2016, Vol 14, No 3
Endometriosis-associated ovarian carcinoma site in particular structures of the abdominal cavity and the pelvis
Curr Gynecol Oncol 2016, 14 (3), p. 139–144
DOI: 10.15557/CGO.2016.0016

Aim: The aim of the study was to determine the frequency of the malignant endometrioma transformation in the structures of the abdominal cavity organs and the pelvis. Material and methods: Making use of the hospital database, we have analyzed histopathological results of patients with ovarian carcinoma operated on between 2004 and 2012 at the Oncology Center in Bydgoszcz. In the case of 69 patients meeting the Sampson criteria, endometriosis and ovarian carcinoma were confirmed in one tissue sample. Following a thorough analysis of operation reports and histopathological results, we have observed the presence of carcinoma texture and endometriosis in: the adnexa, rectovaginal septum, sigmoid colon and the rectum, abdominal integuments, urinary bladder. Results: Endometriosis related to the texture of the carcinoma was present in the adnexa of 30 patients (44.7%), in the rectovaginal septum – in 25 (37.3%), in abdominal integuments – in 7 (10.4%), in the sigmoid colon or rectum – in 3 (4.5%) and within the urinary bladder – in 2 (3%); in the case of 2 patients, endometriosis was focused in several sites. Summary: Differences between patients with ovarian carcinomas, either associated with endometriosis or not – concerning the degree of clinical advancement, histopathological type and prognosis – induce one to search for new methods and new schemes of known therapies.

Keywords: endometriosis, ovarian carcinoma, FIGO
Key problems in the treatment of endometrial cancer in the light of ESMO-ESGO-ESTRO Consensus of December 2015
Curr Gynecol Oncol 2016, 14 (3), p. 145–155
DOI: 10.15557/CGO.2016.0017

In December 2015, representatives of the European Society for Medical Oncology (ESMO), the European Society of Gynaecological Oncology (ESGO) and the European Society for Radiotherapy and Oncology (ESTRO) gathered to achieve a consensus on the current diagnostic methods as well as surgical and adjuvant treatment in endometrial cancer. During the conference, a multipage document identifying the key diagnostic and therapeutic problems, containing current findings together with the level of their scientific credibility was developed, followed by presenting expert consensus achieved by voting as well as a summary of evidence supporting each recommendation. The aim of the paper was to summarize the current ESMO, ESGO and ESTRO expert guidelines for a Polish reader in the absence of national recommendations on the diagnosis and treatment of endometrial cancer. The minimum (essential) preoperative management involves: clinical examination, including inguinal examination, speculum examination, bimanual examination, rectal examination, abdominal and transvaginal ultrasound, and, if indicated, transrectal ultrasound as well as risk assessment for Lynch syndrome if no ovariectomy is planned in FIGO stage I patients under the age of 45. A simple hysterectomy with the removal of the adnexa is the primary surgical protocol. Systematic lymphadenectomy involving pelvic and para-aortic lymph nodes should be performed in all patients (regardless of the histopathological type) with apparent FIGO stage IIIA, IIIB and FIGO stage II as well as in non-endometrioid apparent FIGO stage I cancers. In FIGO stage I endometrioid cancer, depending on the histopathological grade and the invasiveness, which is measured by myometrial invasion (MI), patients should be stratified into three preoperative risk groups: low risk – G1/G2 and MI < 50%, where systematic lymphadenectomy is not needed; intermediate risk – G1/G2, MI > 50% or G3, MI < 50%, where lymphadenectomy can be considered; high risk – G3 and MI > 50%, where lymphadenectomy is obligatory. The excision of the greater omentum should be performed only in serous cancer and carcinosarcoma. Stratification of patients for adjuvant treatment is based on pathological features, such as grading, MI, FIGO, lymphovascular space invasion. There is an urgent need to adapt the ESMO-ESGO-ESTRO consensus to Polish conditions as well as to develop national recommendations for the diagnosis and treatment of endometrial cancer.

Keywords: endometrial cancer, recommendations, surgical treatment, adjuvant treatment, radiation therapy
Salinomycin – a breakthrough in the treatment of ovarian cancer?
Curr Gynecol Oncol 2016, 14 (3), p. 156–161
DOI: 10.15557/CGO.2016.0018

It is believed that cancer stem cells are the primary cause of cancer chemotherapy resistance, metastasis and relapse. The cancer stem cells form a small population of cells present in the tumor (accounting for less than 2% of the tumor mass) and have properties which enable them to survive chemo- and radiotherapy. These cells have the ability to self-renew, do not undergo apoptosis, display overexpression of the ALDH1A1 enzyme and ABC genes which encode transport proteins, and furthermore make use of various signaling pathways (Wnt, Notch, Hedgehog). Cancer stem cells may be identified and isolated from the tumor based on the characteristic biomarkers (CD44+, CD133+, CD117+, BMi1, Oct-4, nestin). It has been demonstrated that salinomycin, an antibiotic obtained from Streptomyces albus, eliminates cancer stem cells, which are resistant to treatment with cytostatics. Salinomycin causes apoptosis of these cells through a number of mechanisms, including the disruption of the Na+/K+ ion balance in biological membranes, inhibition of the Wnt pathway and resistance to transporters, increase in the activity of caspases, activation of the MAPKp38 pathway and inhibition of the nuclear transcription factor NF-κB. Salinomycin has an effect on many types of cancer. It may turn out to be a breakthrough in the therapy of chemotherapy-resistant cancers.

