Persistently low-level "real" serum human chorionic gonadotropin (hCG) after treatment for gestational trophoblastic neoplasia (GTN) in patients desirous of preserving fertility is a diagnostic and management challenge. Among the possible explanations is the presence of false positive ("phantom") hCG or of trophoblasts in a myometrial sanctuary.An 18-year-old woman had persistent low-level hCG values in her serum after treatment for nonmetastatic GTN. Her only child had died, and she wanted to preserve her fertility potential. Phantom hCG was excluded. Positron emission tomography (PET) showed increased uptake in an area of the uterus in which magnetic resonance imaging had shown an ill-defined, ovoid lesion. Removal of the lesion with preservation of the uterus followed by 2 courses of multiagent chemotherapy (methotrexate, dactinomycin and cyclophosphamide) resuited in clinical remission.PET can prove useful in detecting persistent disease in a myometrial sanctuary in patients with resistant, nonmetastatic GTN. Conservative surgical excision with uterine preservation is possible and can be of value in achieving remission.
In Brief Objective To evaluate the correlation between the diagnosis of borderline tumor of the ovary by frozen and permanent pathology. Methods All pathology reports with diagnoses of borderline tumor of the ovary between 1980 and 1998 at Massachusetts General Hospital were reviewed. Univariate and multivariable logistic regression models were constructed for patient age, tumor size, histology, presence of bilateral or extraovarian disease, and concurrent diagnosis of endometriosis or endosalpingiosis. Results We reviewed 140 cases. The average age of patients was 52.3 years. Eighty tumors were serous, 47 mucinous, 11 mixed, and two endometrioid. The mean diameter overall was 13.7 cm (range 1–70 cm), 10.2 cm for serous, and 20.1 cm for mucinous. Diagnoses of borderline tumors by frozen and permanent pathology were consistent in 60% of cases. Frozen section interpreted a benign lesion as malignant (overdiagnosed) in 10.7% of cases, and interpreted a malignant lesion as benign (underdiagnosed) in 29.3%. No variable was a significant predicator of overdiagnosis. In univariate analysis, underdiagnosis was more likely for other types of tumors than serous (P < .001), tumors larger than 20 cm (P = .039), and tumors confined to the ovaries (P = .009). When all variables were included in a multiple regression model, only histology was a significant predictor of underdiagnosis (P = .039). Conclusion Frozen or permanent pathology reports of diagnoses of borderline tumor were consistent 60% of the time, whereas the positive predictive value of borderline by frozen section was 89.3%. Tumors other than serous are more likely to be misinterpreted. The diagnosis of borderline tumor by frozen section is generally accurate, but less so for mucinous tumors than serous tumors.
To identify issues affecting the quality of life (QoL) in women receiving palliative therapy for ovarian cancer.Twenty women with advanced recurrent ovarian cancer were interviewed to establish what issues affect QoL. All patients were receiving palliative chemotherapy or other palliative therapy in the department of Gynecologic Oncology at the Massachusetts General Hospital, and were felt to have a life expectancy of 1 year or less by best clinical estimate.Twenty patients with an average age of 56.7 years participated. Psychosocial issues were more common than physical ones, and patients were more likely to mention issues that positively impact on QoL rather than those with a negative effect. Most patients noted that a sense of hope, enhanced appreciation for day to day life, and a strong support system had a significantly positive effect on QoL. Issues negatively impacting QoL included fear of their disease (90%) and concern for family and friends (100%), particularly children. Most common physical symptoms impacting QoL included fatigue (100%) and anorexia (55%).Little research has been done into QoL issues for ovarian cancer patients receiving palliative care. Available QoL studies tend to focus on the physical aspects of a disease or its treatment. This pilot study suggests that women with advanced, recurrent ovarian cancer feel that psychosocial issues play a greater role in determining QoL than do physical issues. Further QoL studies for these patients should include assessment of psychosocial realms. This information can then be used to design interventions to improve QoL.
