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Characteristics and prognostic factors among premenopausal versus postmenopausal patients with advanced endometrial cancer: a SEER-based analysis
X.Q. Wang, S.Q. Ma, J.Y. Guo, F. Zhao, X.H. Liang
European Journal of Gynaecological Oncology    2020, 41 (1): 1-6.   DOI: 10.31083/j.ejgo.2020.01.5172
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The aim of this study was to assess risk factors associated with developing second cancer in premenopausal and postmenopausal endometrial cancer survivors using data from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate analysis revealed that for both groups age was a risk factor for second cancer development. For premenopausal women, being white versus black, having endometrioid adenocarcinoma compared with other histological types increased the risk of developing a second cancer (p values ≤ 0.018). For postmenopausal women, being Non-Spanish-Hispanic-Latino versus Spanish-Hispanic-Latino, having squamous cell carcinoma versus endometroid adenocarcinoma, N0 compared with N1 nodes, M0 versus M1 metastasis, and no surgery or radiotherapy compared with surgery alone or surgery plus radiotherapy increased the likelihood of developing second cancer (p values ≤ 0.012). The results of Cox proportional hazard analysis indicated that premenopausal and postmenopausal women with endometrial cancer who underwent surgery plus radiotherapy showed the greatest benefit with respect to cause-specific survival (adjusted HR 0.192, 95%CI: 0.135 to 0.274, and adjusted HR 0.206, 95%CI, 0.184 to 0.230, respectively). In summary, risk factors for second cancer in survivors of endometrial cancer differ between premenopausal and postmenopausal women, and suggests that the two groups of women should be managed differently.
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Malignant perivascular epithelioid cell tumor (PEComa) of uterus: A case report with literature review
Joseph J. Noh, Sir-Yeon Hong, Byeong-gie Kim
European Journal of Gynaecological Oncology    2020, 41 (4): 495-499.   DOI: 10.31083/j.ejgo.2020.04.5305
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Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal neoplasm involving various organs. Approximately 70 cases of gynecologic PEComas have been reported in the literature. Due to the paucity of cases, there is no definite treatment regimen established. We describe disease progression in a case of uterine PEComa with pulmonary metastasis in a 37-year-old woman who had been treated with surgery and various regimens of adjuvant treatment including vincristine, ifosfamide, cisplatin, sirolimus, doxorubicin, olaratumab, pazopanib and dacarbazine. Adequate management and prognosis still seem inconclusive and further case reports with randomized trials are needed to delineate the nature of this neoplasm.
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Development of lymphangiosarcoma after pelvic radiation therapy for uterine cervical cancer: A case report and literature review
Hikari Unno, Seiji Mabuchi, Isao Arai, Tomoko Wakasa, Seiichi Yamamasu
European Journal of Gynaecological Oncology    2020, 41 (3): 326-331.   DOI: 10.31083/j.ejgo.2020.03.5082
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Angiosarcoma accounts for 1-2% of all soft tissue sarcomas. Common sites of occurrence include the skin, breast, soft tissue, and liver. Angiosarcoma of the gastrointestinal (GI) tract is very rare. We herein present a case of a 41-year-old woman with lymphangiosarcoma of the small intestine occurring 7 years after pelvic radiotherapy for uterine cervical cancer.

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Malignant bowel obstruction in recurrent gynecologic cancers: who will benefit from palliative surgical intervention?
Rie Nakamura, Yuko Shimoji, Tadaharu Nakasone, Yusuke Taira, Yoshihisa Arakaki, Tomoko Nakamoto, Keiko Mekaru, Wataru Kudaka, Tatsuya Kinjo, Yoichi Aoki
European Journal of Gynaecological Oncology    2020, 41 (4): 513-516.   DOI: 10.31083/j.ejgo.2020.04.5070
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Purpose of Investigation: To define factors that assist in the selection of patients with gynecologic cancer who have malignant bowel obstruction (MBO) for those who are most likely to benefit from palliative bowel surgery. Materials and Methods: Between 2004 and 2014, 11 women who underwent surgery for bowel obstruction after a discharge for the treatment of gynecologic cancer were included. The diagnosis of MBO was confirmed by symptoms and signs of intestinal obstruction along with abdominal X-ray, or a computed tomography (CT) scan. Results: The median age of women was 58 years and the median time to surgery was six days. Colostomy was performed in seven of eleven patients, ileostomy in three, and bowel resection and anastomosis in two. Postoperative oral intake was achieved in ten of eleven cases, with a median period of 77 (range, 27–224) days. The progression free interval (PFI) of the primary cancer was < 6 months in six patients and ≥ 6 months in five. The median duration of post-operative oral intake in patients with PFI of < 6 and ≥ 6 months was 34.5 (range, 0–65), and 120 (range, 89–224) days, respectively (p = 0.0014). The median survival time after surgery in patients with PFI of < 6 and ≥ 6 months was 43 (range, 11–111), and 156 (range 94–253) days, respectively (p = 0.0206). Conclusion: PFI of primary gynecologic cancer is a good indicator that could help select for those patients who would most likely benefit from palliative bowel surgery. Surgery for MBO should be considered for patients without serious contraindications.
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The impact of pre-existing polycystic ovary syndrome on endometrial cancer recurrence
T. Uehara, A. Mitsuhashi, M. Shozu
European Journal of Gynaecological Oncology    2020, 41 (5): 668-674.   DOI: 10.31083/j.ejgo.2020.05.5038
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Purpose: Polycystic ovary syndrome (PCOS) is a risk factor for the development of endometrial cancer (EC). To the present authors’ knowledge, no study has clarified whether pre-existing PCOS is a prognostic factor for post-surgical EC recurrences. The aim of this study was to determine whether pre-existing PCOS is a risk factor for the recurrence of EC even after the surgical treatment of EC in premenopausal women. Materials and Methods: The authors performed a retrospective cohort study on premenopausal EC patients aged 50 years or younger who underwent surgery at this hospital between 2009 and 2013. The median follow-up period was 65.5 months. Results: Of 46 patients with EC, nine (19.6%) had PCOS. Four of the nine PCOS patients developed recurrence of EC, three of whom died of the disease, whereas only one of 37 patients who did not have PCOS developed EC recurrence (44.4% and 2.7%, respectively; p = 0.003). Univariate analysis showed that the progression-free and overall survival of the patients with pre-existing PCOS was worse than that of patients without pre-existing PCOS (p = 0.008 and p = 0.029, respectively). Multivariate analysis revealed that PCOS was a poor prognostic factor for progression-free survival and a marginal poor prognostic factor for overall survival (p = 0.011 and p = 0.061, respectively). Conclusions: Pre-existing PCOS was a risk factor for recurrence in premenopausal post-operative patients with EC aged 50 years or younger.
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Genomic profiling in gynaecological oncology: the future is now!
