子宫内膜癌患者腹腔细胞学阳性的临床意义及对预后的影响

目的 探讨子宫内膜癌患者腹腔细胞学阳性的临床意义及对预后的影响.方法 对1996年1月至2008年12月复旦大学附属肿瘤医院收治的315例子宫内膜癌患者的临床病理资料进行回顾性分析,所有患者均行手术治疗,且均行术中腹水或腹腔冲洗液细胞学检查.对与腹腔细胞学阳性相关的因素,采用相关分析法进行分析;对影响子宫内膜癌患者预后的因素,采用log-rank检验进行单因素分析,采用Cox回归法进行多因素分析.结果 (1)315例子宫内膜癌患者中,30例(9.5%)患者腹腔细胞学阳性.腹腔细胞学阳性与多个子官内高危因素包括病理类型(P=0.013)、手术病理分期(P=0.000)、肌层浸润(P=0.012)、脉管浸润(P=0.012),以及多个子宫外转移危险因素包括子宫浆膜层侵犯(P=0.004)、宫颈受累(P=0.016)、附件转移(P=0.000)和大网膜转移(P=0.000)明显相关,而与病理分级(P=0.152)、淋巴结转移(P=0.066)无明显相关性.(2)315例子宫内膜癌患者的3年总生存率和3年无疾病进展生存率分别为93.0%和85.5%.单因素分析显示,腹腔细胞学阳性及不同手术病理分期、病理类型、肌层浸润深度、病理分级和脉管浸润是影响子宫内膜癌患者预后的危险因素(P＜0.05);多因素分析显示,手术病理分期、肌层浸润深度是影响子宫内膜癌患者预后的独立危险因素(P＜0.05).30例腹腔细胞学阳性患者中,无高危因素患者的3年生存率和3年无疾病进展生存率均显著高于有高危因素者(P＜0.05);进一步分析显示,腹腔细胞学阳性是影响晚期(Ⅲ～Ⅳ期)子官内膜癌患者预后的独立危险因素(P=0.006).结论 腹腔细胞学阳性与多个子宫内高危因素和子宫外转移危险因素密切相关,是影响晚期子宫内膜癌患者预后的独立危险因素.因此,腹水细胞学检查应继续作为全面分期手术的步骤之一,并将结果单独进行报告,是十分有必要的.

Abstract：

Objective To evaluate the clinical significance of positive peritoneal cytology in patients with endometrial cancer.Methods The records of 315 patients with endometrial cancer who were operated at Cancer Hospital, Fudan University between January 1996 and December 2008 were reviewed.Peritoneal cytology were performed and diagnosed in all patients.Factors related with peritoneal cytology were analyzed by correlation analysis.Log-rank test and Cox regression test was used for the analysis of prognosis,respectively.Results (1) Peritoneal cytology were positive in 30 (9.5%) patients.Positive peritoneal cytology was associated with pathological subtype ( P = 0.013 ), stage ( P = 0.000 ), myometrial invasion ( P =0.012), lymph-vascular space invasion ( P = 0.012 ), serosal involvement ( P = 0.004 ), cervical involvement ( P = 0.016), adnexal involvement ( P = 0.000), and omental involvement ( P = 0.000), with no association with grade ( P = 0.152 ) and lymph node metastasis ( P = 0.066 ).( 2 ) Three-year overall survival (OS) and progression-free survival(PFS) were 93.0% and 85.5% ,respectively.Positive peritoneal cytology, surgical stage, pathological subtype, myometrial invasion, grade, and lymph-vascular space invasion were significantly associated with worse prognosis by univariate analysis ( P ＜ 0.05 ), while only surgical-pathology stage and myometrial invasion were independent prognostic factors by multivariate analysis ( P ＜ 0.05 ).For 30 cases with positive peritoneal cytology, the patients with no high risk factors shown significantly prognoses better than those with any risk factors.The results shown that for patients with late stage (stage Ⅲ - Ⅳ ) endometrial cancer with positive peritoneal cytology was significantly associated with the worse OS and PFS by multivariate analysis ( P = 0.006).Conclusions Positive peritoneal cytology was associated with serosal involvement, cervical involvement, adnexal involvement, omental involvement, and late stage.Therefore, peritoneal cytology should be performed and reported separately as a part of full surgical staging procedure.     

