Polipektomia z uzupełniającą chemioterapią u chorej z mięsakiem groniastym szyjki macicy – opis przypadku i przegląd piśmiennictwa

Background: Embryonal rhabdomyosarcoma in a form of a polyp of the uterine cervix occurs mainly in young women in their second decade of life. The characteristic microscopic features are: the submucosal cambium layer and the presence of rhabdomyoblasts in the stroma. So far the treatment has not been well defined and ranges from conservative to radical surgery. Case: The presented case is a 22-year old woman with cervical polyp. Polypectomy with D&C was performed in 2005 and the microscopic examination revealed rhabdomyosarcoma botryoides. Detailed examination diagnosed stage Ia of the disease. The patient received 6 cycles of chemotherapy (Vincristine and Actinomycin). Conclusion: Conservative treatment may be considered in young women with favorable prognostic factors who wish to preserve their fertility. Polypectomy followed by chemotherapy is a possible option for such patients.Mięsak groniasty może występować w postaci polipa szyjki macicy, głownie u młodych kobiet w drugiej dekadzie życia. Na charakterystyczny obraz mikroskopowy składają się zagęszczenia niezróżnicowanych komórek w warstwie podśluzówkowej i obecność rhabdomyoblastów w podścielisku. Leczenie chirurgiczne nie zostało jednoznacznie określone i mieści się w szerokim zakresie od chirurgii oszczędzającej do radykalnej. Opis przypadku: Prezentowany przypadek dotyczy 22 letniej kobiety z polipem szyjki macicy. W 2005 roku wykonano usunięcie polipa oraz wyłyżeczkowanie kanału szyjki i jamy macicy a badanie mikroskopowe materiału wykazało mięsaka groniastego. Po dokładnej diagnostyce ustalono stopień zaawansowania nowotworu Ia. Pacjentka otrzymała 6 cykli chemioterapii wg schematu (VA) Wnioski: U młodych kobiet pragnących zachować płodność, z korzystnymi czynnikami rokowniczymi można rozważyć leczenie oszczędzające. Jedną z możliwych opcji jest usunięcie polipa z uzupełniającą chemioterapią

Analiza klinicznych i histopatologicznych czynników ryzyka u chorych z rakiem szyjki macicy pozwalających na identyfikacją pacjentek, u których można zastosować mniej radykalne leczenie

Objective: To determine clinical and histopathological factors in patients with cervical cancer tumors smaller than 2cm in order to identify those who could be operated less extensively with preservation of reproductive organs and lower morbidity. Material and methods: We retrospectively reviewed the records of patients with cervical cancer and a maximum tumor of 2cm in diameter who were qualified for primary surgery in the years 2001-2007 at the Department of Gynecologic Oncology, Cancer Center in Warsaw. Results: From the group of 110 operated patients, 96 were included into the study. Within the analyzed group the infiltration of the parametrium was found in 4 women (4.2%). All of them had squamous cell cancer; stage IB, grade G3. One patient had a tumor 1.5cm in diameter and 3 patients had tumors up to 2cm in diameter. The involvement of lymph nodes was observed in 3 patients with squamous cell carcinoma: in one case the tumor was intermediate grade (G2) and in two cases low grade (G3). The lymph nodes were involved only in patients with tumors greater than 0.5cm. The lymph vascular space invasion was found in 14 patients (14.7%): in 12 with squamous cell cancer and in 2 with adenocarcinoma. The diameter of the tumor was 0.5-1cm in 4 women, 1-1.4cm in 3 women and 1.5-2cm in the majority (7 women accounted for 29% of all patients in that group). No infiltration of the blood vessels could be seen in all 30 women with tumors smaller than 0.5cm. We found a statistically significant relationship between the size of the tumor and the incidence of lymph vascular space invasion (p=0.024). Conclusion: In selective cases fertility organ preserving surgery is possible and safe. In the group of patients with tumor less than 5 mm in diameter no parametrium involvement or lymph metastases were observed. In such situation cervical conisation can be justified. In well-differentiated (G1) tumors less than 2 cm in diameter, less radical surgical procedures can also be performed because no treatment failure has been observed .Cel pracy: Celem pracy była analiza wybranych czynników klinicznych i histopatologicznych umożliwiających mniej radykalne leczenie chorych na raka szyjki macicy z guzami do 2cm średnicy. Materiał i metody: Grupę badaną stanowiły pacjentki ze zdiagnozowanym rakiem szyjki macicy i guzem wielkoścido 2cm zakwalifikowane do pierwotnego leczenia operacyjnego w latach 2001-2007 w Klinice Nowotworów Narządów Płciowych Kobiecych Instytutu Centrum Onkologii w Warszawie. Wyniki: Z grupy 110 operowanych chorych do retrospektywnej analizy włączono 96 osób. W analizowanej grupie pacjentek naciekanie przymacicz odnotowano u 4 pacjentek (4,2%). We wszystkich tych przypadkach były to raki płaskonabłonkowe, w stopniu zaawansowania IB i zróżnicowania G3. Naciek przymacicz zdiagnozowano u jednej chorej z guzem o średnicy 1,5cm, a u 3 kobiet guz miał średnicę 2 cm. Zajęcie węzłów chłonnych odnotowano u 3 pacjentek z rakiem płaskonabłonkowym przy czym w jednym przypadku był to rak średniozróżnicowany (G2), a w dwóch przypadkach niskozróżnicowany (G3). Zajęcie węzłów chłonnych zaobserwowano jedynie u pacjentek z guzami o średnicy większej niż 0,5cm. Zajęcie naczyń chłonnych zaobserwowano u 14 pacjentek (14,7%), u 12 z rakiem płaskonabłonkowym i 2 z rakiem gruczołowym. U 4 pacjentek rozmiar guza mieścił się w przedziale 0,5-1cm, u 3 1-1,5cm a u zdecydowanej większości (7 chorych co stanowiło 29% wszystkich pacjentek w tej grupie) 1,5-2cm. Zaobserwowano statystycznie znamienną zależność między rozmiarem guza a zajęciem naczyń chłonnych (p=0,024). Wnioski: W wybranej grupie pacjentek z rakiem szyjki macicy leczenie chirurgiczne pozwalające na zachowanie płodności jest bezpieczne i możliwe do wykonania. W grupie chorych z guzem nieprzekraczającym średnicy 5mm nie obserwowano naciekania przymacicz ani zajęcia węzłów chłonnych. W tych sytuacjach leczeniem z wyboru może być konizacja szyjki macicy. Ze względu na brak niepowodzeń w badanym materiale, mniej radykalne leczenie może być również rozważone w grupie pacjentek z dobrze zróżnicowanym guzem(G1) o średnicy nieprzekraczającej 2cm

