F. Rosati

Behaviour of ovarian tumors of low malignant potential treated with conservative surgery

OBJECTIVE Fertility-sparing surgery has been proposed for the treatment of borderline ovarian tumors. The aim of this study was to evaluate the outcome of patients submitted to cystectomy (CYS) compared with patients treated by unilateral salpingo-oophorectomy (USO) or bilateral salpingo-oophorectomy with/without total hysterectomy (radical surgery, RS). METHODS We reviewed retrospectively the data of patients treated in 3 institutions for borderline ovarian tumors. One hundred and sixty-eight patients underwent laparoscopic or laparotomic surgical treatment from 1985 to 2006. Tumor recurrence rate, disease-free survival and site of recurrences were evaluated. Specific prognostic factors, such as stage, histology, micropapillary subtype, exophytic tumor growth, intraoperative spillage, endosalpingiosis, staging procedures, and route of surgery were analysed. RESULTS Thirty-five patients underwent cystectomy, 50 unilateral salpingo-oopohorectomy, and 83 radical surgery. Twelve patients in the CYS group (34.3%), 10 in the USO group (20.0%), and 5 (6.0%) in RS group relapsed. Five-year progression-free survival (PFS) was 59.6%, 78.4%, and 93.5% in CYS, USO and RS groups, respectively. None of the relapsed patients died of disease. CONCLUSIONS Cystectomy is an effective surgical strategy for patients with borderline ovarian tumor. The higher risk of local relapses is not associated with a reduction in the overall survival. The procedure should be offered to young patients with bilateral tumors and to very young ones, considering the higher risk of local relapse.

Transvaginal sonographic appearance of peritoneal pseudocysts

To describe the sonographic features of peritoneal pseudocysts (PPCs) in order to determine the particular aspects that distinguish them from true ovarian cysts.

Oestrogen receptor 1 mRNA is a prognostic factor in ovarian cancer patients treated with neo-adjuvant chemotherapy: Determination by array and kinetic PCR in fresh tissue biopsies

Oestrogen receptors (ESRs) regulate the growth and differentiation of normal ovarian epithelia. However, to date their role as biomarkers in the clinical setting of ovarian cancer remains unclear. In view of potential endocrine treatment options, we tested the role of ESR1 mRNA expression in ovarian cancer in the context of a neo-adjuvant chemotherapy trial. Study participants had epithelial ovarian or peritoneal carcinoma unsuitable for optimal upfront surgery and were treated with neo-adjuvant platinum-based chemotherapy before surgery. RNA was isolated from frozen tumour biopsies before treatment. RNA expression of ESR1 was determined by microarray and reverse transcriptase kinetic PCR technologies. The prognostic value of ESR1 was tested using univariate and multivariate Cox proportional hazards models, Kaplan-Meier survival statistics and the log-rank test. ESR1 positively correlates with proliferation markers and histopathological grading. ESR1 was a significant predictor of survival as a continuous variable in the univariate Cox regression analysis. In multivariate analysis, elevated baseline ESR1 mRNA levels predicted prolonged progression-free survival (P=0.041) and overall survival (P=0.01) after neo-adjuvant chemotherapy, independently of pathological grade and age. We conclude that pretreatment ESR1 mRNA is associated with tumour growth and is a strong prognostic factor in ovarian cancer, independent of the strongest clinical parameters used in clinical routine. We suggest that ESR1 mRNA status should be considered in order to minimize possible confounding effects in ovarian cancer clinical trials, and that early treatment with anti-hormonal agents based on reliable hormone receptor status determination is worth investigating.

Clinical governance network for clinical audit to improve quality in epithelial ovarian cancer management.

