Adult Granulosa Cell Tumors of the Ovary: A Retrospective Study of 36 FIGO Stage I Cases with Emphasis on Prognostic Pathohistological Features

Objective . Adult granulosa cell tumors (AGCTs) represent 2% – 5% of all ovarian malignancies. The aim of this study was to analyze clinical and pathohistological parameters and their impact on recurrence, overall, and disease-free survival in FIGO stage I AGCT patients. Methods. The tumor specimens analyzed in this retrospective study were obtained from a total of 36 patients with diagnosis of ovarian AGCT surgically treated at the Department of Gynecology, Rijeka University Hospital Centre, between 1994 and 2012. Clinical, pathological, and follow-up data were collected. Results. The mean age at diagnosis was 54.5 years with a range of 24 – 84. The majority of the patients, 30 (83%), were in FIGO stage IA, 3 (8%) in stage IC1, 1 (3%) in stage IC2, and 2 (6%) in stage IC3. During follow-up period (median 117.5 months, range 26 – 276), recurrence occurred in 4 patients (12%) with 2 deaths of the disease recorded. In univariate analysis, the 5-year survival rates were signi fi cantly shorter in patients with FIGO substage IC ( p =0 019 ), with positive LVSI ( p =0 022 ), with presence of necrosis ( p =0 040 ), and with hemorrhage ( p =0 017 ). In univariate analysis, the 5-year disease-free survival rates were signi fi cantly shorter in patients treated with fertility surgery ( p =0 004 ), with di ff use growth pattern ( p =0 012 ), with moderate and severe nuclear atypia ( p =0 032 ), and with presence of hemorrhage ( p =0 022 ). FIGO substage IC proved to be independent predictor for recurrence (OR = 16.87, p =0 015 , and OR = 23.49, p =0 023 , resp.) and disease-free survival ( p =0 0002 ; HR 20.84, p =0 02 ) at the uni- and multivariate analyses. Conclusions. FIGO substage IC is predictive of recurrence and disease-free survival in patients with early-stage AGCTs. LVSI, presence of necrosis and hemorrhage, di ff use growth pattern, and nuclear atypia in AGCTs seem to be associated with overall and disease-free survival, so these pathological features should be taken into consideration when managing patients with AGCT

