Search

Rationale: Gastric-type endocervical adenocarcinoma (GAS) is a rare type of cervical adenocarcinoma that is a mucinous adenocarcinoma with a variety of gastral patterns. To date, there are no systematic clinical diagnosis and treatment guidelines., Patient Concerns: In our case, a 49-year-old woman underwent pelvic magnetic resonance imaging (MRI) due to a pelvic mass, and cervical lesions were unexpectedly found. After receiving relevant surgical treatment, the pathological results showed the particularity of the tumor type-cervical gastric adenocarcinoma with a borderline serous tumor of both appendages and the right ovary., Diagnoses: Postoperative routine pathological examination showed mucoepithelial metaplasia accompanied by a borderline serous tumor., Interventions: After gynecological/urinary ultrasound, blood tests, MRI, cervical biopsy, and uterine curettage, "robot-assisted laparoscopic radical hysterectomy + bilateral salpingectomy-ovariectomy + pelvic lymph node dissection + pelvic adhesiolysis" were performed. After the surgery, the patient was treated with radiotherapy and concurrent chemotherapy., Outcomes: After the operation, radiotherapy, and chemotherapy, the patient had no tumor recurrence and is still in good condition., Lessons: The diagnosis of GAS is relatively difficult, its clinical manifestations lack specificity, and the pathogenesis has nothing to do with human papillomavirus infection. The patient was misdiagnosed with vaginitis at a local hospital. However, we found that MRI and pathological examination were helpful for the diagnosis of the disease. Although there are no relevant guidelines to explain the treatment principles of GAS, we believe that early surgery is conducive to the prognosis of the disease because GAS has a certain tolerance to radiotherapy and chemotherapy., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Research Question: What are ovarian stimulation cycle outcomes and acceptance rates of an oocyte accumulation programme in young women with benign ovarian tumour (BOT)?, Design: Retrospective cohort study conducted at the Academic Assisted Reproductive Technology and Fertility Preservation Centre, Lille University Hospital, between January 2016 and December 2019. The number of metaphase II oocytes per cycle and per patient after accumulation were evaluated. Two groups were identified for the analysis: endometrioma ('endometrioma') and dermoid, mucinous or serous cyst ('other cysts')., Results: A total of 113 fertility-preservation cycles were analysed in 70 women aged 27.9 ± 4.8 years. Almost all women had undergone previous ovarian surgery before fertility preservation (89%). Mean anti-Müllerian hormone levels before ovarian stimulation was 12.5 ± 8.7 pmol/l. A total of 6.4 ± 3.4 oocytes were retrieved, and 4.3 ± 3.4 metaphase II (MII) oocytes were vitrified per cycle. All agreed to the oocyte accumulation programme and all underwent at least one cycle. To date, 36 (51%) patients achieved two or three fertility- preservation cycles. After accumulation, 7.0 ± 5.23 MII oocytes were vitrified per patient. No difference was found in ovarian response and oocyte cohort between the 'endometrioma' and 'other cysts' groups. Questionnaires completed after oocyte retrieval revealed abdominal bloating and pelvic pain in most patients, with no difference according to the type of cyst. No serious adverse events occurred., Conclusions: Oocyte accumulation should be systematically offered to young women with BOT irrespective of histological type, as it seems to be well-tolerated. Long-term follow-up is needed to assess the efficiency of oocyte accumulation to optimize the chances of subsequent pregnancies., (Copyright © 2021 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Background/objectives: Pancreatic cystic neoplasms (PCNs) are common, among which 13%-23% are serous cystic neoplasms (SCNs). However, diffuse and multifocal variants of SCNs are extremely rare. The differential diagnosis of SCNs from other PCNs is important as the former entities are benign and do not become invasive., Objective: This study analyzes the clinical characteristics of multifocal/diffuse SCN through a systematic review of the literature and a case report., Methods: A comprehensive literature search was executed in the Ovid MEDLINE, Embase, and Google Scholar databases. The search strategy was designed to capture the concept of multifocal/diffuse SCN cases with sufficient clinical information for detailed analysis. Using the final included articles, we analyzed tumor characteristics, diagnostic modalities used, initial management and indications, and patient outcomes., Results: A review of 262 articles yielded 19 publications with 22 cases that had detailed clinical information. We presented an additional case from our institution database. The systematic review of 23 cases revealed that the diffuse variant is more common than the multifocal variant (15 vs 8 cases, respectively). Patients were managed with surgical intervention, conservative treatment, or conservative treatment followed by surgical intervention. Indications for surgery following conservative management mainly included new onset or worsening of symptoms. Only one case reported significant tumor growth after attempting an observational approach. No articles reported recurrence of SCN after pancreatectomy, and no articles reported mortality related to multifocal/diffuse SCNs., Conclusion: Despite their expansive-growing and space-occupying characteristics, multifocal/diffuse SCNs should be treated similarly to their more common unifocal counterpart., Competing Interests: Declaration of competing interest The authors have no conflict of interests., (Copyright © 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.)

Pancreatic cystic lesions are a common clinical entity. The majority are neoplastic and have the potential for malignant transformation. To assist with patient management, a number of clinical guidelines have been developed over the past decade. However, controversies exist in regards to the various guidelines and treatment strategies they offer. This article will review the various clinical guidelines for management of pancreatic cysts, describe the limitations of these guidelines, and present future directions for improvement in clinical decision making for patients diagnosed with a pancreatic cystic neoplasm., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Pancreatic cystic neoplasms (PCNs) are being increasingly detected because of rapid advances in radiologic technology and an increased imaging demand. The management of PCNs is challenging as most of these neoplasms are asymptomatic, but have malignant potential, and surgical resection has substantial perioperative morbidity and mortality. Endoscopic ultrasonography (EUS)-guided ablation, as a minimally invasive treatment, has received increasing attention in the past few years. However, the resolution after EUS-guided ablative therapy still needs to be improved. In this case report, EUS-guided radiofrequency ablation combined with lauromacrogol ablation was applied for the first time in the treatment of PCN, and it showed complete resolution at a 3-month follow-up.

