Advances in Diagnosis and Treatment of Gynecological Malignancies

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (25 July 2022) | Viewed by 9766

Special Issue Editor

Special Issue Information

Dear Colleagues,

Medical practice is moving towards personalized medicine by means of next-generation sequencing applied to solid or liquid biopsy. Advances in our understanding of the molecular alterations in various gynecological malignancies have enabled the development of increasingly more precise diagnoses, effective targeted therapies, and the prediction of accurate prognoses in the setting of modern immunotherapies. In addition to histopathology coupled with molecular diagnostics, pretargeting for imaging and therapy is gaining consensus in oncological nuclear medicine; moreover, robotic surgical techniques are now a reality. The aim of this Special Issue is to highlight recent advances in the full context of diagnosis and treatment of female cancers.

Prof. Dr. Luca Roncati
Guest Editor

Manuscript Submission Information

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Keywords

  • Gynecological malignancies
  • Histopathology
  • Next-generation sequencing
  • Theranostics
  • Targeted therapy
  • Robotics
  • Personalized medicine

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Published Papers (6 papers)

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Editorial

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2 pages, 170 KiB  
Editorial
Advances in Diagnosis and Treatment of Gynecological Malignancies: A Special Issue in Line with 2030 Agenda
J. Clin. Med. 2022, 11(13), 3797; https://doi.org/10.3390/jcm11133797 - 30 Jun 2022
Viewed by 906
Abstract
Among the 17 Sustainable Development Goals (SDG) of the United Nations 2030 Agenda, “good health and well-being” is point number 3 (SDG3), and all our efforts must be calibrated in this direction worldwide [...] Full article
(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Gynecological Malignancies)