Radical trachelectomy – retrospective analysis of our own case material

Abstract Background: Cytologic prophylactic smears enable diagnosis of cervical cancer in early stages what may allow to preserve reproductive function in selected groups of patients. Aim: Retrospective analysis of our own material in term of oncologic treatment, obstetrics results and percent of surgical complications. Material and methods: In our Department between 01. 06. 2003 and 01. 02. 2011, 14 patients were treated with laparoscopically assisted radical vaginal trachelectomy. In all cases only sentinel node biopsy with negative results allowed to perform radical trachelectomy. In one case tumor recurrence was diagnosed and the patient died. After the procedure two out of fourteen patients became pregnant. One of the patients delivered in 37th week of pregnancy, and the other one miscarried in 11th week. Three patients suffered from surgical complications. Conclusions: Patients with tumor diameter ≤ 2 cm can be treated by using laparoscopically assisted radical trachelectomy, and oncologic results are comparable to classical surgery. The number of surgical complications is slightly higher than in classical method but this method allows to preserve reproductive function in the treated women

Phenolic profiles in apple leaves and the efficacy of selected phenols against fire blight (Erwinia amylovora)

The content and type of phenolic compounds in apple leaves as potential markers of resistance to fire blight were analysed. The amounts of phenolic acids and flavonoids were determined before and after E. amylovora inoculation of leaves of two cultivars: ‘Enterprise’ (highly resistant) and ‘Idared’ (highly susceptible). The basic levels of phenolics in both cultivars was similar but, following the inoculation, in the resistant one faster and more distinguishable changes were observed. The difference between the cultivars was related to the content of the compounds and the rate of release of free phenols from their glucosides. Regarding age dependency, the levels of eight out of 15 phenolics was significantly higher in young leaves of ‘Idared” than in ‘Enterprise’. In the older leaves the differences were limited to four compounds. The amount of salicylic acid in ‘Idared’ was lower than in ‘Enterprise’. In ‘Idared’ accumulation of salicylate after infection was better pronounced than in ‘Enterprise’. Higher levels of naringenin glucosides, 4-hydroxbenzoic acid and gentisic acid were found in ‘Enterprise’. The activity of 13 phenolics tested in vitro against the pathogen showed that gallic acid, phloroglucinol, hydroquinone and phloretin, suppressed its growth. The aqueous solutions of gallic acid, phloroglucinol and hydroquinone also significantly limited the development of disease on pear fruitlet slices but only hydroquinone maintained its protective activity for longer time. It also showed very high efficacy in preventing disease spread on apple shoots. The study adds novel information on the contribution of specific phenolics to apple resistance to fire blight

Measurement of HE4 six months after first-line treatment as optimal time in identifying patients at high risk of progression advanced ovarian cancer

