Metastatic serous borderline ovarian tumor in an internal mammary lymph node: a case report and review of the literature.

Background. Reports of supradiaphragmatic involvement of lymph nodes by serous borderline ovarian tumors are rare. Case. We describe the finding of metastatic tumor involving an internal mammary lymph node in a 74-year-old patient with serous borderline ovarian tumor. The positive lymph node was found incidentally during cardiac surgery 7 years after excision of the patient's serous borderline ovarian tumor. The incidence and significance of pelvic, paraaortic, and supradiaphragmatic lymph node involvement among women with borderline ovarian tumors is discussed. Conclusion. Supradiaphragmatic lymph node involvement can occur among women with serous borderline ovarian tumors. Borderline ovarian tumors should be included in the differential diagnosis of metastatic adenocarcinoma involving the supradiaphragmatic lymph nodes.     

SV40 early genes induce neoplastic properties in serous borderline ovarian tumor cells

ObjectiveSerous borderline ovarian tumors (SBOT) are slow growing, noninvasive ovarian epithelial neoplasms, which tend to recur as low-grade invasive carcinomas (LGC) with a much worse prognosis. We investigated the molecular basis of this progression.MethodsWe established cultures of three SBOTs and one LGC from tumor biopsies, and inactivated p53, Rb and PP2A in the cells with SV40 large T (LT) and small T (ST) antigen. They were examined for cadherins by immunofluorescence and immunoblotting, invasiveness in Boyden chambers, motility by scratch-wound healing assay, anchorage independence by growth in agarose, and protease activity by gelatin zymography, immunoassay and colorimetry. Cells were overexpressed with N-cadherin using an adenovirus.ResultsInactivation of p53, Rb and PP2A by SV40 LT/ST antigen resulted in greatly enhanced growth potential, invasiveness, motility and anchorage independence, and in epithelio-mesenchymal transition, as indicated by morphology and substitution of N-cadherin for E-cadherin. Overexpressed N-cadherin did not induce invasiveness of SBOT cells and there was no consistent change in protease activities, suggesting that these were not primary effectors of the enhanced neoplastic characteristics. Low passage LGC cells were more invasive than SBOT cells, but this difference disappeared with the introduction of LT/ST into the two cell types.ConclusionDownregulation or inactivation of p53, Rb and/or PP2A plays a role in the progression from SBOT to invasive ovarian carcinomas.     

Borderline tumor of the lymph node associated with bilateral serous borderline tumor of the ovary: case report

The pathological diagnosis of a patient who was operated on for ovarian cancer was serous borderline tumor of the ovary. At the same time, pathological examination of one of the paraaortic lymph nodes revealed borderline tumor of the lymph node. We also searched the literature associated with this case.     

Microinvasion links ovarian serous borderline tumor and grade 1 invasive carcinoma

OBJECTIVES: Ovarian serous borderline tumor (SBT) and grade 1 (low grade) serous carcinoma are closely related, but, unlike SBT which has been well studied, there have been few studies looking primarily at grade 1 serous carcinoma. The objective of this study was to better understand the relationship between serous borderline tumors and grade 1 serous carcinomas. METHODS: We performed a clinicopathologic review of 46 women with SBT and 16 with grade 1 serous carcinoma. RESULTS: Thirteen of forty-six (28%) SBTs had a micropapillary pattern, 12/46 (26%) had evidence of microinvasion and 19/46 (41%) had extraovarian implants, of which 1/19 (5%) was invasive. Three of forty-six (7%) of SBTs recurred, all of which were originally advanced stage. No patient with a microinvasive SBT recurred. The 16 grade 1 serous carcinomas divided into those with evidence of coexisting SBTs (5 cases) and those without (11 cases). Nine of sixteen (56%) carcinomas recurred, comprising 5/5 with SBT and 4/11 without. All patients had advanced stage at diagnosis. Microinvasion, invasive implants and recurrences all showed qualitative histologic resemblance to carcinoma. There were no micropapillary areas in any of the carcinomas, although cribriform pattern was seen in these tumors. CONCLUSIONS: Advanced stage at diagnosis was the most important prognostic marker in patients with SBT. Although a micropapillary pattern was common, it did not adversely affect prognosis per se, but was associated with a higher stage. A micropapillary pattern was not seen adjacent to microinvasion or in association with grade 1 serous carcinoma. Microinvasion was common but, in our series, did not appear to worsen the prognosis. Grade 1 serous carcinoma was less common than SBT and had a more unfavorable prognosis. The qualitative histologic similarity between microinvasion, invasive implants, recurrences and grade 1 serous carcinoma suggests that microinvasion represents early invasion and is not just another histologic pattern of SBT. We speculate that some invasive implants and recurrences may be peritoneal grade 1 serous carcinoma.     