Hydatid disease (HD) is a commonly occurring zoonotic disease caused by tapeworms of the genus Echinococcus. It is endemic in many parts of the world and can involve almost any organ of the body. Although HD of the liver and lungs is quite common, ovarian involvement is rare. We present a case of a 24-year-old female patient who was diagnosed with multifocal hydatidosis involving the liver and bilateral ovaries on imaging. Postoperative histopathology confirmed the hydatid disease in the liver and one ovary. However, the cystic lesion in the other ovary turned out to be a borderline serous cystadenoma. This case highlights the limitation of imaging in differentiating between simple hydatid cysts and serous cystadenomas of the ovaries. Another point we learnt is that even in the presence of multifocal hydatidosis in endemic regions, serous cystadenoma needs to be considered in imaging differential diagnosis.

Objectives: Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality., Design: Retrospective multinational study including SCN diagnosed between 1990 and 2014., Results: 2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58 years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40 mm (2-200)), 9% had resection beyond 1 year of follow-up (3 years (1-20), size at diagnosis: 25 mm (4-140)) and 39% had no surgery (3.6 years (1-23), 25.5 mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1 year (n=1271), size increased in 37% (growth rate: 4 mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1)., Conclusions: After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN., Trial Registration Number: IRB 00006477., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Cystic neoplasms of the pancreas are being identified at an increasing frequency largely due to the increased use of abdominal cross-sectional imaging. These neoplasms represent a heterogeneous group of tumors with various genetic alterations, molecular features, and risks of malignancy. Despite the use of high-resolution radiographic studies, endoscopic evaluation, cyst fluid analysis, and novel molecular diagnostics, many of these lesions remain difficult to classify without operative resection. These diagnostic challenges are coupled with an improving but limited understanding of the natural history of these neoplasms. Treatment of pancreatic cystic neoplasms therefore remains controversial but consists largely of a selective tumor-specific approach to surgical resection. Future research remains necessary to better discriminate the biological behavior of these tumors in order to more appropriately select patients for operative intervention.

Background/aims: The aim of this study is to compare the distribution of anatomic sites of first recurrence in African American (AA) patients with ovarian carcinoma compared to Caucasians., Methods: Patients diagnosed with high-grade epithelial ovarian, fallopian tube or peritoneal carcinoma from 2007 to 2013 were identified. Patterns of recurrence were compared for AA and Caucasian patients. Progression-free survival (PFS) and overall survival (OS) were compared., Results: A total of 238 patients were included - 210 Caucasians and 28 AAs. At a follow-up time of 28 months, AAs were more likely to have multiple anatomic sites of recurrence rather than a single site when compared to Caucasians (63.6 vs. 35.5%, p = 0.01). Time to first recurrence was shorter for AA patients (12 vs. 18 months, p < 0.01). PFS and OS did not differ. AA patients with multiple sites of first recurrence had a significantly shorter OS than Caucasian patients with multiple sites of first recurrence (24 vs. 30 months, p = 0.022)., Conclusion: Patterns of first recurrence differ between AAs and Caucasians. AAs have shorter times to first recurrence and are more likely to have multiple anatomic sites involved. AA patients with multiple sites of recurrence have a shorter OS than Caucasian patients with multiple sites., (© 2015 S. Karger AG, Basel.)

Background: Serous cystadenoma is a benign pancreatic cystic neoplasm. Conservative management is favored. We studied the clinical characteristics and course of serous cystadenoma in patients undergoing surgery or conservative management only at an academic referral center., Methods: Patients presenting with serous cystadenoma in the years 2000-2013 were selected. Hospital records were evaluated for patient and serous cystadenoma characteristics., Results: A total of 22 patients with serous cystadenoma were identified. Mean age at diagnosis was 63 years and 82% were women. Diagnosis was incidental in 59%, and 18% presented with unspecific abdominal pain, 14% unexplained weight loss, 4.5% gastrointestinal obstructive symptoms, and 4.5% cholangitis. Location was pancreas body 36%, head 32%, tail 23%, and uncinate 9%. Mean serous cystadenoma diameter at diagnosis was 37 ± 23 mm. After diagnosis five patients underwent surgery. Initial size was similar between surgical and follow-up groups (p = 0.9). Four cases were lost to follow-up; 13 continued conservative management with a mean follow-up time of 54 ± 27 months. The initial and last serous cystadenoma size in the follow-up group remained similar (p = 0.9). Six cases presented significant tumor growth during follow-up (p > 0.05). All patients remained asymptomatic throughout follow-up. No malignancy or serous cystadenoma-related death occurred., Conclusions: Size change of serous cystadenoma was minimal and patients remained asymptomatic during follow-up. Surgery should be limited to symptomatic and selected cases.

The number of patients diagnosed with cystic pancreatic neoplasms (CPN) has increased significantly during the last decade due to the widespread use of cross-sectional imaging. These CPN consist of a heterogeneous group of neoplastic and non-neoplastic lesions with variable histopathological features, clinical presentation, and outcome. Until now we are not able to reliably identify all CPNs that require additional analysis, surgical resection or surveillance. Hence, physicians and surgeons are confronted with a difficult dilemma as they do not want to miss a diagnosis of pancreatic carcinoma, but this often leads to the risk of over- or misuse of diagnostic examinations with a risk of complications and increased health care costs. Currently, four expert consensus guidelines on cystic lesions of the pancreas are available. Unfortunately, recommendations vary considerably between these guidelines. The purpose of this review therefore was to compare the different guidelines and elaborate upon the topics where these guidelines disagree.

Incidental cystic lesions of the pancreas are often detected due to the increased use of cross-sectional imaging. Since mucinous cysts have a malignant potential, whereas pseudocysts and serous cystadenomas are benign, the distinction is of key clinical importance. Current recommendations advocate the use of multiple imaging modalities (CT/MRI/endoscopic US/endoscopic US & fine-needle aspiration) during evaluation and follow-up. This review describes the most frequent cystic lesions of the pancreas and suggests a simple investigation and treatment algorithm.

