BACKGROUND Gestational trophoblastic disease (GTD) encompasses a group of disorders that arise from abnormal growth of trophoblastic tissue. The spectrum of GTD includes 2 major groups: benign and malignant. The benign form is a hydatidiform mole, either complete or partial; the malignant forms, referred to as gestational trophoblastic neoplasia (GTN), consist of invasive moles, choriocarcinomas, placental site trophoblastic tumors, and epithelioid trophoblastic tumors. Most patients who undergo evacuation of a hydatidiform mole by curettage have a disease-free period before a new tumor develops that can be considered malignant. In rare cases, metastasis occurs rapidly and manifests coincidentally before the hydatidiform mole can be evacuated. CASE REPORT A 19-year-old woman in Bandung City, West Java, Indonesia, was diagnosed with a molar pregnancy with early evidence of a mass in her vagina that was suspicious for stage II GTN. The early emergence of a vaginal mass was a rare case of early transformation of a molar pregnancy into GTN. CONCLUSIONS Careful evaluation is warranted of patients with characteristics typical of an intrauterine molar pregnancy who have an early presentation of a vaginal mass because of the possibility that the diagnosis could be GTN.
Tujuan : Mendeskripsikan karakteristik karsinoma ovarium pra-menopause dengan kadar CA 125 ≤ 200 U/mL di RSUP Dr. Hasan Sadikin Bandung dari tahun 2019 sampai 2021. Metode : Penelitian deskriptif ini menggunakan metode total sampling dari data sekunder pasien kanker ovarium yang memenuhi kriteria inklusi dan memiliki variabel lengkap. Hasil : Penelitian yang melibatkan 32 sampel ini, menunjukkan nilai rata-rata CA 125 sebesar 82,63 U/mL dengan interval 3,3–194,8 U/mL. Mayoritas pasien berada pada rentang usia 40–49 tahun (40,6%), sudah menikah (87,5%), berprofesi sebagai ibu rumah tangga (81,3%), dan tinggal di Kawasan Pembangunan Bandung Raya (34,4%). Sebanyak 37,5% pasien adalah nullipara dan memiliki tipe histopatologis tumor epitel mucinous. Stadium tumor terbanyak adalah stadium I (56,3%). Kebanyakan pasien menjalani surgical staging komplit sebagai terapi penyakitnya (46,8%). Kesimpulan : Sebagian besar pasien karsinoma ovarium pra-menopause dengan kadar CA 125 ≤ 200 U/mL pada tahun 2019–2021 berada pada rentang usia 40–49 tahun, sudah menikah, bekerja sebagai ibu rumah tangga, dan berdomisili di Kawasan Pengembangan Bandung Raya. Kebanyakan pasien berstatus nullipara, memiliki tumor dengan tipe histopatologis epitel mucinous, dan terdiagnosis pada stadium I. Tipe pengobatan yang paling umum ditemui adalah surgical staging komplit. Characteristics of Pre-Menopausal Ovarian Carcinoma with CA 125 Level ≤ 200 U/mL in Dr. Hasan Sadikin General Hospital Bandung From 2019–2021 Abstract Objective : To describe the characteristics of pre-menopausal ovarian carcinoma patients with CA 125 Level ≤ 200 U/mL in Dr. Hasan Sadikin General Hospital Bandung from 2019 until 2021. Method : This descriptive study used the total sampling method of secondary data on ovarian cancer patients that have met the inclusion criterias and have complete variables. Results : This study involving 32 samples showed the average level of CA 125 was 82,63 U/mL with the interval of 3,3 – 194,8 U/mL. Majority of the patients were in the age range of 40 – 49 years old (40,6%), has been married (87,5%), were housewifes (81,3%), and lived in Development Area of Bandung Raya (34,4%). About 37,5% patients were nullipara and had mucinous epithelial histopatology type of tumor. The most abundant tumor stage were stage I (56,3%). Most patients had undergoing complete surgical staging for their therapy (46,8%). Conclusion : Most of pre-menopausal ovarian carcinoma patients with CA 125 level ≤ 200 U/mL in 2019–2021 were in the age range of 40 – 49 years old, has been married, had profession as housewifes, and domiciled in Development Area of Bandung Raya. Majority of patients were nullipara, had tumor with mucinous epithelial histopatology type, and were diagnosed at the stage I. The most found therapy were complete surgical staging. Key words : ovarian cancer, CA 125, cancer antigen 125, characteristic
Anogenital Warts (AGWs) are benign proliferations caused by Human Papillomavirus (HPV) infection on the genital or anal areas. Various therapeutic options are available for the treatment of AGWs but there is no best or ideal therapy, and the recurrence of AGWs is significantly high. A promising new therapy that is currently being evaluated is immunotherapy with the intralesional Bacillus Calmette-Guérin (BCG) vaccine. Two cases of a 23-year-old woman and a 41-year-old man were presented with manifestations of condyloma acuminata type AGWs. The patients were immunocompetent and received single dose intralesional BCG vaccine on the largest lesion. Clinical improvements of AGWs lesions were noted starting on the 14th day after receiving therapy by the disappearance of some lesions with no recurrence and side effects. Intralesional BCG vaccine activates the immune system, treats other AGWs lesions that do not receive an intralesional injection, and also prevents recurrence. Although the intralesional BCG vaccine is effective for treating AGWs, further evaluation is still needed for its recurrence.
