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Background: Role of soluble vascular cell adhesion molecule-1 (sVCAM-1) in ovarian cancer is largely unclear. It was shown that mesothelial expression mediates tumour cell invasion and is associated with metastases in advanced ovarian cancer. Material and methods: In our prospective study we measured preoperative serum sVCAM-1 in 37 patients with advanced ovarian cancer and evaluated correlation with disease recurrence. Serum samples were obtained prior to surgery, ascites was collected during the surgery and all analysed by flow cytometric bead-based assay. ROC analysis was used to identify a cut-off value for sVCAM-1. Survival curves were calculated using Kaplan-Meier method. The association between sVCAM-1 and survival was investigated with Cox regression models, adjusting for age at surgery. A p of Results: Mean sVCAM-1 serum concentration in all patients before operation was 1564.68 ± 435.65 ng/ml while mean ascites level was 801.84 ±244.35 ng/ml. Follow up period was minimum 27 and the maximum 58 months. Patients were divided in two groups according to time to recurrence. Group A: 20 patients with disease progress or relapse within 12 months (mean serum level 1660.54±417.93 ng/ml; mean ascites level 827.92±290.36) and group B: 17 patients with tumour relapse after more than 12 months (mean serum level 451.91±441.15ng/ml; mean ascites level 771.16±179.93). There was a correlation between serum and ascites concentrations in group A and not in the patients from group B. The statistically significant difference was observed in serum concentration but not in ascites concentrations of sVCAM-1, There were no differences in grade, histology and stage of the tumour between the groups. sVCAM-1 and age resulted correlated (Spearman r=0.32, p=0.048). In Cox regression models after adjusting for age at surgery, sVCAM-1 above 1,400 ng/ml was associated with impaired DFS (hazard ratio 3.824; 95% confidence interval 1.460 to 9.374; p=0.003) and impaired OS (hazard ratio 13.394; 95% confidence interval 1.693 to 105.3985; p=0.014. Conclusions: This is the first study demonstrating that higher serum sVCAM-1 concentrations at the time of diagnosis might be predictive for early relapse. Serum sVCAM-1 can be potential marker for ovarian cancer follow-up.

Ureaplasma spp. usually causes genitourinary infections; few reports in the literature describe extragenital infections, usually in immunocompromised patients. We present a case of Ureaplasma parvum ventriculitis in an immunocompetent patient related to ventriculoperitoneal drainage and surgery. Ureaplasma parvum was detected with broad range 16S rRNA PCR and cultured on A8 agar.

Introduction/Background Trachelectomy with pelvic lymphadenectomy is considered a viable surgical procedure for fertility preservation in patients with early stage cervical carcinoma. The purpose of this study was to analysis postprocedural follow-up of oncological and fertility outcomes at a single centre. Methodology We conducted a retrospective analysis of women with early stage cervical carcinoma, treated at the University Medical Centre Ljubljana, between 2007 and 2017. The study group was compiled of 26 women, age 22 to 40 years old (mean 32,8 years old). Results Out of 26 women with early stage cervical cancer, 25 women were treated with vaginal radical trachelectomy (VRT) and laparoscopic pelvic lymphadenectomy (LPL) and one with only VRT. Mean age and BMI were 32,8 years and 21,54 kg/m2; respectively. One patient was IA1, two IA2, twenty-two IB1 and one IB2. Histology subtypes included squamous cell carcinoma (n=16), adenocarcinoma (n=8), endometrioid adenocarcinoma (n=1) and clear cell carcinoma (n=1). No perioperative complications were documented, postoperative complications included urinary retention and anaemia. All were treated with conservative measures. Within the follow-up period (12 – 60 months) 3 women (12%) developed disease recurrence, all were treated with local excision and adjuvant chemoradiotherapy. One patient died 15 months after primary treatment, following progression of the disease. Two remaining patients are in remission. Of the 24 women who had neither additional surgical procedures, nor adjuvant therapy, we documented 14 attempted pregnancies. All women with successful pregnancies had a separate procedure; laparoscopic cerclage. Out of 14 pregnancies five ended in miscarriage, one pregnancy resulted in second trimester delivery (24/25. week) and eight resulted in third trimester delivery (34.-38. week). All births were performed with a Caesarean section. Conclusion Cervical carcinoma effects women in reproductive age, limiting their chance for a successful pregnancy. Radical trachelectomy with SNL or pelvic lymphadenectomy should be an option for women that wish to preserve fertility. Good preoperative staging is essential in the process. Our data suggest that surgical approach is associated with low perioperative morbidity. Our recorded pregnancy rate is similar to that described in the literature. Disclosures Authors have nothing to disclose.