Pancreatic serous cystadenomas are uncommon benign tumours that are often found incidentally on routine imaging examinations. Radiological imaging techniques alone have proven to be suboptimal to fully characterize cystic pancreatic lesions. Endoscopic ultrasound, with the addition of fine-needle aspiration in difficult cases, has showed greater diagnostic accuracy than conventional imaging techniques. The best management strategy of these neoplasms is still debated. Surgery should be limited only to symptomatic and highly selected cases and most of the patients should only be strictly monitored. In the current paper, we provide an updated overview on pancreatic serous cystadenomas, focusing our attention on epidemiology, clinical characteristics and diagnostic evaluation; finally, we also discuss different management strategies and areas for future research.

Incidental cystic lesions of the pancreas are often detected due to the increased use of cross-sectional imaging. Since mucinous cysts have a malignant potential, whereas pseudocysts and serous cystadenomas are benign, the distinction is of key clinical importance. Current recommendations advocate the use of multiple imaging modalities (CT/MRI/endoscopic US/endoscopic US & fine-needle aspiration) during evaluation and follow-up. This review describes the most frequent cystic lesions of the pancreas and suggests a simple investigation and treatment algorithm.

Number of newly diagnosed cystic pancreatic tumors is permanently increasing. This fact is primarily related to the development of new diagnostic methods. The main representative ones are: serous cystadenoma, mucinous cystic neoplasm, intraductal papillary mucinous neoplasm and solid pseudopapillar tumor. Because of the malignant potential of these lesions, proper indication of surgical treatment is extremely important. The article highlights and describes our experience in diagnostics and therapy of cystic pancreatic tumors diagnosed in the General Teaching Hospital Prague in the period: 1/ 2008- 12/ 2012. All patients were investigated by computerised tomography and endoscopic ultrasound with fine -  needle aspiration biopsy. Thirty seven patients in total were diagnosed with cystic pancreatic tumors: 19 with serous cystadenoma, 5 with mucinous cystic neoplasm, 5 with mucinous cystadenocarcinoma, 5 with intraductal papillary mucinous neoplasm and 3 with solid pseudopapillar tumor. In 14 cases patients were indicated for surgery, in 1 case signs of malignant transformation were found. Determination of the optimal strategy for diagnostic and therapeutic procedures in patients with cystic pancreatic tumors requires the dia-gnosis, treatment and followup observation in adequately equiped specialized centers.

Pancreatic cystic lesions continue to pose diagnostic and management dilemmas for physicians. This may be related, in part, to the fact that these lesions represent a range of diagnostic possibilities, from inflammatory cysts and nonmucinous cysts to mucinous cysts, which may or may not have foci of invasive malignancy. Adequate characterization of cystic lesions is necessary to help devise a management plan. Moreover, patient-related factors such as comorbid conditions are often essential in deciding whether patients should be managed by a conservative approach of watchful waiting versus surgical resection, if so indicated. This review summarizes the recent advances in the management of pancreatic cystic neoplasms.

Background: von Hippel-Lindau (vHL) disease is a rare condition that leads to characteristic lesions within many different body systems. Pancreatic manifestations of vHL cover a wide spectrum of pathologies, and thus, accurate characterization and management is critical., Methods: A comprehensive and systematic text word and MeSH search of the medical literature was performed to identify studies where information regarding the prevalence, clinical characteristics, and management recommendations could be extracted., Results: Eleven studies were identified but 2 studies utilized the same data set. Of the 10 remaining studies, a total of 1,442 patients with vHL were available for analysis. Four hundred and twenty patients were examined for any type of pancreatic lesion, 362 for simple cysts or serous cystadenomas (SCAs), and 1,442 for neuroendocrine tumors (NETs). Of the 420 assessed for any pancreatic manifestation of vHL, 252 (60%) had a pancreatic lesion identified. Simple cysts that present as the sole manifestation of pancreatic disease were common and found in 169 of 362 (47%) patients. These are usually asymptomatic and do not normally require intervention. SCAs were reported in 39 of 362 (11%) patients and followed a similar benign course; resection is acceptable in symptomatic patients. NETs were identified in 211 of 1,442 (15%) patients, and 27 of 1,442 (2%) lesions behaved malignantly. Management of NETs depends on size, doubling time, and underlying genetics. Renal cell carcinoma is a characteristic in vHL, but there were no cases of pancreatic metastases identified from the included studies. Adenocarcinomas of the pancreas are not pathogenically linked to vHL., Conclusions: This review highlights the wide spectrum and high prevalence of pancreatic lesions in vHL. Simple cysts and SCAs are benign, but NETs require careful observation due to their malignant potential.

Background and Aims: The natural history and growth pattern of pancreatic serous cystic neoplasms (SCNs) are not well understood. This study was designed in order to get insight into the growth rate of SCNs and to suggest recommendations for their management., Methods: Patients with well-documented incidentally discovered or minimally symptomatic SCNs who underwent yearly surveillance MRI were analysed using a linear mixed model. The growth rate and the effects of different fixed factors (sex, personal history of other non-pancreatic malignancies, radiological pattern, clinical presentation, tumour site) and random factors (age and tumour diameter at the time of diagnosis) on tumour growth were investigated., Results: Study population consisted of 145 patients. Estimated overall mean growth rate was 0.28 cm/year, but the growth curve analysis showed a different trend between the first 7 years after the baseline evaluation (growth rate of 0.1 cm/year) and the subsequent period (years 7 to 10, growth rate of 0.6 cm/year, p<0.0001). Tests for fixed effects demonstrated that an oligocystic/macrocystic pattern and a personal history of other tumours are significant predictors of a more rapid mean tumour growth (p<0.0001 and 0.022, growth rates of 0.34 cm/year). Furthermore, tumour growth significantly increased with age (p = 0.0001)., Conclusion: Overall, SCNs grow slowly, and an initial non-operative approach is feasible in all the asymptomatic or minimally symptomatic patients. The oligocystic/macrocystic variant, a history of other non-pancreatic malignancies and patients' age impact on tumour growth. In any case, a significant growth is unlikely to occur before 7 years from the baseline evaluation. Tumour size at the time of diagnosis should not be used for decisional purposes.

