Objective. To evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for detecting recurrent epithelial ovarian cancer limited to retroperitoneal adenopathy. Methods. Fourteen patie...Objective. To evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for detecting recurrent epithelial ovarian cancer limited to retroperitoneal adenopathy. Methods. Fourteen patients (median age = 53 years) with rising serum CA125 levels, and negative or equivocal conventional CT imaging ≥6 months after primary therapy were retrospectively identified as having recurrent disease limited to retroperitoneal lymph nodes by combined PET/CT and underwent surgical reassessment of targeted nodal basins. Fisher’s Exact Test was used to measure the ability of PET/CT to predict isolated retroperitoneal nodal disease. Results. The median increase in serum CA125 from baseline nadir was 14 U/ml (range = 2-76 U/ml). There were 29 target nodes in 15 nodal basins identified with increased metabolic uptake on combined PET/CT.Eleven patients (78.6%) had recurrent ovarian cancer in retroperitoneal lymph nodes targeted by PET/CT. Of 143 nodes retrieved, 59 contained recurrent ovarian cancer (median nodal diameter = 2.5 cm, range = 0.8-5.2 cm). For all target nodal basins, the sensitivity, specificity, positive and negative predictive values, and accuracy for recurrent ovarian cancer in dissected lymph nodes were: 40.7%(24/59), 94.0%(79/84), 82.8%(24/29), 69.3%(79/114), and 72.0%(103/143)(P < 0.001). PET/CT failed to identify microscopic disease in 59.3%of pathologically positive nodes. Conclusion. Combined PET/CT demonstrates high positive predictive value in identifying recurrent ovarian cancer in retroperitoneal lymph nodes when conventional CT findings are negative or equivocal. The high incidence of occult disease within the target nodal basins suggests that regional lymphadenectomy may be necessary for complete secondary cytoreduction of recurrent disease.展开更多
Background. Primary insular carcinoid tumor of the ovary is a rare tumor and accounts for fewer than 1% of all cases of carcinoid in the body. With the exception of a single reported case, all previously described fun...Background. Primary insular carcinoid tumor of the ovary is a rare tumor and accounts for fewer than 1% of all cases of carcinoid in the body. With the exception of a single reported case, all previously described functioning ovarian carcinoid tumors have measured at least 10 cm in diameter. Thus, there appears to be a good correlation between the size of the tumor and the presence of the carcinoid syndrome. Case report. We describe a case of a functioning primary insular carcinoid tumor of the ovary measuring just 6 cm in maximal diameter. Conclusion. Although primary ovarian carcinoid tumor is very rare, a high clinical index of suspicion must be maintained, especially in a patient presenting with carcinoid syndrome and a small adnexal mass.展开更多
Objectives. To evaluate the efficacy of a hyaluronate-carboxy-methylcellulose (HA-CMC) barrier for prevention of pelvic adhesion formation in women undergoing primary cytoreductive surgery with radical oophorectomy fo...Objectives. To evaluate the efficacy of a hyaluronate-carboxy-methylcellulose (HA-CMC) barrier for prevention of pelvic adhesion formation in women undergoing primary cytoreductive surgery with radical oophorectomy for locally advanced epithelial cancer. Methods. Between 3/1/01 and 3/1/02, all patients undergoing primary surgery for locally advanced FIGO Stage III-IV epithelial ovarian cancer were prospectively offered study enrollment. Radical oophorectomy (en bloc rectosigmoid colectomy) with total pelvic peritonectomy was performed as clinically indicated. Intestinal continuity was reestablished via stapled anastomosis following complete cytoreduction of pelvic disease. The entire pelvic peritoneal defect was covered with subdivided sheets of HA-CMC (6.5 cm ×5.0 cm) using a “quilting”technique. The abdominal wall incision site was not treated with adhesion preventive measures. At second-look surgery, four-quadrant pelvic (treated area) and abdominal wall (untreated internal control) adhesion scores were assigned using a previously validated scoring system. Statistical analysis for differences in mean pelvic and abdominal wall adhesion scores was performed using Student’s t test. Results. Fourteen patients satisfied all inclusion criteria. Abdominal wall adhesions were noted in 92.9%of patients. In the pelvis, the dorsal peritoneal surfaces were the most common sites of adhesion formation (42.9%). Overall, the mean pelvic (treated) adhesion score was statistically significantly lower (0.91, SD ±1.04) than the mean abdominal wall (untreated control) score (5.56, SD ±4.55, P = 0.02). There were no instances of intestinal anastomotic leak, and no peri-operative complications directly attributable to HA-CMC were observed. Conclusions. Placement of a HA-CMC barrier is associated with a significant reduction in the extent and density of pelvic adhesion formation following radical oophorectomy and pelvic peritonectomy for locally advanced epithelial ovarian cancer.展开更多