Review of the Management of Ectopic Pregnancy in a Major Teaching Hospital: Laparoscopic Surgical Treatment and Persistent Ectopic Pregnancy

Summary: Two hundred and three cases of ectopic pregnancy were examined to determine the current management trends at the Royal Women's Hospital during a period where laparoscopic and conservative therapies were being increasingly used. Only 25% of patients were managed by the previous method of laparotomy and salpingectomy. Ten (8.8%) of 114 cases treated by laparoscopic procedures had persistent trophoblast activity and 8 of these required further surgical or medical treatment. Seven (14.9%) of 47 cases treated by laparoscopic salpingostomy resulted in persistent ectopic pregnancy (PEP). The postoperative beta HCG profiles of 41 patients were examined to identify differences between the 'persistent ectopic' and 'resolved ectopic' groups. Postoperative serum beta HCG monitoring should be performed at day 4 and day 7 to enable the early detection of treatment failure. The risk of developing a PEP after laparoscopic salpingostomy was significantly increased (p <0.01) if the preoperative serum beta HCG was greater than 3,000 IU/L. A laparoscopic salpingectomy should be performed in cases where the preoperative beta HCG is above 3,000 IU/L and the contralateral tube appears normal.     

Management of vesico-uterine fistulae: a report of six cases

Six cases of vesico-uterine fistulae caused by cesarean section in four and pelvic trauma in two cases were treated during the past 15 years. Both the cases of vesico-uterine fistulae due to pelvic trauma and one case of vesico-uterine fistula due to cesarean section in whom the fistula was detected in the early post-operative period, could be managed successfully by suprapubic urinary diversion and control of infection. Two patients who were seen more than 1 year after the cesarean section, were cured by trans-abdominal closure of the fistula with omental interposition. One patient who reported 3 months after the cesarean section was managed by estrogen and progesterone-induced amenorrhea. The management protocol for vesico-uterine fistula should thus be individualised taking into consideration the etiology, and time interval between its occurrence and institution of treatment regimen.     

The role of omental biopsy in endometrial cancer staging

Omental biopsy is not part of FIGO staging for endometrial cancer. The few studies that have looked into this matter have had conflicting results. This is the largest study in terms of the number of cases studying the incidence of omental involvement in endometrioid and non-endometrioid endometrial cancer. A retrospective study assessing 248 cases of endometrial cancer with omental biopsy at the time of primary surgical treatment for endometrial cancer at the Gynaecological Oncology Centre, Norfolk and Norwich University Hospital between January 2004 and May 2008. Demographic, clinico-pathologic and surveillance data were collected from hospital records, operative notes and histopathology results. The histology included tumour type, stage, grade and omental biopsy. All histological types were included in the study. Two hundred and forty eight patients had an omental biopsy at the time of primary surgical treatment for endometrial cancer during the study period. Of them, 187 cases were stage I, 27 stage II, 27 stage III and seven stage IV. According to histological type, 202 (81.4%) had endometrioid, 20 (8.0%) serous papillary, 20 (8.0%) malignant mixed Mullerian tumour (MMMT), three (1.2%) clear cell and three (1.2%) sarcoma. Overall, six cases (2.4%) had omental involvement, 4/202 (1.98%) with endometrioid type, 1/20 (5.0%) with serous papillary type and 1/20 (5.0%) MMMT. Eighty four percent of omental metastases (five cases) were macroscopic and noted at operation .The overall risk of omental metastases is 2.4% and in the absence of gross lesions the risk is around 0.4%. Most omental metastases can be diagnosed by careful inspection and palpation of the omentum. The possibility of missing microscopic disease is low. Based on these figures and possible increase in morbidity and operative time, omental biopsy cannot be justified as a standard procedure in endometrial cancer staging.     