A 73-year-old woman visited our hospital for a treatment of pancreatic tumor that increased steadily in size of 6 cm in diameter in 1999 to 13 cm in 2008, while remaining in asymptomatic condition throughout this follow-up time. The tumor was big and flowed from many vessels such as portal and superior mesenteric veins and the celiac and superior mesenteric arteries. These were critical for determining tumor respectability and the risk of massive intra-operative hemorrhage was felt to be considerable. Therefore, preoperative embolization of the tumor-feeding arteries arising from the celiac axis (gastroduodenal, splenic and dorsal pancreatic arteries) was performed on the previous day of operation. Tumor resection with pancreaticoduodenectomy and partial resection of portal vein and reconstruction were performed. We got to SMA with the use of "paraduodenal mesenteric approach", we called, and we finished the operation without a blood transfusion. The final pathology confirmed the diagnosis of serous microcystic adenoma.

Unlabelled: Ovarian borderline tumors are rare, their good prognosis depending on their stage at the time of diagnosis, and the presence of invasive implants. There is little information on tumor type identified intra-surgically, as well as on the most favorable treatment in borderline ovarian tumors., Aim: To determine the criteria of identification and presurgery and intra-surgery differentiation of the ovarian borderline tumors from the invasive carcinoma and benign ovarian tumors., Material and Methods: This study included 54 patients with TPMS (ovarian borderline tumors) surgically treated in the past 22 years (January 1988-December 2009) at the 4th Gynecological Clinic of the lasi "Gr. T. Popa" University of Medicine and Pharmacy. In this interval 1,107 ovarian tumors: 575 benign, 478 malignant, and 54 TPMS (4.87%) were recorded. The age of the patients with borderline tumors ranged between 20 and 78 years, mean age 46 years, and the histological types were: mucinous (27 cases), serous (18 cases), mixed (8 cases), and Brenner tumor (1 case)., Results: We have analyzed the distribution of these cases according to the time when surgical treatment was performed. The frequency of borderline ovarian tumors in our study is 4.87%, lower than in the literature. We believe that this low percentage in our study is due to missing the microscopic data in some macroscopic benign tumors., Conclusions: By this research we aimed at elaborating a therapeutic strategy for each case using with discernment the modern treatment (surgery, chemotherapy, radiotherapy), as well as new chemical drugs with the goal of obtaining better results and longer survival. There are no tumor markers which could predict the progression of a borderline ovarian tumor to invasive tumors, but the invasive course is only 0.7%.

Background: Endometrial carcinoma is the fourth most common type of cancer among women in Germany, with more than 11 000 newly diagnosed cases each year. The present lack of clarity about the optimal clinical management of these patients is due in part to inconsistencies in the scientific evidence and in part to recent modifications of the FIGO classification. In this article, the issues requiring clarification are presented and discussed., Methods: This article is based on a selective review of the pertinent literature, including evidence-based guidelines and recommendations., Results and Conclusion: Current scientific evidence does not support the screening of asymptomatic women. On the other hand, women with postmenopausal and acyclic bleeding should undergo histopathological evaluation, particularly if they have risk factors for endometrial cancer. The current FIGO classification divides endometrial cancer into stages depending on the findings at surgery. On the basis of risk stratification (e.g., by tumor stage and histological differentiation grade), women who are judged to be at high risk (FIGO Stage IB and above, Grade 3) should undergo not just hysterectomy and adnexectomy, but also systematic pelvic and para-aortic lymphadenectomy. Risk stratification also determines whether adjuvant radiotherapy should be given. The additional or alternative administration of chemotherapy is a particular consideration for women at high risk, although the pertinent clinical trials to date have yielded conflicting evidence on this point.

Background: Spondylodiscitis is commonly caused by aerobic bacteria. Of all the spinal infections, anaerobic organisms account for less than 3% and are usually seen in postoperative patients., Case Description: We report a rare case of spontaneous onset of spondylodiscitis caused by anaerobe Prevotella that led to the diagnosis of serous cystadenofibroma of the ovaries., Conclusion: The finding of Prevotella species in musculoskeletal infection should prompt investigation of the genitourinary system., (Copyright © 2010 Elsevier Inc. All rights reserved.)

There are only a handful of concepts concerning cancer and carcinogenesis that are currently beyond dispute. One such dogma is the adenoma-carcinoma sequence and that a multistep accumulation of genetic alterations is required for transformation from a benign to a neoplastic tissue. The inevitable derivative of this dogma is that every invasive carcinoma is in fact a missed intraepithelial tumor, and furthermore, a late evolutionary stage in the sequence of development from a precursor lesion. Until fairly recently, high-grade serous ovarian carcinoma seemed to be one of the only known deviants of these concepts. In this article, we discuss the emergence of the fallopian tube fimbria as a field of origin for high-grade serous carcinomas and present a binary model of ovarian cancer pathogenesis that takes into consideration prior epidemiologic, morphologic, and genetic data. With the rise of the fallopian tube secretory epithelial cell as a cell of origin for high-grade pelvic serous carcinomas, the need to develop tools and model systems to characterize the biology and physiology of this cell is recognized.

