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Epithelial ovarian cancer (EOC) is the leading cause of gynecologic cancer-related deaths in Western countries. Main reason is that the disease is frequently asymptomatic in its early stage and is found only when cancer has already spread outside the pelvis and disseminated throughout the abdominal cavity. As the disease progress, many EOC patients have accumulation of fluid in the peritoneal cavity corresponding to malignant ascites formation. This condition may be an extremely distressing complication for the patient, which may need repetitive palliative drainage to relieve pain and discomfort. Mechanism involved in the production of excessive peritoneal fluid is still unclear. Under physiological condition, the high concentration of protein inside the capillary vessels creates an oncotic pressure and promotes fluid reabsorption from the interstitial space into the vessels. Main hypothesis in favor of peritoneal fluid formation are an impaired drainage of the peritoneal cavity due to the obstruction of lymphatic system by tumor cells or an increased filtration rate to the peritoneal cavity due to the increased microvessels membrane-surface lining the peritoneal cavity. In addition, malignant ascites contain high protein and albumin concentration reducing the ratio plasma to peritoneal oncotic pressure and leading to fluid leak into the peritoneal cavity.1 Malignant ascites generally resolve when the underlying disease is successfully treated. EOC is managed by cytoreductive surgery followed by platinum-based chemotherapy and the expected response rate of primary therapy is more than 70%. However, most of these women will experience recurrence 12–18 mo later and progressively a chemoresistant disease will occur. These patients may present a progression of ascites, which may become a major clinical challenge in palliative care setting requiring repetitive paracentesis to alleviate symptoms (pain, anorexia, respiratory distress, fatigue, insomnia, lower extremity edema). Serial paracentesis provide relief of symptoms but also promote loss of proteins, hypovolemia and potential spread of cancer cells to site of drainage. Alternative approach to traditional palliative paracentesis is the “concentrated ascites reinfusion therapy” (CART).2 This procedure is approved by the Japanese national insurance scheme since 1981 and is suggested as a therapy tailored for EOC patient having intractable ascites. To date, there is low level of evidence in the literature supporting that this therapy reduce the progression of disease or improve the quality of life, however it is considered by some investigators as safe since all cellular components such as blood cells and cancer cells are removed. However, malignant ascitic fluid is generally considered as a contributor to the disease progression by facilitating multifocal dissemination of ovarian tumors cells on peritoneal surface. Indeed, it contains angiogenic and growth factors, cytokines, chemokines and extracellular matrix components which are known factors contributing to cell growth, tumor invasion and resistance to TNF-related apoptosis-inducing ligand.1 On the other hand, acellular fraction of ascites also contains antiangiogenic factors3 and factors that promote apoptosis4 which may reduce cancer cells proliferation and survival. Thus, the acellular fraction of ovarian cancer ascites could affect the tumor microenvironment but the mechanisms involved in these tumor-modulating properties are still debated and data are limited to in vitro studies. Recently, chick chorioallantoic membrane (CAM) was used as an in vivo model to study the effect of ascites fluid in combination with taxol on ovarian cancer growth.4 The results from the CAM assay demonstrated that acellular fraction of ascites potentializes the taxol effect on tumor regression. This data supports the hypothesis that the association of CART and chemotherapy has the potential to improve survival of patients with advanced EOC.5 Because tumor cell invasion and dissemination largely depend on the peritoneal microenvironment, the role of CART and factors acting on this environment should be more explored. Finally, ascites represents an accessible and valuable source of material to identify signals that influence tumor growth and to develop new treatment strategy to improve quality of life and survival of EOC patients.

We report a case of an intrauterine fetal infection by the varicella-herpes zoster virus following maternal varicella at 17 weeks' amenorrhea. Prenatal diagnosis of fetal infection was confirmed by serology and fetal damage by ultrasonography. Autopsy of the fetus showed multiorgan manifestation with disseminated foci of necrosis and microcalcifications, encephalitis and unilateral segmental skin scarring with an underlying hypoplastic fixed lower limb. The placenta showed a multifocal chronic villitis with multinucleated giant cells. The lesions included segmental anomalies and multiorgan damage.

