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M264 EARLY-STAGES SQUAMOUS CELL CARCINOMA AND ADENOCARCINOMA OF THE UTERINE CERVIX: SHOULD THE TREATMENT BE DIFFERENT?
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
M264 EARLY-STAGES SQUAMOUS CELL CARCINOMA AND ADENOCARCINOMA OF THE UTERINE CERVIX: SHOULD THE TREATMENT BE DIFFERENT? C. Nogueira-Silva1,2,3 , B. Vides1 , I.H. Silva4 , I. Faustino5 , L. Lombo6 , T. Figueiredo6 , R. Catarino4 , A. Rocha1 , D. Pereira5 , P. Ribas7 . 1 Department of Obstetrics and Gynecology, Hospital of Braga, Braga, Portugal; 2 Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; 3 ICVS/3B’s – PT Government Associate Laboratory, Braga, Portugal; 4 Department of Molecular Oncology Group, Portuguese Oncology Institute, Porto, Portugal; 5 Department of Medical Oncology, Portuguese Oncology Institute, Porto, Portugal; 6 Department of Radiotherapy, Portuguese Oncology Institute, Porto, Portugal; 7 Department of Gynecology, Portuguese Oncology Institute, Porto, Portugal Objectives: Cervical cancer is the most common cause of death from gynecologic cancer worldwide. In the last years the incidence of adenocarcinoma (AC) has increased. Until the moment there is no consensus whether treatment of early-stages should be different according to the histological type [squamous cell carcinoma (SC) and AC]. The aim of this study was to analyze the differences between early-stages SC and AC regarding treatment response, relapse, disease-free survival (DFS) and overall survival (OS). Materials: Medical records of patients with early stages SC or AC of the uterine cervix (IA1-IIA2), treated in the IPO Porto, between 2002–2009. Methods: This is an observational retrospective study, based on consultation of medical records of patients with early stages SC or AC of the uterine cervix (IA1-IIA2), treated in the IPO Porto, between 2002–2009. All IA, IB1 and IIA1 stages, independently of histological type, were treated with surgery or surgery plus radiotherapy. Tumors with dimensions more than 4 cm (IB2 and IIA2) were treated with chemoradiotherapy. For statistical analysis Chi-squared test, Fisher’s exact test, logrank test and Kaplan-Meier analysis were performed. Results: From a total of 452 patients treated in the IPO Porto between 2002–2009, 134 (29.6%) patients presented early stages of cervical cancer. Of these patients 112 (83.6%) presented SC and 15 (11.2%) presented AC. IB2 or IIA2 tumors were found in 45 (40.2%) of SC and 8 (53.3%) of AC. Age at the diagnosis (median: SC 45.5 vs. AC 48 years), menarche, menopause and sexual activity begin age, parity, use of hormonal contraception or hormone therapy, tobacco consumption and other oncological disease history were analyzed and no difference were found between SC and AC patients. A complete response to the primary treatment was 93.5% in SC and 86.7% in AC (p = 0.628). Relapse rate was 17.1% in SC and 26.7% in AC (p = 0.474). The DFS and OS was similar in SC and AC (p = 0.350 and p = 0.766, respectively). Conclusions: In this study no significant difference was found between early-stage SC and AC in treatment response, relapse, DFS and OS. Thus, these results suggest that SC and AC of the uterine cervix should have a similar therapeutic strategy. M265 ABDOMINAL WALL METASTASIS, GROWING TERATOMA SYNDROME AND FEMORAL VEIN INJURY AFTER AN OVARIAN CYSTECTOMY IN A 14-YEAR-OLD GIRL M. Modaresgilani1 , S. Goodarzi1 , A. Mousavi1 , M. Malek3 , R. Shahsiah2 , F. Zamani3 . 1 Imam khomeini hospital, Department of Gyenecologic Oncology, Tehran, Tehran, Iran, Islamic Republic of ; 2 Imam khomeini hospital, Department of Pathology, tehran, tehran, Iran, Islamic Republic of ; 3 Imam khomeini hospital, Department of radiology, tehran, tehran, Iran, Islamic Republic of Objectives: Malignant ovarian germ cell tumors are account for only about 5 percent of all malignant ovarian neoplasms. Ovarian germ cell tumors arise primarily in young women between 10 and
S617
30 years of age and represent 70 percent of ovarian tumors in this age. Appropriate diagnostic approach provide early treatment and disease free survival. Materials: Patient: A 14-year-old girl, referred to our gynecological oncology department with multiple and huge intra-abdominal, pelvic and abdominal wall masses, 2 months after an right ovarian cystectomy, with rupture and spillage during that surgery. The initial histology of the cyst was an ovarian mature teratoma. After tumor marker analysis and imaging, she underwent debulking surgery and chemotherapy with BEP (Bleomycin, Ethoposide, Cisplatin), 12 days after second surgery with the final histology of malignant mixed germ cell tumor (95% immature teratoma, grade III + 5%yolk sac tumor). Finally after 6 months from the second surgery, she underwent the thierd surgery because of Growing Teratoma Syndrome. During tumor resection, her right femoral vein was lacerated that immediately repaired. Her tumoral fascia replaced with dual mesh. Methods: A very interesting and educational case report. Intervention: diagnostic process, Debulking surgery, chemotherapy. Results: After 5 months of the surgery for growing teratoma syndrome, the patient is alive and has good condition. Her tumor markers and imaging are normal. Conclusions: Ovarian tumors in young girls should be always considered as being potentially malignant offer hope for curative treatment. It is advocated preoperative determination of a-fetoprotein (AFP) in all women with ovarian tumors under 40 years of age. Appropriate first surgical approach and tumor spillage prevention are fundamental. Pathologic review in the case of mature teratoma report is reasonable.
