Gynae‐oncology

0019 Case report: cervical tuberculosis diagnosed after treatment for cervical cancer Patricia Ann Factor, Jean Anne Toral, Sybil Lizanne Bravo University of the PhilippinesManila, Manila, The Philippines Tuberculosis has been shown to coexistwithmalignancy, but tuberculosis andcancer in the cervix is extremely rare. This is thefirst caseof cervical tuberculosis diagnosed ina cervical cancer patient who has undergone concurrent chemoradiotherapy and brachytherapy. This is the case of a 38 year old G2 P2 (2002) diagnosed with Squamous cell carcinoma, large cell nonkeratinizing, Cervix, Stage IIIB. The patient underwent pelvic extended beam radiotheraphy from February 3 to March 19, 2015. Concurrently, she was given 6 cycles of chemotherapy with Cisplatin. Brachytherapy with 4000 centi Grays was given in March 27–29, 2015. On follow up one month after the last dose of brachytherapy, there was note of anodularity on the anterior lip of the cervix. A cervical punch biopsy was done which revealed: Chronic granulomatous inflammation with Langhan’s type multinucleated giant cells consistent with tuberculous infection. Negative for atypical/ malignant cells. This patient was started on Anti-Koch’s medication in the form of 2 months intensive treatment with Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol, then 10 months of Isoniazid and Rifampicin. She was seen on the 6 month of treatment at the Out Patient Clinic, there was note of decrease in the size of the nodularity and the rest of the cervix was noted to be smooth. Her Pap Smear was negative for intraepithelial lesion. Cervical tuberculosis complicating cervical malignancy is curable with Anti-Koch’s therapy and has not been shown to adversely affect the course of the carcinoma.

recurrent and metastatic cervical cancer remains a challenge. Metastasis associated or metastasis antigen (MTA) family is central components of the Mi-2/NuRD complex, which is thereby regulating global gene expression networks. Previous studies shown MTA2 highly expressed in several tumors, including hepatocellular carcinoma, gastric cancer, breast cancer and glioma. However, the biological function and gene of MTA2 in cervical cancer remained unknown. Therefore, this study was to examine the biological function of MTA2 on cervical cancer. Immunohistochemistry, western blotting and RT-PCR results shown MTA2 protein and mRNA expression are higher in SiHa and HeLa cells than in C33A cells, and cervical cancer tissue correlated significantly with tumor differentiation and tumor grade. Using boyden chamber motility assay demonstrated that the effect of MTA2 depletion were inhibited metastasis ability, but not involved of the cells proliferation by MTT assay and flow cytometer analysis. Furthermore, the proteinase array indicated the MTA2 knockdown in SiHa and HeLa cells decreased MMP12 protein and mRNA levels. The western blot data shown knockdown of MTA2 were promoted ASK-1, MEK-3, p38/MAPK signaling pathway activation and inhibited the expression of MMP12, as demonstrated by the treatment of RNA interference (siRNA) or phospho-p38 inhibitor (SB203580). Moreover, Western blotting showed that konckdown of MTA2 expression may elevate levels of miR-7 and reduce Sp-1 protein expression. The protein levels of Sp1 were upregulated after transfection with miR-7 inhibitor that reversed cell metastasis and invasion in HeLa and SiHa cells. In addition, in vivo studies using tail intravenous injection in mice models indicated that MTA2 knockdown significantly inhibited metastasis to lung. These results demonstrated that MTA2 plays an important oncogenic role in the metastasis of cervical cancers and may open interesting perspectives to the strategy in human cervical cancer treatment.

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Prediction model for 30-day morbidity after gynecological malignancy surgery Soon-Beom Kang, Seung-Hyuk Shim, Sun-Joo Lee, Soo-Nyung Kim Konkuk University School of Medicine, Seoul, Republic of Korea Objective: The potential risk of postoperative morbidity is important for gynecologic cancer patients because it leads to delays in adjunctive therapy and additional costs. We aimed to develop a preoperative nomogram to predict 30-day morbidity after gynecological cancer surgery. Methods: Between 2005 and 2015, 533 consecutive patients with elective gynecological cancer surgery in our center were reviewed. Of those patients, 373 and 160 patients were assigned to the model development or validation cohort, respectively. To investigate independent predictors of 30-day morbidity, a multivariate Cox regression model with backward stepwise elimination was utilized. A nomogram based on this Cox model was developed and externally validated. Its performance was assessed using the concordance index and a calibration curve. Results: Ninety-seven (18.2%) patients had at least one postoperative complication within 30 days after surgery. After bootstrap resampling, the final model indicated age, operating time, and serum albumin level as statistically significant predictors of postoperative morbidity. The bootstrap-corrected concordance index of the nomogram incorporating these three predictors was 0.656 (95% CI, 0.608-0.723). In the validation cohort, the nomogram showed fair discrimination [concordance index: 0.674 (95% CI = 0.619-0.732] and good calibration (P = 0.614; Hosmer-Lemeshow test). Conclusion: The 30-day morbidity after gynecologic cancer surgery could be predicted according to age, operation time, and serum albumin level. After further validation using an independent dataset, the constructed nomogram could be valuable for predicting operative risk in individual patients.

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Impact of adjuvant hysterectomy on prognosis in patients with locally advanced cervical cancer treated with definitive concurrent chemoradiotherapy: a meta-analysis Seung-Hyuk Shim, Soon-Beom Kang, Sun-Joo Lee, Soo-Nyung Kim Konkuk University School of Medicine, Seoul, Republic of Korea Objective: We investigated the effect of adjuvant hysterectomy (AH) on prognosis in locally advanced cervical cancer (LACC) patients treated with concurrent chemoradiotherapy, through meta-analysis. Methods: EMBASE and MEDLINE databases and the Cochrane Library were searched for published studies comparing LACC patients who received AH after chemoradiotherapy with those who did not, through April 2016. Endpoints were mortality and recurrence rates. For pooled estimates of the effect of AH on mortality/recurrence, random-or fixed-effects metaanalytical models were used. Results: Two randomized trials and six observational studies (AH following chemoradiotherapy, 630 patients; chemoradiotherapy, 585 patients) met our search criteria. Fixed-effects model-based meta-analysis indicated no significant difference in mortality between the groups [odds ratio (OR) = 1.01, 95% confidence interval (CI): 0.58-1.78, P = 0.97] with low cross-study heterogeneity (P = 0.73 and I2 = 0). This pattern was observed in subgroup analysis for study design, radiation type, response after chemoradiotherapy, and hysterectomy type. The pooled OR for AH and recurrence was 0.59 (95% CI: 0.44-0.79, P < 0.05) with low cross-study heterogeneity (P = 0.289 and I2 = 17.8), favoring the AH group. However, this pattern was not observed in the subgroup analysis for the randomized trials. There was no evidence of publication bias. Conclusion: In this meta-analysis, AH following chemoradiotherapy did not improve survival in patients with LACC, although it seemed to reduce the risk of recurrence. Concerning the significant morbidity of AH after chemoradiotherapy, routine use of AH should be avoided.

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Prognostic significance of pretreatment leukocyte alterations in patients with epithelial ovarian cancer Naoko Komura, Seiji Mabuchi, Eriko Yokoi, Katsumi Kozasa, Hiromasa Kuroda, Michiko Kodama, Kae Hashimoto, Kenjiro Sawada, Tadashi Kimura Osaka University, Osaka, Japan Objective: Leukocyte alterations including leukocytosis, neutrophilia or elevated neutrophil to lymphocyte ratio (NLR) have been occasionally observed and been associated with disease severity and poor prognosis in human malignancies. However the prognostic significance of leukocytosis or elevated NLR in ovarian cancer patients remains unclear. We conducted a retrospective study to investigate the prognostic significance of pretreatment leukocytosis and elevated NLR in patients with epithelial ovarian cancer. Methods: Clinical data from 344 epithelial ovarian cancer patients treated with operation and/or chemotherapy from April 2007 to March 2016 were collected, and retrospectively reviewed. Leukocytosis, neutrophilia or elevated NLR were defined as leukocyte count exceeding 10 000/ml, neutrophil count exceeding 8000/ml or NLR exceeding 4.0. Univariate or multivariate analysis was employed to evaluate the association between pretreatment leukocytosis, neutrophilia or elevated NLR and staging, rate of optimal surgery and progression-free survival (PFS). Results: Leukocytosis (24 cases), neutrophilia (24 cases) and elevated NLR (142cases) were found to be associated with short PFS (log-rank: P < 0.005). Elevated NLR was associated with advanced clinical stage (p < 0.0001) and decreased optimal surgery ratio (P = 0.0011). Multivariate analysis demonstrated that leukocytosis, neutrophilia and elevated NLR were predictive of short PFS (hazard ratio: leukocytosis 3.00 [1. 36-5.93 Results: Histological types were serous carcinoma (n = 42), CCC (n = 12), endometrioid carcinoma (n = 15), mucinous carcinoma (n = 53), and undifferentiated carcinoma (n = 6). The prevalence of VTE was significantly higher in CCC (34%) than in non-CCC (17%, P = 0.03). As ITFE increased, the frequencies of CCC and VTE increased significantly (P < 0.001 and P = 0.014, respectively). Multivariate analysis identified TF expression and pretreatment dimerized plasmin fragment D level as significant independent risk factors for VTE development. These factors showed particularly strong impacts on advanced-stage disease (P = 0.021). Conclusions: The 2007 cohort was small, preventing multivariate analysis. This study of a larger cohort yielded stronger evidence that the development of VTE in epithelial ovarian cancer may involve TF expression in cancer tissues.

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Prognostic significance of endomyometrial and parametrial infiltration with positive surgical margin in lymph node-negative FIGO stage IB-IIA cervical cancer treated with radical hysterectomy Tae Introduction: Abnormal vaginal bleeding is very common in daily gynecological practice, either pre-or postmenopausal women, and is a leading sign and symptom of both benign and malignant pathology. As high incidence of cervical and endometrial cancer, in Thailand, fractional curettage including endocervical curettage (ECC) and endometrial curettage is recommended for diagnosis of cervical malignant histopathology. Objective: To evaluate of ECC in diagnosis of malignant pathology in patients with abnormal vaginal bleeding. Methods: After approval from Siriraj Institutional Review Board (SIRB), the retrospective chart review between January 2008 and June 2016 was performed. The inclusion criteria was all patients aged of 35 or more who had abnormal vaginal bleeding and had fractional curettage. Patients with known gynecologic malignancy, and incomplete data were excluded. Results: A total 1296 charts were included in this study. Only 12 patients (0.9%) had detected as malignancy from endocervical curettage. 8 patients were finally diagnosed as endometrial cancer with cervical metastasis in 5 of these, 3 patients without prior Pap smear result were finally diagnosed as cervical cancer (1 squamous cell carcinoma, 1 adenocarcinoma and 1 serous carcinoma) and one was finally found to be metastatic adenocarcinoma of colon. The incidence of endometrial cancer was 6% (78 patients) and, finally, 61 patients had surgical staging. About one-fourth of patients (24.6%) demonstrated endocervical metastasis. Consistency of histopathology between ECC and cervical metastasis from final complete surgical staging was weak (Kappa statistic = 0.3). The rate of fail to detect carcinoma of ECC was 66.67%. Conclusion: ECC is not valuable to perform as a routine practice in patients with abnormal vaginal bleeding and should be preserved for only in selected patients.