Background Osteopontin (sOPN) is a promising blood tumour marker for detecting epithelial ovarian cancer (EOC). However, other clinical uses of sOPN as a tumour marker in EOC are still lacking. Since sOPN concentrations in serum are not associated with those in ascites, we compared clinical value of sOPN concentrations in the two body fluids. Patients and methods The study included 31 women with advanced EOC and 34 women with benign gynaecological pathology. In the EOC group, serum for sOPN analysis was obtained preoperatively, after primary debulking surgery and after chemotherapy. In the control group, serum was obtained before and after surgery. Ascites and peritoneal fluid were obtained during surgery. sOPN concentrations were determined by flow cytometry bead-based assay. Results The sensitivity and specificity of sOPN in detecting EOC was 91.2% and 90.3% (cut-off = 47.4 ng/ml) in serum, and 96.8% and 100% (cut-off = 529.5 ng/ml) in ascites. Kaplan-Meier analysis showed a significant association between higher serum sOPN concentration and overall survival (p = 0.018) or progression free survival (p = 0.008). Higher ascites sOPN concentrations were associated with suboptimally debulked tumour and unresectable disease. Higher serum sOPN concentrations were associated with refractory disease or incomplete response to platinum-based chemotherapy. Conclusions The study showed that ascites sOPN level mirrors present disease and is superior to serum level for diagnostic purposes and surgical planning, although the end result of treatment is the response of the whole body in fighting the disease. The preoperative sOPN concentration in serum thus better reflects disease outcome.

Ovarian cancer has the highest mortality rate among all gynecologic cancers, with most patients presenting with advanced stage tumors. About a third of patients do not respond to primary platinum-based chemotherapy treatment, and over time up to 80 % of others develop chemoresistance, rendering recurrent disease incurable. Moreover, according to latest EMSO-ESGO (European Society for Medical Oncology – European Society for Gynecological Oncology) consensus conference manuscript on ovarian cancer, there are currently no validated molecular predictive biomarkers for platinum resistance. Recent studies suggest that the copper efflux transporters ATP7A and ATP7B play an important role in platinum resistance. In addition, by exploring their role in mediating resistance, new pathways of platinum resistance emerge, such as lysosomal storage disorders, which might be explored in the future as a new target to circumvent platinum resistance. This review outlines a challenging clinical hurdle in ovarian cancer therapy due to platinum resistance, links between the essential trace element copper and cytotoxic platinum-based medicines, and enigmatic mechanisms of ATP7A and ATP7B mediating platinum resistance. It then presents clinical studies showing a significant association of ATP7A and ATP7B with response to cisplatin/carboplatin and prognosis. Based on the results of in vitro assays, disease-relevant animal models, and clinical studies to date, it may be concluded that APT7A and ATP7B deserve further development as predictive markers of platinum resistance in ovarian cancer. Both transporters could play a particularly important role in early estimation of therapy response to identify platinum-resistant tumors and to adjust the treatment of ovarian cancer patients accordingly.