True primary mucinous ovarian carcinomas are rarer than originally thought and their clinical behavior and treatment response are different than more common epithelial ovarian carcinomas. Secondary ovarian neoplasms often mimic the clinical and histological features of mucinous ovarian cancer making their diagnosis, and therefore treatment, more difficult. Misdiagnosis can have a significant impact on both treatment and prognosis. The majority of these secondary ovarian neoplasms arise from the gastrointestinal tract, with mucinous histology often of pancreaticobiliary origin. Our study objective was to review current evidence distinguishing pancreaticobiliary ovarian metastasis from primary mucinous ovarian carcinoma. We utilized a PubMed search using MeSH terms and selected articles were reviewed, synthesized and summarized. Thirty-nine articles were included in the review. The clinical, gross, histological and immunohistochemical features distinguishing primary mucinous ovarian carcinomas from pancreaticobiliary ovarian metastasis were identified. Compared to primary mucinous ovarian carcinoma, metastatic pancreaticobiliary tumors are more often bilateral, <10 cm, have irregular external surface and surface implants, display an infiltrative pattern of invasion and stain for MUC1 and CK17. Primary ovarian mucinous tumors rarely (<3%) have signet ring cells or involvement of the hilum. Metastatic mucinous tumors mimic their primary mucinous ovarian counterparts and their clinical and histopathological features overlap in many ways. However, these metastatic tumors have features that can help differentiate them from primary mucinous carcinoma. With a high index of suspicion and knowledge of the reviewed features, distinguishing these tumors will continue to become easier.
To evaluate the ability of various factors to predict persistent/recurrent disease after excisional biopsy of the transformation zone (cold knife conization or loop electrosurgical excision procedure) with special attention to the endocervical curettage (ECC).We reviewed the charts and histopathology findings of 152 women who underwent endocervical curettage at the time of conization (cold knife conization) or loop electrosurgical excision procedure (LEEP). Age, histopathologic findings on the cervical conization specimen, ectocervical margin, endocervical margin, and ECC specimens were assessed. These findings were analyzed for a relationship with the presence of cervical disease on subsequent follow-up (to include hysterectomy, repeat conization, colposcopically directed biopsies, endocervical curettage, and/or cytology).Positive endocervical margin (odds ratio [OR], 9.168; 95% confidence interval [95% CI], 3.939, 23.488), positive ectocervical margin (OR, 3.561; 95% CI, 1.626, 7.799), positive specimens (OR, 17.683; 95% CI, 5.308, 58.912), and severity of disease (OR, 2.730; 95% CI 1.507, 4.947) on the conization were all individually significantly associated with the presence of persistent/recurrent disease. Age of the patient at the time of cervical conization was not statistically associated with the ability to predict persistent/recurrent disease. In the multivariate analysis, the endocervical curettage (OR, 8.710; 95% CI, 2.302, 32.958) and the endocervical margin status (OR, 9.170; 95% CI, 2.887, 29.125) together were significant predictors of persistent/recurrent disease after adjusting for the other variable. However, when the degree of dysplasia and ectocervical margin status was included in the multivariate analysis, endocervical margin status (OR, 6.761; 95% CI, 2.657, 17.202) and severity of cervical disease (OR, 1.930; 95% CI, 1.038, 3.59) were the only statistically significant predictors of persistent/recurrent cervical neoplasia.In this retrospective analysis, positive endocervical or ectocervical margin, positive ECC specimens, and severity of cervical disease were all predictors of persistent/recurrent disease. However, on the multivariate stepwise logistic regression analysis, only endocervical margin status and severity of neoplasia significantly predicted the occurrence of persistent/recurrent disease. The results of the ECC, after adjustment for the degree of dysplasia and the endocervical margin status, do not add incremental value to the prediction of persistent/recurrent disease. At this time, ECC does not need to be routinely performed at the time of excisional biopsy of the cervical transformation zone.