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Clinical significance of maternal embryonic leucinezipper kinase (MELK) expression and evaluation of OTS167 (MELK inhibitor) in ovarian cancer Yuji Ikeda 1,2 , Sho Sato 1,3 , Akira Yabuno 1 , Shuhei Okabe 1,3 , Satoko Shimoyokkaichi 1,3 , Akiko Iwasa 1,3 , Keiichi Fujiwara 1,3 , Yusuke Nakamura 2 , Kosei Hasegawa 1,3 1 Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan, 2 Section of Hematology/Oncology, Department of Medicine, The University of Chicago, IL, USA, 3 Gynecologic Oncology Translational Research Unit, Project Research Division, Research Center for Genomic Medicine, Saitama Medical University, Saitama, Japan Introduction: We aimed to describe the clinical significance of maternal embryonic leucine zipper kinase (MELK) and explore therapeutic efficacy of MELK inhibitor, OTS167, using ovarian cancer cell line as well as patient derived ovarian cancer cells (PDOCC). Method: mRNA expression of MELK was examined by RT-PCR using 228 samples with epithelial ovarian cancer (EOC). Expression status was compared between tumor locations, normal tissues and tumor, pre-and post-chemotherapy status, and primary and recurrent tumor. Prognostic significances were evaluated by Logrank test. MELK expressions in 11 ovarian cancer cell lines were examined by western blotting, and halfmaximum inhibitory concentration (IC50) values against OTS167 were examined by MTT assay. Cytotoxic effect of OTS167 in 45 PDOCC including 13 derived cells with spheroid formation was evaluated. Result: mRNA of MELK was highly expressed in cases with advanced stage (P = 0.008). High mRNA expression of MELK was significantly associated with shorter progression free survival (P = 0.001) and overall survival (P = 0.097). Relative mRNA expression of MELK was significantly lower in samples with post-chemotherapy (P = 0.0055). In vitro analysis using ovarian cancer cell lines, MELK was highly expressed in 9 of 11 cells and expression levels were inversely correlated with IC50 values of OTS167 (R2 = 0.16). In analysis using PDOCC, administration of OTS167 (10 nM) could significantly suppress the cell survival rate (P = 0.029) even after cell spheroid formation (P = 0.002). Conclusion: MELK was associated with aggressive phenotype and OTS167 has a potential of treatment in ovarian cancer.

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A case report: cellular angiofibroma in the retroperitoneal space during pregnancy Satoko Sasaki, Sari Nakao, Makiko Watanabe, Ayumi Shikama, Nobutaka Tasaka, Manabu Sakurai, Hiroyuki Ochi, Takeo Minaguchi, Toyomi Satoh Faculty of Medicine, University of Tsukuba, Tsukuba, Japan Background: Cellular angiofibroma (CA) is a rare benign mesenchymal neoplasm that occurs equally in both sexes. In females, CA most frequency arises in the vulvovaginal and occurs most often in the fifth decade of life. CA is characterized by small size and usually well-circumscribed margins. We report a clinically atypical and rare case of CA diagnosed during pregnancy. Case Description: A 19-year-old woman was diagnosed as having a giant pelvic tumor (13 cm) besides a normal pregnancy. She underwent magnetic resonance imaging (MRI) at 12 weeks' gestation. The tumor was 16 cm and suspected as aggressive angiomyxoma. At 16 weeks' gestation, her membranes spontaneously ruptured, so she had the delivery with natural labor. She underwent MRI again after delivery. Although the pelvic tumor with abundant blood flow did not grow, infiltration of the tumor to the levator muscle of the anus was suspected. She received surgical resection. The tumor was solid soft and grew caudally in the retroperitoneal space. Part of its surface was adhered, but no invasion was observed. We could almost completely remove the tumor. The size of tumor was 17 cm. It was histologically diagnosed as cellular angiofibroma. Immunohistochemical staining was positive for ER, PgR, focally for h-caldesmon, CD34, and CD99, and negative for s-100. No HMGA2 and RB1 expressions were detected. Based on the above-mentioned results, the case was diagnosed as CA, even though the clinical findings were not typical. The differential diagnosis in this case was aggressive angiomyxoma or angiomyofibroblastoma. Currently, the patient is followed up. Conclusion: The standard management and treatment have not been established yet. To our knowledge, this is the first reported case of CA during pregnancy. Furthermore, our case was a clinically atypical case of CA. We consider this report important to improve the management of the disease.

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The effective of hyperbaric oxygen therapy for late adverse events of radiation therapy in gynecological cancer Murakami Fumihiro, Sakamoto Noritaka, Yoh Takasugi, Tasaki Shingo, Toh Mariko, Fukui Satoko, Kinoshita Miyabi, Ohshima Masayo, Tasaki Kazuto, Yokomine Masato, Kuroda Aki, Shimomura Takuya Department of Obstetrics & Gynecology, St. Mary's Hospital, Kurume, Fukuoka, Japan Introduction: Sometimes late adverse events in radiation therapy suffer from difficulties in its treatment, and often experience cases where it is ineffective even with known conservative treatments. We report on the usefulness of hyperbaric oxygen therapy (HBOT) as a conservative treatment for late adverse events of radiation therapy of cervical cancer. Case presentations: Case 1: A 61-year-old female performed radical surgery for the diagnosis of cervical cancer FIGO stage IB1, and was performed chemoradiotherapy as a postoperative therapy. Followup observation was performed in clinically disease-free state, but chronic intestinal obstruction was repeated from nine months after treatment. Although carried out conservative treatment, but gradually general symptoms such as general fatigue, weight loss, diarrhea and so on worsened. After HBOT was used in combination for conservative treatment, improvement of symptoms such as general condition was recognized, oral ingestion became possible and weight gain was confirmed. The patient had an unremarkable course with no clinical or biochemical evidence of disease recurrence to 18 months after treatment. Case 2: An 83-year-old female performed radiation therapy for the diagnosis of cervical cancer FIGO stage IIIB. Because of complications of early rectal cancer and multiple colon diverticulum, HBOT was used in combination. Adverse events were not observed for 12 months after treatment and no recurrence findings were observed. Conclusion: Although the therapeutic effects of HBOT are common, its treatment indication is still unknown in many cases. HBOT is particularly effective as one of conservative treatments because of the high rate of improvement of ileus, less invasive and no serious side effects than other treatments. 0115 α-mangostin induces apoptosis and enhances cisplatin sensitivity in human cerivcal cancer stem cell Shu-Ching Hsieh 1 , Yi-Hsien Hsieh 2 , Hui-Ling Chiou 1 1 School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan, 2 Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan Cervical cancer is one of the most common female malignancies, and cisplatin-based chemotherapy is routinely utilized in locally advanced cervical cancer patients. α-mangostin is a dietary xanthone that has been shown to have anti-cancer and anti-proliferative properties in various types of human cancer cells. We evaluated the anti-tumor effect of α-mangostin on cervical cancer stem cells (CCSCs), both alone and in combination with cisplatin. In this study, we found that human cervical CSCs cells with α-mangostin exposure resulted in decreased ALDH1 population, CD49f positivity, stemness-related transcription factors (Oct4, Nanog, and Sox2) and induces apoptosis of human CCSCs. Additionally, combination treatment with αmangostin and cisplatin yielded synergistic inhibitory effects in suppressed ALDH1 population, CD49f positivity, stemness-related transcription factors (Oct4, Nanog, and Sox2), loss of MMPs and induced apoptosis of human cervical CSCs cells. Based on our findings, α-mangostin is a promising flavonoid compound targeting the cisplatin-sensitivity cervical cancer stems cells and regulating their stemness, which will be applied as a potential candidate for the development of a cisplatin-sensitivity cervical CSCs agent and combination therapy of human cervical CSCs.

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The distribution and incidence of lymphoceles following lymphadenectomy in patients with gynecologic cancer Soo Youn Song, Ye Won Jung, Jung Bo Yang, Young Bok Ko, Ki Hwan Lee, Heon Jong Yoo Chungnam National University Hospital, Daejeon, Republic of Korea Objectives: To identify the distribution and incidence of lymphoceles following lymphadenectomy in patients undergoing the pelvic lymphadenectomy or pelvic and paraaortic lymphadenectomy for gynecologic cancer. Methods: A total of 86 patients with endometrial, ovarian or cervical cancer underwent pelvic or combined pelvic and paraaortic lymphadenectomy as a primary surgical treatment at single institution from March 2013 to October 2015 and followed up with computed tomography or magnetic resonance imaging. We retrospectively examined the distribution and incidence of lymphoceles after lymphadenectomy. Results: Four to 8 weeks after operation, 27 cases of lymphocele (33.3%) were detected. The incidence of lymphocele after pelvic and paraaortic lymphadenectomy was higher than that after pelvic lymphadenectomy (81.5% and 18.5%, respectively, p < 0.001). The differences of distribution of lymphocyte between pelvic and paraaortic were revealed (75.6% vs 24.4%). We found a statistically significant difference in the incidence of lymphocele between right and left sides (p < 0.012). The incidence of lymphocele of left side was higher than that of right side after pelvic lymphadenectomy (30% vs 70%, respectively, p = 0.038), however, the incidence of lymphocele between right and left sides were not significantly different after paraaortic lymphadenectomy (32.3% vs 67.7%, p = 0.308). Conclusions: The locations where lymphocele was occurred were different after lymphadenectomy for gynecologic malignancy. The incidence of lymphocele in pelvic area is higher than that in paraaortic area after lymphadenectomy for gynecologic cancer. The incidence of left side lymphocele is higher than that of right side lymphocele in pelvic area.

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Primary ewing sarcoma family of tumors arising in the ovary: a case report Yi-Ping Li, Ko-Ping Chang, Wen-Fang Cheng National Taiwan University Hospital, Taipei, Taiwan Background: Ewing sarcoma (EWS) and peripheral primitive neuroectodermal tumor (PNET) comprises the Ewing sarcoma family of tumors (EFT). It is the second most common bone malignancy in children. However, EFT primarily arising in the ovary is extremely rare. Case: We reported a 22-year-old nulliparous woman of primary ovarian EFT with initial presentation of 3 cm teratoma-like ovarian tumor, which rapidly progressed to a 15 cm tumor with liver metastasis in 3 months. She received suboptimal debulking surgery and salvage chemotherapy with vincristine, doxorubicin, cyclophosphamide (VDC) alternated with ifosfamide and etoposide (IE). Conclusion: Primary ovarian EFT was extremely rare. Accurate diagnosis could be made by the combination of immunohistochemical and molecular cytogenetic studies. There was no consensus of treatment and it had a highly aggressive behavior and a poor outcome for metastatic disease.

