Remarkable Response of Primary Squamous Cell Carcinoma of the Ovary to Paclitaxel and Cisplatin

Background: The survival rate of patients with advanced stage primary squamous cell carcinoma of the ovary is dismal and the best treatment is unknown. We describe the response of this tumor to systemic chemotherapy employing paclitaxel and cisplatin.Case: A 31-year-old white woman diagnosed with International Federation of Gynecology and Obstetrics stage IV primary squamous cell carcinoma of the ovary associated with ovarian endometriosis underwent cytoreductive surgery followed by paclitaxel and cisplatin every 4 weeks for 12 courses. The patient tolerated chemotherapy well, demonstrated a dramatic response with disappearance of hepatic metastases, and remains without evidence of disease 2 years after diagnosis.Conclusion: Paclitaxel and cisplatin may be effective in treating primary squamous cell carcinoma of the ovary.     

Coexisting Primary Carcinoma of the Uterus and Ovary with Reference to a Theory of Origin

THE association of primary carcinoma of the uterine body and of the ovary is relatively uncommon but has been reported by a number of workers: Howard Taylor (Jr.) (1929), Shaw (1932), Offutt (1932), Lynch and Dockerty (1945). Jeffcoate (1957) and Holland and Bourne (1959) accept the association in their respective textbooks of gynaecology.     

Clinical Remission Criteria for Epithelial Carcinoma of the Ovary

After primary cytoreductive surgery 188 patients with epithelial ovarian cancer were treated with combination chemotherapy between 1986 and 1989 in the Tokai Ovarian Tumor Study Group. Clinical remission criteria were set in this study and patients were examined to determine if they were in remission or not. Forty-seven cases (25%) had no remission and 85.9% of them died within 20 months after primary surgery. Fifty-seven cases (30.3%) had a remission and a subsequent recurrence. Eighty-four cases (44.7%) had no recurrence and all are currently alive. Independent remission factors by multivariate analysis were higher stage (P = 0.018), clear-cell carcinoma (P = 0.0048), larger maximum residual tumor (P = 0.0023), and PVB therapy (P = 0.026). Independent recurrence factors were higher stage (P = 0.0012), serous cystadenocarcinoma (P = 0.0001), clear-cell carcinoma (P = 0.00409), and PVB therapy (P = 0.0499). A significantly high remission rate and low recurrence rate was achieved using PVB therapy. This criteria has value for the treatment of epithelial ovarian carcinoma. The disease-free survival rate after clinical remission was the same as that after a negative second-look laparotomy, which implies that a second-look lapcarotomy may be unnecessary in the management of epithelial carcinoma of the ovary.     

C－erbB3在卵巢移行细胞癌组织中的过度表达

采用单克隆抗体免疫组化技术对２０例正常卵巢和３２例卵巢移行细胞癌组织进行Ｃ－ｅｒｂ－Ｂ３癌基因产物表达的检测。比较正常卵巢与卵巢移行细胞癌组织Ｃ－ｅｒｂＢ３表达的异同，分析卵巢移行细胞癌组织Ｃ－ｅｒｂＢ３过度表达与预后诸因素间的关系。结果：正常卵巢组织Ｃ－ｅｒｂＢ３的表达率为３０％，卵巢移行细胞癌Ｃ－ｅｒｂＢ３的表达率为４７％（Ｐ＞０．０５）。卵巢移行细胞癌Ｃ－ｅｒｂＢ３过度表达与患者的年龄、临床分期、ＣＡ＿（１２５）水平、组织学分化和淋巴结转移间未见明显关系（Ｐ＞０．０５），但是，Ｃ－ｅｒｂＢ３过度表达的卵巢移行细胞癌患者的预后较差。     

