Meigs’ Syndrome with Elevated Serum CA125: Case Report and Review of the Literature

An elevated serum CA125 level in association with a pelvic mass, pleural effusion, and massive ascites usually signifies a dismal prognosis in a postmenopausal woman. However, surgery and histopathological examination are required for the correct diagnosis and treatment, since an elevated CA125 level can be falsely positive for ovarian malignancy. We present a case of Meigs’ syndrome due to right ovarian fibroma with elevated CA125 level in a postmenopausal woman

Epithelial ovarian cancer in the young in Siriraj Hospital

Objective: To access incidence, risk factors, 5-year progression free survival and overall survival in young patients with epithelial ovarian cancer (EOC) in Siriraj Hospital. Methods: Medical records of patients equal or younger than 40 year of age treated with EOC in Siriraj Hospital from January 1998 to December 2007 were reviewed for clinical characteristics, treatments, and outcomes. Survival curves were generated using Kaplan-Meier method. Cox regression analysis to determine multivariate factor for recurrence and survival was performed. Results: Incidence of patients equal or younger than 40 year old with EOC in Siriraj Hospital was 5.8 % of all EOC. Mean age was 33.4±5.4 years. Sixty five percents of patients had abnormal pretreatment CA-125 level. Majority of the patients were in stage I of EOC. Sixty five percents of patients underwent optimal surgery. Adjuvant chemotherapy was applied in 83.7%. Twenty two patients were dead with a median time to death of 3 months. Five-year progression survival was 84.8% and 5-year overall survival was 76% with the median follow up time of 20.5 months. Abnormal pretreatment CA-125 level and suboptimal surgery were the only two independent prognostic factors for survival. Conclusions: The incidence of EOC in the patients equal or younger than 40 year of age is 5.8% of all EOC. The 5-year overall survival rate was 76%. From multivariate analysis, the independent prognostic factors for overall survival were abnormal pretreatment CA-125 level and suboptimal surgery with the hazard ratio of 6.69 (P<0.001) and 2.79 (P=0.033)

Multiple Primary Malignancies in Gynecologic Cancer Patients in Thai Tertiary Care Center: a 10-Year Retrospective Study

Objective: To investigate the incidence, pathologic features, clinical characteristics, oncologic outcomes, and prognostic factors in gynecologic cancer patients with multiple primary malignant tumors (MPMT). Methods: This single-center retrospective study included the medical records of gynecologic cancer patients diagnosed with MPMT according to Warren and Gates’s criteria who were treated at the Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Siriraj Hospital during January 2006 and December 2016. Relevant demographic, clinical, and pathologic data were collected and analyzed. Results: Of 8,076 cases of gynecologic cancer during the study period, 146 women with MPMT were included. Ninety-four women had multiple primary gynecologic cancers (MPGC), and 52 had gynecologic cancer coexisting with non-gynecologic cancer (GNC). The prevalence of MPGC was 1.2%. Synchronous cancer, nulliparous, premenopause, and early stage of endometrial and ovarian cancer were significantly more common among MPGC than GNC. Five-year recurrence-free survival (RFS) was significantly longer in the MPGC group (87.3% vs. 79.6%). Coexisting endometrial and ovarian cancer was the most frequently observed MPGC, with a 5-year overall survival (OS) and RFS of 98.1% and 86.0%, respectively. Specific to this cancer combination, residual tumor and depth of myometrial invasion were found to be independently associated with shorter RFS. Conclusion: The prevalence of MPGC in this study was 1.2%. Five-year RFS was significantly longer among MPGC than among GNC. Three-quarters of MPGC patients had synchronous endometrial-ovarian cancer. Residual tumor and the depth of myometrial invasion were identified as prognostic factors that were independently associated with RFS in the patients with synchronous endometrial-ovarian cancer

Poorly Differentiated Thyroid Carcinoma Arising in Struma Ovarii: Case Report and Review of the Literature

An 81-year-old woman presented with a pelvic mass. The computed tomography scan showed a non- calcifiedsolidcysticmass,10.4x11.5x6.7centimeters.Sheunderwent totalabdominalhysterectomy withbilateral salpingo-oophorectomy,omentectomyandascitic fluidforcytology. Histopathologyreportedpoorlydifferentiated thyroid carcinoma arising in struma ovarii. Currently she has been free of disease for 5 months from the date of diagnosis

