Akira Yabuno

Laparoscopic Cystectomy of Ovarian Teratoma in Anti-NMDAR Encephalitis: 2 Case Reports

We present 2 case reports of anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis that was successfully treated via laparoscopic ovarian cystectomy. In both cases, resection of an ovarian teratoma resulted in eventual full recovery. Although adnexectomy has been reported for tumor resection in anti-NMDAR encephalitis, we chose ovarian cystectomy to preserve ovarian function. The efficacy of cystectomy is equivalent to that of adnexectomy. This suggests that ovarian adnexectomy may not be necessary in anti-NMDAR encephalitis with ovarian teratoma.

Critical appraisal of bevacizumab in the treatment of ovarian cancer

Bevacizumab is the first molecular-targeted agent to be used for the treatment of ovarian cancer. Bevacizumab is a humanized monoclonal antibody targeting vascular endothelial growth factor. Two randomized Phase III trials evaluated the combination of bevacizumab plus standard cytotoxic chemotherapy for first-line treatment of advanced ovarian cancer. Additional Phase III trials evaluated bevacizumab combined with cytotoxic chemotherapy in platinum-sensitive and platinum-resistant recurrent ovarian cancer. All these trials reported a statistically significant improvement in progression-free survival but not in overall survival. Furthermore, bevacizumab effectively improved the quality of life with regard to abdominal symptoms in recurrent ovarian cancer patients. Bevacizumab is associated with adverse events not commonly observed with cytotoxic agents used to treat gynecological cancers, such as hypertension, bleeding, thromboembolism, proteinuria, delayed wound healing, and gastrointestinal events. However, most of these events can be adequately managed by gynecologists. The clinical trial results with bevacizumab have supported its recent approval in Europe and the United States as a treatment for ovarian cancer. This review presents the latest evidence for bevacizumab therapy of ovarian cancer and describes selection of patients for personalized treatment.

Pazopanib as a second line treatment for uterine and ovarian carcinosarcoma: a single institutional study

Uterine carcinosarcoma (UCS) is a relatively rare tumor in gynecologic malignancy that comprises less than 5% of uterine cancers, but it often shows an aggressive phenotype that has contributed to 30% of uterine cancer deaths [1]. Ovarian carcinosarcoma (OCS) is a very rare ovarian tumor that accounts for only 1% of ovarian cancer, and is composed of both malignant epithelial and mesenchymal elements, as well as UCS [1,2]. Prognosis of UCS and OCS is poor because up to 2/3 of patients present with advanced stage [2,3]. Currently, prognostic factors of carcinosarcoma (CS) are not well defined, but published reports have suggested pathological features and age as prognostic factors [4,5,6]. Previously, gynecological CS had been considered and treated as a sarcoma subtype [7]. However, CS is now recognized as a metaplastic carcinoma with the sarcoma component resulting from dedifferentiation of the carcinoma component [8], and therefore it is recommended that CS is treated similar to high-risk endometrial or ovarian carcinoma [9]. While combination chemotherapy of ifosfamide and paclitaxel is currently considered as a standard chemotherapy for UCS [10], an alternative combination is carboplatin and paclitaxel. The efficacy of combination carboplatin and paclitaxel has been reported in several phase II trials, and this combination appears to be better tolerated [11,12]. Based on these results, the combination of carboplatin plus paclitaxel is often used as a standard first line treatment for UCS or OCS, but second line treatment options are limited.

A case of peritoneal malignant mesothelioma following radiation therapy for cervical cancer

The present study presents a case of peritoneal malignant mesothelioma (PMM) following radiation therapy for cervical cancer. A 34-year-old Japanese woman, without asbestos exposure, was referred to the Department of Gynecologic Oncology, Saitama Medical University International Medical Center due to a cervical mass, and was diagnosed with cervical squamous cell carcinoma (SCC). The serum levels of tumor markers, including SCC antigen and cancer antigen 125 (CA125) were 229.0 ng/ml and 54.4 U/ml, respectively. The patient underwent concurrent chemoradiotherapy (CCRT), and a complete response was achieved. After 54 months, ascites was found at the rectouterine pouch, but peritoneal cytology suggested reactive mesothelial cell. After 62 months of CCRT, magnetic resonance imaging revealed masses in both the salpinges. The serum levels of SCC and CA125 were 0.9 ng/ml and 506.1 U/ml, respectively. Following this, left salpingectomy and peritoneal biopsy were performed laparoscopically. Histologic examination revealed atypical mesothelial cells with no continuity of background tubal epithelium. Immunohistochemistry showed positive staining for calretinin, thrombomodulin, mesothelin and glucose transporter 1. Based on these findings, the patient was diagnosed with PMM epithelioid type and underwent systemic chemotherapy; stable disease status has been obtained for 3 months. This case demonstrates the possibility of PMM occurrence within 10 years after radiotherapy, and indicates the importance of histological and immunohistochemical examination, particularly in cases of an atypical tumorigenesis pattern from the primary cancer.