Figure: Multiple complex masses on sagittal T2-W MRI in pelvic, abdominal cavity, prevesical space and in abdominal wall associated with ascitis. M266 AVAILABILITY OF TRANSVAGINAL NEEDLE BIOPSY FOR SUSPECTED ENDOMETRIAL MALIGNANCY IN PATIENTS UNABLE TO UNDERGO ENDOMETRIAL SAMPLING WITH A CONVENTIONAL CURETTAGE METHOD N. Kawamura1 , T. Sumikura1 . 1 Gynecology, Osaka City Medical Hospital, Osaka, Japan Objectives: Some postmenopausal women with suspected endometrial malignancy cannot undergo endometrial sampling with a conventional curettage-method because of stenosis or atresia of the uterine cervical canal. To distinguish uterine sarcomas from benign leiomyomas, we have performed transcervical needle biopsies for uterine myoma-like tumors since 1994. In this study, we examined the availability of ultrasound (US)-guided transvaginal needle biopsies for the above-described cases. Materials: Six postmenopausal women with suspected endometrial malignancy because of an endometrial thickness of ≥10 mm as detected by US, but who were unable to undergo conventional endometrial sampling because of stenosis or atresia of the uterine cervical canal.
M264 EARLY-STAGES SQUAMOUS CELL CARCINOMA AND ADENOCARCINOMA OF THE UTERINE CERVIX: SHOULD THE TREATMENT BE DIFFERENT? C. Nogueira-Silva1,2,3 , B. Vides1 , I.H. Silva4 , I. Faustino5 , L. Lombo6 , T. Figueiredo6 , R. Catarino4 , A. Rocha1 , D. Pereira5 , P. Ribas7 . 1 Department of Obstetrics and Gynecology, Hospital of Braga, Braga, Portugal; 2 Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; 3 ICVS/3B’s – PT Government Associate Laboratory, Braga, Portugal; 4 Department of Molecular Oncology Group, Portuguese Oncology Institute, Porto, Portugal; 5 Department of Medical Oncology, Portuguese Oncology Institute, Porto, Portugal; 6 Department of Radiotherapy, Portuguese Oncology Institute, Porto, Portugal; 7 Department of Gynecology, Portuguese Oncology Institute, Porto, Portugal Objectives: Cervical cancer is the most common cause of death from gynecologic cancer worldwide. In the last years the incidence of adenocarcinoma (AC) has increased. Until the moment there is no consensus whether treatment of early-stages should be different according to the histological type [squamous cell carcinoma (SC) and AC]. The aim of this study was to analyze the differences between early-stages SC and AC regarding treatment response, relapse, disease-free survival (DFS) and overall survival (OS). Materials: Medical records of patients with early stages SC or AC of the uterine cervix (IA1-IIA2), treated in the IPO Porto, between 2002–2009. Methods: This is an observational retrospective study, based on consultation of medical records of patients with early stages SC or AC of the uterine cervix (IA1-IIA2), treated in the IPO Porto, between 2002–2009. All IA, IB1 and IIA1 stages, independently of histological type, were treated with surgery or surgery plus radiotherapy. Tumors with dimensions more than 4 cm (IB2 and IIA2) were treated with chemoradiotherapy. For statistical analysis Chi-squared test, Fisher’s exact test, logrank test and Kaplan-Meier analysis were performed. Results: From a total of 452 patients treated in the IPO Porto between 2002–2009, 134 (29.6%) patients presented early stages of cervical cancer. Of these patients 112 (83.6%) presented SC and 15 (11.2%) presented AC. IB2 or IIA2 tumors were found in 45 (40.2%) of SC and 8 (53.3%) of AC. Age at the diagnosis (median: SC 45.5 vs. AC 48 years), menarche, menopause and sexual activity begin age, parity, use of hormonal contraception or hormone therapy, tobacco consumption and other oncological disease history were analyzed and no difference were found between SC and AC patients. A complete response to the primary treatment was 93.5% in SC and 86.7% in AC (p = 0.628). Relapse rate was 17.1% in SC and 26.7% in AC (p = 0.474). The DFS and OS was similar in SC and AC (p = 0.350 and p = 0.766, respectively). Conclusions: In this study no significant difference was found between early-stage SC and AC in treatment response, relapse, DFS and OS. Thus, these results suggest that SC and AC of the uterine cervix should have a similar therapeutic strategy. M265 ABDOMINAL WALL METASTASIS, GROWING TERATOMA SYNDROME AND FEMORAL VEIN INJURY AFTER AN OVARIAN CYSTECTOMY IN A 14-YEAR-OLD GIRL M. Modaresgilani1 , S. Goodarzi1 , A. Mousavi1 , M. Malek3 , R. Shahsiah2 , F. Zamani3 . 