A cotyledonoid dissecting leiomyoma is categorized as a leiomyoma with an unusual growth pattern, which is characterized by remarkable extrauterine bulbous growth in continuity with a dissecting myometrial component. A 36-year-old patient was preoperatively diagnosed with a mature cystic teratoma of the left ovary, and according to MRI, the tumor protruded from the uterus into the right broad ligament and was 10 cm in diameter. She underwent laparoscopic surgery to resect ovarian teratoma and the tumor under the right broad ligament. The tumor was almost completely resected and diagnosed as a cotyledonoid dissecting leiomyoma based on intraoperative and pathological findings. Recurrence was not seen for 26 months postoperatively in our case. Gross specimens are often mistaken for malignant lesions, but this was a benign disease. Even if some remnants of the leiomyoma remained postoperatively, recurrence has never been reported. When a cotyledonoid dissecting leiomyoma is resected laparoscopically, intrapelvic structures around it, such as the ureter, uterine artery, bladder, rectum and external iliac vessels, must be given careful attention.
ObjectiveWe conducted a retrospective study to evaluate the correlation between pre-operative and post-operative histological diagnoses on endometrial cancer, and to describe the treatments and outcomes when post-operative diagnoses are downgraded from pre-operative histology.MethodsPatients who underwent surgery for endometrial cancer in our facility between 2010 and 2013 were enrolled in the study. The definition of downgrade discordance is in accordance with the following criteria: 1) the pre-operative and post-operative histological diagnoses were both endometrioid and the final pathology was a lower grade than the pre-operative pathology and 2) the pre-operative diagnosis was not endometrioid, whereas the post-operative diagnosis was endometrioid grade 2 or less.ResultsA total of 250 patients were enrolled, and the concordance rates were 56% for endometrioid adenocarcinoma grade 1 (EMG1), 67% for EMG2, 67% for EMG3, 82% for carcinosarcoma, 71% for serous carcinoma, and 67% for clear cell carcinoma. Eighteen cases (6.6%) were identified as downgrade discordancy. Of the 18 patients, the triage for adjuvant therapy remained the same for 15 cases (83%), all of whom had no evidence of disease at their last visit. Three cases had discordances with respect to triage for adjuvant therapy; the therapies were triaged based on post-operative diagnosis. Of these patients one had a recurrence.ConclusionsGood correlation was observed between pre-operative and final histological diagnoses of endometrioid carcinoma (56%–67%) and type 2 carcinoma (67%–82%). Approximately 7% (18/250) of patients had downgrade discordancy; however, triage for adjuvant therapy did not change for approximately 80% (15/18) of the patients with downgrade discordancy. Further studies are needed to evaluate the effectiveness of triages that are based on post-operative diagnoses.
e17064 Background: We assessed the efficacy and safety of a combination chemotherapy comprising gemcitabine and bevacizumab for the treatment of platinum-resistant recurrent ovarian cancer. Here we report the results of the interim analysis. Methods: Eligible patients showed recurrent, measurable tumors that had progressed within 6 months after the completion of platinum-based chemotherapy. Patients received gemcitabine (1000 mg/m2) on days 1and 8 and bevacizumab (15 mg/kg) on day1 every 3 weeks until disease progression or unacceptable toxicity levels were observed. The primary end point was the proportion of patients who completed three cycles of scheduled chemotherapy. Results: Twelve patients were enrolled in this study and three patients are still undergoing chemotherapy. The proportion of patients who completed three cycles of chemotherapy was 77.8 % (7/9), and response rate was 66.7 % (6/9). Grade ≥ 3 neutropenia, thrombocytopenia, and hypertension were observed in five, one, and one patients, respectively. There was no GI perforation or death in our study. Conclusions: Combination chemotherapy of comprising gemcitabine and bevacizumab was safe and effective in patients with platinum-resistant recurrent ovarian cancer. Therefore, it is important to continue this study. Clinical trial information: 000016619.
Objective: The objective of this study was to evaluate the results of laparoscopic surgery for endometrial cancer covered by statutory health insurance-based care in our hospital. Methods:The patients who received a diagnosis of stageⅠA endometrial cancer on preoperative pathological, magnetic resonance imaging, and computed tomographic examinations were treated with laparoscopic total hysterectomy and bilateral salpingo-oophorectomy. In some cases, additional pelvic lymphadenectomy and para-aortic lymph node biopsy were performed. After surgery, we evaluated patient age, operative time, blood loss, number of extirpated lymph nodes, pathological diagnosis, and surgery-related complications.Results: This procedure was performed in 19 patients. The mean age was 56.5 ± 10.6 years; mean operative time, 309 ± 98 minutes; mean number of extirpated pelvic lymph nodes, 39.6±12.3; and mean blood loss, 250.3 ± 227.8 g. When reviewing 16 patients, excluding those with marked adhesion or large uterine myomas, the mean duration of total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy was 274 ± 76 minutes. The mean blood loss was 151.1 ± 185.8 g. The mean number of extirpated lymph nodes was 33.5 ± 7.7. To date, no surgery-related complications or relapses have been reported. Postoperative chemotherapy was performed for 7 patients (33%), and postoperative radiotherapy for 1 (6%). No adjuvant therapy was performed in the other 11 patients.Conclusions: Laparoscopic surgery for early endometrial cancer is minimally invasive and postoperative recovery is short. It will be one of the standard treatments in the near future. Therefore, long-term prognosis should be analyzed among the different operative procedures in order to effectively introduce insurance coverage of such new medical technology.
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