2019, Vol 17, No 4
Perioperative assessment of myometrial invasion in patients with endometrial cancer – comparison of the accuracy of magnetic resonance imaging and intraoperative pathological assessment
Curr Gynecol Oncol 2019, 17 (4), p. 151–157
DOI: 10.15557/CGO.2019.0018

Aim: The aim of this paper was to compare methods for the assessment of myometrial invasion in patients with endometrial cancer. We analyzed concordance between pelvic magnetic resonance imaging and intraoperative assessment of myometrial invasion performed by a pathologist and final histopathology. Materials and methods: We analyzed clinical material from patients with endometrial cancer who underwent primary surgical treatment in the Center of Oncology (Branch in Krakow) between 2012 and 2014. Pelvic magnetic resonance imaging with an assessment of myometrial invasion was performed preoperatively. During the procedure, the resected uterus was examined intraoperatively. We analyzed the concordance between the assessment of myometrial invasion in pelvic magnetic resonance and intraoperative assessment performed by a pathologist and final histopathological examination. Cohen’s kappa coefficient was used in the statistical analysis. Results: We analyzed medical history of 128 patients with endometrial cancer. The sensitivity of preoperative magnetic resonance imaging and intraoperative assessment was 81% and 84.11%, respectively. Cohen’s kappa coefficient was 0.61% and 0.655%, indicating substantial agreement. Both methods are more accurate in predicting <1/2 myometrial invasion. Intraoperative assessment of myometrial invasion showed higher sensitivity, but lower specificity compared to magnetic resonance imaging. Conclusions: Magnetic resonance and intraoperative evaluation by a pathologist show similar accuracy in the assessment of myometrial invasion. Clinical utility of both these methods for early assessment of myometrial invasion speaks in favor of intraoperative examination, which is a less expensive and faster method.

Keywords: endometrial cancer, magnetic resonance, myometrial invasion
Comparison of pre- and postoperative techniques in the assessment of histological tumor grading in patients with endometrial carcinoma: a descriptive cross-sectional study
Curr Gynecol Oncol 2019, 17 (4), p. 158–163
DOI: 10.15557/CGO.2019.0019

Introduction: This study aimed to compare histological grades in patients with endometrial cancer assessed by pre- and postoperative techniques. Methods: We retrospectively reviewed the records of 43 patients operated on for endometrial cancer between 2012 and 2019. The primary dependent variables included histological grade assessed by preoperative probe curettage and postoperative analysis of surgical specimens. The independent variables included age, surgery type (laparoscopy or laparotomy), pre- and postoperative hemoglobin levels, and the length of hospital stay. Results: The mean age was 62.14 ± 9.14 years, and the length of hospitalization time was 6.51 ± 3.46 days. The mean values of pre- and postoperative hemoglobin levels were 12.44 ± 1.51 mg/dL and 10.91 ± 1.28 mg/dL, respectively. According to the grading results of probe curettage, grade 1, 2, and 3 tumors were found in 21 (48.8%), 19 (44.2%), and 3 (7.0%) patients, whereas the paraffin sections revealed grade 1, 2, and 3 in 12 (27.9%), 22 (51.2%), and 9 (20.9%) patients, respectively. There was a fair but statistically significant agreement between the pre- and postoperative grading (kappa = 0.365, p = 0.001). Discussion: This study confirms literature reports that preoperative histological tumor grade fairly predicts final histological results. Caution is warranted when making clinical decisions solely based on probe curettage. Further improvements in preoperative diagnostic techniques in endometrial cancer are needed.

Keywords: endometrial cancer, curettage, diagnostic techniques and procedures
A new prognostic index in patients with hormone receptor-positive and HER2-negative breast cancer
Curr Gynecol Oncol 2019, 17 (4), p. 164–167
DOI: 10.15557/CGO.2019.0020

Aim: Breast cancer is a heterogeneous disease. This study investigated the pretreatment prognostic significance of a new inflammatory index in hormone receptor positive (HR+) and human epidermal growth factor negative (HER2−) breast cancer patients. Methods: We retrospectively analyzed 80 patients diagnosed with HR+ and HER2− breast cancer between January 2014 and December 2018. We calculated prognostic inflammatory index (PII) = mean platelet volume (MPV) × neutrophil/lymphocyte. PII cut off was the best-predicted value by receiver operating characteristic (ROC) curve analysis. We used the Kaplan–Meier method to determine disease-free survival (DFS). We used the log-rank test to compare the DFS rates between the two patient groups. We performed a multivariate analysis by performing Cox regression analysis with prognostic factors defined in univariate analysis. Results: The median follow-up period was 38 (19–66) months. The 5-year survival was 91.3%. The 5-year DFS was 87.9%. The optimal cut-off value of MPV × neutrophil/lymphocyte ratio was determined as 22 by ROC curve analysis [area under the curve, AUC 735, HR % CI (confidence interval) 0.561–0.909, sensitivity 72.7%, specificity 70.4%]. The number of patients with PII ≤22 was 60, and the number of patients with PII >22 was 32. DFS was worse in the high PII group than in the low PII group (p = 0.001). Multivariate analysis revealed PII as an independent prognostic factor (p = 0.016). Discussion: In this study, we detected elevated MPV × neutrophil/lymphocyte ratio as an independent poor prognostic factor in operated HR+ and HER2− breast cancer patients. Prospective studies are needed to determine the prognostic significance of this index.

