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Introduction. Ovarian cancer is the most lethal gynecological cancer. The most common manifestation of thoracic metastasis is pleural effusion. Pleural effusion with positive cytology is regarded as stage IVa of the International Federation of Gynecology and Obstetrics classification, and the overall five-year survival in these patients is less than 20%. We analyzed the data of patients with ovarian cancer who were treated at the Oncology Institue of Vojvodina, in order to establish the incidence of malignant pleural effusions, laterality of pleural effusions, and clinical manifestations. Material and Methods. The study included 731 patients with ovarian cancer who were treated at the Oncology Institue of Vojvodina from January 2012 to May 2020. The obtained data were compared with data found in the literature in the same period. Results. The incidence of malignant pleural effusion in our study was 5.75%; right-sided pleural effusion was found in 57.15% of patients, 33.33% of patients had effusion on the left side, and 9.52% had bilateral effusions. Thus, unilateral effusion was found in 90.48% of cases, and bilateral in only 9.52%. The most common symptom was dyspnea, reported in 33 patients (78.6%). Conclusion. The incidence of malignant pleural effusion in our study was most similar to data found by Zamboni et al. published in 2015; the right side was the dominant side of pleural effusions. The most common symptoms were dyspnea, shortnes of breath and chest pain.

Objective Based on the SUCCOR study database, our primary objective was to identify the independent clinical pathological variables associated with the risk of relapse in patients with stage IB1 cervical cancer who underwent a radical hysterectomy. Our secondary goal was to design and validate a risk predictive index (RPI) for classifying patients depending on the risk of recurrence. Methods Overall, 1116 women were included from January 2013 to December 2014. We randomly divided our sample into two cohorts: discovery and validation cohorts. The test group was used to identify the independent variables associated with relapse, and with these variables, we designed our RPI. The index was applied to calculate a relapse risk score for each participant in the validation group. Results A previous cone biopsy was the most significant independent variable that lowered the rate of relapse (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.17–0.60). Additionally, patients with a tumor diameter >2 cm on preoperative imaging assessment (OR 2.15, 95% CI 1.33–3.5) and operated by the minimally invasive approach (OR 1.61, 95% CI 1.00–2.57) were more likely to have a recurrence. Based on these findings, patients in the validation cohort were classified according to the RPI of low, medium, or high risk of relapse, with rates of 3.4%, 9.8%, and 21.3% observed in each group, respectively. With a median follow-up of 58 months, the 5-year disease-free survival rates were 97.2% for the low-risk group, 88.0% for the medium-risk group, and 80.5% for the high-risk group (p < 0.001). Conclusion Previous conization to radical hysterectomy was the most powerful protective variable of relapse. Our risk predictor index was validated to identify patients at risk of recurrence.

Background/Aim. The gold standard in treating the advanced ovarian cancer (AOC) is primary debulking surgery (PDS) followed by platinum-based adjuvant chemotherapy. In the AOC, the extent of tumor resection (residual tumor volume) is the most important prognostic factor for overall survival (OS) and progression-free survival (PFS). Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is an experimental treatment of the AOC, introduced in clinical practice in order to improve cytoreduction rate and prolong survival. The aim of this study was to compare the survival and cytoreduction rate of NACT+IDS and PDS in patients with the AOC. Methods. This retrospective cohort study included patients with the AOC, separated into two groups. The first group treated with PDS had 59 patients, while the second group, treated with NACT + IDS, had 33 patients. Results. A lower rate of suboptimal cytoreduction (39.39%) was found in the NACT + IDS group than in the PDS group (57.63%). The percentage of complete cytoreduction was higher in patients treated with NACT + IDS (51.52%) than in those treated with PDS (38.98%). Nevertheless, median OS and PFS were not significantly different between the groups (p < 0.05). OS was 35 months and 31 months in the PDS and NACT + IDS groups, respectively. PFS was 16 months in the PDS and 19 months in the NACT + IDS group. Conclusion. Despite the higher rate of optimal debulking surgery after NACT+ IDS, survival of patients treated with method was not better than those treated with PDS. The decision for either NACT+IDS or PDS should be tailored to the individual patient.

Introduction. Persistent infection with highly oncogenic human papillomavirus is associated with premalignant cervical lesions and cervical cancer, as well as cancers of the vulva and vagina. The aim of the study was to determine the level of knowledge and attitudes towards human papillomavirus infection, its risk factors, clinical manifestations and the use of contraception. Material and Methods. A total of 355 first-year students of the Faculty of Medicine, University of Novi Sad, filled in a non-standardized, self-administered questionnaire designed for the purpose of this study. The collected data included: sexual history of the respondents, the use and knowledge of contraception, human papillomavirus infection, and human papillomavirus vaccine. Results. About 89% of students have heard of human papillomavirus infection, while 75.5% of them knew that human papillomavirus infection is a sexually transmitted disease. Accurate knowledge about human papillomavirus infection was low, while female students showed higher levels of knowledge compared to the male (4.03 ? 3.07 versus 5.56 ?3.37; p < 0.01). Only 27.6% of students knew that young women are at a higher risk of human papillomavirus infection, 45.9% of the respondents knew that the risk of human papillomavirus infection depends on the number of sexual partners, 34.09% of them knew that a condom does not provide complete protection against human papillomavirus infection, 53.5% knew that human papillomavirus can cause cervical cancer, and only 19.7% of students knew that human papillomavirus infection can cause penile cancer. Conclusion. The first-year medical students showed a lack of knowledge about human papillomavirus infection and human papillomavirus-related diseases. General education and health education of young people is necessary primarily in secondary schools, in order to preserve the reproductive health and prevent human papillomavirus-related cancers.

Background: Tumor budding is recognized as an important independent prognostic factor in colorectal carcinoma. The aim of this study was to evaluate the grade of tumor budding and association with other clinical and pathological features in patients with cervical carcinoma. Material and methods: We evaluated pathohistological data from 91 cervical carcinoma patients (mean age: 53.8 years) who underwent radical hysterectomy and pelvic lymphatic dissection at the Oncology Institute of Vojvodina between January 2010 and December 2018. Tumor budding was evaluated in invasive front of the tumor. Based on the number of bud counts/10 high power field, three groups were formed: with no budding, with less than 15 buds, and with more than 15 buds. Results: Eighty (87.91%) of evaluated cervical carcinomas were squamous-cell type, while 12.09% were adenocarcinomas. All carcinomas were graded (HG1-HG3). Average diameter of the tumors was 25 mm (81.6% < 4 cm and 18.4% > 4 cm). Metastases in lymph nodes were present in 30 (32.9%) cases. Based on the number of bud counts/10 high power field there were 35.1% with no budding, 32.9% with less than 15 buds and 37.3% with more than 15 buds. There was a significant association between tumor budding grade and histological grade (p=0.04), as well as with tumor budding grade and the diameter of the tumor (p=0.04). Conclusion: As a quantitative measure of cancer cell dissociation, tumor budding is associated with poor prognosis in cervical carcinoma and should be considered as a prognostic factor.