Keywords: cancer stem cells, ovarian cancer, salinomycin
Epidermal growth factor-like domain-containing protein 7 (Egfl7) as a new potential target for therapy in gynecologic oncology
Curr Gynecol Oncol 2016, 14 (3), p. 162–167
DOI: 10.15557/CGO.2016.0019

Epidermal growth factor-like domain-containing protein 7 (Egfl7) is a secretive gene-encoded protein expressed in endothelial cells of blood vessels, where it plays an essential role in regulating angiogenesis both in physiologic conditions as well as pathologic processes. Egfl7 has also been confirmed to be present in the cells of the central nervous system and several malignant tumors. In vitro studies have shown Egfl7 expression in breast and lung cancer in mice to downregulate endothelial expression of intercellular adhesion molecules (ICAM-1) and vascular cell adhesion molecules (VCAM-1), thus preventing lymphocytes from penetrating blood vessels and migrating to tumor nests. It has been suggested that cancer-associated Egfl7 may promote the escape of cancer from the immune system’s control by suppressing activation of endothelial cells and inhibiting diapedesis (leukocyte extravasation). Egfl7 expression in gynecologic cancers has not yet been investigated. The aim of this study is to present and discuss the current state of knowledge as regards this biomarker’s role in oncology, with particular emphasis on its therapeutic potential. Future research into Egfl7 expression in gynecologic cancers may facilitate development of new anti-angiogenic and/or biological therapies.

Keywords: Egfl7, cancer, angiogenesis, immunotherapy, diapedesis
Primary ovarian carcinoid tumor arising within a mature cystic teratoma
Curr Gynecol Oncol 2016, 14 (3), p. 168–173
DOI: 10.15557/CGO.2016.0020

Primary carcinoid tumor of the ovary in association with a mature cystic teratoma is very rare. Preoperative diagnosis of this tumor is difficult, particularly in the absence of symptoms of carcinoid syndrome. Here, we report a case of a premenopausal woman who underwent operative treatment due to an ovarian mass. The ovary was cystic with a solid mural nodule. Microscopically, the cyst wall revealed features of mature teratoma while the nodule showed features of a low-grade insular carcinoid. Synaptophysin and CD56 were positive. Ki67 index was low. No evidence of primary gastrointestinal or respiratory malignancy was found. The histologic and immunohistochemical characteristics of this tumor, its intimate association with a mature cystic teratoma and the absence of primary malignancy elsewhere were compatible with the diagnosis of a primary ovarian insular carcinoid tumor. This case is reported to raise the awareness of a rare tumor entity among the pathology and gynecologic communities.

Keywords: ovary, mature cystic teratoma, primary carcinoid
Incidentally diagnosed epithelioid trophoblastic tumor immediately after delivery: a case report
Curr Gynecol Oncol 2016, 14 (3), p. 174–177
DOI: 10.15557/CGO.2016.0021

Epithelioid trophoblastic tumor is a rare malignant lesion of gestational trophoblastic disease, and constitutes an abnormal proliferation of placental trophoblasts. Patients with epithelioid trophoblastic tumor are usually of reproductive age, and have had previous gestations including full-term deliveries, molar pregnancies and abortions. The interval between antecedent gestational events and the diagnosis of epithelioid trophoblastic tumor usually ranges from 0 to 264 months (mean, 84 months). Herein, we report a 42-year-old Korean woman (gravida 2, para 2). At 38 weeks of gestation, she underwent a repeat cesarean section and then hysterectomy due to uterine atony. She was incidentally diagnosed with epithelioid trophoblastic tumor, and postoperatively no metastatic disease was observed. The patient presented no clinical evidence of tumor recurrence for 5 years after surgery. This case is remarkable because epithelioid trophoblastic tumor is a rare disease, and the diagnosis of epithelioid trophoblastic tumor followed immediately after delivery.

Keywords: epithelioid trophoblastic tumor, gestational trophoblastic disease, rare tumor, uterine neoplasm
Bowel or ovarian cancer? Ambiguous diagnosis and non-standard treatment with good outcomes. A case report
Curr Gynecol Oncol 2016, 14 (3), p. 178–182
DOI: 10.15557/CGO.2016.0022

The treatment of patients with cancer has recently become more complex and challenging for oncologists. The paper presents a case of a 54-year-old woman treated due to small bowel adenocarcinoma, who underwent primary surgical procedure and adjuvant therapy, and who developed intra-abdominal cancer dissemination. Initially, XELOX regimen was administered, followed by multiorgan resection performed by an interdisciplinary team of gynecologists and surgeons as well as hyperthermic intraperitoneal chemotherapy (HIPEC). The therapy was complicated by impaired wound healing and an enterocutaneous fistula. Currently, the patient is under a follow-up and shows no evidence of recurrence. The wounds after the surgery and fistulas are healed, normal gastrointestinal function is preserved.

Keywords: HIPEC, interdisciplinary therapy, ovarian cancer, small bowel cancer
Intensive anticancer therapy in elderly patients – does it make sense? A case report
Curr Gynecol Oncol 2016, 14 (3), p. 183–187
DOI: 10.15557/CGO.2016.0023

Anticancer therapy in elderly patients poses a great challenge for doctors since not all available therapeutic modalities can improve the wellbeing, alleviate symptoms or improve prognosis in this patient population. The paper presents a case of a 75-year-old woman diagnosed with advanced ovarian cancer who, despite advanced age, received intensive anticancer therapy, i.e. surgical treatment (modified posterior exenteration with the resection of pelvic peritoneum and tumor invasion in the diaphragmatic peritoneum along with its fragment, subtotal colectomy, resection of the omentum, spleen and gastric fragment along with the gastro-transverse ligament and an end ileostomy) as well as adjuvant chemotherapy. Severe complications occurring during treatment were not directly related to the therapy, but resulted from the lack of proper patient care in a home setting.

Keywords: elderly patient, ovarian cancer, anticancer therapy, geriatric oncology