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Metastasis to the iliopsoas muscle from uterine carcinosarcoma: a case report Yumi Ishidera, Kayo Katayama, Go Hirata, Noriko Ando, Hiroshi Yoshida, Hiroyuki Shigeta Yokohama Municipal Citizen's Hospital, Yokohama-shi, Kanagawa-ken, Japan Metastasis of the malignant tumor to the iliopsoas muscle is uncommon. When we looked at the gynecologic cancers, some cases of cervical cancer have been reported, however, only one case of endometrial cancer has been reported to have metastasis to the iliopsoas muscle. Here we report a case of endometrial cancer (carcinosarcoma) which showed metastasis to the iliopsoas muscle. A 68-year-old woman (gravida 2, para 0), suspected to be endometrial cancer stage IB (well-differentiated endometrioid adenocarcinoma), was operated with retroperitoneal endoscopic paraaortic lymphadenectomy, laparoscopic modified radical hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. By pathological examination, she was diagnosed to be uterine carcinosarcoma (stageIIIC1, pT1bN1M0). Metastasis to right-pelvic lymphnode was found and cytology of ascites revealed to be negative. Five cycles of chemotherapy with paclitaxel + carboplatin were performed after surgery. Ten months after the end of chemotherapy, serum CA125 level was shown to be elevated. CT and PET-CT revealed left hydronephrosis and metastatic tumor of left iliopsoas muscle 3 cm in size. Metastasis to the left gluteus maximus muscle was also suspected by MRI. Currently, she was placed the stent in the left ureter and resumed chemotherapy.

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Knockdown of SIM2 enhances radio-resistance and tumor growth by inducing HIF1A in cervical squamous cell carcinoma Kanako Nakamura 1 , Masayuki Komatsu 2 , Fumiko Chiwaki 2 , Yusuke Kobayashi 1 , Kouji Banno 1 , Moito Iijima 1 , Takashi Takeda 1 , Eiichiro Tominaga 1 , Hiroki Sasaki 2 , Mamoru Tanaka 1 , Daisuke Aoki 1 1 Keio University School of Medicine, Shinanomachi, Shinjuku-ku/Tokyo, Japan, 2 National Cancer Center Research Institute, Tukiji, Chuo-ku/Tokyo, Japan Objectives: Development of molecular diagnostics for predicting therapeutic effect is an urgent issue for cervical cancer patients who receive radiotherapy. We recently demonstrated single-minded family bHLH transcription factor 2 (SIM2) is a biomarker to predict chemoradio-sensitivity in esophageal squamous cell carcinoma (ESCC). The aim of this study was to investigate the function of SIM2 and its clinical usability as a biomarker for cervical squamous cell carcinoma (CvSCC) as well as ESCC. Methodology: SIM2 gene expression and overall survival were analyzed using TCGA database. In 5 CvSCC cell lines (SKG-I, SKG-IIIa, BOKU, HCS-2, and CaSki), biological markers which have been reported as radio-resistance markers in CvSCC were assessed by RT-PCR after siRNA knockdown of SIM2. Expression of HIF1A and its target genes were also assessed by quantitative RT-PCR and HIF-1α was evaluated by western blotting under normoxic and hypoxic condition. Moreover, we established SIM2-knockdown SKG-IIIa cell lines and SIM2-overexpressed SKG-I cell line. Cell growth, H2O2 sensitivity and γ-ray sensitivity were assessed under 3D culture in SIM2-knockdown andoverexpressed cell lines. Tumor progression was also evaluated and immunohistochemistry for HIF-1α and CD31 was performed in xenografts. Results: In the database analysis, low SIM2 expression was significantly correlated with poor survival in 248 CvSCC patients (p = 0.0142). SIM2-knockdown increased HIF1A, VEGFA, PDK1 mRNA expression and increased HIF-1α protein level especially under hypoxic condition. SIM2-knockdown significantly increased cell growth, decreased H2O2 and γ-ray sensitivity under 3D culture. Furthermore, SIM2-knockdown increased HIF-1α expression, leading to the enhanced angiogenesis, and promoted tumor growth in a mouse model. On the contrary, SIM2-overexpression suppressed cell growth and enhanced H2O2 sensitivity. Tumor progression was also suppressed in SIM2overexpressed xenografts. Conclusion: SIM2 knockdown enhanced radioresistance and promoted tumor growth via HIF-1α induction in CvSCC. Our results showed that SIM2 can be established as a predictive marker for radio-resistant CvSCC patients.

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Metastasis to the mammary gland from uterine leiomyosarcoma: a case report Michihisa Shiro, Ayaha Matsushita, Naoyuki Iwahashi, Shigetaka Yagi, Yasushi Mabuchi, Sawako Minami, Kazuhiko Ino Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama, Japan Introduction: Metastasis in the mammary gland from extramammary malignancies accounts for 0.3-2.7%. Uterine leiomyosarcoma metastasizing to the breast is extremely rare. We report a case of metastasis to the left mammary gland from uterine leiomyosarcoma. Case: 63 year-old woman, gravida-3 para-2, presented to a breast surgeon in our hospital because she felt a 3 cm tumor in her left breast. Mammography and ultrasound showed a suspicious benign tumor because of the smooth image, but fine-needle aspiration biopsy demonstrated an invasive ductal carcinoma. She was performed PET/CT scan in order to investigate metastatic lesions of other organs. The image of PET/ CT showed possibility of metastases to the liver and lung, and malignant uterine tumor. Gynecologists and breast surgeons performed an operation of transabdominal hysterectomy, bilateral salpingooophorectomy and left mastectomy. Pathological findings showed uterine leiomyosarcoma metastasis to the left mammary gland. After operation, she was given chemotherapy with gemcitabine-docetaxel, but metastatic tumors of the lung and liver was enlarged. She was performed a partial resection of the lung and partial resection of liver. After the operation of 6 months later, recurrent tumors on the right sciatic nerve was revealed by PET/CT. She selected a heavy particle radiotherapy in another hospital. After 4 months later, multiple metastatic tumors to the lung, liver and pelvic organs were revealed. She was given chemotherapy with eribulin. After five course chemotherapy, carcinomatous ascites was uncontrolled. Two years and 4 months after the first operation, she changed hospital nearby home in order to receive best supportive care. Conclusion: Cases of metastasis to the mammary gland from uterine leiomyosarcoma are extremely rare. The image of metastatic tumor of mammary gland by mammography and ultrasound often looks like a benign tumor. It is difficult to diagnose the original malignancies of metastatic tumors in mammary gland by fine needle aspiration.

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Impact of time interval between radical hysterectomy with pelvic node dissection and initial adjuvant therapy on oncological outcomes of early stage cervical cancer Jitti Hanprasertpong, Ingporn Jiamset, Alan Geater, Kittinun Leetanaporn, Thanarpan Peerawong Prince of Songkla, Hatyai, Thailand Introduction: Up to now, there have been no reliable scientific studies examining whether delaying adjuvant therapy after radical hysterectomy with pelvic node dissection (RHND) is associated with poor oncological outcomes of early stage cervical cancer. Neither has the optimal time from radical hysterectomy to initiating adjuvant therapy been examined. Objective: To determine the impact of time interval (TI) from RHND to adjuvant therapy on oncological outcomes in cervical cancer. Methods: The study included 110 stage IA2-IB1 cervical cancer patients who underwent RHND and adjuvant therapy. The patients were divided into 2 groups based on the cut-off points of TI of 4 and 6 weeks, respectively. The associations of TI and clinicopathologic factors with oncological outcomes were evaluated using Cox proportional-hazards regression. Results: The median TI was 4.5 weeks. There were no statistical differences in 5-year recurrence-free survival (RFS) (89.2% vs 81.0%, and 83.2% vs 100.0%) or 5-year overall survival (OS) rates (90.9% vs 97.2%, and 93.2% vs 100.0%) between patients according to TI (≤4 vs >4, and ≤6 vs >6 weeks, respectively). Histology (P < 0.001), deep stromal invasion (P = 0.016) and parametrial involvement (PI) (P = 0.001) were identified as independent prognostic factors for RFS, while prognostic significance of TI for the cut-off point of TI of 4 weeks was evident only among patients with squamous cell carcinoma (HR = 19.2; 95% CI = 1.7-221.0; P = 0.018). Univariate analysis showed that only tumor size (P = 0.023), and PI (P = 0.003) were significantly associated with OS. Conclusion: Delay in administrating adjuvant therapy more than 4 weeks after RHND in early stage squamous cell cervical cancer results in poorer RFS.

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The clinical and economic impact of school-based nine-valent human papillomavirus vaccine on female in Malaysia Yin-Ling Woo 1 , Tun-Ying Hsu 2 , Andrew Pavelyev 3 , Amit Kulkarni 4 1 Department of Obstetrics and Gynaecology, UM Medical Centre, Kuala Lumpur, Malaysia, 2 Medical Affairs, MSD Pharma (Singapore) Pte. Ltd, Singapore, 3 HCL America Inc, Sunnyvale, USA, 4 Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, USA Introduction: Cervical cancer (CC) is the third common cancer for females in Malaysia. Human papillomavirus (HPV) has been shown to be associate. With low cytology screening rate(22%) in Malaysia, prophylactic HPV vaccination needs to be considered for adolescents. Objectives: To examine the epidemiological and economic impact of a nine-valent HPV(6/11/16/18/ 31/33/45/52/58) vaccine program for adolescent females in Malaysia.
Methodology: Using Malaysian data, a previously validated HPV dynamic transmission model was adapted for a school-based vaccination strategy: ninevalent HPV vaccination (three-dose) for 13-year-old girls with 90% coverage. This strategy was compared against bivalent (16/18) and quadravalent (6/11/16/18) HPV vaccination (with ongoing cytology screening), for clinical (incidence of CC, CC mortality, cervical intraepithelial neoplasia (CIN) and genital warts) and economic outcomes. Time horizon was set at 100 years and a discount rate was 3%. Results: Compared to the bivalent and quadravalent HPV vaccination, a nine-valent vaccination program for 13-year-old females in Malaysia would result in an additional reduction of 16/18 related CIN 1 by 50.6%, CIN 2/3 by 48.4%, CC by 35.4%, and CC mortality by 30.3%, due to incremental protection against the additional serotypes of HPV in the nine-valent vaccine. Furthermore, compared to bivalent HPV vaccination, HPV 6/11 related CIN1 would be reduced by 73.3%, and genital warts would be reduced by 78.6% (female) and 65.5% (male). Over 100 years, disease management cost would be reduced by 41.9% (vs bivalent) and 5.1% (vs quadravalent). The incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year gained was negative (cost-saving) compared to bivalent vaccination and RM$3616 compared to quadravalent vaccination. The cost-effectiveness threshold for Malaysia is RM $111996 as three times of GDP per capita in 2015. Conclusion: The nine-valent HPV vaccination for 13-year-old females is very cost-effective regardless the comparators and provides additional reduction in CC, CC deaths, and other HPV-related diseases in Malaysia.