Choriocarcinoma is a subtype of gestational trophoblastic disease. It is a very rare neoplasm, with incidence of about 1 case in 40.000 pregnancies. Gestational form of choriocarcinoma arises most commonly after abortion, while nongestational form develops from pluripotent germ cells. Choricarcinoma is highly malignant and highly chemosensitive type of tumor. A 43-year-old patient diagnosed with extra uterine pregnancy in September 2017 was treated with methotrexate with no response and had surgical removal of right Fallopian tube. Choriocarcinoma was diagnosed one and a half year after extra uterine pregnancy. Radiological imaging before treatment showed pulmonary and inguinal lymph node metastases and tumor invasion of the anterior uterine wall. Surgery was performed due to heavy bleeding and uterine wall invasion. As high risk patient she received chemotherapy. She was followed radiologically and her serum ?-HCG was monitored. Refractivity to the chemotherapy protocol during treatment was observed. Therapy response was achieved after administration of EMA-EP protocol modification i.e. three consecutive negative follow-up values of ?-HCG were obtained and radiological findings were disease free. One month after treatment patient had no signs of disease and ?-HCG level was normal.

This paper seeks to present surgical procedures, results and complications of treatment of verrucous carcinoma (VC) of the vulva treated at the clinics for gynecology and obstetrics within the Faculty of Medicine, University of Novi Sad (Serbia), as well as a literature review of surgical treatment of VC. During a period of 15 years (2005?2019), we performed 76 surgeries of vulvar cancer, nine (11.8%) due to VC of the vulva. In surgical treatment of vulva VC, we performed complete surgical excision of the tumor (three), complete surgical excision of the tumor with defect coverage using VY fasciocutaneous skin flap (two), simplex vulvectomy (two), radical hemivulvectomy (one), and radical vulvectomy (one). We came across two main complications (22.2%): suture bleeding within 12 hours after excision in one patient (11.1%) and lower extremity lymphoedema after inguinofemoral lymphadenectomy with ligation of the great saphenous vein in one patient (11.1%). Out of the total number of nine treated patients, survival rate was 88.8% (eight patients) with death rate of 11.1% (one patient) within 12 months after surgery. In three patients (33.3%), the disease returned after surgery: one residual tumor after surgery, one relapse on the other side one year after surgery, one newly developed invasive squamous cell carcinoma 10 years after primary surgery.

Objective: The present study purposed to determine characteristics of ovarian carcinoma and to analyze predictors of survival in patients with ovarian carcinoma. Method: A retrospective cohort study was conducted including the patients with diagnosed ovarian carcinoma treated at the Clinic for Operative Oncology, Oncology Institute of Vojvodina in the period from January 2012 to December 2016. Seventy-two women with ovarian carcinoma were included in the analysis. The data about the histological type of tumor, disease stage, treatment, lymphatic infiltration, and surgical procedure were collected retrospectively, using the database of the institution where the research was conducted (BirPis 21 SRC Infonet DOO – Information System Oncology Institute of Vojvodina). Descriptive statistics and multivariate analysis using Cox proportional hazards model were performed. Results: The univariate Cox regression analysis identified histology, tumor grade, FIGO (International Federation of Gynecology and Obstetrics) stage, NACT (Neoadjuvant Chemotherapy), number of therapy cycles, type of surgery, and chemotherapy response as independent predictors of mortality. Finally, the type of tumor and chemotherapy response had an increased hazard ratio for mortality in the multivariate Cox regression model. Herewith, the percentage of high-grade, advanced-stage ovarian cancer patients with complete response to chemotherapy, absence of recurrent disease, and lymphovascular space invasion were significant predictors of survival in patients with ovarian carcinoma. Conclusions: Herein, emerging data regarding precision medicine and molecular-based personalized treatments are promising and will likely modify the way the authors provide multiple lines of treatments in the near future.

Introduction/Background* Peritoneal cytology was analysed in endometrial carcinoma and its correlation to the histological type, FIGO classification of tumour, tumour grade and age. The goal was to determine presence of tumour cells in peritoneal cytology and its correlation to histological type, FIGO classification of tumour, tumour grade and age in the moment of surgical treatment. Second goal was follow up the patients with and without positive peritoneal cytology and early stage tumor. Methodology The study was retrospective included patients that have been surgically treated at the Oncology Institute of Vojvodina in period of October 2012. up to January 2020. 300 patients were analysed. Comparison was made between two groups in FIGO classification, histological type, grade of tumour and age in the moment of surgical treatment. Result(s)* Results show no statistical significance in difference between age of patients in the moment of surgical treatment (p=0.126). There was statistical significant difference in positive peritoneal cytology between group with endometrioid compared with nonendometrioid endometrial carcinoma (p=0.000) group. Also there was, statistical significant difference between group with endometrial cancer confined to uterus compare with patients with carcinoma beyond the uterus (p=0.000) and statistically significant was confirmed with high tumor grade (p=0.000). Conclusion* The positive peritonal cytology was found statisticaly significance in the group of the patients with non endometroides type of the tumor, highest tumor grade and higher FIGO classification. For these group of patients have to consider to still recommend using peritoneal washings cytology analyses during surgery.

Introduction/Background Endometrial cancer is the most common malignancy of the female reproductive tract. Lymph node metastases are an important prognostic factor in endometrial cancer. Several prognostic factors have been shown to correlate with lymph node metastasis: depth of myometrial invasion, cervical infiltration, histologic grade of the tumor, tumor diameter, serous histology, lymphovascular invasion, and positive peritoneal cytology. Methodology Finding the pathohistological parameters that will indicate with greater certainty the possibility of metastases in the lymph nodes, on the basis of which it will be evaluated whether such patients should undergo lymphadenectomy or not. A retrospective analysis of patients with endometrial cancer who underwent surgery at the Oncology Institute of Vojvodina (Clinic for Operative Oncology – Department of Gynecology) in the period from 2012 to 2018.The study included 120 patients who underwent hysterectomy with bilateral adnexectomy and pelvic lymphadenectomy. Results Among patients who had lymph node metastases, there were statistically significant more patients (p Conclusion Histopathological parameters such as type 2 endometrial cancer, myometrial invasion depth greater than 50%, cervical stroma infiltration, lymphovascular invasion and positive peritoneal cytology increase the chances of lymph node metastases. Tumor size (> 2 cm) as well as histologic grade did not correlate with a higher incidence of lymph node metastases. In this study, both the parametrial infiltration and the number of lymph nodes removed have clinical significance, but not statistical significance.

