CA 125 regression after two cycles of neoadjuvant chemotherapy as prognostic factor in patients with advanced ovarian cancer and primary peritoneal serous cancer who underwent interval surgical cytoreduction

OBJECTIVES: The aim of our study was to assess the prognostic role of CA 125 regression during neoadjuvant chemotherapy (NAC) in patients with ovarian cancer (OC) or primary peritoneal serous carcinoma (PPSC) that underwent interval debulking surgery (IOC). MATERIAL AND METHODS: Thirty one patients with advanced OC or PPSC (FIGO stage IIIC and IV) who underwent initial exploratory surgery, followed by NAC containing platinum analogs, have been analyzed, retrospectively. We have used a regression coefficient (RCA 125), which was calculated as following: log10 (CA 125 level measured after two cycles of NAC/baseline CA 125) for statistical analysis. The median value of RCA 125 reached -0.788 and has been used to dichotomize. Optimal IOC has been performed in 67.74% (21/31) patients, suboptimal in 25.81% (8/31) patients and 6.45% (2/31) of patients did not undergo IOC due to the progression of the disease. RESULTS: We have noted significant correspondence between time to progression and RCA 125 in univariate analysis, which we have also confirmed in multivariate analysis (HR 0.27; 95% CI, 0.15-0.96; p = 0.0178). Similarly, we have observed significant relationship between overall survival, RCA 125 and extension IOC in univariate analysis. Multivariate analysis confirmed that RCA 125 was independent prognostic factor, HR-0.18 (95% CI, 0.07-0.56; p = 0.004). In case of patients with high RCA 125, a greater rate of optimal debulking cytoreduction (p = 0.0278, U = 50.0) has been observed. CONCLUSIONS: RCA 125 after two courses of NAC appears to be an important prognostic factor in patients with OC or PPSC, who underwent IOC High RCA 125 during NAC seems to be a good predictive factor in order to achieve optimal IOC.     

Giant benign ovarian tumor coexisting with late pregnancy--a case report

We have reported a rare case of a giant ovarian tumor which, due to the lack of proper health care on the side of the patient, had not been diagnosed until 27 weeks of pregnancy. The patient did not demonstrate any clinical symptoms till the moment of the diagnosis. Peripheral blood analysis showed severe anemia at the admission. The right adnex with the multilocular cystic tumor containing bloody fluid and measuring 40 cm in diameter, was removed in the course of the surgical procedure. The histological diagnosis of the tumor was: serous cyst. Surgical removal of the giant tumor allowed for further development of pregnancy and enabled vaginal delivery of healthy newborn at term.     

Assesment of selected parameters depending on the size of abdominal wall incision in patients subjected to minilaparotomy due to benign gynaecological diseases

