Palliation of recurrent endometriosis with radiotherapeutic ablation of ovarian remnants

Objective: To review the use of radiotherapy for relieving the symptoms of recurrent endometriosis caused by functioning ovarian remnants.Design: Retrospective study (case report).Patient(s): A woman with recurrent endometriosis of 14 years' duration.Intervention(s): After hysterectomy and bilateral oophorectomy, hormonal management, and multiple explorations for recurrent endometriosis, cycling ovarian remnants were confirmed histologically. Pelvic irradiation was used to ablate this tissue. A dose of 15 Gy in 10 daily fractions was given through anterior and posterior opposed fields using 18-mV photons.Result(s): The patient had a prompt increase in FSH levels associated with castration levels of serum E₂. A review of the literature on the use of radiotherapy in this clinical situation is presented.Conclusion(s): Radiotherapy should be considered in selected patients when ovarian castration is not a viable surgical option and hormonal therapies have failed.     

Characteristics of clear cell ovarian cancer arising from endometriosis: A two center cohort study

Objective

Endometrioid and clear cell ovarian tumors have been referred to as “endometriosis associated ovarian cancers”. However, very few studies have compared clinical and prognostic features of endometriosis-associated cancers or cancers not associated with endometriosis according to specific histotypes. We have investigated clinical and histological features of the largest published series of clear cell ovarian cancers arising in endometriosis using a retrospective database.

Methods

Seventy three patients with a primary diagnosis of either pure clear cell ovarian cancer and mixed endometrioid-clear cell ovarian cancer have been divided into two groups according to the detection of cancer strictly arising from ovarian endometriosis or not (n = 27 and n = 46, respectively). Clinical and pathological data have been compared.

Results

Patients with clear cell carcinomas arising from endometriosis tend to be significantly younger (51.4 ± 10.0 and 58.4 ± 11.2 years, p = 0.02). FIGO stage, laterality, prevalence of pure versus mixed histology, and presence of synchronous endometrial carcinoma were not significantly different between the two groups. Unilateral ovarian involvement was more frequent in cases arising in endometriosis (85% vs 63%, p = 0.04). Ascites was not found in any of the endometriosis-associated cancer cases vs 19.5% in patients without endometriosis. The presence of endometriosis did not affect 5-year overall survival rates.

Conclusions

Endometriosis per se does not appear to be associated with a lower stage tumor or to predict prognosis in ovarian clear cell cancers. Unilateral involvement and reduced presence of ascites may be linked to the cystic nature of endometriosis which frequently presents as monolateral and in which associated tumors are more likely to be longer confined to the ovary before spreading.     

血清CA125半衰期判定卵巢上皮性癌预后的价值

目的 探讨血清ＣＡ１２５半衰期在卵巢上皮性癌中的预后价值。方法 回顾性分析３０例卵巢上皮性癌患者在化疗过程中血清ＣＡ１２５半衰期值（ｔ１／２）与生存时间的关系。结果 血清ＣＡ１２５半衰期值（ｔ１／２）≤２０天组的中位生存时间为３６个月,ｔ１／２〉２０天组中完全缓解率为２７．３％,两者存在极显著差异（ｐ＝０．００１）。多因素生存分析表明：ＣＡ１２５半衰期和细胞分级、残余瘤灶大小均是独立的预后因素。结     

The role of thrombocytosis in prognostic evaluation of epithelial ovarian tumors

Background  Thrombocytosis has been reported in a variety of solid tumors, including certain gynecologic cancers such as endometrial, vulvar, and cervical cancers. The present study aims to determine the incidence of thrombocytosis in women with epithelial ovarian tumors and to evaluate its association with clinical and pathologic prognostic factors. Material and methods  Between January 2001 and December 2006, 292 patients were diagnosed with epithelial ovarian tumors, and they underwent primary surgical treatment and subsequent platinum-based chemotherapy at the Gynecologic Oncology Department of the study center. The medical records of these patients were evaluated retrospectively. Results  Of the 292 women with epithelial ovarian tumors undergoing primary surgical exploration, 124 (42.5%) had thrombocytosis, indicating platelet counts >400 × 10⁹/l. Patients with thrombocytosis were found to have statistically higher levels of preoperative CA-125 levels, more advanced stage disease, higher grade tumors, and shorter periods of survival. Thrombocytosis is a significant negative prognostic factor for survival in patients with epithelial ovarian tumors. Conclusions  Thrombocytosis is frequently detected in preoperative evaluation of women diagnosed with epithelial ovarian tumors. The data obtained by the previous and present studies suggest that thrombocytosis is associated with factors reflecting a more aggressive tumor biology, and predicting poor survival in women with epithelial ovarian tumors. However, these data are limited by the retrospective nature of the studies and do not confirm a casual relationship between thrombocytosis and tumor behavior. Molecular studies investigating the expression of platelet secretory factors are required to clarify the differences among data provided by the literature.     

