate, dan levothyroxine.