BACKGROUND: There is a lack of information as to which molecular processes, present at diagnosis, favor tumour escape from standard-of-care treatments in cervical cancer (CC). RAIDs consortium (www.raids-fp7.eu), conducted a prospectively monitored trial, [BioRAIDs (NCT02428842)] with the objectives to generate high quality samples and molecular assessments to stratify patient populations and to identify molecular patterns associated with poor outcome. METHODS: Between 2013 and 2017, RAIDs collected a prospective CC sample and clinical dataset involving 419 participant patients from 18 centers in seven EU countries. Next Generation Sequencing has so far been carried out on a total of 182 samples from 377 evaluable (48%) patients, allowing to define dominant genetic alterations. Reverse phase protein expression arrays (RPPA) was applied to group patients into clusters. Activation of key genetic pathways and protein expression signatures were tested for associations with outcome. FINDINGS: At a median follow up (FU) of 22 months, progression-free survival rates of this FIGO stage IB1-IV population, treated predominantly (87%) by chemoradiation, were65•4% [CI95%: 60•2-71.1]. Dominant oncogenic alterations were seen in PIK3CA (40%), while dominant suppressor gene alterations were seen in KMT2D (15%) and KMT2C (16%). Cumulative frequency of loss-of-function (LOF) mutations in any epigenetic modulator gene alteration was 47% and it was associated with PIK3CA gene alterations in 32%. Patients with tumours harboring alterations in both pathways had a significantly poorer PFS. A new finding was the detection of a high frequency of gains of TLR4 gene amplifications (10%), as well as amplifications, mutations, and non-frame-shift deletions of Androgen receptor (AR) gene in 7% of patients. Finally, RPPA protein expression analysis defined three expression clusters. INTERPRETATION: Our data suggests that patient population may be stratified into four different treatment strategies based on molecular markers at the outset. FUND: European Union's Seventh Program grant agreement No 304810.

Cervical cancer is the third most common malignancy in pregnancy. Pregnancy does not have a detrimental effect on the survival of patients with cervical carcinoma. Management of cervical carcinoma in pregnancy depends on the stage of the disease, tumor size, nodal status, pathohistological characteristics of the tumor, the gestation of pregnancy, age and parity of patient and her motivation to preserve the pregnancy. In pregnant patients with the locally advanced cervical carcinoma (LACC) and strong desire to continue the pregnancy, the neoadjuvant chemotherapy (NACT) could be the option to preserve pregnancy while having cancer under the control. The goal of NACT in treatment of LACC in pregnancy is: 1. To treat, stabilize and prevent further dissemination of the disease until the term 2. To decrease the volume and extent of the tumor, making it more operable or radiosensitive after delivery 3. To effect on lymph node metastasis and distant micrometastasis during pregnancy Chemotherapy should not be applied during the organogenesis, before 10th, preferably 14th week of gestation. Administration of chemotherapy after the first trimester is not related tothe increased number of congenital malformations. If applied in the second or third trimester, chemotherapy is connected withfetal growth restriction, low birth weight, and preterm labor. Since data on safety and efficacy of NACT in LACC in pregnancy are still limited and based on a low level of evidence from 37 cases known so far, this treatment modality should remain experimental and reserved to highly motivated patients wishing to preserve the pregnancy.

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SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer FREE http://orcid.org/0000-0002-1908-3251Luis Chiva1, Vanna Zanagnolo2, Denis Querleu3, Nerea Martin- Calvo4, Juan Arévalo-Serrano5, Mihai Emil Căpîlna6, Anna Fagotti7, Ali Kucukmetin8, Constantijne Mom9, Galina Chakalova10, Shamistan Aliyev11, Mario Malzoni12, http://orcid.org/0000- 0001-5809-3535Fabrice Narducci13, Octavio Arencibia14, Francesco Raspagliesi15, Tayfun Toptas16, David Cibula17, Dilyara Kaidarova18, http://orcid.org/0000-0001-6763-9720Mehmet Mutlu Meydanli19, Mariana Tavares20, Dmytro Golub21, http://orcid.org/0000-0003-3140-4772Anna Myriam Perrone22, Robert Poka23, Dimitrios Tsolakidis24, Goran Vujić25, http://orcid.org/0000-0001-8935- 0311Marcin A Jedryka26, Petra L M Zusterzeel27, Jogchum Jan Beltman28, Frederic Goffin29, Dimitrios Haidopoulos30, Herman Haller31, Robert Jach32, Iryna Yezhova33, Igor Berlev34, Margarida Bernardino35, Rasiah Bharathan36, Maximilian Lanner37, Minna M Maenpaa38, http://orcid.org/0000-0002-4403-3707Vladyslav Sukhin39, Jean-Guillaume Feron40, Robert Fruscio41, 42, Kersti Kukk43, Jordi Ponce44, Jose Angel Minguez45, http://orcid.org/0000-0002-9618- 5606Daniel Vázquez-Vicente45, Teresa Castellanos45, Enrique Chacon46 and http://orcid.org/0000-0002-9700-0853Juan Luis Alcazar47 On behalf of the SUCCOR study Group Author affiliations Abstract Background Minimally invasive surgery in cervical cancer has demonstrated in recent publications worse outcomes than open surgery. The primary objective of the SUCCOR study, a European, multicenter, retrospective, observational cohort study was to evaluate disease-free survival in patients with stage IB1 (FIGO 2009) cervical cancer undergoing open vs minimally invasive radical hysterectomy. As a secondary objective, we aimed to investigate the association between protective surgical maneuvers and the risk of relapse. Methods We obtained data from 1272 patients that underwent a radical hysterectomy by open or minimally invasive surgery for stage IB1 cervical cancer (FIGO 2009) from January 2013 to December 2014. After applying all the inclusion-exclusion criteria, we used an inverse probability weighting to construct a weighted cohort of 693 patients to compare outcomes (minimally invasive surgery vs open). The first endpoint compared disease-free survival at 4.5 years in both groups. Secondary endpoints compared overall survival among groups and the impact of the use of a uterine manipulator and protective closure of the colpotomy over the tumor in the minimally invasive surgery group. Results Mean age was 48.3 years (range ; 23–83) while the mean BMI was 25.7 kg/m2 (range ; 15–49). The risk of recurrence for patients who underwent minimally invasive surgery was twice as high as that in the open surgery group (HR, 2.07 ; 95% CI, 1.35 to 3.15 ; P=0.001). Similarly, the risk of death was 2.42-times higher than in the open surgery group (HR, 2.45 ; 95% CI, 1.30 to 4.60, P=0.005). Patients that underwent minimally invasive surgery using a uterine manipulator had a 2.76-times higher hazard of relapse (HR, 2.76 ; 95% CI, 1.75 to 4.33 ; P

