2017, Vol 15, No 2
Angiogenic cytokines VEGF, TGF-β1, IL-8 and TNF secretion by human ovarian cancer cells
Curr Gynecol Oncol 2017, 15 (2), p. 99–104
DOI: 10.15557/CGO.2017.0009

Objectives: Angiogenesis is a process that is indispensable in cancer progression. A complex network of tumor and microenvironment stimuli regulate angiogenesis. VEGF, TGF-β1, IL-8 and TNF belong to the angiogenic factors that are key points in vessel formation. The aim of the study was to assess h-VEGF, TGF-β1, IL-8 and TNF secretion by human ovarian cell lines. Material and methods: OVA 2, OVA 4, OVA 9, OVA 11 and OVA 14 cell lines were established in our laboratory. The cells derived from primary and metastatic tumors of epithelial and non-epithelial origin. SK-OV-3, MDAH 2774, CAOV-1 and OVP-10 were the cell lines obtained from other sources. The concentration of VEGF, TGF-β1 and IL-8 was determined in culture supernatants by using the ELISA tests. Results: OVA 11 secreted all the evaluated cytokines. MDAH 2774 was the source of h-VEGF, TGF-β1, IL-8. SK-OV-3 secreted h-VEGF and IL-8. OVA 4 secreted TGF-β1 and TNF. TNF was the only studied cytokine secreted by CAOV-1, OVA 2 and OVA 9 cell lines. OVA 14 did not secret any of the cytokines. Conclusions: The investigated cell lines present heterogeneous profile of angiogenic cytokine secretion and seem to be an interesting set of models for the study of angiogenic signaling, or target therapy.

Keywords: VEGF, TGF-β, IL-8, TNF, ovarian cancer, cell line
Analysis of pre- and postoperative pathological findings in endometrial cancer
Curr Gynecol Oncol 2017, 15 (2), p. 105–112
DOI: 10.15557/CGO.2017.0010

Objective: The study was conducted to compare pre- and postoperative histopathological findings in women with endometrial cancer as well as to evaluate the diagnostic value of dilatation and curettage procedure in patients with endometrial pathology. Material and method: We evaluated histopathological findings of patients diagnosed with endometrial cancer during postoperative histopathological examination. All patients were treated in the Clinical Department of Gynecologic Oncology, Nicolaus Copernicus Memorial Specialist Hospital in Łódź between 2010 and 2015. A comparison of postoperative and preoperative findings based on specimens obtained by dilatation and curettage was performed. The vast majority of preoperative diagnoses and pathological assessments were performed outside the Clinical Department of Gynecologic Oncology in Łódź. A total of 115 patients were included in the study. Results: In the analyzed group, the type of cancer in preoperative examination matched the postoperative diagnosis in 86.96%. The compatibility of grading (assessed for endometrioid endometrial cancer) reached only 53.9%. Endometrioid endometrial cancer was the most common cancer in the examined set of curettage specimens. Histopathological compliance was 30.3% for G1 endometrioid endometrial cancer, 73.1% for G2 endometrioid cancer and 37.5% for G3 endometrioid cancer. Preoperative grading was overestimated in 10.75% and underestimated in 30.11% of cases. A shift from G1 to G2 was most commonly reported. Conclusions: Preoperative consultation with pathologists with extensive oncology experience before making medical decisions as well as treatment and postoperative assessment in medical centers experienced in gynecologic oncology seem to be crucial in predicting outcomes in this group of patients.

Keywords: endometrial cancer, dilatation and curettage, histopathology, compliance
Facts about ovarian cancer in Maysanian women
Curr Gynecol Oncol 2017, 15 (2), p. 113–119
DOI: 10.15557/CGO.2017.0011

Background: Ovarian cancer is one of the commonest gynecologic malignancy. It is the most common cause of death due to gynecologic tumors, and accounts for 50% of deaths due to all gynecologic cancer types. Objectives: The aim was to discuss and assess ovarian cancer in Misan province and to underline its impact for increased awareness and interest in screening and early diagnosis by the determination of the prevalence rates among Maysanian women. Methods: The study lasted six months. During this period, we obtained a lot of data from records of the Al-Shifaa Oncology Center in Misan province, Iraq. Between September 2016 and February 2017, 50 cases of ovarian cancer from 282 gynecologic cancers were recorded. Complete history was obtained for every case. Results: The study showed that ovarian cancer constituted 17.73% of all types of cancer. It usually occurred in patients aged 60–70 years (30%). Women lived in urban areas 1.5 times more frequently than in rural areas. The most common histopathological type of ovarian cancer was ovarian serous carcinoma (46%). The most common stages were stage III and IV, accounting for 76%. Conclusion: Ovarian cancer is the third most common gynecologic cancer type. It was more common in women aged 60–70 years. Regarding the family history, the results were insignificant. The most common histopathological type of ovarian cancer in this study was ovarian serous carcinoma. The most common stages of the disease were advanced stages III and IV.

