Cervix carcinoma: Treatment with combination cisplatin and bleomycin

Thirty patients with metastatic carcinoma of the cervix were treated with a combination of cisplatin and bleomycin. Thirty patients were evaluable for toxicity and 24 were evaluable for response. Thirteen patients achieved a partial remission for an objective response rate of 54% with a median duration of 3.5 months. The response rate for extrapelvic disease without prior radiation was 57% while the response rate for disease recurring in the previously irradiated pelvic area was only 36%. Response rates were higher in tumors with nonsquamous histology. Survival times for responders and nonresponders were not significantly different. Significant toxicity was observed. It is concluded that the combination of high-dose cisplatin and bleomycin infusion in patients with recurrent cervix cancer has an improved response rate. However, these responses are of short duration and drug toxicity is significant. The role of this combination for adjuvant studies is discussed.     

Phase II trial of medroxyprogesterone acetate in advanced ovarian cancer: An EORTC gynecological cancer cooperative group study

Progestin therapy of ovarian carcinoma in the past has been reported to lead to varying response rates. A multicenter phase II study of high-dose MPA was conducted in 53 patients with epithelial ovarian cancer who had received adequate trials of conventional therapy with cytotoxic agents. Forty-one patients were included for response and toxicity evaluations. Only one partial response has been recorded with a duration of 20 weeks. Stabilization of disease was observed in 7 patients. The present investigation shows that MPA given at the present high dose is not effective in patients extensively pretreated with chemotherapy.     

Vaginal hemangiopericytoma: A light microscopic and ultrastructural study

A case of a vaginal hemangiopericytoma in a 20-year-old woman was studied by light and electron microscopy. The neoplastic cells had round-to-oval nuclei with one or two nucleoli; fine chromatin; a foamy, cyanophilic cytoplasm; and an increased nuclear cytoplasmic ratio. Light microscopically, the tumor was composed of spindle-shaped or round cells proliferating around vascular spaces. Mitotic figures, necrosis, and hemorrhage were difficult to find. Electron microscopically, the neoplastic cells occurred in clusters, each of which was enclosed by a basal lamina. The cytoplasm contained abundant free ribosomes, flattened elements of rough endoplasmic reticulum, small Golgi apparatus, round or elongated mitochondria, lysosomes, glycogen particles, and sometimes pinocytotic vesicles and bundles of microfilaments with large dense spots. Desmosomes were also seen. In addition, the cytoplasmic process of the benign vascular pericytes was directly in contact with the neoplastic cells which had varying degrees of cytodifferentiation. The neoplastic cells in this lesion are consistent with an origin from pericytes, confirming the findings of this neoplasm when it arose in other sites.     

A survey of tumor markers in patients with squamous cell carcinoma of the uterine cervix

The circulating levels of carcinoembryonic antigen (CEA), α-fetoprotein (AFP), and chorionic gonadotrophin (B-hCG) were correlated with the extent of disease in 47 patients with squamous cell carcinoma of the uterine cervix. Pretherapy serum CEA levels were elevated (> 10 ng/ml) in 12 of 47 (26%) of the patients. The greatest incidence and the highest CEA elevations were observed in the sera of patients with Stage III disease. No elevations of serum AFP were observed in any of the patients, and B-hCG was elevated in only 4 of the 47 cases. In 2 of the 4 cases, elevations of the serum B-hCG were associated with pregnancy and in the remaining 2 cases the serum CEA value was also elevated. Contrary to a study reported by other investigators, our data indicate the the tumor marker profile consisting of CEA, AFP, and B-hCG does not increase the incidence of abnormal findings when compared to the CEA test used alone. Also, our CEA data are consistent with other reports which demonstrate that CEA may be a useful tumor marker in 23% of the patients with Stage I and II disease, 57% of the patients with Stage III disease, and 33% of patients with Stage IV disease. The serum CEA test does not appear to be useful for the early detection of noninvasive (in situ) disease.     

Endodermal sinus tumor of the vagina: A report of nine cases and review of the literature

Nine cases of endodermal sinus tumor of the vagina from children 6 months to 2 years of age are reported. The two patients treated before the advent of modern chemotherapy died 6 to 13 months postoperatively despite attempted complete surgical resection of the tumor in one of the cases. One patient who was treated initially by hysterectomy and vaginectomy had lung metastases 6 months postoperatively and died despite chemotherapy. Six patients who were treated by a surgical procedure and received vincristine, actinomycin D, and cyclophosphamide, with radiation therapy in two cases, were alive and free of disease from 2 to 9 years postoperatively.     