OBJECTIVES: Considering the enormous advantages of minimally invasive surgery, attempts to introduce less invasive trans-abdominal incisions might represent an alternative to classic gynecologic surgery. The aim of this study is to assess the feasibility and clinical outcome of minilaparotomy in patients operated due to benign gynecological diseases and to analyze selected parameters with regard to the abdominal wall incision size. DESIGN: In this retrospective study, we have described our experience with 26 patients, undergoing minilaparotomy for benign adnexal or uterine diseases. MATERIAL AND METHODS: 26 patients with benign uterine or adnexal diseases, hospitalized from November 2003 until March 2006 at the Department of Surgical and Endoscopic Gynecology at the Polish Mother's Memorial Hospital--Research Institute in Lód?, had undergone successful surgical treatment by means of minilaparotomy. The following procedures were included in the analysis: myomectomy (17 patients), ovarian cystectomy (3 patients), myomectomy and ovarian cystectomy at the same time (3 patients), bilateral salpingo-oophorectomy (1 patient), supracervical hysterectomy (1 patient) and total abdominal hysterectomy with salpingo--oophorectomy (1 patient). RESULTS: The patients' mean age and BMI were 33.85 years (14-50) and 22.95 (18.73-45.17), respectively. The mean operative time was 72.69 min (45-120). The diameter of trans-abdominal incision was 3-6cm and the mean diameter of removed lesions was 76.88 mm (47-200). The mean intraoperative decrease of haematocrit and haemoglobin value was 4.8% (0.2-12.4) and 1.4 g/dl (0.2-3.7), respectively. Blood transfusion was required in case of 3 patients but only in one case it was caused by intraoperative blood loss. There were no significant intra- or postoperative complications. 16 patients needed analgesics for 2.33 days after surgery. Body temperature up to 38 degrees C was observed in 4 patients for 2.5 days. The average time of hospitalization after the surgery was 4.58 days. We have noted a negative correlation between the size of trans-abdominal incision and several factors: operative time, intraoperative blood loss, period of analgesic therapy and time of hospitalization after the surgery. None of these factors was correlated with patients' age or BMI. One-month follow up after the surgery revealed satisfactory wound healing and no complains in case of all patients. All patients deemed the cosmetic effect of the surgery very good. CONCLUSION: Minilaparotomy seems to be a very simple, useful and safe surgical technique which might be an alternative to laparotomy in the management of benign gynecologic diseases. Minilaparotomy is of great value, especially in situations when laparoscopic or vaginal approach is too complicated or too dangerous due to technical reasons.     

Value of the intraoperative assessment of the depth of myometrial invasion in endometrial carcinoma

OBJECTIVES: The aim of the study was to evaluate the value of intraoperative assessment of depth of myometrial invasion in patients with FIGO stage I of the endometrial carcinoma. MATERIAL AND METHODS: A total number of 112 patients with FIGO stage I of the endometrial carcinoma undergoing surgery were enrolled in the study. All patients had undergone intraoperative assessment of the depth of myometrial invasion performed by a surgeon. The depth was determined as more or less than 50% of myometrial thickness according to FIGO classification. Gross visual estimation of the depth of myometrial invasion at the time of the operation was compared with the final histopathological report. Sensitivity, specificity and positive and negative predictive values of the method were determined by means of statistical analyses. RESULTS: The depth of the myometrial invasion was accurately determined by the surgeon in 82.1% of cases. Sensitivity and specificity were 68% and 82.1%, respectively. The accurate prediction rate of the myometrial invasion in the group of patients with well differentiated (G1) endometrial carcinoma was higher (88.4%) than in group with moderately and low differentiated tumour (78.3%). CONCLUSIONS: The accuracy of macroscopic evaluation of myometrial invasion is high and reaches up to 82.1%. The accurate determination rate increases if the differentiation of tumour is higher.     

Thrombotic thrombocytopenic purpura in pregnancy. A case report

Thrombotic thrombocytopenic purpura (TTP) is characterized by microangiopathic hemolytic anemia and thrombocytopenia, accompanied by microvascular thrombosis that causes variable degrees of tissue ischemia and infarction. About 10-20% of TTP cases are associated with the pregnancy. Preterm delivery and intrauterine fetal death are frequent pregnancy complications of TTP. The following paper presents the case of a 32-year-old woman with TTP relapse at 10 weeks of her second pregnancy. Despite regular fresh frozen plasma transfusions, intrauterine fetal death occurred at 21 weeks of gestation. Current views on TTP management during pregnancy have been presented in the article as well.     

Operative treatment of benign ovarian tumours in adolescent patients: laparotomy or laparoscopy?