Luca Roncati, Maria Vadalà, Pepe Valentina, Veronica Corazzari, Beniamino Palmieri
European Journal of Gynaecological Oncology    2020, 41 (3): 323-325.   DOI: 10.31083/j.ejgo.2020.03.5363
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Nowadays, thanks to next generation sequencing, it is simultaneously possible to search for driver mutations in hundreds of cancer-related genes with high sensibility and specificity, by exploiting formalin-fixed paraffin-embedded tumor material, from biopsy samples and surgical specimens, or circulating tumor DNA in the patient's blood. In addition to indicate the genomic alterations, this modern technology provides information about: the approved therapies in the patient’s cancer type or in other tumor types for a personalized oncology; potential clinical trials; mutational burden and microsatellite instability (MSI). This last datum is particularly relevant because the U.S. Food & Drug Administration (FDA) has approved the use of pembrolizumab for all unresectable or metastatic, MSI-high or mismatch repair deficient, solid malignancies, among which there are 17-32% of sporadic endometrial carcinomas and 10-17% of sporadic ovarian cancers. Similarly, the FDA has approved olaparib for the maintenance treatment of adult patients with advanced epithelial ovarian, fallopian tube or primary peritoneal cancer, characterized by deleterious or suspected deleterious germline or somatic mutations in ‘breast cancer’ (BRCA) genes, who are in complete or partial response to first-line platinum-based chemotherapy. Therefore, we are facing an era of innovation in gynaecological oncology, in which molecular profiling is joining immunomorphological typing for new health goals.

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New treatment strategy for ovarian cancer with a BRCA gene mutation
Tadahiro Shoji, Kotoka Kikuchi, Hayato Kogita, Nanako Jonai, Hidetoshi Tomabechi, Akiko Kudoh, Eriko Takatori, Takayuki Nagasawa, Masahiro Kagabu, Tsukasa Baba
European Journal of Gynaecological Oncology    2021, 42 (1): 1-9.   DOI: 10.31083/j.ejgo.2021.01.2251
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Mutated BRCA1/2 genes have been identified as causative genes for ovarian cancer, and it has been reported that 10–20% of all epithelial ovarian cancers have a BRCA mutation. As novel treatment drugs utilizing this BRCA gene mutation, significant attention has been paid to adenine dinucleotide poly (ADP-ribose) polymerase inhibitors. Among them, olaparib has been reported to be useful in patients with a BRCA mutation in Study 19 and SOLO-2 trials. It is important to establish a system for genetic counseling and to perform BRCA gene testing in patients with ovarian cancer. For patients with BRCA -mutated advanced cancer, if adequate response to chemotherapy has been achieved, olaparib is recommended as maintenance therapy for both advanced and recurrent cases. For patients without BRCA gene mutation, bevacizumab combined with chemotherapy or as maintenance therapy is also an option.
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The impact of secondary cytoreductive surgery on survival in first recurrence of platinum sensitive epithelial ovarian cancer
Silvia Ortega, José Angel Mínguez, José Manuel Aramendía, Marta Santisteban, Fernando Martinez-Regueira, Pablo Martí-Cruchaga, Juan Luis Alcázar, Matías Jurado
European Journal of Gynaecological Oncology    2020, 41 (4): 523-530.   DOI: 10.31083/j.ejgo.2020.04.8051
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Objective: Analyze the effect on survival of secondary cytoreduction surgery (SCS) in treatment of first recurrence platinum-sensitive epithelial ovarian cancer (REOC). Methods: Retrospective analysis of patients with first REOC who had platinum time-free interval (TFIp) > 6 months and were treated either with SCS followed by chemotherapy or chemotherapy only (CT). Clinical data such as patient's performance status and number of sites with metastases were specifically assessed. The primary endpoint was overall survival (OS). Results: Seventy-one patients were treated either by SCS (n = 37) or CT (n = 34). Complete resection after SCS was achieved in 89% of patients. After a median follow-up of 51.2 months, median OS, and progression-free survival (PFS) were 68.2 and 21.6 months, respectively, for the whole series of the SCS patients had better survival and disease progression survival than the CT only patients (HR: 0.33, 95%CI: 0.17-0.6; p = 0.001) and (HR: 0.28, 95%CI: 0.15-0.5; p = 0.001), respectively. TFIp < 12 months and multiple metastases were most important prognostic factors for risk of death (HR: 7.7 and 6.2, respectively) and recurrence (HR: 5.8 and 3.8, respectively). Probability to undergo successful SCS is related to oligometastatic disease and no residual disease after first surgery (OR: 30.0 and 5.9, respectively). Conclusions: In women with REOC oligometastatic disease and no residual disease at first surgery are associated with successful SCS. In these patients oligometastatic disease and long platinum TFI are associated with improved probability of survival.
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Multicentric assessment of cervical HPV infection co-factors in a large cohort of Greek women
Panteleimon Mnimatidis, Abraham Pouliakis, George Valasoulis, George Michail, Aris Spathis, Christine Cottaridi, Niki Margari, Maria Kyrgiou, Maria Nasioutziki, Alexandros Daponte, Konstantinos Dinas, Evangelos Paraskevaidis, Ioannis Panayiotides, Dimitrios-Dionysios Koutsouris
European Journal of Gynaecological Oncology    2020, 41 (4): 545-555.   DOI: 10.31083/j.ejgo.2020.04.5180
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Purpose of Investigation: Despite the general principle that persistent high risk human papillomavirus (hr-HPV) infection may progressively cause cervical cancer (CxCa), demographic aspects may still identify groups at high risk for HPV infection and consequently for precancerous lesions. The role of demographic parameters on cervical status, the diagnostic accuracy of cytology, HPV genotyping, and their possible combinations, were investigated in this study. Materials and Methods: 11,072 women from diverse locations across Greece participated in the study. Liquid Based Cytologic (LBC) assessment was followed, when necessary, by HPV-genotyping and histologic confirmation. Demographic characteristics were also assessed. Results: Life style parameters such as age, number of sexual partners, condom use, parity and marital status, education level, and combination of smoking/condom use, were significant factors for CIN2+ lesions (p < 0.05). For LSIL+ detection, cytology had maximum sensitivity: 96.90%, HPV-typing: 72.55% and co-testing: 98.97%, for HSIL+ detection: 98.49%, 92.22%, and 99.55% respectively. Conclusions: There are notable relationships between lifestyle, demographic details, and cervical status. Despite the differences in sensitivity and specificity levels, co-testing might offer some marginal improvement in the detection of particular pre-cancerous conditions.
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Should we search for high-risk HPV in vaginal vault Pap smear after hysterectomy due to CIN2+?
I. Ferreira, C. Estevinho, A. Torgal, C. Carrapatoso, F. Costa
European Journal of Gynaecological Oncology    2020, 41 (2): 157-162.   DOI: 10.31083/j.ejgo.2020.02.5226
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Women with a history of hysterectomy due to malignant or premalignant cervical disease are currently submitted to tight surveillance, which consists of vaginal Pap tests for as long as 20 years in the late follow-up period. Nevertheless, published literature has concluded that vaginal Pap screening has a very low detection yield. Also, these recommendations are almost entirely from an era before high-risk HPV (hrHPV) DNA testing. The authors' aim is to review these women's current management and share the scarce recommendations available for the management of abnormal vaginal Pap and/or adjunctive hrHPV DNA tests in these patients.