Estrogen and progestin are involved in ovarian carcinogenesis. Change in nm23-H1 expression and the PIK3/AKT pathway are involved in carcinogenesis, development, invasion and metastasis of ovarian cancers. Therefore, it is critical to understand the signaling pathways that regulate hormone-induced cell migration and invasion in ovarian cancer. We investigated nm23-H1, AKT and pAKT expression by using immunohistochemical staining in ovarian clear cell adenocarcinoma, ovarian benign, borderline and malignant serous tumors and analyzed their relationship with prognostic factors. Using ES-2 and SKOV-3 ovarian cancer cell lines, we studied the modulation of estrogen and progestin on cell migration and invasion as well as their effect on AKT, pAKT and nm23-H1 expression. Furthermore, the signaling pathways were examined using pharmacological inhibitors (LY294002 and PD98059) or AKT siRNA combined with estrogen or progestin in the two cell lines. Weak nm23-H1 and high AKT and pAKT expression was observed in ovarian serous adeno-carcinoma and ovarian clear cell adenocarcinoma. Our data demonstrated that the expression of nm23-H1 was negatively correlated with tumor stage and grade and lymph node metastasis, whereas the expression of AKT/pAKT was positively correlated with these clinic factors. Estrogen up-regulated pAKT expression and reduced nm23-H1 expression, which ultimately resulted in increased cell migration and invasion. In contrast, progestin reduced pAKT expression and increased nm23-H1 expression, which inhibited cell migration. PIK3 kinase inhibitor LY294002 antagonized the effect of estrogen. On the other hand, it reinforced the effect of progestin. Our data suggest that AKT and pAKT are unfavorable prognostic factors for ovarian serous adenocarcinoma and clear cell carcinomas whereas nm23-H1 expression predicates favorable patient prognosis. Estrogen down-regulates nm23-H1 expression and promotes cell migration and invasion by activating the PIK3/AKT pathway. Progestin has an opposing effect.

Serous cystadenoma of the pancreas is a diagnosis being entertained with increasing frequency. The histopathologic findings, diagnostic strategy, differential diagnosis, and treatment strategy of these generally benign but sometimes symptomatic lesions are discussed. Based on the available case series, surgical resection should be considered in good-risk patients with symptomatic tumors, with tumors at least 4 cm in maximum diameter, or in whom a more worrisome diagnosis cannot be excluded.

Background/aims: Due to enhanced imaging modalities, pancreatic cysts are being increasingly detected, often as an incidental finding. They comprise a wide range of differing underlying pathologies from completely benign through premalignant to frankly malignant. The exact diagnostic and management pathway of these cysts remains problematic and this review attempts to provide an overview of the pathology underlying pancreatic cystic lesions and suggests appropriate methods of management., Methods: A search was undertaken with a Pubmed database to identify all English articles using the keywords 'pancreatic cysts', 'serous cystadenoma', 'intraductal papillary mucinous tumour', 'pseudocysts', 'mucinous cystic neoplasm' and 'solid pseudopapillary tumour'., Results: The mainstay of assessment of pancreatic cysts is cross-sectional imaging incorporating CT and MRI. Fine-needle aspiration (FNA) (often with endoscopic ultrasound) may provide valuable additional information but can lack sensitivity. Symptomatic cysts, increasing age and multilocular cysts (with a solid component and thick walls) are predictors of malignancy. A raised cyst aspirate CEA, CA 19-9 and mucin content (including abnormal cytology), if present, can accurately distinguish premalignant and malignant cysts from benign ones., Conclusion: In summary, all patients with pancreatic cystic lesions, whether asymptomatic or symptomatic, must be thoroughly investigated to ascertain the underlying nature of the cyst. Small asymptomatic cysts (<3 cm) with no suspicious features on imaging or FNA may be safely followed up. Follow-up should continue for at least 4 years, with a repeat FNA if needed. An algorithm for the management of pancreatic cystic tumours is also suggested. and IAP., (Copyright 2008 S. Karger AG, Basel.)

Aim: The ovarian cancer is the most malignant disease from all oncogynecological localizations. There are different scientific opinions whether the different histological types have different prognosis and survival. The aim of our research work was to evaluate if the endometrioid cancer of the ovary has a different prognosis from the serous ovarian cancer., Methods: 84 patients were evaluated for five years period from 2003 till 2008. The patients with endometrioid ovarian cancer (42) were matched with the patients with serous ovarian cancer (42). They were matched for age, grading,stage, and level of cytoreduction., Results: 84 patients (42 with endometrioid cancer and 42 with serous ovarian cancer) were evaluated for 5 years period. The five years survival of the patients with endometrioid ovarian cancer was 62% while the five years survival for patients with serous ovarian cancer was 72%. In patients with endometrioid ovarian cancer the mean survival rate was 58 months, and for patients with serous ovarian cancer 70 months (P=0.30). The estrogen receptor levels were not statistically significant between the two groups (P=0.110), while the progesteron receptor levels were statistically different (P<0.002)., Conclusions: In patients with endometrioid and serous ovarian cancer, while taking into consideration the age, grading, stage and level of cytoreduction--there is no difference for the five years survival or the length of survival.

Objective: The survival rate for the most common gynecologic cancer, endometrial cancer, has fallen significantly in the last 25 years. Stage III (International Federation of Gynecology and Obstetrics) disease accounts for most of the deaths. We evaluated prognostic factors, treatment-related survival, and routinely used assessments for identifying stage III disease before the operation., Study Design: The data for patients with endometrial cancer stage III (n = 101) who had been treated at the McGill University Health Center between 1989 and 2003 were analyzed., Results: Stage IIIA, IIIB, and IIIC tumors accounted for 63%, 4%, and 33% of the data, respectively. The cause-specific survival at 2, 3, and 5 years was 82%, 77%, and 67%, respectively. In multivariate analysis with an adjustment for the standard prognostic variables, the final tumor grade, adnexal involvement, and lymph node dissection were significant predictors of cause-specific survival (P = .001, .028, and .017, respectively). Of the preoperative investigations, an elevated CA-125 level was a significant predictor of cause-specific survival in multivariate analysis (P = .029)., Conclusion: An elevated CA-125 level, adnexal involvement, the final tumor grade, and lymph node dissection were independent predictors for cause-specific survival.

Recently, there has been an increased recognition of neoplasms of the pancreas other than ductal adenocarcinoma. Although not as well studied or characterized as pancreatic adenocarcinoma there are many distinct lesions which exhibit diverse biological behaviors and varying degrees of malignancy. These lesions include: endocrine neoplasms, cystic tumors, solid pseudopapillary tumors, acinar cell carcinoma, squamous cell carcinoma, primary lymphoma of the pancreas, and metastatic lesions to the pancreas. These less common neoplasms are being diagnosed more frequently as the number and sensitivity of diagnostic imaging studies increase. This review article discusses the clinical course, diagnosis, and treatment of these less common, but quite relevant, neoplasms of the pancreas.