Introduction/Background During the last three decades, fertility preservation was established as a new treatment modality for young patients with early cervical cancer, less than 2 cm, using different surgical approaches and techniques such as vaginal or abdominal simple or radical trachelectomy, total laparoscopic or robotic trachelectomy even large conisation with laparoscopic lympadenectomy. A further goal for gynecological oncology is to consider a fertility-preserving approach in patients with bulky cervical cancer, without compromising the oncology outcome. Methodology The thirty years old nulliparous with uterine sqamous cervix cancer FIGO stage IB2, 3 cm, underwent neoadjuvant chemotherapy, three cycles of Cisplatin and Ifosfamide dose dense regime according to Prague protocol. MRI was performed pre and post NACT treatment. Results Due to complete pathologic response after three cycles of neoadjuvant chemotherapy conservative surgery was performed. The patient underwent laparoscopic pelvic lymphadenectomy, uterine cervix conisation and the cervical canal curettage. The histopathology of specimen confirmed the complete response, with H SIL only. There was no need for adjuvant treatment. At the first follow up the length of uterine cervix was sufficient and PAP smear was normal. One year after surgery, patient is without disease. At the last control she was in sixteen weeks of gestation. Conclusion Until now, small case control studies concluded that neoadjuvant chemotherapy followed by conservative fertility spare surgery in young patients with bulky cervical cancer who respond well to chemotherapy, is an acceptable approach. Still, more evaluation and data is needed for this group of patients before widespread use. Disclosure Nothing to disclose.

The aim of the study was to compare thoracic epidural analgesia (TEA) and intravenous patient-controlled analgesia (IV-PCA) after open colorectal cancer surgery. This prospective study included sixty patients scheduled for elective open colorectal surgery and randomized to either postoperative IV-PCA with morphine (n=30) or TEA with a mixture of levobupivacaine, fentanyl and adrenaline (n=30). Th e primary outcome was return of bowel function. The secondary outcome was quality of postoperative analgesia at rest, on coughing and during mobilization. Intermediate outcomes included patient satisfaction, time out of bed, rate of side effects and postoperative complications, and time of discharge. Recovery of postoperative ileus occurred sooner (p

Clinical criteria for genetic testing of genes other thanBRCA1/2in epithelial ovarian cancer (EOC) still do not exist. We assessed the frequency and predictors of deleterious mutations in 19 cancer predisposition genes in high-grade serous ovarian cancer (HGSOC) in Serbia. Next-generation sequencing was used to identify germline mutations in the whole coding regions of a gene panel. Patients’ characteristics and sequencing data were summarized with descriptive statistics and compared using chi-square test. Among 131 HGSOC patients, 23 hadBRCA1(17.6%) while 5 hadBRCA2(3.8%) mutation. In addition, 9 (6.9%) pathogenic mutations were detected in other genes includingBRIP1(n = 2;1.5%),CHEK2(n = 2;1.5%),NBN(n = 3;2.3%) andRAD51C(n = 2;1.5%). Factors that predicted forBRCA1/2mutations were: breast and ovarian cancers in the same patient (p = 0.031), young age of EOC (p = 0.029), menstrual status (p = 0.004) and family history of cancer (p BRCA1/2mutation carriers but will not help identify mutations in other cancer susceptibility genes. Until better predictors emerge we should be performing wider genetic testing of EOC in order to identify all mutation carriers.

Oxidative stress has been associated with cervical cancer. Our aim was to examine lipid peroxidation and the extent of oxidative stress in women diagnosed with different stages of cervical cancer in order to evaluate its potential role in the evolution of cancer.We measured the concentration of thiobarbituric acid reactive substances, activities of antioxidative enzymes and 8-hydroxy-2-deoxyguanosine in 153 subjects. Enzymatic activity as well as TBARS concentration were measured spectrophotometrically, while 8-OHdG was determined by gas chromatography-mass spectrometry. PPatients were categorized: group II H-SIL; group III FIGO Ia-Ib and group IV FIGO IIa-IV.Our results showed highly significant increase in the level of lipid peroxidation in group IV when com pared to the control group, group II and group III (p0.001). Activity of superoxide dismutase was also significantly higher in group IV when compared to control group (p0.01), group II (p0.01) and group III (p0.05). Activity of catalase was also significantly higher in group IV when compared to control group (p0.005), group II (p0.005) and group III (p0.05). Activity of glutathione-S-transferase was also significantly higher in group IV when compared to control group (p0.05), group II (p0.05) and group III (p0.05). Activities of glutathione peroxidase and glutathione reductase showed no significant differences among the groups. Level of 8-OHdG was significantly higher in group IV than in the other groups (p0.01).It can be concluded that oxidative stress is possibly involved in the pathogenesis of cervical cancer, demonstrated by increased lipid peroxidation and an altered antioxidant defense system and higher levels of 8-OHdG.Utvrđeno je da postoji veza između oksidativnog stresa i cervikalnog karcinoma. Naš cilj bio je da ispitamo lipidnu peroksidaciju i nivo oksidativnog stresa kod žena kojima je dijagnostikovan cervikalni karcinom u različitim fazama da bi se otkrila njegova eventualna uloga u razvoju karcinoma.Merili smo koncentraciju reaktivnih supstanci tiobarbiturne kiseline, aktivnosti antioksidativnih enzima i 8-hidroksi-2-deoksigvanozina kod 153 ispitanice. Enzimska aktivnost kao i koncentracija TBARS merene su spektrofotometrijski, dok je 8-OhdG određen pomoću gasne hromatografije – masene spektrometrije. Pacijentkinje su podeljene u kategorije: grupu II H-SIL; grupu III FIGO Ia-Ib i grupu IV FIGO IIa-IV.Naši rezultati pokazali su vrlo značajan porast nivoa lipidne peroksidacije u grupi IV u poređenju s kontrolnom grupom, grupom II i grupom III (p0,001). Aktivnost superoksid-dismutaze bila je takođe značajno viša u grupi IV u poređenju s kontrolnom grupom (p0,01), grupom II (p0,01) i grupom III (p0,01). Aktivnost katalaze bila je isto značajno viša u grupi IV u poređenju s kontrolnom grupom (p0,005), grupom II (p0,005) i grupom III (p0,05). Aktivnost glutation-S-transferaze je takođe bila značajno viša u grupi IV u poređenju s kontrolnom grupom (p0,05), grupom II (p0,05) i grupom III (p0,05). Aktivnosti glutation peroksidaze i glutation reduktaze nisu ukazale na značajne razlike između grupa. Nivo 8-OHdG bio je značajno viši u grupi IV nego u ostalim grupama (p0,01).Može se zaključiti da oksidativni stres potencijalno učestvuje u patogenezi cervikalnog karcinoma, na šta ukazuju povišena lipidna peroksidacija i promene su sistemu antioksidativne zaštite i povišen nivo 8-OHdG.

