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Background To analyze the 5- and 7-year survival outcomes for women with platinum-sensitive recurrent epithelial ovarian cancer (REOC) who underwent secondary cytoreductive surgery (SCS) plus platinum-based hyperthermic intraperitoneal chemotherapy (HIPEC). Methods From the electronic databases of the Department of Obstetrics and Gynecology at the Catholic University of the Sacred Heart of Rome and of the S. Orsola Hospital, University of Bologna, a consecutive series of REOC patients were selected using the following inclusion criteria: primary platinum-free interval (PFI-1) of 6 months or longer, completeness of secondary cytoreduction score (CC) of 1 or lower, minimum follow-up period of 48 months, Eastern Cooperative Group (ECOG) performance status at recurrence of 1 or less, and platinum-based HIPEC. Progression-free survival (PFS) and post-relapse survival (PRS) were calculated as the time between SCS + HIPEC and secondary recurrence or death, respectively. Results The final study population included 70 women with platinum-sensitive REOC. The median follow-up time was 73 months (range 48–128 months), and the median PFI-1 was 19 months (range 6–100 months). At the time of recurrence, the median peritoneal cancer index was 7 (range 1–21), and a CC score of 0 was achieved for 62 patients (88.6 %). As the HIPEC drug, we used oxaliplatin in 17 cases (38.6 %) and cisplatin in 43 cases (61.4 %). No postoperative deaths were observed, and the complication rate for grades 3 and 4 disease was 8.6 %. The median PFS duration was 27 months (range 5–104 months), and the 5- and 7-year PRS rates were respectively 52.8 and 44.7 %, (median PRS 63 months). Conclusions The current study demonstrated favorable 5- and 7-year PRS rates for platinum-sensitive REOC patients undergoing SCS + HIPEC, which encourages the inclusion of patients in randomized clinical trials for definitive conclusions to be drawn.

ObjectivesIntroduction. The TCGA project identified four distinct prognostic groups of endometrial carcinoma (EC) based on molecular alterations among which two are correlated with an intermediate prognosis: the MisMatch Repair deficient (MMRd) and the No Specific Molecular Profile (NSMP) groups. NSMP represents a heterogenous subset of patients frequently harboring CTNNB1 alterations and presenting distinctive clinicopathologic features comparing with the CTNNB1 non mutant ones. miRNAs are oncological key players that have not been integrated with the TCGA EC classification. The study aimed to evaluate the miRNA expression profile in EC to identify potential novel biomarkers of diagnosis and prognosis.MethodsWe analyzed miRNA expression in 72 ECs specimens previously classified as MMRd (31) and NSMP (41), including 15 with CTNNB1 mutations. In the discovery step, miRNA expression profile was evaluated in 30 cases through TaqMan Advanced miRNA arrays. Subsequently, in the validation step, four miRNAs were analyzed in the total cohort of ECs by specific miRNA Assays.ResultsComparison of CTNNB1 mutant versus non-mutant ECs (irrespective of MMRd/NSMP status) in the discovery cohort showed 39 differentially expressed miRNAs. The top deregulated 4 miRNAs (miR-187, miR-325, miR-499a-3p and 5p) were further validated in 72 ECs. miR-499a-3p and miR-499a-5p maintained the statistical significance showing higher expression in CTNNB1 mutant ECs (p<0.0001, for both). Furthermore, miR-499a expression was able to identify EC subgroups with longer recurrence free survival.ConclusionsConclusion. miR-499a may be a useful biomarker and could be integrated in the current TGCA classification scheme to better stratify EC patients

Introduction/Background*Sentinel node mapping (SNM) has replaced lymphadenectomy for staging surgery in apparent early-stage endometrial cancer (EC). Here, we evaluate the long-term survival of three different approaches of nodal assessment in low, intermediate, and high-risk EC.MethodologyThis is a multi-institutional retrospective study evaluating long-term outcomes (at least 3 years of follow-up) of EC patients having nodal assessment between 2006 and 2016. In order to reduce possible confounding factors, we applied a propensity-matched algorithm.Result(s)*Charts of 940 patients were evaluated: 174 (18.5%), 187 (19.9%), and 579 (61.6%) having SNM, SNM followed by backup lymphadenectomy and lymphadenectomy, respectively. Applying a propensity score matching algorithm (1:1:2) we selected 500 patients: 125 SNM vs. 125 SNM plus backup lymphadenectomy vs. 250 lymphadenectomy. Baseline characteristics of the study population were similar between groups. The prevalence of nodal disease was 14%, 16%, and 12% in patients having SNM, SNM followed by backup lymphadenectomy and lymphadenectomy, respectively. Overall, 19 (7.6%) patients were diagnosed with low volume nodal disease (7 and 12 patients with micrometastasis and isolated tumor cells). The mean (SD) follow-up time was 62 (±11) months. The survival analysis comparing the three techniques did not show statistical differences in terms of disease-free (p=0.750) and overall survival (p=0.899). Similarly, the type of nodal assessment did not impact survival outcomes after stratification on the basis of uterine risk factors.Conclusion*Our study highlighted that SNM provides similar long-term oncologic outcomes than lymphadenectomy. Further evidence is warranted to assess the prognostic value of low-volume disease detected by ultrastaging and the role of molecular/genomic profiling.