Background: Compared with their ovarian counterparts, serous borderline tumors of the fallopian tube are uncommon, with limited experience about their clinical behaviour. We present a case of serous borderline tumor of the fallopian tube with unusual presentation and summarise all the published cases to date., Case Presentation: A case of serous borderline tumor of the fallopian tube in a 34-year old patient is presented, incidentally found during routine gynecologic examination. At laparoscopy the tumor was unusually presented as hematosalpinx and was treated by salpingectomy. Cell-cycle analysis of the tumor tissue revealed a diploid DNA content and a low S-phase fraction. There was no evidence of the disease during the follow-up period of 4.6 years., Conclusion: The current case and review of the literature suggest salpingectomy as the optimal treatment for patients with serous borderline tumor of the fallopian tube.

Objective: To define the natural history and optimal management of serous cystadenoma of the pancreas., Summary Background Data: Serous cystadenoma of the pancreas is the most common benign pancreatic neoplasm. Diagnostic criteria, potential for growth or malignancy, and outcomes are not well defined. As a result, management for patients with serous cystadenomas varies widely in current practice., Methods: A total of 106 patients presenting with serous cystadenoma of the pancreas from 1976-2004 were identified. Hospital records were evaluated for patient and tumor characteristics, diagnostic workup, treatment, and outcome. Twenty-four patients with serial radiographic imaging were identified, and tumor growth curves calculated., Results: Mean age at presentation was 61.5 years and 75% of patients were female. The most common symptoms were abdominal pain (25%), fullness/mass (10%), and jaundice (7%); 47% were asymptomatic. Mean tumor diameter was 4.9 +/- 3.1 cm, which did not vary by location. Tumors <4 cm were less likely to be symptomatic than were tumors > or =4 cm (22% vs. 72%, P < 0.001). The median growth rate in the patients who had serial radiography was 0.60 cm/y. For tumors <4 cm at presentation (n = 15), the rate was 0.12 cm/y, whereas for tumors > or =4 cm (n = 9), the rate was 1.98 cm/y (P = 0.0002). Overall, 86 patients underwent surgery, with one perioperative death., Conclusions: Large (>4 cm) serous cystadenomas are more likely to be symptomatic. Although the median growth rate for this neoplasm is only 0.6 cm/y, it is significantly greater in large tumors. Whereas expectant management is reasonable in small asymptomatic tumors, we recommend resection for large serous cystadenomas regardless of the presence or absence of symptoms.

Background: Pancreatic cystic tumors commonly include serous cystadenoma (SCA), mucinous cystadenoma (MCA), and mucinous cystadenocarcinoma (MCAC). A differential diagnosis with pseudocysts (PC) can be difficult. Radiologic criteria are not reliable. The objective of the study is to investigate the value of cyst fluid analysis in the differential diagnosis of benign (SCA, PC) vs. premalignant or malignant (MCA, MCAC) lesions., Methods: A search in PubMed was performed with the search terms cyst, pancrea, and fluid. Articles about cyst fluid analysis of pancreatic lesions that contained the individual data of at least 7 patients were included in the study. Data of all individual patients were combined and were plotted in scatter grams. Cutoff levels were determined., Results: Twelve studies were included, which comprised data of 450 patients. Cysts with an amylase concentration <250 U/L were SCA, MCA, or MCAC (sensitivity 44%, specificity 98%) and, thus, virtually excluded PC. A carcinoembryonic antigen (CEA) <5 ng/mL suggested a SCA or PC (sensitivity 50%, specificity 95%). A CEA >800 ng/mL strongly suggested MCA or MCAC (sensitivity 48%, specificity 98%). A carbohydrate-associated antigen (CA) 19-9 <37 U/mL strongly suggested PC or SCA (sensitivity 19%, specificity 98%). Cytologic examination revealed malignant cells in 48% of MCAC (n = 111)., Discussion: Most pancreatic cystic tumors should be resected without the need for cyst fluid analysis. However, in asymptomatic patients, in patients with an increased surgical risk, and, in patients in whom there is a diagnostic uncertainty about the presence of a PC, cyst fluid analysis helps to determine the optimal therapeutic strategy.

Background: Significant progress has been made in understanding the molecular biology of ovarian carcinoma. Along with the molecular characteristics of cancer, the patient's response to the tumour may also contribute to survival; in particular, the effect of the immune system may play an important role on survival of cancer patients., Patients and Methods: We analysed the CD3 positive tumour-infiltrating T cells and direct molecular assessment of T cell receptors (TCRs) gamma and beta in 95 advanced ovarian carcinomas., Results: Gamma/delta T cells are statistically correlated with a brief disease-free interval (P=0.036). CD3 positive tumour-infiltrating T cells are correlated with a brief disease-free interval and with survival (P=0.004 and P=0.0001, respectively). CD3 positive tumour-infiltrating T cells are associated with clinical responsiveness to chemotherapy (P=0.003)., Conclusions: Further studies are required to better understand the role of gamma/delta T cells in ovarian carcinoma, yet these data underline the importance of host immune response to cancer and the need to better study immune mechanisms to modulate the therapeutic treatment of cancer.

Systemic metastases from ovarian carcinoma are frequent, but they seldom affect the central nervous system. We present here the case of a patient treated for an ovarian cancer by surgery and chemotherapy. Three months after the end of chemotherapy, the patient developed cerebral metastases from ovarian carcinoma (CMOC) treated by iterative surgery and and whole brain irradiation. As the frequency of solitary cerebral metastasis of ovarian cancer is higher than with other cancers, it is likely that they behave slightly differently. Literature analysis reveals an increase in the incidence of CMOC since the middle of the nineties. CMOC can occur during or after adjuvant chemotherapy and the best management strategies to better define determinants of survival for patients are not well known. It appears that a better outcome of CMOC may be obtained by an aggressive treatment, if possible, including surgery, radiotherapy, and chemotherapy. Taking into account the increase in the incidence of the CMOC and their early occurrence, some authors have proposed a prophylactic brain radiotherapy in patients who receive adjuvant chemotherapy.