Patterns of pelvic and paraaortic lymph node involvement in ovarian cancer

One hundred eighty patients with ovarian cancer underwent complete pelvic lymphadenectomy (n = 75) or pelvic and paraaortic lymphadenectomy (n = 105). Twenty-one patients underwent a preoperative biopsy of the scalene lymph nodes. The incidence of positive lymph nodes was 24% in stage I (n = 37), 50% in stage II (n = 14), 74% in stage III (n = 114), and 73% in stage IV (n = 15). Of the 105 patients who underwent pelvic and paraaortic lymphadenectomy, 13 (12%) had positive pelvic and negative paraaortic nodes and 10 (9%) had positive paraaortic and negative pelvic nodes. Positive scalene nodes were found in four patients (19%) later shown to have stage IV disease. One hundred forty patients were studied for number of involved nodes and node groups, size of nodal metastases, residual tumor, and survival. Of the 81 patients with positive nodes, most had only one or two positive node groups or one to three positive individual nodes. A few patients had seven to eight involved node groups with up to 44 positive nodes. Greater numbers of positive nodes were found in stage III than stage IV. The size of the largest nodal metastasis was not related to the clinical stage or survival, but did correlate with the number of positive nodes. Stage III patients with no residual tumor had a significantly lower rate of lymph node involvement than those with tumor residual (P less than 0.01). Actuarial 5-year survival rates of patients with stage III disease and no, one, or more than one positive nodes were 69, 58, and 28%, respectively.     

Pelvic lymph node dissection in early ovarian cancer: success of retrieval of lymph nodes by individual lymph node groups in respect to pelvic laterality

Objective

To evaluate the differences in number of harvested retroperitoneal pelvic lymph nodes by specific lymph node regions in respect to pelvic laterality.

Study design

We extracted cases of early ovarian cancer (EOC) with lymphadenectomy from the medical database which were treated at our institution in the period between 1994 and 2008. Recommendations of FIGO and EGSOC (European Guidelines for Staging in Ovarian Cancer) for staging of ovarian malignancies were followed. Stage of the disease was established on the basis of intra-abdominal condition which we found during surgery and histopathologic status of retroperitoneal lymph nodes (LN). For each case and every LN group, we subtracted the number of dissected lymph nodes on the left side from the number of dissected lymph nodes on the right side of the pelvis. The result would represent the difference between number of removed LN on each side of the pelvis for specific LN group. A negative difference means that a greater number of LN was extracted from the left side and a positive difference that the greater number of LN was extracted from the right side of the pelvis. We used Wilcoxon signed-rank test for statistical analysis of differences.

Results

48 cases with EOC underwent lymphadenectomy. In three cases, metastatic retroperitoneal pelvic lymph nodes were found. There were 79.1%, 50.0%, 45.8%, 93.8%, 52.1%, 60.4% and 70.8% of cases with left-right difference in number of removed lymph nodes in external iliac region, common iliac region, presacralic, above obturator nerve, under obturator nerve, lateral from the external ilac vessels and lateral from the common iliac vessels nodal group, respectively. The mean differences between left and right groups were in the range from 2 to 4 lymph nodes. There was no identifiable bias toward either side of the pelvis for any of the analyzed lymph node groups.