Background: Incidence of endometrial carcinoma in Vojvodina is 15-20/100 000. In 75% cases, endometrial carcinoma is diagnosed in postmenopausal period. In 90 % of patients, the first clinical sign is postmenopausal bleeding. The aim of the study was to investigate clinical and histopathological characteristics in patients with postmenopausal bleeding. Methods: The study included 122 patients with postmenopausal bleeding. All of these patients underwent gynecological examination and vaginal ultrasound. We obtained materials for histopathological analysis by fractionate explorative curettage. Once we had definitive histopathological findings, we divided patients in two groups A (endometrial carcinoma) and B (benign changes). Results: We confirmed significant statistical differences between examined group A and B, including age (64.49 compared with 58.81 years), postmenopausal period (13.67 instead 9.11 years), and length of uterine corpus (6.41 instead 5.25 cm). Conclusion: Elderly women with longer postmenopausal interval and postmenopausal bleeding had increased risk for endometrial carcinoma. Measurement of endometrial thickness by transvaginal ultrasound appeared to be insufficient parameter for differentiating the benign from the malignant changes of endometrium. Patients with endometrial carcinoma had significantly longer corpus of uterus comparing to patients with benign changes. Body mass index was not found to be significant risk factor in development of endometrial carcinoma in the examined groups. Obesity was diagnosed in both groups, suggesting that increased body mass index is a risk factor for development of pathological changes in endometrium, which could lead to postmenopausal bleeding.

Background: During the last three decades, fertility preservation has been established as a new treatment modality for young patients with early cervical cancer. In preservation of the uterine corpus in fertility sparing surgery one of the most important factors is evaluation of absence of internal uterine ostium or uterine corpus tumor infiltration. The aim was to evaluate the accuracy of nucler magnetic resonance (NMR) in detection of infiltration of uterine isthmuscervical part in cervical cancer patients without fertility preservation. Methods: In 60 patients with cervical cancer FIGO stage IA-2 - IVA, NMR was performed before the operation. Radical hysterectomy Piver class III was performed in 57 patients and pelvic exenteration in three patients with FIGO stage IVA. The histopathological material was examed at the Department of pathology and cytology and it was used as a gold standard. Results: The patient average age was 44.7, (range: 25-65 years). Squamous cervical cancer was diagnosed in 53 (88.3%), adenocarcinoma in 4 (6.7%), and adenosquamous carcinoma in 3 (5%) patients. According to NMR findings, 7 (11.7%) patients were with uterine isthmus-cervical infiltration when compared with histopathological examination, which established infiltration in 10 (16.7%) patients. Sensitivity of NMR was 60%, specificity 98%, positive predictive value 85.7%, and negative predictive value was 92.5% with overall accuracy 91.7%. Conclusion: Sensitivity of NMR was low compared with other studies but with high specificity and overall accuracy. The positive predictive value was relatively acceptable. Negative findings of NMR for corporal infiltration and precise evaluation of the depth of stromal infiltration and length of the proximal cervix without infiltration are important in preoperative diagnostic for fertility preservation surgery.

Background: Ovarian cancer is among the sixth leading cancers in Vojvodina and the fifth leading cause of cancer death among female population in Vojvodina according to Cancer Registry of Vojvodina in 2010. The majority of ovarian cancers cases are diagnosed at an advanced stage, FIGO stage III-IV with poor prognosis. The aim of the study was to evaluate newly diagnosed ovarian cancer among female population in Vojvodina (Serbia) and South Great Plain region in Hungary in 2007- 2012 period. Methods: The evaluation was based on the data from hospital registries for malignant diseases at the Oncology Institute of Vojvodina and the Department of Oncotherapy, University of Szeged. Results: The majority of patients were diagnosed in advanced disease (FIGO stage III-IV) in both regions. Serous epithelial ovarian cancer was the most common cancer type among studied women in both regions. The average age of women diagnosed with ovarian cancer was 60 years; there was no significant statistical difference related to patients? age in both studied regions. Advanced stage of ovarian cancer investigated in our study showed a moderate descending liner trend with no significant statistical difference. The results from our study were similar when compared with the epidemiological data from the literature. Conclusion: The lack of efficient screening methods is the major obstacle to improve the prognosis of women affected by this disease. Further investigations and introduction of new technologies applied to medical discoveries offers new hope for finding effective screening policies.

Introduction. Sentinel node biopsy in breast cancer has been a standard procedure at the Institute for Oncology of Vojvodina since 1999 and we have done more than 700 biopsy. Before the introduction of axillary sentinel lymph node biopsy, lymph nodes were routinely dissected, and this approach was the gold standard in surgical treatment of breast cancer. The study was aimed at presenting our results in performing sentinel node biopsy in clinical practice for operative treatment in breast cancer. Material and Methods. All patients (n=791) were women with clinically T1-2, N0-1, M0 breast cancer. Sentinel lymph node marking was performed by both contrast blue dye (Patentblau V) and radiotracer (antimony sulfide marked with Tc99m). Both contrast media were applied peritumorally or periareolarly. After sentinel lymph node biopsy all patients underwent breast-conserving surgery or mastectomy with or without lymph node dissection of level I and II (depending on sentinel lymph node status). Results. Sentinel lymph node biopsy was negative in 543 (68.7%) patients, and positive in 248 (31.3%) patients. Solitary tumor was present in 722 (91.2%) cases, multifocal tumors in 36 (4.57%), multicentric in 28 (3.55%) and bilateral in 5 (0.68%) patients. The mean duration of follow-up was 60.59 months (median 65, range 12- 132). Distant metastases were mostly found in bones (39.13%). Conclusion. The number of complications related to axillary dissection can be reduced and the patient’s quality of life can be improved by avoiding complete axillary lymph node dissection.

Background: To determine the level of knowledge among women about factors responsible for the development of cervix carcinoma and the necessity of education and health promotion. Methods: Three groups of women were interviewed according to measuring instruments by the specially created questionnaire for this research. The statistically significant difference in answers was determined by the ANOVA test. Results: In most of the investigated factors (7 of 11) statistically significant differences in answers were observed among the groups. Only six participants in all groups indicated human papillomavirus as the factor responsible for the development of cervix carcinoma. Conclusion: In all three groups of the interviewed women, bacterial and viral causes of the disease were highly ranked in comparison to other risk factors. Only a small number of participants indicated human papillomavirus as an etiological factor. There is need to improve the knowledge about risk factors through health promotion and health education in order to change the epidemiological situation concerning cervical carcinoma.