Background: The aim of this study is to evaluate the rate and the clinical outcomes of lymph node involvement in patients treated for borderline ovarian tumor (BOT)., Study Design: Forty-two patients were treated for BOT with a procedure that included lymphadenectomy. Twenty-four patients underwent a pelvic lymphadenectomy, 6 a paraaortic lymphadenectomy, and 12 both procedures. Thirty-two patients underwent systematic lymphadenectomy, five because of associated cancer (uterine cervix or corpus) and five because of bulky nodes discovered during the surgical procedure., Results: An endosalpingiosis was present in 11 (26%) patients who underwent lymphadenectomy. Eight patients had nodal involvement related to the BOT. All patients with nodal involvement had serous BOT with peritoneal implants. None of the patients with a mucinous tumor had nodal involvement. None of the patients with early-stage disease (without peritoneal disease) had nodal involvement discovered after routine lymphadenectomy. None of the patients with nodal involvement died of borderline tumor. One patient died of a complication of adjuvant therapy (leukemia after chemotherapy)., Conclusions: The prognosis of patients with borderline tumors of the ovary and nodal involvement is excellent. Routine lymphadenectomy should not be performed in patients with early-stage disease. This procedure should be carried out in patients with serous tumor and enlarged lymph nodes.

Cystic lesions of the pancreas are encountered frequently in clinical practice. Cystic neoplasms of the pancreas are much less common. In order to diagnose and most effectively treat these lesions, the surgeon must understand their clinical presentation in order to plan appropriate preoperative evaluation and therapeutic intervention. The following is a descriptive outline of the most common types of cystic neoplasms of the pancreas and a discussion of their preoperative, intraoperative, and postoperative management. The goal of the paper is to provide a functional understanding of cystic neoplasms of the pancreas so that they may be recognized and appropriately treated.

The prognosis for patients with ovarian serous borderline tumors is generally considered to be excellent. It is worse for women with an advanced stage, especially when invasive peritoneal implants are present. There is no general agreement regarding standard treatment in such cases. To clarify the significance of this invasive peritoneal proliferation and to devise a rational treatment approach, we review the available series. From this review of literature, it appears necessary to emphasize the importance of an initial adequate peritoneal staging of all ovarian tumors. After a complete removal of the lesions, the question of adjuvant therapy must be discussed.

Expression of blood group-related carbohydrate antigens was examined in frozen sections from a series of ovarian carcinomas of different histological types using an indirect immunoperoxidase technique. Antigenic specificities belonging to the O(H) and Lewis blood group families (H-1, H-2, Le(a), sLe(a), Le(x), sLe(x), Le(b) and Le(y)) or the mucin-core family (Tn, sTn and TF) were studied. A distinct difference in antigen expression between mucinous and other ovarian carcinomas (serous and endometrioid) was observed. Specifically, mucinous tumors tended to express sTn, Le(a) and sLe(a) strongly and homogeneously, whereas serous and endometrioid tumors rarely expressed these specificities and, in contrast, expressed Le(y) and H type 2 antigen strongly. When expressed in serous tumors, sTn was usually distributed in a heterogeneous pattern, whereas sTn expression in mucinous tumors was much more homogeneous. The distribution of Le(y) in serous tumors was noticeably homogeneous. H-1, Le(x), sLe(x), Le(b), TF and Tn specificities were rarely expressed in any type of ovarian carcinoma. Our results provide further support for the different histogenesis of mucinous and non-mucinous tumors and indicate alternative differentiation pathways for the 3 pathological subtypes of ovarian tumor. They also provide the basis for the choice of carbohydrate antigens for active and passive immunotherapy of ovarian carcinomas.

Cystic pancreatic neoplasms comprise a heterogeneous group of pathologic entities. Mucinous cystic tumors and serous cystadenomas account for more than 75% of reported cases. While serous cystadenomas are almost uniformly benign, mucinous cystic tumors all have malignant potential and must be treated as such. While both clinical and biochemical features can distinguish among the various cystic pancreatic lesions, surgical resection is often required for both definitive diagnosis and treatment. When surgery is performed, benign lesions should be treated with pancreatic parenchymal sparing procedures if anatomy permits. Standard surgical oncologic principles should be employed when treating indeterminate or malignant lesions.

Objective: To study the clinical features and management of borderline ovarian tumor (BOT)., Methods: Retrospectively study 70 cases of BOT., Results: Age 16-76 years old, average 45.6 year old; histological type: mucinous 46(65.7%), serous 21(30%); stage: I 46 (65.7%), II 1(1.4%), III 11(15.7%), IV 0%, relapse 12(17.1%). Tumor marker: elevated CA125 11/21, carcinoembryonic antigen (CEA) 6/10., Treatment: all patients were operated, 45 were given adjuvant therapy., Outcome: No evidence of disease (NED) 45, with evidence of disease (WED) 4, died of disease (DOD) 11, died of intercurrent disease (DID) 10. 11 patients who were given conservative surgery were NED, there were 2 long term CR among 16 patients with residual disease who were given adjuvant treatment. The 5, 10, 20 and 30-year survival is 90.0%, 87.1%, 87.1% and 85.6% respectively. COX hazard regression model analysis showed that histological type (r = 24.825), stage (r = 2.236) and residual disease (r = 2.083) were the main factors which impact on the prognosis of BOT., Conclusions: (1) The proportion of mucinous tumor is higher than that of serous tumor in this group; (2) Surgery is the proved only effective treatment of BOT till now, without any residual disease is expected; (3) Adjuvant therapy can't improve the prognosis of BOT; (4) CA125 and CEA can be two effective tumor markers in monitoring of BOT.