ANALYSIS OF PROGNOSTIC FACTORS AND OF TYPE OF TREATMENT IN PATIENTS WITH ENDOMETRIAL CANCER IN THE FIRST FIGO STAGE

Cilj rada. Ispitati važnost histopatoloških čimbenika rizika i svrsishodnost načina liječenja u bolesnica s rakom endometrija u kirurškom – FIGO stadiju I. Metode. Retrospektivno je izdvojeno 219 bolesnica s rakom endometrija u kojih je učinjen sveobuhvatni staging (lavat negativan, limfne žlijezde negativne). Srednja dob bolesnica iznosila je 59 godina (SD 8, min. 39, maks. 75 godina). Vrijeme promatranja iznosilo je od 1 do 180 mjeseci, medijana 68 mjeseci. Analizirani su u odnosu na petogodišnje preživljenje sljedeći prognostički čimbenici: dob bolesnice, dubina invazije miometrija, histologija i diferenciranost tumora, vrsta histerektomije i primjena adjuvantne radioterapije. U 85 bolesnica učinjena je radikalna histerektomija, dok je njih 55 primilo adjuvantnu radioterapiju. Rezultati. Ukupno preživljenje promatrane skupine bolesnica iznosi 92,8%. Analizom svih prognostičkih parametara nije nađena značajnost u razlici preživljenja. Od 219 bolesnica njih 82 (37,4%) imale su kumulativne negativne prognostičke čimbenike, slabo diferencirani tumor ili neendometrioidni histološki nalaz ili invaziju miometrija preko polovice, a preživljenje između visoko rizične i nisko rizične skupine se bitno ne razlikuje (93,9% odnosno 91,2%). Primjena radikalne histerektomije uz adjuvantnu radioterapiju ne daje bolje rezultate preživljenja od radikalne histerektomije. Zaključak. Prema našoj retrospektivnoj analizi čimbenika rizika u bolesnica s rakom endometrija prvog FIGO stadija, analizirani čimbenici rizika nemaju prognostičko obilježje. Primjena radikalne histerektomije s ili bez adjuvantne radioterapije zdjelice ne pruža bolje rezultate u smislu preživljenja, i daljnju primjenu treba temeljito preispitati.Objective. To analyze the effect of histopathologic characteristics and usefullness of therapy mode in FIGO stage I endometrial cancer patients. Methods. Retrospectively were analyzed 219 endometrial cancer patients with hysterectomy, salpingoophorectomy and pelvic lymphadenectomy (peritoneal cytology and nodes negative). Patients characteristics include age, myometrial invasion, FIGO substages, histologic type, tumor grade, type of hysterectomy and adjuvant radio¬therapy. The mean age was 59 years (SD 8, Min. 39, Max. 75 years). Follow up ranges from 1 to 180 months (median 68). In 85 patients radical hysterectomies were performed and 45 patients received adjuvant radiotherapy. Results. Five year disease related survival was 92,8%. There is no significant difference among analyzed histopathologic patient’s characteristics related to five years survival. In 82 (37.3%) patients out of 219 were found cumulative negative prognostic factors (high risk patients) including non-endometrioid histology, poor tumor differentiation and/or outer half of miometrial invasion. There is no difference in survival between low (91,2%) and high risk patients (93,9%). Radical hysterectomy as well as adjuvant radiotherapy has no advantage in five year survival. Conclusion. This retrospective study has not identified histopathologic prognostic significant characteristics in FIGO stage I endometrial cancer patients. The use of radical hysterectomy and/or adjuvant radiotherapy has not better five years survival and should be reevaluated

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH OVARIAN CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak jajnika i jajovoda po učestalosti je peta zloćudna bolest žena u Hrvatskoj. Histološki je rak jajnika najčešće epitelnog podrijetla, i to seroznog podtipa. Rjeđi su različiti neepitelni malignomi jajnika, a posebnu skupinu čine epitelni karcinomi niskoga zloćudnog potencijala karakterizirani neinvazivnošću, klinički indolentnim tijekom i dobrom prognozom te primarni rak potrbušnice i rak jajovoda. Klinički su ovi zloćudni tumori u ranim stadijima razvoja uglavnom asimptomatski, zbog čega se najčešće dijagnosticiraju u kasnijim stadijima bolesti. Dijagnoza se potvrđuje patohistološkim nalazom, a iznimno citološkim nalazom nakon provedene dijagnostičke obrade. O liječenju odlučuje multidisciplinarni tim uzimajući u obzir dob, opće stanje i komorbiditete bolesnice, kao i obilježja samog tumora uključujući stadij bolesti, histološki tip i gradus tumora. Principi liječenja primarnog raka potrbušnice i jajovoda temelje se na principima liječenja epitelnog raka jajnika koji obuhvaćaju primjenu kirurških zahvata, kemoterapije, imunoterapije i hormonske terapije, kao i suportivno-simptomatskih mjera tijekom cijelog liječenja. Razlikuje se terapijski pristup rjeđim, neepitelnim histološkim tipovima tumora koji se češće dijagnosticiraju u ranim stadijima bolesti, imaju indolentniji tijek pa se kod ovih bolesnica češće primjenjuju poštedni kirurški zahvati s ciljem očuvanja plodnosti. U tekstu koji slijedi predstavljene su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja te praćenja bolesnica s rakom jajnika, jajovoda i potrbušnice u Republici Hrvatskoj.Ovarian cancer together with fallopian tube represents the fifth most common female cancer in the Republic of Croatia. Epithelial ovarian cancer, serous subtype, encompasses most of malignant ovarian neoplasms. Less common are various non-epithelial ovarian malignancies. A special group consists of epithelial carcinomas of low malignant potential with clinically indolent flow, good prognosis and no invasion, and primary cancer of the peritoneum and fallopian tube cancer. Clinically, these malignant tumors are generally asymptomatic in early stages, and usually diagnosed in advanced stages. The diagnosis is confirmed by pathological examination, and occasionally, cytological findings after completing diagnostic procedures. Multidisciplinary team makes treatment decisions, taking into account age, general condition and comorbidities of the patient and characteristics of the tumor itself, including disease stage, histological type and grade of the tumor. The principles of treatment of primary peritoneal and fallopian tube cancer are based on the principles of treatment of epithelial ovarian cancer involving surgery, chemotherapy, immune and hormone therapy, and symptomatic-supportive care throughout the treatment. Less common histological types have a different treatment approach being more frequently diagnosed in the early stages of the disease, have more indolent flow, so in these patients conservative surgeries with the goal of preserving fertility are more often employed. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with ovarian carcinoma, fallopian tube and primary peritoneal cancer in the Republic of Croatia