The aim of the study was to analyze the overall survival (OS) and progression free survival (PFS) of patients with high grade and advanced stage epithelial ovarian cancer (EOC) with at least 60 months of follow-up treated in a single gynecologic oncology institute. We compared primary debulking surgery (PDS) versus neoadjuvant chemotherapy plus interval debulking surgery (NACT + IDS) stratifying data based on residual disease with the intent to identify the rationale for therapeutic option decision and the role of laparoscopic evaluation of resectability for that intention. Patients and methods. This is observational retrospective study on consecutive patients with diagnosis of high grade and International Federation of Gynecology and Obstetrics (FIGO) stage III/IV EOC referred to our center between January 2008 and May 2012. We selected only patients with a follow-up of at least 60 months. Primary endpoint was to compare PDS versus NACT + IDS in term of progression free survival (PFS) and overall survival (OS). Secondary endpoints were PFS and OS stratifying data according to residual disease after surgery in patients receiving PDS versus NACT + IDS. Finally, through Cox hazards models, we tested the prognostic value of different variables (patient age at diagnosis, residual disease after debulking, American Society of Anesthesiologists (ASA) stage, number of adjuvantchemotherapy cycles) for predicting OS. Results. A total number of 157 patients were included in data analysis. Comparing PDS arm (108 patients) and NACT + IDS arm (49 patients) we found no significant differences in term of OS (41.3 versus 34.5 months, respectively) and PFS (17.3 versus 18.3 months, respectively). According to residual disease we found no significant differences in term of OS between NACT + IDS patients with residual disease = 0 and PDS patients with residual disease = 0 or residual disease = 1, as well as no significant differences in PFS were found comparing NACT + IDS patients with residual disease = 0 and PDS patients with residual disease = 0; contrarily, median PFS resulted significantly lower in PDS patients receiving optimal debulking (residual disease = 1) in comparison to NACT + IDS patients receiving complete debulking (residual disease = 0). PDS arm was affected by a significant higher rate of severe post-operative complications (grade 3 and 4). Diagnostic laparoscopy before surgery was significantly associated with complete debulking. Conclusions. We confirm previous findings concerning the non-superiority of NACT + IDS compared to PDS for the treatment of EOC, even if NACT + IDS treatment was associated with significant lower rate of post-operative complications. On the other hand, selecting patients for NACT + IDS, based on laparoscopic evaluation of resectabilty prolongs the PFS and does not worse the OS compared to the patients not completely debulked with PDS. Na odločitev o vrsti zdravljenja bolnikov z napredovalim melanomom lahko pomembno vpliva status mutacij v genih za BRAF, NRAS IN c-KIT. Pogostost mutacij in njihove medsebojne povezave s histološkimi značilnostmi tumorskih tkiv na slovenski populaciji do sedaj še niso bili raziskani. Bolniki in metode. Analizo smo izvedli retrospektivno. Mutacije BRAF, NRAS in c-KIT smo določili na 230 patoloških vzorcih bolnikov, ki smo jih nameravali zdraviti s sistemsko terapijo zaradi metastatskega melanoma na Onkološkem Inštitutu Ljubljana med leti 2013 in 2016. Zbrali smo histološke značilnosti primarnih tumorjev in klinične podatke bolnikov ter jih testirali na medsebojno povezanost z mutacijskim statusom. Rezultati. Povprečna starost 230 bolnikov je bila 59 let (razpon 25%85). Moških je bilo 141 (61,3 %) in žensk 89 (38,7 %). Ugotovili smo 129 (56,1 %) mutacij BRAF, 31 (13,5 %) NRAS in 3 (1,3 %) c-KIT mutacij v tkivnih vzorcih. Med 129 bolniki z mutacijami BRAF je imelo 114 (88,4 %) bolnikov mutacijo V600E in 15 (11,6 %) mutacijo V600K. Bolniki z BRAF mutacijami so bili ob diagnozi mlajši (52 v primerjavi s 59 let, p < 0,05), bolniki z NRAS mutacijami starejši (61 v primerjavi s 55 leti, p < 0,05). Število mutacij c-KIT je bilo prenizko za smiselno testiranje na medsebojne povezanosti, je pa bil eden izmed treh melanomov s c-KIT mutacijo melanom sluznice. Zaključki. Rezultati analize so v skupini slovenskih bolnikov z metastatskim melanomom odkrili visok delež mutacij BRAF ter nizek delež mutacij NRAS in c-KIT v primerjavi s predhodno objavljenimi raziskavami v Evropi in Severni Ameriki. Eden od glavnih vzrokov so specifične značilnosti naše študijske populacije, ki niso bile enake kot značilnosti celotne populacije bolnikov z melanomom.

Background The incidence of cervical cancer (CC) in Slovenia in 2011 was 13.2 per 100,000 women. The treatment of early stages of invasive cervical carcinoma involves several surgical techniques. In this article the authors would like to present a new combination of two methods which help to preserve fertility and to improve pregnancy outcome. The first procedure, radical vaginal trachelectomy (RVT), begins with laparoscopic pelvic lymphadenectomy. All suspicious lymph nodes are sent to frozen section. If those lymph nodes are negative, the procedure continues vaginally. Almost the entire cervix is removed with parametria and vaginal cuff. Permanent cerclage stitch is applied and covered with vagina on what is left of uterus. Second procedure, laparoscopic abdominal cerclage (LAC), begins with pneumoperitoneum. Mersilene tape is introduced in the abdominal cavity and placed through the visceral peritoneum at the isthmic part of the uterus with a Berci's needle. It is knotted and remains permanently. Materials and methods For the first procedure all the patients with confirmed cervical carcinoma (FIGO Stage IA₁, IA₂, and IB₁) and with the desire for fertility were recruited. For the second procedure, all the patients after RVT and after miscarriage after 14th week of gestation were recruited. Results RVT was performed in 15 patients and laparoscopic abdominal cerclage in three of them (21.5%). All three patients achieved pregnancies and after 36th weeks of gestation delivered by cesarean section (100%). Conclusions RVT alone is an indication for LAC. Considering its success, LAC should be performed before any miscarriage.

