Dedifferentiated endometrioid adenocarcinoma with trophoblastic components: Prolonged remission after treatment with bleomycin, etoposide, and cisplatin.

Dedifferentiated endometrial adenocarcinoma (DEAC) with trophoblastic components is a rare neoplasm with an aggressive behavior and a poor prognosis. Only seven cases have been reported in the literature. We present a 61-year-old patient who was diagnosed with Stage IB dedifferentiated endometrioid adenocarcinoma with trophoblastic elements.

Prospective Validation of an Ex Vivo, Patient-Derived 3D Spheroid Model for Response Predictions in Newly Diagnosed Ovarian Cancer.

Although 70-80% of newly diagnosed ovarian cancer patients respond to first-line therapy, almost all relapse and five-year survival remains below 50%. One strategy to increase five-year survival is prolonging time to relapse by improving first-line therapy response. However, no biomarker today can accurately predict individual response to therapy.

Women with breast and uterine cancer are more likely to harbor germline mutations than women with breast or uterine cancer alone: A case for expanded gene testing.

Objective: We explored the germline mutation spectrum and prevalence among 1650 women with breast and uterine cancer (BUC) who underwent multi-gene hereditary cancer panel testing at a single commercial laboratory.

Methods: The combined frequency of mutations in 23 BC and/or UC genes was compared between BUC cases and control groups with (1) no personal cancer history; (2) BC only; and (3) UC only using logistic regression.

Results: Fourteen percent (n = 231) of BUC cases tested positive for mutations in BC and/or UC genes and were significantly more likely to test positive than individuals with BC only (P < 0.

Clitoral priapism due to distant clitoral metastasis of high-grade serous ovarian carcinoma: A case report and review of the literature.

•Cutaneous metastasis at the initial presentation of ovarian carcinoma is rare.•Clitoral metastasis in a gynecological malignancy can occasionally present as clitoral priapism.•Clitoral priapism can be treated with oral or intramuscular alpha blockade.

Does Routine Posttreatment PET/CT Add Value to the Care of Women With Locally Advanced Cervical Cancer?

Objectives: The aim of this study was to determine the necessary reduction in recurrence rate that would make postchemoradiation positron emission tomography (PET)/computed tomography (CT) to direct completion hysterectomy for locally advanced cervical cancer (LACC) cost-effective.

Methods: A decision model evaluated costs and recurrence rates of 2 posttreatment surveillance strategies in LACC: (1) routine surveillance without PET/CT and (2) PET/CT after 3 months to triage to completion hysterectomy. Incremental cost-effectiveness ratios were expressed in dollars per additional cancer recurrence avoided.

Lymph Node Micrometastases in Early-Stage Cervical Cancer are Not Predictive of Survival.

Although patients with early-stage cervical cancer have in general a favorable prognosis, 10% to 40% patients still recur depending on pathologic risk factors. The objective of this study was to evaluate if the presence of lymph node micrometastasis (LNmM) had an impact on patient's survival. We performed a multi-institutional retrospective review on patients with early-stage cervical cancer, with histologically negative lymph nodes, treated with radical hysterectomy and pelvic lymphadenectomy for the study period 1994 to 2004.

Survival advantage of marriage in uterine cancer patients contrasts poor outcome for widows: a Surveillance, Epidemiology and End Results study.

Background: Marriage confers a survival advantage for many cancers but has yet to be evaluated in uterine cancer patients. We sought to determine whether uterine cancer survival varied by self-reported relationship status.

Methods: Data were downloaded from the Surveillance, Epidemiology, and End Results program for women diagnosed with uterine cancer (between 1991 and 2010 in nine geographic regions).

A clinicopathologic study of vaginal intraepithelial neoplasia.

Objective: To evaluate the natural history of vaginal intraepithelial neoplasia (VAIN) and to identify risk factors for invasive vaginal carcinoma.

Methods: The records of all women with VAIN diagnosed at military treatment facilities over a 10-year period with minimum follow-up of 12 months were reviewed. Patient demographics and clinical information related to the diagnosis and treatment of VAIN were recorded.

Growing teratoma syndrome: Brief communication and algorithm for management.

Growing teratoma syndrome (GTS) is a rare condition among women with ovarian germ cell tumours. Women with GTS classically present during or after systemic chemotherapy with normalised tumour markers and a mass pathologically consistent with mature teratoma. Awareness of this syndrome is necessary to prevent unnecessary chemotherapy and allow optimal management.

The impact of disease distribution on survival in patients with stage III epithelial ovarian cancer cytoreduced to microscopic residual: a Gynecologic Oncology Group study.

Objective: To assess the survival impact of initial disease distribution on patients with stage III epithelial ovarian cancer (EOC) cytoreduced to microscopic residual.