Laparoscopic tubal ligation. A follow-up report on the Yoon falope ring methodology.

The Yoon Falope Ring methodology was examined on a prospective basis in 2299 patients from October 1973 through June 1978. The Yoon Falope Ring, made of medical-grade silicone rubber, can be applied by single- or double-puncture laparoscopy, by minilaparotomy, or transvaginally by either colpotomy or the culdoscopic technique. The patients were followed at 6-month intervals when possible. An overall follow-up rate of 75%, for a total of 37,140 woman-months, was achieved. The most significant complication was tubal transection; this occurred in 76 (3.3%) of cases during the study period. To date, the overall pregnancy failure rate, excluding luteal phase pregnancy, is 0.42% per 100 woman-years. As a laparoscopic methodology its versatility is well suited for outpatient, local anesthetic use. Although serosal bowel application was encountered in 2 early cases, it does not pose the same potential morbidity as does the bowel burn associated with electrocoagulation. A ring application to the serosal surface of the bowel can be removed laparoscopically, whereas a burn to the bowel requires laparotomy for probable resection and reanastomosis of the involved area. Intraand post-operative pain may be slightly higher than with electrocoagulation but is less than with the Pomeroy procedure. The advantages of the technique are multiple. It is a simple, safe, effective and easily learned methodology. It eliminates the morbidity and mortality associated with coagulation sterilization. When used in a training program, it is easily adaptable to a variety of surgical approaches.     

The omentum and omentectomy in epithelial ovarian cancer: A reappraisal: Part II — The role of omentectomy in the staging and treatment of apparent early stage epithelial ovarian cancer

Objective

This article reviews the literature concerning the role of omentectomy in the staging and treatment of clinically apparent early stage epithelial ovarian cancer.

Methods

A review of the English language literature based on a MEDLINE (PubMed) database search using the keywords: ovary, cancer, carcinoma, omentum, and omentectomy. An additional collection of reports was found by systematically reviewing all references from retrieved papers.

Results

Historically, the realization that ovarian cancer cells have a predisposition to metastasize to the omentum has led to the inclusion of omentectomy, both for the purpose of accurate staging of ovarian cancer and for its possible therapeutic benefit. In apparently early stage epithelial ovarian cancer, microscopic disease in the omentum is found in 0–22% of the cases; however extra-ovarian disease isolated to the omentum is found in 2–7% of cases at most. There are no specific guidelines as to how much of the omentum should be removed, but pathology studies show that for the purpose of staging and detecting microscopic disease, omental biopsies are probably sufficient in a grossly normal appearing omentum. In cases where adjuvant chemotherapy is planned, the role of omentectomy appears to be primarily for staging, while its therapeutic role remains unclear in microscopic omental disease.

Conclusions

In apparent early stage ovarian cancer, the presence of isolated omental metastases is relatively rare. For staging purposes in such cases, random omental biopsies rather than total omentectomy may suffice. Furthermore, chemotherapy appears to effectively treat microscopic disease and therefore if this is already planned the benefit of omentectomy is unclear.     

Ⅱ型子宫内膜癌行网膜切除手术必要性的探讨

Objective?To investigate whether omentectomy should be a part of a procedure in patients with typeⅡendometrial cancer(EC). Methods?Patients diagnosed with typeⅡEC in Peking University Third Hospital between 2006 and 2019 were retrospectively reviewed. Data of patients, including histological types, depth myometrial invasion, adnexal involvement, lymphovascular invasion, and omental metastasis were recorded. Risk factors of omental metastasis were analyzed. Results?115 patients with typeⅡEC have received omentectomy or omentum biopsy. 14.8% (17/115) were diagnosed as omental metastases,4 cases were microscopic omental metastases. The highest rate of omental metastasis was found in carcinosarcoma (21.4%, 3/14). Adnexal metastasis and lymphovascular invasion were the factors associated with omental metastasis (P=0.000, 0.039, respectively). Conclusion?Omental metastasis is not uncommon in typeⅡEC. Omentectomy should be a part of the procedures in patients with typeⅡEC.     

