Inflammatory Breast Metastases of Ovarian Cancer: A Case Report

BACKGROUND: Metastasis to the breast from extramammary malignancies is rare. CASE: A 35-year-old woman presented with bilaterally inflammatory breast involvement, 2 years after the diagnosis of stage IIIC epithelial ovarian cancer. Neoplastic tissue was immunohistochemically positive using antibodies against OC125 and negative for gross cystic disease fluid protein-15 (BRST-2) and estrogen receptor in biopsy material in the breast. Combination chemotherapy consisting of paclitaxel, cisplatin, and anthracycline was started. She died 18 months after the breast metastasis. CONCLUSION: Ovarian carcinoma usually presents with signs and symptoms related to the tumor burden within the abdominal cavity. The finding of isolated, distant metastases such as breast involvement without intraabdominal disease is extremely rare. Determining the origin of the primary tumor is important in directing the actual therapy.     

74例上皮性卵巢癌患者BRCA基因突变状况及临床意义分析

目的： 统计上皮性卵巢癌（EOC）患者的胚系乳腺癌易感基因（BRCA）致病突变情况,分析其与临床病理特征的关系。方法： 收集2017年1月—2020年1月在天津市中心妇产科医院诊治的EOC患者的胚系BRCA 基因检测情况,并对BRCA基因致病突变与患者临床病理资料进行分析。结果： 74例EOC患者中BRCA1突变18例（24.3%）,BRCA2突变7例（9.5%）,主要突变方式包括框移突变15例,无义突变5例,突变主要集中在外显子编码区（CDS9和CDS10）。BRCA基因突变组和BRCA基因野生组患者的临床分期、组织病理学类型、淋巴结转移、血清CA-125水平、恶性肿瘤家族史进行比较,差异均无统计学意义（P>0.05）。BRCA基因突变组患者无复发生存期（RFS）长于BRCA基因野生组,差异有统计学意义（Z=-1.931,P=0.027）;2组患者遗传性乳腺癌卵巢癌综合征家族史（HBOC家族史）率比较差异有统计学意义（χ² =4.059,P=0.044）。结论： 有HBOC家族史的EOC患者的家系女性成员进行BRCA基因检测是筛查卵巢癌高危患者的有效手段。     

Splenectomy and Surgical Cytoreduction for Ovarian Cancer

Objective. The aim of this study was to evaluate the role of splenectomy, as a surrogate marker for aggressive tumor cytoreduction in ovarian cancer, and its impact on patient morbidity and survival.Methods. A retrospective cohort study of 35 patients who underwent splenectomy for ovarian cancer cytoreduction between August 1986 and May 1998 was performed. Data abstracted from the medical record included patient demographics, preoperative imaging, surgical procedures, tumor distribution, postoperative complications, chemotherapy treatment, and follow-up information.Results. Splenectomy was performed in 13 patients at the time of primary cytoreduction and in 22 patients at the time of secondary cytoreduction. Preoperative diagnosis of splenic involvement was frequently made prior to secondary surgery, 77.3% compared to 15.4% of primary cases. In addition, parenchymal splenic involvement was more commonly observed at recurrence, 59.1% vs 23.1% at initial presentation. Disease distribution in secondary cytoreduction cases tended to be more focal, macronodular, and have no ascites. Cytoreduction to less than 1 cm disease was achieved in 100% of primary patients and 86% of secondary patients. Major morbidity (pneumonia, PE, sepsis, pancreatitis, MI) occurred in 23.1% of primary patients and 28.6% of secondary patients. Combining splenectomy with other cytoreductive procedures may make splenectomy itself seem more morbid. With a 17-month median follow-up, median progression-free interval was 24 months in primary patients and 14 months in secondary patients. Among secondary patients, median survival time after splenectomy and cytoreduction was 41 months.Conclusions. Splenectomy at the time of primary and secondary cytoreduction for ovarian cancer can be performed with acceptable morbidity. Secondary cytoreduction patients may be selected preoperatively by their progression-free interval, prior degree of cytoreduction, and macronodular tumor involvement on imaging studies. Identification of splenic involvement allows for appropriate counseling and preoperative preparation.     

