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Ultrasound and Histopathologic Correlation of Ovarian Cystadenofibromas: Diagnostic Value of the "Shadow Sign"

Timor-Tritsch, Ilan E; Yoon, Esther; Monteagudo, Ana; Ciaffarano, Jeanine; Brandon, Caroline; Mittal, Kushbakhat R; Wallach, Robert C; Boyd, Leslie R
OBJECTIVES/OBJECTIVE:Cystadenofibromas (CAFs) are rare benign ovarian tumors without a widely accepted ultrasound (US) pattern. They are usually described by as thin-walled, unilocular or multilocular, and at times septated cysts with scant blood flow and no solid components. We describe a unique US feature, the "shadow sign," seen in prospectively diagnosed benign CAFs. We also provide the histopathologic basis for this typical US appearance. METHODS:Ultrasound (US) examinations were performed in our obstetric and gynecologic US unit. Pathologic examinations were performed by a dedicated gynecologic pathology team. The US and pathology department's database was searched for the diagnosis of a CAF between 2010 and 2017. RESULTS:We identified 20 patients who underwent transvaginal US examinations with a sole US diagnosis of a CAF, and the tumors were surgically removed. The common US feature across the 20 cases was the presence of hyperechoic avascular shadowing nodules. The correlating histologic features were unilocular or multilocular cysts with a smooth internal wall surface lined by a simple epithelium and occasional robust polypoid fibrous stroma. CONCLUSIONS:This US marker helps in differentiating CAFs from borderline ovarian tumors, which do not show this US feature. We hope that recognizing the suggested shadow sign as an additional descriptor of CAFs will lead to minimizing their unnecessary removal and eliminating additional and unnecessary imaging by computed tomography and magnetic resonance imaging.
PMID: 30927305
ISSN: 1550-9613
CID: 3779052

Disseminated Intravascular Coagulation Syndromes in Obstetrics

Wallach, Robert C
PMID: 26901325
ISSN: 1873-233x
CID: 1964722

Ovarian Cancer in BRCA Mutation Carriers: Improved Outcome After Intraperitoneal (IP) Cisplatin

Kwa, Maryann; Edwards, Susan; Downey, Andrea; Reich, Elsa; Wallach, Robert; Curtin, John; Muggia, Franco
BACKGROUND: Ovarian cancer arising in women with BRCA mutations is known to have a more favorable outcome and to be more responsive to platinum-based regimens than in those without a hereditary background. We analyze our previously published intraperitoneal (IP) studies in relation to BRCA mutation status and update their outcomes. METHODS: Among 62 patients with ovarian cancer enrolled in IP platinum doublet studies in clinical trials (with etoposide (n = 18), with floxuridine (n = 30), and with topotecan (n = 14)), a deleterious BRCA mutation was eventually identified in 10 patients. The outcomes in these BRCA mutation carriers are described and compared with survival of others in respective trials. RESULTS: Ten patients that were confirmed to have BRCA mutations-all with high-grade and stages IIC to IV disease-survived a median of 10 years (range: 4-18+) after receiving IP cisplatin-based regimens. Two continue with no evidence of disease since their IP treatment, while four others remain alive with recurrences after 8, 9, 10, and 11 years, respectively. CONCLUSIONS: This experience suggests that IP cisplatin leads to favorable long term outcomes in advanced ovarian cancer in women with defective homologous recombination (i.e., with deleterious BRCA mutations). Whether such cisplatin dose-intensification from IP relative to (intravenous) IV drug administration leads to superior results in these mutation carriers requires further study.
PMID: 24081797
ISSN: 1068-9265
CID: 807142

Best practices in risk-reducing bilateral salpingo-oophorectomy: The influence of surgical specialty [Meeting Abstract]

Malacarne, D; Long, Y; Boyd, L; Wallach, R; Pothuri, B; Fishman, D; Curtin, J; Blank, S
Objective: Risk-reducing BSO (RRBSO), or prophylactic removal of the adnexae in women at increased genetic risk of ovarian cancer, diminishes ovarian cancer risk. While many general gynecologists (GG) perform these procedures, some argue that they should be performed exclusively by gynecologic oncologists (GO). Crucial aspects of the procedure include attention to removing all adnexal tissue, systematic methods and processing to detect occult disease, and communication between surgeon and pathologist. After compiling a "best practices" protocol for performing RRBSO, we sought to identify how often these practices were followed and whether surgeons' training affected implementation. Methods: All cases of RRBSO from 2006 to 2010 at a single institution were identified.We abstracted data from the medical record, including type of surgeon and year of procedure. We reviewed operative reports to determine if pelvic washings were obtained; whether the upper abdomen, and peritoneal surfaces were inspected; and whether a retroperitoneal approach was used to skeletonize the infundibulopelvic (IP) ligament and maximize length of this pedicle. The pathology report was used to determine if the applicable preoperative diagnosis was noted and whether the entirety of the fallopian tubes and ovaries was sectioned or if only representative sections were reviewed. Fisher's exact test and chi-square were used as appropriate to compare differences between groups (InStat, LaJolla, CA). Results: Among 290 RRBSOs, 26 were performed by GGs and 264 by GOs. When performed by GOs, the ovaries and fallopian tubes were more likely to be completely sectioned compared with GG cases: 231/264 (88%) vs. 17/26 (65%) (P =0.003). GOs were more likely to perform pelvic washings 228/264 (86%) when compared to GGs 13/ 26 (50%) (P < 0.0001). GOs were more likely to use a retroperitoneal approach to skeletonize the IP ligaments 172/264 (65%) when compared to GGs 6/26 (23%) (P < 0.0001). GOs were more likely to include a description of t!
EMBASE:71103847
ISSN: 0090-8258
CID: 452952

