Tanja Pejovic

Laparoscopic management of adnexal masses the opportunities and the risks.

Suspected ovarian neoplasm is a common clinical problem affecting women of all ages. Although the majority of adnexal masses are benign, the primary goal of diagnostic evaluation is the exclusion of malignancy. It has been estimated that approximately 5–10% of women in the United States will undergo a surgical procedure for a suspected ovarian neoplasm during their lifetime. Despite the magnitude of the problem, there is still considerable disagreement regarding the optimal surgical management of these lesions. Traditional management has relied on laparotomy to avoid undertreatment of a potentially malignant process. Advances in detection, diagnosis, and minimally invasive surgical techniques make it necessary now to review this practice in an effort to avoid unnecessary morbidity among patients. Here, we review the literature on the laparosopic approach to the treatment of the adnexal mass without sacrificing the principles of oncologic surgery. We highlight potentials of minimally invasive surgery and address the risks associated with the laparoscopic approach.

Comparative genomic hybridization study of placental site trophoblastic tumour: a report of four cases

Placental site trophoblastic tumour (PSTT) is a neoplastic proliferation of the implantation intermediate trophoblast. Although clinicopathological studies are not uncommon in case reports or small series, molecular and genetic studies are quite limited. Four archived cases of PSTT were successfully analysed by comparative genomic hybridization (CGH) in this study. Regional chromosomal gains were observed in two cases. One case showed chromosomal gains in the regions of 19p13.2, 21q11–21 and 22q12. The second case demonstrated a single regional chromosomal gain involving 21q21. No chromosomal loss is observed. The remaining two cases showed a balanced CGH profile without detectable chromosomal gain or loss. In summary, although chromosomal alterations detectable by CGH are not common, rare chromosomal gains do occur in PSTT. The recurrent chromosomal gain involving chromosomal 21q observed in two of our cases deserves additional studies to ascertain whether it carries any pathobiological significance.

Comparative genomic hybridization of fine needle aspirates from breast carcinomas

Detailed knowledge of chromosomal aberrations in a specific tumor may facilitate the development of individually tailored chemotherapy, hormone or gene therapy. Unfortunately, karyotype analysis requires living cells and is complicated by the low number of good metaphase spreads obtained. Comparative genomic hybridization (CGH), however, is capable of detecting and mapping genome‐wide amplifications and deletions using an equimolar mixture of normal and tumor cell DNA. We show here that even the few cells from a fine needle aspirate of a tumor are sufficient for a direct CGH assay, independent of DNA amplification. Ten primary breast cancers were analyzed by CGH. A fresh frozen fine needle aspirate and a formalin‐fixed and paraffin‐embedded section were used for each tumor. Metaphases from each CGH reaction were imaged, and a sum ratio profile was determined for every chromosome. The ratio profiles of DNA isolated from the 2 material sources were then compared. Fine needle aspirates and the paraffin‐embedded material of a single tumor yielded the same fluorescence ratio profiles, albeit with slightly different confidence intervals. Different tumors showed a variety of aberrations. The most frequently observed changes were 1q+, 8q+, 14q–, 16p+, 16q–, 17p–, 17q+, 19q+, 20q+, 21q– and 22q–. The ability of CGH to assess chromosomal changes in breast cancer from fine needle aspirates could facilitate genetic evaluation of tumors prior to surgery. Int. J. Cancer 88:607–613, 2000.

Cytogenetical diagnosis in paraffin-embedded fetoplacental tissue using comparative genomic hybridization.