乳腺卵巢双原发癌研究进展

乳腺卵巢双原发癌（double primary breast and ovarian cancer,DPBOC）为女性生殖系统多原发恶性肿瘤（multiple primary malignant neoplasms,MPMNs）常见的一种类型。乳腺、卵巢均为性激素调节器官,两者有着相似的内分泌调节机制。由于乳腺癌患者确诊时多为早期,预后佳,再患原发性卵巢癌的风险较普通女性增高。对散发性乳腺癌或卵巢癌的研究已相对成熟,而DPBOC的发病机制尚不明确,且由于缺乏敏感度及特异度较高的筛查手段,其难以与转移性肿瘤相鉴别,因此较少引起临床医师的关注。综述DPBOC的发病机制、与乳腺癌卵巢转移的鉴别诊断、治疗及预防等,对此类疾病进行深入探讨,使临床医师重视第二原发癌器官的早期监测,对高危人群采取必要的预防措施,抓住最佳治疗时机,尽可能延长双原发癌患者的生存时间。     

Secondary Cytoreductive Surgery for Patients with Recurrent Epithelial Ovarian Carcinoma

OBJECTIVE: The aim of this prospective study was to evaluate the influence of secondary cytoreductive surgery on survival of patients with recurrent epithelial ovarian cancer. METHODS: Between June 1993 and June 1999, 149 patients after primary treatment underwent secondary cytoreductive surgery: 69 (46.3%) had recurrence-free interval (RFI) 7-12 months, 59 (39.6%) RFI 13-24 months, and 21 (14.1%) RFI >24 months. Exclusion criteria included secondary cytoreduction during second-look laparotomy, interval cytoreduction, and palliative surgery in patients with intestinal obstruction or progressive disease. RESULTS: The median follow-up was 27 months. According to multivariate analysis, RFI groups, prior chemotherapy combination, and residual tumor after secondary surgery were associated independently with overall survival. Residual tumor after secondary surgery was by far the most strongly predictive factor for patient's survival (hazard ratio (HR) 2.65; 95% confidence interval (CI) 1.43-4.92). The 2-year survival rates were 22.3, 62.9, and 22.7%, respectively, for patients with RFI 7-12, 13-24, and >24 months. The 5-year survival was 29% for patients with RFI 13-24 months. No patients with RFI 7-12 and >24 months outlived the 4-year estimate. Unexpectedly, RFI >24 months was not correlated significantly with overall survival. However, 17 patients (81%) with RFI >24 months were heavily treated with chemotherapy before secondary surgery. CONCLUSIONS: Patients who have documented gross disease preoperatively should be selected for a secondary debulking operation; the entity of surgical effort would be modulated in relation to previous treatment.     

A Critique of Surgical Cytoreduction in Advanced Ovarian Cancer

Due in most part to the abundant retrospective evidence suggesting that surgical cytoreduction is essential to the management of advanced ovarian cancer, most clinicians do not question its application. Irrespective, there are many who still doubt its value, given its unique role in ovarian cancer, in comparison to other solid tumors. While many papers have extolled the virtues of debulking surgery, few have taken the opposing view. This paper attempts to expose the weaknesses in the current available data regarding surgical cytoreduction in advanced ovarian cancer. By reviewing the retrospective data, the theoretical benefits of surgery, cellular kinetics, the fallacies of residual disease, interval debulking surgery, and neoadjuvant chemotherapy, a critique of debulking surgery is made. Issues surrounding perioperative morbidity and its impact on quality of life have not been adequately addressed. Despite the need for randomized trials of surgery in advanced ovarian cancer, they are unlikely to occur. The window of opportunity with respect to studying the questions on the optimal timing, degree of aggressiveness, and patient selection for surgery has likely passed. Biases and ethical issues based upon the data cited in this paper have and will continue to hamper our ability to fully elaborate the benefits of surgery with respect to survival and quality of life.     

