Publications by authors named "Sarah Ehmann"

11 Publications

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Isolated splenic high-grade serous carcinoma: A case report.

Gynecol Oncol Rep 2021 Aug 23;37:100818. Epub 2021 Jun 23.

Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

We present a unique case of high-grade serous carcinoma isolated to the spleen at the time of diagnosis, without any tumor present in the ovary, fallopian tubes, omentum or uterus, which was pathologically consistent with metastatic Mullerian carcinoma. Tumor sequencing with the MSK-IMPACT (Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets) multigene tumor panel test was performed, which revealed somatic mutations in PALB2 and in ARID1, as well as a TP53 hotspot mutation.
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http://dx.doi.org/10.1016/j.gore.2021.100818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8253960PMC
August 2021

Case report: Sentinel lymph node mapping of endometrial carcinoma occurring in uterine didelphys.

Gynecol Oncol Rep 2021 May 30;36:100769. Epub 2021 Apr 30.

Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

•In a bleeding postmenopausal woman with didelphys uterus, endometrial biopsy should be taken from both uterine cavities.•Sentinel lymph node mapping has not been previously described in the setting of endometrial cancer and uterine didelphys.•Routine sentinel lymph node mapping was successfully performed in a patient with endometrial cancer and uterine didelphys.
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http://dx.doi.org/10.1016/j.gore.2021.100769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8134959PMC
May 2021

Diaphragm hernia after debulking surgery in patients with ovarian cancer.

Gynecol Oncol Rep 2021 May 31;36:100759. Epub 2021 Mar 31.

Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Over 80% of patients with epithelial ovarian cancer present with advanced disease, FIGO stage III or IV at the time of diagnosis. The majority require extensive upper abdominal surgery to obtain complete gross resection. This may include splenectomy, distal pancreatectomy, partial hepatectomy, cholecystectomy, and usually diaphragmatic peritonectomy or resection. Following surgery, diaphragmatic hernia-a very rare but serious complication-may occur. We describe four cases of left-sided diaphragmatic hernia resulting after debulking surgery, which included left diaphragm peritonectomy and splenectomy, in patients with advanced ovarian cancer. In association with the current shift towards more extensive debulking surgery for ovarian cancer, more patients may present with postoperative left-sided diaphragm hernia, making the prevention, diagnosis, and management of this complication important to practicing gynecologic oncologists. Intraoperatively the diaphragm should be checked thoroughly to rule out any defects, which should be closed. A diaphragmatic hernia may be easily misdiagnosed because the patient can present with various symptoms. While rare, these hernias require prompt identification, intervention and surgical correction to avoid serious complications.
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http://dx.doi.org/10.1016/j.gore.2021.100759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042427PMC
May 2021

Minimally invasive repair of a left diaphragm hernia after debulking surgery for advanced ovarian cancer.

Gynecol Oncol Rep 2021 May 11;36:100713. Epub 2021 Feb 11.

Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Eighty percent of women with ovarian cancer have advanced disease (FIGO stage III or IV) at the time of diagnoses and require extensive upper abdominal surgery to obtain complete gross resection (Minig et al., 2015, Eisenhauer et al., 2006). A diaphragmatic hernia is defined as abdominal contents bulging into the thoracic cavity (Spellar and Gupta, 2020). While rare following primary debulking surgery (PDS), these present with a variety of symptoms and are often misdiagnosed. Computed tomography (CT) is the diagnostic gold standard (Vertaldi et al., 2020). This video demonstrates repair of a left-sided complex diaphragm hernia via robotic video-assisted thoracic surgery in a 45-year-old with stage IVB ovarian cancer. She previously underwent extensive PDS, including modified posterior exenteration, bilateral salpingo-oophorectomy, omentectomy, bilateral pelvic lymph node dissection, appendectomy, bilateral diaphragm peritonectomy, splenectomy, resection of a right mediastinal lymph node, and insertion of a right chest tube. Complete gross resection was achieved. No left-sided diaphragm resection or repair was performed during the initial surgery. She received standard adjuvant chemotherapy with paclitaxel, carboplatin and bevacizumab. Six months postoperatively a surveillance CT scan revealed a small left hemidiaphragm hernia containing parts of the stomach. Although initially asymptomatic, she developed mild symptoms on follow-up, especially with lying supine. Imaging showed an increase in the size of the diaphragm defect. After completion of her maintenance bevacizumab therapy, corrective surgery was performed to prevent incarceration of the stomach. This video demonstrates the complex repair of this 4 × 6 cm defect located in the central tendon of the diaphragm. On two-week follow-up after corrective surgery, the patient's symptoms had resolved.
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http://dx.doi.org/10.1016/j.gore.2021.100713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941203PMC
May 2021

Modern day screening for Lynch syndrome in endometrial cancer: the KEM experience.

Arch Gynecol Obstet 2021 10 12;304(4):975-984. Epub 2021 Mar 12.

Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte (KEM), Henricistrasse 92, 45136, Essen, Germany.