Introduction/BackgroundBilateral salpingo-oophorectomy offers the greatest risk reduction for ovarian cancer in high-risk women with an identified BRCA germline mutation. The aim of this study was to define the incidence of precursor lesions and cancer after RRSO.MethodologyWe retrospectively reviewed 71 BRCA-mutated patients who underwent RRSO from 2012 to 2017. All cases were examined according to the protocol for Sectioning and Extensively Examining the FIMbriated End (SEE-FIM).ResultsThe median age at RRSO was 49.9 years. BRCA 1 mutation was detected in 46/71 (64.8%) patients, BRCA2 mutation in 25/71 (35.2%) patients. 50/71 (70.4%) patients had breast cancer. BRCA1 breast cancer was more frequently high grade (G3) and showed a strong association to triple negative phenotype (p=0.001), high TILs (tumor-infiltrating lymphocytes), and aberrant expression of p53 (p=0.01). Occult invasive gynecological cancer was detected in two patients: a tubal high grade serous carcinoma in a BRCA2+ patient and an ovarian low-grade endometrioid carcinoma in a BRCA1+ patient. 5 (7%) STIC (Serous Tubal Intraepithelial Carcinoma), 5 (7%) STIL (Serous Tubal Intraepithelial Lesion) and 13 (18.3%) SCOUT (Secretory Cell Outgrowth) were detected. 10 patients had endometriosis and benign ovarian lesions were found in 17 cases. The detection rate of STIC/STIL or invasive cancer was 16.9% (12/71). Tubal lesions were more common in BRCA2 mutation carriers (68% vs. 39%).ConclusionIn our institution, a rigorous surgical protocol with meticulous pathologic review at RRSO yielded an overall detection rate of 9.8% for occult gynecological carcinoma in BRCA mutation carriers.DisclosureNothing to disclose.

Introduction/BackgroundLymphomas involving the gynecologic tract are uncommon and may occur as de novo or secondary as a part of systematic disease. Among gynecological lymphomas, the ovary is the most common anatomic site, accounting for 1.5% of ovarian neoplasm. Involvement of the cervix is more frequent than the uterine body and accounts for less than 1% of extranodal lymphomas. The aim of our study is to improve the use of ultrasound to detect or suspect promptly ovarian and uterine lymphoma through our experience.MethodologyPatients with histological diagnosis of ovarian and uterine lymphomas, from 2011 to 2018, were retrospectively recruited from the database of our Gynecological Oncology Unit. The sonographic reports and digital images were analyzed, recording specific features.ResultsWe recruited seven patients. Five out of seven (71%) of them had ovarian lymphoma, two of them had uterine lymphoma (29%).The echotexture of all the masses had a follicular architecture, reminding the nodular-appearing proliferation in the histology. Median age of the patients was 40 years (range 12–71). All the lymphomas appeared as hypoechoic, without cones of shadows and calcification; lymphomas were discretely solid masses in 5/7 (71%) (median diameter 71 mm, range 26–103 mm), borders were well defined in all the ovarian lymphoma, and shaded in all uterine lymphoma. Internal cystic lacunae were in 3/7 (43%). Vascularisation was moderate in 3/7 cases (43%), and strong in 4/7 (57%), with an evidence of a lead vessel in 5/7 cases (71%).ConclusionOvarian and uterine solid lesions with heterogeneous nodular echogenicity,follicular architecture, rich in vascularization and presence of lead vessel, should be suspected of being lymphoma.DisclosureNothing to disclose.Abstract EP446 Table 1Ultrasound features of ovarian and uterine lymphomasAge of diagnosis (years)LocalizationEchogenicityCone of shadowsVascularization (CS)Lead vesselHistologyInternal cystic lacunaeCalcifications Patient 1 43 Ovary Hypoechoic No 3 Yes Diffuse B Non Hodgkin Lymphoma Yes No Patient 2 21 Ovary Hypoechoic No 3 Yes Diffuse B Non Hodgkin Lymphoma No No Patient 3 12 Ovary Hypoechoic No 4 Yes Aggressive linfocitary B lymphoma No No Patient 4 28 Ovary Hypoechoic No 4 Yes Common linfoblastic lymphoma Yes No Patient 5 71 Ovary Hypoechoic No 3 Yes Aggressive linfocitary B lymphoma Yes No Patienr 6 51 Uterus (body) Hypoechoic No 4 No Centrofollicular B lymphoma No No Patient 7 51 Uterus (cervix) Hypoechoic No 4 No Follicular lymphocitic lymphoma No No Abstract EP446 Figure 1Gray-scale features in ovarian lymphoma in 12 old patientAbstract EP446 Figure 2Vascularization in ovarian lymphoma in 12 old patient

