Southern African Journal of Gynaecological Oncology - latest Issue
Volume 8, Issue 1, 2016
Author Greta DreyerSource: Southern African Journal of Gynaecological Oncology 8 (2016)More Less
Four cases of monodermal cystic teratoma, consisting of thyroid tissue, are described in this short research report. Clinical features ranged from totally asymptomatic to large tumours with ascites and epithelial cancer markers (cancer antigen 125) correlated with tumour size and the presence of ascites. The pre-histology diagnosis remains problematic in this rare and interesting disease. Both hyperthyroidosis and malignancy are rare.
The expression status of human epidermal growth factor receptor 2 in epithelial ovarian cancer in Ibadan, Nigeria : researchSource: Southern African Journal of Gynaecological Oncology 8, pp 5 –9 (2016) http://dx.doi.org/10.1080/20742835.2015.1115197More Less
Background : It has been proposed that the overexpression of the human epidermal growth factor receptor 2 (HER2/neu protooncogene) could be a possible therapeutic target in epithelial ovarian cancer, as has been the case in breast carcinomas. However, there is lack of knowledge on the status of the gene in neoplasms which occur in black women. The objective of this study was to determine HER2/neu expression status in EOC in black women.
Method : Ninety cases of EOC were evaluated for HER2/neu protein expression using immunohistochemistry.
Results : HER-2/neu expression was observed in 33 of the 90 cases (37%), of which 15 EOC cases (17%) were weakly or moderately positive, and 18 (20%) strongly positive. A significant association was not found between HER-2/neu expression and age, International Federation of Gynecologists and Obstetrics (FIGO) stage, grading and histological subtypes (p-values of 0.463, 0.360, 0.975 and 0.168, respectively). However, there were more cases of advanced-stage disease (III/IV) with HER-2 expression than early-stage EOC (I/II). In this study, 21%, 36% and 42% of HER2/neu-positive tumours were grades 1, 2 and 3, respectively. A higher proportion of serous carcinomas (as opposed to mucinous carcinomas) was also observed to be HER2/neu positive.
Conclusion : HER2/neu expression was observed to increase with advanced stages of cancer, and was more commonly seen in serous, rather than in mucinous, carcinomas.
Lymphovascular space invasion in early-stage endometrial cancer : adjuvant treatment and patterns of recurrence : researchSource: Southern African Journal of Gynaecological Oncology 8, pp 10 –15 (2016) http://dx.doi.org/10.1080/20742835.2016.1175708More Less
Background : In early-stage endometrial cancer, lymphovascular space invasion (LVSI) is an independent predictor of relapse of disease and poorer survival. Nevertheless, adjuvant treatment for LVSI-positive patients is variable.
Methods : Early-stage endometrial cancer patients with LVSI, treated in Melbourne between 2000 and 2010, were retrospectively reviewed. Outcomes of patients observed after hysterectomy were compared with those who had had adjuvant EBRT or VBT.
Results : A total of 95 patients met the inclusion criteria. After surgery, 40 patients were observed, 48 patients received adjuvant EBRT and 7 adjuvant VBT. Nineteen patients developed recurrent disease (20.0%), of which 12.5% were in the observation group, 27.1% in the EBRT group and 14.3% in the VBT group (p-value 0.217). Fewer vaginal recurrences and more distant recurrences were found in both the RT groups (p-value 0.636 and 0.648 respectively). Multivariate analysis for overall survival (OS) and cancer-related survival (CRS) revealed a non-significant decrease of hazards in both the radiotherapy (RT) groups when compared with the observation group.
Conclusions : In patients with LVSI, adjuvant RT was not shown to reduce recurrence rates or improve OS or CRS. Previous reports have suggested that LVSI may be as important as nodal status for the risk of distant recurrence, therefore the use of systemic therapy should be further investigated.
Expression of adhesion molecule epithelial cadherin and matrix metalloproteinase-9 in squamous neoplasia of the uterine cervix : researchSource: Southern African Journal of Gynaecological Oncology 8, pp 16 –20 (2016) http://dx.doi.org/10.1080/20742835.2015.1110419More Less
Background : The objective of the study was to evaluate the expression of cell adhesion molecules [epithelial cadherin (E-cadherin)] and extracellular matrix protease [matrix metalloproteinase (MMP)-9] in preinvasive and invasive lesions of squamous neoplasia of the uterine cervix.