The aims of our study were to determine the prevalence of simple ovarian cysts in asymptomatic postmenopausal patients and to investigate the natural history of these cysts by ultrasonographic follow-up examinations. Three thousand five hundred and eighty-five women participated in the volunteer pelvic cancer screening program. Entry criteria were as follows: postmenopausal, no clinical symptoms, and no previous gynecologic pathology. An anechoic, small cyst less than 5 cm in greatest diameter was classified as a simple ovarian cyst. A scoring system to determine malignant potential had been established previously. All simple cysts had a score of 2 or less and had a morphology typical of benign lesions. In the case of a positive finding, the patient would be seen at 3 to 6 month intervals. The decision for surgical intervention was made by a private gynecologist or patient or if an interval change was noted. One thousand seven hundred and sixty-nine postmenopausal women (49.34% of all patients from the screening program) participated in this study. One hundred and sixteen simple cysts were found, with a prevalence of 6.6% in our population. Among those patients, 27 (23.28%) simple cysts resolved spontaneously, 69 (59.48%) have persisted, and 20 (17.24%) have been lost to follow-up study. Eighteen women (26.09%) with persistent simple ovarian cyst underwent surgery. No malignant ovarian conditions were identified. In conclusion, simple ovarian cysts are more common in postmenopausal women than previously was thought. This condition is very unlikely to be malignant and can be followed conservatively.

Ten serous neoplasms of low malignant potential (LMP) resected during pregnancy were found in the files of the University of Texas M. D. Anderson Cancer Center (UTMDACC). Microscopically, all tumors had marked epithelial proliferation with abundant eosinophilic cells, and eight had intraluminal mucin. Multiple areas of microinvasion were found in eight cases. Additional unusual features were found in three cases. One patient presented with a serous LMP tumor in a supraclavicular lymph node. After resection of an ovarian serous LMP tumor, she was treated with chemotherapy and is without evidence of disease after 21 years. One patient had tumor resected at 24 weeks of gestation and at 2 months postpartum. Marked regression of the epithelial proliferation, the number of eosinophilic cells, and the amount of mucin was seen in the second specimen. Another patient had multiple peritoneal nodules at cesarean section, one of which was biopsied and diagnosed as a primary serous LMP of the peritoneum with multiple areas of microinvasion. Two months later a diagnostic laparoscopy was performed and no residual disease was found. All patients are alive with no evidence of disease. In summary, serous LMP tumors during pregnancy have microscopic and clinical features suggesting aggressive behavior; however, these features appear to regress at the termination of the pregnancy.

Background: Macrocystic serous cystadenoma (MSC) of the pancreas is a new entity that has recently been well recognised. This tumour is quite similar in aspect to the mucinous cystic tumours (MCT) but its prognosis is much better, so that a correct diagnosis before surgery is important., Patients: Three patients undergoing surgery in the 1st Surgical Clinic of the University of Bologna for suspected cystic lesions were found to have macrocystic serous cystadenoma (MSC) of the pancreas. In two cases a biopsy was performed during surgery, but in only one was a correct diagnosis of MSC made; in the other the diagnosis was lymphangioma. In the remaining case a biopsy was not performed because the high 19/9 CA level in the blood suggested a diagnosis of MCT of the pancreas. In all 3 cases the tumour was successfully removed by surgery., Conclusions: Macrocystic serous cystadenoma (MSC) of the pancreas represents a variant of the serous cystic tumors, which encompass microcystic adenoma and serous cystadenocarcinoma. MSC must be distinguished from MCT because it exhibits a different biological pattern and requires a different surgical approach. Therefore, we would underline the importance of a biopsy in making the differential diagnosis.

The distinct pathologic and biologic nature of ovarian tumors of low malignant potential (LMP) has been officially recognized by FIGO and the World Health Organization. LMP tumors may comprise 10% of ovarian neoplasms; they occur at a mean age of 40 years. Pregnancy, breast-feeding, and the use of oral contraceptives are protective against the development of tumors of LMP. A history of infertility and use of infertility drugs appear to increase the risk of these tumors. No association with hereditary ovarian cancer syndromes has been reported. The survival associated with these tumors is 99% at mean follow-up of 7 years for patients with stage I disease, and 92% for those with stage II and II disease. Retrospectively, more patients appear to have died from complications associated with adjuvant therapy than from progressive disease. The recommended treatment is surgical, consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node biopsies, peritoneal washings, and tumor debulking. In young patients with early-stage disease, conservative surgery, preserving the uterus and contralateral ovary, is acceptable. A role has not yet been established for adjuvant therapy, whether radiotherapy or chemotherapy. Laboratory investigations have not demonstrated that these tumors represent an intermediate step between benign ovarian tumors and carcinoma nor have they identified that small subset of tumors with aggressive clinical behavior. We should perhaps consider tumors of LMP in the same light as "benign" proliferative gynecologic conditions, such as endometriosis and leiomyomata.

Twenty patients with ovarian borderline epithelial tumors were analysed. The tumor in 9 patients were serous and in 11 patients mucinous in nature type. 15 cases were classified as of stage I, 3 cases of stage II and 2 cases of stage III, according to the FIGO staging. All pathologic slides were re-reviewed to confirm the diagnosis and no patients were lost to follow-up. Total hysterectomy and unilateral or bilateral salpingo-oophorectomy were done in 12 patients, among whom, 2 died of tumor recurrences. Unilateral adnexectomy was done in 8 patients, and none died of tumor recurrence. Fourteen patients received post operative chemotherapy 1-8 courses with PAC regimen, 12 patients were alive up to the present. Six patients did not receive chemotherapy and among these 3 with stage Ia were alive and 1 with stage Ib died of tumor recurrences. The survival rate of stage I was 92.3%. Our results indicated that the prognosis was closely related to clinical staging. We suggested that patients of stage I who wish to preserve childbearing function may be treated with unilateral salpingo-oophorectomy, and chemotherapy should be given to the patients with high risk factors. Because of the indolent nature of these tumors, long-term follow-up at least 10 years is necessary.