ObjectivesSentinel node mapping (SNM) has replaced lymphadenectomy for staging surgery in apparent early-stage endometrial cancer (EC). Here, we evaluate the long-term survival of three different approaches of nodal assessment in low, intermediate, and high-risk EC.MethodsThis is a multi-institutional retrospective study evaluating long-term outcomes (at least 3 years of follow-up) of EC patients having nodal assessment between 2006 and 2016. In order to reduce possible confounding factors, we applied a propensity-matched algorithm.ResultsCharts of 940 patients were evaluated: 174 (18.5%), 187 (19.9%), and 579 (61.6%) having SNM, SNM followed by backup lymphadenectomy and lymphadenectomy, respectively. Applying a propensity score matching algorithm (1:1:2) we selected 500 patients: 125 SNM vs. 125 SNM plus backup lymphadenectomy vs. 250 lymphadenectomy. Baseline characteristics of the study population were similar between groups. The prevalence of nodal disease was 14%, 16%, and 12% in patients having SNM, SNM followed by backup lymphadenectomy and lymphadenectomy, respectively. Overall, 19 (7.6%) patients were diagnosed with low volume nodal disease (7 and 12 patients with micrometastasis and isolated tumor cells). The mean (SD) follow-up time was 62 (±11) months. The survival analysis comparing the three techniques did not show statistical differences in terms of disease-free (p=0.750) and overall survival (p=0.899). Similarly, the type of nodal assessment did not impact survival outcomes after stratification on the basis of uterine risk factors.ConclusionsSNM provides similar long-term oncologic outcomes than lymphadenectomy. Further evidence is warranted to assess the prognostic value of low-volume disease detected by ultrastaging and the role of molecular/genomic profiling

Introduction/Background*In the last decade, sentinel lymph node mapping (SLNM) has gained a central role in endometrial cancer (EC) surgical staging. However, different technical steps of SLNM still remain object of discussione. Terofere, a randomized control trial (RCT) was conducted to compare cervical and hysteroscopic indocyanine green (ICG) injection for SLNM of newly diagnosed EC undergoing surgical staging. The prima-ry endpoint of the study was to compare these two techniques in term of para-aortic detection rate.MethodologyThis RCT included women with apparent stage I or II histologically confirmed endometrial cancer undergoing surgery were included in the study. Two groups were distinguished according to two different techniques of indocyanine green (ICG) sentinel lymph node mapping (SLNM): cervical versus hysteroscopic injection. This randomized trial was not blinded for both the patients and the surgeons.Result(s)*Since March 2017 until April 2019, 165 patients were randomized: 85 (51.5%) in the cervical group and 80 (48.5%) in the hysteroscopic group. After randomization, 14 (8.5%) patients were excluded from the study. Finally, 151 patients were included in the analysis: 82 (54.3%) in the cervical group and 69 (45.7%) in the hysteroscopic group. Hysteroscopy injection demonstrated a 10% higher accuracy to detect SNLs in the paraaortic area compared to cervical injection, although this difference did not reach statistical significance. The hysteroscopic technique was better in detecting isolated SLN para-aortic (5.8% vs 0%). Cervical injection was correlated with higher SLN detection rates at pelvic level compared to hysteroscopic injection. Pelvic and overall detection was superior in the cervical group.Conclusion*The current study suggests the use of cervical injection rather than hysteroscopic injection due to its better identification of sentinel nodes (particularly in the pelvic area). Although, detection of SLN in the para-aortic area was slightly superior in patients undergoing a hysteroscopic injection, no significant difference with cervical injection was detected.

Background: Second trimester emergency cerclage is an option for pregnant women presenting bulging fetal membranes. Despite a significant prolongation of pregnancy might be achieved, serious fetal and maternal events have been reported. Exclusion of infections through preprocedure amniocentesis has been proposed. Methods: A 37-year-old woman, gravida 4 para 1, was admitted at 21 weeks of gestation to our University Hospital due to bulging fetal membranes. An amniocentesis was performed in order to exclude an actual amniotic infection. Our Microbiology Department found a negative amniotic culture for bacteria and Mycoplasma and a normal glucose and interleukin-6 level, so a cervical cerclage was performed. The patient was discharged home on oral erythromycin. Results: After 48 h, the patient complained of hyperpyrexia, shivers and reduced fetal movements. Ultrasound at admission showed absent cardiac activity and after cerclage removal a non-viable fetus was delivered vaginally. Piperacillin and tazobactam were started, but the clinical course of the patient deteriorated and she developed a cold septic shock and was submitted to hysterectomy and transferred to the ICU of our hospital. Conclusion: This report heralds that even after negative amniocentesis, a life-threatening infection may not be excluded in women candidate for emergency cerclage due to bulging fetal membranes.