THE AIM: The aim of the study was a retrospective analysis of operative procedures, laparoscopy or laparotomy, carried out in cases of benign adolescent ovarian tumours. MATERIAL AND METHODS: A retrospective review of 709 patient charts with ovarian tumours, who had undergone surgical interventions at The Department of Surgical Gynaecology and Endoscopy of The Polish Mother's Memorial Hospital--Research Institute in ?ód?--has been conducted. Among groups of girls treated either with laparoscopy or laparotomy, the following parameters were analysed: age of the patients, character of the tumour (based on the pathological result), size of the lesion, type of the surgical procedure, duration of the hospitalisation and postoperative complications. RESULTS: 109 girls had ovarian tumours operated--54 times laparoscopy and 55 laparotomy times were performed. An average age of patients who underwent laparoscopy was 16.2 years, in case of laparotomy: 15.3 years (p > 0.05). An average size of tumours excised in laparotomy was 82 mm (60-190 mm), whereas in laparoscopy 64 mm (30-80 mm) (p > 0.05). The most common laparotomic procedure was the ovarian cystectomy (63%) and cystovariectomy (32%), while during laparoscopy the cystectomy was performed in 92% (p > 0.05). Duration of the laparoscopy was shorter, average was 46.7 min, whereas mean time of laparotomy was 49.2 min (p > 0.05). Also duration of postoperative hospitalisation was longer in case of laparotomy, its average time was 5.4 days in comparison with laparoscopy--2.8 days (p < 0.05). CONCLUSIONS: Laparoscopy performed in adolescents due to benign ovarian tumours seems to be a very safe way of the surgical treatment. Moreover, laparoscopy reduces duration of hospitalisation and convalescence, also giving a nice cosmetic effect.     

Krukenberg tumor--8 years after surgical treatment of gastric carcinoma

The aim of the study was to discuss the case of Krukenberg tumor in a patient, eight years after the diagnosis and surgical treatment of gastric carcinoma. We have concluded that there was no safe period after which distant metastases may be excluded. In case of gastric carcinoma diagnosed in women, a regular gynecological examination is necessary due to a high propability of metastases into ovaries, even if the clinical stage of gastric carcinoma is low.     

The 3020insC NOD2 gene mutation in patients with ovarian cancer

OBJECTIVE: There is an increasing evidence that genetic factors play a role in the etiology of malignant tumors. Mutations of BRCA1 and BRCA2 genes are responsible for an increased risk of ovarian cancer. The role of mutations in NOD2 gene in this type of neoplasm is still under investigation. THE AIM: The aim of this study was to determine: 1. incidence of NOD 2 3020insC constitutional mutation in a group of consecutive women with ovarian cancer, 2. risk of developing ovarian cancer in patients with NOD2 gene mutation, 3. clinical and pathological features of ovarian cancer in NOD2 gene mutation carriers. PATIENTS AND METHODS: Clinical and pathological data were collected from 257 non-selected patients with primary epithelial ovarian cancer. The researches identified NOD2 3020insC gene mutation. On the basis of patient source documentation we obtained the data concerning the age of patients at diagnosis, histopathological recognition, FIGO stage and morphological grade G. RESULTS: 19 out of 257 women were identified with germ-line 3020insC mutation of NOD2 gene (7.39%). An increased risk of ovarian cancer in NOD2 mutation carriers was not revealed (OR=1.01; p=0.928; 95% Cl=0.61-1.66). The mean age at diagnosis of patients with NOD2 mutation was 54.8 (SD=9.9), while for non-carriers it was 53.2 (SD=10.2). The difference between these frequencies was statistically irrelevant (p=0.550). Clinical and pathological profile of ovarian cancer was made. We assessed the following features: age at disease onset, histopathology, FIGO stage and morphological grade G. For NOD2 mutation carriers no statistically significant features of ovarian cancer were revealed. CONCLUSION: 1. Despite high frequency of constitutional mutations occurrence in NOD2 gene in women with ovarian cancer, genetic testing seem not to be justified in all women diagnosed with this disease. 2. Due to a lack of increased risk of ovarian cancer in NOD2 gene mutation carriers, proceedings for them may not differ from recommendations for general population. 3. It is difficult to determine characteristic clinical and pathological features of ovarian cancer for NOD2 gene mutation carriers.