2019, Vol 17, No 2
Diagnostic utility of p16INK4a and Ki-67 immunohistochemistry in cervical biopsy specimens in women with ASCUS cytology
Curr Gynecol Oncol 2019, 17 (2), p. 55–60
DOI: 10.15557/CGO.2019.0006

Objectives: The aim of the study was to evaluate the usefulness of p16 and Ki-67 immunohistochemistry in women diagnosed with ASCUS in follow-up colposcopy with histology. The relationship between the accuracy of p16, Ki-67 and HR HPV DNA testing as biomarkers of cervical intraepithelial neoplasia was evaluated. Material and methods: 272 women with cytological diagnosis of ASCUS underwent colposcopy and cervical biopsy. Sections were processed for immunohistochemistry with mouse anti-human p16 and anti-Ki-67 monoclonal antibodies. The HPV test was performed in these patients without knowledge of cytology results. Results: Histopathology revealed 143 patients diagnosed with CIN1, 24 as CIN2 and 34 as CIN3. The HR HPV test was positive in 127 cases (70 CIN1, 24 CIN2 and 33 CIN3 patients). p16 positivity was present in 68 cases of CIN1 and HR HPV positive, in 24 CIN2 and HR HPV positive and in 33 of CIN3 HR HPV positive patients. Ki-67 positivity was present in 69 CIN1, 24 CIN2 and 34 CIN3 cases. The sensitivity of the HR HPV test, colposcopy, p16 and Ki-67 was high. The highest specificity was reported for the HR HPV test. Conclusions: Our data show that a combined use of p16INK4a and Ki-67 helps to distinguish true dysplastic transformation from its benign mimics and determine the severity of dysplasia in doubtful cases. The use of both biomarkers may result in better management of women with ASCUS cytology followed by histopathology.

Keywords: cervical intraepithelial neoplasia, ASCUS, p16INK4a, Ki-67, HR HPV
New approach to uterine fibroid morcellation with a focus on the risk of dissemination of previously undiagnosed uterine sarcoma
Curr Gynecol Oncol 2019, 17 (2), p. 61–68
DOI: 10.15557/CGO.2019.0007

Uterine fibroids are the most common benign tumors of the female genital tract. They occur in about 70% of the female population including about 25% of women of reproductive age, with 15–30% requiring treatment. In contrast, uterine sarcomas in the European population account for only 3–7% of all malignant tumors located in the uterus, so they are relatively rare. The risk of dissemination of previously undiagnosed uterine sarcoma during laparoscopic treatment of uterine fibroids using a morcellator has been estimated by the U.S. Food and Drug Administration at 0.28%. Multifaceted activities aimed at reducing the level of risk include, among others, the development of appropriate standards, so that patients in risk groups are accurately identified as well as technological improvements in surgical techniques. Diagnostic tools enabling appropriate patient selection for tailored treatment also comprise ultrasonography and magnetic resonance imaging. Advances in medical technology have led to the development of the technique of “contained morcellation” which involves fragmentation of the tissue specimen into smaller pieces under visual control and its extraction without any contact with tissues in the abdominal cavity. In addition to multiple advantages, the method also has certain limitations and drawbacks. Despite that, morcellation containment bags have become a widely used element of surgical kits. Regularly updated guidelines and technological advancements in operating room equipment give hope for a gradual reduction of the risk of adverse events associated with the surgical treatment of the most prevalent benign tumor of the female genital tract.

Keywords: laparoscopy, morcellation, fibroids, sarcomas
Etiology and risk factors of pelvic organ prolapse and urinary incontinence
Curr Gynecol Oncol 2019, 17 (2), p. 69–77
DOI: 10.15557/CGO.2019.0008

Due to the increased health awareness of women and their desire to maintain appropriate life quality, pelvic organ prolapse and urinary incontinence are the most common reasons for reporting to a gynecologist or a urologist. Problems associated with this pathology have been the subject of research for more than two decades. Pelvic organ prolapse and urinary incontinence often coexist and, contrary to previous beliefs, they require specialist diagnostic and therapeutic approaches. Proper diagnostic and therapeutic process requires knowledge and understanding of these conditions as well as the associated anatomical and functional anomalies. A revision surgery is needed in about 33% of patients receiving surgical treatment due to pelvic organ prolapse, which may indicate that the primary treatment failed to identify and manage all defects. Precise location of pelvic floor damage and knowledge on its risk factors may reduce the rates of revision surgeries. Considering the ageing of the population, this is undoubtedly of great importance as the number of women presenting with these conditions will continue to grow, which will translate into reduced quality of life.

Keywords: pelvic organ prolapse, urinary incontinence, pelvic floor
Systemic inflammatory response in gynecologic cancers
Curr Gynecol Oncol 2019, 17 (2), p. 78–82
DOI: 10.15557/CGO.2019.0009

The role of inflammatory response in carcinogenesis is the subject of numerous studies. A concept of systemic inflammatory response was developed to identify the relationship between increased inflammatory response and the course of cancer and prognosis. Inflammatory markers are used to estimate progression-free survival in e.g. colon cancer. Some inflammatory markers are also useful in estimating total survival in patients with esophageal, liver, gastric or pancreatic cancer. In this paper, we evaluated the current state of knowledge on the role of inflammatory markers in estimating prognosis in patients with endometrial, ovarian and cervical cancer. The markers used include the neutrophil-to-lymphocyte ratio (NLR), Glasgow Prognostic Score (GPS), Modified GPS (mGPS), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR). There are ongoing studies investigating the role of neutrophils in increasing the production of vascular endothelial growth factor (VEGF) – one of the key mediators of neoangiogenesis in tumors. Well-known inflammatory markers, such as C-reactive protein (CRP), elevated levels of which may indicate shorter survival in ovarian carcinoma, are also useful. There is preliminary evidence supporting the relationship between increased inflammatory response and prognosis in gynecologic cancers. However, prospective studies in larger patient populations are needed to introduce inflammatory markers into everyday clinical practice.

Keywords: ovarian cancer, cervical cancer, endometrial cancer, inflammation
The risk of endometriosis-associated malignant transformation in a scar after cesarean section: a case report and a review of literature
Curr Gynecol Oncol 2019, 17 (2), p. 83–88
DOI: 10.15557/CGO.2019.0010

Malignant transformation of endometriosis in the abdominal wall is very rare. Only 50 cases have been described in literature so far. We present a case of a 45-year-old woman with endometrioid cancer, which arose from focal endometriosis in a surgical scar after cesarean section. The time elapsed between cesarean section and the diagnosis of cancer was 22 years. The patient reported to the Clinic of Gynecologic Oncology of the University Hospital in Krakow with a 15-cm abdominal wall tumor located in the region of cesarean section scar. Imaging modalities (abdominal and pelvic computed tomography and ultrasound) showed a solid tumor in the abdominal wall with invasion to abdominal muscles as well as inguinal and external iliac lymph node involvement. Due to the stage of the disease, the patient was put on neoadjuvant chemotherapy. In the light of increasing rates of cesarean section, an increased risk of malignant transformation of endometriosis in the abdominal wall should be considered.

Keywords: endometriosis in the scar after cesarean section, malignant transformation, endometrioid cancer