Human papillomavirus (HPV) is one of the most common sexually transmitted diseases worldwide. Cervical and other anogenital cancers, cervical and anal intraepithelial neoplasia, genital warts, and recurrent respiratory papillomatosis are HPV associated diseases. Prophylactic HPV vaccines are composed of HPV L1 capsid protein that self-assemble into virus-like particles (VLPs) when expressed in recombinant systems. Two types of prophylactic vaccines are designed as a bivalent vaccine to protect against high-risk HPV types 16 and 18 and a quadrivalent vaccine designed to protect against HPV 16 and 18, and low-risk, genital wart-causing HPV 6 and 11. Proof-of-principle trials have suggested that intramuscular injections of VLPs result in strong adaptive immune responses that are capable of neutralizing subsequent natural infections. Recent research on the safety and efficacy of candidate prophylactic vaccines against HPV have shown very promising results with nearly 100% efficacy in preventing the development of persistent infections and cervical precancerous lesions in vaccinated individuals.

Imidacloprid is an insecticide most commonly used on vegetables, potato sugar beet, fruit, cereal, maize and rice. Imidacloprid residue has been determined in spiked onion and in onion samples. Sample preparation consisted of dichlormethane extraction of imidacloprid from onion, followed by purification of the obtained extract on a LC-Florisil disposable cartridge. The HPLC-DAD method bas been developed on reversed-phase for separation of imidacloprid with a mixture of 0.01 M phosphate buffer (pH = 3.15): acetonitrile. Recovery of imidacloprid, repeatability, linearity limit of detection and limit of quantifi-cation have been determined.

Introduction Amniotic fluid volume reduction can have serious consequences prior to 24 gestational weeks hypoplasia of fetal lungs and later in pregnancy cord compression and fetal hypoxia as well as contractions of extremities. Diagnosis of oligohydramnios is made either after a subjective estimation of amniotic fluid reduction or if the biggest amniotic fluid pocket is less than 1 cm. Amnioinfusion is a procedure during which a crystalloid solution, most often saline, is instilled into the amniotic cavity substituting amniotic fluid. To estimate the efficacy and safety of amnioinfusion using our results and literature review. Material and methods Up to 800 ml of sterile saline solution was instilled intraamniotically (10-15 ml/min) in cases where the amniotic fluid index was less than 10 and intraamniotic infection was excluded. After that, 1 g of Longaceph was given intraamniotically. Infusion was stopped immediately when 800 ml was instilled, if a subjective estimation showed that there was enough fluid or if contractions occurred. Results During a six-month period there were five amnioinfusions - four therapeutical and one diagnostic; in four cases the procedure was successful and in one preterm rupture of membranes occurred 20 hours after the procedure. The procedure was most often done in the first half of the third trimester and continuation of pregnancy in successful cases was between 4 and 5 weeks, with average fetal weight gain of about 1200 gr No complications occurred in cases where pregnancy continued. Conclusion In our preliminary study amnioinfusion led to prolongation of pregnancy in majority of cases providing better maturation of fetal lungs and higher birth weight, without any complications. Further studies are necessary to reach definite conclusions about the efficacy and safety of amnioinfusion.

Postmenopausal vaginal bleeding (PMB) is the leading symptom of endometrial cancer. More than 70% of patients with endometrial cancer are postmenopausal. Despite PMB as a leading symptom in diagnosis of endometrial cancer, PMB could be caused by some benign processes in endometrium such as hyperplasia and focal endometrial disease, such as a polyp. The golden standard for histological evaluation of the endometrium is curettage. Transvaginal ultrasound (TVS) and measurement of endometrium thickness is also one of the favored methods in the last decade. Sonographic imaging of the endometrium can be extremely helpful, because endometrial cancer is nearly always associated with thickening and heterogeneity of the endometrium except in case of atrophy-associated adenocarcinoma of the endometrium, which is not associated with thickening. Hysteroscopy found place as a favored method in diagnosis of focal endometrial lesions. Saline infusion sonohysterography (SIS) is a relatively new imaging procedure. The SIS will show whether the endometrium is diffusely thickened, in which case curettage would be the next step, or focally thickened, in which case hysteroscopy with biopsy would be the next step. Combination of some diagnostic procedures, such as TVS, SIS, hysteroscopy, endometrial biopsy and curettage, should decrease false positive and false negative results which may affect the correct diagnosis and treatment.

Introduction Cervical cancer is the second most common cancer in women worldwide and the second cause of cancer death among women. About 95% (90% in developed countries) of invasive carcinomas are of sqamous types, and 5% (10% in developed countries) are adenocarcinomas. FIGO classification of cervical carcinomas, based on clinical staging and prognostic factor dictate therapeutic procedures and help in designing treatment protocols. Therapeutic modalities Surgical therapy includes conization, radical hysterectomy with pelvic lymphadenectomy and palliative operation urinary diversion and colostomy. Radiotherapy, brachytherapy and teletherapy are most recently combined with chemotherapy as concurrent chemoradiation. Discussion and conclusion No change in therapeutic modalities will ever decrease mortality rate of cervical carcinoma as much as education, prevention and early screening. The 5-year survival for locally advanced disease has not improved during the last 40 years as a result of failure to deliver therapy to the paraaortic region. Paraaortic lymph nodes should be evaluated before therapy planning by different imaging procedures, or more exactly by surgical staging: laparoscopy or laparotomy. Radical operations of cervical carcinoma should be performed by experienced surgeons, educated for this type of operation, with sufficient number of cases.

Ovarian cancer takes the second place in the incidence of all genital carcinomas occurring in pregnancy. In spite of a low overall incidence of ovarian cancer in pregnancy and, in most cases, asymptomatic clinical picture, the routine use of ultrasonographic examination in early pregnancy has led to a more frequent detection of adnexal masses in pregnant women. The authors presented a case of a 35-years-old patient with the diagnosis of unilocular cyst in the left ovary detected by ultrasonography at gestational week 8, with the subsequent sinistral adnexectomy administered for the rupture of the cystic tumor. Based on the histopathological examination we established the diagnosis of a serous cystadenocarcinoma stage I. The patient refused any proposed modality of oncologic diagnostics and therapy, and delivered a healthy female newborn of 3630g/49 cm, 10 days after the probable term of delivery. The control MRI, 8 months post partum did not confirm the presence of any pathological changes of either genital organs or any other organ of the small pelvis. The patient is in good general condition, under continual medical observation.