Phase 1/pharmacology study of intraperitoneal topotecan alone and with cisplatin: potential for consolidation in ovarian cancer

Andreopoulou, Eleni; Chen, Thomas; Liebes, Leonard; Curtin, John; Blank, Stephanie; Wallach, Robert; Hochster, Howard; Muggia, Franco
PURPOSE: Most ovarian cancers recur after first-line treatment. We studied the pharmacology, tolerability, and therapeutic potential of intraperitoneal (IP) topotecan, alone and with IP cisplatin. METHODS: Patients received IP topotecan 1.5 mg (flat dose) daily on days 1-5 (level 0) via IP catheter. Subsequent cohorts received IP cisplatin 50 mg/m(2) on day 1 added to topotecan 1.5 mg on days 1-3 (level I), topotecan 1.25 mg on days 1-3 (level II), or topotecan 1.25 mg on days 1-5 (level III). Plasma and IP concentrations of total and lactone (E-ring closed) topotecan were measured on days 1 and 2 in cycles 1 and 2. RESULTS: Sixteen patients (15 tubo-ovarian, 1 gastric cancers) were entered at levels 0 (3), I (4), II (4), or III (5). Dose-limiting neutropenias occurred in seven patients at dose levels I and III; grade 3 thrombocytopenia occurred in two at level III. Other toxicities included grade 1 hives in two, serum creatinine elevations in two, and Staphylococcus epidermidis and chemical peritonitis (one each). A median progression-free survival of 13 months was recorded among ovarian cancer patients who had minimal (6) or no residuum (3) after platinum-based induction; 5 are alive at 4 years. Topotecan's AUC IP/AUC plasma ratios ranged from 13 to 119. CONCLUSION: Topotecan IP for 3-5 days is tolerable; occasionally, myelosuppression is dose-limiting. Topotecan 1.25 mg (days 1-3) with IP cisplatin 50 mg/m(2) (day 1) is a regimen suitable for consolidation in phase 3 trials.
PMID: 21069334
ISSN: 0344-5704
CID: 161219

CA-125 surveillance for women with ovarian, fallopian tube or primary peritoneal cancers: What do survivors think? [Meeting Abstract]

Boyd, L.; Bedell, S.; Curtin, J.; Wallach, R.; Pothuri, B.; Muggia, F.; Tiersten, A.; Blank, S.
ISI:000290292300148
ISSN: 0090-8258
CID: 132764

Intraperitoneal chemotherapy: Who, what, when, and how in diverse academic settings [Meeting Abstract]

Boyd, LR; Novetsky, A; Pua, TL; Pothuri, B; Curtin, JP; Wallach, RC; Blank, SV
ISI:000208852004169
ISSN: 1527-7755
CID: 2142202

Outcomes of endometrial cancer cases in a private versus public hospital setting [Meeting Abstract]

Pua, TL; Boyd, LR; Novetsky, AP; Garcia, L; Devine, K; Curtin, JP; Pothuri, B; Hope, JM; Wallach, RC; Fishman, DA; Blank, SV
ISI:000264230200165
ISSN: 0090-8258
CID: 97674

Epidemiology and treatment of cervical cancer cases in a private versus public hospital setting [Meeting Abstract]

Boyd, LR; Pua, TL; Novetsky, AP; Pothuri, B; Curtin, JP; Hope, JM; Wallach, RC; Fishman, DA; Blank, SV
ISI:000264230200084
ISSN: 0090-8258
CID: 97670

Microvascular contrast sonographic imaging to detect early-stage epithelial ovarian cancer [Meeting Abstract]

Hope, JM; Fleischer, A; Lyseck, A; Blank, SV; Pothuri, B; Wallach, RC; Curtin, JP; Fishman, DA
ISI:000264230200057
ISSN: 0090-8258
CID: 97669