Objectives: The objective of the study was to assess the usefulness of determining HE4 and CA125 in ovarian cancer patients, to indicate which of the measurements may be optimal in the prognosis, depending on the treatment scheme. Material end methods: The concentrations of CA125 and HE4 were performed in 70 patients with advanced ovarian cancer during I-line therapy and after treatment. The subjects were divided based on the treatment scheme: group I - primary surgery and adjuvant chemotherapy, II- neoadjuvant therapy, and surgery. Results: Multivariate analysis showed that HE4 levels six months after treatment was significantly higher in patients with disease progression. ROC analysis in the group of patients treated with neoadjuvant therapy showed that the cut-off values indicating relapse for HE4 and CA125 after six months of follow up, were > 90.4 pmol/L, > 25.6 IU/mL, respectively. In the group of patients not treated with neoadjuvant therapy, the cut-off points differentiating patients with progression were: HE4 > 79.1 pmol/L, CA125 > 30.7 IU/mL. We demonstrated significantly higher HE4 and CA125 at both 6- and 12-months follow-up in patients treated with neoadjuvant therapy. In both groups of patients, the cut-off points were lower than those proposed by the manufacturer of the kits. Conclusions: Measurement of HE4 six months after treatment may be useful in identifying patients at high risk of progression, especially when CA125 levels may be non-specifically elevated. The cut-off values indicating relapse for HE4 and CA125 after six months of follow up may be lower than the normal range

Nuclear survivin expression is a positive prognostic factor in taxane-platinum-treated ovarian cancer patients

<p>Abstract</p> <p>Background</p> <p>Survivin is an inhibitor of apoptosis and a regulator of mitotic progression. TP53 protein is a negative transcriptional regulator of survivin. The aim of our study was to evaluate the clinical significance of survivin expression in advanced stages ovarian cancer with respect to the TP53 status.</p> <p>Methods</p> <p>Survivin and TP53 expression was evaluated immunohistochemically in 435 archival samples of ovarian carcinomas (244 patients were treated with platinum/cyclophosphamide-PC/PAC; 191-with taxane-platinum (TP) agents). Univariate and multivariate statistical analyses were performed in patients groups divided according to the administered chemotherapeutic regimen, and in subgroups with and without TP53 accumulation (TP53+ and TP53-, respectively).</p> <p>Results</p> <p>Nuclear and cytoplasmic survivin expression was observed in 92% and 74% of the carcinomas, respectively. In patients treated with TP, high nuclear survivin expression decreased the risk of disease recurrence and death, and increased the probability of high platinum sensitivity (p < 0.01), but only in the TP53(+) group, and not in the TP53(-) group.</p> <p>Conclusions</p> <p>It appears that TP53 status determines the clinical importance of nuclear survivin expression in taxane-platinum treated ovarian cancer patients.</p

Recurrence risk analysis in patients treated for I clinical stage of endometrial cancer

Introduction: The risk of endometrial cancer recurrence is estimated to be about 20%. In most cases, such situations are recognized in the first 3 years after the primary treatment. Early detection of such episodes leads to effective treatment. The aim of this study was to evaluate some histoclinical factors in the risk of recurrence. Material and methods: Between the year 2001 and 2003, 203 from 243 patients with endometrial cancer underwent surgery. All procedures were performed in accordance with surgical – pathological staging system. The following histoclinical factors were taken into account: age, number of deliveries, BMI, use of estrogens, co- morbidity, histoclinical type, grading and the spread of cancer inside the uterus, pelvis and retroperitoneal space. Results: 29 recurrences (14,3%) were found in all analyzed groups. The mean time of follow – up was 43 months. The mean time of recurrences was 16 months (9 – 51 months). Lymph node metastases were recognized in 28 patients (13,7%). The most important factors in the multivariate analysis were: type of histology ( serous or clear cell cancer) and lymph node involvement. Recognizing 2 or more metastatic lymph nodes significantly increased the risk of recurrences. Conclusion: In patients with endometrial cancer the risk of recurrences increases when lymph node metastases are recognized. This risk is 5 times higher when 2 or more lymph nodes are involved, comparing with patients with one node metastasis . Four times higher recurrence risk is observed in serous or clear cell cancer, comparing with other histological types

Smooth muscle tumor of uncertain malignant potential (STUMP) – clinico-pathomorphological analysis of the cases and literature review