0148
Late recurrence of early stage cervical cancer more than 3 years after radical hysterectomy with pelvic node dissection Jitti Hanprasertpong, Ingporn Jiamset Prince of Songkla University, Hatyai, Thailand Introduction: The survival rates of early stage cervical cancer patients after radical hysterectomy with pelvic node dissection (RHND) are good. Nevertheless, 10-18% of patients had disease recurrence, the majority of recurrences develop in the first 2-3 years after treatment, in some patients, recurs after 3 years later. In the past, there have been a few studies of late recurrence of cervical cancer. The incidence and outcomes of late recurrence, which would justify longterm follow-up, is not well addressed and no independent risk factors specific for late recurrence have been examined. Objective: The aim of this study was to evaluate the clinicopathologic characteristics and outcomes of patients who developed late recurrence (>3 years) of early stage cervical cancer after RHND compared with those of patients who developed early recurrence (≤3 years). We also aimed to identify the risk factors of late recurrence. Methods: Between 1999 and 2015, records of 515 early stage cervical cancer patients were reviewed. Fifty-three patients developed recurrence, 35 early and 18 late. The clinicopathologic characteristics and outcomes were compared between these 2 groups. Of the 515 patients, 307 patients who remained tumor-free for at least 3 years after RHND were reviewed. Results: No significant differences were found in clinicopathologic characteristics and clinical outcomes between the 2 groups with regard to age, stage, histology, tumor size, lymphovascular space invasion, stromal invasion, parametrial involvement, node status, vaginal margin, preoperative blood testing, adjuvant therapy, symptom status at recurrence, site of recurrence or survival after recurrence. Late recurrence was detected in 18 of the 307 patients (5.9%). Only node status and deep stromal invasion (DSI) were independently associated with late recurrence. Conclusion: Lymph node metastasis and DSI are risk factors for late recurrence. Careful long-term follow-up is needed, particularly in cases with lymph node metastasis and/or DSI.

0150
A case of Meigs' syndrome with concomitant massive ascites and a huge pelvic mass Mai Orita, Mariko Jitsumori, Mariko Hashimura, Anna Umeda, Satoshi Nakagawa, Ayako Hosoi, Kumiko Kazumi, Kazuya Miyanishi, Toshiya Yamamoto Sakai City Medical Center, Sakai, Osaka, Japan A 62-year-old, nulligravida woman visited a local hospital owing to dyspnea. She had massive ascites, because of which abbominocentesis was performed; 11 L of ascites was drained. Computed tomography (CT) revealed a huge pelvic mass; therefore, she was referred to our department. Her CA125 and D-dimer levels were elevated (583 U/mL and 29 μg/mL, respectively). Enhanced CT revealed bilateral pleural effusion, massive ascites, and a solid left ovarian tumor, 18 cm in diameter; ovarian cancer was highly suspected. Neoadjuvant chemotherapy was planned and cytological examination was performed. Cytology of the both pleural effusion and ascites yielded negative results; therefore, laparotomy was performed. Fibroma was pathologically diagnosed during surgery. Pleural effusion and ascites disappeared soon after surgery and did not relapse. A final pathological diagnosis of fibroma and Meigs' syndrome was confirmed.

0151
A case of pseudo-Meigs' syndrome caused by primary ovarian cancer Mariko Hashimura, Mariko Jitsumori, Anna Umeda, Satoshi Nakagawa, Ayako Hosoi, Kumiko Kazumi, Kazuya Miyanishi, Toshiya Yamamoto Sakai City Medical Center, Sakai, Osaka, Japan We report a rare case of pseudo-Meigs' syndrome caused by primary ovarian cancer. A 51-year-old woman with a history of hysterectomy due to uterine fibroma presented at a local clinic because of cough and dyspnea. Computed tomography (CT) revealed massive pleural effusion in the right chest. She was subsequently referred to the Department of Respiratory Medicine in our hospital. Cytology of the pleural effusion yielded negative results. She was referred to the Department of Obstetrics and Gynecology because CT revealed a huge pelvic mass (20 cm in diameter) and ascites. She was diagnosed with ovarian cancer and laparotomy was subsequently performed. Cytology of the ascites yielded positive results and pathological diagnosis of a pelvic mass was endometrioid adenocarcinoma. The clinical diagnosis was stage IIB ovarian cancer. Pleural effusion disappeared soon after surgery and did not relapse. We concluded that this case was of pseud-Meigs' syndrome caused by primary ovarian cancer.

0152
A case of stage IB ovarian cancer which para-aortic lymphadenopathy was highly suspected preoperatively with positron emission tomographycomputed tomography Mariko Jitsumori, Mariko Hashimura, Anna Umeda, Satoshi Nakagawa, Ayako Hosoi, Kumiko Kazumi, Kazuya Miyanishi, Toshiya Yamamoto Sakai City Medical Center, Sakai, Osaka, Japan A 38-year-old woman was referred to our hospital from a local clinic because of bilateral ovarian swelling and elevated serum CA125 levels (1213 U/mL). Magnetic resonance imaging revealed bilateral ovarian tumors (right: 4.8 × 6.8 cm; left: 4.0 × 6.3 cm). Positron emission tomography-computed tomography (PET-CT) revealed high accumulation in the para-aortic lymph nodes (Suvmax: 3.4) and in bilateral ovaries (Suvmax: right = 11.4, left = 11.9); laparotomy was subsequently performed. Pathological examination during surgery confirmed the presence of malignant ovarian tumors. Remarkable para-aortic lymph node swelling (10 × 3 cm) was observed. Total hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy, and retroperitoneal lymphadenectomy were performed, and optimal surgery was achieved. Post-pathological diagnosis was endometrioid adenocarcinoma (G3) without lymph node metastasis (0/45). Post-surgical diagnosis was stage IB ovarian cancer. Adjuvant chemotherapy including paclitaxel and carboplatin was administered. Although PET-CT is useful for preoperative estimation of ovarian cancer, staging surgery is essential for precise clinical diagnosis.

0155
Endometrial sarcoma: case report of a rare endometrial malignancy Panagiotis Sarhanis, Arain Sumaira, Christos Spyroulis Northwick Park Hospital, Harrow, UK Introduction: Endometrial sarcoma is a very rare malignancy of the endometrial cavity. It accounts for 0.2% of the totla uterine malignancies. But, despite being very rare disease, it has high incidence of recurrence, which can occur even 20 years after the initial presentation of the disease. We present a case of endometrial sarcoma and we highlight the importance of MDT discussion for the management of this disease. Case presentation: A 56 year old woman referred by her GP to the RAC of NPH due to a 3 day episode of postmenopausal bleeding. She was seen on 15th of November in the RAC of NPH by the Oncology lead. Prior to the clinic appointment she had an ultrasound scan, the endometrial thickness of which was 26 mm and a mass in the posterior uterine wall which was characteristic of a fibroid. A pipelle biopsy was attempted in the clinic, but without success. She was booked for a diagnostic hysteroscopy with endometrial biopsy. On 28th of November, she had a hysteroscopy which shown a large polypoid lesion at the lower uterine wall and a large fiboid in the endometrium. A resectoscope inserted to remove the fibroid, but without success due to the large polyp at the lower wall which obstructed the passage. We removed with a tissue forceps multiple pieces of the polyp and sent them for histology. Histology confirmed the presence of low grade endometrial sarcoma. She had an MRI of the pelvis on 29th of November which didn't show metastasis to adjacent structure. We discussed the case in MDT and we decided for a TAH + BSO in a tertiary unit (Hammesrmith hospital) Discussion: The treatment of choice is surgery and due to high recurrence rate, the follow-up needs to be thorough and extend to the 5 year period (once/year) 0156 Anti-cancer effect of ulipristal acetate in uterine leiomyosarcoma Jeong-Won Lee 1 , Ji Eun Hong 1 , Ji-Hye Kim 1 , Chel Hun Choi 1 , Byoung-Gie Kim 1 , Duk-Soo Bae 1 , Woo Young Kim 2 1 Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea, 2 Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Objectives: Although uterine leiomyosarcoma (LMS) is an aggressive tumor associated with a high risk of recurrence, current radiotherapy and chemotherapy is limited role in the treatment. Therefore, the introduction of a new therapy for LMS of the uterus is urgently needed. Ulipristal acetate (UPA, selective progesterone receptor modulator) is used for pre-operative treatment of moderate to severe symptoms of uterine fibroids because UPA-treated fibroids shown about inhibition of proliferation and induction of apoptosis and remodeling of the extracellular matrix. However, anticancer effect of LMS has not yet been reported. This study was designed to investigate preclinical efficacy of UPA as anti-cancer agent in LMS cells. Methods: We treated UPA in human LMS cells including SK-UT-1 and MESSA to evaluate the effect on cell proliferation using MTT assay. To check the apoptosis according to UPA treatment, we performed ELISA in LMS cells. In addition, in vivo therapy experiments of UPA were done using xenografts using SK-UT-1 and MESSA in nude mice. SK-UT-1 or MESSA cells were injected s.c, into mice (n = 10 per group) and these were randomly assigned to two groups: PBS (control), oral UPA 2 mg/kg once daily. Result: UPA significantly inhibited the cell survival and increased the apoptosis in SK-UT-1 and MESSA cells. In in vivo experiments, UPA significantly decreased the tumor growth in both mice with SK-UT-1 and MESSA cells compared with control (both p < 0.001). Moreover, the immunohistochemical analysis using in vivo tumor samples showed that UPA treated group decreased Ki-67 expression and increased apoptosis revealed by TUNEL assay compared with control. Conclusions: We found that UPA have anti-cancereffects in LMS cells via the action to cell proliferation and apoptosis through in vitro and in vivo tests. Further studies using patient-derived tumor xenograft model and detailed mechanisms of anti-cancer effects for UPA will be needed.

