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Purpose: To study the characteristics of borderline tumors (BOT) diagnosed during pregnancy, as either first diagnosis or relapse, to evaluate safety of expectant management., Methods: 15 women affected by BOT during pregnancy were included, to evaluate clinical and histo-pathological characteristics. Age of patient, parity, gestational age, follow-up time, size of tumor, surgical approach, type and timing of surgery, FIGO stage, and histologic type were obtained through retrospective review., Results: All patients except one were diagnosed with serous BOT (BOTs). Median follow-up time was 147 ± 57 months. Eight women received first diagnosis of BOT and seven had diagnosis of BOT recurrence during pregnancy, including three with a second relapse and four with a third relapse. BOT were diagnosed at FIGO stage I in most patients (75%) of the first group and in 14.3% of the second group, respectively. Micropapillary pattern was present in 71.4% of patients with first diagnosis of BOT, but only in 14.2% in case of relapse. All relapses were BOTs. No patient with BOT and concomitant pregnancy developed an invasive recurrence later. Overall, 24 relapses occurred in 10 patients (66.7%). Altogether 24 pregnancies occurred during follow-up, with a high livebirth rate (91.6%) and only 2 spontaneous miscarriages., Conclusion: According to our experience, an "expectation management" could be a safe option in case of both relapse of BOTs during pregnancy and first suspicion of BOT in pregnant women at advanced gestational age., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Transvaginal sonographically guided puncture may be used for diagnostic and therapeutic purpose in general gynecology and in oncology. To define the complication rate of this technique, 500 consecutive procedures were reviewed; 289 procedures were on cystic masses, 146 on solid tumors, 34 on mixed tumors, and 31 on other lesions. No life-threatening complications occurred. Early mild and self-limited complications developed in eight procedures (1.6%). Short-term complications occurred in four cases (0.8%; two infections, one pelvic pain, one hemorrhage); two of these required surgery. Transvaginal sonographically guided puncture is safe and does not entail a higher risk of infection than transabdominal punctures.

Objective: To evaluate the anti-tumour activity and toxicity of ifosfamide (5 g/m2 continuous infusion) and mitoxantrone (10 mg/m2) given in combination every 3 weeks in patients with ovarian cancer resistant to at least two previous regimens which included platinum., Patients and Methods: Additional eligibility criteria were an ECOG performance status < or = 2 and measurable disease. Of 47 patients entered in the study, 8 were defined as platinum-resistant and 39 as potentially sensitive according to Markman's criteria. Thirty-five patients had also received paclitaxel as last treatment before entering this study. Tumour response was evaluated every three cycles., Results: One complete and 11 partial responses were reported, for an overall response rate of 25% (95% CI: 14%-40%). Three of the partial responders were resistant to platinum. None of the 7 partial responders pretreated with taxol had responded to it. The overall median survival was 11 months. Neutropenia G4 was reported in 18 patients (42%) with hospitalisation because of febrile neutropenia in 3 of them., Conclusions: In patients with ovarian cancer failing at least 2 previous therapies including platinum, the combination of ifosfamide and mitoxantrone has shown an antitumour activity comparable to that of paclitaxel, with acceptable toxicity. Objective responses were reported also in patients failing paclitaxel, suggesting a lack of cross resistance.

Background: Central nervous system (CNS) involvement by ovarian carcinoma is rare., Patients and Methods: From September 1982 to September 1994, 23 patients with CNS metastases from ovarian carcinoma were observed in our institution., Results: Their median age at the time of CNS metastasis diagnosis was 59 years, and the median interval between diagnosis of ovarian cancer and documentation of the metastasis was 35 months. The most common symptoms related to CNS involvement were motor weakness, headache, seizures, dizziness and visual disturbances. One patient had meningeal carcinomatosis; 22 had parenchymal lesions (18 cerebral and 4 cerebellar). Nine patients had a single CNS lesion, and 13 had multiple metastatic sites. CNS was the only site of disease in 9 patients, while 8 had concomitant extraperitoneal dissemination. The median survival (MS) from diagnosis of cerebral metastases for the entire series was five months. Four patients were not treated (MS 3 months); 14 received radiotherapy (MS 5.5 months), and five underwent surgical resection of solitary metastases followed by radiotherapy (MS 17 months). Number of CNS lesions, extent of the disease at the time of CNS metastasis and treatment were the only factors which significantly affected survival, Conclusions: The prognosis of patients with CNS metastasis from ovarian carcinoma appears poor. However, early diagnosis followed by multimodal treatment may result in significant palliation and improve overall survival in a selected group of patients.

The authors prospectively evaluated the effects of three different schedules of cisplatin (DDP) administration in 60 patients with advanced epithelial ovarian cancer. The individual total dose of DDP was 450 mg/m2 in all three groups, and the anti-cancer response at the end of treatment was similar for the different regimens. The clinical and neurophysiologic results confirmed that axonal sensory neuropathy occurred after the standard administration of DDP (75 mg/m2 in 3-week cycles) and probably not only the peripheral, but also the central sensory pathway, was involved. Although the total dose of the drug was identical, the two less conventional schedules were less neurotoxic. These results suggest that not only the total-dose intensity, but also the single-dose intensity are relevant in the onset of DDP-induced sensory neuropathy; therefore, the use of less neurotoxic schedules may prevent or reduce sensory nerve damage.

Sensorimotor polyneuropathy is the most common of the paraneoplastic syndromes involving the nervous system. Its incidence is high (more than 50%) in the patients undergoing neurophysiological investigation, and it is considered to be more frequent in subjects with lung and breast cancers. In this study we evaluated a series of 58 women with epithelial ovarian cancer at FIGO stages I and III. The aim of the study was to assess the incidence and characteristics of peripheral nerve involvement during the course of the disease both clinically and neurophysiologically. Our results suggest that in women with epithelial ovarian cancer (1) the incidence of subclinical polyneuropathy is high; (2) sensory involvement is predominant in stage I, but motor involvement is frequent in stage III; and (3) the incidence of peripheral nerve involvement increases with progression of the cancer.

From 1982 to 1989 positive alpha-fetoprotein (AFP) levels were detected after surgery in 3 patients with pure immature teratoma, 7 patients with mixed germ cell tumors and 16 patients with pure endodermal sinus tumor (EST) of the ovary. In the three patients with pure immature teratoma, AFP serum levels became spontaneously undetectable in one month without chemotherapy. The marker was thereafter negative, despite the persistence of tumor in 2 patients, and a relapse in the third one. The serum levels of AFP did not correlate with the stage of EST and mixed germ cell tumors. The monitoring of AFP serum levels during treatment correlated with response to chemotherapy: of the 16 patients with pure EST, 14 achieved a serological complete response and did not undergo second look surgery; two patients had a serological partial response. One of them reached a serological complete response after further chemotherapy. The other patient with liver extragonadic tumor underwent liver lobectomy with negative histology. Among 7 patients with mixed germ cell tumor, 6 achieved a serological and pathologic complete response. The 7th patient had a serological complete response, but microscopic residual tumor at second look laparotomy. The decrement curve of AFP was not predictive for recurrence. However, AFP monitoring was useful for an early diagnosis of relapse in 4 patients. AFP is a reliable marker for the diagnosis, treatment evaluation and follow-up of patients with pure EST and a useful marker in the clinical management of mixed germ cell tumors of the ovary.