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Malignancy-transformed mature cystic teratoma surgical treatment requires comprehensive staging procedures including pelvic/para-aortic lymphadenectomy
B. Barczyński, K. Frąszczak, M. Bilski, J. Szumiło, I. Wertel, M. Sobstyl, G. Polak, L. Grzybowska-Szatkowska, J. Kotarski
European Journal of Gynaecological Oncology    2020, 41 (3): 484-488.   DOI: 10.31083/j.ejgo.2020.03.5146
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This report presents the case of squamous cell cancer (SCC) originating from a mature cystic teratoma (MCT) diagnosed in pregnant women, in whom retroperitoneal spread to para-aortic lymph nodes was confirmed as the only evidence of extraovarian disease in a relatively short time after primary tumor excision. The 35-year-old multipara was diagnosed in early pregnancy with an ovarian tumor. The patient qualified for elective caesarean section with left ovarian cystectomy. Pathological result proved SCC in MCT and the patient underwent debulking surgery without total pelvic and para-aortic lymphadenectomy. Final staging confirmed ovarian malignancy FIGO IA, and no adjuvant treatment was recommended. Early imaging examination during routine follow-up demonstrated enlarged para-aortic lymph nodes and the patient qualified for total pelvic and para-aortic lymphadenectomy. Postoperative pathology result confirmed metastases in para-aortic lymph nodes and standard adjuvant chemotherapy was administered.

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High-grade endometrial cancer survival (endometrioid to non-endometrioid histology comparison)
S. Srdelić Mihalj, V. Čapkun, I. Kuzmić-Prusac
European Journal of Gynaecological Oncology    2020, 41 (1): 16-22.   DOI: 10.31083/j.ejgo.2020.01.4731
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Purpose of Investigation: To analyze overall survival (OS) and disease-free survival (DFS) in a retrospective series of 125 patients with serous, clear cell, and high-grade endometrioid carcinoma having undergone complete treatment (primary surgery, oncology treatments, and follow up) at the present institution. Materials and Methods: All women with high-grade endometrial cancer having undergone surgery (1998-2012) and postoperatively treated and monitored at Split University Hospital Center, whose tissue samples were stored at Department of Pathology, Split University Hospital Center, were included in the study. Survival time was analyzed with Kaplan- Meier method and the log-rank test was used to assess between-group differences. Cox proportional hazard regression model was used on multivariate survival analysis. Patients were followed from the time of primary surgery until death or last follow up in December 2015. Results: Women with serous and clear cell endometrial cancer had similar survival compared to those with high-grade endometrioid endometrial cancer. On multivariate analysis, only earlier stage was an independent predictor of improved survival. Conclusions: The present findings suggest that serous and clear cell endometrial carcinomas have a similar prognosis compared to high-grade endometrioid carcinoma of the uterus.
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Prognostic factors for types I and II epithelial ovarian cancer in the elderly
X.Z. Cheng, Z. Zhou, M.Y. Yang, Y.L. Cai, F. Deng, X.X. Chen
European Journal of Gynaecological Oncology    2020, 41 (1): 7-15.   DOI: 10.31083/j.ejgo.2020.01.4826
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Purpose: No consensus exists on whether age is independently associated with poor prognosis in epithelial ovarian cancer (EOC). This study aimed to examine the prognostic factors of EOC in elderly patients. Materials and Methods: A total of 665 EOC patients from Jiangsu Institute of Cancer Research (JICR, People's Republic of China) were retrospectively analyzed between 1996 and 2015. For validation, 990 cases who consulted at MD Anderson Cancer Center (MDACC, USA) from 1990 to 2011 were recruited. The associations between survival durations and covariates were assessed by Cox proportional hazards model and log-rank test. Results: Histological type II (p = 0.01) and suboptimal surgery outcome (p = 0.00) were more common in the elderly (age ≥ 70 years) patients with EOC than in younger patients from JICR. The International Federation of Gynecology and Obstetrics (FIGO) stage, histological type, and optimal surgery were independently associated with overall survival (OS; p = 0.00, p = 0.03, and p = 0.00, respectively) and progression-free survival (PFS; p = 0.00, p = 0.02, and p = 0.00, respectively) in the EOC patients. Both OS and PFS were lower in the elderly patients with type I EOC than in the younger cases (136.5 months vs. 191.8 months at p = 0.00 and 35.5 months vs. 75.1 months at p = 0.01, respectively). The OS and PFS of the elderly patients were poorer than those of the younger cases with type II EOC (38.4 months vs. 42.3 months at p = 0.00 and 14.9 months vs. 16.8 months, p = 0.04, respectively). In type II ovarian cancer patients who achieved optimal debulking, the median OS and PFS durations of younger patients remained longer than those of elderly patients (50.2 months vs. 68.0 months, p = 0.00 and 14.9 months vs. 19.2 months, p = 0.01, respectively). Conclusions: Compared with young patients, elderly EOC more commonly presented with an aggressive histological type and poor performance status and was more frequently undertreated. Advanced age was independently associated with poor prognosis in EOC, even after the influence of histological type and surgical outcome was eliminated.
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Mesonephric-like carcinoma of the uterine corpus: A case report and literature review
Hyang Sook Jeong, Yuki Gen, Hui Ryun Joo, Ji Geun Yoo, Seung Geun Yeo, Dong Choon Park
European Journal of Gynaecological Oncology    2020, 41 (5): 664-667.   DOI: 10.31083/j.ejgo.2020.05.5420
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This report describes a woman with uterine mesonephric-like carcinoma and reviews the literature on this rare condition. A 60-year-old woman was referred for abdominal discomfort. Pelvic magnetic resonance imaging showed a tumor, about 7.0 cm in diameter in her left ovary. Surgical exploration, however, showed that both ovaries were grossly free of tumor. Rather, a protruding cancerous mass was found on the left side of her uterus. The tumor was composed of cells with various growth patterns and was diffusely positive for PAX8 and GATA3 on immunohistochemistry. The apical luminal border of the glandular structures was positive for CD10, and the glandular structures were focally positive for EMA. The final diagnosis was mesonephric-like carcinoma, stage pT3N1M. Conclusion: Diagnosing mesonephric-like carcinoma is pathologically challenging because these tumors are rare and present with a wide spectrum of morphologic patterns. Positive staining for PAX8 and GATA3 and a luminal staining pattern of CD10 can support the diagnosis.
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Stem cells in ductal breast cancer: immunohistochemical expression of CD44, CD24, CD133, and ALDH-1 markers in 104 cases
D. Korfias, J. Contis, M. Frangou-Plemenou, K. Gennatas, A. Kondis, D. Vlachodimitropoulos
European Journal of Gynaecological Oncology    2020, 41 (1): 36-41.   DOI: 10.31083/j.ejgo.2020.01.4810
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Objective: The aim of this study was to evaluate the immunohistochemical expression of stem cell markers CD44, CD24, CD133, and ALDH-1 in breast carcinomas and investigate any correlation with stage, degree of tumor differentiation, cell proliferation index, and hormone receptors status. Materials and Methods: One hundred and four cases of invasive ductal breast carcinomas were studied and classified according to grade and stage, hormonal status, and C-erbB2 expression. A semi-automatic Ventana method was used to examine by semi-quantitative method the immunohistochemical expression of anti-CD133, CD24, CD44, and ALDH1 antibodies. Results: CD44, CD24, and ALDH1 markers demonstrated a statistically significant correlation with higher disease stage and triple negative cancers (94%-55.5%). CD133 correlated with triple negative cancers (55.5%). No correlation with other clinical data or tumor differentiation was observed. Conclusion: Triple negative breast cancers express specific stem cell markers responsible for cell/stroma interaction and this is a useful tool in predicting tumor progression and developing specific targeted therapies.