To examine the expression of vascular endothelial growth factor (VEGF) in the cervical tissue of individuals divided into the control group (normal cervix), group A (HSIL lesions), and group B (cervical cancer, FIGO stage I-IIA). Analyzed was also the expression of VEGF between groups and subgroups in group A and B. The expression of VEGF was also compared with histopathological parameters in group B.Examined was the histopathological material taken from 109 operated patients. The patients were divided into 3 groups based on the definitive histopathological findings: control group (30 patients), group A (33 patients), and group B (46 patients). Immunohistochemistry was performed to examine the expression of VEGF.The expression of VEGF was negative in the control group, while in 11 patients (33.33%) from group A and 28 patients (60.87%) from group B it was significantly different (p0.05) compared to the control group. There was neither statistically significant difference in the expression of VEGF in group A regarding the type of intraepithelial lesion, nor in group B regarding the FIGO disease stage (p0.05). In patients with poor histopathological prognostic parameters such as tumor diameter ≥ 2 cm (24/46), depth of stromal invasion ≥ 10 mm (32/46), positive lymph nodes (17/46), and with infiltration of the uterine body (11/46) a statistically significant difference was confirmed regarding the expression of VEGF.The increased VEGF expression in groups A and B compared with the control group indicated the importance of VEGF as a proangiogenic factor in neoangiogenesis in precancerous and cancerous changes in the cervix. The frequent expression of VEGF in the subgroup of patients with poor histopathological prognostic factors (group B) indicated the importance of the activity of proangiogenic factors in the process of cervical cancer neoangiogenesis. Further investigations should be aimed at these markers as prognostic factors in the high risk group of patients with cervical cancer who should receive adjuvant therapy after radical operation and consider using antiangiogenic drugs as part of adjuvant treatment.

Due to gynecological oncology general strategy and everyday aspiration for individual approach to malignant tumors, guidelines in treatment approach are not finally established, and they are controversial in some demands with age of the patients. If we look general treatment strategy approach to invasive endometrial cancer it is proved that operative treatment is priority and base line of treating endometrial carcinoma I and II clinical stage (FIGO) if there is general conditions for surgery, allowing complicated treatment in this age. Previous experience are showing that decision about application of therapy procedures in treatment of endometrial carcinoma every case have to has individual approach, regarding all known prognostic criteria: clinical stage, histological type, myometrial infiltration, lymph-vascular space involvement, size of the tumor and its localiza?tion, depth of myometrial infiltration, invading of serosa, cervix and adnexa, present of hormonal tissue receptors, information about lymph node: number, size and size of the biggest metastases, data about both extra nodular expansion of tumor and peritoneal cytology. The use of postoperative radiotherapy should be limited to group of patients with highly enough risk of locoregional recurrence (15% and more) as risk warranty of morbidity connected to radiological treatment. Therefore, the goal of postoperative radiotherapy appliance is to achieve maximum locoregional disease control and survival without relapse. New Radiotherapy (RT) techniques, Conformal Radiotherapy (CFRT) and Intensity Modulated radiotherapy (IMRT), reduce the risk of complications, especially for patients with multimodal treatment.

Cervical cancer is the most frequently diagnosed malignant disease in pregnancy. The clinical symptoms are scarce or none. The diagnosis is made primarily with a cervical smear, as well as a colposcopic examination and directed cervical biopsy. The treatment of cervical cancer depends on the stage of the disease, the gestation period, and a patient?s wish to carry a pregnancy to term. The illustrated case is of a patient who with the diagnosed presence of microinvasive squamous cell cancer, due to cervical biopsy, in the 1st trimester of pregnancy. In the 2nd trimester, diagnostic conization was performed in order to exclude the presence of the invasive disease. The definite histopathologic findings indicated the presence of cancer in situ. The conization margins were negative and thus the patient was successfully cured. The patient had a cesarean birth in the 36th week of pregnancy and she gave birth to an alive female newborn. Women are given the chance to have cervical cancer diagnosed and treated in the early stages of pregnancy owing to the introduction of a cervical smear in the modern protocol of antenatal protection.

Epithelial ovarian cancer belongs to the most common and most deadly of all types of ovarian carcinomas. Ovarian cancer affects women in the age group 65 years and older more frequently than younger women. Approximately 75% of cases will have spread beyond the ovaries at the time of diagnosis. Twenty-two year old patient was treated at the Institute of Oncology Sremska Kamenica, in the period from 1998 until 2000. In 1993, she underwent left salphingo-oopherectomy; histopathological finding was mucinous cystadenoma of the ovaries. In 1994, mucinous papillary cystadenoma with borderline malignancy confirmed by histopathological findings was found after abdominal hysterectomy with right salpingo-oopherectomy and total omentectomy. The patient was well until 1998 when she palpated a tumor mass in the front abdominal wall with pain in that region. Tumor was extirpated and final histopathological finding was mucinous adenocarcinoma in fibrous tissue. The patient received with chemotherapy (carboplatin and cyclophosphamide) and external-beam radiotherapy. Recurrence free survival rate was 20 months but in April 2000, patient came back with recurrence of the disease. It was the same spread into abdominal wall. Rectus abdominis muscle was resected and plastic surgery of abdominal wall was performed. After operation patient received second line chemotherapy according to the same protocol. However, during the treatment the disease spread into abdominal cavity and affected small intestine and liver.

Introducing laparoscopy in gynecology during the 1960s in Europe placed gynecology as pioneer in this less invasive approach in surgery. At that time, gynecological laparoscopy was predominantly used in diagnostics by means of direct visualization of pelvis minor. During the 1970s the gynecologists shifted the use of endoscopic technology from diagnostic to surgical purposes such as tubal ligation. From that time, laparoscopy has become a leading technique in diagnostics and surgical treatment of benign lesions in gynecology . By using laparoscopy in detection of bladder and prostate carcinoma spreading into the lymph nodes urologists have become the pioneers of the use of laparoscopy in the field of oncology . During the late 1980s, the initiators of endoscopic oncology began with laparoscopic evaluations of the condition and spreading of the malignant disease. The first reports were available at the beginning of 1990s, and with them came the controversial opinions about the usefulness of laparoscopy and minimal invasive surgery in gynecologic oncology. Disagreements were mainly associated with medicolegal aspects of possible consequences resulted from inadequate surgical treatment of malignant diseases.

