Ovarian carcinoma associated with pregnancy: A clinicopathologic analysis of 23 cases and review of the literature

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to analyze and describe cases of ovarian cancer in pregnant women treated at our center and to review the literature concerned, and to discuss the rationale for therapy.</p> <p>Methods</p> <p>Twenty-Three patients of ovarian malignancies during pregnancy were treated at Vali- Asr Hospital between 1991 and 2002. Data on treatment and follow-up were evaluated.</p> <p>Results</p> <p>The incidence of ovarian carcinoma associated with pregnancy in our series was 0.083/1000 deliveries. Eleven (47.8%) were found with ovarian malignant germ cell tumors, five (21.7%) with low malignant potential tumors, four (17.4%) with invasive epithelial tumors, and three (13%) with sex cord stromal tumors. Seventeen (73.9%) of the patients were diagnosed in stage I and had complete remission. Five of the six in advanced stage died. The mean follow-up was 36.3 months. The prognosis was significantly related with stage and histological type (<it>P </it>< 0.05). Sixteen healthy live babies were recorded in this group, and two premature newborn died of respiratory distress syndrome. Chemotherapy was administered to 44% of the patients, in two cases during pregnancy. Overall survival at 5 years was 61%. In most of case conservative surgical treatment could be performed with adequate staging and debulking.</p> <p>Conclusion</p> <p>Early finding of ascitis by ultrasound and persistent large ovarian mass during pregnancy may be related to malignancy and advanced stage. Pregnant women in advanced stage of ovarian cancer seem to have poor prognosis.</p

Maternal serum Dehydroepiandrosterone Sulfate levels and the efficiency of labor

To evaluate the maternal serum dehydroepiandrosterone (DHEA) sulfate levels as a factor influencing labor ‘efficiency’ at term and unsuccessful labor induction. This is a prospective study. In this study the mean (± standard error) maternal serum DHEA sulfate levels of 90 singleton pregnant women in 3 groups with spontaneous labor, need for augmentation and need for induction were compared.Pregnancies complicated by diabetes mellitus, hypertension, fetal growth restriction, tobacco consumption, corticosteriod use or chorioamintis were excluded. Bishop score of all cases was less than 5. Serum DHEA sulfate levels were measured by radioimmunoassay. Dehydroepiandrosteone sulfate levels and other obstetric variables were correlated retrospectively with the clinically determined requirements of oxytocin augmentation of labor, and the outcome of each induction attempt. The t-test, Variance analysis Kruskal –Wallis test, Mann-Whitney test, chi-square (X2) distribution, linear correlation and regression were used for statistical analysis. P&lt;0.05 was considered statistically significant. This study showed that the mean (± standard error) maternal serum DHEA sulfate level was not significantly higher in women who progressed spontaneously through labor (n=30) than in those who required augmentation (n=30) (60.78±4.22 versus 70.38±5.84). No significant difference was found between the mean DHEA sulfate levels of spontaneous labor group (n=30) and cases who had prolonged latent phase (n=21) (66.78±4.22 versus 67.02±7.13) or prolonged active phase disorders (n=9) (60.78±4.22 µg/dl versus 78.22±10.23 µg/dl p=0.25)This study showed that the mean maternal serum DEHA sulfate level was significantly higher in women with spontaneous labor (n=30) than in those who needed induction (n=30) (60.78±4.22 µg/dl versus 39.49±4.56 µg/dl, respectively; p=0.001).In the group who needed induction, the mean DHEA sulfate level waa significantly higher in women who progressed to active labor (n=18) than in whom attempts were unsuccessful (n=12). (48.83±6.48 µg/dl versus 26.96±5.10, respectively p=0.035). in the group who were induced, the main cause of C/S was failure of labor progression (77.8%).The mean DHEA level was significantly higher in women with spontaneous labor (n=28) than in those requiring cesarean delivery (n=7) (61.01±4.22 µg/dl versus 24.67±7.06, respectively; p=0.001). The maternal serum DHEA sulfate level did not correlate significantly with cervical Bishop score on admission (r=0.02, p=0.78). DHEA sulfate may be an important factor iin successful labor induction, and in efficient labo

"STUDY OF CONCURRENT CISPLATIN AND EXTERNAL RADIOTHERAPY PRIOR TO RADICAL HYSTERECTOMY AND LYMPHADENECTOMY IN PATIENTS WITH STAGE IB-IIB CERVICAL CANCER"

The purpose of this study was to describe the feasibility of a combined preoperative chemoradiation program Ib-IIa, bulky and suspicious IIb by radical surgery in patients with stage Ib-IIb cervical cancer. From September 1999 to April 2002, 30 patients with carcinoma of the cervix were treated with preoperative external beam radiotherapy of 45 Gy in 5 weeks. Patients received concurrent continuous infusion of cisplatin 50 mg/m2 for one day in week during 5 weeks of radiation. Radical surgery was performed 4-6 weeks after completion of the preoperative treatment. Toxicity with chemoradiation was usually mild. Two patients developed vesicovaginal fistula, and four developed long-term hydronephrosis that needed ureteral stenting. Clinical response was observed in 100% of the patients (23.7% complete response). The analysis of the surgical specimens revealed complete pathological response in 43.3% of the cases and partial pathological response in 56.7%. The degree of pathological response was not predictable by the degree of clinical response. Thirty months disease-free survival and overall survival were 66.3% and 77.31%, respectively. Patients with complete and partial pathological response were not significantly different in terms of disease-free survival (p= 0.08) and overall survival (p= 0.3). Cisplatin in preoperative chemoradiation is effective and usually welltolerated in bulky cervical cancer and parametrial invasion, inducing a high rate of clinical and pathological complete responses. When this therapy is followed by radical surgery, disease-free and overall survival rates are higher. The latter may be possible only through extensive surgical resection with a parallel increase in complication rates

LONG TERM ORAL ETOPOSIDE AS SECOND LINE THERAPY IN RECURRENT EPITHELIAL CARCINOMA OF THE OVARY

There is a continuing need to identify new agents that are active in ovarian cancer. Etoposide is a derivative of the plant alkaloid epipodophyllotoxin. The availability of etoposide in oral preparation allows prolonged administration by the oral route. In this study, activity and toxicity of etoposide in women with recurrent ovarian cancer are described from a case series of women with recurrent ovarian cancer who had measurable disease. All patients had prior platinum-based chemotherapy and developed progressive disease. Oral etoposide was given as 50 mg/day for 21 days every 4 weeks until progression of disease or prohibitive toxicity. From December 1999 to January 2004, 32 patients were enrolled in this study. Thirty patients received a total of 133 cycles of etoposide. Median age of patients was 49 years (range, 19 to 75). The median number of etoposide cycles was 4 (range, 1 to 12). There were 5 partial responses (16.6%). The mean response duration was 4.8 months (range, 3.5 to 6); median progression-free interval was 7 months (range, 3 to 13) and median survival time was 12.5 months (range, 1.3 to 36). The major toxicity was leukopenia. One patient required red blood cell transfusions and the main non-hematologic toxicity was nausea and vomiting. There were no treatment-related mortalities. Although etoposide appears to exhibit modest activity in recurrent ovarian cancer after platinum-based therapy, response and survival durations are short