Objective: To evaluate the ability of pulsatility index (PI), resistance index (RI), and hypoxia inducible factor-1α (HIF-1α) expression in predicting the clinical response after radiation in patients with cervical cancer. Methods: A prospective cohort was carried on in Department of Obstetric and Gynecology Dr. Hasan Sadikin Hospital/ Faculty of Medicine, Padjadjaran University, during the period of July 2017 to March 2018 which include 51 samples with stage IIB to IVA cervical cancer. Tumor perfusion and oxygenation were evaluated using color Doppler ultrasound indices (pulsatility index and resistance index) and the expression of hypoxia inducible factor-1α (HIF-1α). The clinical response was assessed 2 months after external radiation. Result: Among 51 patients, 31 patients demonstrated good response and 20 patients demonstrated poor response to radiation. The mean value of PI was significantly lower in patients who demonstrated good response as compared to patients with poor response (0.84±0.916 vs. 1.70±1.260, p = 0.004). The mean value of RI did not differ significantly (0.29±0.112 vs. to 0.36±0.189 p =0.173). HIF-1α expression was significantly lower in patients who demonstrated good response as compared to patients with poor response (1.83±1.529 vs. 6.55±2.625, p = 0.0001). In multivariate model, PI and HIF-1α expression both predicted the clinical response after radiation. Conclusion: PI and HIF-1α expression predict the clinical response after radiation in patients with cervical cancer.
BACKGROUND: Ovarian cancer is the most dangerous gynecologic cancer and one of the top five causes of cancer death in women. One of the intraoperative strategies to diagnose and manage women with ovarian cancer is by doing intraoperative frozen section examination during surgery, but not all hospitals in Indonesia have this facilities, thus makes it difficult to achieve intraoperative diagnosis, which lead to substandard management of patients with ovarian cancer. AIM: The purpose of this study is to investigate if one can determine whether an ovarian tumor is benign or not based on the gross appearance of the tumor. METHODS: This study is a comparative, analytic, and cross-sectional study to compare the results of operator’s assessment with the results of intraoperative frozen section examination in determining malignancy during surgery. After the tumor was removed, it was assessed by operator based on the gross appearance of the tumor whether the tumor was benign or not, then the tumor underwent frozen section examination, and based on the frozen section examination results, the patient was treated accordingly. Both of the results then compared to the histopathologic (paraffin block) results, as the gold standard of pathologic diagnosis. RESULTS: This study shows that variables ascites, tumor seedings, tumor surface, tumor consistency, tumor lobes, and lymph node enlargement are statistically significant (p < 0.05). The combinations of highly significant variables (p < 0.01) show that a combination of ascites and irregular tumor surface give the suggestions that an ovarian is highly likely a non-benign tumor. CONCLUSION: In the absence of intraoperative frozen section examination in a hospital, operator’s assessment based on gross appearance of the tumor can be used as a substitute for intraoperative frozen section examination to determine the malignancy of an ovarian tumor during surgery.
