Mihai Meirovitz

Peritoneal papillary serous carcinoma: Study of 15 cases and comparison with stage iii–iv ovarian papillary serous carcinoma

Background and Objectives: Peritoneal papillary serous carcinoma (PPSC) is histologically and clinically similar to stage III–IV ovarian papillary serous carcinoma (OPSC). The purpose of this study was to investigate the clinical findings, treatment, and outcome of PPSC patients compared with stage III–IV OPSC patients.

Sister Mary Joseph’s nodule originating from endometrial carcinoma incidentally detected during surgery for an umbilical hernia: a case report

IntroductionUmbilical metastasis (Sister Mary Joseph’s nodule) is rare. It is encountered in 1–3% of patients with intra-abdominal and/or pelvic malignancy, with gastric carcinoma being the commonest origin in men and ovarian carcinoma—in women. Only 27 cases of Sister Mary Joseph’s nodule originating from endometrial carcinoma have previously been documented in the literature.Case reportIn a 51-year-old woman, a Sister Mary Joseph’s nodule coexisting with a large fibroid uterus was incidentally detected during surgery for suspected strangulated umbilical hernia. Subsequent laparotomy confirmed endometrial carcinoma metastasizing to the umbilical region.ConclusionThis is the 28th case reported in the literature of Sister Mary Joseph’s nodule originating from endometrial carcinoma and the first case of Sister Mary Joseph’s nodule originating from endometrial carcinoma incidentally detected during surgery for umbilical hernia. Surgeons should be aware of the possibility of Sister Mary Joseph’s nodule coexisting with an umbilical hernia.

Placental site trophoblastic tumor: report of four cases and review of literature

Placental site trophoblastic tumor (PSTT) is a rare variant of gestational trophoblastic disease that originates from the implantation site intermediate trophoblast. We report four patients with PSTT and review pertinent literature. Three patients presented with disease confined to the uterus and one patient with disease extension beyond the uterus. Antecedent pregnancy was full-term pregnancy in three patients and termination of a 21-week pregnancy in one patient. Interval from the antecedent pregnancy was <1 year in three patients and 13 years in one patient. Primary treatment was simple hysterectomy in three patients and radical hysterectomy in one patient. Overall, three patients received chemotherapy; one had EP/EMA as adjuvant chemotherapy, one had EMA/CO for rising levels of serum β-hCG and one had BEP then VIP for recurrent disease. The three patients with disease confined to the uterus have remained after treatment alive and with no evidence of disease, whereas the one patient with disease extension beyond the uterus died of disease despite surgery and aggressive chemotherapy. It is concluded that disease extension beyond the uterus is the most important adverse prognostic factor. Other adverse prognostic factors are interval from antecedent pregnancy >2 years, age >40 years, and mitotic count >5 mitotic figures/10 high-power fields. Because of the relative insensitivity to chemotherapy, hysterectomy is the mainstay of treatment. EP/EMA seems to be the most effective first-line chemotherapy available to date for metastatic and relapsing PSTT

Uterine papillary serous carcinoma: study of 19 cases

OBJECTIVE Uterine papillary serous carcinoma (UPSC) is an uncommon highly malignant variant of endometrial carcinoma that histologically and clinically resembles ovarian papillary serous carcinoma. The purpose of this study was to present the conjoined experience of two regional hospitals in the south of Israel (Soroka Medical Center, Beer-Sheva and Kaplan Hospital, Rehovot) of handling this tumour. STUDY DESIGN Data from the files of 19 patients with UPSC who were managed at these hospitals between July 1991 and June 1997 were evaluated. RESULTS The three-year survival rate was 57.3% overall; 83.3% for Stage I and 21.2% for Stages II, III, and IV combined (P<0.02). Eighteen patients had primary surgery which included total abdominal hysterectomy and bilateral salpingo-oophorectomy and 15 (83.3%) of them received postoperative adjuvant therapy which included radiotherapy and/or systemic chemotherapy. CONCLUSIONS The prognosis of patients with UPSC is worse than that of patients with other forms of endometrial carcinoma. Primary surgery comprised of total abdominal hysterectomy, bilateral salpingo-oophorectomy and staging is the mainstay of treatment. The type of postoperative treatment is not consistent. By and large, adjuvant pelvic radiotherapy is usually given in early-stage disease and adjuvant systemic chemotherapy is usually prescribed in advanced-stage disease.

Lymphoma-like lesion of the uterine cervix.

Lymphoma-like lesion of the uterine cervix is a benign reactive lymphoid hyperplasia associated with chronic cervicitis that may pose a problem in differential diagnosis from malignant lymphoma. It is a rare entity and only about 20 cases have been reported in the world literature. Two cases of cervical lymphoma-like lesion are described. In both patients, the diagnosis was based on microscopic examination of biopsies taken from the uterine cervix. One patient subsequently had a cervical conization that confirmed the diagnosis of lymphoma-like lesion. Both patients are well, alive and with no evidence of malignant lymphoma. It is concluded that the diagnosis of lymphoma-like lesion is based on the well-established characteristic microscopic features of this lesion. Immunohistochemical staining is usually not helpful in distinguishing this lesion from malignant lymphoma. No specific treatment is necessary for this condition.