Background and Objectives Accurate surgical staging and maximal tumor reduction are the basic management principles of epithelial ovarian cancer (EOC). The purpose of our study is to report on staging practices and the primary surgery of EOC in a region that has no tertiary oncological referral center and no surgical gynecological oncologist. Methods Between 1 January 1989 and 30 December 1995, the Valais Cancer Registry had registered 157 patients with ovarian cancer stage I–IV. Hospital case notes were reviewed retrospectively and patients who did not have a surgical abdominal exploration (n = 20), with borderline (n = 12) or non-epithelial tumors (n = 13), operated upon in other regions (n = 8) and without complete medical records (n = 2) were excluded. Therefore 102 patients were evaluated. Results The interventions have been performed in 7 regional hospitals and 1 private clinic by 24 obstetricians-gynecologists and 8 general surgeons. In early EOC, 9% random peritoneal biopsies and 3% retroperitoneal lymph node samplings have been performed. In advanced EOC, 40% of patients had total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy and 42% had cytoreductive surgery with a residual tumor of ≤2 cm. Conclusions The present study is a population-based study over a 7-year period within a region that has only community hospitals. Patients with early EOC had incomplete staging and patients with advanced EOC an insufficient rate of radical surgery. Women with a suspicion of ovarian cancer should be referred to centers with experienced tumor surgeons. J. Surg. Oncol. 2000;75:19–23. © 2000 Wiley-Liss, Inc.

doi:10.1016/j.ijgo.2008.09.020 The mean UIC in the control group was 137.2±5.9 μg/L (median 112 μg/L, range 62–465), but it was significantly lower in the pregnant women (Pb0.01). MeanUIC in thewomenwhowere in the first, second, and third trimesters of pregnancy were 93.6±6.6 μg/L (median 85 μg/L, range 28–223), 90.11±6.4 μg/L (median 82 μg/L, range 25–165), and 89.8 ±3.6 μg/L (median 88 μg/L, range 39–113), respectively (Fig. 1). Notably, severe iodinedeficiency (UIC less than 50 μg/L)was found in 12 pregnant womenwhowere in thefirst trimester, 2 in thesecond, and2 in the third. These results demonstrate that even in an urban areawhere iodine intake is expected to be adequate, pregnant women may be at risk of IDD. They also indicate the need to monitor iodine intake during pregnancy in areas with recently established salt iodization programs, and raise the question of whether iodine supplementation in pregnancy should be generalized or tailored on an individual basis.

A 24-year-old patient with 7-week amenorrhoea consulted for vaginal bleeding without abdominal pain. Ultrasonography revealed a 7 × 4 cm solid right pelvic mass. There was no visible intrauterine gestational sac. The serum β-human chorionic gonadotropin (β-hCG) level was 11 998 IU/l. Emergency laparoscopy was performed for a presumptive diagnosis of ectopic pregnancy. At laparoscopy, the right ovary was enlarged with a non-haemorrhagic 7 × 4 cm solid lesion, which was resected. The histological diagnosis was a dysgerminoma with immunohistochemistry showing nests of syncytiotrophoblastic cells, which were the origin of the hCG production. There was no pregnancy, either intrauterine or ectopic. There was no evidence of metastasis from the dysgerminoma on the positron-emission tomography scanner. The patient underwent a second procedure for surgical staging of this ovarian germ-cell tumour. This ovarian dysgerminoma was staged FIGO 1A, and the patient did not receive adjuvant therapy. There was no recurrence at the last 8-month follow-up.

e19599 Background: Infertility secondary to adjuvant chemotherapy is a major problem in young women with breast cancer. We developed a multidisciplinary-multicenter network, the “RRCF”, aiming to o...