Research

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10 pages, 1047 KiB  
Article
Postoperative Femoral Nerve Palsy and Meralgia Paresthetica after Gynecologic Oncologic Surgery
J. Clin. Med. 2022, 11(21), 6242; https://doi.org/10.3390/jcm11216242 - 22 Oct 2022
Cited by 1 | Viewed by 1993
Abstract
Femoral nerve palsy and meralgia paresthetica following gynecologic cancer surgery are rare, but severe and long lasting. Here, we aimed to study their incidence, severity, possible risk factors and its time to remission. Between January 2008 and December 2017 976 gynecologic cancer patients [...] Read more.
Femoral nerve palsy and meralgia paresthetica following gynecologic cancer surgery are rare, but severe and long lasting. Here, we aimed to study their incidence, severity, possible risk factors and its time to remission. Between January 2008 and December 2017 976 gynecologic cancer patients were identified in our institutional database receiving surgery. Complete patient charts were reviewed retrospectively. Possible risk factors were analyzed by Fisher’s exact test. 441 (45.18%) out 976 were treated for Ovarian cancer. In total 23 patients were identified with a postoperative neurological leg disorder. A femoral nerve palsy was present in 15 patients (1.5%) and a meralgia paresthetica in 8 patients (0.82%). Three patients showed both disorders. Duration of surgery (p = 0.0000), positioning during surgery (p = 0.0040), femoral artery catheter (p = 0.0051), prior chemotherapy (p = 0.0007), nicotine abuse (p = 0.00456) and prior polyneuropathy (p = 0.0181) showed a significant association with a postoperative femoral nerve palsy. Nicotine abuse (p = 0.0335) and prior chemotherapy (p = 0.0151) were significant for the development of a meralgia paresthetica. Long lasting surgery, patient positioning and femoral arterial catheter placement are risk factors for a postoperative femoral nerve palsy in gynecologic cancer surgery. Polyneuropathy, nicotine abuse, and prior chemotherapy are predisposing risk factors for a femoral nerve palsy and a meralgia paresthetica. A resolution of symptoms is the rule for both disorders within different time schedules. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Gynecological Malignancies)
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18 pages, 1677 KiB  
Article
Intraperitoneal Triamcinolone Reduces Postoperative Adhesions, Possibly through Alteration of Mitochondrial Function
J. Clin. Med. 2022, 11(2), 301; https://doi.org/10.3390/jcm11020301 - 07 Jan 2022
Cited by 1 | Viewed by 1581
Abstract
Adhesions frequently occur postoperatively, causing morbidity. In this noninterventional observational cohort study, we enrolled patients who presented for repeat abdominal surgery, after a history of previous abdominal myomectomy, from March 1998 to June 20210 at St. Vincent’s Catholic Medical Centers. The primary outcome [...] Read more.
Adhesions frequently occur postoperatively, causing morbidity. In this noninterventional observational cohort study, we enrolled patients who presented for repeat abdominal surgery, after a history of previous abdominal myomectomy, from March 1998 to June 20210 at St. Vincent’s Catholic Medical Centers. The primary outcome of this pilot study was to compare adhesion rates, extent, and severity in patients who were treated with intraperitoneal triamcinolone acetonide during the initial abdominal myomectomy (n = 31) with those who did not receive any antiadhesion interventions (n = 21), as documented on retrospective chart review. Adhesions were blindly scored using a standard scoring system. About 32% of patients were found to have adhesions in the triamcinolone group compared to 71% in the untreated group (p < 0.01). Compared to controls, adhesions were significantly less in number (0.71 vs. 2.09, p < 0.005), severity (0.54 vs. 1.38, p < 0.004), and extent (0.45 vs. 1.28, p < 0.003). To understand the molecular mechanisms, human fibroblasts were incubated in hypoxic conditions and treated with triamcinolone or vehicle. In vitro studies showed that triamcinolone directly prevents the surge of reactive oxygen species triggered by 2% hypoxia and prevents the increase in TGF-β1 that leads to the irreversible conversion of fibroblasts to an adhesion phenotype. Triamcinolone prevents the increase in reactive oxygen species through alterations in mitochondrial function that are HIF-1α-independent. Controlling mitochondrial function may thus allow for adhesion-free surgery and reduced postoperative complications. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Gynecological Malignancies)
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12 pages, 14885 KiB  
Article
An Application of Machine Learning That Uses the Magnetic Resonance Imaging Metric, Mean Apparent Diffusion Coefficient, to Differentiate between the Histological Types of Ovarian Cancer
J. Clin. Med. 2022, 11(1), 229; https://doi.org/10.3390/jcm11010229 - 31 Dec 2021
Cited by 6 | Viewed by 1415
Abstract
This retrospective single-center study included patients diagnosed with epithelial ovarian cancer (EOC) using preoperative pelvic magnetic resonance imaging (MRI). The apparent diffusion coefficient (ADC) of the axial MRI maps that included the largest solid portion of the ovarian mass was analysed. The mean [...] Read more.
This retrospective single-center study included patients diagnosed with epithelial ovarian cancer (EOC) using preoperative pelvic magnetic resonance imaging (MRI). The apparent diffusion coefficient (ADC) of the axial MRI maps that included the largest solid portion of the ovarian mass was analysed. The mean ADC values (ADCmean) were derived from the regions of interest (ROIs) of each largest solid portion. Logistic regression and three types of machine learning (ML) applications were used to analyse the ADCs and clinical factors. Of the 200 patients, 103 had high-grade serous ovarian cancer (HGSOC), and 97 had non-HGSOC (endometrioid carcinoma, clear cell carcinoma, mucinous carcinoma, and low-grade serous ovarian cancer). The median ADCmean of patients with HGSOC was significantly lower than that of patients without HGSOCs. Low ADCmean and CA 19-9 levels were independent predictors for HGSOC over non-HGSOC. Compared to stage I disease, stage III disease was associated with HGSOC. Gradient boosting machine and extreme gradient boosting machine showed the highest accuracy in distinguishing between the histological findings of HGSOC versus non-HGSOC and between the five histological types of EOC. In conclusion, ADCmean, disease stage at diagnosis, and CA 19-9 level were significant factors for differentiating between EOC histological types. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Gynecological Malignancies)
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7 pages, 497 KiB  
Article
Placental Leucine Aminopeptidase as a Potential Specific Urine Biomarker for Invasive Ovarian Cancer
J. Clin. Med. 2022, 11(1), 222; https://doi.org/10.3390/jcm11010222 - 31 Dec 2021
Cited by 5 | Viewed by 1360
Abstract
Background: A non-invasive and sensitive biomarker for the detection of ovarian cancer (OvCa) is lacking. We aim to investigate if urinary placental leucine aminopeptidase (P-LAP) can serve as a reliable biomarker for OvCa. Methods: P-LAP activity was measured using a LAP assay kit [...] Read more.
Background: A non-invasive and sensitive biomarker for the detection of ovarian cancer (OvCa) is lacking. We aim to investigate if urinary placental leucine aminopeptidase (P-LAP) can serve as a reliable biomarker for OvCa. Methods: P-LAP activity was measured using a LAP assay kit (Serotech Co., Ltd., Sapporo, Japan) in the urine of 22 patients with benign or borderline malignant ovarian tumors and 18 patients with OvCa. In this assay, L-methionine was added at 20 mM because P-LAP is functional, but other aminopeptidases are inhibited at this dose of L-methionine. Results: The mean urinary P-LAP activity was significantly higher in the OvCa group than in the benign or borderline malignant tumor group. When the cut-off value of P-LAP was determined as 11.00 U/L, its sensitivity and specificity for differentiating invasive cancer were 77.8% and 95.5%, respectively. Conclusion: Although the usefulness of this test should be confirmed in a larger cohort of cases and controls, our study is the first to highlight the importance of urinary P-LAP as a biomarker for OvCa. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Gynecological Malignancies)
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Review

