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"Ovaries"
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466 Laparoscopic management of huge ovarian cyst; novel technique
This is a case of 35 years old patient who presented with a massive ovarian mass. She underwent fertility-preserving ovarian cystectomy. The technique describes how to manage such ovarian masses while maintaining cancer hygiene and limitation of spillage risks.
Journal Article
125 Results of a randomized phase ii trial of paclitaxel and carboplatin versus bleomycin, etoposide and cisplatin for newly diagnosed and recurrent chemonaive stromal ovarian tumors
ObjectivesTo determine the progression free survival (PFS) of paclitaxel and carboplatin (PC) versus bleomycin, etoposide, and cisplatin (BEP) for treatment of newly diagnosed Stage IIA-IV or recurrent chemotherapy-naive ovarian sex cord-stromal tumors (SCST).MethodsThis study was a phase II, open-label, noninferiority trial. Eligible women with SCST were equally randomized to PC (6 cycles P 175 mg/m2 and C AUC=6 IV every 3 weeks), or BEP (4 cycles B 20 units/m2 IV push day 1, E 75 mg/m2 IV days 1–5, and cisplatin 20 mg/m2 IV days 1–5 every 3 weeks). The targeted 128 patient accrual and PFS hazard ratio (HR)=0.67 provided 85% power to exclude noninferiority margin HR=1.10.Results63 patients were accrued at the interim futility analysis (31 PC and 32 BEP). Median age was 48 years. 87% had granulosa cell tumors. 37% had measurable disease. The DSMB closed the study early for futility of PC. The futility analysis was supported by 21/16 PFS events on the PC/BEP arms respectively, with an estimated HR=1.12 [95% CI: 0.58 to 2.16]. Median PFS was 27.7 months [7.4 to 41.0] for PC and 19.7 months for BEP [95% CI: 10.4–52.7]. PC patients had fewer grade 3 or higher adverse events (PC 77% vs BEP 90%). Differences included infections (0 vs 10%), low neutrophil count (65% vs 84%), and low WBC (22 vs 40%). One death NOS occurred on PC.ConclusionsCompared to BEP, PC failed to improve PFS in ovarian SCSTs. PC showed a more favorable side effect profile.
Journal Article
133 Outcomes of minimally invasive staging for clinical stage I ovarian clear cell carcinoma
ObjectivesCompare outcomes of open and minimally invasive staging (MIS) for patients with early stage ovarian clear cell carcinoma (OCCC).MethodsPatients with clinical stage I OCCC, no history of another tumor and known mode of surgery, diagnosed between 2012–2015 were drawn from the National Cancer Database. Impact of MIS on overall survival (OS) of patients who at least one month of follow-up was assessed with the log-rank test. A Cox model was constructed to control for confounders.ResultsA total of 1402 patients were identified; 438 (31.2%) had MIS. Conversion rate was 11.6%. Laparotomy and MIS groups were comparable in terms of age, race, insurance, co-morbidities, chemotherapy administration, rate of capsule rupture and final pathologic stage distribution. Patients who had MIS had shorter hospital stay (median 2 vs 4 days, p<0.001), smaller tumors (median 8.5 vs 12.5 cm, p<0.001) and were less likely to undergo lymphadenectomy (75.4% vs 82.5%, p=0.002), but had comparable number of lymph nodes removed (median 12 vs 14, p=0.06). Unplanned re-admission rates were comparable between MIS and open (2.1% vs 3.2%, p=0.23). There was no difference in OS between patients who had MIS (n=374) and open surgery (n=858), p=0.64; 3-year OS rates were 87.1% and 88.7% respectively. After controlling for confounders, MIS was not associated with worse survival (HR: 0.92, 95% CI: 0.65, 1.30).ConclusionsFor patients with apparent early stage OCCC, open and MIS staging have similar oncologic outcomes.
