2011, Vol 9, No 1
A nalysis of B7H4 and HLA-G immunoreactivity within ovarian cancer relapse and its microenvironment according to the preceding applied chemotherapy
CURR. GYNECOL. ONCOL. 2011, 9 (1), p. 9-17
ABSTRACT

Introduction: We decided to examine the immunoreactivity of two antigens, B7H4 and HAL-G, within ovarian cancer cells and the macrophages that infiltrate the ovarian cancer microenvironment. It is well known that these two antigens are responsible for the inhibition of both cytotoxic T lymphocytes and NK cells. It has also been suggested that the response of the patient to applied therapy (surgery and chemotherapy) may be related to the status of the tumor microenvironment. Certainly, both B7H4 and HLA-G have been found in the ovarian cancer nest. Methods: We analyzed the immunoreactivity levels of both B7H4 and HLA-G on ovarian cancer cells with respect to the number of different chemotherapy regiments the patient underwent between the first- and second-line surgeries. Additionally, we detected the immunoreactivity of these two antigens on the macrophages present in the ovarian cancer microenvironment. The immunoreactivity analysis was performed on tissue samples derived from 17 patients. Result: In our study, we observed a statistically significantly higher amount of infiltration of B7H4-positive macrophages into the ovarian cancer relapse microenvironment in those patients who had had more than one type of chemotherapy regiment between surgical procedures compared to those who had had only one. Likewise, the HLA-G immunoreactivity level was higher in the first than in the second group. Conclusion: An immunosuppressive ovarian cancer relapse microenvironment, as indicated by the presence of suppressive macrophages, may be related to the need to supplement the primary chemotherapy.

Keywords: HLA-G, B7H4, ovarian cancer relapse, chemotherapy, macrophages
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Combined treatment of stage I cervical cancer: experience of the Gynecologic Oncology Clinic of the Wroclaw Medical University
CURR. GYNECOL. ONCOL. 2011, 9 (1), p. 18-25
ABSTRACT

Aim of study: Patients affected with high-risk stage I cervical cancer undergo surgical treatment combined with adjuvant radio- or radiochemotherapy. The purpose of the present study was to assess the outcome of FIGO stage IB cervical cancer patients treated at a single center (Gynecologic Oncology Clinic of the Wroclaw Medical University, Poland) compared with worldwide data presented at the 2006 FIGO Annual Report. Patients and methods: Retrospective analysis included in total 61 patients with squamous-cell cervical cancer, treated at our institution since 2003 thru 2005. In this group, 45 patients underwent Wertheim-Meigs procedure, 16 – simple hysterectomy with adnexectomy. Fifty-eight patients received adjuvant external beam radiotherapy and brachytherapy, while 3 – brachytherapy alone. Twenty-seven patients received conventional teleradiotherapy and 31 – conformal radiotherapy. Results: Overall 5-year survival rate in the entire study population was 75.9%. In patients undergoing Wertheim-Meigs procedure and conventional radiotherapy vs. conformal radiotherapy, 5-year survival rates were 72.2% and 75%, respectively. In patients undergoing simple hysterectomy with adnexectomy and conventional vs. conformal radiotherapy, 5-year survival rates were 71.8% and 80%, respectively. Conclusions: To sum up, use of conformal radiotherapy favorably affected treatment outcomes, particularly in patients undergoing simple hysterectomy with adnexectomy. In spite of progress in therapeutic techniques, no significant improvement in patients affected with cervical cancer was obtained, while treatment outcomes in Poland appear significantly worse than those reported in the FIGO report.