Conclusion

There is a right and left prevalence of retrieved LN by individual LN regions in the pelvis that could be influenced by asymmetry in right-left pelvic LN distribution. However, we did not find any evidence that the observed imbalance is, on average, directed toward either side of the pelvis.     

Contralateral pelvic and aortic lymph node metastasis in clinical stage I epithelial ovarian cancer.

Bilateral pelvic and aortic node lymphadenectomy is recommended for clinically localized unilateral epithelial ovarian adenocarcinoma (International Federation of Gynecologists and Obstetricians stage IA). The laterality of nodal metastasis in clinical stage I disease is rarely documented in the literature. Some authors have reported that ipsilateral node dissection is adequate for staging. A patient with contralateral pelvic and aortic lymph node metastasis and clinical stage I epithelial ovarian adenocarcinoma is presented. Pathologic findings were consistent with contralateral-only lymph node metastasis. This case illustrates the importance of bilateral lymph node sampling for appropriate staging of clinically localized epithelial ovarian cancer.     

Asymmetries in pelvic lymph nodes and their metastatic involvement by gynecologic cancer cells

AIM: The aims of this study were to re-examine left-right asymmetry in pelvic lymph node distribution in patients with gynecologic malignancies, and to investigate if there is a left-right asymmetry in pelvic lymph node metastatic involvement by gynecologic cancer cells. METHODS: The oncologic database of our gynecologic department was reviewed to identify patients who had pelvic lymphadenectomy as part of treatment for a variety of gynecologic malignancies. Right and left lymph node counts with and without involvement of cancer cells were retrieved from the pathological reports. RESULTS: Three hundred and thirteen patients were included in the study. The numbers of external iliac, and hypogastric + obturator lymph nodes were higher on the right side than on the left in all gynecologic malignancies. The numbers of involved external iliac, and hypogastric + obturator lymph nodes by metastatic cancer cells were significantly higher on the right side than on the left in all gynecologic malignancies. CONCLUSION: The results suggest the existence of a left-right asymmetry in pelvic lymph node distribution and pelvic lymph node distribution involved by gynecologic cancer cells. This situation may be due to the asymmetry in the number of pelvic lymph nodes. In addition, stronger cell-mediated immune activity in the left side of humans may be associated with the blocking of metastatic invasion of cancer cells from gynecologic malignancies in the left side of the body.     

Case report of serous ovarian tumor of borderline malignancy (Stage Ic) in a pregnant woman

We encountered a case of Stage Ic ovarian serous borderline malignancy in the first trimester of pregnancy. At laparotomy, spontaneous rupture of the capsule and a small amount of serous ascites was observed. Because of the laparotomy during pregnancy, correct staging of the tumor might not be performed. This case presented a major problem in deciding the treatment strategy, which are reported here together with some discussion of the literature on the preservation of fertility in borderline ovarian malignancy.     

Metastasis to sigmoid colon mucosa and submucosa from serous borderline ovarian tumor: response to hormone therapy

Abstract.   Lee E-J, Deavers MT, Hughes JI, Lee J-H, Kavanagh JJ. Metastasis to sigmoid colon mucosa and submucosa from serous borderline ovarian tumor: response to hormone therapy. Int J Gynecol Cancer 2006; 16(Suppl. 1): 295–299.
Distant metastasis to sites other than lymph nodes of borderline ovarian tumor is rare. We describe a case metastasized to sigmoid colon mucosa and submucosa. The metastatic lesion was detected incidentally by screening colonoscopy 7 years after the patient was treated for the primary tumor. The metastatic lesion responded well to treatment with oral Arimidex 1 mg/day. A follow-up colonoscopy with biopsy and imaging studies after 3 months of treatment revealed no evidence of disease in the sigmoid colon. This case showed that the sigmoid colon mucosa and submucosa should be considered as one of distant metastatic sites of a serous borderline ovarian tumor and the favorable response to Arimidex provides support the use of hormone therapy in women with serous borderline ovarian tumor.     