We sought to compare VeraCept (VC175), a novel nitinol intrauterine contraceptive (IUC) with 175 square-mm of copper surface area, to a copper T380S IUC.We enrolled parous women into a randomized subject-blinded comparison of VC175 and a copper T380S in a 2:1 fashion at a single clinic. The primary outcomes were total adverse events and continuation at 12 months. We also examined pain on insertion, ease of placement, expulsion, tolerability and pregnancy. Subjective ratings were on a 5-point Likert scale (0, no pain to 5, worst pain). We followed subjects through 24-month follow-up.We enrolled 300 women with 199 randomized to VC175 and 101 to the T380S. Insertion was successful in 198 subjects for VC175 and 100 for the T380S. Mean age was 25 years (range 18, 41), and median parity was 2 (range 1, 8), with 39% having only had Cesarean deliveries. No subjects developed clinical infection or reported serious adverse events. In the VC175 and T380S groups, mean pain at insertion was 1.4 and 2.4, respectively (p.01). At the 12-month primary endpoint for VC175 and T380S, respectively, continuation was 84% and 68% (p.002) with expulsions in 5.0% and 12.0% (p.05) and removal for pain/bleeding in 3.5% and 17.0% (p.01). At the 24-month visit for VC175 and T380S, respectively, continuation was 77% and 62% (p.02 by log-rank). One ectopic pregnancy was identified at the 12-month follow-up in a VC175 user. No other pregnancies were diagnosed. With 297.3 and 132.4 woman-years, pregnancy rates were 0.3 and 0.0 per 100 woman-years for VC175 and T380S, respectively.VC175 resulted in less pain at insertion, fewer expulsions and higher total continuation than the T380S, with similar contraceptive efficacy.VC175 is a promising new intrauterine copper contraceptive on a nitinol frame that warrants further clinical trials.

Background Primary treatment of patients with advanced epithelial ovarian cancer consists of chemotherapy either before (neoadjuvant chemotherapy, NACT) or after primary surgery (adjuvant chemotherapy). The goal of primary treatment is no residual disease after surgery (R0 resection) what is associated with an improvement in survival of patients. There is, however, no evidence of survival benefits in patients with R0 resections after prior NACT. Methods We retrospectively reviewed the records of patients who were treated with diagnosis of epithelial ovarian cancer at Institute of Oncology Ljubljana in the years 2005–2007. The differences in the rates of R0 resections, progression free survival (PFS), overall survival (OS) and in five-year and eight-year survival rates between patients treated with NACT and patients who had primary surgery were compared. Results Overall 160 patients had stage IIIC epithelial ovarian cancer. Eighty patients had NACT and eighty patients had primary surgery. Patients in NACT group had higher rates of R0 resection (42% vs. 20%; p = 0.011) than patients after primary surgery. PFS was 14.1 months in NACT group and 17.7 months after primary surgery (p = 0.213). OS was 24.8 months in NACT group and 31.6 months after primary surgery (p = 0.012). In patients with R0 resections five-year and eight-year survival rates were 20.6% and 17.6% in NACT group compared to 62.5% and 62.5% after primary surgery (p < 0.0001), respectively. Conclusions Despite higher rates of R0 resections achieved by NACT, survival of patients treated with NACT was inferior to survival of patients who underwent primary surgery. NACT should only be offered to patients with advanced epithelial cancer who are not candidates for primary surgery.