Uterine myomas are one of the most common benign tumours, occurring in 20-40% of women of reproductive age. Ulipristal acetate (UPA) is a possible option for medical treatment of myomas. It induces amenorrhea and can reduce myoma volume before surgical treatment. Since its introduction in our department, we uncovered an unknown effect: migration of myoma.We describe three clinical case of myoma migration following three months UPA pre-operative treatment. The first woman presented with a FIGO 2 myoma, which migrated in FIGO 3. A previously planned hysteroscopy converted into a laparoscopy. The second woman also presented with a FIGO 2 myoma, which migrated in FIGO 3. Initially, a hysteroscopy was planned, but ultimately surgery was no longer required. The third woman presented with a FIGO 2-5 myoma, which migrated in FIGO 1. The previously planned laparoscopy converted into a vaginal myomectomy.UPA induces a proapoptotic and anti proliferative effect of leiomyoma cells. It reduces expression of VEGF and reduces collagen deposition in the extracellular matrix. These mechanisms could induce migration of myoma. UPA as pre-operative treatment can induce migration of myoma and, therefore, can lead to perioperative conversion of surgery.

Background Little information is available regarding the association between vulvar intraepithelial neoplasia grade 3 (VIN3) and Behçet’s disease (BD). We report here concomitant VIN3 and genital ulcers in a patient with BD. Case A 44-year-old Caucasian woman with a history of BD, which had been evolving for 6 years, presented with ulcerated and papillomatous lesions on the vulva. Biopsies revealed a multifocal VIN3 positive for high-risk human papillomavirus (HPV) 33. Multiple biopsies were performed to exclude invasive cancer and VIN3 was treated with laser vaporization. Conclusion We report clinical and anatomopathological features of a rare case of multifocal, high-risk, HPV-related VIN3. We also discuss the possible pathogenesis in the context of BD, featuring chronic ulceration and intrinsic or treatment-induced immunosuppression.

ObjeCtive To assess and compare the accuracy of visual inspection with acetic acid (VIA), visual inspection with Lugol’s iodine (VILI), and human papillomavirus (HPV) testing as alternative standalone methods for primary cervical cancer screening in sub-Saharan Africa. Design Systematic review and meta-analysis of diagnostic test accuracy studies. Data sOurC es Systematic searches of multiple databases including Medline, Embase, and Scopus for studies published between January 1994 and June 2014. review methOD s Inclusion criteria for studies were: alternative methods to cytology used as a standalone test for primary screening; study population not at particular risk of cervical cancer (excluding studies focusing on HIV positive women or women with gynaecological symptoms); women screened by nurses; reference test (colposcopy and directed biopsies) performed at least in women with positive screening results. Two reviewers independently screened studies for eligibility and extracted data for inclusion, and evaluated study quality using the quality assessment of diagnostic accuracy studies 2 (QUADAS-2) checklist. Primary outcomes were absolute accuracy measures (sensitivity and specificity) of screening tests to detect cervical intraepithelial neoplasia grade 2 or worse (CIN2+). results 15 studies of moderate quality were included (n=61 381 for VIA, n=46 435 for VILI, n=11 322 for HPV testing). Prevalence of CIN2+ did not vary by screening test and ranged from 2.3% (95% confidence interval 1.5% to 3.3%) in VILI studies to 4.9% (2.7% to 7.8%) in HPV testing studies. Positivity rates of VILI, VIA, and HPV testing were 16.5% (9.8% to 24.7%), 16.8% (11.0% to 23.6%), and 25.8% (17.4% to 35.3%), respectively. Pooled sensitivity was higher for VILI (95.1%; 90.1% to 97.7%) than VIA (82.4%; 76.3% to 87.3%) in studies where the reference test was performed in all women (P

