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Ovarian cancer is the second most common gynecological malignancy, yet it has the highest case-fatality ratio of all gynecologic malignancies. Surgery followed by combination platinum-taxane chemotherapy is the standard approach to the management of primary epithelial ovarian cancer. However, standard treatment of patients with recurrent ovarian cancer remains poorly defined. Secondary cytoreductive surgery (SDS) at the time of relapse has been proposed as a means of improving the prognosis of recurrent ovarian cancer patients with a treatment-free interval of at least 6 months.In the present study, we retrospectively collected 16 patients with recurrent epithelial ovarian cancer who might benefit most from SDS and evaluated the impact of SDS on the outcomes for this highly select patient group.We found that SDS led to excellent outcomes, with a 73.1% 8-year overall survival rate after initial treatment, a 67.9% 5-year overall survival rate after prior SDS, and a 31.3% 5-year progression-free survival rate after prior SDS. Although the findings were not significant, these results suggest that repeated SDS might improve outcomes for this patient group.The present study may provide a platform for discussion of the impact of aggressive or repeated SDS on the survival of patients with recurrent epithelial ovarian cancer and favorable prognostic factors. Further multi-institutional studies with larger number of patients are mandatory to confirm the present findings.

Objective Pregnancy does not increase the risk of bleeding from a brain arteriovenous malformation (AVM), but once an AVM has bled during pregnancy, the rate of rebleeding during the same pregnancy is high. Therefore, termination of the pregnancy is an option for patients in whom the AVM is located in an eloquent area. We report a woman with an intracerebral hemorrhage from a brain AVM who underwent a second-trimester therapeutic abortion by vaginal cesarean section. Case report A 30-year-old multiparous woman visited our emergency department at 17 weeks of gestation complaining of a sudden-onset headache with vomiting. She had no history of headaches or seizures. Based on the clinical presentation, computed tomography and magnetic resonance imaging, we made a clinical diagnosis of Spetzler–Martin Grade III AVM. Before undergoing stereotactic radiosurgery as a primary treatment, we advised her to terminate her pregnancy and performed a vaginal cesarean section at 19 weeks of gestation. Two months later, the patient underwent gamma knife surgery for the underlying lesion, without complications. Follow-up angiography and magnetic resonance imaging showed that the AVM had disappeared completely. Conclusion Although its indications are limited, vaginal cesarean section is a useful option for terminating a pregnancy that compensates for the disadvantages of dilatation and curettage and systemic abortifacients.

OBJECTIVE The function of granulosa cells is regulated by various hormones and growth factors. Our aim is to clarify the regulation of vascular endothelial growth factor (VEGF) production via mitogen-activated protein kinase (MAPK) induced by low level laser therapy (LLLT) in human granulosa cells. METHODS A human granulosa cell line, KGN cells, were cultured and incubated after LLLT (60mW, GaAlAs 830nm). The levels of VEGF in the culture media were determined by an enzyme-linked immunosorbent assay. The activation of MAP kinase in KGN cells was detected by western blot analysis. RESULTS VEGF production was significantly increased by LLLT in a time-dependent manner. MAP kinase activity was increased by LLLT. In addition it was enhanced by LLLT and follicle-stimulating hormone (FSH) stimulation. CONCLUSIONS The results suggested that VEGF is induced by LLLT through mechanisms involving MAPK. The increase in VEGF may contribute to neovascularization, which in turn would promote various ovulation phenomena as well as follicular growth.

Meningeal metastasis is rare in the clinical course of ovarian carcinoma and its prognosis is extremely poor. We experienced a case of carcinomatous meningitis from metastatic ovarian small cell carcinoma. A 33-year-old woman with atypical genital bleeding, was diagnosed with a right ovarian tumor and referred to our department. She underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymphadenectomy. It was an optimal debulking surgery. She was diagnosed with ovarian carcinoma classified as Stage IIIc according to the Féderation Internationale de Gynécologie et d'Obstétrique classification system. Histological findings showed small cell carcinoma of the pulmonary type. The tumor was bilateral with paraaortic lymph node involvement. The patient was treated with irinotecan and cisplatin (CPT-P therapy). After 4 courses of CPT-P therapy, multiple liver metastases and Virchow's lymph node metastases were found. She was treated with amrubicin as a second-line chemotherapy, but the treatment was ineffective. Five months after surgery, the patient complained of severe headache and nausea. Lumbar puncture was performed and cytology was positive. Magnetic resonance brain imaging indicated meningeal thickening. The patient was diagnosed with meningeal metastasis and received 19-Gy whole cranial irradiation. In spite of these treatments, her disease progressed rapidly and she was often drowsy. She died of aspiration pneumonia 6 months after surgery.