腹腔镜手术并发症34例分析

目的 探讨腹腔镜手术的并发症及其相关因素。方法 回顾性分析北京协和医院妇产科近6扑的1769例腹腔镜手术病例及34例出现并发症的病例情况。手术包括附件手术1421例，子宫肌瘤剔除术52例，腹腔镜辅助的阴式子宫切除术296例，并发症指术中出现的需额外处理或术后出现的因手术术身引起需行再次手术或保守治疗的情况。结果 并发症发生率为1.9%，需开腹手术处理者6例（0.3%)。附件手术、肌瘤剔除术及阴式子宫切除术的并发症发生率分别为0.9%、1.9%及6.8%。与穿刺及气腹有关的并发症12例（35.3%)，包括腹壁血管、大网膜血管损伤及严重的皮下气肿；术中并发症5例（14.7%)，其中大出血3例，膀胱破裂1例，均改开腹手术，另1例为负极板放置处大腿皮肤烧伤；术后并发症17例（50.0%)，其中2例术后腹腔内出血再次开腹止血，术后并发症还包括肠道并发症、神经麻痹及发热。结论 妇科腹腔镜手术的并发症不容忽视，并发症的发生与手术的难度有关。阴式子宫切除术并发症的发生远高于附件手术及子宫肌瘤剔除手术。     

Chronic Abdominal Pain Secondary to Omental J-Flap: Report of Two Patients

Two patients with a history of stage IB cervical cancer who had undergone prior radical abdominal hysterectomy, omental J-flap placement, and postoperative whole pelvic radiation therapy required subsequent exploratory laparotomy with resection of omental J-flap for treatment of chronic abdominal pain 5 and 2 years, respectively, following J-flap placement. Issues relating to this unusual possible long-term complication of omentoplasty are discussed.     

Serum, pleural effusion, and ascites CA-125 levels in ovarian cancer and nonovarian benign and malignant diseases: a comparative study

OBJECTIVES: Cancer antigen-125 (CA-125) is not a specific tumor marker and it is synthesized by normal and malignant cells of different origins. Recently it has been shown that various diseases are associated with increased CA-125 levels, especially in the presence of serosal fluid. The aim of this study is to investigate serum and fluid CA-125 levels in patients with different diseases. METHODS: A total of 133 patients and 23 healthy control cases were included in the study and divided into eight groups on the basis of disease and the presence of fluid in the serosal cavities. Serum and serosal fluid CA-125 levels were measured by a commercial enzyme immunoassay kit at the same time. Comparisons among the groups were made. RESULTS: Abnormal levels of serum CA-125 were observed in 76% of ovarian cancer patients; 96% in patients with ascites and 56% in patients without ascites. Moreover, elevated serum CA-125 levels were detected in 52% of patients with hepatic diseases, in 100% of patients with nongynecologic peritoneal carcinomatosis, and in 87% of patients with pleural effusion. Serum and fluid CA-125 levels were significantly higher in cases of ovarian cancer with ascites than in the other groups (P < 0.01). A positive correlation between serum CA-125 levels and ascites amounts was observed in cases of ovarian cancer with ascites (P < 0.01, r = 0.81). Furthermore, no correlation was observed between ovarian mass volume and serum CA-125 levels in ovarian cancer patients with stage I disease without ascites (P = 0.08, r = 0.48). CONCLUSIONS: Although CA-125 levels may be considered a sensitive tumor marker in patients with epithelial ovarian cancer, it was determined that high serum CA-125 levels were closely related to the presence of serosal fluids and serosal involvement, whatever the origin is. These results should be considered in the interpretation of CA-125 elevation in patients with ovarian cancer.     

