Gynecological Neoplasms are the Major Cause for Malignant Effusions

Background: Malignant effusions occur frequently in gynecologic neoplasms and may worsen the prognosis for these patients. Therefore a more detailed analysis for the different cavities is necessary to describe the association between the various histological subtypes and the time related occurrence of malignant effusions in gynecological malignancies. Methods: Malignant effusion specimens from patients diagnosed at Bayreuth Hospital from June 2013 to December 2018 were reevaluated retrospectively and correlated with the histolgogical subtype of primary tumors and with the clinical follow-up.Results: 435 patients with malignant effusions were analyzed, including 273 women and 162 men. 54.2% of patients developed malignant effusions in the pleural space in (54.2%) patients, in the peritoneum in (43.9%) patients and in the pericardium in (1.9%). Gynecological malignancies appear most common in (n=147, 34.0%; mean age 67.3 years) patients with predominant occurrence of ovarian carcinoma in malignant abdominal cytology in 75/191 (39.3%) patients, mostly of high-grade serous papillary subtype in 72/75 (96.1%), and only breast cancer in malignant pleural effusions in 49/236 (20.7%), frequently of 39/49 (79.6%) invasive carcinomas of no specific type. Both involvement of pleural- and peritoneal cavity in 244 female patients with gynecological-, lung- and gastrointestinal neoplasms we obtained in 37 (15.2%) patients, most common in 31/37 (83.78%) gynecological tumors and exclusively of high-grade serous papillary subtype. Malignant ascites occured in patients with lower genital tract tumors in 81/86 (94.2%) within one year after primary diagnosis, whereas breast cancer involves the peritoneum in 2/10 (20%) and the pleural cavity in 11/49 (22.4%) after 12 months. Conclusions: Gynecological neoplasms were the major cause of malignant effusions in our study. The high-grade serous papillary subtype of lower tract gynecological is most aggressive with predominant occurrence in the peritoneum and exclusive secondary involvement of the pleural cavity. Therefore, an alone/exclusive/sole involvement of the pleural cavity characterize the invasive breast carcinoma of no special type compared to predominant occurrence of the lobular subtype in malignant ascites. Breast cancer showed a statistical significant late occurrence in effusion fluids 12 months after primary diagnosis in contrast to early involvement in gynecological- as well as pulmonary- or gastrointestinal malignancies.

Assessing Effectiveness of Colonic and Gynecological Risk Reducing Surgery in Lynch Syndrome Individuals

Background: Colorectal (CRC) and endometrial cancer (EC) are the most common types of cancer in Lynch syndrome (LS). Risk reducing surgeries (RRS) might impact cancer incidence and mortality. Our objectives were to evaluate cumulative incidences of CRC, gynecological cancer and all-cause mortality after RRS in LS individuals. Methods: Retrospective analysis of 976 LS carriers from a single-institution registry. Primary endpoints were cumulative incidence at 75 years of cancer (metachronous CRC in 425 individuals; EC and ovarian cancer (OC) in 531 individuals) and all-cause mortality cumulative incidence, comparing extended (ES) vs. segmental surgery (SS) in the CRC cohort and risk reducing gynecological surgery (RRGS) vs. surveillance in the gynecological cohort. Results: Cumulative incidence at 75 years of metachronous CRC was 12.5% vs. 44.7% (p = 0.04) and all-cause mortality cumulative incidence was 38.6% vs. 55.3% (p = 0.31), for ES and SS, respectively. Cumulative, incidence at 75 years was 11.2% vs. 46.3% for EC (p = 0.001) and 0% vs. 12.7% for OC (p N/A) and all-cause mortality cumulative incidence was 0% vs. 52.7% (p N/A), for RRGS vs. surveillance, respectively. Conclusions: RRS in LS reduces the incidence of metachronous CRC and gynecological neoplasms, also indicating a reduction in all-cause mortality cumulative incidence in females undergoing RRGS.

Female Malignancies and Immunotherapy: What’s New?

For many years, the therapeutic advances in gynecological neoplasms have remained steady, however, in recent years, the application of the most modern “-omics” sciences has shed light on the pathogenesis and on neoplastic progression, with important implications in the introduction of targeted treatments that are more effective and less toxic [...]

Primary gynecological neoplasms and clinical outcomes in patients diagnosed with breast carcinoma

The purpose of this study was to quantify and describe nonmammary neoplasms (n-MN), particularly gynecological neoplasms, in a patient population previously diagnosed with breast cancer. Data were collected prospectively in our institutional review board–approved registry for patients diagnosed with infiltrating breast cancer or ductal carcinoma in situ. Patients who developed a second, n-MN were identified; neoplastic site, time to development after breast cancer, and clinical outcomes were recorded. FIGO stage was recorded for patients who developed a gynecological neoplasm. Synchronous bilateral breast cancer was defined as a second, contralateral diagnosis made within 12 months of the first and, similarly, synchronous n-MN were defined as those identified within 1 year of a breast cancer diagnosis. Outcome curves were generated using the method of Kaplan and Meier, and compared using the log-rank test. Of 4126 patients diagnosed with breast cancer, 3% developed a n-MN, the majority of which were nongynecological and asynchronous to the initial breast cancer diagnosis. Three percent of patients diagnosed with breast cancer were diagnosed with a second, n-MN. Among patients who developed a n-MN, most developed a nongynecological cancer more than 1 year after the initial breast cancer diagnosis, and their outcomes were significantly worse than those patients who did not develop a n-MN.