A. Cazzolla

Skin metastases in ovarian carcinoma: a report of nine cases and a review of the literature

OBJECTIVE Cutaneous involvement is unusual at presentation and during the course of ovarian carcinoma. The aim of the present study was to determine the incidence, clinicopathologic characteristics and prognostic factors of skin metastases in ovarian cancer patients. METHODS A retrospective chart review was conducted on 220 patients with epithelial ovarian carcinoma treated at our unit between 1991 and 2001. Pertinent clinical information, pathologic data, treatment, and prognostic factors for survival following documentation of skin metastases were collected. Survival time was calculated from the time of diagnosis of ovarian cancer and from the time of diagnosis of the cutaneous metastasis. RESULTS FIGO stage at the time of ovarian cancer diagnosis was stage III = five patients (56%), and stage I and stage IV = two patients each (22%). Most patients had serous papillary cystoadenocarcinoma of the ovary (78%), and one each had endometrioid and mucinous carcinomas (12%). Seven patients (78%) had poorly differentiated tumors. Only one patient had a skin metastasis at the time of ovarian cancer diagnosis; in the remaining patients the average time of appearance of skin metastases after the diagnosis of ovarian cancer was 23.4 +/- 12 months (range 4 to 37). The diameter of the skin lesions ranged between 0.5 and 3 cm. Three patients had a single skin nodule, while six had multiple skin lesions. Eight patients (89%) have died of disease and median survival after diagnosis of the skin metastases was 4 months (range 2 to 65). One patient (Cases 1) is alive without tumor 4 months after diagnosis of the skin metastases. Overall survival after diagnosis of skin metastasis from ovarian cancer was 4 months (range 2 to 65). CONCLUSION Skin involvement is a late complication that occurs rarely in ovarian cancer patients. Prognosis after skin metastases is poor and the most important prognostic factor associated with survival is the interval time between diagnosis of ovarian cancer and documentation of cutaneous involvement.

Surgical treatment of recurrent ovarian cancer: report of 21 cases and a review of the literature

AIM To evaluate the role of secondary cytoreductive surgery in patients with recurrent ovarian cancer. PATIENTS AND METHODS A retrospective chart review was conducted on 21 patients submitted to secondary cytoreductive surgery for apparently isolated and resectable recurrence of ovarian cancer, after a disease-free interval of at least 12 months. RESULTS Fifteen patients (71%) had complete surgical debulking with no macroscopic tumor at the completion of the surgical procedure. Eight patients (38%) required an intestinal resection but no colostomy was performed. Eleven complications were recorded in nine patients, but no operative death occurred. The median survival time for all patients after diagnosis of recurrent disease was 29 months (range 6-96 months). Survival time after diagnosis of recurrence was not significantly related either to known prognostic factors of ovarian cancer or to the length of the clinical remission time. The absence of residual disease after salvage surgery was the only factory associated with prolonged survival. CONCLUSION Secondary cytoreductive surgery is a safe procedure which should be offered to recurrent ovarian cancer patients with apparently isolated and resectable disease, and without ascitis.

Groin recurrence in carcinoma of the vulva: management and outcome

The aim of the study was to investigate the management and outcome of inguinal recurrence in vulvar carcinoma patients. A retrospective chart review was conducted on 140 patients with squamous cell carcinoma of the vulva treated between 1994 and 2006. Twenty-one patients were found to have groin recurrence. Median interval between primary treatment of vulvar cancer and groin recurrence was 7 months. Three patients refused any treatment, 3 received chemotherapy, 2 inguino-pelvic radiotherapy and 13 had resection of the groin recurrence. After surgery seven patients received irradiation of the groin and pelvis, and three patients received chemotherapy. One patient died following surgery; 19 patients died of disease with the median survival after diagnosis of inguinal recurrence of 9 months. Only one patient is alive without evidence of disease at 60 months following surgery. In univariate analysis, stage and grade at diagnosis, age and performance status at the recurrent disease, and the extent of residual tumour after resection of groin recurrence were predictors for survival. Groin recurrences from vulvar carcinoma carry a poor prognosis. Multi-modal treatment may result in a palliation of the disease, and a very limited number of patients have long-term survival.

Transforming Growth Factor-β1 in Hemangioma of the Ovary

Hemangioma of the ovary is extremely rare. We report the case of a 32-year-old woman who complained of pelvic pain due to a large right adnexal mass. On surgical exploration a 10 × 8 cm hemangioma of the ovary was resected. Expression of transforming growth factor-β1 was studied, and the possible role of this molecule in the development of the tumor is discussed.