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH UTERINE CERVICAL CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak vrata maternice, u odnosu na malignome drugih ginekoloških sijela, jest bolest mlađih žena koja se može redovitim kontrolama i zdravstvenim odgojem prevenirati, a u slučaju pojave bolesti učinkovito liječiti. Metode liječenja uključuju kirurgiju, radioterapiju i kemoterapiju, ovisno o stadiju bolesti i općem stanju bolesnica. Odluku o liječenju donosi multidisciplinarni tim. S obzirom na važnost ove bolesti, potrebno je definirati i provoditi standardizirani pristup u dijagnostici, liječenju i praćenju ovih bolesnica. U tekstu koji slijedi iznesene su kliničke smjernice s ciljem implementacije standardiziranih postupaka u radu s bolesnicama s rakom vrata maternice u Republici Hrvatskoj.Cervical cancer, in comparison with other gynecological malignancies, mainly affects younger women. It can be prevented trough educational programs, screening and early detection. It also can be efficiently treated when it appears. Treatment modalities include surgery, chemotherapy and radiotherapy, according to the stage of the disease and patient condition. Treatment decisions should be made after multidisciplinary team discussion. Due to the significance of this disease it is important to define and implement standardized approach for diagnostic, treatment and monitoring algorithm as well. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with uterine cervical cancer in the Republic of Croatia

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH ENDOMETRIAL CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak trupa maternice javlja se u većini slučajeva u poslijemenopauzalnih žena, a najčešće se očituje ginekološkim krvarenjem. Nakon raka jajnika i vrata maternice treći je uzrok smrti žena od raka spolnog sustava. Dijagnoza se postavlja patohistološkim pregledom kiretmana ili bioptata, a definitivni stadij bolesti utvrđuje se analizom uzoraka dobivenih histerektomijom i obostranom salpingoovariektomijom sa zdjeličnom i paraaortalnom limfadenektomijom. U tekstu koji slijedi sadržane su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja i praćenja bolesnica s rakom trupa maternice u Republici Hrvatskoj.Uterine cancer occurs mainly in postmenopausal women, usually as vaginal bleeding. Following ovarian and cervical cancer it is the third most common cause of female reproductive system cancer death. Diagnosis is set by analyzing samples obtained via hysterectomy with salpingo-oophorectomy and pelvic / paraaortal lymphadenectomy. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, treatment and monitoring of patients with uterine cancer in the Republic of Croatia

Primary carcinosarcoma of the vagina associated with differentiated squamous intraepithelial neoplasia in a patient with complete uterine prolapse: case report and review of the literature.

Vaginal carcinosarcomas (VCSs) are rare and clinically aggressive neoplasms. Primary vaginal malignancies are among the rarest malignant tumors, so clear management guidelines and optimal therapy, especially in the presence of significant pelvic organ prolapse, has not been determined. Here, we present a case of primary VCS closely associated with differentiated squamous intraepithelial neoplasia (DSIN), from which it appeared to have arisen in a postmenopausal patient with complete uterine prolapse. The unusual presentation of our case with DSIN in the adjacent vaginal epithelium with possible diagnostic pitfalls emphasizes the need for systemic presentation of these cases to help pathologists and clinicians know that such lesions can initially present in a patient with complete uterine prolapse. To our knowledge, this is the first case of vaginal DSIN described in the literature to date