Journal Article
Comparison of survival outcomes in optimally or maximally cytoreducted stage IIIC ovarian high-grade serous carcinoma: women with only peritoneal tumor burden versus women with both peritoneal and lymphogenous dissemination
Introduction/BackgroundThe aim of this study was to analyze the survival outcomes of stage IIIC ovarian high-grade serous carcinoma (HGSC) patients with both peritoneal and lymphatic dissemination (IP(+)/RP(+)) who had undergone maximal or optimal cytoreduction followed by intravenous carboplatin/paclitaxel chemotherapy to those women with stage IIIC ovarian HGSC who have only peritoneal involvement (IP(+)/RP(-)) treated similarly.MethodologyWe performed aretrospective, multicenter study by participation of five gynecologic cancer centers. At first, stage IIIC ovarian HGSC patients were classified asoptimally or maximally debulked cohorts. Then in each cohort, patients were divided into two groups:The IP(+)/RP(–) group included women with transcoelomic spread outside the pelvis with no nodal disease,The IP(+)/RP(+) group included patients with transcoelomic dissemination outside the pelvis in addition to positive nodal status.Survival outcomes were compared between the two groups in each cohort.ResultsA total of 405 ovarian HGSC patients were analyzed. In the optimally debulked cohort (n=257), the median progression-free survival (PFS) and overall survival (OS) for the IP(+)/RP(-) group (n=69) was 24 and 57 months, respectively compared to 21 and 58 months in the IP(+)/RP(+) group (n=188) (p=0.78, and p=0.40; respectively). In the maximally debulked cohort (n=148), the median PFS and OS for the IP(+)/RP(-) group (n=55) was 35 and 63 months, respectively compared to 25 and 51 months in the IP(+)/RP(+) group (n=93) (p=0.49, and p=0.31; respectively).ConclusionOur findings indicated no survival difference between the IP(+)/RP(-) and the IP(+)/RP(+) groups after maximal or optimal cytoreduction.DisclosureNothing to disclose.
Journal Article
EP743 Abnormally high levels of Ca19–9 – a mature cystic teratoma case report
Introduction/BackgroundMature cystic teratoma (MCT) is one of the most common benign neoplasms, accounting for 10–20% of all ovarian tumors. Several studies showed CA19-9 -associated with gastrointestinal adenocarcinomas, has been suggested as a potential marker in prediction of ovarian MCT. The relationship between CA19-9 elevation and clinical characteristics of MCT has not been well established.MethodologyTo the extent of our database search, we describe a case of MCT with the highest level of the serum Ca19-9 described in literature.Results51 year old women presented with chronic abdominal pain to our clinic, a pelvic examination and transvaginal ultrasound revealed a 78 × 59 mm multiloculated complex mass with echogenic areas arising from the left adnexa. The ovary was not visualised seperately from the mass. Abdominal examination was normal. Pre-operative CA-125 level was 23 U/ml (range 0–35 U/ml) and CA 19-9 level was 76.810 (range 0–35 U/ml) respectively.Salphingooopherectomy with midline laparotomy was planned. ?ntraoperatively a 10 cm torsioned adnexial mass was visualied. Oopherectomy specimen was sent to frozen section which revealed a mature cycstic teratoma. Extensive histologic sectioning confirmed the diagnosis. The patient's postoperative period was uncomplicated and Ca19-9 sample retained two days postoperatively was 39.882 U/ml.ConclusionSeveral retrospective studies mentioned CA 19-9 elevation appears to correlate with a larger tumor diameter and higher rate of ovarian torsion which corraletes with our case. Another retrospective study evaluating 215 patients with ovarian MCT concluded that serum CA19-9 levels were correlated with larger tumor size, although they failed to show a positive relationship between bilaterality and CA19-9 elevation.CA19-9 elevation was also correlated with the presence of fat component in the tumor at gross pathology findings. Unfortunately since the specimen was disected in frozen section and the cyst has a large sebum component we were not able to figure fat ratio.DisclosureNothing to disclose.Abstract EP743 Figure 1Intraoperative image of the mass
Journal Article
305 A rare case of borderline brenner tumor
ObjectivesTo report a case of borderline Brenner tumorMethodsCase report and literature reviewResultsA 70-year old woman had lower abdominal pain and was found to have a large tumor in the pelvic cavity which had both cystic and solid leisions by ultrasonography and MRI. We underwent a surgery of total hysterectomy, bilateral salpingo-oophorectomy, omentum resection, pelvic and para-aortic lymph node dissection according to a frozen section diagnosis of borderline or malignant tumor of the ovary. The final pathological diagnosis was borderline Brenner tumor, StgaeIC3, which shows an exuberant papillary transitional cellular component with mild nuclear atypia lined by mucinous columnar epithelium without invasion to the stroma. There is no recurrent and metastasis at postoperative 3 months.ConclusionsBorderline Brenner tumor of the ovary is a rare tumor, which has only about 30 case reports of published English literatures. At present, we don’t have enough knowledge about the characteristics of the tumor to decide appropriate treatment. Additional collection of data of this tumor is necessary to establish diagnosis and treatment.