Objectives: This retrospective study was designed to evaluate the clinical and pathological features and outcomes of patients diagnosed with uterine smooth muscle tumor of uncertain malignant potential (STUMP). Material and methods: Ten patients diagnosed with uterine STUMP and seen between 2008 and 2011 at the Memorial Cancer Center – Institute of Oncology in Warsaw were identified using the institution databases. Variables of interest included histopathological details, age at diagnosis, types of treatment and recurrence rate. Results: The mean age at diagnosis was 41 years (range 25–56 years). The mean follow-up time was 16 months (range 4–29 months). Diameter of the tumors ranged from 3 to 29 cm. Uterine bleeding was the second most frequent symptom observed in this cohort. In three cases conservative procedure was performed, whereas in other patients hysterectomy was performed. No recurrence was observed during the follow-up period. In all tumors mitoses were less than 10 per 10/hpf, atypia of middle or severe type, and in 3 cases necrosis was observed. In half of the tumors expression of TP53 was found, and value of MIB 1 was estimated at 2-35%. Conclusions: STUMP should be diagnosed by experienced pathologists due to the fact that they are often misdiagnosed as leiomyosarcomas. Clinical behavior of these tumors allows to consider a conservative management in patients wishing to preserve fertility

Borderline ovarian tumors – diagnosis, treatment and follow-up

Tumors of borderline malignancy account for approximately 20% of all ovarian tumors. Their diagnostic criteria mainly include: the absence of destructive stromal invasion, stratification of epithelial cells, moderate mitotic activity and non-intensified nuclear atypia. The mainstay of treatment is surgery. Indications for radical treatment include older patient’s age and considerable advancement of the disease. The surgery should involve hysterectomy with salpingo-oophorectomy and removal of all macroscopic tumor foci as well as staging, which includes: peritoneal fluid sampling, omentectomy and peritoneal biopsy. Adjuvant treatment is not recommended except for cases with invasive implants. Over 50% of patients with borderline tumors are women at the child-bearing age. In these patients, the wish to preserve fertility should be considered. Conservative treatment consists of tumor removal, preservation of the uterus and at least a part of one ovary as well as staging. The follow-up period should be long since the disease can recur after several or even a dozen or so years. Patients with risk factors (advanced FIGO stage, presence of implants, incomplete staging or a residual tumor mass) should be followed every 3–4 months for the first 2 years, and subsequently, every 6 months. A similar follow-up pattern is recommended in patients after conservative treatment, particularly because most recurrences typically occur within the first 2 years after surgery. The total frequency of relapse is approximately 10–11%. These cases usually involve recurring borderline tumors, but approximately 30% are invasive (2.5–3% of malignant transformation). Conservative treatment is associated with a higher risk of relapse (up to 35%). However, in such cases, tumors are usually of borderline malignancy and can be effectively managed surgically. Invasive relapse is associated with poor prognosis.Guzy o granicznej złośliwości stanowią około 20% guzów jajnika. Kryteriami rozpoznania są: brak destrukcyjnego naciekania podścieliska, nawarstwianie komórek nabłonka, umiarkowana aktywność mitotyczna i nienasilona atypia jądrowa. Podstawową metodą leczenia jest chirurgia. Wskazania do leczenia radykalnego to starszy wiek pacjentki i znaczne zaawansowanie choroby. Zakres operacji powinien obejmować usunięcie macicy z przydatkami i wszystkich makroskopowych ognisk nowotworu oraz staging, w którego skład wchodzą: pobranie płynu z otrzewnej, usunięcie sieci, biopsje otrzewnej. Leczenie adiuwantowe nie jest rekomendowane, z wyjątkiem przypadków, w których obecne są wszczepy inwazyjne. Ponad 50% chorych z guzami o granicznej złośliwości to kobiety w wieku rozrodczym – u nich leczenie powinno uwzględniać chęć zachowania płodności. Leczenie oszczędzające polega na usunięciu zmian nowotworowych z zachowaniem macicy i przynajmniej fragmentu jednego jajnika oraz oceną stopnia zaawansowania. Obserwacja po leczeniu powinna być wieloletnia, ponieważ nawroty mogą występować po kilku, a nawet kilkunastu latach. Chore z czynnikami ryzyka (zaawansowany stopień FIGO, obecność implantów, niepełny staging lub pozostawiona masa resztkowa nowotworu) przez 2 pierwsze lata powinny mieć kontrole co 3–4 miesiące, a następnie co 6 miesięcy. Podobną obserwację zaleca się u pacjentek po leczeniu oszczędzającym, zwłaszcza że największy odsetek nawrotów występuje w ciągu 2 lat po operacji. Częstość nawrotów wynosi około 10–11%. Najczęściej są to wznowy typu granicznego, niemniej około 30% nawrotów ma charakter inwazyjny (2,5–3% transformacji złośliwej). Leczenie oszczędzające wiąże się z wyższym ryzykiem nawrotu (nawet 35%), jednak wznowy mają charakter graniczny i są skutecznie leczone chirurgicznie. Wystąpienie wznowy inwazyjnej wiąże się ze złym rokowaniem