Kliničke upute za dijagnostiku, liječenje i praćenje bolesnica oboljelih od raka jajnika Hrvatskoga onkološkog društva i Hrvatskog društva za ginekologiju i opstetriciju Hrvatskoga liječničkog zbora te Hrvatskoga ginekološkoonkološkog društva [Clinical recommendations for diagnosing, treatment and monitoring of patients with ovarian cancer - Croatian Oncology Society and Croatian Society for Gynecology and Obstetrics as Croatian Medical Association units and Croatian Society of Gynecological Oncology]

Ovarian cancer together with fallopian tube represents the fifth most common female cancer in the Republic of Croatia. Epithelial ovarian cancer, serous subtype, encompasses most of malignant ovarian neoplasms. Less common are various non-epithelial ovarian malignancies. A special group consists of epithelial carcinomas of low malignant potential with clinically indolent flow, good prognosis and no invasion, and primary cancer of the peritoneum and fallopian tube cancer. Clinically, these malignant tumors are generally asymptomatic in early stages, and usually diagnosed in advanced stages. The diagnosis is confirmed by pathological examination, and occasionally, cytological findings after completing diagnostic procedures. Multidisciplinary team makes treatment decisions, taking into account age, general condition and comorbidities of the patient and characteristics of the tumor itself, including disease stage, histological type and grade of the tumor. The principles of treatment of primary peritoneal and fallopian tube cancer are based on the principles of treatment of epithelial ovarian cancer involving surgery, chemotherapy, immune and hormone therapy, and symptomatic-supportive care throughout the treatment. Less common histological types have a different treatment approach being more frequently diagnosed in the early stages of the disease, have more indolent flow, so in these patients conservative surgeries with the goal of preserving fertility are more often employed. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with ovarian carcinoma, fallopian tube and primary peritoneal cancer in the Republic of Croatia

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH ENDOMETRIAL CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak trupa maternice javlja se u većini slučajeva u poslijemenopauzalnih žena, a najčešće se očituje ginekološkim krvarenjem. Nakon raka jajnika i vrata maternice treći je uzrok smrti žena od raka spolnog sustava. Dijagnoza se postavlja patohistološkim pregledom kiretmana ili bioptata, a definitivni stadij bolesti utvrđuje se analizom uzoraka dobivenih histerektomijom i obostranom salpingoovariektomijom sa zdjeličnom i paraaortalnom limfadenektomijom. U tekstu koji slijedi sadržane su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja i praćenja bolesnica s rakom trupa maternice u Republici Hrvatskoj.Uterine cancer occurs mainly in postmenopausal women, usually as vaginal bleeding. Following ovarian and cervical cancer it is the third most common cause of female reproductive system cancer death. Diagnosis is set by analyzing samples obtained via hysterectomy with salpingo-oophorectomy and pelvic / paraaortal lymphadenectomy. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, treatment and monitoring of patients with uterine cancer in the Republic of Croatia

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH ENDOMETRIAL CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak trupa maternice javlja se u većini slučajeva u poslijemenopauzalnih žena, a najčešće se očituje ginekološkim krvarenjem. Nakon raka jajnika i vrata maternice treći je uzrok smrti žena od raka spolnog sustava. Dijagnoza se postavlja patohistološkim pregledom kiretmana ili bioptata, a definitivni stadij bolesti utvrđuje se analizom uzoraka dobivenih histerektomijom i obostranom salpingoovariektomijom sa zdjeličnom i paraaortalnom limfadenektomijom. U tekstu koji slijedi sadržane su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja i praćenja bolesnica s rakom trupa maternice u Republici Hrvatskoj.Uterine cancer occurs mainly in postmenopausal women, usually as vaginal bleeding. Following ovarian and cervical cancer it is the third most common cause of female reproductive system cancer death. Diagnosis is set by analyzing samples obtained via hysterectomy with salpingo-oophorectomy and pelvic / paraaortal lymphadenectomy. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, treatment and monitoring of patients with uterine cancer in the Republic of Croatia