Recurrence in Uterine Tumors with Ovarian Sex-Cord Tumor Resemblance: A Case Report and Systematic Review

Objective: The aim of this study was to evaluate the prognostic factors of recurrence in uterine tumors resembling ovarian sex-cord tumors (UTROSCT) and to determine clinical-pathological characteristics, treatment options and outcome. Material and Method: An electronic literature search was conducted from 1976 to 2018. After the comprehensive evaluation and conjunction with our case, the study included 79 cases. Results: The median age at initial diagnosis was 49 years (range; 16-86 years). The age was under 40 years in 21 (26.6%) patients. Whereas 68 patients underwent at least hysterectomy, 9 patients had organ sparing surgery. There was necrosis in 4 (5.1%) patients, atypia in 16 (20.3%) patients, and infiltrative tumor border in 34 (43%) patients. At least one mitosis per 10 high power fields was determined in 36 (45.5%) patients. The tumor involved at least part of the myometrium in 54 (68.3%) patients. Median follow-up time was 30 months (range; 3-296 months). Recurrence was determined in 5 (6.3%) patients. The disease free survival (DFS) was significantly related only to surgery type. None of the pathologic features were associated with DFS. The 5-year DFS was 86% and 96% in patients who underwent organ sparing surgery or not, respectively (p=0.038). Conclusion: The accurate pathologic diagnosis of UTROSCT has great value in shaping surgical management and management during the follow-up period. Organ sparing surgery was related to poor DFS. Although recurrence is rare, it should be kept in mind for patients with UTROSCT

Prenatal Diagnosis Of Tay-Sachs Disease

OBJECTIVE: To emphasize the efficacy and safety of the prenatal invasive procedures for prenatal diagnosis of Tay-Sachs disease. STUDY DESIGN: In this case series, the results of the prenatal invasive procedures that were performed for diagnosing Tay-Sachs disease in 8 patients between 2000 and 2008 are reported. The samples were obtained by chorionic villus sampling or by cordocentesis. Total hexosaminidase level and the percentage of isoenzyme ß-Hexosaminidase A were measured in fetal samples. RESULTS: There were 8 patients in diagnosed prenatatlly between 2000-2008. Sufficient material for enzyme analysis was obtained without any complications. Total hexosaminidase levels and the percentage of hexosaminidase were in normal limits in all fetal samples. All pregnancies ended up with uneventful term births. CONCLUSION: Tay-Sachs disease can be diagnosed prenatally by measuring hexosaminidase enzyme activity in fetal tissue samples with an acceptable complication rate. Prenatal diagnosis should be offered to families who have affected siblings with Tay-Sachs disease

Fordyce Spot of Vulva Confused with Condyloma Accuminatum

Fordyce spots are ectopic sebaceous glands which are most commonly seen on lips and oral mucosa. Patients are asymptomatic and do not require treatment unless cosmetic concerns arise. Fordyce spots can also be seen on vulva. However, in such patients, more common vulvar disorders including condyloma accuminatum may be considered clinically instead of Fordyce spots. Therefore, any vulvar lesion without typical appearance should be sampled and examined histopathologically before initiating treatment. A woman with vulvar Fordyce spots who was misdiagnosed to have condyloma accuminata is presented. The patient admitted to a gynecologist with a complaint of chronic vulvar pruritus. After vulvar inspection, topical imiquimod cream was given with a presumed diagnosis of condyloma accuminatum. The patient then admitted to our hospital without commencing therapy. She was subjected to biopsy after examination due to atypical lesions. Papules located on both labia minora were reported to be Fordyce spots and random biopsy was consistent with chronic inflammation. Therefore, she was given topical corticosteroid instead of imiquimod

Does Preoperative Diagnosis of Endometrial Hyperplasia Necessitate Intraoperative Frozen Section Consultation?

