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Laparoscopic assisted surgical staging (LASS) for endometrial cancer
August 1994, Vol. 1, No. 4, Part 2
The Journal of the American Association of Gynecologic Laparoscopists
14 (8.6-25.1), 3.2 (1-6), 1 (0.3-2.8) and 3.7 (1.9-6) in 9 mucinous cysts, and 6.9 (0.5-104), 18(1-132), 0.8 (0.11.9) and 2.1 (1-5.4) in 10 cases with mixed histotypes. Corresponding cystic fluid levels were 342,864 (1,4183,404,682), 228,000 (117-2,500,000), 106 (0.5-2,908) and 1.3 (0.4-51) in endometriomas; 843,895 (10,8421,676,948), 740,039 (77-1,280,000), 470 (61-880) and 2.5 (1-4) in dermoids; 3,485 (27.2-149,804), 9,007 (36.4:153,475), 1,631 (402-11,096) and 1 (0.5-2.5) in mucinous cysts, and 13,068 (5,300-43,767), 412 (1142,700), 0.8 (0.4-5.3) and 2.3 (1-4) in the mixed histotype group. No significant between group differences were detected in serum marker levels. Patients in the mucinous cyst group had significantly lower CA 125 cystic fluid levels c o m p a r e d with w o m e n with endometriomas and dermoids (P<0.05). Fluid aspirate tumor marker measurements did not aid in the differential diagnosis of benign ovarian cysts, mainly due to the extremely wide scattering of values.
hormone replacement therapy, and other complications. This case report and review of the meager medical literature covers the pertinent aspects of care in these patients.
The Role of Hysteroscopy i. Missed Abortions 1BJvan Herendael, 2T Slangen,:aB Van Buick, 4j Dumon. 1Endoscopic Training Center, Antwerp, Belgium and University of Varese, Italy; 2Jan Palfijn General Hospital, Antwerp, Belgium; 3Endoscopic Centre, Antwerp, Belgium; 4Division of Human Genetics, University of Antwerp, Antwerp, Belgium. Reviewing the possible causes of missed abortions, it becomes obvious that culturing the tissues is the major difficulty and often a setback for the diagnosis. The reason is the difficulty for the geneticist to obtain a representantive sample of fetal tissue. In a multicenter trial in Antwerp, Belgium, we designed a technique to use a hysteroscope equipped with a throughflow system and the possibility to pass instruments through a side channel, to view the fetuses from six weeks onwards. First, the sac is opened and inspected for the presence of a yolk sac. In a second step the fetus is visualized and inspected for gross anatomic malformations. If such malformations exist, biopsies are taken to confirm the visual impressions with the genetic results to make a map to diagnose genetic malformations through direct visualization. If no gross malformations are visible, biopsies are taken at specific sites to facilitate the work in the lab. The first results, including the diagnosis of a 45 X aberration, are discussed.
Laparoscopic Assisted Surgical Staging (LASS) for Endometrial Cancer TO Vidal, 2j Garza-Leal, 3j. Iglesias, 4D Salvidar, 4R Garza. ' Department of Gynecologic Oncology; 2Department of Special Procedures; 3Department of Gynecology; 4Department of Ob/Gyn; University Hospital, Monterrey, Mexico.
We r e p o r t the first four cases of L A S S for endometrial cancer in Mexico. Four patients diagnosed with endometrial adenocarcinoma were selected. These patients underwent peritoneal washing, vaginally assisted laparoscopic hysterectomy, bilateral salpingo-ophorectomy and pelvic biopsies. These biopsies included dissection of common iliac vessel, hypogastric and external vessels, and obturator nerve. An average of 10 nodes were obtained (8-11). In all patients both the nodes and the peritoneal washings were negative. The pathologic surgical staging was: three patients with IBG2 and one patient with IAG2. The patients were discharged on the sixth postoperative day, without complications. The follow-up is of 1 to 7 months and all are alive and without tumor activity. Patients with endometrial cancer often have associated obesity, diabetes and hypertension. For this reason the practice of minimally invasive surgery reduces morbidity. However, a full knowledge of a n a t o m y , oncologic g y n e c o l o g y , and o p e r a t i v e laparoscopy is imperative.
Serum and Cyst Fluid Tumor Marker Levels in the Differential Diagnosis of Benign Ovarian Cysts P Vercellini, S Oldani, I Felicetta, L Trespidi, T Bramante, PG Crosignani. Clinica Ostetrica e Ginecologica "L Mangiagalli", Universita di Milano, Milano, Italy.