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Magnetic seed localisation for non-palpable lesions in patients undergoing breast conservative surgery
A. Conversano, C. Balleyguier, M.K. De Fremicourt, H. Alkhashnam, C. Mazouni, J. Arfi-Rouche, N. Leymarie, F. Rimareix
European Journal of Gynaecological Oncology    2020, 41 (1): 48-53.   DOI: 10.31083/j.ejgo.2020.01.4985
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Purpose: Breast-conservative surgery is the standard procedure for breast cancer when tumour resection does not lead to significant cosmetic sequelae. The usual technique to locate non-palpable lesions is the wire-guided localization (WGL). However, the WGL may migrate and cause interference with the electro cautery. The placement of the WGL has to be performed on the day before or the day of the surgery, causing organizational problems. To optimize care pathway and increase ambulatory activity, the authors studied the feasibility and efficacy of a 5-mm iron seed MAGSEED. Materials and Methods: During four months, 20 seeds were placed in 19 patients undergoing a lumpectomy for non-palpable breast lesions. The evaluation questionnaire was filled by radiologists, surgeons, and patients. Results: All clips were detected. The radiological and surgical team found the MAGSEED simple and intuitive. Placement was done by ultrasound and stereotaxic guidance up to 15 days before surgery. Time of lumpectomy was reduced to an average of 11 minutes. Patients' pain level was low (2/10). Conclusion: The use of MAGSEED for the detection of non-palpable breast lesions is simple, safe, and feasible. A comparative randomized prospective study should be performed between MAGSEED and WGL to study the medico-economic outcomes and the surgical and radiological benefits of the magnetic seed.
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Nutritional assessment among patients with cervical cancer and controls
B. Bárány, R. Póka
European Journal of Gynaecological Oncology    2020, 41 (1): 23-29.   DOI: 10.31083/j.ejgo.2020.01.4964
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The present study aims to acquire an insight into the nutrition of cervical cancer patients, to assess food consumption pattern in patients and controls, to identify assess dietary deficiencies in women recently diagnosed with cervical cancer compared to controls, and to investigate dietary changes during treatment. This study was conducted among 65 patients diagnosed with cervical cancer, and 170 controls, at the Division of Gynecological Oncology of the University of Debrecen, in Hungary. The authors used the food frequency questionnaire and the three-day diet record to assess nutrition. Based on the results, the consumption frequency of vegetables and legumes was significantly lower among the cases. Patients' dietary intake of vitamin D, C, and folate was significantly lower at the time of diagnosis, compared to controls. Nutrient intake is similarly insufficient among patients during the treatment. The present results show nutritional problems among cervical cancer patients and further research is required.
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The role of erythropoietin and erythropoietin receptor expression in breast cancer
M.P. Budzik, A.M. Badowska-Kozakiewicz
European Journal of Gynaecological Oncology    2019, 40 (1): 7-15.   DOI: 10.12892/ejgo4266.2019
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Erythropoietin (EPO) plays a number of important functions in the body. Contrary to original beliefs, its activity is not limited to exerting effects on cells along the erythropoietic pathway. Newly published results continue to provide information on novel functions of the protein in other types of tissues, as well as on the important roles played by EPO in pathological processes. With no doubt, EPO has a significant impact on the biology of breast cancer cells by affecting cells’ proliferation, apoptosis, resistance to chemotherapy, as well as expression of various types of receptors. EPO exerts its direct action on breast cancer stem-like cells by activation of specific signaling pathways responsible for protection of the tumor from chemotherapy and accelerating disease progression. EPO could inhibit chemotherapeutic drug-induced apoptosis and cytotoxicity. Its correlation with tissue hypoxia may play a significant role in the therapeutic resistance of hypoxic tumors. In recent years, the role of endogenous EPO in regulation of carcinogenesis was also noted. Exogenous EPO, in the form of rhEPO, had been introduced with best intention to treat patients with cancer-related anemia in the course of breast cancer. While it decreases the transfusion requirements and improves the quality of life of cancer patients, randomized trials have demonstrated that rhEPO administration is associated with shorter progression-free and overall survival. Observations allow also to say that EPO antagonizes treatment with the anti-HER2 antibody trastuzumab by activating EpoR/JAK2 downstream effectors, effectively bypassing HER2 signaling. Although increasing amount of information is available regarding the role of EPO and EpoR in breast cancer, elucidation of the activity and involvement of these proteins in complex processes occurring within the cancer cells requires extensive research. Every set of results being published answers some of the questions while instead raise new ones.

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An elderly patient with primary cervical CD5-positive diffuse large B-cell lymphoma: a case report and review of the literature
Gengrong Liu, Zhenglei Shen, Liefen Yin, Zhe Zhang, Lingmei Yin, Ke Wang, Huan Yang, Jin Yao
European Journal of Gynaecological Oncology    2020, 41 (4): 500-503.   DOI: 10.31083/j.ejgo.2020.04.5298
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Objective: To increase our understanding of the clinical features, diagnosis and treatment, and prognosis of primary cervical CD5+ diffuse large B-cell lymphoma (DLBCL) in an elderly patient. Materials and Methods: We analyzed a case of an elderly patient with primary cervical CD5+ DLBCL and reviewed the literature. Results: The clinical features of this patient were not specific and were manifested as fever, significantly elevated LDH, normal blood test results, an unidentified fraction (6.5%) of cells shown by bone marrow puncture, unexpressed T-system and medullary system markers, and a primary lesion of the cervix found upon positron emission tomography-computed tomography (PET-CT). Cervical biopsy plus immunohistochemical staining showed a CD5+DLBCL, and the diagnosis was confirmed and R-CHOP therapy achieved a favorable therapeutic effect. Conclusions: The clinical manifestations of primary cervical CD5+DLBCL are not specific but PET-CT combined with cervical biopsy can clarify the diagnosis with R-CHOPas the preferred therapeutic regimen.
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Preoperative discriminating performance of the IOTA-ADNEX model and comparison with Risk of Malignancy Index: an external validation in a non-gynecologic oncology tertiary center
N. Tug, M. Yassa, M. Akif Sargın, B. Dogan Taymur, K. Sandal, Ertunc Mega
European Journal of Gynaecological Oncology    2020, 41 (2): 200-207.   DOI: 10.31083/j.ejgo.2020.02.4971
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Aim: This study aimed to externally validate the International Ovarian Tumor Analysis-Assessment of Different Neoplasias in the adnexa IOTA-ADNEX model in a tertiary center without a specific gynecologic oncology unit to be used for referral to an oncology center, and to compare its performance with Risk of Malignancy Index (RMI) I-IV. Materials and Methods: Data of 285 women who underwent surgery for an adnexal mass with known CA-125 values were prospectively collected and retrospectively analyzed. Preoperative scores of ADNEX model and RMI I-IV were compared with final histopathological diagnosis. Patients were further classified according to their menopausal state. Results: Rate of malignancy was 9.1%. Sensitivity and specificity rates of ADNEX model in discriminating malignant tumors were found to be 88.5% and 84.6%, respectively (AUC 0.865 ± 0.039), irrespective of menopausal state at 10% cut-off value as proposed by the original article. Optimal cut-off value of ADNEX model to discriminate malign tumors was found as 14%. ADNEX model exhibited superior sensitivity and specificity compared to all four RMI models. This model was able to discriminate benign lesions from borderline, Stage I ovarian cancer (OC) and Stage II-IV OC, borderline tumors from Stage II-IV OC, and Stage I from Stage II-IV OC (AUC > 0.700) very well. On the other hand, discrimination between borderline with Stage I tumors (AUC 0.576 ± 0.152) was mediocre. Conclusion: ADNEX model adds a stratified classification and might be clinically useful for the triage of patients admitted to a non-oncologic center with suspicious adnexal masses to be referred to specialized oncology units.

