M. Sotiropoulou

Mucinous but not clear cell histology is associated with inferior survival in patients with advanced stage ovarian carcinoma treated with platinum-paclitaxel chemotherapy†

Mucinous and clear cell histology have been associated with adverse prognosis in ovarian carcinomas. The authors compared the outcome of these subtypes with that of serous tumors in patients who were treated with combination paclitaxel/platinum at their center.

Abdominal radical trachelectomy for treatment of deep infiltrating endometriosis of the cervix

Surgical management of deep infiltrating endometriosis can be very challenging even for experienced gynecologists. Radical procedures like bowel resection and nephrectomy have been reported for treatment of the disease. Our aim is to report abdominal radical trachelectomy for treatment of deep infiltrating endometriosis of the cervix causing obstructive uropathy and diminished kidney function. We present a 38‐year‐old woman who was treated in our department for cervical endometriosis involving the vagina and left parametrium. Abdominal radical trachelectomy, insertion of a pig‐tail catheter in the left ureter and end‐to‐end anastomosis of the uterus with the vagina was performed to remove the endometriotic lesion. Cooperation between gynecologists, urologists and nephrologists enabled fertility preservation as well as improvement of renal function. Deep infiltrating endometriosis is a complex disease that requires a multidisciplinary approach. Abdominal radical trachelectomy for cervical lesions seems feasible in this setting and helps preserve fertility.

Management of a pregnancy complicated by yolk sac tumor

BackgroundThe management of ovarian cancer during pregnancy represents a major challenge and requires close multidisciplinary team approach.CaseA 35-year-old pregnant woman with a yolk sac tumor underwent left salpingo-oophorectomy at 25xa0weeks of gestation. Chemotherapy was deferred to the end of the pregnancy owing to concerns for potential fetal risks. Alpha-feto protein level was used to monitor the underlying disease activity. The patient underwent exploratory laparotomy with cesarean section followed by total hysterectomy, omentectomy, right salpingooophorectomy, pelvic, and para-aortic lymphadenectomies at 32xa0weeks of gestation. She received four postoperative courses of chemotherapy (cisplatin, etoposide, and peplomycin). Currently, mother and child are doing well 6xa0months after the last chemotherapy cycle.ConclusionIn a case of yolk sac tumor in the second trimester of pregnancy, radical surgery combined with elective caesarian section followed by chemotherapy could achieve remission and rescue of fetus. However, the treatment needs to be individualized as there is lack of evidence.

What is the accuracy of frozen section in the diagnosis of mucinous ovarian tumours? A 9-year review of performance in a Greek tertiary referral centre

PurposeThis retrospective study aimed to evaluate the diagnostic accuracy of the intra-operative frozen sections (FS) of mucinous ovarian tumours (mOT).MethodsBetween 2007 and 2015, a total of 105 mucinous ovarian samples were collected during laparotomy. The intra-operative FS accuracy was evaluated and potential factors correlated with increased inaccuracy assessed using both univariate and multivariate analysis.ResultsThe overall FS accuracy was 82.6%, while diagnostic discrepancy observed in 18/105 cases, including under-diagnosis in 14 and over-diagnosis in four cases. Amongst six cases diagnosed as benign with FS, five were upgraded to low malignant potential and one to malignant in the final formalin fixed, paraffin embedded section (FFPES). Amongst the 37 low malignant potential (LMP) cases, two were finally diagnosed as benign and eight as malignant. Amongst malignant tumours the diagnostic agreement occurred in 21/23 cases, while solely two cases were over-diagnosed. The false FS interpretation resulted in inadequate surgical management in 8/105 (7.6%) cases. Misdiagnosis had a statistically significant association with tumour size greater than 13xa0cm. The ratio of tumour size per number of frozen sections (TSFSR) less than 8 found to be an independent predictor of inaccuracy [OR 2.46, 95% confidence interval (CI) 1.74–3.46, Pxa0<xa00.001].ConclusionsThe accuracy rate of FS in our study was 82.6%. Frozen section had low accuracy amongst LMP tumours adversely influencing the adequate surgical management. This discordance seems to reflect adverse predictors such as the LMP heterogeneity, maximal tumour diameter and low TSFSR.