Background The true prognostic factors for induced medical abortion are unknown. We sought to investigate the effects of a patient's obstetric parameters on the induction���abortion interval in second-trimester medical abortion. Study Design We studied 216 consecutive women. Pregnancy was terminated with cervical preparation using osmotic dilators followed by 1 mg vaginal gemeprost administered every 3 h for a maximum of five doses in the first 24 h. All variables are expressed in categorical form (parity, gestational age, maternal age and body mass index) and analyzed by the Cox proportional hazards model. Results Parity ���3 was associated with a shorter duration of the induction���abortion interval (adjusted hazards ratio 1.96; 95% confidence interval 1.13���3.40). A gestational age ���16 weeks was associated with a longer duration of the induction���abortion interval (0.71; 0.52���0.98). No significant association was found in maternal age and body mass index. Conclusions In combination with osmotic dilators and gemeprost, gestational age and parity are independent factors that affected the induction to abortion interval of second-trimester medical abortion.

Mucinous epithelial ovarian tumors generally have estrogenic stroma, although the frequency of endometrioid adenocarcinoma with functioning stroma is very low. And while synchronous development of carcinomas in the endometrium and ovaries is a fairly common phenomenon, the distinction of a single clonal tumor with metastasis from two independent primary tumors may present a diagnostic challenge. We present a rare case of a 31-year-old woman with endometrioid adenocarcinoma of the ovary with functioning stroma and endometrial endometrioid adenocarcinoma who showed symptoms of virilization. Her preoperative levels of serum testosterone and estradiol were as high as 553 ng/dL and 177 pg/mL, respectively, and her serum gonadotropin levels were suppressed. After surgery, the serum levels of testosterone and estradiol decreased and that of follicle-stimulating hormone increased. To develop a mean of differentiating a single tumor with metastasis from synchronous primary ovarian and endometrial cancers, we performed a microsatellite analysis. Twenty-five dinucleotide microsatellite markers were selected, and microsatellite analysis was performed by a high-resolution method using fluorescence-labeled polymerase chain reaction and laser scanning. In this case, both ovarian carcinoma and endometrial carcinoma demonstrated loss of heterozygosity (LOH). However, the LOH findings of the ovarian tumor and endometrial tumor were different. Loss of heterozygosity analysis may be helpful to differentiate synchronous primary ovarian and endometrial cancers from a single tumor with metastasis.

Objective: The Signal Transducer and Activator of Transcription 3 (STAT3) protein regulatesmany aspects of cellular functions, such as proliferation, apoptosis, and angiogenesis. Enhanced expression of STAT3 protein has been demonstrated in the endometriotic tissues, suggesting the involvement of this molecule in the pathogenesis of endometriosi.Wedesigned the present study to evaluate the efficacy of STAT3 inhibitors as promising drug for the treatment of endometriosis. Materials and methods: Ovarian endometriotic cyst tissues were obtained from patients who had undergone a salpingooophorectomy or evisceration for the treatment of ovarian endometriotic cysts. This study was approved by the institutional review board of the Faculty of Medicine, Oita University, and written informed consent was obtained from all patients. Ovarian endometriotic cyst stromal cells (ECSCs) were isolated by collagenase digestion and cultured in the presence of STAT3 inhibitors (WP1066, S3I-201, and Cryptotanshinone). The effects of these STAT3 inhibitors on the proliferation, apoptosis, and vascular endothelial growth factor (VEGF) expression were investigated by cell death detection ELISA, caspase3/7 assay, modified MTT assay, and VEGF ELISA, respectively. Results: All of three STAT3 inhibitors inhibited the cell proliferation and VEGF production in ECSCs, and induced the apoptosis of these cells. Discussion: STAT3 inhibitors are promising candidates for the treatment of endometriosis. At present, STAT3 inhibitors are clinically used as the anti-cancer drugs. The clinical application of these agents for endometriosis is expected in the future.

1518 Background: Detailed family history collection is necessary to detect gynecological cancer patients suspected of Lynch syndrome (LS). However, clinicians have little time for family history in...

Caesarean scar pregnancy (CSP) is very rare, but is increasing in frequency, with an increase in caesarean section deliveries ( Rotas et al. 2006). Treatment may be with combined systemic and intra...

Clear cell adenocarcinomas of the uterine cervix are identified by cytological, histological and structural findings in the female genital tract, such as the vagina, endometrium and ovary. Clear ce...