Republic of Korea
Objective: Current standard therapy for cervical cancer is concurrent chemoradiation (CCRT) with weekly cisplatin for the patients with locally advanced disease. However, CCRT with cisplatin still have serious side effects in these patients. The purpose of this study was to determine the capacity of MK-1775, a potent wee-1 inhibitor, to modulate radiosensitivity in cervical cancer cell models including in vitro, cell line xenograft and patient-derived tumor xenografts (PDXs). Methods: We checked the expression of wee1, γH2AX, p-cdc2 Y15 and p-HH3, and cell proliferation after MK-1775 administration in cervical cancer cell lines. Clonogenic survival assay was used to test the radiosensitivity of MK-1775 in cell lines. Moreover, we performed the in vivo therapy experiments for the combination of irradiation and MK-1775 in cell line xenograft and PDX subcutaneous models. Irradiation and MK-1775 treatment were started when the average tumor volume reached 100 mm3. X-rays (2 Gy x 3 days) were delivered locally to the tumor-bearing legs of anesthetized mice. MK-1775 (60 mg/kg) was administered orally 1 h before irradiation for 3 days. Results: In clonogenic survival assay, MK-1775 and irradiation significantly decreased cell survival compared with radiation alone in both cells. MK-1775 decreased the phosphorylation of cdc2Y15, co-treatment caused DNA damage with increased γH2AX expression and increased the expression of p-HH3 compare with radiation alone. Therefore, we found that MK-1775 abrogates the radiation-induced G2 arrest. In cell-line xenograft with SiHa cells, co-treatment significantly decreased the tumor volume compare with control, MK-1775 alone or radiation alone group. Moreover, we confirmed same effects in two PDX models for cervical squamous carcinomas. Conclusion: These results indicate that human cervical cancers are significantly radiosensitized by the potent and selective wee1 kinase inhibitor, MK-1775, in both the in vitro and in vivo models including PDX. Introduction: Uterine cervical cancer is the most common primary gynecologic malignant disease in Japan. Conventional cervical testing has been shown to be extremely effective in reducing cervical cancer incidence and mortality. However, early cervical neoplasms and invasive cancers have been increasing gradually in young women. The population with cervical cancer screening experience is quite low compared to other developed countries. Objectives: We studied the status of uterine cervical cancer screening in annual company checkups and clarified problems. Methodology: Questionnaires were sent to occupational health physicians through Sansuiken (Alumni association of UOEH). Overall, 127 valid responses showed that cervical cancer screening has been conducted in 100 companies (79%; including health insurance society). We obtained detailed information from 50 among 100 responses. Results: Mandatory cervical Pap tests are conducted at just 6 companies (12%) and annual Pap tests at 35 of 48 (73%). Only 18 of 49 companies (37%) start Pap tests for employees 20 years old, and Pap test is started at 30 years at 9 of 49. Of the 31 294 of 86 695 women (36%) screened for cervical cancer, abnormal Pap smear results were found in 3.0%. The cervical cancer screening rate have been increasing compared to our previous studies (17% in 2004, 23% in 2008). Colposcopy and punch biopsy were conducted in Gynae-oncology © Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
Copyright of individual abstracts remains with the authors.
70% (61 of 87 women) of those with abnormal results. Twelve of 26 companies had no information about detailed examination results. Conclusion: Uterine cervical cancer screening by companies is very useful because of growth in the female working population. Physicians at companies should therefore survey female health care by including uterine cervical cancer screening. It is important to notice an information that cervical cancer incidence and mortalities are increasing among young women in Japan.

0160
Current practices of cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy in treatment of peritoneal surface malignancies: an international survey of oncologic surgeons Han-Na Lee, Young-Bok Ko, You-Jin Kim, Yong-Joong Song, Myong-Cheol Lim, Sang-Yoon Park, Heon-Jong Yoo Chungnam National University Hospital, Daejeon, Republic of Korea Background: The goal of the current study was to investigate current clinical practice of CRS using HIPEC among tumor surgeons and to respect uncompromising opinions. Method: An online questionnaire was conducted to the corresponding authors who wrote the international paper on CRS with HIPEC and to the member of Korean Society of Peritoneal Surface Malignancies. The questionnaire include 20 general multiple choice questions to access opinions about the analysis of people who join this survey. Result: The response rate was 16% (34/217). The results of our study demonstrate that all of respondents replied the invasion to numerous mesenteries is the most crucial factor that interrupts the right treatment of peritoneal surface malignancies. Most surgeons used a sugarbaker's staging system for measuring the extent of peritoneal invasion during operation. Others (21%) used their own peritoneal carcinomatous index. Sixty five percent of respondents described performing CRS with HIPEC with a closed system. More than half of surgeon demonstrated the infusion temperature of infusing liquid while performing HIPEC is 42°C (53%). Forty eight percent of respondents (13/27) used 90 minutes of HIPEC perfusion time and 30% surgeons (8/27) used 60 minutes. Nineteen percent of respondents (5/27) described 30 minutes of perfusion time. Conclusion: In this study, we found that the invasion to numerous mesenteries is the most crucial factor that interrupts the right treatment of peritoneal surface malignancies. As the surgical experience increases, the factors that interrupt the right treatment of peritoneal surface malignancies might be decreased. These results should be further verified by future studies based on a large prospective cohort.

0161
Prognostic impact of the time interval from primary surgery to start of chemotherapy in advanced ovarian cancer Mayu Shiomi, Kiyoshi Yoshino, Mamoru Kakuda, Aiko Kakigano, Michiko Kodama, Eiji Kobayashi, Kae Hashimoto, Seiji Mabuchi, Yutaka Ueda, Takuji Tomimatsu, Kenjiro Sawada, Tadashi Kimura Osaka University Hospital, Osaka, Japan Objective: Delay of postoperative chemotherapy may cause poor prognosis in ovarian cancer. The aim of the present study was to evaluate whether time interval from surgery to start of chemotherapy (TTC) has an impact on clinical outcome. Methods: We retrospectively studied age, neoadjuvant chemotherapy, residual disease, histology type, TTC from 65 patients with International Federation of Gynecology and Obstetrics stage III or IV ovarian cancer who were treated between January 1, 2011 and May 31, 2015. PFS and OS were analyzed with the Kaplan-Meier method and log-rank test in univariate analyses. In multivariate analyses, cox regression analysis was used to evaluate the effect of prognostic factors expressed as hazard ratios (HR). Results: The median follow-up time was 32 months. The median PFS was 15 months. The 3-years OS was 72%. The median TTC (range) was 29 (11-89) days. The main reason that TTC was more than 30 days was bowel obstruction. Chemotherapy completion rate was 82.5%. In both univariate and multivariate analyses, TTC ( 30 or 30 ≤) was not a significant prognostic factor. In multivariate analyses, only histology type (non-Conclusion: TTC did not have prognostic impact on patients with advanced ovarian cancer in our cases. However, some previous studies reports that the prolongation of TTC is the poor prognostic factor. It is necessary to collect and analyze cases.

0164
Coexistence of adenocarcinoma of cervix and bilateral mucinous cyst adenoma of ovary in a young lady: a rare case report Nazneen Ahmed, Shoyela Shahnaz, Asifa Ali, Rajat Biswas Chittagong General Hospital, Chittagong, Bangladesh Introduction: Synchronous tumours of the ovary and cervix are rarely reported especially tumours of different histopathology. Synchronous multiple primary tumours are comprises only about 0.63% of all genital malignancies. We report a very rare case of coexistent cervical adenocarcinoma with bilateral mucinous cyst adenoma in a young virgin lady. Case report: A 20 years old young unmarried lady presented to our hospital with lump in lower abdomen associated with severe pain. She also complaint of weight loss and anorexia. On physical examination she was found anaemic, abdomen was distended. A tense, tender, immobile and irregular lump about 20x25cm in size was found occupying the lower abdomen. Speculum and digital vaginal examination was not performed. Rectovaginal examination revealed a 3-4 cm firm growth on cervical region. On investigation tuberculin test was negative. CA-125 was 101 U/ml, CEA 11.5 mg/dl. USG suggests a huge multicystic mass in pelvis extending up to upper abdomen. EUA done and biopsy was taken from cervix. Histopathology result showed chronic cervicitis. HPV DNA test was negative. Our preoperative diagnosis was malignant ovarian tumour. Exploratory laparotomy was performed. We found both ovaries about 20x18 cm in size, multicystic, surface was studded with engorged blood vessels. No healthy tissue was found. Uterus was normal in size but cervix was replaced by a growth which anteriorly adhered to bladder and posteriorly adhered to sigmoid colon. After proper counseling the parents subtotal hysterectomy with bilateral sulphingoophorectomy with partial omentectomy was done. Malignant cells were identified in peritoneal fluid cytology. Histopathology report revealed mucinous cyst adenoma of ovary and adenocarcinoma of cervix. She was advised for chemotherapy of 6 cycles with paclitaxel and carboplatin. Conclusion: Our case highlights tumours of different histopathology in a young lady deserve further studies to enhance our knowledge to this rare though potential occurrence.

0168
A rare case of rapidly progressive metastatic vulvovaginal choriocarcinoma following ectopic pregnancy Mishu Mangla 1 , Deepak Singla 2 1 Himalyan Institute of Medical Sciences, Dehradun, India, 2 AIIMS, Rishikesh, India Choriocarcinoma rarely develops following an ectopic pregnancy, although if it does, it is very aggressive and is associated with extensive metastasis. We report a case of 30 years old multipara, admitted with complaints of vulvovaginal mass and shortness of breath 45 days after salpingectomy for ruptured ectopic pregnancy. Beta HCG was 111 314 IU/ml. She was diagnosed as a case of metastatic choriocarcinoma, FIGO stage 4b with WHO prognostic score of 11. She received 5 cycles of chemotherapy for treatment and 2 cycles further to prevent relapse. So, routine beta HCG monitoring even after surgical management of ectopic pregnancy and immunohistochemistry along with histopathology should be done for early diagnosis of such cases so that treatment could be instituted timely thus improving prognosis.

0171
Questionnaire survey on the patient's impression of laparoscopic surgery for gynecologic cancer Go Hirata, Katayama Kayo, Yumi Ishidera, Hiroyuki Shigeta, Hiroshi Yoshida Gynecological Endoscopy and Surgery Center, Yokohama city, Kanagawa Prefecture, Japan Study objectives: To investigate the patient's impression of laparoscopic surgery for gynecologic cancer. Methods: We sent a multiple-choice questionnaire form by mail to the patients who underwent either open or laparoscopic surgery for gynecologic cancer in our department.

0174
A rare case of recurrent ovarian adenocarcinoma metastatic to the pericardium Shiely Mae Llaguno-Mundiz, Constancia Wilhelmina Torres San Pedro Hospital, Davao City, The Philippines Introduction: Ovarian carcinoma is a rare cause of pericardial effusion and has been estimated that only 2.4% of patients with epithelial ovarian carcinoma will develop pericardial involvement. We describe a patient with recurrent ovarian adenocarcinoma who eventually developed malignant pericardial effusion. Objectives: The objectives of this case are to describe the natural history and management of metastatic ovarian adenocarcinoma, to review the pathophysiological mechanisms of cardiac metastasis and to discuss clinical presentation and management of malignant pericardial effusion. Methodology: R.M., a 51-year-old G2P2, was diagnosed with stage IIIA, grade 3 endometrioid adenocarcinoma in 2009 and was treated with adjuvant chemotherapy carboplatin-paclitaxel. In 2013 and 2015, adjuvant chemotherapy was given due to recurrence of disease. In 2016, recurrent disease was once again diagnosed. She had chemotherapy resistant to carboplatin-paclitaxel, thus the treatment plan was modified into gemcitabine and bevacizumab. However, the patient had poor compliance due to financial constraints. One month following treatment cessation, the patient presented a three week history of worsening dyspnea, demonstrating massive pericardial effusion on cardiac echo. Due to impending cardiac tamponade, tube pericardiostomy was performed draining 1.5 L of bloody pericardial fluid, followed by resolution of her symptoms. Pericardial biopsy was positive for malignant cells compatible with metastatic adenocarcinoma. Results: Six weeks later, she presented again with dyspnea, on and off cough and abdominal distention. A cardiac echo demonstrated pleural effusion and trace to minimal pericardial effusion. Chest tube thoracostomy was performed but afforded no relief on patient's condition. Few hours later, the patient had cardiopulmonary arrest and was pronounced dead.
Conclusions: Pericardial effusion is a rare but ominous complication of ovarian cancer. Relief of symptoms and cancer stabilization are the main goals of treatment. Awareness of different etiologies of pericardial effusion and timely diagnosis are essentials to the appropriate management of the case.