小儿造血干细胞移植后出血性膀胱炎的临床特征与危险因素分析

目的 分析小儿造血干细胞移植(HSCT)后出血性膀胱炎(HC)的临床特点，探讨其发病危险因素。 方法 对1998年10月至2004年6月中山大学附属二院儿科完成的52例小儿HSCT后11例HC的临床资料进行回顾分析。 结果 11例HC中轻度(Ⅰ~Ⅱ度)6例，重度(Ⅲ~Ⅳ度)5例；早发性4例，迟发性7例；发病时间为术后+2d至+25d(中位数为+15d)，病程3~60d(中位数为17d)。临床表现均有血尿，其中典型尿频、尿急、尿痛及肉眼血尿7例。HC患儿组中性粒细胞植入时间和血小板植入时间与非HC患儿组比较差异无显著性(P>0.05)。受者移植年龄≥6岁、aGVHD阳性、CMV感染组的HC发生率分别高于年龄<6岁(321%和83%，P<0.05)、GVHD阴性(34.6%和7.7%，P<0.05)、CMV未感染组(62.5%和13.6%，P<0.05)。 结论 小儿HSCT后HC有其自身的临床特征；受者移植年龄≥6岁、aGVHD阳性、CMV感染为其发生的危险因素。     

上皮性卵巢癌细胞凋亡指数和肿瘤微血管密度与肿瘤复发的关系

目的　研究上皮性卵巢癌细胞凋亡、增殖状态和肿瘤微血管生成及其与肿瘤复发之间的关系。方法　对 1996年 10月至 1999年 10月间 45例上皮性卵巢癌石蜡组织切片采用DNA原位缺口末端标记 (TUNEL)方法,检测细胞凋亡指数(AI);应用FⅧ相关抗原及增殖细胞核抗原 (PCNA),采用SABC法,检测卵巢癌中的肿瘤微血管密度(MVD)及细胞增殖状态(PI)。结果　不同的组织类别,临床分期,组织分级中AI、PI差异无显著性(P>0.05)。卵巢癌中的AI/PI平均值为 0.0621±0.0281,临床Ⅲ ~Ⅳ期肿瘤AI/PI显著低于临床Ⅰ ~Ⅱ期肿瘤(P<0.05);MVD在不同组织类别,不同临床分期中的差异有显著性意义(P<0.05); 6例复发性上皮性卵巢癌中AI/PI与MVD均高于未复发者。结论　上皮性卵巢癌组织中凋亡的发生远低于细胞的增殖,细胞凋亡的相对减少与细胞增殖共同参与了肿瘤的发展。随着卵巢癌的进展,肿瘤血管生成是增多的。复发性上皮性卵巢癌中AI/PI与MVD均高于未复发者。     

Prognostic value of p53 accumulation in epithelial ovarian carcinomas

Aim: To evaluate the prognostic significance of p53 expression in epithelial ovarian carcinomas (EOC), and to look for correlations between p53 and other disease parameters. Material and methods: Immunohistochemical techniques were used to evaluate p53 expression in paraffin-embedded tissue specimens of 50 EOC cases. Results: p53 immunoreactivity was present in 33 of the 50 cases (66%). The expression of the p53 did not show any association with the tumor histologic type, grade or with the disease stage. However, p53 accumulation was significantly more prevalent among tumors with high mitotic index (p<0.01). Although median survival was low in the p53 negative cases, this biologic marker did not reveal as an independent prognostic factor in Cox’s regression analysis. Conclusion: Abnormalities of p53 expression which is an inducer of apoptosis occur commonly in EOC. Although we could not find it as an independent prognostic factor, p53 expression should be studied in larger series to reveal its accurate prognostic significance. Received: 14 May 2001 / Accepted: 16 July 2001     

Clinical manifestations in patients with ovarian clear cell carcinoma with or without co-existing endometriosis

Objectives. The symptoms associated with ovarian cancer are vague. Endometriosis, which causes dysmenorrhea and dyspareunia, is frequently detected along with ovarian clear cell carcinoma (OCCC). We have therefore evaluated the clinical manifestations of OCCC based on the co-existence of endometriosis.

Methods. A retrospective analysis was conducted on 43 patients who had been treated for OCCC at the National Cancer Center between June 2000 and July 2007. Using medical records and the cancer registry, the clinical features and laboratory findings were analysed.

Results. Endometriosis was identified in 16 (37.2%) of the 43 patients with OCCC. The main presenting symptoms included a hard, palpable mass (32.6%), and newly developed or an exacerbation of dysmenorrhea (32.6%) and dyspareunia (25.6%). Gastrointestinal symptoms, pelvic pain, and abdominal distension existed in nine (20.9%), eight (18.6%) and one (2.3%) of the patients, respectively. The symptoms did not differ statistically in patients with or without endometriosis. Thirty-seven percent (11/30) of the patients had a normal CA-125 level (<35 U/ml); 18.8% (3/16) of the patients without endometriosis and 57% (8/14) of the patients with endometriosis had normal levels of CA-125 (<35 U/ml). Nine of 16 (56.3%) patients with early stage OCCC had a normal CA-125 level.