Ovarian malignant luteinized thecoma--an unusual tumor in an adolescent

Malignant luteinized thecoma is an extremely rare ovarian tumor. The fifth reported case of this tumor presenting in a 13-year-old epileptic child on anticonvulsant therapy with a rapidly enlarging pelvic-abdominal mass is discussed. At laparotomy, bilateral ovarian involvement, massive ascites, and omental and bowel serosal metastases were present. The pathological diagnosis was difficult with initial diagnoses of ovarian edema, endodermal sinus tumor, and ovarian fibrosarcoma. The final diagnosis of malignant luteinized thecoma was made by recognizing the presence of lutein cells with foamy vacuolated cytoplasm and intracytoplasmic staining for oil red O. Electron microscopy also demonstrated vacuolated cells with multiple fat globules. After surgical debulking the patient was treated with combination chemotherapy with complete response. The similarities of this case to three previously reported bilateral thecomas presenting in children on anticonvulsant therapy is discussed.     

The progression of disease stage in twin-twin transfusion syndrome.

OBJECTIVE: To estimate the frequency of progression or regression of disease stage in pregnancies complicated by twin-twin transfusion syndrome (TTTS) managed with non-placental laser techniques. METHODS: A cohort of TTTS pregnancies within the sole perinatal center for the state of Western Australia was examined. All cases of prenatally identified TTTS from 1992 to 2002 were staged at diagnosis (retrospectively prior to 2000, prospectively since). Amnioreduction and septostomy were the principal therapies used. Features associated with progression, regression or stability were identified. RESULTS: During the study period, 71 cases of TTTS were managed. Amnioreduction was performed in 73.2%, with no difference in the median number of procedures by stage (p = 0.178). In 21.1% of cases, TTTS resolved completely with persistent normalization of amniotic fluid volumes after amnioreduction (median number of procedures: 2). Disease resolution was associated with pregnancy prolongation, greater gestational age at delivery (36 weeks vs. 28.4 weeks, p < 0.001) and increased perinatal survival (100% vs. 42.6%, p < 0.001) compared with stage progression. Logistic regression analysis predicted that the probability of both infants surviving was 80% if the pregnancy remained at Stage I or II throughout, compared with a probability of 50% if it reached Stage III or more at 26 weeks, and only 25% if the disease reached Stage III or more at 16 weeks' gestation. CONCLUSION: Pregnancy outcome for TTTS managed with amnioreduction techniques is correlated with stage at diagnosis and the subsequent disease evolution. However, the progression of stage in TTTS is unpredictable and the likelihood of spontaneous fetal demise was not different between stages.     

Laparoscopic management of an 11-week rudimentary uterine horn pregnancy using extracorporeal Roeder knot to secure the dilated vascular pedicle

Pregnancy in a uterine rudimentary horn carries a high risk of uterine rupture with severe and potentially lethal intra-abdominal haemorrhage. There is now growing evidence that this condition can be safely managed by minimally invasive surgery. We report a case of an unruptured 11-week rudimentary horn pregnancy that was diagnosed and treated laparoscopically. We have performed a literature review using PubMed, Embase and Cochrane Database of Systematic Reviews to identify relevant cases and draw conclusions with regards to their management. We have collated 20 published cases of rudimentary horn pregnancies that were managed by laparoscopy. The surgical technique appears consistent among these cases with few variations. In advanced gestations, feticide may need to be performed. Morcellation has been shown to be possible without compromising patient safety from trophoblast spill. The possibility of uncommon presentations such as duplicated or absent ureter should be taken into account. Extracorporeal Roeder knot can be used safely to secure unusually dilated vascular pedicles. Overall, laparoscopy appears to be as safe as and potentially superior to laparotomy for the management of rudimentary horn pregnancies.     