Keywords: cervical cancer, combination treatment, 5-year survival rates, radiotherapy, surge
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Antiemetic drugs used during anticancer chemotherapy, with special emphasis on aprepitant
CURR. GYNECOL. ONCOL. 2011, 9 (1), p. 26-37
ABSTRACT

Nausea and vomiting are symptoms occurring in 70% of patients treated for late-stage cancer, exerting a tremendous impact on their quality of life and everyday activity. Severity of nausea and vomiting depends on the following factors: type and dose of cytostatic agent, treatment protocol and way of administration, as well as on the patient’s age, gender and alcohol abuse. Novel antiemetic drugs include EMEND, containing aprepitant as active substance. It acts by blocking neurokinin 1 receptor (NK1). In vivo, NK1 receptor is activated by binding substance P, which results in feeling of nausea and vomiting. EMEND blocks this reaction by preventing binding of substance P to the NK1 receptor. Furthermore, this agent does not show any affinity to serotonin-, dopamine- or corticosteroid-associated receptors. In spite of a noticeable progress in cancer chemotherapy, no worthwhile improvement has been obtained in the treatment of nausea and vomiting – well known adverse effects of cytostatics, considerably compromising the patients’ quality of life. Therefore, in 2009, representatives of two scientific societies – the European Society for Medical Oncology (ESMO) and the Multinational Association of Supportive Care in Cancer (MASCC) – have met in Perugia, Italy, in order to develop a consensus concerning preventive and therapeutic management in this group of patients. This meeting has produced recommendations for prevention and treatment of chemotherapy-associated nausea and vomiting. These guidelines, depending on goal of prevention, are presented in the paper.

Keywords: antiemetic drugs, aprepitant, ovarian cancer, chemotherapy, surgical treatment
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Rare malignant breast tumors
CURR. GYNECOL. ONCOL. 2011, 9 (1), p. 38-46
ABSTRACT

This paper presents a concise discussion of atypical presentations of selected malignant breast tumors, including both tumors of epithelial origin (adenocarcinomas other than ductal carcinoma and lobular carcinoma, which together account for about 10% of malignant breast tumors; this group includes: tubular carcinoma, invasive cribriform carcinoma, “pure” mucinous carcinoma, invasive solid papillary carcinoma, medullary carcinoma, metaplastic carcinoma and Paget cancer), non-epithelial origin (primary sarcoma and primary lymphoma) and mixed tumors (malignant phyllodes tumor – adenomyxoma) and metastases to the breast of tumors originating in other locations (taken together, non-adenomatous tumors account for about 5% of all malignant breast tumors). Summarized are epidemiological data and characteristic features of histological appearance and clinical presentation of selected, rare breast tumors. In total, the so-called atypical forms of breast cancer account for 10-15% of all newly diagnosed cases of malignancies at this location, resulting in 1500-2200 new cases annually in Poland alone. Principles of diagnosis and treatment of these rare entities may be slightly different from those used in typical forms of breast cancer, particularly in the case of non-adenocarcinomatous tumors. Furthermore, the authors emphasize the crucial role of histological verification prior to institution of any treatment in the case of clinical doubt and discordance of data provided by histological and imaging studies and clinical observation (the “triple diagnosis” principle).

Keywords: breast cancer, breast sarcoma, breast lymphoma, epidemiology, treatment
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Imaging diagnosis in germ cell and sex cord-stromal tumors
CURR. GYNECOL. ONCOL. 2011, 9 (1), p. 47-50
ABSTRACT

Clinical diagnosis of ovarian tumors is the more difficult, the earlier is the clinical stage at presentation. On the other hand, while early-stage conditions are much more difficult to detect, early diagnosis is associated with the best outcomes. Rare sex cord-stromal and germ cell tumors present sonographic features similar to other ovarian tumors. Sonographic report should address the following: location, size and echogenicity of ovaries, location of adnexal lesions and their relation to other pelvic structures, precise description of solid elements, septations and papillomatous excrescences within the tumor as well as presence of free fluid within the peritoneal cavity. In suspected malignant tumors, most useful prognostic features include papilliform excrescences, so their location, size and number must be always documented. Furthermore, number and thickness of septations is of great prognostic significance. Description of tumor morphology should include its external and internal walls. Sonographic diagnosis may predict malignancy of lesion based on such features as solid areas, papilliform excrescences, septations or abnormal pattern of tumor vasculature. Due to neoangiogenesis in malignant tumors, study of vasculature and perfusion is also important. A typical finding in a malignant tumor is increased late-diastolic flow velocity, reduced resistance index RI to less than 0.5 and pulsation index to less than 0.8. Frequent is also elevation of peak systolic velocity PSV to over 12 cm/s. In spite of sophisticated and continuously improved imaging techniques in sonography, including “color” and “power” options in angio-Doppler studies as well as introduction of 3D/4D technique, malignant process may at best be suspected. Final diagnosis of malignant tumor is always based on histological studies.

