John P. Micha

Three-consecutive-day topotecan is an active regimen for recurrent epithelial ovarian cancer☆

OBJECTIVEnThe aim was to determine the response rate and toxicity of topotecan administered Days 1-3 every 21 days for recurrent epithelial cancers of the ovary, peritoneum, or fallopian tube. A 3-day regimen may be more convenient and less expensive than a 5-day schedule.nnnMETHODSnPatients with recurrent epithelial cancer of the ovary, peritoneum, or fallopian tube who had adequate hepatic, renal, and hematologic function were eligible for participation. Topotecan (2 mg/m(2)) was administered for 3 consecutive days every 21 days. Response was measured clinically and serologically. Granulocyte colony stimulating factors (GCSF) were not utilized prophylactically, but could be added under specific conditions.nnnRESULTSnThirty-one patients with recurrent ovarian cancer whose median age was 63 (range 32-84) received 165 cycles of topotecan (median = 6; range 2-8) and are evaluable for toxicity. The median number of prior regimens was 1. Topotecan was administered on schedule in 96.6% of cycles. Grade 3/4 neutropenia was seen in 29.1 and 23.6% of courses, respectively; but only 3.4% of cycles required GCSF support (6 cycles for 2 patients). Grade 4 thrombocytopenia was rare (1% of cycles). Nonhematologic toxicity was mild. The response rate for 28 evaluable patients was 32.1% (10.7% complete response (CR) and 21.4% partial response (PR)); stable disease was seen in 17.9% of patients. The median progression-free interval (PFI) for all patients was 15.5 weeks (range 5-40). Eighteen platinum-sensitive patients demonstrated a 43.4% response rate (12.5% CR and 31.3% PR); stable disease was documented in 18.8%. The median PFI for platinum-sensitive patients was 18.5 weeks (range 5-40).nnnCONCLUSIONnTopotecan is an effective regimen with acceptable toxicity for recurrent ovarian cancer when administered for 3 consecutive days (2 mg/m(2)) every 21 days. It can be delivered on schedule without GCSF support in the vast majority of patients.

Chemotherapy and patient co-morbidity in ventral site hernia development

OBJECTIVEnThe risk factors associated with early ventral site hernia development following cancer surgery are ill defined and associated with an undetermined incidence.nnnMETHODSnWe analyzed 1,391 gynecologic cancer patient charts to identify the number of post-operative ventral site hernias over a nearly 6 year period. The following study variables were noted for evaluation: patient demographics, disease co-morbidity (hypertension, cardiovascular disease, diabetes), body mass index (BMI), treatment (e.g., chemotherapy regimen), intra-operative (e.g., bleeding) and postoperative (e.g., infection) complications, time to hernia development and length of hospital stay.nnnRESULTSnTwenty-six gynecologic cancer patients who developed a post-operative ventral hernia and subsequently underwent herniorrhaphy by our gynecologic oncology service were identified. The patient groups overall time to initial hernia development was 11.23 months. Following a multiple regression analysis, we found that treatment (e.g., bevacizumab, liposomal doxorubicin or radiotherapy associated with compromised wound healing [p=0.0186] and disease co-morbidity [0.0432]) were significant prognostic indicators for an accelerated time to hernia development. Moreover, five patients underwent treatment associated with compromised wound healing and also had disease co-morbidity. In this sub-group, post-operative hernia development occurred more rapidly (3.8 months) than the overall group of patients. BMI and age did not impact time to hernia development (p>0.05).nnnCONCLUSIONnIn the present gynecologic cancer patient series, a tendency for early post-operative hernia development appeared to coincide with treatment associated with compromised wound healing and disease co-morbidity. Gynecologic cancer surgeons should anticipate this potential complication and consider employing prophylactic intra-operative mesh to potentially prevent this condition.

Marlex mesh mimicking an adnexal malignancy.

Hernia post-operative repair problems are infrequent and easily managed, but plug migration can be a more complicated event. Mesh plug migration is very uncommon and rarely presents as a suspected malignancy. We document a case involving a 79-year-old woman who exhibited a complex right-sided cystic mass that was presumed to be an adnexal malignancy. However, following surgery, the retroperitoneal mass was actually a PerFix mesh plug that migrated from an initial hernia surgery.

Successful management of acute renal failure with a vaginal pessary: a case report

Persistent uterine prolapse with secondary acute renal failure is a very uncommon event. We report the case of a 77-year-old woman with a 5-year history of uterine prolapse. She was referred to our gynecologic oncology service for 3rd degree uterine prolapse and was found to have bilateral hydronephrosis and acute renal insufficiency. The patient was fitted for a pessary to manage the uterine prolapse, which resulted in resolution of her hydronephrosis and renal insufficiency. Prompt assessment with nephrology consultation and pessary placement for patients with 3rd degree genital prolapse is imperative to ensure that irreversible renal complications do not manifest themselves.

Delayed Staple Erosion into the Bladder After Removal of a Benign Ovarian Mass

We describe the case of a 54-year-old woman who presented with an ovarian mass in September 2000. The patient remained asymptomatic for 4 years until she developed a persistent urinary tract infection and hematuria. After a computed tomographic scan of the pelvis revealed urolithiasis, the secondary finding of potential staple erosion via cystoscopy was realized. Delayed staple erosion rarely occurs and can result in detrimental patient outcome. The diagnosis and management of this unusual complication are documented.

The safety and feasibility of minimally invasive sentinel lymph node staging using indocyanine green in the management of endometrial cancer

OBJECTIVESnThe purpose of this study was to report on the feasibility of laparoscopic sentinel lymph node (SLN) staging using indocyanine green (ICG) in the management of endometrial cancer.nnnSTUDY DESIGNnWe retrospectively evaluated the charts of presumed, clinical stage I endometrial cancer patients who underwent robotic-assisted surgery that incorporated mapping with ICG and SLN dissection from January 2016 until February 2017. Patient demographics, operative characteristics (e.g., complications, lymph node counts) and pathology data were evaluated.nnnRESULTSnThere were 87 patients who were included in the study. A total of 370 lymph nodes were removed, of which 245 were SLNs; unilateral and bilateral mapping of the SLNs was achieved in 84 (96.5%) and 71 (81.6%) of subjects, respectively. There were 10 (11.5%) patients who had metastatic disease identified within 22 (5.9%) of the total (nu202f=u202f370) lymph nodes extracted, 19 (7.7%) of which were sentinel lymph nodes. We did not observe any intraoperative complications.nnnCONCLUSIONnThe results from our study suggest that minimally invasive SLN staging using ICG is a feasible procedure that is potentially effective at detecting metastases, which may ultimately attenuate the incidence of surgical morbidity.

Low-grade pelvic masses with spindle cell and fibroblastic proliferation: a case report

BackgroundAbdominal-pelvic masses containing spindle cell and fibroblastic proliferation are very rare. Since scant studies have reported on the pathologic characteristics inherent in this disease, appropriate clinical management is undetermined.Case presentationWe report on an 87 year-old woman who presented with large abdominal pelvic masses, ascites, ureteral obstruction, and an elevated CA-125 serum level. The patient underwent surgical resection of the lesions and has since done very well. Final pathology revealed a low-grade ovarian tumor with spindle cell and fibroblastic proliferation.ConclusionTo the best of our knowledge, this appears to be the only reported clinical case of a patient with this rare histology.