On the results of hydatidiform mole managed by Niigata method

We have managed 518 cases of total mole patients in our Ob-Gyn clinic in the past 13 years by the Niigata postmole management method. Serial urinary hCG determination by sensitive assay (Higonavis and RIA) is the key examination in it. There are two critical points of urinary hCG determination: 1,000iu/L at the 5th week and 100iu/L at the 8th week after the termination of hydatidiform mole. The urinary hCG patterns are classified into type I if the hCG regression curve falls below both of them, and into type II if it follows curves other than type I. Among 89 cases of postmole patients who were administered no anti-cancer chemotherapy, 73 cases (82%) showed a type I hCG regression pattern, eight cases of which (11%) were complicated mole such as metastatic mole and invasive mole. Sixteen cases (18%) showed type II, but 8 of them (50%) were diagnosed as uncomplicated mole. The rate of complication among 118 cases of hydatidiform mole who had a molar pregnancy terminated and were followed up totally in our clinic was 24.6% and that of referral cases after molar evacuation was 21.3%, which is significantly higher than others reported in literature. There occurred no postmolar choriocarcinoma from uncomplicated mole patients who had their LH level confirmed in their urinary hCG determination, but 1 case (2.7%) did occur from LH level confirmed metastatic mole, and 3 cases (3.9%) from LH level confirmed metastatic invasive mole. It was shown that lung shadows on chest roentgenogram mostly take about 40 days to appear after D & C of hydatidiform mole and after surgery for uterine invasive mole.(ABSTRACT TRUNCATED AT 250 WORDS)     

Endometrial stromal sarcoma: review of Mayo Clinic experience, 1945-1980

Uterine sarcomas are uncommon malignancies. We retrospectively examined 24 cases of "high grade" endometrial stromal sarcomas (ESS). The histologic diagnosis was made if there was a high grade sarcoma with a high mitotic index and nuclear anaplasia. Heterologous elements could be present, if focal only. Leiomyosarcomas, mixed mesodermal sarcomas, and carcinosarcomas were excluded. Mitotic index was expressed as the number of mitoses per 10 high-power fields in active areas. Tumor grade was based on nuclear anaplasia. ESS were 5.7% of all uterine sarcomas. Median age was 58.2 years; median duration of symptoms was 67.5 days. Abnormal bleeding was the presenting complaint in 91.7%. Uterine enlargement was seen in 33%; protrusion through the cervical os was seen in 9 cases. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed in 95.8%. Twenty patients had myometrial involvement; 5 patients had serosal spread and extrauterine disease; residual disease was seen in 3 patients. Adjuvant radiation was not beneficial. Ten patients had recurrences: 60% in the pelvis, 50% each with subcomponent of abdominal or distant disease. Overall survival was 3.4 years and was significantly associated with extent of disease, size of the primary tumor, and grade.     

Tension-free vaginal tape: 162 cases in a district general hospital.

From March 1999 to July 2002 a prospective study was carried out of 162 consecutive cases of urodynamically confirmed stress and mixed incontinence who underwent the tension-free vaginal tape (TVT) procedure. Patients were followed up at 6 weeks and 6 months and with a quality of life questionnaire at 1 year. The intraoperative complication rate was 7.6% and the postoperative complication rate was 18.8%. The subjective cure rate for patients suffering from urodynamic stress incontinence was 85%, with a further 11% experiencing significant improvement in their symptoms. The subjective cure rate for patients with mixed incontinence was 88%, with a further 9% experiencing significant improvement. The TVT procedure appears to be safe and effective for both stress and mixed incontinence for up to three years in a district general hospital. Complications in the short term are uncommon and can be managed easily.     

Placental site trophoblastic tumor. Report of three cases and review of the literature

Three cases of placental site trophoblast tumor (PSTT) are added to 74 cases in the English language literature. One case presented with an anorexic syndrome, the other two with amenorrhea and abnormal vaginal bleeding. The three patients, whose lesions were confined to the uterus, were treated by total hysterectomy and their follow-up has been uneventful. Review of the literature showed that 62 patients with PSTT were alive and 15 had died, two as a complication of treatment. The diagnosis of PSTT may be difficult on a dilatation and currettage specimen. Metastases are a powerful indicator of adverse outcome. Prognosis, as assessed on pathologic criteria, is unreliable; however, a mitotic count of more than five mitoses per 10 high power fields is significant. Surgery is the mainstay of treatment. Hysterectomy is generally indicated, but young patients who wish to remain fertile may be treated by conservative surgery. In a few cases of progressive disease, chemotherapy has achieved remission, but generally chemotherapy and radiotherapy are ineffective. Long-term follow-up is essential as PSTT may progress after years of remission. Serum human chorionic gonadotrophin (hCG) levels are the best available marker of disease, but the disease may still progress even if hCG levels are not raised.     