Anogenital warts (AGW) are among the most common sexually transmitted infections worldwide. The condition may be persistent, increase in size and number, and have a high recurrence rate. There are many therapeutic options of AGW, but none of them prevented recurrence, only yielded partial responses and have the propensity to cause scars. Immunotherapy by purified protein derivative (PPD) is one of the therapeutic options for AGW, which effectively reduces the number of lesions until complete clearance, with minimal side effects and less recurrence rate. This case report aims to demonstrate the effectiveness, safety, and low recurrence rate of intralesional PPD injection as an alternative therapy for AGW. We reported one case of AGW in an immunocompetent 30-year-old homosexual man who was given 3 doses of 0.2 mL PPD injected intralesionally. As a result, clinical improvement was observed starting from the 18th day, with some of the lesions decreasing in size, and on the 46th day, all of the lesions disappeared. There was no significant side effect. Within two years of follow-up, no recurrence was observed. Intralesional injection of PPD can stimulate the immune response against human papillomavirus (HPV) infection both on the injection site and distant from the injection site. Previous studies have shown promising results of intralesional PPD, with low recurrence in over six-month follow-up and no side effects. Intralesional injection of PPD can be considered as an alternative therapy due to its minimal side effects and its long-term low recurrence rate.
Abstract Purpose. Cytoreduction has an important role in improving the survival rate of epithelial ovarian cancer (EOC) patients. The use of preoperative CA-125 as an optimal predictor cytoreduction in patients with ovarian cancer is still controversial. This study aimed to assess the ability of preoperative serum CA125, FASN and GLS as a predictor of cytoreductive surgery in epithelial ovarian cancer (EOC). This observational-analytic cross-sectional study included 109 women diagnosed with epithelial ovarian cancer (EOC) between 2017-2019, who had serum CA-125, GLS, FASN measured preoperatively and underwent cytoreductive surgery. Result. The average value of serum CA-125, FASN, and GLS in the suboptimal cytoreduction were higher than the optimal cytoreduction group. The cut off point (COP) of CA-125 was 248.55 (p=0.0001) with 73.2% sensitivity and 73.6% specificity, FASN was 0.445 (p=0.017) with 62.5% sensitivity and 60.4% specificity, and GLS was 22.895 (p=0.0001) with 73.2% sensitivity and 75.5% specificity. The COP value of CA-125 and GLS combined was 29.16 (p=0.0001) with sensitivity 82.1% and spesificity 73.6%, while the COP of CA-125, GLS, and FASN combined was 0.83 (p=0.0001) with 87.5% sensitivity and 73.6% specificity. If the value of biomarker serum more than COP will more likely have suboptimal cytoreductive surgery. Conclusion. The role of CA125, FASN and GLS levels in predicting suboptimal cytoreductive surgery for patients with ovarian cancer seems questionable. However, the combination of CA-125 and GLS or CA-125, FASN and GLS are able to increase the sensitivity, specificity, and accuracy classification to predict suboptimal cytoreductive surgery.
Background: Clear cell ovarian carcinoma (CCOC) is a type of epithelial ovarian cancer, representing 5-11% of ovarian cancers.CCOCs tend to occur in the fifth to seventh decades of life, with only 10% of cases occurring in the fourth decade.On the other side, papillary thyroid carcinoma is the most common histology type of thyroid carcinoma and is associated with locoregional spread.Herein, we present a rare case of double-primer ovarian and thyroid cancer, which is a clear cell ovarian carcinoma metachronous with papillary thyroid carcinoma.Case Report: A 47-year-old nulliparous woman presented to our Gynecology Oncology facility with an abdominal mass that had progressively increased in size over the last three months.She had a history of papillary thyroid cancer ten years previously and was treated with radioiodine (I-131).Physical examination revealed an immobile abdominal cystic mass measuring 20 × 18 × 15 cm.Ultrasound imaging revealed a cystic mass with a solid part, measured 16.1 × 10.9 × 12.84 cm, with M4 feature of the IOTA simple rule.CA-125 tumor marker levels were 190.1 U/mL.Ovarian cancer was suspected, and surgical staging with total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, frozen sectioning, and adhesiolysis was performed.Histopathological examination revealed a clear cell ovarian carcinoma.Discussion: Papillary thyroid carcinoma tends to be a locoregional metastasis, whereas distant metastases are rare.Distant metastasis often occurs decades after the primary tumor, with the most common metastatic sites being the lungs and bones.This raises an important clinical question concerning the etiology of the ovarian carcinoma: whether it represents a metastasis from the pre-existing thyroid carcinoma or a distinct primary neoplasm.Determining the precise relationship between these malignancies is crucial for guiding treatment strategies and understanding the biological behavior of the tumors involved.In this case, clear cell ovarian carcinoma arose separately from papillary thyroid carcinoma.Conclusion: Double primer cancer of the ovary and thyroid, which is a clear cell ovarian carcinoma metachronous with papillary thyroid carcinoma, is possible.