0175
Screening of Lynch syndrome using risk assessment criteria and deficiencies of mismatch repair proteins in patients with ovarian cancer Takashi Takeda, Kouji Banno, Megumi Yanokura, Yusuke Matoba, Haruko Kunitomi, Masataka Adachi, Yusuke Kobayashi, Akira Hirasawa, Eiichiro Tominaga, Daisuke Aoki Keio University School of Medicine, Tokyo, Japan Introduction: Lynch syndrome is a cancer predisposition syndrome caused by germline mutation of DNA mismatch repair (MMR) genes MLH1, MSH2, MSH6 and PMS2. It has been reported that about 0.4% of ovarian cancer patients have germline mutation of MMR genes. Amsterdam II criteria do not include ovarian cancer and revised Bethesda Guidelines are mainly focused on colorectal cancer, therefore these criteria are not useful for screening of Lynch syndrome in patients with ovarian cancer. Objectives: We analyzed deficiencies of MMR proteins and microsatellite instability (MSI) in patients with ovarian cancer who met the Lynch syndrome risk assessment criteria of the Society of Gynecologic Oncologists (SGO) for screening, with the goal of investigating the frequency of ovarian cancer in Lynch syndrome. Methodology: The subjects were 130 patients with ovarian cancer who visited our hospital in 2015-2016. After an approval from the ethics committee, written informed consent was obtained. A new selfquestionnaire for family history was prepared to identify cases meeting the SGO criteria. MSI, immunohistochemistry and methylation of MMR genes were analyzed using surgical specimens of these patients. Results: Of the 130 cases, 26 (20.0%) met the SGO criteria for a 5-10% chance of having Lynch syndrome. Three of these 26 cases showed MSI-high and loss of MMR protein: Two cases had loss of MSH2 and MSH6, probably having Lynch syndrome with MSH2 mutation. Another case had loss of MLH1 and PMS2 with methylation of MLH1, indicating sporadic ovarian cancer. These results indicate that risk assessment using SGO criteria may be able to detect Lynch syndrome in 1.5% (2/130) of patients with ovarian cancer, and in 7.7% (2/26) of patients who meet the criteria.
Conclusion: This diagnosis procedure may be useful for screening of Lynch syndrome in patients with ovarian cancer.

0176
Introduction of laparoscopic hysterectomy for endometrial cancer at a public cancer center Yuichiro Miyamoto, Aki Hara, Kensuke Tomio, Kazuko Kubota, Koji Horie, Harushige Yokota Saitama Cancer Center, Saitama, Japan Purpose: Minimum invasive surgery for malignant tumor in gynecology is still more desirable, and laparoscopic surgery for endometrial cancer became covered by health insurance in Japan from 2014. At our hospital, which is a public regional cancer center, total laparoscopic hysterectomy (TLH) for endometrial cancer has been newly introduced. We report on the first five cases treated with this procedure at our hospital. Methods: An application was made to the ethical review board at our hospital for the new procedure. All cases were stage 1a endometrial carcinoma Grade1. In each case, TLH and adnexectomy and pelvic lymphadenectomy was performed. The operative duration, total blood loss, days of hospital stay, total number of dissected lymph nodes, severe operative complication and pre-and post-operative pathological examination were investigated.

Results:
No serious complications occurred postoperatively. The operative duration tends to be longer, but the blood loss and days of hospital stay tend to be favorable, and dissected lymph nodes are the same compaird to open laparotomy method. None of the patients required any further treatment.

Conclusions:
Laparoscopic Hysterectomy for endometrial cancer was successfully introduced in our hospital. Since the long term prognosis is not clear, careful case selection and further investigation is necessary. Gynecologic oncologists who are experienced in open surgery require practice using dry box training to learn suturing and ligature techniques to make the transition from open to laparoscopic procedures.

0188
A new flow-cytometer-based cell analysis platform and its application as the ascitic cytology assist system Takenori Maruta 1 , Yukihiro Hirata 1 , Etsuko Ko 1 , Suguru Odajima 1 , Yuriko Niwa 1 , Naoki Yoshikawa 1 , Akina Tsuda 1 , Satoru Funaki 1 , Hiromi Komazaki 1 , Shigeki Niimi 1 , Shigeki Abe 2 , Takashi Umezaki 3 , Isoko Arasaki 3 , Kazuhiko Ochiai 1 , Aikou Okamoto 4 0196 Cervical cancer screening with VIA in eastern Nepal -3 years analysis Pappu Rijal, Rabindra Bhatta, Shailaja Chhetri, Tarun Pradhan, Ajay Agrawal BPKIHS, dharan, Nepal Cervical cancer is responsible for 275 000 deaths annually, about 88% of which occurs in developing countries. The high mortality in developing countries is the lack of effective screening programs. Visual inspection of the cervix (VIA) after acetic acid application is believed to be an effective method for screening in resource-limited settings. In Nepal as per National Cancer Registry Programme, shows that cervical cancer accounts for 21.4% of all cancers in women and is the second most common cancer in women. Aims and objectives: to estimate the VIA positivity rate our population and see the efficacy of the treatment with cryotherapy during follow up after treatment. Materials and methods: a retrospective analysis of all VIA test from March 2012 to April 2015 were analyzed to estimate the VIA positivity rate of the screened population. Guidelines for screening were as according to the national guidelines 2010 of Nepal. Mobile screening camps were conducted in remote areas and screening was carried out. Results: A total of 12 444 clients were screened during the study period. More than 98% had been screened for cervical cancer for the first time, complications following cryotherapy was low. The VIA positivity rate was 5.9%. Out of those positives 639 were treated with cryotherapy, 78 with LEEP, 23 rejected any form of treatment, during the follow up at the end of one year 618 were found to be VIA negative, 90 lost to follow up, 9 were found to be positive. Repeat VIA positivity rate at the end of one year during follow up was 1.2%. Conclusion: Screening for cervical cancer with VIA and treatment with cryotherapy is a feasible and acceptable form of screening in our setup. Organized screening system could be beneficial to save the lives of many women.

0201
Cervical cancer in pregnancy: a case report Freddy Wagey, Bismarck Laihad, Agustina Tobing Sam Ratulangi University, Manado, North Celebes, Indonesia Introduction: Cervical cancer is one of the most devastating conditions that can complicate a pregnancy. Cervical cancer during pregnancy is relatively uncommon. Type of treatment needs to be individualized and depends on gestational age, disease stage, and patient choice regarding definitive treatment. Extensive counseling regarding the maternal and foetal risks is required. Radical surgery is the treatment of choice for the early stages of disease. Objective: The management of cervical cancer in pregnancy Method: Case Report Results: A 37 years old gravida 3 para 2 abortus 0 referrred from obstetrician and gynecology with diagnose stage II A of Cervical cancer with gestational age 7-8 weeks. After counseling regarding the maternal and foetal risk, Radical Histerectomi was performed. The histopathologic finding revealed carcinoma in situ of the cervix uterine and the intrauterine foetus. Conclusion: The management cervical cancer in pregnancy is determined by gestational age, the stage of disease and patient choice regarding definitive treatment. Radical surgery is the treatment of choice for the early stages of disease. Keywords: Cervical cancer, Pregnancy, Radical Histerectomi.

0203
Laparoscopic surgery for obese endometrial cancer patients Kayo Katayama 1 , Hiroshi Yoshida 2 , Go Hirata 2 , Yumi Ishidera 2 , Yuka Oi 2 , Haruya Saji 1 , Hiroyuki Shigeta 2 1 Fujisawa City Hospital, Fujisawa, Japan, 2 Yokohama Municipal Citizen's Hospital, Yokohama, Japan Introduction: Obese women are known to have higher risk (2~10 times) of endometrial cancer than non-obese women. Obese women tend to have type 1 endometrial cancer which is generally well differentiated and estrogen dependent. Because this type of endometrial cancer tends to be found in its early stage, laparoscopic surgery seems to be important for the treatment of endometrial cancer. Objectives and methods: Thirty eight patients who underwent laparoscopic surgery for early stage endometrial cancer are included in this study. The results of surgery are compared between obese patients (BMI more than 35, n = 4) and non-obese patients (BMI less than 35, n = 34). Results: No complications were observed during and after the surgery such as an infection of the wound, diastasis and ileus in all patients. All obese patients had Diabetes. The difference was not significant in operation time, bleeding amount and the number of lymph nodes extracted between obese patients and non-obese patients who underwent Total Laparoscopic modified Radical Hysterectomy + Bilateral Salpingo-oophorectomy + Pelvic Lymphadenectomy (TLmRH + BSO + PLA). However, significantly longer operation time and increased blood loss were noted in obese patients compared to non-obese patients who underwent TLmRH + BSO without lymphadenectomy. Conclusions: It is suggested that longer operation time and increased blood loss are needed for the laparoscopic hysterectomy of obese patients compared to non-obese patients. Although it is sometimes difficult to maintain a field of view in laparoscopic surgery for obese patients, it can be performed safely by the addition of the trocars which hold and tow a uterus and using a device which tows and fixes a bladder and the colon to an abdominal wall.