miR-520 promotes DNA-damage-induced trophoblast cell apoptosis by targeting PARP1 in recurrent spontaneous abortion (RSA)

The establishment and maintenance of successful pregnancy mainly depends on trophoblast cells. Their dysfunction has been implicated in recurrent spontaneous abortion (RSA), a major complication of pregnancy. However, the underlying mechanisms of trophoblasts dysfunction remain unclear. DNA-damage-induced cell apoptosis has been reported to play a vital role in cell death. In this study, we identified a novel microRNA (miR-520) in RSA progression via regulating trophoblast cell apoptosis. Microarray analysis showed that miR-520 was highly expressed in villus of RSA patients. By using flow cytometry analysis, we observed miR-520 expression was correlated with human trophoblast cell apoptosis in vitro, along with decreased poly (ADP-ribose) polymerase-1 (PARP1) expression. With the analysis of clinic samples, we observed that miR-520 level was negatively correlated with PARP1 level in RSA villus. In addition, overexpression of PARP1 restored the miR-520-induced trophoblast cell apoptosis in vitro. The status of chromosome in trophoblast implied that miR-520-promoted DNA-damage-induced cell apoptosis to regulate RSA progression. These results indicated that the level of miR-520 might associate with RSA by prompting trophoblast cell apoptosis via PARP1 dependent DNA-damage pathway.     

Depth of invasion for appendiceal metastasis of ovarian cancers: does it have any clinical significance?

Aim:  Depth of appendiceal metastasis in patients with epithelial ovarian carcinoma (EOC) has not been previously analyzed for a possible relationship with clinico-pathological variables.
Methods:  Sixty-nine patients with EOC treated at Hacettepe University were retrospectively analyzed. All of the patients had appendiceal metastasis. Pathological slides were re-reviewed by the same pathologist. Appendiceal metastases were defined as serosal (if tumoral spread involved only serosa of the appendix) or sero-mucosal (if tumoral spread also involved either muscular or mucosal surfaces of the appendix). Univariate and multivariate analysis did not reveal a significant difference with respect to the prognostic variables between the groups.
Results:  Thirty-nine patients had serosal appendiceal metastasis (56.5%), while the remaining 30 patients (43.5%) had appendiceal metastasis extending toward the muscular layer (seromucosal metastasis: 16 within muscularis mucosa, 14 within the mucosa of the appendix). The mean age at the time of diagnosis was 54.58 years (range, 26-88 years), with no significant difference between the groups ( P  = 0.9). Comparison of the survival rates between the two groups did not reveal a significant difference. Three-year survival rates were 23.3% in the serosal metastasis and 27.9% in the seromucosal metastasis group ( P  = 0.9). This figure was 25% for patients with only muscular metastasis and 41.6% for patients with appendiceal metastasis extending to the mucosal layer ( P  = 0.2).
Conclusion:  This is the first report to analyze the metastatic pattern of EOC on the appendix with respect to depth of invasion which could not reveal a significant difference.     

Malignant lymphocyst after Wertheim''s operation

Lymphocyst is a well-known complication after Wertheim's operation with an incidence varying from 2 to 20%. The majority are asymptomatic. However, when complications occur, the symptoms depend on the location and the pressure effects created. Most of the lymphocysts occur within 1 year after surgery and need to be differentiated from a hematoma or urinoma. At present, there is no standard management of early lymphocysts. Conservative management, ultrasound-guided needle aspiration, or percutaneous insertion of an indwelling catheter have been successfully employed. Intraperitoneal marsupilization with or without omental falp is also highly effective. When pelvic lymphocysts occur later than normal, the diagnostic dilemma is to differentiate benign collections from those involving recurrent tumor. Fine-needle biopsy of the cyst wall under ultrasound guidance is more effective in identifying recurrence than cytological evaluation of the fluid. Nonetheless, if such facility is not readily available, surgical drainage and excision of the cyst wall should be considered to ensure early diagnosis of recurrence.