Keywords: breast cancer, estrogen receptor, progesterone receptor
Malignant ovarian tumors in adolescents: a single center study
Curr Gynecol Oncol 2019, 17 (4), p. 168–172
DOI: 10.15557/CGO.2019.0021

Objectives: To investigate the incidence, clinical manifestations, treatment methods, accuracy of frozen section analyses, histopathological properties, and outcomes of malignant ovarian tumors in adolescents. Materials and methods: Adolescent females <21 years old with malignant ovarian tumors who were treated between January 2000 and December 2016 were reviewed retrospectively. Patient demographics, clinical characteristics, complaints, cancer antigen 125 (CA-125), alpha-fetoprotein (AFP) and stages of malignant ovarian tumors according to the International Federation of Gynecology and Obstetrics, surgical pathological features, treatments and recurrences were evaluated. Results: A total of 964 patients, 22 of which were <21 years of age (2.2%) with primary ovarian tumors, were evaluated. The highest percentage of tumors were germ cell tumors and epithelial tumors (n = 9 and n = 9 both, 45%). Two germ cell tumors and 1 sex cord tumor, but no epithelial tumors, were diagnosed in patients <17 years of age. Eight of 9 epithelial tumors were borderline ovarian tumors, a well-differentiated serous cystadenocarcinoma was detected in 1 patient. The median follow-up period was 103.4 ± 40.06 months. Conclusions: In contrast to previous reports, this study shows no difference in the occurrence of germ cell and epithelial tumors in patients <21 years of age when compared with adult patients. Fertility-sparing surgery with or without chemotherapy had favorable outcomes.

Keywords: ovarian tumors, germ cell tumors, borderline ovarian tumors, adolescent
CD133 cells in endometrial cancer
Curr Gynecol Oncol 2019, 17 (4), p. 173–177
DOI: 10.15557/CGO.2019.0022

Endometrial cancer is one of the most common malignancies in women in Western Europe. Its incidence is constantly increasing. The prognosis is poor, especially in the case of recurrent and advanced stages of the disease. Therefore, new therapeutic options are constantly sought to improve the prognosis for women with this type of cancer. One of the targets of modern diagnostic and therapeutic methods for endometrial cancer may be cancer stem cells. These are cells with the properties of a bone marrow stem cell that has acquired an oncogenic mutation, gained the ability to self-renew, differentiate and generate the entire cancer cell population. Many studies are focused on searching for a marker (or markers) of cancer stem cells that would allow their precise identification and development of individualized targeted therapy. The CD133 glycoprotein, also known as prominin-1, appears to be a promising surface marker for identifying cancer stem cells, including endometrial cancer. The aim of the paper is to present studies on the concept of cancer stem cells in endometrial cancer, especially those related to CD133 cells, which display stem-like properties.

Keywords: endometrial cancer, cancer stem cells, prominin-1, CD133 antigen
Urological aspect of pelvic exenteration for gynecologic oncologic indications
Curr Gynecol Oncol 2019, 17 (4), p. 178–184
DOI: 10.15557/CGO.2019.0023

Endometrial and cervical cancers belong to the most common neoplasms in women. Surgery is the primary treatment approach and may be combined with other methods, such as radiation or systemic therapy, if needed. Despite radical primary treatment, recurrence or disease progression may occur is some patients. Although the management is relatively simple and associated with lower mortality and complication rates in patients with early stage cancer, surgical treatment of advanced and recurrent tumors is much more complex and often requires extensive procedures. Pelvic exenteration involves removal of part or all of the pelvic organs. In the case of cancer that persists or recurs after primary treatment, the surgery is difficult and usually associated with high rates of postoperative complications and higher perioperative mortality. However, it gives patients a chance to survive, which may be impossible without surgical intervention. It can alleviate the symptoms of the underlying disease in carefully selected patients. Pelvic exenteration is performed in two stages: resection and reconstruction. During reconstruction, gastrointestinal and urinary tract continuity is reestablished, and the mode of reconstruction differs depending on many factors, especially in the case of the urinary tract, which will be discussed in this paper.

Keywords: exenteration, lesser pelvis, cervical cancer
Two cases of malignant peritoneal mesothelioma without asbestos exposure
Curr Gynecol Oncol 2019, 17 (4), p. 185–188
DOI: 10.15557/CGO.2019.0024

Malignant peritoneal mesothelioma is a rare disease and usually develops in individuals aged between 50 and 69 years. Exposure to asbestos is reported in 80% of cases of pleural mesothelioma, but in peritoneal type such an exposure is noted in only 8% of cases. Prognosis is poor for mesothelioma with a median survival of <1 year. Here, we report two cases of malignant peritoneal mesothelioma without history of exposure to asbestos.

Keywords: malignant peritoneal mesothelioma, peritoneal malignancy, surgical treatment
Swyer syndrome with dysgerminomas: ambiguity of pathologic diagnosis
Curr Gynecol Oncol 2019, 17 (4), p. 189–192
DOI: 10.15557/CGO.2019.0025

Swyer syndrome – or pure gonadal dysgenesis – is one of the type of gonadal dysgenesis. The affected person suffers from primary amenorrhea, does not develop secondary sex characteristics. Seventeen-year-old girl was admitted due to right ovarian tumors of small cell carcinoma. Dysgerminoma shares several clinical and pathologic entities with small cell carcinoma. We reported a case of dysgerminoma in Swyer syndrome with pathologic ambiguity.

Keywords: Swyer syndrome, dysgerminoma, immunohistochemistry