BACKGROUND: Superficially invasive neoplasias of the uterine cervix are a matter of controversy in terms of their definition, prognostic factors and selection of treatment to minimize the risk of recurrences. METHODS: Forty-three women with invasive cervical carcinoma, operated from 1993 to 2003, were postoperatively staged as IA cervical carcinoma. There were 28 patients who were submitted to class III radical hysterectomy, 9 patients to class II hysterectomy, 2 patients to class I hysterectomy, and 2 patients to abdominal trachelectomy and pelvic lymph node dissection. Mean age of patients was 44 years (range, 27-64 years). RESULTS: Twenty-three patients (56.1%) were stage with IA1 and 18 (43.9%) with stage IA2 disease according to the 1995 FIGO classification. Tumor histology revealed squamous cell carcinoma in 38 (92.6%) cases, adenocarcinoma in 2 (4.8%) cases and glassy cell carcinoma in 1 (2.4%). The average number of examined lymph nodes was 17.4 (2-53). Lymphovascular space invasion was identified in 3 patients. None of the 41 patients had metastasis to the pelvic lymph nodes or developed recurrence of disease. CONCLUSION: The results suggest that patients with cervical cancer stage IA1 have an extremely low risk of pelvic lymph node metastasis and an excellent prognosis, so nonradical management that excludes pelvic lymph node dissection could be as effective as radical surgery in these patients. Stage IA2 invasive squamous carcinoma of the cervix should be treated with radical hysterectomy with lymph node dissection considering the presence of risk factors. The treatment should be individualized and based on an exhaustive pathological evaluation of an adequate cone biopsy specimen.

Introduction. Ovarian cancer is one of the leading health problems, as it is the underlying cause of disease and deaths of a large number of women around the world. Postmenopausal female population, in whom ovarian carcinoma is most often diagnosed in advanced stages of the disease, is primarily affected. Material and methods. We used data from Hospital Registry for Malignant Neoplasms at Oncology Institute of Vojvodina, for the period from 2001 to 2008, according to which 422 cases of ovarian carcinoma were reported. The obtained data were classified into three groups according to FIGO classification of ovarian malignant neoplasms. The statistical assessment of data employed the method of linear trend and tests of statistical significance (t-test). Results. The results of our study showed that most cases of diagnosed disease were advanced forms of ovarian cancer, FIGO stages II and IV. The linear trend of the reported cases in stage I for the period 2001/2008 showed a descending trend. According to the processed data, in the same period of time, stage II showed an ascending trend, while stages III and IV described together showed a moderate ascending linear trend. Conclusion. A vast majority of cases of ovarian cancer are detected in advanced stages of the disease, which is at the same time the group with the worst prognosis. Special attention should be paid to the group of patients with positive family history, as well as the presence of BRCA1 and BRCA 2 genetic mutations. Currently existing diagnostic procedures have not given good results individually in terms of high sensitivity for diagnosis of early stages.

Treating pregnant patients with a verified malignant disease represents a great clinical problem. Pregnancy-associated invasive cervical cancer is usually diagnosed at an early stage (approximately 70%). A 27-year-old patient was given the diagnosis of a pathohistologically verified cervical carcinoma, International Federation of Gynecology and Obstetrics stage IB1, in the 17th gestational week (GW). A radical abdominal trachelectomy was performed in the 19th GW. The patient was undergoing regular examinations at our institute of oncology while the Clinic of Gynecology and Obstetrics in Novi Sad, Serbia, monitored the pregnancy. In 36th GW, the patient had a cesarean section, with no visible traces of relapse, with good postoperative recovery and normal results in the newborn. The patient was discharged on the fifth postoperative day and advised to have her condition monitored at our institute of oncology. One year after radical trachelectomy, the patient is in the 15th GW of a new pregnancy with a normal Papanicolaou smear result.

Introduction Increased amniotic fluid volume may significantly increase the risk for preterm delivery. Amniodrainage is a symptomatic treatment by which excess amniotic fluid is reduced to provide fetal lung maturation. The aim of this study is to estimate the efficacy and safety of this procedure, our results and give a literature review. Material and methods Sonografic criteria were used (AFI> 400 ml, or the biggest amniotic fluid pocket > 150 mm) to choose patients in whom 18G needle was used to allow leaking of excessive amniotic fluid. Results 10 patients underwent 26 procedures. The procedures were performed at 28.6th week gestation, on average and 6.25 weeks average gain or 1000 g. We had two sets of monochorionic twins with twin-to-twin transfusion syndrome (TTTS), where one child survived. One procedure was followed by premature placental abruption, and premature delivery in 28th week. The rest of procedures were uneventful. Conclusion In our series of 10 women, 26 procedures were performed to prolong pregnancies, enable fetal maturation and weight gain. In majority of cases amnioreduction was done without complications, so we could repeat the intervention and prolong the pregnancy. Survival of one child in two TTTS pregnancies should not be regarded unsuccessful in our conditions.

Introduction Ovarian epithelial carcinoma is one of the most common gynecologic malignancies and the fifth most frequent cause of cancer death in women. Ovarian cancer affects women 65 years of age and older more frequently than younger women. Material and methods Four young patients with ovarian epithelial carcinoma were treated at the Institute of Oncology in Sremska Kamenica, Serbia and Montenegro, in the period 1981-2000. The median age at diagnosis was 17,3 years. Final histopathological findings revealed cystadenocarcinoma, either mucinous or serous. The stage of the disease was established using International Federation of Gynecology-Obstetrics (FIGO) Classification. Spread of the disease dictated the extent of operation and postoperative chemotherapy. Patients were strictly followed-up at the Institute. Results The first two patients underwent unilateral adnexectomy as initial treatment. Final histopathological examination revealed an epithelial ovarian carcinoma, stage IIIa and IIb. Total hysterectomy with unilateral adnexectomy and total omentectomy were performed in both patients as second treatment with chemotherapy, according to the Cisplatin/Carboplatin and Cyclophosphamide (CP) protocol following surgery. Another two patients underwent total hysterectomy with bilateral adnexectomy and total omentectomy as initial treatment with chemotherapy, CP protocol, following surgery. Both patients had stage IIc. Despite treatment, in two patients with stage IIIa and IIc, metastases were diagnosed. In 2 patients survival was over five years. One patient lived less than 3 years, and one less than 4 years. Discussion Ovarian carcinomas are difficult to diagnose at early stage. Histologic confirmation of the diagnosis, surgical staging, and aggressive surgical debulking, when possible, are all part of the initial evaluation and treatment. In most cases, surgery is followed by chemotherapy. The risk increases from 15.7 to 54 per 100,000 in the age group 40-79 years. Our study included 4 patients, medium age 17,3, with epithelial ovarian carcinoma which warns us to think twice when we get an adolescent patient with an adnexal mass. Conclusion Advancing age, the major risk factor for development of ovarian carcinoma is, of course, unalterable. We investigated 4 patients medium age 17,3 years, with epithelial ovarian carcinoma. Pelvic masses found in women of reproductive age, must also be evaluated preoperatively to determine the probability of malignancy.