Complete Response in a Patient with Granulosa Cell Tumor Treated with a Combination of Leuprolide and Tamoxifen

Background: Adult granulosa cell tumors (GCTs) are frequently hormonally active. Thus, hormonal agents have been evaluated for the treatment of advanced-stage or recurrent disease. Case Report: A 39-year-old patient presented with recurrent GCT. The patient received multiple treatment modalities, including surgery and 2 different chemotherapy regimens (cisplatin- and taxane-based). Abdominal computed tomography following these treatments showed local recurrence with multiple implants. The patient's inhibin B level increased to 187 pg/ml at this time. The patient was treated with leuprolide 11.25 mg every 3 months and tamoxifen 20 mg twice daily. The patient's inhibin B level began to decrease after 1 month and returned to normal after 4 months. The patient has been maintained on this treatment for 2 years and has tolerated the drugs well. Conclusion: The combination of leuprolide and tamoxifen had limited side effects in the presented patient and might be a viable treatment option for women with advanced-stage or recurrent adult ovarian GCTs

Unilateral Massive Ovarian Edema Mimicking Ovarian Malignancy

Background and AIMS: Massive ovarian edema, only around 80 cases reported in literature, is a rare entity often misdiagnosed for a malignancy posing the patient at risk for over-treatment with resultant hormonal dysfunction and infertility. METHODS: A 20-year-old nulliparous woman presented with a right adnexial mass of 17x8cm after 3 weeks of abdominal pain with presumptive diagnosis of ovarian malignancy. All tumor markers were in normal range. RESULTS: During laparotomy, a semi-twisted enlarged ovary was found. Frozen section of the wedge biopsy revealed massive ovarian edema. Oooferectomy was not performed. CONCLUSIONS: Massive ovarian edema should be kept in mind in differential diagnosis of solid ovarian masses in young women. Conservative surgery should be the rule in order to preserve future fertility

THE VALUE OF LYMPHATIC MAPPING IN THE MANAGEMENT OF CERVICAL CANCER

Cervical cancer is second most common cancer among women under the age of forty years in the world. Radical hysterectomy and pelvic lymphadenectomy are the mostly used procedures in early stages of cervical cancer. In 90% of the patients undergone radical hysterectomy pelvic lymph node metastasis were negative. Therefore pelvic lymphadenectomy do not add any benefit to the survival of the patients, on the contrary the morbidity may increase due to procedure. Currently no method is present to detect accurately preoperative lymph node metastasis. But in the past years sentinel lymph node studies were performed, to perform lymphadenectomy in node positive patients and to avoid lymphadenectomy due to complications in node negative patients. In this paper the value of lymphatic mapping in the management of cervical carcinoma is reviewed. Various investigators studied patent blue, lymphoscintigraphy and combine methods to evaluate the sentinel lymph node metastasis and best results were obtained by combine methods

Assessment of endometrial hyperplasias in 69 tamoxifen-treated asymptomatic postmenopausal women

OBJECTIVE: To analyze the relationship between transvaginal ultrasonography (TU), hysteroscopy and endometrial histology in asymptomatic postmenopausal women with breast cancer using tamoxifen, in terms of hyperplasias. Design: Prospective study Setting: University clinic Patients: 69 postmenopausal aymptomatic breast cancer women on tamoxifen Interventions: TU and hysteroscopy plus endometrial biopsy Main Outcome Measures: Sensitivity specifity, positive and negative predictive values of diagnostic procedures were calculated. The relationship between duration of tamoxifen use and development of hyperplasias are calculated by using simple logistic regression. RESULTS: Most common abnormality encountered was polyps (60.9%). A case of endometrioid adenocarcinoma on a polyp and 6 cases of hyperplasia (one atypical hyperplasia) along with the polyps were categorized into “polyps only” by hysteroscopy. Hence all would have been missed if biopsies if biopies were not taken. Positive predictive value (PPV) of TU was calculated to be 69.6%. Sensitivity and PPV of hysteroscopy is low for hyperplasia (33.3% and 50% respectively). A positive correlation was noted (p = 0.002) between duration of tamoxifen use and development of hyperplasia related changes. CONCLUSIONS: Long term use of tamoxifen in ostmenopausal asymptomatic breast cancer patients is associated with higher incidence of hyperplasia related changes. Hyperplasia might coexist with or on a polyp, therefore hysteroscopy might miss these pathologies if ample amount of biopsies are not taken

Recurrence of Granulosa Tumor of The Ovary in a Bartholin Gland

Objective: Granulosa type of sex-cord stromal tumor of the ovary is rare. They tend to recur late mostly in the pelvis, but intraabdominal and hepatic metastases are also seen. We would like to present a case, operated for granulosa tumor 10 years ago, who had a recurrence in bartholin gland along with intraabdominal metastases. As far as we know, this is the first case in literature of a granulosa tumor recurring in a bartholin gland. Results: Having optimally operated for a stage I granulosa tumor (macrofollicular and diffuse types - grade 2 differentiation) 10 years ago, the 54 year-old-patient with complaints of abdominal distention and presence of a palpable mass in vulva was diagnosed to have widespread relapse. She had mild complaints for almost a year but she did not seek medical advice. The main necrotic mass was around 25 cm and she had two other omental metastasis of around 7 cm, all optimally removed by surgery. The other mass of 5x2.5 cm located in the bartholin gland was also excised. All lesions were reported to be recurrence of the granulosa cell tumor. The patient had adjuvant chemotherapy and was well at her 6th month of postoperative follow-up. Conclusions: Although mostly recurring in pelvis and abdomen, we document a case of recurrent granulosa cell tumor of the ovary in vulvar bartholin gland. Since granulosa tumor recurrences are thought to arise from occult disease, it may be speculated that this recurrence was spread from the intra-abdominal metastasis hematogenously

Assessment of Endometrial Hyperplasias in 69 Tamoxifen-Treated Asymptomatic Postmenopausal Women

Objective: To analyze the relationship between transvaginal ultrasonography (TU), hysteroscopy and endometrial histology in asymptomatic postmenopausal women with breast cancer using tamoxifen, in terms of hyperplasias

Fertility outcomes after preconceptional laparoscopic abdominal cerclage for second-trimester pregnancy losses

Objective(s): Cervical incompetence is an important cause of recurrent pregnancy loss, typically presenting in the second trimester with silent cervical dilation and premature delivery of the fetus. We aimed to evaluate the conception rate and time to conception or failure to conceive after preconceptional laparoscopic abdominal cerclage (LAC)