Article: Association between ovarian endometriosis and malignancy in the peri-menopausal period: report of two cases and review of the literature[show abstract] [hide abstract]
ABSTRACT: The association of endometriosis and ovarian malignancy is about 1%, with a peak incidence in patients over 45years. The best way of treating peri- and post-menopausal women with endometriosis is still a very controversial issue. We report two cases of peri-menopausal women in which endometriosis was associated to ovarian malignancy. The first case was a 49-year-old woman who underwent laparoscopic oophorectomy for an ovarian endometrioid cyst. Definitive histology showed ovarian endometrioid cyst with endometrioid and clear cell carcinoma. Subsequently, surgical restaging was performed. The other case was a 49-year-old woman who underwent hysterectomy and bilateral oophorectomy for an ovarian mass suggestive of endometriosis and uterine myomas. At frozen section examination, ovarian adenocarcinoma was found and staging procedure was performed. Definitive histology showed carcinosarcoma of the ovary with areas of endometriod adenocarcinoma. Given the non-infrequent association between ovarian endometriosis and cancer, more data are needed to decide for an aggressive or conservative approach to peri-menopausal endometriosis.Gynecological Surgery 04/2012; 7(1):13-17.
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ABSTRACT: Granulosa cell tumor (GCT) of the ovary is an uncommon neoplasm, often diagnosed at an early stage. Surgery is necessary for definitive diagnosis and staging. Complete staging is recommended as for epithelial ovarian cancer and a restaging procedure is sometime required. The staging procedure should include evaluation of para-aortic and pelvic lymph nodes. We report three cases of laparoscopic restaging of GCT. The patients were treated in our Institution from August 2005 to January 2007. They were diagnosed an ovarian cyst and underwent laparoscopic adnexectomy. Histology showed a GCT (one case of juvenile type in a 38-year-old woman). All the patients were submitted to laparoscopic restaging with pelvic and para-aortic lymphadenectomy. Mean operation time was 195min. A mean number of 32 lymph nodes were removed. No major intraoperative or postoperative complication occurred. Patients were discharged on the second or third postoperative day. All the patients are well and without disease. Laparoscopic restaging of GCT is feasible and allows para-aortic and pelvic lymphadenectomy. Patients restaged by laparoscopy benefit of a less invasive treatment.Gynecological Surgery 04/2012; 6(1):77-81.
Article: Angiogenesis and molecular markers in advanced epithelial ovarian cancer: a retrospective study.Annamaria Ferrero, Daniela Dompè, Nicoletta Ravarino, Angela Ramella, Luca Fuso, Furio Maggiorotto, Elisa Tripodi, Paolo Zola[show abstract] [hide abstract]
ABSTRACT: The role of molecular markers in ovarian cancer is still a matter of debate. Angiogenesis is a necessary condition for tumor growth. Hypoxia induces angiogenesis, and cyclooxygenase-2 (COX-2), p53 and HER2 are involved in cancer proliferation and angiogenesis regulation. The aims of this study were to evaluate the relationship between intratumoral microvessel density (IMD) and the expression of molecular markers that affect angiogenesis (COX-2, p53 and HER2) in advanced epithelial ovarian cancer (EOC), to analyze their prognostic and predictive value and their association with clinicopathological features, such as serum hemoglobin level at diagnosis (Hb). Immunohistochemical staining with CD34 (for IMD), COX-2, p53 and HER2 antibodies was performed in 113 patients with advanced EOC who had undergone primary surgery. Clinicopathological data were collected and statistical analyses were performed. Neither IMD, COX-2 nor HER2 had any predictive or prognostic value in EOC. A relationship that approached statistical significance was found between p53 expression and a complete response to treatment (p=0.05). p53 expression and tumor grade were inversely associated (p=0.012). Hb<12g/dl had predictive value (p=0.02). In our series IMD, COX-2 and HER2 had neither prognostic nor predictive value in advanced EOC. p53 and Hb may be predictive factors. The results and clinical usefulness of immunohistochemistry are controversial. Further evaluations are required to determine whether the serum levels of molecular markers correlate with the results of immunohistochemical assays and whether they offer any prognostic and/or predictive value. Targeted therapy remains the ultimate goal of these studies.Gynecologic Oncology 08/2011; 123(2):301-7. · 3.89 Impact Factor
Article: Laparoscopic bipolar coagulation of hypogastric artery in postpartum haemorrhage: a case report.[show abstract] [hide abstract]
ABSTRACT: Background. Postpartum haemorrhage (PPH) is a significant contributor to worldwide maternal morbidity and mortality. When PPH continues despite aggressive medical treatment, early consideration should be given to surgical intervention. Various surgical interventions may be used but conservative interventions are recommended primarily. Case. This case report describes laparoscopic coagulation of hypogastric artery technique in a patient with PPH. Conclusions. Laparoscopic ligature of the hypogastric artery for PPH treatment can be a valid alternative to laparotomy in patients with vaginal delivery.Case reports in obstetrics and gynecology. 01/2011; 2011:250325.
Article: Pretreatment platelet and hemoglobin levels are neither predictive nor prognostic variables for patients with locally advanced cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy: a retrospective Italian study.Angiolo Gadducci, Stefania Cosio, Paolo Zola, Giancarlo Tisi, Annamaria Ferrero, Elisa Piovano, Renza Cristofani, Carlo Greco, Enrico Sartori[show abstract] [hide abstract]
ABSTRACT: To assess the predictive and prognostic values of pretreatment platelet and hemoglobin levels in patients with locally advanced cervical cancer who underwent neoadjuvant chemotherapy followed by radical hysterectomy. The authors retrospectively assessed 140 patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB2-IIB cervical cancer who underwent chemosurgical treatment. Median pretreatment platelet and hemoglobin levels were 272,000/μL and 12.5 g/dL, respectively. Fourteen patients achieved a pathologically complete response, and 26 had an optimal partial response, with an optimal pathological response rate of 28.6%. By univariate analysis, optimal pathological response rate was associated with well/moderately differentiated grade (P = 0.02) and platinum-/paclitaxel-based chemotherapy regimen (P = 0.04), but not with platelet and hemoglobin levels. Multiple logistic regression confirmed that tumor grade (odds ratio, 2.827; 95% confidence interval [95% CI], 1.250-6.397; P = 0.01) and chemotherapy regimen (odds ratio, 5.416; 95% CI, 1.459-20.110; P = 0.01) were independent predictors of optimal pathological response. Five-year recurrence-free survival and 5-year overall survival were 66 % and 73%, respectively. By log-rank test, recurrence-free survival and overall survival were associated with pathological response (P = 0.0002 and P = 0.001), lymph node status, (P = 0.008 and P = 0.002), lymphovascular space status (P = 0.005 and P = 0.003), and parametrial and/or surgical margin status (P = 0.004 and P = 0.001), but not with platelet and hemoglobin levels. On multivariate analysis, pathological response (hazard ratio [HR], 7.999; 95% CI, 1.916-33.394; and HR, 6.007; 95% CI, 1.426-25.307) and parametrial and/or surgical margin status (HR, 2.061; 95%CI, 1.047-4.058; and HR, 2.561; 95% CI, 1.244-5.271) were independent prognostic variables of recurrence-free survival and overall survival. The achievement of an optimal pathological response is the strongest independent prognostic variable for patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy, whereas pretreatment platelet and hemoglobin levels seem to be neither predictive of response to chemotherapy nor prognostic of long-term outcome.International Journal of Gynecological Cancer 11/2010; 20(8):1399-404. · 1.65 Impact Factor