Background. Vascular cell adhesion molecule-1 (VCAM-1) is associated with ovarian cancer progression but the origin of its soluble form (sVCAM-1) in serum is not well investigated. The purpose of this study was to elucidate whether the concentration of sVCAM-1 in serum correlates with the concentration in ascites, that represents local tumour environment, and with systemic inflammation, various clinicopathological characteristics, and patient outcome. Patients and methods. Thirty-six patients with advanced ovarian cancer were included in the study. Serum for sVCAM-1 analysis was obtained prior to surgery. Ascites samples were collected at the beginning of the operation. Clinical data were collected from patients’ medical records. sVCAM-1 in samples was analysed by flow cytometric bead-based assay. The mean follow-up period was 11 months (range 0-23) from the time of surgery. Results. Serum sVCAM-1 concentrations are positively correlated to ascites sVCAM-1 concentrations. There was a weakly positive correlation of serum sVCAM-1 with tumour size and no correlation with inflammatory tumour markers, FIGO stage or grade. Higher concentrations of sVCAM-1 were associated with poor disease outcome (death from ovarian cancer) in almost all cases before chemotherapy was started. Conclusions. This is the first study demonstrating that serum concentrations of sVCAM-1 in advanced ovarian cancer patients correlate with sVCAM-1 concentrations in ascites, thus expressing the biologic potential of malignant disease to metastasis, rather than systemic inflammation. Higher serum and ascites sVCAM-1 concentrations might have predictive potential for different biologic behaviour.

The authors present their experience with the detection of the sentinel node, which is the first node to receive drainage from a malignant tumor, in patients with cervical cancer. Fifty women who were scheduled to undergo radical abdominal hysterectomy and systematic pelvic lymphadenectomy for treatment of stage IA2 to IIA primary carcinoma of cervix from January 2003 to January 2005 served as study subjects. Sentinel lymph node (SNL) mapping was done with an intracervical injection of 4 mL methylene blue. Pelvic lymph nodes appeared blue 15 minutes after dye injection and remained colored for 70 minutes. A 25-gauge standard needle was used to slowly, under constant pressure, inject the dye into the cervix to a depth of 5 to 10 mm at 3, 6, 9, and 12 o'clock positions, taking care to avoid injecting into the tumor itself. The abdomen was then opened, and the right retroperitoneal space on the right pelvis was opened. Using blunt dissection, the avascular paravesical and pararectal spaces were developed. The blue lymphatics could then be followed to the first node with obvious or faint dye uptake. This sentinel node was dissected and removed. The procedure was repeated on the left side before proceeding with lymphadenectomy. After the SNLs were removed on both sides, bilateral pelvic lymphadenectomy followed by radical hysterectomy was performed in all patients. The technique was considered to have failed when no sentinel node was identified or when there was inadequate injection of the dye. If the SNL was negative on histology, but other nodes in the drainage area were positive, the outcome was considered to be a false-negative. Sentinel nodes were considered positive when they contained macrometastases, micrometastases, or isolated tumor cells. Sentinel nodes were processed in the routine fashion with hematoxylin & eosin staining, but negative sentinel nodes underwent additional processing using serial step sections and wide-spectrum cytokeratin immunohistochemical analysis. The mean age of participants was 45.9 years. The most common preoperative diagnosis was clinical stage IB1 cervical cancer. Two women had microinvasive cancer stage IA2. Seventeen patients underwent a cone biopsy before surgery. Residual carcinoma in situ was diagnosed in 18% of these patients, one third of whom had lesions larger than 2 cm. A total of 1093 lymph nodes were retrieved (mean, 21.9 per patient). Eighty-six sentinel nodes were identified in 45 patients (detection rate, 90%). Forty SNLs were on the right side in 34 patients, and 46 SNLs were on the left side in 38 patients. Twenty-five women (50%) had two SNLs identified and 18 (26%) had one SNL identified. In five women, there were three SNLs, and two patients had four sentinel nodes. No sentinel nodes were identified in five patients (failure rate, 10%). Inadequate injection technique with intraperitoneal spillage accounted for two of the failures. A third was attributed to injection of the methylene blue into the tumor in a woman with bulky cervical cancer. After this, patients with bulky tumors were excluded from the study. The external iliac and obturator areas were the most common sites of SNL (55% and 38%, respectively). SNLs were similarly distributed on both sides of the pelvis. In this series, sentinel nodes detected in the common iliac area (n = 5) typically were the only positive nodes found on the same side. There was one parametrial SNL, but no dye could be seen beyond it. Twenty-five positive nodes were identified in 10 patients (20%), including seven with unilateral involvement and three with bilateral spread. Thirteen of the 25 positive nodes were identified as sentinel nodes and were found in nine of the 10 patients. In five patients, the SNL was the only positive node detected. The one woman with a false-negative SNL had stage IB 1 squamous cervical cancer and one positive right parametrial lymph node and 35 negative pelvic lymph nodes. Bilateral SNLs identified in this patient were negative by serial step and wide-spectrum cytokeratin immunohistochemical analysis.