Keywords: gynecologic malignancy, ovarian cancer, Misan province, serous carcinoma
Diagnosis and treatment of breast cancer in pregnancy
Curr Gynecol Oncol 2017, 15 (2), p. 120–128
DOI: 10.15557/CGO.2017.0012

Pregnancy-associated breast cancer accounts for 10–20% of all breast cancers in women under the age of 30 years. The diagnosis and treatment of this type of cancer require an assessment of the risk of different management methods for the embryo or fetus. Computed tomography and positron emission tomography are absolutely contraindicated in pregnancy. Surgical management, i.e. radical mastectomy, which may be performed at any stage of pregnancy, or breast conserving treatment, which is recommended only in the third trimester, is standard treatment. Doxorubicin/anthracycline-based chemotherapy is considered relatively safe in the second and the third trimester. Hormonal treatment, trastuzumab and bisphosphonates are contraindicated. Special restrictions have been introduced for radiation therapy. The consequences of intrauterine exposure to radiation depend on the stage of pregnancy, radiation dose and dose rate. Preimplantation radiation can cause death of the embryo or radiation-induced carcinogenesis. There is a risk of delayed fetal growth and organ malformations in the period of organogenesis. Exposure to radiation between 8 and 25 weeks gestation is associated with the risk of intellectual disability, microcephaly and carcinogenesis. Exposure after 25 weeks gestation is associated only with the risk of carcinogenesis. It was estimated that targeting the chest with therapeutic radiation doses during pregnancy causes unacceptable fetal exposure to radiation. Electron beam intraoperative irradiation of the breast tumor bed is the only acceptable radiation method in the first and the second trimester. The decision on initiation and continuation of cancer therapy in a pregnant patient should be based on a detailed analysis of potential benefits and risks as well as patient’s will.

Keywords: pregnancy, radiation therapy, breast cancer, radiation, guidelines
Repeated radiotherapy in a patient with a vaginal recurrence – a case report
Curr Gynecol Oncol 2017, 15 (2), p. 129–141
DOI: 10.15557/CGO.2017.0013

A recurrent disease may assume the form of a local relapse within the area of the removed tumor (or in the uterus after radiotherapy) or in the neighborhood through extension of the neoplastic process or metastasis. Recurrences are asymptomatic in approximately 30% of patients and diagnosed during a routine check-up. In 35–40% of patients, vaginal bleeding is the first symptom, whereas 16% of women complain about pelvic pain. It must be remembered that urinary disorders may also be the first manifestation of a local recurrence. Until recently, patients with recurrences in a previously irradiated site were not candidates for a repeated radiotherapy mainly because of organs at risk, and more precisely – because of the dose deposited in these organs during the primary treatment. Currently, the dynamic development of new planning and treatment techniques using external-beam radiation makes it possible to consider re-irradiation in selected cases. However, planning and conducting such a treatment is difficult and time-consuming. It requires highly specialized radiotherapy techniques and an individual approach. This article presents a patient with a disease recurrence in the vaginal stump after comprehensive treatment and discusses elements that need to be taken into consideration for repeated radiotherapy to be planned and conducted.

Keywords: recurrence, repeated radiotherapy, planning, vagina
In postmenopausal women, some uterine leiomyosarcomas mimic a cystic degeneration of uterine myoma: two case reports and a literature review
Curr Gynecol Oncol 2017, 15 (2), p. 142–145
DOI: 10.15557/CGO.2017.0014

Uterine leiomyosarcoma is an uncommon malignancy accounting for approximately 1% of gynecologic oncology cases. Most uterine leiomyosarcomas occur in menopausal women and they are notorious for their aggressive character, early dissemination, and poor prognosis. It is difficult to accurately differentiate uterine leiomyosarcoma from leiomyomas, especially when leiomyomas undergo degenerative changes. We treated two menopausal women with a uterine mass showing cystic change. Clinical work-up included needle aspiration, sonography, computed tomography, and serum tumor markers to differentiate uterine leiomyosarcoma from leiomyoma. All results were negative for malignancy, but uterine leiomyosarcoma was ultimately diagnosed by pathological examination. Until an accurate preoperative diagnostic method is available, menopausal women diagnosed with a degenerating cystic uterine fibroid should be considered to have a malignancy intraoperatively in order to prevent tumor cells from intraperitoneal spreading.

Keywords: degenerating cystic uterine leiomyoma, uterine leiomyosarcoma, uterine malignancies
Gestational trophoblastic neoplasia after miscarriage with dilatation and curettage with normal histological findings
Curr Gynecol Oncol 2017, 15 (2), p. 146–148
DOI: 10.15557/CGO.2017.0015

Gestational trophoblastic neoplasia may develop after a molar, term, ectopic pregnancy, or an abortion. The diagnosis of gestational trophoblastic neoplasia can be made solely based on changes in human chorionic gonadotropin levels without pathologic confirmation. It is important to distinguish molar pregnancy from that disease, as treatment for these entities differs. However, gestational trophoblastic neoplasia developing after a term or ectopic pregnancy, or an abortion may be difficult to diagnose, because there is no tissue confirmation. In such cases, the time between a previous pregnancy event and the current event, and an inconsistency between very high levels of human chorionic gonadotropin and the size of lesions in the uterine cavity may be warning signs of gestational trophoblastic neoplasia. The role of curettage in the treatment of the disease is limited. We present a case of gestational trophoblastic neoplasia that developed after an abortion, serving as a reminder illustration that gestational trophoblastic neoplasia can develop not only after molar pregnancies, but also after other pregnancy events.

Keywords: molar pregnancy, gestational trophoblastic neoplasia, abortion, curettage