Serum and cystic fluid levels of CA 125, CA 19.9, carcinoembryonic antigen (CEA), and alpha-fetoprotein (AFP) were assayed in 74 consecutive women of median age 30 years (range 15 to 74 years) undergoing surgery for adnexal cysts of presumed benign nature. Median (range) serum levels of CA 125, CA 19.9, CEA and AFP were-46.5 IU/ml (4.3-406), 28,5 IU/ml (1-96.3), 1.4 ng/ml (0.5-3.5) and 2.4 ng/ml (19.9) in 44 endometriotic cysts; 22.5 (4.7-82), 4.9 (1226), 1.3 (0.7-4.8) and 4 (0.5-10.5) in 11 dermoid cysts,
$38
The Journal of the American Association of Gynecologic Laparoscopists
14 (8.6-25.1), 3.2 (1-6), 1 (0.3-2.8) and 3.7 (1.9-6) in 9 mucinous cysts, and 6.9 (0.5-104), 18(1-132), 0.8 (0.11.9) and 2.1 (1-5.4) in 10 cases with mixed histotypes. Corresponding cystic fluid levels were 342,864 (1,4183,404,682), 228,000 (117-2,500,000), 106 (0.5-2,908) and 1.3 (0.4-51) in endometriomas; 843,895 (10,8421,676,948), 740,039 (77-1,280,000), 470 (61-880) and 2.5 (1-4) in dermoids; 3,485 (27.2-149,804), 9,007 (36.4:153,475), 1,631 (402-11,096) and 1 (0.5-2.5) in mucinous cysts, and 13,068 (5,300-43,767), 412 (1142,700), 0.8 (0.4-5.3) and 2.3 (1-4) in the mixed histotype group. No significant between group differences were detected in serum marker levels. Patients in the mucinous cyst group had significantly lower CA 125 cystic fluid levels c o m p a r e d with w o m e n with endometriomas and dermoids (P<0.05). Fluid aspirate tumor marker measurements did not aid in the differential diagnosis of benign ovarian cysts, mainly due to the extremely wide scattering of values.
hormone replacement therapy, and other complications. This case report and review of the meager medical literature covers the pertinent aspects of care in these patients.
The Role of Hysteroscopy i. Missed Abortions 1BJvan Herendael, 2T Slangen,:aB Van Buick, 4j Dumon. 1Endoscopic Training Center, Antwerp, Belgium and University of Varese, Italy; 2Jan Palfijn General Hospital, Antwerp, Belgium; 3Endoscopic Centre, Antwerp, Belgium; 4Division of Human Genetics, University of Antwerp, Antwerp, Belgium. Reviewing the possible causes of missed abortions, it becomes obvious that culturing the tissues is the major difficulty and often a setback for the diagnosis. The reason is the difficulty for the geneticist to obtain a representantive sample of fetal tissue. In a multicenter trial in Antwerp, Belgium, we designed a technique to use a hysteroscope equipped with a throughflow system and the possibility to pass instruments through a side channel, to view the fetuses from six weeks onwards. First, the sac is opened and inspected for the presence of a yolk sac. In a second step the fetus is visualized and inspected for gross anatomic malformations. If such malformations exist, biopsies are taken to confirm the visual impressions with the genetic results to make a map to diagnose genetic malformations through direct visualization. If no gross malformations are visible, biopsies are taken at specific sites to facilitate the work in the lab. The first results, including the diagnosis of a 45 X aberration, are discussed.
Laparoscopic Assisted Surgical Staging (LASS) for Endometrial Cancer TO Vidal, 2j Garza-Leal, 3j. Iglesias, 4D Salvidar, 4R Garza. ' Department of Gynecologic Oncology; 2Department of Special Procedures; 3Department of Gynecology; 4Department of Ob/Gyn; University Hospital, Monterrey, Mexico.
We r e p o r t the first four cases of L A S S for endometrial cancer in Mexico. Four patients diagnosed with endometrial adenocarcinoma were selected. These patients underwent peritoneal washing, vaginally assisted laparoscopic hysterectomy, bilateral salpingo-ophorectomy and pelvic biopsies. These biopsies included dissection of common iliac vessel, hypogastric and external vessels, and obturator nerve. An average of 10 nodes were obtained (8-11). In all patients both the nodes and the peritoneal washings were negative. The pathologic surgical staging was: three patients with IBG2 and one patient with IAG2. The patients were discharged on the sixth postoperative day, without complications. The follow-up is of 1 to 7 months and all are alive and without tumor activity. Patients with endometrial cancer often have associated obesity, diabetes and hypertension. For this reason the practice of minimally invasive surgery reduces morbidity. However, a full knowledge of a n a t o m y , oncologic g y n e c o l o g y , and o p e r a t i v e laparoscopy is imperative.
Serum and Cyst Fluid Tumor Marker Levels in the Differential Diagnosis of Benign Ovarian Cysts P Vercellini, S Oldani, I Felicetta, L Trespidi, T Bramante, PG Crosignani. Clinica Ostetrica e Ginecologica "L Mangiagalli", Universita di Milano, Milano, Italy.
Serum and cystic fluid levels of CA 125, CA 19.9, carcinoembryonic antigen (CEA), and alpha-fetoprotein (AFP) were assayed in 74 consecutive women of median age 30 years (range 15 to 74 years) undergoing surgery for adnexal cysts of presumed benign nature. Median (range) serum levels of CA 125, CA 19.9, CEA and AFP were-46.5 IU/ml (4.3-406), 28,5 IU/ml (1-96.3), 1.4 ng/ml (0.5-3.5) and 2.4 ng/ml (19.9) in 44 endometriotic cysts; 22.5 (4.7-82), 4.9 (1226), 1.3 (0.7-4.8) and 4 (0.5-10.5) in 11 dermoid cysts,
$38