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Development of high-risk HPV associated cervical dysplasia despite HPV-vaccination: a regional dysplasia center cohort study
A.K. Fischer, K. Reuter-Jessen, H.-U. Schildhaus, T. Hugo, A.H. Scheel, S. Merkelbach-Bruse, E. Heinmöller, R. Buettner, B. Jasani, J. Walbeck, J.Rüschoff, P. Middel
European Journal of Gynaecological Oncology    2020, 41 (1): 80-84.   DOI: 10.31083/j.ejgo.2020.01.5093
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The present study was conducted to examine the frequency of CIN/squamous intraepithelial lesions in patients after vaccination and respective HPV types observed at their referral to a regional center for screening of cervical dysplasia.
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Indocyanine green is superior to blue colorimetric method for identifying sentinel lymph nodes during laparoscopic surgery for uterine malignancies: a pilot study
E. Kobayashi, M. Kakuda, T. Takiuchi, M. Kodama, M. Shiomi, S. Kakuda, Y. Ueda, K. Sawada, T. Tomimatsu, K. Yoshino, T. Kimura
European Journal of Gynaecological Oncology    2020, 41 (2): 176-180.   DOI: 10.31083/j.ejgo.2020.02.5073
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Aim: The objective of this study was to compare indocyanine green (ICG) and blue colorimetric methods for detection of sentinel lymph nodes (SLN) during laparoscopic surgery for uterine malignancies. Materials and Methods: Over a two years and 3months period, laparoscopic surgery was performed on 16 cases of uterine malignancies using near infrared (NIR) fluorescence imaging of ICG tracer uptake to direct SLN biopsy (NIR-FI-SLNB). ICG was injected into the uterine cervix prior to surgery. For comparison of detection efficacy, blue dye used for traditional colorimetric method was injected concurrently into 14 of these 16 cases. After pneumoperitoneum, we opened the retroperitoneum to laparoscopically identify the SLN. After biopsy of the SLN, a systemic pelvic lymph node dissection was performed. Results: Using ICG, we were able to identify SLN in 15/16 cases (93.7%), and achieved bilateral pelvic mapping in 12/16 (75%). With the blue dye, we were also able to identify SLN in only 64.3% of the 14 cases so tested, and bilateral pelvic mapping in only 14.3%. There were no intraoperative complications during any of the procedures. For conducting a laparoscopic bilateral SLN biopsy, we found that use of ICG was significantly superior to the blue colorimetric method (14.3% vs. 75%, p = 0.0009). Conclusions: These pilot data provide suggestive evidence that the laparoscopic NIR fluorescence imaging for SLN biopsy provide superior efficacy, compared to the traditional blue colorimetric method, without additional complications.
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Re-evaluation of preoperative endometrial smears for the cytodiagnosis of uterine leiomyosarcoma
K. Sonoda, M. Nogami, K. Kodama, Y. Oda, K. Kato
European Journal of Gynaecological Oncology    2020, 41 (2): 167-170.   DOI: 10.31083/j.ejgo.2020.02.4950
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Introduction: Uterine leiomyosarcoma (ULS) is a highly aggressive and lethal tumor. The absence of specific symptoms and diagnostic imaging findings makes the diagnosis of ULS challenging. Endometrial sampling reportedly has a significantly lower predictive value in diagnosing ULS compared with epithelial uterine malignancies. Materials and Methods: The authors retrospectively reviewed the preoperative endometrial cytology findings in seven of the 12 patients with ULS who were treated in this institution between 2008 and 2017. The other five patients did not have preoperative samples obtained for cytology. Results: Only one of the seven patients was originally diagnosed with a malignant tumor, with preoperative cytology showing rounded tumor cells with enlarged, irregular, hyperchromatic, and sometimes multiple nuclei, with conspicuous nucleoli in a necrotic background. After re-evaluation of the preoperative specimens, atypical cells were detected in four of the six patients who were initially deemed to have negative findings. A monomorphic population of spindle cells with slightly hyperchromatic, elongated nuclei was detected in two patients. Another two patients had rounded tumor cells with a moderate amount of basophilic cytoplasm and round or oval nuclei with minimal atypia. Conclusion: Novel diagnostic techniques are needed to accurately identify ULS in the preoperative period. Careful microscopic observation of the entire cytological specimen, together with detailed patient medical information, are essential to making a correct preoperative diagnosis of ULS.
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Impact of the human papillomavirus vaccination on patients who underwent conization for high-grade cervical intraepithelial neoplasia
P. Ortega-Quiñonero, M. Remezal-Solano, M.C. Carazo-Díaz, D. Prieto-Merino, M.I. Urbano-Reyes, L. García de Guadiana-Romualdo, J.P. Martínez-Cendán
European Journal of Gynaecological Oncology    2019, 40 (3): 402-407.   DOI: 10.12892/ejgo4628.2019
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Objectives: To test whether the human papillomavirus (HPV) vaccination in patients undergoing loop diathermy conization (LEEP) for high-grade intraepithelial neoplasia (CIN 2-3) is effective in preventing recurrence of CIN 2-3 in our area. Materials and Methods: A retrospective review was conducted on 242 patients undergoing LEEP for CIN 2-3 and 42.6% received the HPV vaccine (bivalent or tetravalent) immediately before or after conization. Follow up was conducted at 3, 6, 12, 18, and 24 months to detect CIN 2-3 recurrence. Results: Regardless of the HPV type, 27 (11.1%) patients developed CIN 2-3 recurrence during post-LEEP follow up. Of the 70 vaccinated with bivalent vaccine, two (2.8%) showed recurrence, of the 33 vaccinated with tetravalent vaccine, three (9%), and of the 139 unvaccinated 61 (43.9%) developed recurrence. Of the patients infected with HPV genotypes 16/18, in the non-vaccinated group, 15 (21.7%) patients had recurrence, whereas in the vaccinated group, three (5.9%) were diagnosed with recurrence (p < 0/05). The multivariate logistic regression analysis showed that the vaccination acted as a protective factor for CIN 2-3 recurrence (OR: 0.360 (95% CI: 0.125-1.000; p < 0.05). However, neither the type of vaccine nor the time of vaccination showed a significant association with the onset of recurrence. Conclusions: The HPV vaccine appears to be a recommendable preventative strategy in reducing the risk of recurrent disease for patients treated for CIN 2-3.

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Demodex folliculorum mite infestation in gynecological cancers: A case control study
Zeyneb Bakacak, Mustafa Kaplanoğlu, Murat Bakacak, Tuncay çelik
European Journal of Gynaecological Oncology    2020, 41 (4): 583-586.   DOI: 10.31083/j.ejgo.2020.04.3687
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Objective: To determine the frequency of Demodex (D.) folliculorum infestation in patients with gynecological cancer. Materials and Methods: This cross-sectional study was conducted between January 2015 and May 2015. Eighty-seven patients with gynecologic cancer and ninety control subjects were included and the patients characterics were recorded. Demodex was detected by standardized skin surface biopsy for skin lesions. Results: No statistically significant difference was found between the groups in terms of age, diabetes mellitus, body mass index (BMI), hypertension, and the use of radiotherapy and chemotherapy. D. folliculorum infestation was increased in the patient group (47.1%) when compared to the control group (8.9%) (p < 0.001). The frequency of D. folliculorum was higher in the cancer groups and particularly in ovarian cancer (58.7%). Conclusions: Patients with gynecological cancers are at risk for D. folliculorum mite infestation and this is explained by the immunosuppressed condition of the patients due to the cancer.