Methods: We reviewed data from 417 stage III EOC patients cytoreduced to microscopic disease and given adjuvant intravenous platinum/paclitaxel on one of three randomized Gynecologic Oncology Group (GOG) trials. We subdivided patients into three groups based on preoperative disease burden: (1) minimal disease (MD) defined by pelvic tumor and retroperitoneal metastasis (2) abdominal peritoneal disease (APD) with disease limited to the pelvis, retroperitoneum, lower abdomen and omentum; and (3) upper abdominal disease (UAD) with disease affecting the diaphragm, spleen, liver or pancreas.

The use of acellular dermal allograft for vulvovaginal reconstruction.

Background: Many different techniques that require the surgeon to harvest autologous tissue to create a neovagina have been described in the literature.

Technique: We describe a technique for creating a neovagina with the use of an acellular dermal allograft as a replacement for split-thickness skin graft. Three patients are presented who had a successful creation of a neovagina with this technique.

Gemcitabine-associated large vessel vasculitis presenting as fever of unknown origin.

Gemcitabine is a nucleoside analogue used for treatment of multiple cancers. Recent reports describe small to medium vessel vasculitis as a rare complication of therapy. We report a case of significant large vessel vasculitis presenting as fever of unknown origin in a patient treated adjuvantly with docetaxel and gemcitabine for uterine leiomyosarcoma.

Clinical decision making using ovarian cancer risk assessment.

Objective: Although any adnexal abnormality found at imaging can be concerning for an ovarian malignancy, the clinician must perform an evaluation to decide if the actual likelihood of malignancy justifies the risk of surgery. When determining the likelihood of an asymptomatic, incidental adnexal mass being malignant, the provider must answer one important question: Do the clinical findings warrant the potential morbidity of surgery? This article will focus on the decision making that goes into such an evaluation.

Conclusion: A patient's medical history, physical examination, CA-125 level, and imaging characteristics are all factors that impact the ultimate decision of whether a patient can be observed with repeat imaging or should proceed to surgical evaluation.

Incidental gynecological findings on computed tomographic colonography: prevalence and outcomes.

Objectives: Computed tomographic colonography (CTC) is an investigational method for detecting colorectal polyps. Our objectives were to determine the prevalence of gynecologic findings found incidentally on CTC, and to determine the incidence of additional radiological studies and surgical procedures.

Methods: An electronic database identified female patients who underwent CTC at Walter Reed Army Medical Center from January 2002 to July 2005.

Benign disorders of the ovary.

Most ovarian disorders are benign, with the majority being functional ovarian cysts and benign neoplasms. Imaging can often aid in diagnosis and risk assessment. Benign ovarian disorders are frequently incidental findings, but they may cause symptoms from hormonal overproduction, mass effects, or torsion.

Complications of gynecologic surgery.

Complications during gynecologic surgery result from the proximity of the uterus and ovaries to other critical pelvic structures. These structures include the urinary tract, bowel, nerves, and vasculature. Knowledge of pelvic anatomy is important when performing these procedures and is critical in cases of altered anatomy from adhesive disease and during intraoperative hemorrhage.

Establishing a mean postvoid residual volume in asymptomatic perimenopausal and postmenopausal women.

Objective: To estimate mean postvoid residual (PVR) volumes among perimenopausal and postmenopausal women without significant lower urinary tract or pelvic organ prolapse symptoms.

Methods: Patients presenting for well-women encounters were offered study participation. Women with a history of urinary incontinence greater than twice per week, urinary retention, symptomatic pelvic organ prolapse, or neurologic disorders were excluded.

The prevalence of HR-HPV DNA in ASC-US Pap smears: A military population study.

Objective: To determine the prevalence of HR-HPV DNA in ASC-US Pap smears following implementation of the Bethesda 2001 classification system.

Methods: A computer database of Pap smears obtained within Department of the Army medical facilities was queried for the study period August 2002 to June 2004. All ASC-US Pap smears that underwent reflex testing for HR-HPV DNA were included.

The use of acellular dermal graft for vulvovaginal reconstruction in a patient with lichen planus.

Background: Vulvovaginal lichen planus is an inflammatory dermatosis that can progress to an erosive form with scarring of the vulva, resorption of the labia minora, vaginal synechiae, and vaginal obliteration secondary to desquamative vaginitis. Traditionally, conservative medical therapy has consisted of topical corticosteroids and immunosuppressants.

Case: A 61-year-old woman with a history of refractory erosive vulvovaginal lichen planus presented with complete obliteration of the vaginal vault.

Laparoscopic exposure in obese high-risk patients with mechanical displacement of the abdominal wall.

Background: Patients with morbid obesity or pulmonary disease are at a higher risk for complications during advanced laparoscopic procedures. Higher intraperitoneal carbon dioxide pressures required to elevate the pannus can negatively impact hemodynamic and respiratory parameters.

Cases: We describe a technique that uses a combination of a mechanical retractor and a Foley catheter inserted midway between the umbilicus and the pubic symphysis that assists in elevating the anterior abdominal wall.