Background: In women with endometrial hyperplasia, there is a risk for co-existent endometrial cancer when patients are subjected to immediate surgical treatment. Aims: The aim of this study was to investigate the frequency of endometrial cancer and the accuracy of frozen section analysis at the time of hysterectomy among patients with endometrial hyperplasia, to reveal whether or not a preoperative diagnosis of endometrial hyperplasia necessitates frozen section consultation. Study Design: Retrospective cross-sectional study. Methods: A department database review was performed to identify patients who were subjected to hysterectomy with a preoperative diagnosis of endometrial hyperplasia, during the period from 2007 to 2014. Results: The study group included 189 cases. The final pathological examination revealed endometrial cancer in 16 women (8.4%). The risk of cancer in patients with endometrial hyperplasia was 1 of 125 (0.8%) in simple hyperplasia without atypia, 1 of 21 (4.8%) in complex hyperplasia without atypia and 14 of 43 (32.5%) in atypical hyperplasia. Of women with cancer, 2 of 16 (12.5%) had high-risk features. Frozen section analysis was requested in 46 cases. Frozen sections helped to identify six out of 11 cases of endometrial cancer (54.5%). The sensitivity, specificity and positive and negative predictive values of frozen section analysis for the detection of endometrial cancer among women with endometrial hyperplasia were 54.4%, 97.2%, 85.7% and 87.5%, respectively. Conclusion: Although a significant proportion of patients with atypical endometrial hyperplasia are diagnosed with endometrial cancer following hysterectomy, most of these cases have low-risk features and do not require surgical staging. Additionally, intraoperative frozen section analysis if not helpful for diagnosing concurrent endometrial cancer in patients with endometrial hyperplasia. Therefore, it seems that patients with endometrial hyperplasia can be operated upon in settings with no available method for obtaining frozen sections intraoperatively.WoSScopu

Stage Iiic Transitional Cell Carcinoma And Serous Carcinoma Of The Ovary Have Similar Outcomes When Treated With Platinum-Based Chemotherapy

Objective: Previous studies reported better outcomes for transitional cell carcinoma (TCC) of the ovary when compared with more common histologic types such as serous epithelial ovarian cancers (EOCs). The aim of this study was to compare the survival outcomes of platinum- based chemotherapy in patients with stage IIIC TCCs and serous EOCs. Material and Methods: Clinicopathologic features and survival data of patients with FIGO stage IIIC TCC and serous EOC who had undergone primary surgery followed by six cycles of intravenous platinum/taxane between 2007 and 2015 were retrieved from the database of Hacettepe University Hospital. Results: We identified 14 (10.9%) TCCs and 114 (89.1%) serous EOCs. The median follow-up duration was 28 months (range, 3-101 months). Univariate analysis revealed that the TCCs and serous EOCs had similar progression-free survival (PFS) and overall survival (OS). Patients with residual disease less than 1 cm had longer OS than patients with residual disease greater than 1 cm (75.0 vs. 45.0 months, p=0.012). Cox regression analysis of all potential prognostic factors showed that the only independent prognostic factor significantly associated with OS was residual disease less than 1 cm [hazard ratio=0.38; 95% confidence interval: (0.19-0.77); p=0.007]. Conclusion: Surgically treated advanced stage TCCs did not have a significantly better prognosis after platinum/taxane-based chemotherapy when compared with serous EOCs. Residual tumor volume after primary surgery was the only independent predictor of OS in patients with EOC. Our results demonstrate the significance of achieving optimal cytoreduction in all histologic subtypes of EOC.PubMedScopu

Pregnancy after Cancer Treatment and Pregnancy Associated Cancer: A Single Center Experience with 96 Cases

OBJECTIVE: The objective of our study was to evaluate our experience on pregnancies after cancer treatment and pregnancy-associated cancer. STUDY DESIGN: The clinical records of 96 pregnant women including previously received treatment for cancer and association of cancer with pregnancy who admitted to our department were enrolled between 2002 and 2012. Demographics, pregnancy outcomes, maternal and fetal complications, perinatal outcomes, cancer types and treatments performed were evaluated. RESULTS: The study group was consisting of 96 cases, 59 out of 96 were cancer survivors and 37 were pregnancy-associated cancer patients. Of those thirty seven, 25 were synchronous with the pregnancy and 12 were metachronic. Pregnancies resulted in 77 healthy newborns, 7 abortions and 12 medical terminations. The most common type of cancer was the breast cancer in 25 patients, followed by thyroid, leukemia, osteosarcoma, lymphoma and ovarian cancer. Patients were treated for their cancer with different modalities including surgery, chemotherapy and radiotherapy. We encountered maternal mortality in 8 cases, all occurred after delivery. CONCLUSIONS: Since management of a pregnancy of a cancer survivor and pregnant woman with cancer a hard work, multidisciplinary approach involving gynecologists, pediatricians, oncologists is essential. Interval between cancer and pregnancy and timing of initiation of therapy in cases of pregnancy associated cancer are important issues in the perspective of fetal/neonatal well-being

Can we predict surgical margin positivity while performing cervical excisional procedures?