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The role of p16 / Ki-67 dual staining in HPV positive and negative women in the early diagnosis of cervical precancerous lesions: Cytology, colposcopy and conization protocol
Selçuk Kaplan
European Journal of Gynaecological Oncology    2020, 41 (4): 569-576.   DOI: 10.31083/j.ejgo.2020.04.2081
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Aim: The aim of this study was to evaluate the relationship between p16 / Ki-67 dual staining used for the definition of precancerous cervical lesions with histological results and HPV positivity. Materials and Method: This study is a cross-sectional study of 468 patients who were followed up in our center with the diagnosis of cervical intraepithelial neoplasia between 2016 and 2019 using the cytology, colposcopic biopsy and conization results, HPV test and p16 / Ki-67 dual staining results. SPSS 22 program was used in the analysis of the data. In the analysis of qualitative data, chi-square test and binary logistic regression analysis were used. The compatibility of both models with bilateral logistic regression test was good (omnibus test < 0.001). The correct estimate percentage of the model is 71.4% and 80.3%. p <0.05 is considered important. Results: In the binary logistic regression test established between HPV types and p16 / Ki-67 dual staining positivity, other high risk HPV types, HPV 16, 18 and 16-18, increased p16 / Ki-67 positivity ratio in this order. In the binary logistic regression test established between abnormal cytology and p16 / Ki-67 dual staining positivity in the colposcopy results, there was p16 / Ki-67 positivity increasing in proportion with the degree of HGSIL lesions. Conclusion: This study created with cytology / colposcopy and LEEP conization protocol shows that; in effective screening for early diagnosis and treatment in cervical cancer, p16 / Ki-67 biomarkers can be used effectively.
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The outcomes of fertility sparing surgery in epithelial ovarian cancer
Emine Karabuk, Burak Karadag, Ceyda Karadag, M. Faruk Kose, M. Murat Naki, E. Nilufer Guler
European Journal of Gynaecological Oncology    2020, 41 (3): 391-395.   DOI: 10.31083/j.ejgo.2020.03.5147
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Conservative surgery has long been discussed as a treatment option in women with ovarian cancer at reproductive age. However, current guidelines recommend conservative surgery only in selected patients. There is considerable interest on pregnancy and delivery rates after fertility-sparing surgery (FSS), with several ongoing studies on this subject. The aim of the present multi-center study was to evaluate survival and pregnancy outcomes in patients that underwent fertility-sparing surgery. This retrospective study included 19 patients who underwent fertility-sparing surgery due to invasive epithelial ovarian cancer between 2002 and 2014. The median duration of follow-up was 59.5 months (range 10-152 months). A total of 10 full-term pregnancies and 3 spontaneous abortions occurred in 7 patients (36.8%) following FSS. Ten patients (52.6%) underwent prophylactic surgery after a median period of 49 months (16-119 months), while 2 patients (10.5%) developed recurrent disease after prophylactic surgery. Accurate staging in patients with early stage epithelial ovarian cancer and regular follow-up has shown promising reproductive outcomes. In light of the current data, fertility-sparing surgery should be considered in selected patients with stage I epithelial ovarian cancer. There is still no consensus, however, on the selection criteria of eligible patients for fertility-sparing surgery.

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Sustained effects of theory-based physical activity intervention for socioeconomically diverse obese endometrial cancer survivors: A Longitudinal analysis
A. Rossi, C.E. Garber, M. Ortiz, V. Shankar, D.Y. Kuo, N.S. Nevadunsky
European Journal of Gynaecological Oncology    2020, 41 (3): 343-351.   DOI: 10.31083/j.ejgo.2020.03.5163
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Purpose of Investigation: Assess the sustained effects of a 12-week physical activity intervention on physical activity, physical function, waist circumference, and quality of life among urban, socioculturally diverse endometrial cancer survivors. Materials and Methods: Twenty-three obese women with a history of endometrial cancer within the previous five years with no evidence of cancer recurrence volunteered for a 12-week physical activity intervention based on social cognitive theory. Classes were offered 2x/week and included 30 minutes of behavioral counseling and 60 minutes of exercise. Pedometers were distributed, and participants were instructed to walk ≥ 90 min/week at home. A longitudinal analysis of baseline, post-intervention and 12-week follow-up response profile model was fitted using restricted maximum likelihood estimation approach. Results: Mean participant age was 64 ± 8 years, and BMI was 37 ± 6 kg?m-2. Seventy-eight percent of participants were non-white. Improvements in waist circumference (-4.8 cm, p = 0.009), and the six-minute walk test (13 m, p = 0.042) persisted 12 weeks after the completion of the intervention. Among the psychosocial variables, walking self-efficacy (p = 0.022), and outcome expectations (p = 0.040) also retained improvements at follow-up. Quality of life, assessed using the Functional Assessment of Cancer Therapy, improved post-intervention (p < 0.001), but this improvement was not sustained at follow-up (p = 0.14). Conclusion: This physical activity intervention led to meaningful sustained improvements in physical function, waist circumference and physical activity-related psychosocial variables. Replication of these results using controlled design with larger samples sizes should be conducted to confirm these findings and determine the long-term effectiveness of physical activity interventions.

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Bevacizumab in combination with metronomic oral cyclophosphamide: an effective and well-tolerated treatment for patients with recurrent ovarian cancer
C.J. Heesterbeek, A.M. Thijs, R.H.M. Hermans, D. Boll, G.-J. Creemers
European Journal of Gynaecological Oncology    2020, 41 (3): 364-367.   DOI: 10.31083/j.ejgo.2020.03.5267
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Purpose of Investigation: In this study the authors describe their clinical experience with metronomic oral cyclophosphamide and bevacizumab in terms of efficacy and tolerability in patients with recurrent ovarian cancer beyond first-line treatment. Materials and Methods: This retrospective, descriptive study included 59 patients with recurrent ovarian cancer. They were treated with intravenous bevacizumab (10 mg/kg, once every three weeks) in combination with oral cyclophosphamide (100 mg once daily). Patients had received at least one line of platinum-based chemotherapy prior to combined bevacizumab and cyclophosphamide treatment. Both platinum sensitive patients and platinum resistant patients were included. Results: Treatment with combined bevacizumab and cyclophosphamide was administered as a third line therapy in 42.4% of patients. The median number of cycles of bevacizumab administered with oral cyclophosphamide was 7 (range 1-40). A response was demonstrated in 37 (62.7%) patients, with a median progression free survival of 6 months (range 0-44). No toxicity was recorded in the medical report of 39% of patients, with only mild toxicities reported in the others. Conclusion: Bevacizumab combined with metronomic cyclophosphamide appears to be a well-tolerated and effective therapy with sustainable remissions in this selective group heavily pretreated ovarian cancer patients. This regimen should be considered in patients who are not suitable or have no need for more toxic systemic treatment.