Background Determination of the tumor marker concentration in peritoneal fluid (PF) may help to assess its potential to detect small concentration changes between benign ovarian pathology and early stage ovarian cancer. Peritoneal washing, which can also be obtained when PF is absent, is already included in the International Federation of Gynecology and Obstetrics (FIGO) staging classification for ovarian cancer but sampling has not yet been standardized. Since our aim was to evaluate the relationship between marker concentration in PF and washing, standardization of the sampling protocol was a prerequisite to ensure reliable results. Methods Thirty-three women with non-malignant pathology of the reproductive organs were included in the study. We used three promising tumor markers for evaluation of the marker concentration in local fluid: osteopontin (sOPN), splice variant 6 of sCD44 (sCD44-v6) and vascular cell adhesion molecule-1 (sVCAM-1). After aspiration of PF, washing of the uterus, ovaries and pelvic peritoneum was performed with saline solution. Patients were divided into two groups based on the solution volume: A-20 ml and B-50 ml. To determine the efficiency of washing in relation to solution volume, washing was repeated three times. Concentrations of markers in samples were determined using flow cytometry. Results Mean concentrations of markers were significantly higher (P

Background Intraoperative injury of the obturator nerve has rarely been reported in patients with gynecological malignancies undergoing extensive radical surgeries. Irreversible damage of this nerve causes thigh paresthesia and claudication. Intraoperative repair may be done by end-to-end anastomosis or grafting when achieving tension-free anastomosis is not possible. Case presentation A 28-year-old woman with stage IB cervical cancer underwent fertility–sparing surgery, including conization and bilateral pelvic lymphadenectomy. The left obturator nerve was damaged intraoperatively during pelvic dissection. Conclusion Immediate laparoscopic repair was successful and there was no functional deficit in the left thigh for six months postoperatively.

Deep infiltrating endometriosis with colorectal involvement is a complex disorder, often requiring segmental bowel resection. Complete removal of all visible lesions is considered the adequate treatment of infiltrating endometriosis in order to reduce recurrence. In this article, we describe our experience with laparoscopic management of deep infiltrating endometriosis with involvement of the rectum.A retrospective analysis of data from patients with deep infiltrating endometriosis with rectal involvement who underwent a laparoscopic surgery in the years 2002-2009 at the Department of Obstetrics and Gynecology at our institution was done.Between 2002 and 2009, a laparoscopic partial rectal resection was performed in 52 patients, and laparoscopic disk resection was performed in 4 cases with deep infiltrating endometriosis. The mean age of patients was 34.4 years (range, 22-62 years). Preoperative symptoms included dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. The laparoscopic procedure was converted to formal laparotomy in 3 patients (5.4%). The mean duration of surgery was 145 minutes. Postoperative complications included 3 cases of anastomotic leakage with rectovaginal fistula in two cases and intraabdominal bleeding in 1 case. The mean hospital stay was 7 days. Postoperatively, nine patients had a normal delivery, two of them after in vitro fertilization treatment.Laparoscopic rectal resection for deep infiltrating endometriosis is a relatively safe procedure, when performed by a surgeon and a gynecologist with sufficient experience in laparoscopic colorectal surgery.

Background Despite advances in surgery and combination chemotherapy, ovarian cancer is first in terms of death rates of gynaecological malignancies. More than 90% of ovarian cancers arise from surface epithelium and the serous histological subtype is the most commonly diagnosed epithelial ovarian carcinoma. Extensive seeding of the peritoneal cavity by tumour cells is often associated with ascites, particularly in advanced, high-grade serous carcinomas. Currently CA-125 is the most widely used biomarker in the evaluation and management of women with epithelial ovarian cancer. However, in approximately 15% of these patients CA-125 is not indicative of disease status or progression. Therefore, an alternative tumour marker would be useful. Osteopontin is a secreted, integrin-binding glykophosphoprotein which is overexpressed in ovarian cancer cells and thus may serve as a serum biomarker. By combining the data from blood and fluid from the proximity of the tumour we might be more likely to discover a protein biomarker secreted from the tumour rather than deriving from another part of the body.

Late rupture of external iliac artery pseudo-aneurysm is an uncommon complication in patients who undergo extensive gynecologic radical surgeries. A 28-year-old woman with stage IB cervical cancer underwent pelvic lymphadenectomy and extrafascial trachelectomy. Two months after surgery, massive bleeding from ruptured pseudo-aneurysm of the external iliac artery occurred. Endovascular management with covered stent placement was feasible and safe to stop bleeding.