Method : The study included 14 cases of cervical intraepithelial neoplasia (CIN) and 43 cases of squamous cell carcinoma (SCC). Immunohistochemistry (IHC) testing was performed for E-cadherin and MMP-9 using the polymer technique. The pathological prognostic parameters, like tumour grade, stage, lymphovascular space invasion and mitosis were compared with the expression of these markers.
Results : The mean age of the patients with CIN was 40.1 years, and 50.9 years for those with SCC. Complete uniform membranous expression of E-caherin was demonstrated in the normal epithelium and most CIN (79%). MMP-9 was not expressed in the normal epithelium, whereas 43% of CIN (of which 67% were CIN grade III) were positive. Loss of membranous E-cadherin was shown in 88% of SCC, and MMP-9 with variable intensities expressed in 74%. A statistically significant association was established between the expression of these immune markers in preinvasive and invasive lesions, although there was no significant association with the prognostic parameters. In addition, the loss of E-cadherin was evident in patients with recurrence, while the expression of MMP-9 was demonstrated in 60%.
Conclusion : The loss of membranous E-cadherin and the gain of cytoplasmic MMP-9 are markers of neoplastic transformation in squamous neoplasia of the uterine cervix. However, the expression of these immune markers in our study did not relate to the prognostic parameters, indicating the importance of these markers in early neoplastic transformation.
Palliative chemotherapy in recurrent carcinoma cervix : experience from a regional cancer centre in southern India : researchSource: Southern African Journal of Gynaecological Oncology 8, pp 21 –24 (2016) http://dx.doi.org/10.1080/20742835.2016.1175152More Less
Aims : To evaluate the clinical outcome and complications with two different palliative chemotherapy regimens in recurrent cervical carcinoma.
Methods and materials : Forty (40) women with recurrent cervical squamous cell carcinoma were treated with palliative chemotherapy using paclitaxel plus cisplatin or single-agent docetaxel. Clinical outcome and toxicities were analysed. The parameters in two arms were compared using Student's t-test and statistical analysis was done using R software.
Results : At a median follow up of 1.35 years the clinical outcome was complete response/partial response in 50% and 60% and progressive disease in 20% and 10% of the patients with either paclitaxel/cisplatin or docetaxel, respectively, which was not statistically significant. Stable disease (SD) was 30% in both arms. Toxicity included nausea, seen in all the patients in both arms, and diarrhoea, seen in 90% and 70% of the patients in the two arms, respectively. Grade II to III neutropenia was seen in 10% of patients with paclitaxel/cisplatin and none with docetaxel. Hypersensitivity was encountered in 40% and 30% in the two arms, respectively.
Conclusion : There was no significant difference in clinical outcome and morbidity in patients with either paclitaxel/cisplatin or single-agent docetaxel. Further prospective clinical trials with larger study groups and longer follow-up are required to substantiate these claims.
Source: Southern African Journal of Gynaecological Oncology 8, pp 25 –27 (2016) http://dx.doi.org/10.1080/20742835.2015.1116186More Less
Extraovarian peritoneal serous papillary carcinoma is an uncommon malignant tumour characterised by peritoneal involvement with ascites, which is similar to ovarian serous papillary carcinoma histologically. Our case involved only the surface and superficial cortex of the ovaries, with peritoneal involvement, as described in the literature.
Source: Southern African Journal of Gynaecological Oncology 8, pp 28 –30 (2016)More Less
Struma ovarii are a rare type of monodermal teratoma. Preoperative diagnosis of struma ovarii is difficult as the symptoms, clinical presentation and image on ultrasound are often similar to that of ovarian carcinoma. These patients, with mostly benign disease, often have more extensive surgery than necessary. We present the cases of four women who were diagnosed with struma ovarii postoperatively. They illustrate a range of symptoms and varied surgical approaches. The objective of this mini review is to raise awareness of the diagnosis of struma ovarii. The extensiveness of surgery, mostly in premenopausal women, can be reduced if there is a high suspicion of struma ovarii prior to surgery. An ovarian cyst with a large solid component may be suggestive of this diagnosis and magnetic resonance imaging if possible, and serum thyrogglobulin may aid in diagnosis. It is also prudent to test for hyperthyroidism if the diagnosis is suspected, to avoid thyroid crisis during surgery.