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Vaginal stenosis after radiation therapy for pelvic cancer: prevention and treatment options - a review of the current literature
D. Charatsi, M. Tolia, P. Vanakara, N. Tsoukalas, M. Nikolaou, D. Korfias, G. Nikolaou, A. Daponte, G. Kyrgias
European Journal of Gynaecological Oncology    2019, 40 (2): 185-189.   DOI: 10.12892/ejgo4496.2019
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Purpose: Pelvic radiotherapy holds a vital role in the management of gynaecological and pelvic gastrointestinal cancers. However, radiotherapy can result in shortening and narrowing of the vagina which is known as vaginal stenosis. The objective of this paper is to review the prevention and treatment options of radiation-induced vaginal stenosis and discuss their benefits and side-effects as well. Materials and Methods: A literature search was performed (1972-2017) on PubMed, Cochrane Database of Controlled Trials, and SCO-PUS with no language restrictions. Cross references from the included studies were hand-searched. The criteria for the included studies were any and every measure for preventing radiation-induced vaginal stenosis. Results: The use of vaginal dilators, sexual intercourse, and topical therapies are the current options for the management of vaginal stenosis after pelvic radiotherapy. Conclusion: Vaginal dilation should be encouraged in cancer survivors after pelvic radiotherapy, with counseling by expertized medical and paramedical personnel. Limited evidence exists in favor of the use of vaginal lubricating creams for radiation-related vaginal irritation.

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The prognostic significance and immuno-expression of survivin, mutant p53 and bcl-2 in 92 cases of epithelial ovarian cancer
Chados Nikolaos, Gregoriou Odysseas, Salakos Nicolaos, Kondis Agatha, Deligeoroglou Efthymios
European Journal of Gynaecological Oncology    2020, 41 (4): 517-522.   DOI: 10.31083/j.ejgo.2020.04.5335
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Background: Survivin is a member of the inhibitors of apoptosis protein family, commonly detected in human cancers and fetal tissue, with the ability to regulate programmed cell death and cell division. Aim of this study is to investigate the immuno-expression of survivin and its correlation with other anti-apoptotic markers (mutant p53 and bcl-2) in human ovarian cancer and assess the prognostic significance and possible therapeutic role of this protein in the future. Materials and Methods: Ninety-two cases of primary epithelial ovarian cancer over a 10-year period were included in the study. Sixty-six cases were diagnosed with serous ovarian cancer and twenty-six with endometrioid. All cases were fixed in formalin and paraffin-embedded standard techniques and processed by an immunostain method, in order to assess the survivin-positive cases and their prevalence in nucleus or cytoplasm. Results: Survivin cytoplasmic immuno-expression is associated with more advanced stage and grade of the ovarian disease. Nuclear survivin was more pronounced in tumors with better prognosis. Mutant p53 and bcl-2 were also positively co-expressed and associated with poor survival rate in all cases of serous ovarian carcinoma. Neither survivin nor bcl-2 were expressed in any case of endometrioid ovarian cancer. Conclusion: Survivin can play a key role as a potential future tumor marker to determine prognosis and predict response to various therapies.
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Endometrial dedifferentiated carcinoma: a case report. Pathological review at a single institution and systematic review of published literature
T. Sakamoto, M. Miyamoto, T. Kono, H. Tsuada, H. Matsuura, T. Aoyama, M. Takano, K. Furuya
European Journal of Gynaecological Oncology    2020, 41 (2): 163-166.   DOI: 10.31083/j.ejgo.2020.02.4911
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Background: Endometrial dedifferentiated carcinoma (DC) is a rare histological subtype with an unclear clinical outcome. Materiasl and Methods: The authors conducted a pathological review of patients with endometrial endometrioid carcinoma treated in this hospital between 1990 and 2013 according to 2014 World Health Organization criteria. They systematically reviewed PubMed literature and the present case concerning the clinical features of DC. Results: One (0.25%) of 375 DC patients was identified. A PubMed search detected 46 patients in 13 studies. Stage information was detailed in 45 patients, as follows: 9 (20%) Stage I, 5 (11%) Stage II, 10 (22%) Stage III, and 21 (47%) Stage IV. Surgical details were reported for 12 patients; 7 (58%) with complete resection, and 5 (42%) with incomplete resection. Early stage and complete resection improved overall survival (p < 0.01, p = 0.02, respectively). Conclusion: DC is a rare and aggressive histological subtype. Further research is needed to investigate new treatment strategies for DC.
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Combined measurement of miRNA-183, HE4, and CA-125 increases diagnostic efficiency for ovarian cancer
J. Liang, X. Yang, L. Liu, L. Qiao, P. Peng, J. Zhou
European Journal of Gynaecological Oncology    2020, 41 (1): 30-35.   DOI: 10.31083/j.ejgo.2020.01.4788
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Objective: This study aimed to determine the role of miR-205, miR-182, and miR-183 expression in the serum of ovarian cancer patients in the early diagnosis of ovarian cancer. Materials and Methods: The expression of miR-205, miR-182, miR-183, CA-125, and HE4 was detected in the sera of 101 patients with ovarian cancer, 50 patients with benign ovarian diseases, and 50 healthy volunteers. The results were validated in 98 patients with ovarian cancer, 50 patients with benign ovarian diseases, and 53 healthy volunteers. The expression of miR-205, miR-182, miR-183, CA-125, and HE4 was subjected to ROC analysis and binary logistic regression analysis. Results: The sensitivity of miR-182 and CA-125 was highest (0.901% and 0.832, respectively), but the specificity was low (both 0.27) in the early diagnosis of ovarian cancer. HE4 had the highest specificity in the early diagnosis of ovarian cancer. The sensitivity, specificity, and AUC of HE4 were 0.842, 0.81, and 0.847, respectively. Binary logistic regression analysis showed that three variables were suitable for the diagnostic model: Y=Logit(P)=-5.457+5.365*miR183+0.019*HE4+0.004*CA125. Based on the diagnostic model, ROC analysis showed that the sensitivity, specificity, and AUC were 0.97, 0.85, and 0.951, respectively. Statistical validation showed that the sensitivity, specificity and AUC were 0.941, 0.86, and 0.951, respectively. Conclusion: miR-183 has high specificity and sensitivity in the diagnosis of ovarian cancer. Measurement of miR-183 combined with HE4 and CA-125 is of value for the early diagnosis and evaluation of ovarian cancer.
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Concordance of preoperative and postoperative histological grades in endometrioid type endometrial cancer
H. Cokmez, A. Yilmaz
European Journal of Gynaecological Oncology    2020, 41 (2): 208-213.   DOI: 10.31083/j.ejgo.2020.02.5016
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Purpose of Investigation: To investigate concordance between grades determined by endometrial sampling and final pathology, and factors affecting this concordance, in endometrioid type endometrial cancer. Materials and Methods: In this retrospective study, 330 endometrioid type endometrial cancer patients were enrolled. For evaluating the concordance between histological grades in preoperative and postoperative pathology reports, Kappa statistic and comparative analyses were performed. Results: In 230 of 330 (69.7%) patients, the endometrial sampling-determined grade was in concordance with the final histological grade. The concordance was minimal according to the Kappa statistic in all patients (K = 0.390; 95% confidence interval = 0.666-0.047; p < 0.01). There was no significant correlation between diabetes mellitus, cancer antigen (Ca) 125, and Ca 19-9 status, and grade concordance (p = 0.86, p = 0.715, p = 0.774, respectively). Conclusion: In endometrioid type endometrial cancer, concordance between preoperative and postoperative histological grades was minimal. Therefore, histological grading by preoperative sampling alone is insufficient for decisionmaking in pelvic lymphadenectomy.