BackgroundEpithelial ovarian cancer (EOC) is the most lethal gynecological cancer. Several hospitals throughout the region provide primary treatment for these patients and it is well know that treatment quality is correlated to the hospital that delivers. The aim of this study was to investigate the management and treatment of EOC in a Region of the North Italy (Emilia-Romagna, Italy).MethodsA multidisciplinary group made up of 11 physicians and 3 biostatisticians was formed in 2009 to perform clinical audits in order to identify quality indicators and to develop Region-wide workup in accordance with the principles of evidence-based medicine (EBM). The rationale was that, by setting up an oncogynecology network so as to achieve the best clinical practice, critical points would decrease or even be eliminated. Analysis of cases was based on the review of the medical records.Results614 EOC patients treated between 2007 and 2008 were identified. We found only 2 high-volume hospitals (≥ 21 patients/year), 3 medium-volume hospitals (11–20 operated patients/year), and 7 low-volume hospitals (≤ 10 operated patients /year). Only 222 patients (76.3%) had a histological diagnosis, FIGO surgical staging was reported only in 206 patients (70.9%) but not all standard surgical procedures were always performed, residual disease were not reported in all patients. No standard number of neoadjuvant chemotherapy cycles was observed.ConclusionsThe differences in terms of treatments provided led the multidisciplinary group to identify reference centers, to promote centralization, to ensure uniform and adequate treatment to patients treated in regional centers and to promote a new audit involving all regional hospitals to a complete review of the all the EOC patients.

Three‐dimensional power Doppler imaging of uterine artery pseudoaneurysm treated unsuccessfully with selective embolization

A 24-year-old primigravida underwent a scheduled Cesarean delivery at 39 weeks’ gestation for breech presentation. Five weeks after the Cesarean section she presented to our emergency department with sudden onset of heavy vaginal bleeding and abdominal pain. Transvaginal ultrasound examination (Accuvix XQ, Medison Corp, Seoul, Korea) showed a hypoechoic area, measuring 14.4 × 8.8 mm, located at the level of the lower uterine segment, adjacent to the Cesarean suture, which involved the majority of the myometrial wall on the right side of the uterus (Figure 1a). Color Doppler sonography confirmed bidirectional systolic and diastolic flow (peak systolic velocity, 0.70 m/s; resistance index, 0.53) within the area, which appeared to be connected to the right uterine artery, findings consistent with a pseudoaneurysm of this vessel (Figure 1b). The patient underwent pelvic angiography and embolization of the pseudoaneurysm. Selective hypogastric arteriography using a 5-F cobra shaped catheter was performed and multiple metallic coils of 3 mm in diameter were deployed across the origin of the pseudoaneurysm from the uterine artery, followed by pledgets of gelatine sponge. Repeat ultrasound

Gp273, the Ligand Molecule for Sperm-Egg Interaction in the Bivalve Mollusk, Unio elongatulus, Binds to and Induces Acrosome Reaction in Human Spermatozoa Through a Protein Kinase C-Dependent Pathway

Abstract In a previous article, we suggested that gp273, the ligand molecule for sperm-egg interaction in the bivalve mollusk Unio elongatulus has functional carbohydrate epitopes in common with a human zona pellucida glycoprotein, probably ZP3. We demonstrated that: 1) anti-gp273-purified immunoglobulin G (IgG), which recognizes a carbohydrate gp273 epitope including a Lewisa-like structure, interacts with a zona pellucida protein; 2) human sperm specifically bind to gp273; and 3) binding is reversed by anti-gp273 IgG. In the present study, we confirm this suggestion by demonstrating that heat-solubilized zonae pellucidae reverse gp273-human sperm binding, that gp273-binding sites are restricted to the acrosomal region, and that gp273 induces the acrosome reaction in human sperm. We also demonstrated that gp273-binding sites on human sperm function as signaling receptors because exposure of spermatozoa to this glycoprotein results in significant stimulation of protein kinase C (PKC) activity. Because the PKC inhibitor, bisindolylmaleimide I, reverses both PKC activation and the acrosome reaction, this kinase is a key component of the signal transduction pathway activated by gp273 and leading to the exocytotic event.