晚期上皮性卵巢癌经腹腔镜和开腹的初次肿瘤细胞减灭术或中间型减瘤术的临床对比研究

目的:比较经腹腔镜和开腹晚期上皮性卵巢癌初次肿瘤细胞减灭术(PDS)或(IDS)的手术效果,探讨经腹腔镜和IDS用于治疗晚期上皮性卵巢癌的临床效果。方法:选择2009年1月1日至2017年12月31日陆军军医大学附属西南医院妇产科收治的晚期上皮性卵巢癌患者237例,根据手术途径分为腹腔镜组210例,其中96例接受PDS,114例接受IDS;开腹组27例,其中22例接受PDS,5例接受IDS。比较两组的手术风险、术后相关参数和远期疗效。结果:手术风险:腹腔镜组的手术时间、出血量和术中输血、术中损伤比例少于开腹组(P<0.05);术后相关参数:腹腔镜组的住院时间、术后肛门排气时间、术后开始化疗时间、术后并发症少于开腹组(P<0.05)。腹腔镜组内IDS较PDS的手术时间(3.3±1.0小时vs 3.8±1.0小时)和术中输血比例(16.7%vs 33.3%)显著减少,开腹组内IDS较PDS的手术时间(3.4±0.6小时vs 5.2±1.7小时)显著减少,差异均有统计学意义(P<0.05)。腹腔镜组和开腹组的OS和PFS比较,差异无统计学意义(P>0.05);腹腔镜组内PDS和IDS的OS(92.0个月vs 56.0个月)、PFS(26.0个月vs 22.0个月)比较,差异无统计学意义(P>0.05);开腹组内PDS和IDS的OS(57.5个月vs 35.2个月)、PFS(33.0个月vs 17.0个月)比较,差异无统计学意义(P>0.05)。结论:经腹腔镜相较于开腹肿瘤细胞减灭术,IDS相较于PDS,都可以降低手术风险且并不影响患者的预后,对于晚期上皮性卵巢癌患者而言都是合适的治疗方案。     

腹腔温热化疗在晚期卵巢癌中的临床应用

多数卵巢癌患者确诊时已属临床晚期,虽然经过理想的肿瘤细胞减灭术及以顺铂为基础的联合化疗,仍有部分患者出现复发、耐药。因此,晚期卵巢癌仍是当前女性生殖系统恶性肿瘤中引起死亡的主要原因。腹腔温热化疗（IPHC）是一项很有希望的治疗措施,为提高晚期、复发和耐药患者的生活质量,改善患者预后提供了一种方法。对IPHC的药物代谢动力学及其在晚期及复发与耐药卵巢癌中的可行性、有效性、安全性进行综述。     

Concomitant Laparoscopic and Thoracoscopic Resection of Recurrent High-Grade Ovarian Cancer

Study Objective

To describe the first case of combined endoscopic management of a thoracic and abdominal recurrence of ovarian cancer.

Long‐Term Effects of Breast Cancer Surgery,Treatment, and Survivor Care

Women are increasingly surviving breast cancer, but up to 90% experience unexpected long‐term sequelae as a result of treatment. Symptoms may include physical, functional, emotional, and psychosocial changes that can dramatically alter the quality of life for breast cancer survivors. Primary care clinicians, including midwives, are likely to care for these women and should be familiar with common symptoms, treatment, and best practices to avoid permanent dysfunction. A holistic approach to assessment, treatment, and referral as needed is the most effective strategy. Although women experience significant changes after breast cancer treatment, many fail to receive thorough assessment of their symptoms, education about interventions, and treatment options to optimize health promoting strategies. Disparities exist in treatment availability, options, and survivorship. Long‐term physical changes include anatomic changes, chronic pain, phantom breast pain, axillary web syndrome, and lymphedema. In addition, women may have decreased strength, aerobic capacity, mobility, fatigue, and cognitive dysfunction. Emotional and psychosocial changes include depression, anxiety, fatigue, concerns about body image, and issues with sexuality. Treatment should be multifactorial based on thorough assessment of symptoms and can include medication, exercise, counseling, physical and occupational therapy, and alternative and complementary therapies. Primary care and gynecologic clinicians are well positioned to provide thorough evaluation, education, treatment, and referral for the most common sequelae of mastectomy and breast cancer treatments.     

