Ovarian cancer grade IV, clinical group II

Female patient V., aged 82, stayed at the Department of Gynecology of the Clinical Hospital from January 4, 2002, till March 5, 2002.

Diagnosis: Ovarian cancer grade IV, clinical group II. Concomitant diseases: ischemic heart disease, atherosclerotic miocardiosclerosis, aortal and coronary atherosclerosis, grade 1 chronic circulatory insufficiency. Foreign body (bullet) in the left lung.

On admittance, the patient complained of periodic yellowish vaginal discharge, dull ache in the lower abdomen, loss of weight by 6 to 8 kg, general weakness. On gynecologic examination, USE of small pelvis organs, and abdominal cavity puncture through the posterior vaginal vault, ovary tumors were diagnosed and operated on October 21st, 2002. Taking into account patient’s age and disseminating nature of the disease, the surgery was confined to laparotomy, resection of uterine appendices and metastatic tumor of the radix mesenterii of small bowel. No complications reported during and after the operation.

Pathohistological examination No. 499-540, dated January 21, 2002: low-differentiated solid-papillary carcinoma.

In postoperative period, against the background of detoxication therapy, the patient was subjected to chemotherapy: 120 mg tiofen (intra-abdominal administration through a drainage tube), 800 mg cyclophosphan (intramuscular administration). The treatment was interrupted because of agranulocytosis and hemorrhagic syndrome (macular and petechial rush) developed. Since February 3, the patient received hemostimulating therapy as transfusion of erythromass (150 ml every other day), and 280 ml leukomass in the total amount; daily intramascular injections of 30 mg prednisolon, 0.6 g leukogen, 1.2 g pentoxyl. However, in spite of the therapy, leukocytes counts decreased to 0.5 g/l (February 14, 2002).

On 16th of February, hematopoietic cells of human embryonic liver were transplanted intravenously: sample 3-194-K; volume of cells, 1.5 ml; cell count 34x10⁶/ml; CFU-GM, 40.1x10³. The volume of transplanted cells amounted to 30% of the total mass of this sample stored in the cryobank.

After 8 to 10 hours from transplantation, the syndrome of early posttransplantation improvement of general condition was observed in the patient: decrease of weakness, improvement of motional activity, decrease of dyspnea and palpitation, good appetite.

In 3 to 5 days, symptoms of cytostatic agranulocytosis disappeared; no fresh petechiae were reported on skin. Appearance of erythrocytes containing fetal hemoglobin in the blood evidences involvement of fetal hematopoietic cells in hematopoiesis.

The peripheral blood counts of patient V., female, 82 years old with ovarian cancer, grade IV, clinical group II. Cytostatic agranulocytosis. Hemorrhagic syndrome.
Transplantation: February 16, 2002

Date Indices	22.01	03.02	14.02	16.02 1st day	21.02 5th day	24.02 8th day	27.02 11th day	2.03 14th day	5.03 17th day
Erythrocytes, 1012/l	3.8	2.7	2.9	3.0	3.1	3.1	3.1	3.1	3.2
Hemoglobin, g/l	137	85	91	93	97	100	97	95	93
Color index	0.90	0.95	0.95	0.80	0.90	1.00	0.95	0.95	0.95
Reticulocytes, ppm	—*	0.1	0.0	0.0	0.8	2.0	2.0	1.9	1.6
Leukocytes, 109/l	13.8	1.8	0.5**	0.8**	3.1	3.6	3.1	4.7	4.7
Basophils	1	0	0	0	1	1	1	1	1
Eosinophils	0	1	0	4	3	3	5	0	1
Myelocytes	0	0	0	8	13	16	12	6	2
Metamyelocytes	0	0	0	1	2	2	1	2	1
Stem	5	3	9	5	12	15	17	22	20
Segmented	86	70	32	38	33	33	32	42	51
Lymphocytes	5	24	48	35	30	26	27	18	16
Monocytes	3	2	11	9	6	4	5	10	8
Thrombocytes, 109/l	273	90	22	40	54	68	152	98	120
ESR, mm/hr	25	28	20	18	12	5	8	10	15
Erythrocytes containing fetal hemoglobin (ppm)	—	—	0.0	0.1	0.7	1.4	3.0	4.2	4.0

* Not identified.
**Differential blood count for calculation of 50 cells.