Cervical cancer is a malignancy in the lower part of the uterus and is the fourth most common female cancer in the world and the second largest in Indonesia. Optimal management of 'bulky' cervical cancer stage IB2 and IIA2 is controversial; the administration of neoadjuvant chemotherapy before definitive treatment can reduce recurrence and good therapeutic response, but for resistant patients, neoadjuvant chemotherapy will delay definitive therapy. A marker is needed to identify which patients are resistant to chemotherapy. Clinical factors and angiogenesis factors are known to affect therapy. This study is to analyze clinical factors (tumor size, hemoglobin, age, parity, histological type and differentiation) and angiogenesis factors (HIF1-alpha, VEGF, microvascular density and Cervix Vascular Doppler Ultrasound) effect on neoadjuvant chemotherapy response of IB2 and IIA2 cervical cancer
Methodology
Cohort analytic research has been conducted at Dr. M Djamil Central Hospital Padang Indonesia with 35 cervical cancer stage IB2 and IIA2 patients who were given neoadjuvant chemotherapy. Clinical factors and angiogenesis factors were examined and recorded before being given chemotherapy. HIF1-Alfa, VEGF and Microvascular density (MVD) measure using immunohistochemical methods in cervical cancer biopsy tissue, chemotherapy response based on RECIST criteria (measurements of the longest diameter of the tumor before and after neoadjuvant chemotherapy) using transrectal ultrasound
Results
The results of 35 patients showed that a good chemotherapy response was found in 80% of cases. Statistical analysis showed that only angiogenesis (Doppler and VEGF) factors (p <0.05) significantly affected the neoadjuvant chemotherapy response of IB2 and IIA2 cervical cancer.
Conclusion
Angiogenesis factors (Doppler ultrasound and MVD) have significant impact on tumor size reduction in neoadjuvant chemotherapy for cervical cancer stage IB2 and IIA2
Background: Polycystic ovary syndrome (PCOS) is a chronic disorder and is one of the most common endocrine disorders in women of a reproductive age. The prevalence of PCOS is growing globally; 52% of women in Southeast Asia alone suffer from this disorder. This disorder is caused by chronic hyperandrogenism, which hinders folliculogenesis. There is also a close relationship between hyperandrogenism and hyperinsulinemia/insulin resistance (IR), and it is estimated that 40–80% of PCOS patients suffer from insulin resistance (IR). Mesenchymal stem cells (MSCs) and their secretomes have been shown to alleviate PCOS symptoms by decreasing IR and androgen secretion by reducing inflammation. This study aimed to systematically review the literature to study the reported potential of MSCs and their secretomes in decreasing inflammation markers in PCOS treatment. Methods: A systematic literature search was performed on EMBASE, PubMed (MEDLINE), and the Cochrane Library with the terms insulin-resistant PCOS, mesenchymal stem cells, and secretome or conditioned medium as the search keywords. A total of 317 articles were reviewed. Four articles were identified as relevant for this systematic review. Results: The results of this study supported the use of mesenchymal stem cells and their secretions in decreasing inflammatory markers in the treatment of polycystic ovary syndrome. Conclusions: This review provided evidence that treatment with mesenchymal stem cells and their secretomes has the potential to treat PCOS due to its ability to downregulate androgen levels and increase insulin sensitivity, which thereby lowers the level of proinflammatory factors.