0223
Comparison of survival outcomes in epithelial ovarian cancer patients with and without normal-sized ovary carcinoma syndrome: a propensity-score matching study E-Sun Paik, Hyun-Jin Choi, Ju-Young Park, Ji-Hye Kim, Myeong-Seon Kim, Min-Jeong Yun, Chel-Hun Choi, Jeong-Won Lee, Byoung-Gie Kim, Duk-Soo Bae Samsung Medical Center, Seoul, Republic of Korea Objective: Normal-sized ovary carcinoma syndrome (NOCS) is an ovarian cancer with ovaries being of normal size, accompanied by diffuse metastatic disease of the peritoneal cavity. We aimed at comparing survival outcomes of EOC patients with and without NOCS by propensity score matched analysis. Methods: The clinical records of EOC patients treated at Samsung Medical Center between 2002 and 2015 were retrospectively reviewed. We identified 430 EOC patients with serous type histology and FIGO stage III and IV who underwent primary debulking surgery and adjuvant chemotherapy. A propensity score match was performed to compare 87 patients with NOCS to 87 patients without NOCS according to age, FIGO stage, initial CA-125 level, residual disease status after primary debulking surgery, pelvic lymph node status and paraaortic lymph node status. Results: The matching was successful without significant differences between the two groups in all matched variables. After matching, there was no significant differences in progression-free survival (PFS) and overall survival (OS) between group with and without NOCS (median PFS,24.8 vs. 20.8 months,p = 0.384,median OS,68.6 vs. 57.0 months,p = 0.359). Conclusions: The current study among matched patients indicates there are no statistically significant survival differences between EOC patient with and without NOCS. Further investigations are needed for more information. The primary outcome of this study was to evaluate the surrogacy of PFS for OS by clinical variables. Correlation analyses with all pair-wise comparison were performed to assess the association of PFS and OS for each clinical variable. After multivariate analysis for PFS and OS, scatter plot with hazard ratio (HR) (with 95% CI) of PFS and OS were drawn for clinical variables. Results: Of the 1134 EOC patients, 611 (53.9%) experienced relapse and a further 417 (36.8%) died within a median follow-up period of 47 months (range, 3~177 months). For entire cohort, there is a significant linear correlation between PFS and OS (p-value <0.0001), and the degree of correlation is high (Spearman correlation coefficient = 0.8243). In Z-test using Fisher's transformation, patients with early stage (I, II) (0.9059, p < 0.001), lower grade (0.9019, p < 0.001), and non-serous histology (0.8853, p < 0.001) showed higher correlation coefficient. In patients with no residual disease (0.8661, p < 0.001), no pelvic lymph node metastasis (0.8275, p < 0.001), no paraaortic lymph node metastasis (0.8267, p < 0.001), higher correlation coefficient was shown. In scatter plot for HR of PFS and OS, presence of residual disease, high grade, neoadjuvant chemotherapy, lymph node metastasis were not located within estimated regression area implicating low correlation coefficient. Conclusions: The treatment effect on OS is largely predictable according to that on PFS in EOC, especially for patients with early stage, low grade, non-serous, no residual disease, without lymph node metastasis.

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The prognostic role of preoperative neutrophillymphocyte ratio and platelet-lymphocyte ratio in early-stage cervical cancer Prachratana Nuchpramool, Jitti Hanprasertpong Prince of Songkla University, Hatyai, Songkhla, Thailand Introduction: At present, inflammation mediators (such as chemokines, cytokines, prostaglandin), C-reactive protein, neutrophil-lymphocyte ratio (NLR) or plateletlymphocyte ratio (PLR) are prognostic factors in several types of cancer including ovarian cancer, and endometrial cancer. However the prognostic role of NLR and PLR on clinical outcomes of cervical cancer still controversy especially in early stage. Objective: To evaluate the prognostic role of preoperative NLR and PLR in predicting oncologic outcomes in stage IA2-IB1 cervical cancer patients after RHPLD.
Methodology: This study included 484 early stage cervical cancer patients who underwent RHPLD from 2001 to 2016 at Songklanagarind Hospital. Preoperative NLR, PLR and clinicopathologic features were analyzed to find factors relevant to the OS and DFS. Results: The 5-year OS and 5-year DFS were 88.3% and 96.9%, respectively. The median of NLR and PLR of 1.8 and 119, respectively, were the cut-off values. The independent factors associated with OS were age (p = 0.005), parametrial involvement (p = 0.039), node positive (p = 0.014), and anemia (p = 0.015) and DFS were histological cell type (p = 0.001), deep stromal invasion (p = 0.001), and node positive (p = 0.013). High NLR significantly correlated with age (p = 0.011), tumor size >2 cm (p = 0.045), and patients who received adjuvant treatment (p = 0.038). Only patients who received adjuvant treatment were significantly related with high PLR. Conclusion: This study reveals no statistically significant NLR and PLR that predict oncological outcome of early stage cervical cancer after RHPLD.

0230
Is pelvic lymphadenectomy always necessary for selected early stage cervical cancer? Kulisara Nanthamongkolkul, Jitti Hanprasertpong Prince of Songkla University, Songkhla, Thailand Background: Early-stage cervical cancer (stages IA2-IB1) has a low incidence of lymph node metastasis (LNM). The pelvic lymphadenectomy, which is the routine surgical treatment, causes serious morbidities. Several studies have tried to determine low risk patients for which the pelvic lymphadenectomy can be omitted, but the results have been inconsistent.
Objective: To identify potential clinicopathological risk factors of lymph node metastasis in early-stage cervical cancer. Methods: The study included 496 patients diagnosed with stages IA2-IB1cervical cancer who underwent a radical hysterectomy with pelvic lymphadenectomy. The potential risk factors of LNM were evaluated. Results: The incidence of LNM in this cohort was 4.84% (24/496). LNM was more common in patients with deep stromal invasion (DSI), tumor size >2 cm, lymph vascular invasion (LVSI) and parametrial involvement (PI). Multivariate analysis showed DSI (P = 0.004) and PI (P = 0.008) were independently associated with LNM. Conclusion: Da Vinci robotic surgical operating system applied in radical hysterectomy is safe, feasible, patients trauma with small, fast recovery, worthy of clinical popularization and application.

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The significance of preoperative serum cancer antigen 125 in malignant ovarian germ cell tumors Ju-Hyun Kim, Jeong-Yeol Park Asan Medical Center, Seoul, Republic of Korea Objective: To determine the prognostic value of preoperative serum cancer antigen 125 (CA 125) in malignant ovarian germ cell tumors (MOGCTs). Methods: Using information from medical databases, we investigated 161 patients with histologically diagnosed MOGCTs between 1993 and 2014. We chose the optimal cut-off value of CA 125 by using a receiver operating characteristic (ROC) curve. Results: The median patient age was 24 years (range, 6-52 years). The most common histologic type was immature teratoma. Forty-eight patients had a normal range of serum preoperative CA 125(<35 U/mL). Most patients had stage I disease. Fertility-sparing surgery was performed for 138 patients, and staging surgery in 118 patients. The median tumor size was 15 cm. Ninety-four patients had ascites at surgery. Spillage of the tumor was observed in 51 patients. Fourteen patients had positive cytology, 12 had lymph node metastasis, and 61 patients had ovarian surface involvement. Six patients had residual tumors. We determined the reference level of CA 125 (>78 U/ mL) using a ROC curve. On univariate analysis, lymph node metastasis, positive cytology, ascites, ovarian surface involvement, tumor rupture, age, tumor size, and stage were significantly associated with elevated serum preoperative CA 125 levels (>78 U/mL). Patients with an elevated serum preoperative CA 125 level (>78 U/mL) had poorer disease-free survival, but this was not statistically significant. However, elevated preoperative CA 125 (>78 U/mL) was significantly associated with poorer overall survival. Conclusion: Elevated preoperative serum CA 125 is associated with poorer prognostic factors and may have prognostic value in patients with MOGCTs.

0245
Long-term outcomes after laparoendoscopic single-site surgery in endometrial cancer Jin Hwi Kim, Keun Ho Lee The Catholic University, Seoul, Republic of Korea Study Objective: To assess the surgical outcomes and long-term results of laparoendoscopic single-site surgery (LESS) in patients with early-stage endometrial cancer. Design: Retrospective cohort study (Canadian Task Force classification II-2). Setting: Two referral cancer centers. Patients: 93 women with endometrial cancer managed by laparoscopy from 2011-2013 in two referral centers. Interventions: Demographic, surgical, perioperative and pathological characteristics of 26 consecutive patients who underwent LESS and control group consisted of 67 consecutive patients who underwent conventional multi-port laparoscopic surgical staging were analyzed and then compared. Recurrence-free and overall survival was calculated by use of Kaplan-Meier method. Measurements and Main Results: No patient in the LESS or conventional laparoscopic surgery (CLS) group required an additional trocar or conversion to laparotomy. There were no intergroup differences in mean age, menopause status, body mass index, and previous history of abdominal surgery. Further, there were no inter-group differences in the number of total (LESS vs CLS, 22.2 ± 18.2 vs 24.9 ± 10.6, P = 0.48) lymph nodes retrieved; hemoglobin difference (1.5 ± 1.4 vs 1.4 ± 1.0, P = 0.90). The mean operative time was 198.8 ± 71.4 minutes in the LESS group and 249.2 ± 74.0 minutes in the CLS group (P < 0.01). The mean length of hospital stay was 5.1 ± 1.2 days in the LESS group and 8.0 ± 2.2 in the CLS group (P < 0.01). Overall and disease-free 5-year survival rates did not differ between the 2 groups. (95.2% and 92.2% versus 76.4% and 75.6%, respectively). Conclusion: Laparoendoscopic single-site surgery was a feasible, safe, and efficacious procedure for patients with endometrial cancer, with similar survival and recurrence rates and without any more complications compared to the conventional laparoscopic surgical staging.

0252
Xanthogranulomatous inflammation of the omentum mimicking metastatic ovarian malignancy -a case report Kamrun Nesa Begum Chittagong General Hospital, Chittagong, Bangladesh Introduction: Xanthogranulomatous inflammation is a special form of chronic inflammation in which the affected organ is destroyed and is replaced by large number of lipid laden histocytes. Xanthogranulomatous inflammation of omentum is not uncommon. Its presentation as mass lesion in pelvic cavity and invasion of surrounding tissue can lead to misdiagnosis of neoplastic lesion. Also radiological evaluation, surgical findings and gross features mimics ovarian malignancy. Objective: The case is of interest in view of its diagnostic dilemma-due to clinical manifestations, radiological and macroscopic features resemblance to metastatic ovarian malignancy. Case: A 42 year old multiparous woman presented with complaints of dyspepsia, abdominal pain, a lump in the lower abomen for 5-6 months. On abominal examination revealed an ill-defined, irregular mass, mixed consistency with restricted mobility. Per vaginal examination showed uterus not felt separately and revealed the same mass. On ultrasound examination revealed a large pelvic solid-cystic mass about 11.9x10.8x9.07 cm possibly of left adnexal origin with mild ascites. Hematological and tumour markers are normal except CA-125 (105 u/ml). A provisional diagnosis of complex ovarian cyst was made; planned for laparotomy. She underwent total abdominal hysterectomy with bilateral salphingo-oopherectomy and partial omentetectomy. Ascetic fluid was sent for analysis and the specimen was sent for histopathological examination. It revealed both sided papillary serous cyst adenoma and xanthogranulomatous inflammation of omentum and no malignant cell was found both in cytology and histopathology. Intraoperatively the omentum was found thick, as an omental cake and the nodules over the surface mimicks metastatic ovarian malignancy. Preoperative MRI scanning and peroperative frozen section biopsy may aid in the diagnosis of this condition and thus avoid aggressive surgical treatment. Conclusion: Knowledge and consideration of this distinct inflammatory lesion should be there while treating patient with tuboovarian mass to avoid unnecessary radical surgical procedure especially in young female.