A case of endometrioid carcinoma of the ovary associated with pregnancy

This is the second report of endometrioid carcinoma of the ovary associated with an intrauterine pregnancy. The previous report presented six cases, making this the seventh. Characteristics of the tumor are reviewed, as are the guidelines for the management of ovarian carcinoma complicating pregnancy.     

Pelvic exenteration: A 7-year experience

From August 1972 through December 1979, 37 exenterations have been performed at the Milton S. Hershey Medical Center of the Pennsylvania State University. The majority were total pelvic exenterations for recurrent carcinoma of the cervix. Exenterations for primary carcinoma of the rectosigmoid portended to a poor prognosis as only one of seven survived more than 2 years. The 2-year survival for the overall series is 43%. A new postoperative complication of recurrent cancer, the formation of a fistula between the functioning gastrointestinal tract and the ileal loop, was seen in three patients.     

Intense eosinophilic stromal infiltration in carcinoma of the uterine cervix: A clinicopathologic study of 14 cases

Stromal responses to tumor, usually characterized by the intensity of the lymphoplasmacytic infiltration, have been felt to be of prognostic significance in a wide range of neoplasms. Little attention has been focused on stromal reactions composed primarily of infiltration by eosinophilic leukocytes. We describe here the clinical and histopathological findings in 14 patients with invasive carcinoma of the uterine cervix in whom pronounced eosinophilic infiltration was observed in the stroma in the initial diagnostic biopsy material. These patients tended to have early stage disease, had associated increased lymphoplasmacytic stromal response, and were somewhat younger than the patients lacking this intense eosinophilic infiltration. A suggestion of improved survival was noted in patients with intense stromal eosinophilia treated primarily with radiation therapy.     

Extraperitoneal extension of pseudomyxoma peritonei: A case report

Pseudomyxoma peritonei, a disseminated intraabdominal neoplasm, which is the result of either metaplasia of the abdominal mesothelium or direct implantation of mucinous epithelium, typically does not metastasize outside the peritoneal cavity. A case of well documented pseudomyxoma peritonei with extraperitoneal disease in the form of a colonic polyp is presented. Its etiology may be related to the multiple surgical procedures the patient had undergone.     

A comparison of two radioimmunoassay methods for the detection of carcinoembryonic antigen in patients with ovarian or cervical cancer

The carcinoembryonic antigen (CEA) was measured by radioimmunoassay (RIA) in the serum of patients with carcinoma of the ovary (100), cervix (100), and healthy controls (100). Two methods were used in the RIA for the precipitation of the CEA immune complex: (i) double antibody (DA), and (ii) ammonium sulfate (AS). The mean value of the controls was 14.67 ± 4.09 ng CEA/ml of serum using the DA technique. Based on the control's mean value +2 SD, there were 3% positive results in the control group, 16 and 19% positive results in the ovarian and cervical cancer groups, respectively. With the AS technique, all the control values were less than 1.5 ng CEA/ml of serum. This gave 20 and 3% positive results in the ovarian and cervical cancer groups, respectively. Although the assays (DA and AS) are comparable, the results show that only six ovarian and one cervical cancer patient had positive CEA levels, when determined by both the DA and AS techniques.     

Stage I carcinoma of the endometrium: A 5-year experience utilizing preoperative cesium

A treatment protocol for the management of stage I endometrial carcinoma utilizing preoperative cesium is evaluated. One hundred and twelve consecutive patients were treated according to this protocol over a 5-year period. Based on this experience and a literature review a new protocol is recommended. The significant changes include primary surgery without preoperative cesium, primary treatment based on grade without regard to uterine size, modified radical hysterectomy for G3 tumors, pelvic radiotherapy for clear cell carcinoma confined to the pelvis regardless of depth of invasion, cytoxan, adriamycin, and cis-platinum for papillary serous tumors, and postoperative vaginal cuff cesium for G2 and G3 tumors not requiring pelvic radiotherapy.     

Adenoid cystic carcinoma of the cervix: a case report with implications for chemotherapeutic treatment

There have been 59 other cases of adenoid cystic carcinoma of the cervix reported in the literature. Therefore, little is known of the true biological behavior or therapeutic responsiveness of these tumors. We are reporting a case of adenoid cystic carcinoma of the cervix, FIGO Stage I-B, initially treated with radical hysterectomy and bilateral pelvic lymphadenectomy. Two years after surgery, the patient presented with recurrent disease in the pelvis and multiple lung metastasis. She subsequently was treated with chemotherapy consisting of cytoxan, Adriamycin, and cis-platinum with a sustained complete clinical response.     