Significance of Lymph Node Sampling in Epithelial Carcinoma of the Ovary

From 1979 to 1984, 127 patients operated on for ovarian cancer underwent pelvic, para-aortic, or pelvic and para-aortic lymph node sampling. Forty-seven patients proved to be stage I (14 IA and 33 IC), 14 were stage II (3 IIA, 8 IIB, and 3 IIC), 58 were stage III (7 IIIA, 13 IIIB, and 38 IIIC), and 8 were stage IV. Positive lymph nodes were found in 4.2% of patients at stage I, 35.7% at stage II, 41.3% at stage III, and 87.5% at stage IV. With regard to grading, positive lymph nodes were found in 4.4% of G1, in 21.6% of G2, and in 49.1% of G3. A significant increase in survival (P= 0.04) was found for patients classified as stage IIIC only according to lymph node involvement compared to patients in peritoneal stage IIIC with positive lymph nodes (3-year survival: 46% vs 12%). A small increase in survival was observed for N− patients compared to N+ patients, at both stage III and IV, even with same residual tumor size, but the difference is not statistically significant. All other things being equal, because the prevalence of lymph node positivity depends closely on the number of lymph nodes removed and examined (OR = 3.9 for >10 lymph nodes removed compared to 1–5 lymph nodes removed), lymph node sampling does not seem to be a reliable method for evaluating the retroperitoneal status. With regard to the therapeutic role of systematic lymphadenectomy, few data in literature are available and, most important, are not derived from experimental studies. Probably, only randomized studies with a large number of patients will provide useful answers.     

Squamous Cell Carcinoma Arising in a Dermoid Cyst of the Ovary

Summary: A case of unexpected squamous cell carcinoma arising from a benign cystic teratoma is presented. The tumour occurred in a 57-year-old Chinese patient. No recurrence was evident after 1 year. The literature is briefly reviewed.     

Squamous Cell Carcinoma Arising in Mature Cystic Teratoma of the Ovary

Treatment results of 26 patients with squamous cell carcinoma (SCC) arising in mature cystic teratoma of the ovary were analyzed. Four nulliparous patients with stage Ia tumors underwent conservative salpingo-oophorectomy. Following surgery, 2 patients had successful pregnancies. The remaining 7 patients with stage Ia tumors were observed after hysterectomy and bilateral salpingo-oophorectomy. Fifteen patients with stage Ic–IV tumors underwent cytoreductive surgery followed bycis-platinum-based chemotherapy with or without sequential radiotherapy. The mean survival was 63.9 months. The overall actuarial disease-free survival at 2 years was 69%, and by stage was as follows: stage I, 100% (13/13); stage II, 100% (2/2); stage III, 30% (3/10); and stage IV, 0% (0/1). A significant difference in disease-free survival was noted in stage (P= 0.0001). Optimal versus suboptimal operation was associated with a median Kaplan–Meier survival of 65 months versus 34.8 months, with actuarial disease-free survival at 2 years of 60 and 0%, respectively (P= 0.0210). Our study shows that 67% (16/24) of the patients had SCC antigen levels exceeding 2 ng/ml, which by stage was as follows: stage I, 5/11 (45%); stage II, 1/2 (50%); stage III, 9/10 (90%); and stage IV, 1/1 (100%). After completion of treatment, all 8 patients with recurrent lesions had reelevated SCC antigen levels in series SCC antigen monitoring. In conclusion, positive prognostic factors of disease-free survival were optimal cytoreduction and lower FIGO stage. We suggest that multimodality therapy, including aggressive cytoreduction followed bycis-platinum-based chemotherapy with or without sequential radiotherapy, is recommended. In addition, we suggest that serum SCC antigen monitoring may be helpful in early detection of cancer recurrence.     

Uterine and Ovarian Conservation in Advanced Small Cell Carcinoma of the Ovary

Background: The decision to recommend removal or conservation of a normal ovary and uterus in a young woman with advanced ovarian cancer is difficult and controversial.Case: A 21-year-old patient with a large-cell variant of small-cell carcinoma of the ovary stage IIIc underwent optimal debulking surgery with preservation of the normal appearing uterus and opposite adnexa followed by aggressive multi-agent chemotherapy. She is menstruating normally and is free of disease, more than 2 years since completion of chemotherapy.Conclusion: In selected cases, conservation of the uninvolved ovary and uterus in patients with advanced-stage, small-cell carcinoma of the ovary may not compromise survival.