OC186: Sonographic features of peritoneal carcinomatosis

and this therapy was continued for eight weeks. The reduction of the volume as well as the weight of the xenografts was significantly shown by this combined therapy, in comparison to a group of the drug used alone, ultrasound irradioation alone, or in the controls. No major side effect was observed in any mice of the groups. The effect of anti-angiogenesis for this tumor was remarkably demonstrated on real-time by contrasted color ultrasound, non-invasively. The microvessel density of the tumors was significantly decreased in this combination therapy compared to other groups. These results suggest that there is an accelerated (boosting) effect of ultrasound for anti-angiogenesis drug therapy for human uterine sarcoma and this combination therapy might be a potential candidate for a new cancer treatment.

OC227: Early 3D aspects of recurrence of borderline ovarian tumors

important for fetal viability, supplying the fetal brain and heart with oxygen and glucose. The objective of the study was to investigate the glucose uptake in fetal organs using PET during acute and chronic hypoxia. Methods: In 12 fetal sheep PET imaging was performed on a highresolution PET scanner (Siemens ECAT/EXACT, Germany). Blood flow volume in the umbilical vein (UV) and ductus venosus (DV) was measured using color Doppler ultrasound systems and the umbilical supply to the liver was calculated. For acute hypoxia, oxygen was reduced in the ventilated gas mixture. Fetoscopic coagulation of major placental vessels was performed using a 30◦ endoscope and bipolar forceps (Karl Storz, Germany) in three pregnant ewes (GA 85 ± 8 days, mean ± SD) for chronic hypoxia. FDG uptake in fetal brain and liver was estimated using dynamic PET imaging over 60 min. Input functions were derived from arterial and venous blood samples of mother sheep scaled by fetal blood samples taken from the umbilical cord vein by cordocentesis under ultrasound guidance to determine gas values in the UV. Results: During hypoxia fetal pH, BE and umbilical liver blood supply were reduced significantly. FDG uptake of the heart increased during hypoxia, but was not changed significantly in the liver.

P41.11: Three‐dimensional power Doppler angiography in the diagnosis of pseudoaneurysm of the uterine artery

artery PI, had increased risk for Cesarean section and lower birth weight, lower gestational age at delivery, lower apgar scores and higher need for neonatal intensive care. Uterine Doppler test have a positive prediction value of 58% to predict adverse perinatal outcome and therefore it could be useful to assess SGA fetus with normal umbilical Doppler. CPR at diagnosis of SGA was not useful to assess the subsequent adverse outcome.

P29.07: Early diagnosis and conservative management of cervical ectopic pregnancy

Objectives: To evaluate the criteria of early diagnosis and the role of conservative management in the treatment of cervical pregnancies. Methods: We made a retrospective analysis of all cervical ectopic pregnancies diagnosed in our department from January 2001 to December 2005. The diagnosis of cervical pregnancy was made by transvaginal ultrasound (empty uterine cavity, distended/enlarged cervix, gestational sac below the level of internal os, negative ‘sliding sign’, peritrophoblastic blood flow on Doppler evaluation). Data about medical history were recorded in all cases. Serum human chorionic gonadotropin (hCG) levels were evaluated at time of diagnosis and during the follow-up until resolution. Conservative management was obtained with administration of systemic (50 mg/m2) and/or intra-amniotic (50 mg) methotraxate. After three months from the treatment all patients underwent an hysteroscopic evaluation of cervical canal and uterine cavity. Results: Five cases of ectopic pregnancy were diagnosed during the study period. No risk factors were found in patients medical history. Sonographic diagnosis was between 7 and 10 weeks of gestation. Serum hCG levels at diagnosis were between 4446 and 10 087 IU/L. Two cases were successfully treated with systemic and intraamniotic administration of methotrexate, three case were managed successfully with a single dose of intra-amniotic metothrexate. Serum hCG levels started to decrease from day 4 after the treatment. No early or late complications occurred. All patients were followed up until serum hCG levels were < 5 IU/L. Hysteroscopic evaluation confirmed absence of sinechiae/lesions at the level of cervical implant of ectopic pregnancy in all patients. Conclusion: Early diagnosis of cervical pregnancy allows a conservative fertility-sparing management that is effective and safe.