Axillary lymph node metastasis from serous ovarian cancer: a case report and review of the literature

Introduction  The symptoms and findings of ovarian cancer are parallel with the degree of intra-abdominal expansion of the tumor. Metastases in the early stage occur by peritoneal fluid’s tracking via the circulatory system. Renal and cerebral metastases of ovarian cancer have been previously reported, but axillary lymph node metastasis is quite rare. Axillary lymph node metastasis usually occurs in the advanced stage. Materials and methods  We present a 47-year-old female who had applied adjuvant chemotherapy following cyto-reductive surgery because of stage 3C ovarian cancer. Axillary lymph node metastasis was detected in the postoperative 32 months. Conclusion  As tumors in axillary lymph nodes are found in patients with an ovarian carcinoma, the treatment is also so important too. Metastasis to the breast be differentiated accurately from primary breast cancer, because prognosis and treatment differ significantly. Accurate diagnosis of these metastases may allow more appropriate theraphy such as chemotherapy and prevent the patient from an unnecessary major breast surgery.     

Radical hysterectomy for cervical carcinoma in pregnant women--a case of decidua mimicking metastatic carcinoma in pelvic lymph nodes

Intraoperative histology is commonly used to guide the treatment of women with carcinoma of the cervix. We present a case where frozen section of the pelvic lymph nodes from a pregnant woman was suggestive of metastatic cervical carcinoma but final histology showed only decidual change.     

Coexistence of borderline ovarian epithelial tumor, primary pelvic hydatid cyst, and lymphoepithelioma-like gastric carcinoma

ObjectivesBorderline ovarian tumors (BOTs) represent a heterogeneous group of ovarian epithelial neoplasms. Despite a favorable prognosis, 10–20% of BOTs exhibit progressively worsening clinic. Primary involvement of pelvic organs with echinococcus is very rare. Lymphoepithelioma-like gastric carcinoma is a rare neoplasm of the stomach.Case ReportA 58-year-old woman referred with abdominal swelling and gastric complaints. Imaging studies revealed a huge cystic mass with multiple septations and solid component, another cystic mass with an appearance of cyst hydatid in the pelvis, and thickening of the small curvature of stomach. Gastroscopy revealed an ulcer with a suspicious malignant appearance, and histology of the endoscopic specimen showed severe chronic inflammation and lymphocytic infiltration. No other involvement of hydatid cyst was detected. In the exploration, there was a 25 cm cystic lesion with solid components arising from right ovary, another 6 cm cyst over the former, 7 cm cystic lesion arising from left ovary, and 10 cm mass near the small curvature of the stomach. Excision of the masses; total gastrectomy with esophagojejunal anastomosis; total abdominal hysterectomy; bilateral salpingo-oophorectomy; omentectomy; appendectomy; splenectomy; and pelvic, paraaortic, and coeliac lympadenectomy were performed. Final pathology revealed lymphoepithelioma-like gastric carcinoma, bilateral serous BOT, and hydatid cyst.DiscussionHydatid cyst should always be considered in the differential diagnosis of abdominopelvic masses in endemic regions of the world. Preoperative diagnosis of primary pelvic hydatid disease is difficult and awareness of its possibility is very important especially in patients residing in or coming from endemic areas.     

Debulking of pelvic and para-aortic lymph node metastases in ovarian cancer with the cavitron ultrasonic surgical aspirator

Six patients with metastatic ovarian cancer with extensive involvement of the pelvic and/or para-aortic lymph nodes underwent surgical debulking with the Cavitron Ultrasonic Surgical Aspirator. Intraoperative and postoperative morbidity was minimal. It is suggested that this technique may be used for cytoreductive surgery in combination with standard surgical techniques.     

Malign mural nodules associated with serous ovarian tumor of borderline malignancy: a case report and literature review

Background  

Cystic tumors of ovary, whether benign, borderline, or malignant may be associated with mural nodule of various types, including sarcomas, sarcoma-like mural nodules (SLMN), and foci of anaplastic carcinoma. Cases of serous borderline ovarian tumor with mural nodules of mixed type are very rare.     