Keywords: germ cell tumors, sex cord-stromal tumors, sonography, tumor morphology, vascular perfusion pattern
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Cancer diagnosis in pregnant women
CURR. GYNECOL. ONCOL. 2010, 9 (1), p. 51-57
ABSTRACT

According to current estimates, about 1 out of 1000 pregnancies is complicated by neoplastic disease. Incidence of cancer during pregnancy shows a growing trend, as women decide to procreate at a later age. Early and reliable diagnosis is crucial in cancer treatment. Several modalities are used to detect a neoplasm. In the setting of pregnancy, diagnostic possibilities are very limited. Pregnancy-associated physiological alterations occurring in female organism may influence some of the tests, therefore their reliable interpretation requires considerable experience on the part of the clinician. Furthermore, so diagnostic techniques can not be applied during initial gestational weeks due to their deleterious impact on the fetus. Also, some tumor markers may be useless. Fetus-safe diagnostic modalities include: cytological smear, colposcopy, sonography, manual palpation, colonoscopy, lab tests, fine needle biopsy, bone marrow biopsy and lumbar puncture. Most of them are routinely used, also in pregnant women. Some techniques are safe, if used cautiously. With adequate preventive measures, they may be considered harmless for both mother and fetus. These include: guided biopsy, conization of cervix, magnetic resonance imaging, mammography and, in selected cases, radiography. Diagnostic modalities contraindicated during pregnancy are mainly radiography, computed tomography, laparoscopy (in some authors’ opinion) and studies involving administration of radioactive isotopes.

Keywords: cancer, pregnancy, diagnosis, therapy, risk factors
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Recurrence of granulosa cell tumor of the ovary 7 years after primary sparing surgery – case report and review of the literature
CURR. GYNECOL. ONCOL. 2010, 9 (1), p. 58-62
ABSTRACT

Granulosa cell tumor of the ovary is a rare gonadal tumor, accounting for 1-5% of all malignant ovarian tumors. It may take two histological forms: mature (95%), occurring mostly in the 5th decade, and juvenile, developing mostly in young women. In most cases, it is diagnosed at FIGO stage I. The tumor is hormonally active, secreting estrogens and/or, rarely, androgens. While being a slow-growing and moderately malignant, even after appropriate therapy, it often recurs several years after first diagnosis. We present a case of granulosa cell tumor of the ovary in a young woman, 7 years after diagnosis and correct, sparing surgical treatment. At laparoscopy, during tumor removal, the lesion has been torn apart, and also tumor tissue was detected in contralateral ovary, spared during primary surgery. Due to invasion of existing ovary and dissemination after tumor rupture at laparoscopy, radical surgery was opted for, with excision of existing adnexae, uterus and subsequent staging. Persistent tumor focus was found within the pelvic peritoneum. The patient was referred for adjuvant treatment by chemotherapy (the BEP protocol). Currently, management of granulosa cell tumor relies in surgery, both sparing (in the case of young women at an early clinical stage), and radical. An important aspect of treatment is adjuvant chemotherapy, rarely – radiotherapy. Recurrence rate is estimated at 10-33% of all cases, both within the pelvis and, even more frequently, out of it. Ten-year survival rate in patients with recurrence is estimated at 57%. A review of pertinent literature is included.

Keywords: granulosa cell tumor of the ovary, surgical treatment, adjuvant chemotherapy, recurrence, review of literature
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