We designed this study to evaluate any factors associated with positive surgical margin in conisation specimens and to determine the optimal cone size. The medical records of patients who had undergone a loop electrosurgical excision procedure (LEEP), cold-knife conisation (CKC) and needle excision of the transformation zone (NETZ) procedure were reviewed retrospectively. Two hundred and sixty eight women fulfilled the inclusion criteria. Univariate analyses showed that ‘postmenopause’, ‘HSIL on smear’, ‘previous colposcopic examination revealing HSIL in endocervical curettage (ECC) material and in two or more ectocervical quadrants’ and ‘managing with LEEP’ were significant predictors of surgical margin positivity. Nulliparous patients showed significantly lower rate of surgical margin positivity. ‘Postmenopause’, ‘previous colposcopic examination revealing HSIL in ECC material and in two or more ectocervical quadrants’ and ‘HSIL on smear’ were identified as independent predictors of surgical margin positivity according to multivariate analyses.IMPACT STATEMENT What is already known on this subject? Previous studies demonstrated ‘menopause’, ‘Age ≥50’, ‘managing with LEEP’, ‘disease involving >2/3 of cervix at visual inspection’, ‘training level of the surgeon’, ‘cytology squamous cell carcinoma’ and ‘mean cone height’ as factors associated with positive surgical margin in conisation specimens. What do the results of this study add? In our study, univariate analyses showed that ‘postmenopause’, ‘HSIL on smear’, ‘previous colposcopic examination revealing HSIL in endocervical curettage material and in two or more ectocervical quadrants’ and ‘managing with LEEP’ were associated with surgical margin positivity. On the other hand, nulliparous women showed significantly lower rate of surgical margin positivity compared with parous women. Multivariate analyses showed that ‘postmenopause’, ‘previous colposcopic examination revealing HSIL in endocervical curettage material and in two or more ectocervical quadrants’ and ‘HSIL on smear’ were independent predictors of surgical margin positivity in conisation specimens. What are the implications of these findings for clinical practice and/or further research? We can predict high-risk patients with regard to surgical margin positivity. Prediction of high-risk patients and management with a tailored approach may help minimise surgical margin positivity rates

Uterine Smooth Muscle Tumors of Unknown Malignant Potential (STUMP): A Dilemma for Gynecologists and Pathologists

Uterine smooth muscle tumors of uncertain malignant potential (STUMP) belong to a subcategory of uterine smooth muscle tumors. The clinical behavior of these tumors is also not clarified. It is hard to state which histological features of STUMPs might represent high recurrence rates. The follow up period also has not been mentioned. For clinicians, STUMPs are difficult tumors to manage since they clinically present as ordinary fibroids. For pathologists, diagnosis of these tumors could be difficult because these tumors are rare and a certain level of expertise in gynecological pathology is required to make a correct diagnosis. Here we report a patient with STUMP that subsequently recurred as a leiomyosarcoma, aiming to remind the disease and its recurrence risk even if followed strictly

Is neurosurgery with adjuvant radiotherapy an effective treatment modality in isolated brain involvement from endometrial cancer? From case report to analysis

WOS: 000393415900019PubMed ID: 27984379Aim: The aim of this study was to evaluate the treatment options and post-brain involvement survival (PBIS) of patients with isolated brain involvement from endometrial cancer (EC). Materials and Methods: The literature electronic search was conducted from 1972 to May 2016 to identify articles about isolated (without extracranial metastases) brain involvement from EC at recurrence and the initial diagnosis. Forty-eight articles were found. After comprehensive evaluation of case series and case reports, the study included 49 cases. Results: The median age of the patients at initial diagnosis was 57 years (range, 40-77 years). Poor differentiation was determined in 36 (73.5%) patients. Thirty-five (71.4%) patients had a single brain lesion. Lesion was found in the supratentorial part of the brain in 33 (67.3%) patients. Median PBIS for all cohorts was 13 months (range, 0.25-118 months) with 2-year PBIS of 52% and 5-year PBIS of 37%. Age, tumor type, grade, disease-free interval, diagnosis time of brain lesion, localization, and number of brain lesionwere not predictive of PBIS. Two-year PBIS was 77% in patients who underwent surgical resection and radiotherapy, whereas it was 19% in the surgical resection-only group, and 20% in the primary radiotherapyYonly group (Ps = 0.003 and 0.001, respectively). Chemotherapy was not associated with improved PBIS. Conclusions: Although neuroinvasion from EC appearsmostly with a disseminated disease, there is a considerable amount of patients with isolated brain involvement who would have a higher chance of curability. Surgery with radiotherapy is the rational current management option, and this improves the survival for isolated brain involvement from EC