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Robinson W.R.,Section of Gynecologic Oncology | Beyer J.,Texas Tech University Health Sciences Center | Griffin S.,Texas Tech University Health Sciences Center | Kanjanavaikoon P.,Tulane University
International Journal of Gynecological Cancer | Year: 2012

Objectives: To identify patterns of metastasis in patients with recurrent ovarian cancer. The influence of the route of chemotherapy administration and sequence of agents on those patterns is also examined. Methods: A total of 233 women were treated for primary and secondary recurrences after a diagnosis of stage III ovarian cancer. As initial treatment, all underwent optimal debulking surgery followed by combined intraperitoneal/intravenous (IP) chemotherapy with cisplatin/paclitaxel (99 of the 233 women) or intravenous (IV) carboplatin/paclitaxel (134 of the 233 women). Recurrent disease was then treated with either carboplatin with or without liposomal doxorubicin (CLD) or bevacizumab (BEV). The data were reviewed and the types of treatment, sites of metastasis, and timing of recurrence are described. Results: Thirty-five subjects developed extraperitoneal recurrent ovarian cancer, with 26 subjects (74%) after IP treatment, and 9 subjects (26%) after IV treatment. Of these extraperitoneal recurrences, 26 were in the thoracic/pulmonary cavity, 7 were within the central nervous system (CNS), and 2 were in the cutaneous tissues. The CNS and cutaneous lesions were secondary recurrences, and all occurred in subjects who had initially received IP cisplatin/paclitaxel followed by IV BEV for recurrent disease. Conclusions: Extraperitoneal recurrences were more common in women treated with IP chemotherapy for ovarian cancer. Specifically, women treated with IV BEV as secondary therapy after IP were at particularly high risk of extraperitoneal metastases, including in the CNS and cutaneous tissues. Physicians should be aware of the possibility of unusual metastases after the combination of IP chemotherapy and BEV, and future prospective studies of this population should carefully evaluate recurrence site patterns. Copyright © 2012 by IGCS and ESGO. Source

Vaksman O.,Hebrew University of Jerusalem | Hetland T.E.,Section of Gynecologic Oncology | Trope' C.G.,Section of Gynecologic Oncology | Trope' C.G.,University of Oslo | And 2 more authors.
Human Pathology | Year: 2012

MicroRNAs are posttranscriptional regulators of messenger RNA synthesis that are intracellularly processed and transferred by the microRNA-regulating machinery consisting of Drosha, Dicer, and Argonaute. The present study analyzed the expression and clinical role of the microRNA-regulating machinery in advanced-stage ovarian carcinoma. Drosha, Dicer, Argonaute 1, and Argonaute 2 messenger RNA levels were analyzed in 144 specimens (82 effusions, 33 primary carcinomas, and 29 solid metastases) using quantitative polymerase chain reaction. Dicer, Argonaute 1, and Argonaute 2 protein levels were analyzed in 103 of the above specimens by Western blotting. Argonaute 1, Argonaute 2, and Drosha messenger RNAs were overexpressed in effusions compared with primary carcinomas and solid metastases (P <.001), whereas Argonaute 1 protein expression was highest in solid metastases (P =.004). Significantly higher expression of all 4 messenger RNAs was found in effusions compared with primary carcinomas (P <.001 to P =.006), whereas Argonaute 2 messenger RNA (P =.002), Drosha messenger RNA (P =.009), and Dicer protein (P =.006) were overexpressed in solid metastases compared with primary carcinomas. Drosha, Dicer, Argonaute 1, and Argonaute 2 messenger RNAs and protein levels in effusions were unrelated to clinicopathologic parameters. In primary carcinomas, higher levels of 3 messenger RNAs were significantly associated with high-grade histology (P =.003 for Dicer and P =.01 for Drosha and Argonaute 1). Higher Argonaute 2 messenger RNA levels in prechemotherapy effusions were related to shorter progression-free survival (P =.049), a finding that retained its significance in multivariate Cox analysis (P =.046). In conclusion, Drosha, Dicer, Argonaute 1, and Argonaute 2 are differentially expressed at different metastatic sites in ovarian carcinoma compared with primary carcinomas, suggesting a role for these molecules in tumor progression. Their clinical role in metastatic ovarian carcinoma merits further research. © 2012 Elsevier Inc. Source

Mahdi H.,Section of Gynecologic Oncology | Rosa G.,Cleveland Clinic | Harper H.,Cleveland Clinic | Shepard D.,Cleveland Clinic | And 2 more authors.
International Journal of Gynecological Pathology | Year: 2016

We report our experience with prostatic-Type tissue in ovarian teratomas, and in particular we highlight a case of prostatic-Type adenocarcinoma arising within a mature cystic ovarian teratoma in a 32-yr-old woman. On gross examination, the cyst consisted of typical features of a dermoid cyst. Closer examination revealed a single 1.5-cm solid nodule within the cyst. Microscopically, it was composed of a small cyst-like structure lined by urothelium and to one side glandular and stromal tissue consistent with prostate parenchyma. Within the prostatic-Type tissue, there were malignant glands morphologically and immunohistochemically supportive of prostatic-Type adenocarcinoma Gleason score 3+3=6. There were also areas consistent with high-grade prostatic intraepithelial neoplasia. Although there are several reports in the literature of benign prostatic-Type tissue arising within ovarian as well as testicular teratomas, to our knowledge, prostatic-Type adenocarcinoma arising in a mature ovarian teratoma is an extremely rare phenomenon, with only 1 previous report in the literature. © Copyright 2016 International Society of Gynecological Pathologists. Source

Espino-Strebel E.E.,Section of Gynecologic Oncology
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society | Year: 2010

Radical hysterectomy has been the treatment of choice for early-stage cervical cancer. Since its introduction in oncology, modifications to the original technique were made to enhance feasibility, improve cure rate, and decrease postoperative complications. Among these are the identification and preservation of pelvic autonomic nerves, known as the nerve-sparing radical hysterectomy (RH). This retrospective study was conducted to compare the nerve-sparing with the conventional RH in terms of feasibility and safety, including bladder dysfunction and perioperative and postoperative complications and morbidities. Patients with biopsy-proven early-stage cervical carcinoma, cervical carcinoma with central tumor recurrence or persistence after primary radiotherapy, and endometrial carcinoma with cervical involvement treated with RH with or without nerve-sparing technique were included. The perioperative and postoperative complications and bladder function of these patients were analyzed. Ninety-seven patients with early-stage cervical cancer and 24 patients with clinical stage II endometrial cancer underwent RH with or without nerve-sparing technique in a nonrandomized fashion. There was no statistically significant difference between the 2 procedures in terms of duration of surgery, intraoperative blood loss, duration of hospitalization, and morbidity. Patients who underwent the nerve-sparing approach had a statistically significant earlier return of bladder function, with a mean of 9.4 days for the cervical cancer cases (vs 21 days in the non-nerve-sparing group) and a mean of 8.5 days for the endometrial cancer cases (vs 22.6 days in the non-nerve-sparing group). The technique of sparing the pelvic autonomic nerves during RH for early-stage cervical cancer and clinical stage II endometrial cancer is comparable to the conventional method in terms of perioperative complications and morbidity, but is more favorable in terms of return of bladder function. Source

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