The First Laparoendoscopic Single-Site Surgery (LESS) for Endometrial Cancer in Siriraj Hospital

70-year-old woman presented with post-menopausal bleeding. She underwent laparoendoscopic single-site surgery (LESS) for hysterectomy, bilateral salpingo-oophorectomy (BSO), peritoneal washing for cytology, and bilateral pelvic lymph node dissection (BPND). The pathology revealed stage IB, grade I endometrioid adenocarcinoma. She received vaginal brachytherapy postoperatively

Prevalence of ovarian mass and diagnostic performance of ultrasonography pattern recognition among women at the Gynaecologic Ultrasonography Unit at University Hospital in Thailand

The aim of this retrospective study was to determine the prevalence of ovarian masses and calculate the diagnostic performance of the pattern recognition approach in ovarian pathology. A total of 1001 patients diagnosed with ovarian mass were included, of which 92.6% were diagnosed with ovarian pathology and the presence of a pathological result, while 7.4% of cases were diagnosed with functional ovarian cyst. The prevalence of ovarian malignancy was 15%. A specific ultrasound diagnosis was suggested in 62.9% of all cases, while sonographers did not explicitly provide a diagnosis in remaining cases. A subjective assessment showed 80.3% sensitivity (95% confidence interval (CI) 68.7–89.1) and 97.6% specificity (95% CI 96–98.6) in differentiating between benign and malignant ovarian masses. The sensitivity and specificity for the diagnosis of endometriotic cyst were 77.03% and 90.63% and 63.19% and 94.3% for mature cystic teratoma, respectively. In conclusion, assessment showed good performance in differentiating between benign and malignant ovarian mass and it was possible to diagnose several specific ovarian tumours. Impact Statement What is already known on this subject? Pattern recognition is an acceptable method for classifying ovarian mass, which exhibits specific morphological features on grey-scale ultrasonography, and can be used to predict nature and histological type. What do the results of this study add? Even in the hands of an expert examiner, there were a number of cases in which the diagnoses could not be specifically stated. Pattern recognition correctly classified 90.3% of ovarian masses as either benign or malignant and correctly provided specific histologic diagnoses after exclusion of unspecified diagnosis in 80.6% of all cases. The diagnostic performance of this approach was high in differentiating between benign and malignant ovarian mass and in diagnosing some specific ovarian pathologies. What are the implications of these findings for clinical practice and/or further research? A subjective assessment is simple and easy to use in clinical practice and has shown promising results in classifying benign and malignant ovarian mass. Moreover, it can also be used to make some specific diagnoses. However, specialised and experienced gynaecological ultrasound examiners are required to provide the most accurate diagnosis. Therefore, criteria to describe ultrasound features and convincing operators to make a definite diagnosis as often as possible should be encouraged. A prospective study to verify diagnostic performance of pattern recognition or comparing with other ultrasonographic diagnostic tools should be considered

Comparison of the Oncologic Outcomes between Exploratory Laparotomy and Laparoscopic Surgery for Endometrial Cancer: Siriraj Experience

Objective: This study was undertaken to evaluate surgical and oncologic outcomes for patients with endometrial cancer, compared between exploratory laparotomy and laparoscopic surgery. Methods: In total, 324 patients who diagnosed with endometrial cancer during January 2007 to December 2016 were enrolled. The comprehensive surgical staging procedures, including total hysterectomy, bilateral salpingo-oophorectomy (BSO), pelvic lymphadenectomy (PL), and/or para-aortic lymphadenectomy (PAL) were undergone. Demographic, clinical, treatment, operative, outcome, and survival outcome were recorded and evaluated. Results: 81 patients performed laparoscopy without conversion. No significant difference in baseline characteristics and pathological characteristics between two groups was observed. When compared with laparotomy group, the laparoscopy group had longer operative time, shorter hospital stays, and lower blood loss. Two-year overall survival (OS) was 97.9% and 95.1% in the laparotomy and laparoscopy groups, respectively (p=0.263). In addition, 2-year disease-free survival (DFS) between both groups was equal (93.7% versus 88.6%, respectively; p=0.309). Conclusion: Laparoscopic surgery is an efficacious, achievable and safe technique for patients with endometrial cancer. Good surgical skills and proper surgical techniques are required to effectuate optimal outcomes