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9 pages, 1238 KiB  
Review
Is It Possible to Diagnose Preoperatively a Tubal Ectopic Hydatidiform Molar Pregnancy? Description of a Case Report and Review of the Literature of the Last Ten Years
J. Clin. Med. 2022, 11(19), 5783; https://doi.org/10.3390/jcm11195783 - 29 Sep 2022
Cited by 2 | Viewed by 1769
Abstract
Synopsis: Nowadays there are no clinical, laboratory, or ultrasound criteria to differentiate ectopic tubal pregnancy from tubal molar pregnancy, so a preoperative diagnosis is not possible. Objective: Tubal ectopic hydatidiform moles are a rare type of gestational trophoblastic disease. The aim of our [...] Read more.
Synopsis: Nowadays there are no clinical, laboratory, or ultrasound criteria to differentiate ectopic tubal pregnancy from tubal molar pregnancy, so a preoperative diagnosis is not possible. Objective: Tubal ectopic hydatidiform moles are a rare type of gestational trophoblastic disease. The aim of our work is to understand if it is possible to diagnose, preoperatively, a tubal ectopic molar pregnancy, starting from the evaluation of a complicated case report up to performing a review of the literature. Materials and Methods: A 27-year-old woman was referred to our department for right pelvic pain, vaginal bleeding, and positive beta-hCG (590 mUI/mL). At the ultrasound, the uterine cavity was empty and a unilocular cyst of 15 mm below the right ovary, suspicious of ectopic pregnancy, was described. Serial measurements of daily beta-hCG (2031 → 2573 → 3480 mUI/mL) and, after five days, a laparoscopic salpingectomy, were performed. The pathologist confirmed a diagnosis of “incomplete invasive vesicular mole with extrauterine implant”. A review of the literature was performed, following the PRISMA statement, and searching all the articles related to this topic in the last ten years from PUBMED. We obtained data from thirteen studies, describing fourteen cases. Discussion: Considering the data from the literature, the main clinical symptoms were pelvic pain (100%), vaginal bleeding (64%), vomiting (7%), and fever (7%). By ultrasound examination, left adnexal mass on ten women (72%), and right adnexal mass on four (28%), were described. An assessment of ectopic pregnancy was made in all cases, but no preoperative diagnosis of tubal molar pregnancy was made. Beta-hCG levels were the same as patients with ectopic tubal pregnancy. Conclusion: Nowadays there are no clinical, laboratory, or ultrasound criteria to differentiate ectopic tubal pregnancy from tubal molar pregnancy. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Gynecological Malignancies)
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