Gastrostomy Using a “Gastrofix” as an Alternative for Nasogastric Tubes in Ovarian Cancer Surgery

Objective.The aim of this study was to evaluate the use of a gastrostomy instead of a nasogastric tube following surgery for advanced ovarian cancer.Design.This was a retrospective observational study.Setting.The study was performed in a university teaching hospital.Participants.Thirty-four women undergoing debulking surgery for ovarian carcinoma participated.Methods.In order to increase patients' comfort during the first postoperative days we inserted for gastric decompression a transcutaneous instead of a transnasal tube following debulking surgery. Only patients with bowel involvement and/or extensive tumor load in the upper abdomen were included in the study. In this study we report on the use of a gastrostomy using a Cystofix drainage catheter, resulting in what we call a “Gastrofix.” The Gastrofix was placed in 34 patients with ovarian cancer. In 32 (94%) patients an extraperitoneal hysterectomy and bilateral salpingo-oophorectomy was performed, in 16 (47%) a resection of the diaphragmatic peritoneum, in 14 (41%) patients a paraaortic lymphadenectomy, and in 12 (35%) patients part of the bowel was resected.Results.Free oral liquid intake and poor fiber diet were started after 5.5 days (median, range from 3–8 days) and 8 days (median, range from 4–12 days), respectively. The catheter was clamped off after 5 days (median, range from 2–8 days) and removed after 7 days (median, range from 3–11 days). Of the 34 patients only 12 (35%) received antiemetics (median of 4 days, range from 1–7 days). In 1 patient (3%) pain at the insertion site was observed on the third and fourth postoperative days. In 3 patients (9%) some fluid leakage at the insertion site was noted. In 4 patients (12%) the catheter fell out prematurely on days 0, 4, 6, and 9, respectively. In none of the patients were infection or fistulas at the insertion site noted. In all patients there was a satisfactory drainage of gastric content.Conclusion.After debulking surgery, the use of a Gastrofix resulted in an adequate gastrointestinal decompression without major complications. This technique may increase the comfort of the patient during the postoperative phase considerably.     

Long-Term Consequences Following Conservative Management of Epithelial Ovarian Cancer in an Infertile Patient

A 35-year-old woman with primary infertility underwent an ovarian cystectomy for a 5 x 4 cm left adnexal mass. There was no macroscopic evidence of metastatic disease. The final pathology report revealed a poorly differentiated serous cystadenocarcinoma. Because the patient desired to retain child-bearing capacity, she refused a surgical staging of her ovarian cancer. She elected to receive combination chemotherapy. This was then followed by a negative reassessment laparotomy. The patient was diagnosed with recurrent, metastatic ovarian carcinoma 10 years later.     

Hormone Levels in Pregnancy and Subsequent Risk of Maternal Breast and Ovarian Cancer: A Systematic Review

Objective

Some maternal hormone levels in pregnancy are associated with a higher risk of breast and ovarian cancer. This study systematically assessed the association between blood hormone levels measured in pregnancy and future risk of these cancers.

交界性卵巢肿瘤再分期手术11例临床分析

目的:探讨交界性卵巢肿瘤再分期手术的临床价值.方法:2006年1月至2010年12月在外院初次手术未全面分期而在我院接受再分期手术的交界性卵巢肿瘤患者共11例,平均年龄34.1岁,其中ⅠA期9例,ⅠB期2例;组织学类型:浆液性交界性肿瘤7例,黏液性交界性肿瘤3例,子宫内膜样交界性肿瘤1例.结果:经过再分期手术,4例患者分期提高,包括1例黏液性交界性卵巢肿瘤,1例子宫内膜样交界性卵巢肿瘤和2例浆液性交界性卵巢肿瘤.初次手术残留肿瘤的部位为对侧卵巢1例,腹腔冲洗液中3例发现肿瘤细胞(其中1例初次手术为腹腔镜术中肿瘤破裂).再分期术后随访至今,共随访18 ～ 70个月,平均随访时间42.6个月,分期未改变的7例患者和分期提高的4例患者均无复发.结论:对于交界性卵巢肿瘤,是否再分期手术需结合患者初次手术探查的彻底性、肿瘤的组织学亚型和患者的观点综合考虑,再分期手术对于浆液性肿瘤患者可能有益.