Purpose: Current guidelines for Lynch syndrome detection in endometrial cancer (EC) patients rely either on risk evaluation, based on personal/family history, or detection of mismatch repair (MMR) deficiency on tumor tissue. We present a combined screening algorithm for Lynch syndrome.

Methods: In this study, 213 consecutive patients treated for EC at Kliniken Essen-Mitte between 2014 and 2018 were included. Personal/family history was evaluated by the Amsterdam II, revised Bethesda/German-DKG criteria and prediction model PREMM. MMR testing was performed by immunohistochemistry (IHC) and/or polymerase chain reaction (PCR) based microsatellite analysis on tumor tissue. MLH1 promoter methylation analysis was performed in case of MLH1 loss or microsatellite instability.

Results: Based on personal/family history 2/213 (Amsterdam II), 31/213 (revised Bethesda/German-DKG) and 149/213 (PREMM) patients were identified as at risk for Lynch syndrome. MMR analysis was performed by IHC in 51.2%, by PCR in 32.4%, and in 16.4% of patients both methods were used. MMR deficiency was detected in 20.6% (44/213). Methylation analysis was performed in 27 patients of whom, 22 (81.4%) showed MLH1 promoter hypermethylation. Only 9% of MMR deficient patients were identified as at risk for Lynch syndrome by the revised Bethesda/German-DKG criteria. A pathogenic germline mutation was discovered in 3 out of 20 patients that underwent genetic testing. None of these patients were younger than 50 years or had a family history of Lynch syndrome-associated malignancies.

Conclusion: General MMR assessment is a feasible strategy to improve the detection of Lynch Syndrome in patients with EC.
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http://dx.doi.org/10.1007/s00404-021-06006-wDOI Listing
October 2021

Acute pericarditis after transabdominal cardiophrenic lymph node dissection and pericardotomy during ovarian cancer debulking surgery: A case report.

Gynecol Oncol Rep 2021 Feb 11;35:100683. Epub 2020 Dec 11.

Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

•Complete gross resection as part of debulking surgery is crucial in advanced ovarian cancer.•Supradiaphragmatic lymph node resection may prolong survival in patients with ovarian cancer.•We report acute pericarditis after supradiaphragmatic lymph node resection and pericardotomy.
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http://dx.doi.org/10.1016/j.gore.2020.100683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750320PMC
February 2021

Why was GOG-0213 a negative trial?

J Gynecol Oncol 2021 Jan 2;32(1):e19. Epub 2020 Dec 2.

Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

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http://dx.doi.org/10.3802/jgo.2021.32.e19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767651PMC
January 2021

Prevalence of and Mutations in Patients with Primary Ovarian Cancer - Does the German Checklist for Detecting the Risk of Hereditary Breast and Ovarian Cancer Adequately Depict the Need for Consultation?

Geburtshilfe Frauenheilkd 2020 Sep 2;80(9):932-940. Epub 2020 Sep 2.

Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen.

mutations are the leading cause of hereditary epithelial ovarian cancer (EOC). The German Consortium for Hereditary Breast and Ovarian Cancer has defined inclusion criteria, which are retrievable as a checklist and facilitate genetic counselling/testing for affected persons with a mutation probability of ≥ 10%. Our objective was to evaluate the prevalence of the mutation(s) based on the checklist score (CLS). A retrospective data analysis was performed on EOC patients with a primary diagnosis treated between 1/2011 - 5/2019 at the Central Essen Clinics, where a genetic analysis result and a CLS was available. Out of 545 cases with a result (cohort A), 453 cases additionally had an extended gene panel result (cohort B). A mutation was identified in 23.3% (127/545) in cohort A, pathogenic mutations in non- genes were revealed in a further 6.2% in cohort B. In cohort A, 23.3% (127/545) of patients had a (n = 92) or (n = 35) mutation. Singular EOC (CLS 2) was present in 40.9%. The prevalence for a mutation in cohort A was 10.8%, 17.2%, 25.0%, 35.1%, 51.4% and 66.7% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively. The mutation prevalence in cohort B was 15.9%, 16.4%, 28.2%, 40.4%, 44.8% and 62.5% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively. The mutation prevalence in EOC patients positively correlates with a rising checklist score. Already with singular EOC, the prevalence of a mutation exceeds the required 10% threshold. Our data support the recommendation of the S3 guidelines Ovarian Cancer of offering genetic testing to all patients with EOC. Optimisation of the checklist with clear identification of the testing indication in this population should therefore be aimed for.
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http://dx.doi.org/10.1055/a-1222-0042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467803PMC
September 2020

Sentinel lymph node mapping with fluorescent and radioactive tracers in vulvar cancer patients.

Arch Gynecol Obstet 2020 03 13;301(3):729-736. Epub 2020 Feb 13.

Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte (KEM) gGmbH, Evang. Huyssens-Stiftung Essen-Huttrop, Henricistrasse 92, 45136, Essen, Germany.