Journal Article
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) affects 5-20% of women of reproductive age worldwide. The condition is characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology (PCOM) - with excessive androgen production by the ovaries being a key feature of PCOS. Metabolic dysfunction characterized by insulin resistance and compensatory hyperinsulinaemia is evident in the vast majority of affected individuals. PCOS increases the risk for type 2 diabetes mellitus, gestational diabetes and other pregnancy-related complications, venous thromboembolism, cerebrovascular and cardiovascular events and endometrial cancer. PCOS is a diagnosis of exclusion, based primarily on the presence of hyperandrogenism, ovulatory dysfunction and PCOM. Treatment should be tailored to the complaints and needs of the patient and involves targeting metabolic abnormalities through lifestyle changes, medication and potentially surgery for the prevention and management of excess weight, androgen suppression and/or blockade, endometrial protection, reproductive therapy and the detection and treatment of psychological features. This Primer summarizes the current state of knowledge regarding the epidemiology, mechanisms and pathophysiology, diagnosis, screening and prevention, management and future investigational directions of the disorder.
Journal Article
Effect of resveratrol and metformin on ovarian reserve and ultrastructure in PCOS: an experimental study
PCOS is a reproductive hormonal abnormality and a metabolic disorder. It is frequently associated with insulin resistance, hyperandrogenism, chronic inflammation, and oxidative stress. We aim to investigate the potential therapeutic effects of combined therapy of resveratrol and metformin on polycystic ovaries via SIRT1 and AMPK activation.
Wistar albino rats were divided into control and experimental (PCOS) groups. DHEA-induced PCOS rats were given resveratrol (20 mg/kg/day), metformin (300 mg/kg/day) and combined therapy. At the end of the experiment, the body and ovarian weight of rats were measured and blood samples were analyzed for FSH, LH, testosterone, AMH, TNF-α and MDA levels. Histopathological evaluation of ovaries were carried out by light and electron microscopy. SIRT1 and AMPK immunreactivity and TUNEL assay were scored. Data were statistically analyzed by SPSS programme.
Metformin and combined treatment groups reduced the body and ovary weights compared to the PCOS group. Serum testosterone levels were significantly higher in the PCOS group than in the control group and this was reduced when PCOS was treated with all but especially resveratrol. All the treatment groups decreased LH, LH/FSH, TNF-α and tissue AMH levels which were induced in the PCOS group, whereas metformin was unable to improve the increased MDA and plasma AMH levels. Treatment with resveratrol and/or metformin ameliorated the elevated number of secondary and atretic follicles and the decreased number of Graafian follicles in the PCOS group, which indicates the effect of the treatments on the maintenance of folliculogenesis. Light and electron microscopic findings supported the analysis of follicular count. Increased number of TUNEL (+) granulosa cells in the PCOS group were reduced significantly in the treatment groups. Resveratrol and metformin increased SIRT1 and AMPK immunreactivity, respectively, compared to the PCOS group.
The results suggest that combined therapy of metformin and resveratrol may improve the weight gain, hormone profile and ovarian follicular cell architecture by inducing antioxidant and antiinflammatory systems via SIRT1 and AMPK activation in PCOS.
Journal Article
Polycystic ovary syndrome and mitochondrial dysfunction
Polycystic ovary syndrome (PCOS) is a prevalent hormonal disorder of premenopausal women worldwide and is characterized by reproductive, endocrine, and metabolic abnormalities. The clinical manifestations of PCOS include oligomenorrhea or amenorrhea, hyperandrogenism, ovarian polycystic changes, and infertility. Women with PCOS are at an increased risk of suffering from type 2 diabetes; me\\tabolic syndrome; cardiovascular events, such as hypertension, dyslipidemia; gynecological diseases, including infertility, endometrial dysplasia, endometrial cancer, and ovarian malignant tumors; pregnancy complications, such as premature birth, low birthweight, and eclampsia; and emotional and mental disorders in the future. Although numerous studies have focused on PCOS, the underlying pathophysiological mechanisms of this disease remain unclear. Mitochondria play a key role in energy production, and mitochondrial dysfunction at the cellular level can affect systemic metabolic balance. The recent wide acceptance of functional mitochondrial disorders as a correlated factor of numerous diseases has led to the presupposition that abnormal mitochondrial metabolic markers are associated with PCOS. Studies conducted in the past few years have confirmed that increased oxidative stress is associated with the progression and related complications of PCOS and have proven the relationship between other mitochondrial dysfunctions and PCOS. Thus, this review aims to summarize and discuss previous and recent findings concerning the relationship between mitochondrial dysfunction and PCOS.
Journal Article