Long-term disease-free survival following surgery and active specific immunotherapy with allogeneic vaccine in a patient with high-risk malignant melanoma of the vulva

Vulvar malignant melanoma with deep vertical penetration of the tumor and involvement of regional lymph nodes carries a very poor prognosis. The case of a 25-year-old woman with a history of a Breslow depth 6.0 mm and Clark Level IV primary vulvar malignant melanoma, involving the anterior part of the left labium major, 1 cm from the clitoris, is reported. The patient had undergone a left radical hemivulvectomy and bilateral groin dissection. There were two of thirteen superficial left groin nodes containing metastatic melanoma. The patient had been treated postoperatively with an allogeneic specific anti-melanoma vaccine in combination with high-dose cimetidine and has survived without disease for more than five years. To the best of our knowledge this is the first case report in the literature of active specific immunotherapy with allogeneic vaccine in vulvar malignant melanoma. This case illustrates that the behavior of malignant melanoma, including vulvar malignant melanoma, is unpredictable and active specific immunotherapy with allogeneic vaccine may have a role in the postoperative treatment of high risk vulvar malignant melanoma.

Primary rhabdoid tumor of the ovary: When large cells become small cells

Highlights • The third case of pure primary malignant rhabdoid tumor of the ovary (MRTO) is described• SMARCA4 and SMARCB1 genetic analysis and immunohistochemistry are necessary for correct diagnosis of MRTO• MRTO and small cell carcinoma of the ovary, hypercalcemic type are essentially the same and should be treated as such

Dermatomyositis and peritoneal papillary serous carcinoma

We describe an unusual case of peritoneal papillary serous carcinoma (PPSC) arising in a female patient with dermatomyositis (DM). Despite periodic extensive searches for an underlying malignancy, no malignancy had been detected in this patient during the first 2.5 years after the diagnosis of DM. It was only when the patient presented with pleural effusion and ascites that the underlying intra-abdominal malignancy was detected by laparoscopy. Treatment with four cycles of pre-operative chemotherapy (taxol and cisplatin) resulted in tumor regression with amelioration in the muscular manifestation of the DM, but without parallelic amelioration in the skin manifestations of the DM. Explorative laparotomy confirmed the presence of papillary serous carcinoma in the omentum, surface of the left ovary and the retroperitoneal lymph nodes, and established the diagnosis of PPSC. Following two cycles of postoperative chemotherapy, the patient is alive with no evidence of internal malignancy. However, although muscle strength and enzymes have remained normal, no effect on the skin manifestation of DM has been observed. This case illustrates that, alongside the more frequently occurring ovarian carcinoma, PPSC should also be considered in the differential diagnosis of the underlying malignancy that may occur in the female patient with DM.

Prepregnancy obesity: a risk factor for future development of ovarian and breast cancer.

The aim of this study was to investigate the association between a history of prepregnancy obesity and a woman’s future long-term risk for the development of female malignancies. A population-based study compared the incidence of long-term female malignancies in a cohort of consecutive women with and without a diagnosis of prepregnancy obesity. Deliveries occurred between the years 1988 and 2013, with a mean follow-up duration of 11.6 years. Women with known malignancies before the index pregnancy and known genetic predisposition for malignancy were excluded from the study. Female malignancies were divided according to specific type (ovary, uterine, breast, and uterine cervix). A Kaplan–Meier survival curve was used to estimate the cumulative incidence of malignancies. A Cox proportional hazards model was used to estimate the adjusted hazard ratios for female malignancy. During the study period, 106 251 deliveries fulfilled the inclusion criteria; 2.2% (n=2360) occurred in patients with a history of prepregnancy obesity. During the follow-up period, patients with prepregnancy obesity had a significantly increased risk for hospitalization because of female malignancies as a group and specifically ovarian and breast cancer. Using a Kaplan–Meier survival curve, patients with a previous diagnosis of prepregnancy obesity had a significantly higher cumulative incidence of female malignancies. Using a Cox proportional hazards model, adjusted for confounders such as gestational diabetes mellitus and maternal age, prepregnancy obesity remained independently associated with long-term risk for female malignancies (adjusted hazard ratio: 1.4; 95% confidence interval: 1.1–1.9; P=0.045). Prepregnancy obesity is an independent risk factor for long-term female malignancies such as ovarian and breast cancer.

Is Radical Hysterectomy Necessary in Early Cervical Cancer

Aims: To estimate the prevalence of tumor spread to the parametrium, vagina and uterine corpus in radical hysterectomy specimens and define a subgroup of patients with low-risk of extracervical involvement, who may benefit from less radical surgery. Methods: We retrospectively reviewed 96 patients with stage IA1-IIA cervical cancer who had undergone radical hysterectomy and pelvic lymphadenectomy. Results: Tumor spread beyond the uterine cervix was evident in 45 (47%) patients. Thirteen (13%) of the 96 patients had parametrial tumor spread, 12 (13%) had vaginal tumor extension, and 23 (24%) had uterine corpus involvement. Tumor size >2 cm, stromal invasion to a depth of ≥8 mm, and lymph vascular space invasion (LVSI) were significantly associated with extracervical invasion. Twenty-five patients had stromal invasion of <8 mm and no LVSI, of which only 1 (4%) had extracervical involvement. On the contrary, extracervical involvement was evident in 44 patients (63%) among those who had stromal invasion of ≥8 mm and/or LVSI (p < 0.001). Among women with LVSI, extracervical tumor spread was seen with any tumor size and any depth of stromal invasion. All patients with stromal invasion to a depth of >15 mm had extracervical invasion. Conclusion: Patients with tumor size <2 cm, depth of invasion of <8 mm and no LVSI could be considered for less radical surgery.