Elsevier

Gynecologic Oncology

Volume 111, Issue 3, December 2008, Pages 523-526
Gynecologic Oncology

Case Report
Is there any possibility of fertility-sparing surgery in patients with clear-cell carcinoma of the ovary?

https://doi.org/10.1016/j.ygyno.2008.04.001Get rights and content

Abstract

Background

In epithelial ovarian cancer (EOC), fertility-sparing surgery (FSS) has mainly been chosen for stage IA disease. The purpose of this study was to clarify the clinical outcome of patients with clear-cell carcinoma of the ovary (CCC) who would usually undergo radical surgery.

Cases

After a central pathological review and search of the medical records from multiple institutions between 1988 and 2005, a total of 10 CCC patients treated with FSS were retrospectively evaluated in the current study. The mean age was 35.9 years (range: 32–39 years). The median follow-up time was 35.4 months (range: 21.7–153.2 months). The stage was IA in 4 patients, and IC in 6 patients {IC(b) in 5 patients, and IC(2) in one}. Nine patients received adjuvant chemotherapy. Nine patients were alive and one patient with stage IC(2) died of the disease at a follow-up time of 36.8 months. Five pregnancies were observed in 4 patients.

Conclusions

Although there is no worldwide criterion for FSS in CCC patients at present, it seems that, in selected patients, this surgical approach could be adopted. This should be investigated by additional studies in a larger series.

Section snippets

Background

Epithelial ovarian carcinoma (EOC) is the leading cause of death from gynecological malignancy [1]. The standard surgical treatment of patients with EOC is based on hysterectomy and bilateral salpingo-oophorectomy with peritoneal sampling (peritoneal washing, omentectomy, multiple peritoneal biopsies, and the removal of peritoneal implants) with or without lymph-node sampling [2]. However, several reports have estimated that 3–17% of all EOCs occur in women under 40 years of age [3], [4], [5],

Cases

In the current study, FSS was carried out only when we could not obtain informed consent for our recommended surgical procedure from CCC patients who strongly desired to preserve fertility. As shown in Table 1, the mean age was 35.9 years (range: 32–39 years). The median follow-up time was 35.4 months (range: 21.7–153.2 months). All patients were nulliparous and received unilateral salpingo-oophorectomy. Two patients received laparoscopic cystectomy as an initial surgery prior to secondary

Conclusions

In general, patients with CCC have a poorer prognosis compared with those with other pathological types of EOC [14], [15]. Ordinary, standard surgery for stage I-CCC includes intact tumor removal, total abdominal hysterectomy and bilateral salpingo-oophorectomy, omentectomy, lymph-node sampling, peritoneal and diaphragmatic sampling, and multiple washing for cytology. Although CCC generally affects older women, it can also be observed in women of childbearing age, frequently associated with a

Conflict of interest statement

The authors declare that they have no conflicts of interest to disclose.

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