Background Most women in developing countries have never attended cervical screening programmes and often little information exists on type-specific human papillomavirus (HPV) prevalence among these populations. Self-sampling for HPV testing (self-HPV) using a dry swab may be useful for establishing a screening program and evaluating HPV prevalence. Our aim was to evaluate self-HPV using a dry swab stored at room temperature. Methods This community-based study in Madagascar consisted of 449 women aged 30–65. Eligible women were provided a dry swab to perform self-HPV. HPV analysis was accomplished by two different real-time PCR tests using the same extracted DNA from the samples. Results Overall, 52 (11.6 %) specimens were invalid for HPV detection. The delay between sampling and laboratory processing of DNA extraction considerably increased invalid results. Overall HPV prevalence of 14 hrHPV types detected by the two PCR tests was found to be 38.2 % (n = 152). Distribution of 19 hrHPV and 9 low-risk HPV (lrHPV) types revealed most frequently 53 and 68 among hrHPV and HPV 54, HPV 70 and HPV 42 among lrHPV. Agreement between the two PCR methods for any of the 14 high-risk HPV (hrHPV) strains detected was 89.9 % (kappa = 0.77, 95 % CI: 0.71–0.84). In 385 (85.7 %) samples the DNA load of ß-globin demonstrated a signal with medium or high level copies. Conversely, in 28 (60.9 %) invalid samples the signal was undetectable. The HPV-DNA load signal was predominantly of intermediate level (58.5 %, n = 218). Conclusions Self-HPV using a dry swab stored at room temperature could be a useful method for HPV screening and for conducting population-based surveys on HPV prevalence in resource-poor settings.

Background Cervical cancer, although largely preventable, remains the most common cause of cancer mortality among women in low-resource countries. The objective of this study was to assess knowledge and awareness of cervical cancer prevention among Cameroonian healthcare workers. Methods A cross-sectional self-administered questionnaire in 5 parts with 46 items regarding cervical cancer etiology and prevention was addressed to healthcare workers in six hospitals of Yaoundé, Cameroon. The investigators enlisted heads of nursing and midwifery to distribute questionnaires to their staff, recruited doctors individually, in hospitals and during conferences and distributed questionnaires to students in Yaoundé University Hospital and Medical School. Eight hundred and fifty questionnaires were distributed, 401 collected. Data were analyzed with SPSS version 16.0. Chi-square tests were used and P-values < 0.05 were considered significant. Results Mean age of respondents was 38 years (range 20-71 years). Most participants were aware that cervical cancer is a major public health concern (86%), were able to identify the most important etiological factors (58%) and believed that screening may prevent cervical cancer (90%) and may be performed by Pap test (84%). However, less than half considered VIA or HPV tests screening tests (38 and 47%, respectively). Knowledge about cancer etiology and screening was lowest among nurse/midwives. Conclusion Knowledge of cervical cancer and prevention by screening showed several gaps and important misconceptions regarding screening methods. Creating awareness among healthcare workers on risk factors and current methods for cervical cancer screening is a necessary step towards implementing effective prevention programs.

Metastatic endometrial cancer (EC) at initial presentation is a rare disease. The present aim was to evaluate prognostic factors and overall survival in patients diagnosed with metastatic EC.Using data from the Geneva Cancer Registry, the authors included all patients diagnosed with Stage IVB EC from 1980-2007. Estimates of survival were calculated using the Kaplan-Meier method and compared using the log-rank test.A total of 38 patients were identified. The most frequent metastases were peritoneal or pleural carcinomatosis (66%, n=25) and hematogenous metastases (53%, n=20). Five-year survival rate was 5.7% (95% confidence interval: 0.0-13.3), and median survival was 7.6 months. Survival of patients with a single metastasis at the time of diagnosis was longer than for patients with multiple metastases (16 versus two months, respectively; p0.00 1).Metastatic EC is rare disease with very poor prognosis particularly for patients with multiple site metastases.