Purpose: Application of radioactive tracers for sentinel lymph node biopsy (SLNB) in vulvar cancer has been established, however, the use of radioisotopes is expensive and requires complex logistics. This exploratory study evaluated the feasibility of near-infrared fluorescence-based SLNB in comparison to the gold standard using radioactive guidance.

Methods: At Evangelische Kliniken Essen-Mitte (Essen, Germany) between 02/2015 and 04/2019, 33 patients with squamous cell vulvar cancer and unifocal tumors (32 midline, 1 lateral) smaller than 4 cm underwent SLNB as part of their routine primary surgical therapy. Radiolabeled nanocolloid technetium 99 (Tc) was injected preoperatively and indocyanine green (ICG) intraoperatively. Demographic and clinical data were retrieved from patients' records, and descriptive statistics were applied. The detection rate of the ICG fluorescence technique was compared with the standard radioactive approach.

Results: In patients with midline tumors, bilateral SLNB was attempted. SLNB was feasible in 61/64 (95.3%) groins with Tc and in 56/64 (87.5%) with ICG. In total, 125 SLNs were excised; all SLNs were radioactive and 117 (93.6%) also fluorescent. In 8 patients with BMI > 30 kg/m, SLNB was successful in 14/15 groins (93.3%) with Tc and 13/15 groins (86.7%) with ICG. Upon final histology, infiltrated nodes were present in 9/64 (14.1%) groins and 10/125 SLNs; one positive SLN was not detected with ICG.

Conclusions: SLNB using ICG is a promising technique, however, the detection rate obtained was slightly lower than with Tc. The detection rate increased over time indicating that experience and training may play an important role besides further methodological refinements.
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http://dx.doi.org/10.1007/s00404-019-05415-2DOI Listing
March 2020

Low-grade Serous Tumors: Are We Making Progress?

Curr Oncol Rep 2020 Jan 27;22(1). Epub 2020 Jan 27.

Gynaecology and Gynaecological Oncology, Kliniken Essen-Mitte, Henricistraße 92, 45136, Essen, Germany.

Purpose Of Review: This review provides an overview of the current clinical standard in low-grade serous ovarian cancer (LGSOC). The available evidence for surgery and standard treatments is elaborated. In addition, we discuss recent findings and novel treatments for LGSOC.

Recent Findings: Two large multicenter trials studying MEK inhibitors in LGSOC have been presented in the last year. Binimetinib demonstrated an activity in LGSOC, especially in KRAS-mutated disease. Trametinib was associated with an improved progression-free survival in relapsed LGSOC. Based on the current results, MEK inhibitors could be an alternative treatment for LGSOC. Surgery is an important step in the treatment of LGSOC. Hormonal therapy and bevacizumab can be beneficial, next to chemotherapy. Targeted treatments, such as the MEK-inhibitor trametinib, seem to be efficient and should be introduced into clinical practice.
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http://dx.doi.org/10.1007/s11912-020-0872-5DOI Listing
January 2020

Defining the Need for Surgery in Small-Bowel Obstruction.

J Gastrointest Surg 2017 07 13;21(7):1136-1141. Epub 2017 Apr 13.

Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.

Background: Small-bowel obstruction is a frequent disorder in emergency medicine and represents a major burden for patients and health care systems worldwide. Within the past years, progress has been made regarding the management of small-bowel obstructions, including the use of contrast agent swallow as a tool in the decision-making process.

Objectives: This is a prospective controlled study investigating the central role of contrast agent swallow in the diagnostic and treatment algorithm for small-bowel obstruction at a university department of surgery. Endpoints were the correct identification of patients who needed operative treatment and the accuracy of a conservative treatment decision including the analysis of dropout from this routine algorithm.

Methods: We performed a single-center analysis of 181 consecutive patients diagnosed with a small-bowel obstruction based on clinical, radiologic, and sonographic findings. Patients with clinical signs of strangulation or peritonitis underwent immediate surgery (group 1). Patients without signs of peritonitis and incomplete stop in the initial abdominal plain film were considered eligible for Gastrografin® challenge (group 2).

Results: Seventy-six of the 181 patients (42.0%) underwent immediate surgery. A Gastrografin® challenge was initialized in 105 of the 181 patients (58.0%). Twenty of these 105 patients (19.1%) with persisting or progressive symptoms and absence of contrast agent in the colon after 12 and 24 h subsequently underwent surgery. Here, a segmental bowel resection was necessary in 6 of these 20 patients (30.0%). In 16 out of 20 patients (80.0%) who failed the Gastrografin® challenge, a corresponding correlate in terms of a strangulation was detected intraoperatively. The Gastrografin® challenge had a specificity of 96% and a sensitivity of 100%; accuracy to predict the need for exploration was 96%.

Conclusion: A straightforward algorithm based mainly on contrast agent swallow for patients with small-bowel obstructions enabled a timely and very accurate differentiation between patients qualifying for conservative and operative treatment.
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http://dx.doi.org/10.1007/s11605-017-3418-xDOI Listing
July 2017
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