Quantitation and origin of immunoglobulins A, G and M in the secretions and fluids of the reproductive tract of the sow

Immunoglobulin quantitation of fluids obtained from several regions of the female reproductive tract indicated the presence of IgG, IgA and IgM. IgG was almost invariably present in greatest amounts and IgM always made the smallest contribution. Although much of this immunoglobulin was derived from serum, evidence of the molecular size of IgA, the IgA and IgG ratios and that obtained from experiments involving the injection into sows of 125I-labelled immunoglobulin indicated that local synthesis within the tract also occurred.     

Use of the automatic surgical stapler for intestinal anastomosis associated with gynecologic malignancy: Review of 283 procedures

Between the years 1974 and 1980, 283 intestinal stapling procedures involving the large and small bowel have been performed on the Gynecologic Oncology service. The automatic surgical staplers used in this series were: the gastrointestinal anastomosis (GIA), the thoracoabdominal (TA-55/30), and the end-to-end anastomosis (EEA) stapler (United States Surgical Corp., Stamford, Conn.). The 283 stapling operations were performed on 162 patients. Fifty-three of the patients had received pelvic irradiation prior to the intestinal operations. The complication rate was low, and compared very favorably with other techniques of gastrointestinal anastomosis which were performed by the same authors. There was one disruption of a small-bowel anastomosis, temporary stricture in three anastomoses of rectum to colon, a leak in a low colonie-rectal anastomosis which resulted in a pelvic abscess, and a rectovaginal fistula. Fifty-two patients underwent urinary diversion by bowel conduit. In all of these cases the conduit was fashioned with the aid of the automatic stapler. The low complication rate in gastrointestinal anastomoses performed with the automatic surgical staplers supports the conclusion that this is a technically superior method which provides better utilization of operating time on radical pelvic procedures.     

Argyrophilic carcinoma of the cervix: a report of a case with coexisting cervical intraepithelial neoplasia

Argyrophil cell carcinoma of the cervix is a subtype of cervical carcinoma which is analogous to carcinoid and oat cell tumors of the lung. It has a correspondingly poor overall prognosis and has previously been assumed to be derived from the neural crest via argyrophilic cells in the normal endocervix. We have recently encountered a case of argyrophil cell (oat cell) carcinoma of the cervix coexisting with cervical intraepithelial neoplasia which was argyrophil negative. The etiologic significance of this observation and the therapy of this unique cervical neoplasm are described herein.     

Gastric outlet obstruction caused by ascitic fluid entrapment in the lesser sac—A complication of advanced ovarian cancer: Report of two cases

Two patients are reported with advanced ovarian cancer presenting with symptoms suggesting gastric outlet obstruction. In each case the symptomatology and clinical findings were caused by gastric compression secondary to entrapment of ascitic fluid in the lesser sac. This complication may be suggested by an upper gastrointestinal series, but is unequivocally diagnosed by computed tomography. Resection of the lesser omentum, repeat paracenteses, or insertion of a LeVeen peritoneovenous shunt into the lesser sac may all be used therapeutically for decompression of the stomach.     

Origin of carcinoma in secretory endometrium—A study using a whole-organ sectioning technique

Uteri from four patients with endometrial adenocarcinoma and concomitant “functioning” endometrium were examined by a whole-organ sectioning technique. All showed one or several “progesterone-refractory” mucosal areas or polyps, mainly in the tubal recesses. In one patient the adenocarcinoma obviously originated in a fundal polyp, and in the others the tumors could have arisen in mucosal areas not adequately responding to progesterone. These findings do not in fact contradict the “unopposed estrogen” theory of the genesis of endometrial carcinoma.     

Combination chemotherapy of ovarian granulosa cell tumor with cis-platinum and doxorubicin

Two patients with metastatic granulosa cell tumors were treated with cis-platinum and doxorubicin, 50 mg/m² of each drug being given by intravenous bolus every 21 days. Both patients attained complete clinical remission. One, who refused second-look surgery, is alive and free of disease 18 months after cessation of treatment. The other patient had minimal gross residual disease at second-look laparotomy. This regimen shows promise in the treatment of disseminated stromal cord tumors.     

Serum immunoglobulin concentrations in sera of patients with carcinoma of the cervix

Serum immunoglobulin concentrations were determined in 19 patients with cancer of the cervix and 49 healthy control women matched for age and parity. A significantly greater number of the cancer patients showed evidence of high levels (greater than mean ± 2 SD of the healthy control levels) of IgG and IgA, but not the IgM levels, as compared with the healthy controls. The possibility that these raised serum immunoglobulins are specific for tumor-antigens contained within or on the surface of malignant cells was discussed.