1 Imam khomeini hospital, Department of Gyenecologic Oncology, Tehran, Tehran, Iran, Islamic Republic of ; 2 Imam khomeini hospital, Department of Pathology, tehran, tehran, Iran, Islamic Republic of ; 3 Imam khomeini hospital, Department of radiology, tehran, tehran, Iran, Islamic Republic of Objectives: Malignant ovarian germ cell tumors are account for only about 5 percent of all malignant ovarian neoplasms. Ovarian germ cell tumors arise primarily in young women between 10 and
S617
30 years of age and represent 70 percent of ovarian tumors in this age. Appropriate diagnostic approach provide early treatment and disease free survival. Materials: Patient: A 14-year-old girl, referred to our gynecological oncology department with multiple and huge intra-abdominal, pelvic and abdominal wall masses, 2 months after an right ovarian cystectomy, with rupture and spillage during that surgery. The initial histology of the cyst was an ovarian mature teratoma. After tumor marker analysis and imaging, she underwent debulking surgery and chemotherapy with BEP (Bleomycin, Ethoposide, Cisplatin), 12 days after second surgery with the final histology of malignant mixed germ cell tumor (95% immature teratoma, grade III + 5%yolk sac tumor). Finally after 6 months from the second surgery, she underwent the thierd surgery because of Growing Teratoma Syndrome. During tumor resection, her right femoral vein was lacerated that immediately repaired. Her tumoral fascia replaced with dual mesh. Methods: A very interesting and educational case report. Intervention: diagnostic process, Debulking surgery, chemotherapy. Results: After 5 months of the surgery for growing teratoma syndrome, the patient is alive and has good condition. Her tumor markers and imaging are normal. Conclusions: Ovarian tumors in young girls should be always considered as being potentially malignant offer hope for curative treatment. It is advocated preoperative determination of a-fetoprotein (AFP) in all women with ovarian tumors under 40 years of age. Appropriate first surgical approach and tumor spillage prevention are fundamental. Pathologic review in the case of mature teratoma report is reasonable.
Figure: Multiple complex masses on sagittal T2-W MRI in pelvic, abdominal cavity, prevesical space and in abdominal wall associated with ascitis. M266 AVAILABILITY OF TRANSVAGINAL NEEDLE BIOPSY FOR SUSPECTED ENDOMETRIAL MALIGNANCY IN PATIENTS UNABLE TO UNDERGO ENDOMETRIAL SAMPLING WITH A CONVENTIONAL CURETTAGE METHOD N. Kawamura1 , T. Sumikura1 . 1 Gynecology, Osaka City Medical Hospital, Osaka, Japan Objectives: Some postmenopausal women with suspected endometrial malignancy cannot undergo endometrial sampling with a conventional curettage-method because of stenosis or atresia of the uterine cervical canal. To distinguish uterine sarcomas from benign leiomyomas, we have performed transcervical needle biopsies for uterine myoma-like tumors since 1994. In this study, we examined the availability of ultrasound (US)-guided transvaginal needle biopsies for the above-described cases. Materials: Six postmenopausal women with suspected endometrial malignancy because of an endometrial thickness of ≥10 mm as detected by US, but who were unable to undergo conventional endometrial sampling because of stenosis or atresia of the uterine cervical canal.