0269
Sentinel lymph nodes mapping in cervical cancer stage IAI -IIB -a single center experience So-Hyun Nam, Dae-Yeon Kim, Jong-Hyeok Kim, Yong-Man Kim, Young-Tak Kim, Joo-Hyun Nam, Ju-Hyun Kim Asan Medical Center, Seoul, Republic of Korea Objective: The purpose of this study was to determine the validity and detection rate of sentinel lymph nodes (SLN) mapping using Indocyanine green(ICG) in patients with stage IAI -IIB cervical cancer. Methods: A prospective observational study was performed. Hundred-three patients were included with histologically diagnosed with cervical cancer stage IAI -IIB who were treated at Asan Medical Center, Seoul, Korea from 2015-2017. After using ICG to detect SLN during surgery, we removed SLN following standard radical surgery and bilateral pelvic lymphadenectomy. Results: The median patient age was 45 years (range, 29-77 years). The most common surgery was a laparoscopic radical hysterectomy (44.7%). Eight patients (7.8%) underwent fertility-sparing surgery, and the robotic radical hysterectomy was performed for 41 patients (39.8%). The most common histologic type was squamous cell carcinoma (69.3%). Stage IB1 was most common (61.2%). The median tumor size was 2.4 cm (range, 0.1-8 cm). Eighty-eight patients (85.4%) had bilateral pelvic SLN. The mean number of SLN was 2 (range, 0-5). The most common location of SLN was obturator. Twenty-seven patients had nodal metastasis after lymphadenectomy on final H&E. The sentinel node was the only positive node in 9%(n = 9) of cases. Side specific detection rate was 92.7%. A total of 35 hemipelvis had lymph node metastasis, 25 of which involved the SLN, resulting in a sensitivity of 71.4%, false negative rate (FNR) of 28.6%, specificity of 100% and accuracy of 94.8%. Tumor size, lymphovascular space involvement, parametrium involvement, previous LEEP history and vagina involvement status were associated with false negative detection rate of SLN mapping. In the case of tumor size less than 4 cm and negative imaging study, the study revealed that a sensitivity of 90.9%, FNR of 9.1.%, specificity of 100% and accuracy of 99.2%. Conclusions: SLN mapping should be performed carefully according to Tumor size, lymphovascular space involvement, parametrium involvement, previous LEEP history and vagina involvement status.

0280
The characteristics of the patient and the stage of cervical cancer in Hasan Sadikin Hospital in Bandung period of 2012 Ana Mariana Hasan Sadikin Bandung Hospital, Bandung, West Java, Indonesia Cervical cancer is the second most cancer that affects women across the world, there are about 500 000 new cases and 250 000 deaths each year. Cervical cancer can be triggered by a number of risk factors such as age, age of first marriage, education level, occupation, and parity, as well as the stadium. The research object is the entire medical records of patients with cervical cancer in RSHS hospital period of 2012. The study was conducted using descriptive method with cross sectional study. There are 485 cases of gynecologic cancer at the RSHS hospital period of 2012, the highest is 224 cases of cervical cancer. The most age is 41-50 years (48.6%), then >50 years (32.4%), 31-40 years (18.1%) and ≤30 years (1.0%). The most age of first marriage is <20 years (73.3%), then ≥20 years (26.7%). The most education level is elementary (57.1%), then high school (20.0%), junior high school (16.2%), university level (5.7%) and not school (1.0%). Most jobs is housewife (89.5%), then teachers (3.8%), civil servants (2.9%), traders (1.9%), private employees (1.0%), and farmers (1.0%). Most parity is ≥3 (74.3%), then <3 (25.7%). Stage IIIB is the highest (37.1%), then IB1 (12.4%), IIB (11.4%), IB2 (11.4%), IIA2 (9.5%), IIA (4.8%), IIA1 (3.8%), IIIA (3.8%), IVB (1.9%), IA (1.0%), IB (1.0%), II (1.0%), IVA (1.0%). Conclusion, the most age of patient with cervical cancer is 41-50 years (48.6%), the most age of first married <20 years (73.3%), the most education level is low educational (58.1%) and most of them is in elementary level (57.1%), the highest employment is housewife (89.5%), and the highest parity is ≥3 (74.3%). Stage at diagnosis is the most advanced stage (55.2%) and most of them is stage IIIB (37.1%). Keywords: cervical cancer, characteristics, stage 0283 Case report on endometrial stromal sarcoma Shoyela Shahnaz, Shahena Akhhter, Afroja Ferdous Chittagong Medical College Hospital, Chittagong, Bangladesh Introduction: Endometrial stromal sarcoma (ESS) are very rare malignant tumours that constitute approximately 10% of all Uterine sarcomas but only around 0.2% of all uterine malignancies. Compare d to other Uterine malignancies. ESS effects younger women and the mean age is 42 to 58 years ESS is an indolent tumours with local recurrences and distant metastasis can occur even 20 years after initial diagnosis. Case presentation: A 28 years old para-1 presented with pain and lump in lower abdomen she had cesarean section one year back due to transverse lie at term. Her post-operative period was uneventful. Six months following operation she felt heaviness in lower abdomen. She was in her lactational amenorrhaeic period. Her husband was abroad since her childbirth. She visited a doctor and ultrasonography of whole abdomen was done, single uterine myoma of 10 x 12 cm was found. Clinically her vital signs were normal. Abdominal examination revealed tenderness in lower abdomen. On bimanual examination uterus was found 12 weeks pregnant uterus size, firm. Fornices were free and cervix looked apparently healthy on speculum examination. After counselling, she underwent myomectomy. But Cleavage of myoma could not be identified properly & it was difficult to remove the mass. She recovered well, but histopatholigical report showed low grade endometrial. Stromal sarcoma of uterine Corpus. Medical board was arranged involving senior Gynecologists and oncologists. Total abdominal hysterectomy and bilateral salpingo -oopherectomy was performed. Radical surgery was advised because of the poor salvage in case of residual or recurrence of the disease and very few cases were presented so far. Conclusion: It is an indolent tumour with local recurrences and distant metastasis can occur even 20 years after initial diagnosis. There need to be an index of suspicion whenever we deal a case with myoma or adenomyosis.

0291
Activation of TWIST1 by COL11A1 promotes ovarian chemoresistance and anti-apoptosis through modulating NF-κB-mediated Iκκβ expression Yi-Hui Wu 1 , Yu-Fang Huang 1 , Tzu-Hao Chang 2 , Cheng-Yang Chou 1 1 National Cheng Kung University Hospital, Tainan, Taiwan, 2 Taipei Medical University, Taipei, Taiwan Introduction: We have shown that collagen type XI alpha 1 (COL11A1) promotes ovarian cancer progression and is associated with chemoresistance to cisplatin and paclitaxel in ovarian cancer cells.
Objectives: Here we test the hypothesis whether TWIST1 regulated by COL11A1 could have a role in the resistance to anti-cancer drugs in ovarian cancer cells. the cellular activities during diseased state and the magnitude of protein expression required for cancer progression. Conclusion: This study has identified MMP-9 in AV-EVs as a promising candidate biomarker to screen for malignant ovarian cancer in patients with cysts. It provides preliminary data to support further investigation of MMP-9 in AV-EVs in a larger cohort of women with ovarian cysts.

0349
A case of primary fallopian tubal carcinoma diagnosed with primary peritoneal cancer before first debulking surgery Satoshi Nakagawa, Mariko Jitsumori, Mariko Hashimura, Ayako Hosoi, Kumiko Kazumi, Kazuya Miyanishi, Satoru Munakata, Toshiya Yamamoto Sakai City Medical Center, Sakai, Japan Recently, it is suggested that that serous tubal intraepithelial carcinoma (STIC) is may be an occult source of primary peritoneal carcinoma. This case report describes a 59-year-old Japanese woman, gravida 1, para 1 who presented with progressive massive ascites. The computed tomography scan, abdominopelvic magnetic resonance imaging, and diagnostic paracentesis suggested peritoneal carcinoma. There was no visible lesion on uterus and adnexa. Blood CA-125 was elevated at 1900UI/mL. After 4 courses neoadjuvant chemotherapy with paclitaxel and carboplatin, operation was perrformed. Although there was no malignant lesion in bilateral ovary, STIC and invasive serous adeno carcinoma was observed in fallopian tube. They showed positive immunohistochemical staining for P53 and MIB1, and we diagnosed with primary tubal cancer. Conclusion: Primary peritoneal carcinoma can be associated with STIC and careful pathological investigation of fallopian tube should be performed after surgical treatment.

0360
Isolated metastasis to the uterine cervix from primary breast carcinoma: a case report Joan Marice Toh, Leo Francis Aquilizan St. Luke's Medical Center, Quezon City, The Philippines Metastasis of malignancy to the uterine cervix is a rare event in itself. Breast cancer is a commonly diagnosed malignancy in women that has been extensively studied, and it has been known that common areas of metastasis are the lungs, skin, liver and brain. Since the 1980s, there have been a handful of reported cases of metastasis to the uterine cervix. We present the case of a 64-year-old Gravida 4 Para 1 (1031) who developed postmenopausal bleeding 9 years after treatment of the primary breast cancer, which after work-up, turns out to be an isolated metastatic lesion to the cervix. In cases such as this one, surgery is a reasonable treatment option that is sufficient in itself without the need for chemotherapy or radiation. Our patient was offered a different treatment option, which is chemotherapy, instead of proceeding straight to the treatment option presented by most case reports. This paper aims to highlight possible routes of metastasis, to emphasize the need for regular gynecological examination in patients with breast cancer, as well as the importance of aggressive treatment in the form of surgery in cases of isolated cervical metastasis.

0371
Non-Hodgkin's lymphoma of the cervix: the unexpected and unusual presentation Suzanne Khaw 1,2 1 Westmead Hospital, NSW, Australia, 2 Fairfield Hospital, NSW, Australia Background/Introduction: Female genital tract lymphoma is an extremely rare diagnosis 1 accounting for only 1.5% of extra nodal non-Hodgkin's lymphoma and a meagre less than 0.5% of gynaecological cancer 2 . Primary lymphoma of cervix is considered less common compared to cervical involvement in a multi organ disease 3 . Majority of these rare cases are diagnosed during routine screening on Papanicolaou (Pap) cytology smear 4 . Due to the limited number of primary lymphoma of the cervix, a standard regime has not been developed 5. This is a case report of a 73 year old non-English speaking background lady who presented to her obstetrician with one month history of post-menopausal bleeding per vaginum. Histology revealed a high grade large B cell non-Hodgkin's lymphoma with a high proliferative index, expressing C-MYC protein in a high proportion of cells and CD10 and LCA positive on a cervical biopsy. Objectives: This poster presents the rarity of cervical lymphoma; including it's incidence, clinical presentation, diagnostic dilemma from benign conditions as well as treatment regime. Methods (including type of data collected): Case report and literature search/review on Pubmed/MEDLINE. Comparing both in terms of presentation, diagnosis and treatment management. Results: Patient has been diagnosed in a timely manner and appropriately managed as well as treated.