Comparative genomic hybridization (CGH) is a FISH‐related technique used to assess global chromosomal aberrations in a variety of human tumours. Recently CGH has been applied to cytogenetic analysis of fresh frozen fetoplacental tissues. Here we report the application of CGH to paraffin‐embedded placental samples. Ten samples from paraffin‐embedded blocks of 6 control placentas and fetoplacental tissue from 10 aneuploidies, and 2 unbalanced aberrations were evaluated. Balanced karyotype profiles were obtained from samples of healthy placentas and all samples from the same placenta appeared to have similar confidence intervals. CGH analysis of four cases of trisomy 21, three cases of trisomy 18, one case of trisomy 13, one case of trisomy 15 and one case of trisomy 7 all showed overrepresentation of the respective trisomic chromosome. The CGH profile was also in accordance with the karyotyping of a case with isochromosome 21. The CGH profile of a case with der (2)t(2;6)(q37.3;q22.2) revealed partial trisomy for chromosome 6 between q21 and q27. CGH may be a useful adjunct in prenatal genetic diagnosis when retrospective diagnosis is needed from archival samples. Copyright

Hematologic Malignancies in Pregnancy

Hematologic malignancies are among the most commonly diagnosed neoplasms that occur during pregnancy.1 Their incidence seems to be independent of pregnancy. Pregnant women with hematologic neoplasms present several diagnostic and therapeutic challenges to the clinician. Their rare occurrence and their nonspecific symptoms often delay the diagnosis. Hematologic malignancies are second only to melanoma in their ability to metastasize to the placenta. The chemotherapeutic agents used to treat hematologic malignancies have teratogenic potential, although human studies have not confirmed this theoretic risk.2

Rare Tumors in Pregnancy

Cancer is among the leading causes of non-accidental death in the United States in women aged 15–35, accounting for 19% of mortality in this age group, and it is the leading cause of death in women age 35–54, accounting for 41% of deaths in this group.1 About 1 in 1000 women will be affected by cancer while pregnant. As the tendency for delaying pregnancy until the late reproductive years continue, more cases of cancer complicating pregnancy are expected.

Genomic Assessment of Ovarian Cancer

Publisher Summary This chapter reviews the genomic assessment of ovarian cancer. The normal human ovary is lined by a cuboidal epithelium. These cells remain quiescent for most of their lifespan, proliferating only to repair the ovarian surface after ovulation. Epidemiologic evidence demonstrates a clear correlation between the frequency of ovulation and the incidence of epithelial ovarian cancer. As a result, particular attention in the search for precursors to ovarian cancer has focused on small inclusion clefts that persist after repair of the ovarian surface. The molecular environment influencing these clefts is unique—the epithelia lining these clefts express specific cell adhesion molecules, including cadherins, not normally observed in other areas of the ovarian surface epithelium. Linkage analysis of familial breast and ovarian cancers provided insights into the molecular basis of ovarian cancer. Improved means to detect and/or eradicate the lesions may prove fruitful for preventing ovarian cancer. Research efforts, designed to improve the early detection of ovarian cancer or optimize its clinical management at later stages, are likely to be more successful based on the understanding of molecular events responsible for this disease. These efforts identify two genes, BRCA1 and BRCA2, each clearly associated with an increased incidence of ovarian cancer. About 60% of familial ovarian cancers are associated with mutations at the BRCA1 locus. The BRCA2 gene plays a role in DNA repair by homologous recombination. About 35% of hereditary ovarian cancers may be attributed to BRCA2 mutations.

CHAPTER 34 – The Laparoscopic Management of Adnexal Masses and Ovarian Cancer

The potential of laparoscopic approach for management of various benign gynecologic problems is well recognized. This chapter highlights the role and risks of laparoscopy in treatment of adnexal masses and ovarian cancer. The laparoscopic approach offers several distinct advantages over laparotomy that includes magnified pelvic and abdominal anatomy allowing precise diagnosis, and improved identification of subtle changes representing metastatic disease. Additional benefits of laparoscopy in gynecologic oncology include: lower morbidity, improved post-operative recovery, and reduced cost. Numerous procedures in gynecologic oncology can be accomplished by endoscopic approach. It is also used in management of benign or suspicious adnexal masses in pre and postmenopausal women, staging of early ovarian cancer, and staging of selected cases of advanced cancer of the ovary. Formal training program within the subspecialty of gynecologic oncology is needed to establish and propagate skills necessary to perform advanced laparoscopic surgery. The competency of a larger number of gynecologic oncologists in operative laparoscopy can thus facilitate organization of large, prospective trials, needed to objectively assess the utility and safety endoscopic procedures.