文摘Objective. To evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for detecting recurrent epithelial ovarian cancer limited to retroperitoneal adenopathy. Methods. Fourteen patients (median age = 53 years) with rising serum CA125 levels, and negative or equivocal conventional CT imaging ≥6 months after primary therapy were retrospectively identified as having recurrent disease limited to retroperitoneal lymph nodes by combined PET/CT and underwent surgical reassessment of targeted nodal basins. Fisher’s Exact Test was used to measure the ability of PET/CT to predict isolated retroperitoneal nodal disease. Results. The median increase in serum CA125 from baseline nadir was 14 U/ml (range = 2-76 U/ml). There were 29 target nodes in 15 nodal basins identified with increased metabolic uptake on combined PET/CT.Eleven patients (78.6%) had recurrent ovarian cancer in retroperitoneal lymph nodes targeted by PET/CT. Of 143 nodes retrieved, 59 contained recurrent ovarian cancer (median nodal diameter = 2.5 cm, range = 0.8-5.2 cm). For all target nodal basins, the sensitivity, specificity, positive and negative predictive values, and accuracy for recurrent ovarian cancer in dissected lymph nodes were: 40.7%(24/59), 94.0%(79/84), 82.8%(24/29), 69.3%(79/114), and 72.0%(103/143)(P < 0.001). PET/CT failed to identify microscopic disease in 59.3%of pathologically positive nodes. Conclusion. Combined PET/CT demonstrates high positive predictive value in identifying recurrent ovarian cancer in retroperitoneal lymph nodes when conventional CT findings are negative or equivocal. The high incidence of occult disease within the target nodal basins suggests that regional lymphadenectomy may be necessary for complete secondary cytoreduction of recurrent disease.
文摘Background. Primary insular carcinoid tumor of the ovary is a rare tumor and accounts for fewer than 1% of all cases of carcinoid in the body. With the exception of a single reported case, all previously described functioning ovarian carcinoid tumors have measured at least 10 cm in diameter. Thus, there appears to be a good correlation between the size of the tumor and the presence of the carcinoid syndrome. Case report. We describe a case of a functioning primary insular carcinoid tumor of the ovary measuring just 6 cm in maximal diameter. Conclusion. Although primary ovarian carcinoid tumor is very rare, a high clinical index of suspicion must be maintained, especially in a patient presenting with carcinoid syndrome and a small adnexal mass.
文摘Objectives. To evaluate the efficacy of a hyaluronate-carboxy-methylcellulose (HA-CMC) barrier for prevention of pelvic adhesion formation in women undergoing primary cytoreductive surgery with radical oophorectomy for locally advanced epithelial cancer. Methods. Between 3/1/01 and 3/1/02, all patients undergoing primary surgery for locally advanced FIGO Stage III-IV epithelial ovarian cancer were prospectively offered study enrollment. Radical oophorectomy (en bloc rectosigmoid colectomy) with total pelvic peritonectomy was performed as clinically indicated. Intestinal continuity was reestablished via stapled anastomosis following complete cytoreduction of pelvic disease. The entire pelvic peritoneal defect was covered with subdivided sheets of HA-CMC (6.5 cm ×5.0 cm) using a “quilting”technique. The abdominal wall incision site was not treated with adhesion preventive measures. At second-look surgery, four-quadrant pelvic (treated area) and abdominal wall (untreated internal control) adhesion scores were assigned using a previously validated scoring system. Statistical analysis for differences in mean pelvic and abdominal wall adhesion scores was performed using Student’s t test. Results. Fourteen patients satisfied all inclusion criteria. Abdominal wall adhesions were noted in 92.9%of patients. In the pelvis, the dorsal peritoneal surfaces were the most common sites of adhesion formation (42.9%). Overall, the mean pelvic (treated) adhesion score was statistically significantly lower (0.91, SD ±1.04) than the mean abdominal wall (untreated control) score (5.56, SD ±4.55, P = 0.02). There were no instances of intestinal anastomotic leak, and no peri-operative complications directly attributable to HA-CMC were observed. Conclusions. Placement of a HA-CMC barrier is associated with a significant reduction in the extent and density of pelvic adhesion formation following radical oophorectomy and pelvic peritonectomy for locally advanced epithelial ovarian cancer.