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Ten-year survival in patients with endometrial adenoacanthoma and endometrial adenocarcinoma with malignant squamous cell differentiation
U. Indraccolo, R. Martinello, G. Scutiero, G. Bernardi, C. Borghi, O. Brasile, P. Greco
European Journal of Gynaecological Oncology    2020, 41 (3): 361-363.   DOI: 10.31083/j.ejgo.2020.03.5376
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Objectives: It is acknowledged that squamous differentiation in the endometrial adenocarcinoma does not affect the outcome of type I cancer. However, it has been recently reported that the so-called shadow cell differentiation is likely present in endometrial adenoacanthomas. As the shadow cells differentiation suggests a caspase-independent cell death, based on the previous reports it can be hypothesized that the endometrial adenoacanthoma would have a better prognosis than the endometrial adenocarcinoma with squamous differentiation. Methods: From a database of 829 endometrial cancer, 34 endometrial adenoacanthomas and 18 endometrial adenocarcinomas with malignant squamous differentiation were assessed. The Kaplan-Meier curves were generated and compared for endometrial adenoacanthomas and endometrial adenocarcinomas with malignant squamous differentiation. Results: the 10-year survival in patients with adenocarcinoma with malignant squamous differentiation is significantly lower than the survival in patients with adenoacanthoma. Advanced stage (2009 FIGO II or over) was more likely found in adenocarcinoma with malignant squamous differentiation at the surgery time. Matching groups for the FIGO stage, there were no difference in overall survival. Conclusion: patients with endometrial adenoacanthoma have a better prognosis than patients with endometrial adenocarcinoma with malignant squamous differentiation probably because of the earlier stage diagnosis.

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Expression and therapeutic potential of macrophage migration inhibitory factor and CD74 in ovarian cancer
Y. S. Lee, J. M. Baek, E. K. Park, C. J. Kim, H. J. Lee, J. O. Kim
European Journal of Gynaecological Oncology    2020, 41 (1): 65-69.   DOI: 10.31083/j.ejgo.2020.01.4887
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Purpose of Investigation: To evaluate macrophage migration inhibitory factor (MIF) and CD74 expression in ovarian cancer, and to explore whether these expression levels correlate with clinicopathologic parameters. Materials and Methods: A total of 151 tissue samples were collected from May 2009 through May 2015. The collected samples included ten normal ovaries, 41 benign epithelial ovarian tumors, 38 borderline tumors, and 62 malignant epithelial ovarian tumors. CD74 and MIF expression was assessed by immunohistochemistry and a retrospective study was conducted. Results: Immunohistochemical analysis showed that MIF and CD74 expression was significantly higher in ovarian tumors, including ovarian cancer, than in normal ovary tissues. Furthermore, high MIF expression was correlated with lymph node metastasis (p = 0.048) and ovary surface invasion (p = 0.039). Conclusion: The present findings suggest that co-expression of MIF and CD74 in ovarian cancer is associated with poor clinical parameters and may serve as a therapeutic target for the treatment of ovarian cancer.
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Uterine adenosarcoma admixed with a primitive neuroectodermal tumour (PNET): a case report and review of the literature
I. Pecorella, F. Alesini, F. Gianno, A. Tornese, V. Colagiovanni, M. Monti
European Journal of Gynaecological Oncology    2020, 41 (1): 110-115.   DOI: 10.31083/j.ejgo.2020.01.5059
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Herein the authors report a case of uterine adenosarcoma admixed with primitive neuroectodermal tumour (PNET) and review the literature on these rare neoplasms, as well as data files of their Gynaecologic Pathology Centre in Rome, Italy.
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Taraxacum officinale extract induces antitumorigenic effects in ovarian carcinoma cell lines
K. Menke, M. Schwermer, K. Falke, J. Felenda, C. Beckmann, F. Stintzing, A. Voigt, A. Schramm, T.J. Zuzak
European Journal of Gynaecological Oncology    2019, 40 (1): 106-112.   DOI: 10.12892/ejgo4460.2019
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Purpose of Investigation: Patients suffering from ovarian cancer often use mistletoe preparations in combination with Taraxacum officinale (dandelion) extracts as supplementary therapy to conventional medicine. However, scientific data concerning antitumorigenic effects of Taraxacum extracts and co-treatment with mistletoe extracts are insufficient. Materials and Methods: Sensitivity of cancer cell lines towards a Taraxacum extract was determined by cell viability assays. Effects of Taraxacum on cell proliferation, cell cycle distribution, mitochondrial integrity, as well as migration and invasion were investigated in ovarian carcinoma cells (NIH:OVCAR-3 and SKOV-3). Results: Taraxacum extract caused a reduction of cell viability in a panel of adult cancer cell lines (cervical-, colon-, endometrial-, hepatocellular-, lung-, mamma-, ovarian-, pancreatic-, and urinary bladder carcinoma), whereby gynecological tumors were particularly susceptible. Inhibitory effects on cell viability, migration, mitochondrial integrity, and induction of apoptosis were observed in ovarian cancer cells. Combined therapy with mistletoe extracts revealed synergistic effects. Conclusion: This study provides first preclinical data on the antitumorigenic effects of Taraxacum and demonstrates the effectiveness of a combination treatment with mistletoe extracts in ovarian cancer cells.

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Infertility and borderline malignant ovarian tumors: a case of successful pregnancy after fertility-preserving management of the disease
T. Armeanu, R. Maftei, G. Simionescu, D. Nicolaiciuc, N. Plopa, B. Doroftei
European Journal of Gynaecological Oncology    2020, 41 (2): 284-288.   DOI: 10.31083/j.ejgo.2020.02.4989
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For women of reproductive age diagnosed with gynaecologic cancers, techniques that aim to preserve the fertility are a growing area of research. Fertility-sparing surgical techniques should be an option for these patients, since removing the abnormal ovarian tissue may restore conceiving potential. The authors present the case of a 26-year-old woman diagnosed incidentally with a borderline ovarian tumor during an infertility check-up, who obtained a spontaneous pregnancy two months after laparoscopic unilateral adnexaectomy, followed by IVF and embryo-banking.
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Surgical complications and survival after pelvic exenteration: our experience following 60 procedures
M.E. Căpîlna, B. Szabo, J. Becsi, M. Morariu, M. Gheorghe, S.L. Kiss, B. Moldovan
European Journal of Gynaecological Oncology    2020, 41 (2): 171-175.   DOI: 10.31083/j.ejgo.2020.02.5040
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Purpose of Investigation: Analyse the results of pelvic exenteration for pelvic malignancies in a tertiary referral center. Materials and methods: Between 2011 and 2018, 60 patients underwent a pelvic exenteration. The indications were cervical (44 patients), vaginal (4), recurrent ovarian (6), endometrial (2), vulval (2), recurrent sigmoid colon (1), and bladder cancer (1). Results: Out of the 60 exenterations, 31 were total, 21 anterior, and 8 posterior. A Bricker non-continent ileal or sigmoid urinary conduit was performed in 51 out of 52 anterior and total exenterations. Early complications occurred in 34 patients of whom four perioperative deaths (6.6 %). Among the 60 patients, at this moment, 33 are alive, 25 are dead, and two are lost to follow-up. Conclusion: Pelvic exenteration for recurrent or advanced pelvic malignancies can be associated with long-term survival and even cure without high perioperative mortality in properly selected patients. However, postoperative complications can be lethal.
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  • Volume 42, Issue 2