Visual inspection with acetic acid (VIA) is one of the methods recommended by the World Health Organization for cervical cancer screening. VIA is simple and low-cost; it, however, presents high subjectivity. We conducted a systematic literature search in PubMed, Google Scholar and Scopus to identify automated algorithms for classifying images taken during VIA as negative (healthy/benign) or precancerous/cancerous. Of the 2608 studies identified, 11 met the inclusion criteria. The algorithm with the highest accuracy in each study was selected, and some of its key features were analyzed. Data analysis and comparison between the algorithms were conducted, in terms of sensitivity and specificity, ranging from 0.22 to 0.93 and 0.67 to 0.95, respectively. The quality and risk of each study were assessed following the QUADAS-2 guidelines. Artificial intelligence-based cervical cancer screening algorithms have the potential to become a key tool for supporting cervical cancer screening, especially in settings where there is a lack of healthcare infrastructure and trained personnel. The presented studies, however, assess their algorithms using small datasets of highly selected images, not reflecting whole screened populations. Large-scale testing in real conditions is required to assess the feasibility of integrating those algorithms in clinical settings.

Visual inspection with acetic acid (VIA) is recommended by the World Health Organization for primary cervical cancer screening or triage of human papillomavirus-positive women living in low-resource settings. Nonetheless, traditional VIA with the naked-eye is associated with large variabilities in the detection of pre-cancer and with a lack of quality control. Digital-VIA (D-VIA), using high definition cameras, allows magnification and zooming on transformation zones and suspicious cervical regions, as well as simultaneously compare native and post-VIA images in real-time. We searched MEDLINE and LILACS between January 2015 and November 2021 for relevant studies conducted in low-resource settings using a smartphone device for D-VIA. The aim of this review was to provide an evaluation on available data for smartphone use in low-resource settings in the context of D-VIA-based cervical cancer screenings. The available results to date show that the quality of D-VIA images is satisfactory and enables CIN1/CIN2+ diagnosis, and that a smartphone is a promising tool for cervical cancer screening monitoring and for on- and off-site supervision, and training. The use of artificial intelligence algorithms could soon allow automated and accurate cervical lesion detection.

Background To evaluate if human papillomavirus (HPV) self-sampling (Self-HPV) using a dry vaginal swab is a valid alternative for HPV testing. Methods Women attending colposcopy clinic were recruited to collect two consecutive Self-HPV samples: a Self-HPV using a dry swab (S-DRY) and a Self-HPV using a standard wet transport medium (S-WET). These samples were analyzed for HPV using real time PCR (Roche Cobas). Participants were randomized to determine the order of the tests. Questionnaires assessing preferences and acceptability for both tests were conducted. Subsequently, women were invited for colposcopic examination; a physician collected a cervical sample (physician-sampling) with a broom-type device and placed it into a liquid-based cytology medium. Specimens were then processed for the production of cytology slides and a Hybrid Capture HPV DNA test (Qiagen) was performed from the residual liquid. Biopsies were performed if indicated. Unweighted kappa statistics (к) and McNemar tests were used to measure the agreement among the sampling methods. Results A total of 120 women were randomized. Overall HPV prevalence was 68.7% (95% Confidence Interval (CI) 59.3–77.2) by S-WET, 54.4% (95% CI 44.8–63.9) by S-DRY and 53.8% (95% CI 43.8–63.7) by HC. Among paired samples (S-WET and S-DRY), the overall agreement was good (85.7%; 95% CI 77.8–91.6) and the κ was substantial (0.70; 95% CI 0.57-0.70). The proportion of positive type-specific HPV agreement was also good (77.3%; 95% CI 68.2-84.9). No differences in sensitivity for cervical intraepithelial neoplasia grade one (CIN1) or worse between the two Self-HPV tests were observed. Women reported the two Self-HPV tests as highly acceptable. Conclusion Self-HPV using dry swab transfer does not appear to compromise specimen integrity. Further study in a large screening population is needed. Trial registration ClinicalTrials.gov: NCT01316120