Conclusions. The main presenting symptoms in patients with OCCC include a hard, palpable mass, dysmenorrhea and dyspareunia, irrespective of co-existing endometriosis. A normal CA-125 level has limited value in excluding OCCC, especially in the early stages.     

卵巢癌合并子宫内膜异位症病例分析

目的分析卵巢癌病例中子宫内膜异位症的发生情况及其相互关系。方法 对210例原发性卵巢恶性肿瘤中合并有子宫内膜异位症的患者进行回顾性分析。结果 原发性卵巢恶性肿瘤合并子宫内膜异位症25例，发生率为11．9％，其中内膜样癌12例，透明细胞癌6例，黏液性4例，浆液性2例，其他类型1例。结论子宫内膜异位症与卵巢内膜样癌和透明细胞癌关系密切，内膜异位症病灶恶变可能是这两型卵巢癌的来源之一。     

Endometriosis and the subsequent risk of epithelial ovarian cancer

ObjectiveThere is a possible correlation between endometriosis and an increased risk of epithelial ovarian cancer (EOC), but many uncertainties remain, including race, exposure or surveillance time, and surgical confirmation. Therefore, we carried out a large-scale, nationwide, controlled cohort study in the Taiwanese women to respond to these uncertainties.Materials and methodsA historical cohort study was performed by linking the National Health Insurance Research Database of Taiwan. Each patient diagnosed with endometriosis (n = 7537) between 2000 and 2009 was background matched with up to two women without endometriosis (n = 15,074). The total was 136,643 person-years of follow-up and 24 women having new EOC. Cox regression analysis was used to determine the relationship between the EOC incidence rate and an endometriosis status.ResultsThe EOC incidence rate of the endometriosis and non-endometriosis women was 3.31 per 10,000 person-years and 0.99 per 10,000 person-years, respectively, contributing to an adjusted hazard ratio (HR) of 3.28 (95% confidence interval, 1.37–7.85). The women with surgical confirmation had a much higher adjusted HR (3.87; 95% confidence interval, 1.58–9.47). No significantly statistical difference of surveillance time between women with and without endometriosis (3.87 years vs. 3.73 years). The occurrence of EOC was not also affected by exposure time of women with endometriosis.ConclusionTaiwanese women with endometriosis really had a risk of newly developed EOC, especially those who had a surgical diagnosis, and this three-fold increase of risk was neither influenced by exposure time nor biased by surveillance.     

Therapy-related myeloid leukemia after treatment for epithelial ovarian carcinoma: an epidemiological analysis

Objective

Therapy related acute myeloid leukemia (t-AML) is a potential late complication of cytotoxic therapy, and it is of particular concern in the treatment of patients with epithelial ovarian carcinoma (EOC) exposed to multiple courses of chemotherapy during the course of their disease. This study examines the incidence, characteristics and clinical outcomes of patients who developed secondary myeloid-type leukemia after a diagnosis of EOC.

Methods

National Cancer Institute's Surveillance, Epidemiology and End Results database was pooled for diagnosis of secondary myeloid leukemia after an initial diagnosis of EOC. This group of patients was compared to patients with de novo AML, and to EOC patients who did not develop secondary myeloid leukemia. Demographic, cytopathological and survival data were recorded. Cox Proportional Hazards model was used to calculate hazard ratios (HR) for developing secondary leukemia and to determine the statistically significant variables impacting survival. Kaplan-Meier estimates of survival were obtained and comparisons between the groups were performed using log-rank test.

Results

One hundred and nine myeloid leukemia cases were identified among 63,359 patients with a prior diagnosis of EOC for an overall incidence of 0.17%. The median latency to development of leukemia was 4 years (range 0-27 years). Median survival from the time of secondary leukemia diagnosis was 3 months and significantly worse than the 6 month median survival in patients with de novo AML (p < 0.001). Age at leukemia diagnosis greater than 65 and development of secondary vs. de novo leukemia had a statistically worse prognosis on multivariate analysis (HR of 2.69, 95%CI 2.60-2.78 and 1.81, 95%CI 1.49-2.20 respectively). The development of secondary leukemia was more common with EOC diagnosis made prior to the platinum/taxane era (HR 6.70, 95%CI 3.69-12.18). There was no difference in median survival between EOC patients who developed AML and those who did not.

Conclusion

Development of t-AML is a rare but lethal event among EOC patients, and its incidence has decreased significantly since the use of platinum/taxane-based chemotherapy became the standard of care.