腹腔镜下和经腹广泛子宫切除及盆腔淋巴结切除术治疗早期子宫恶性肿瘤的临床效果比较

目的:比较腹腔镜下和经腹广泛子宫切除及盆腔淋巴结切除术治疗子宫恶性肿瘤的临床效果。方法:对我院2008年9月～2010年12月68例早期子宫恶性肿瘤患者行腹腔镜下广泛子宫切除及盆腔淋巴结切除术(腹腔镜组),随机抽取同期60例经腹广泛子宫切除及盆腔淋巴结切除术的病例做对照(开腹组),比较两种术式的手术相关情况,术后恢复情况,手术并发症及术后生存质量等。结果:行腹腔镜手术的68例患者中无1例中转开腹,腹腔镜组在手术时间,术中出血量,淋巴结切除数目,手术并发症,术后住院日和术后体温恢复时间与开腹组相比具有明显优势,差异具有统计学意义(P<0.05);但在膀胱功能恢复时间,盆腔引流液,尿管拔出时间等方面比较,差异无显著意义(P>0.05)。结论:腹腔镜下广泛子宫切除及盆腔淋巴结切除术可达到开腹手术的安全性及有效性,并具有创伤小,术野清晰,并发症少,恢复快等优点,为微创手术治疗妇科恶性肿瘤提供了良好的应用前景。     

Laparoscopic pelvic and paraaortic lymph node dissection in the obese

OBJECTIVE: The aim of this study was to determine the utility of laparoscopic pelvic and paraaortic lymph node dissection in obese women. METHODS: We performed a retrospective analysis from 1/8/96 to 1/14/01 at the University of Oklahoma Health Science Center, evaluating patients who had a Quetelet index (QI) > or =28 and had planned laparoscopic bilateral pelvic and paraaortic lymph node dissections (lnd) for their gynecologic cancer. This group was compared to a matched group of patients that had lnd done by laparotomy. Patients were identified by our institution's database and data were collected by review of their medical records. Data were collected regarding demographics, stage, histology, length of stay, and procedural information including completion rates, estimated blood loss (EBL), operating room (OR) time, lymph node count, assistant, and complications. Associations between variables were analyzed using Student t tests and chi(2) testing, Excel v9.0. RESULTS: Fifty-five patients had planned laparoscopic lnd (Group 1) and 45 patients had lnd via laparotomy (Group 2). All patients had the diagnosis of endometrial cancer. The percentage of stage I patients did not differ between groups (42/55, 71.2% versus 37/45, 82.2%, P = n.s.). Age and QI were also similar between groups, (64.6 versus 58.4, 40.0 versus 39.3, P = n.s.). Laparoscopy was completed in 35/55 (63.6%) cases. Reasons for conversion included obesity (23.6%), adhesions (1.8%), intraperitoneal cancer (5.5%), and bleeding (5.5%). QI > or =35 was associated with a decreased success rate compared to QI <35 (44.4% versus 82.1%, P = 0.004). There was no difference in successful laparoscopy when the first assistant was a fellow or a community obstetrician/gynecologist (61.0% versus 50.0%, P = n.s.). The patients in Group 1 who had laparoscopy completed had a longer OR time compared to those in Group 2 (265.3 versus 140.7 min, P < 0.0001), EBL and transfusion rates were equivalent (361.8 versus 344.2 ml, 5.6% versus 6.7%, P = n.s.), and length of stay was shorter (2.8 versus 4.5 days, P = 0.0004). Group 1 had significantly fewer postoperative fevers (5.5% versus 31.1%, P = 0.0007), fewer postoperative ileus (0% versus 13.3%, P = 0.005), and a trend for fewer wound infections (9.0% versus 22.2%, P = 0.07). CONCLUSIONS: Obesity is not a contraindication to laparoscopic pelvic and paraaortic lymph node dissection. The overall success rate was significantly higher in those patients with a QI <35. Advantages include shorter hospital stay, fewer postoperative fevers, fewer postoperative ileus, and possibly fewer wound infections.