Histological study of microinvasive carcinoma of the uterine cervix.

Fifty-three cases of microinvasive carcinoma, 107 cases of carcinoma in situ, and 52 cases of dysplasia were studied histologically. When the original squamocolumnar junction (SCJ) was defined as it was at the last cervical gland, most of the abnormal epithelia located in the zone between this SCJ and 10 mm proximal to SCJ. Concerning the spreading extent of abnormal epithelium there was an apparent tendency that the more severe the lesion, the wider was the extent. The circumferential extent of the lesions was closely correlated to the longitudinal extent. The type of invasion was classified into four groups: drop, fingerlike, bulky, and confluent type. Since many invasions which began from the surface epithelium remained within 1 mm in depth, and invasions from a cervical gland were initially noted in deeper areas, the depth of invasion measured from the surface epithelium may not directly reflect the progression of the lesions.     

Coexistent squamous cell carcinoma and adenocarcinoma of the uterine cervix

The clinical and pathological features of 20 patients with coexistent squamous cell carcinoma and adenocarcinoma of the uterine cervix have been analyzed. Various combinations of in situ and invasive carcinomas were found. Located adjacent to each other and at times intermingling, these lesions probably originated from the subcolumnar reserve cells of the transformation zone. They are early lesions and may be precursors of adenosquamous and mucoepidermoid carcinomas of the cervix. The diagnosis of these double carcinomas depends upon being aware that the two entities may coexist in the same cervix. Treatment is conventional, and the prognosis is not worsened by the presence of the two types of neoplasms.     

Hypercalcemia in patients with squamous cell carcinoma of the cervix.

Hypercalcemia was identified in approximately 1% of the patients with epidermoid cervical cancer admitted to the gynecologic oncology service at LAC/USC Women's Hospital over a 6.5-year period. Nonspecific neurologic manifestations of weakness, obtundation, and coma were the predominant presenting features. The response to anticalcemic therapy depended upon the extent of the underlying malignancy and the presence of uremia. The appearance of hypercalcemia in these patients usually signified a rapidly deteriorating clinical course which was irreversible despite aggressive medical management in some instances. Recent concepts in the humoral mechanisms of cancer related hypercalcemia, briefly reviewed here, may provide safer and more successful avenues of treatment for salvageable patients in the near future.     

Epidemiological differences between adenocarcinoma and squamous cell carcinoma of the uterine cervix

Adenocarcinoma of the uterine cervix was significantly more common than squamous cell carcinoma of the cervix in unmarried patients (relative risk 2.07) and in nulliparous patients (relative risk 1.96). It also occurred more often in women with arterial hypertension (relative risk 3.62), previous subtotal hysterectomy (relative risk 3.89), and agrarian life style (relative risk 2.95). No difference was noted in mean age, age distribution, age at marriage, age at first delivery, menarche, or menopause. No association of adenocarcinoma of the cervix with pregnancy was found. On the basis of common risk factors it is suggested that cervical adenocarcinoma is epidemiologically more closely related to endometrial adenocarcinoma than to squamous cell carcinoma of the cervix.     

T and B lymphocytes in patients with squamous cell carcinoma of the uterine cervix

Subpopulations of peripheral lymphocytes were enumerated in Japanese with squamous cell carcinoma of the uterine cervix. T lymphocyte counts were carried out in SRBC rosette tests and B lymphocyte counts by immunobead rosette tests using antibody-coated polyacrylamide beads. “Active”T lymphocytes were significantly depressed in patients with dysplasia, carcinoma in situ, and advanced carcinoma; number of “total” T lymphocytes was also significantly lower in those with carcinoma in situ as compared to healthy controls. There was a decreased number of “total” B lymphocytes in patients with advanced carcinoma, and an increased number of IgA-bearing B lymphocytes in stage II invasive carcinoma, respectively. The present findings suggest that depression of cell-mediated immunity associated with T lymphocytes is responsible for the initiation of cervical carcinoma.     

Tumor cell kinetics-directed chemotherapy for advanced squamous carcinoma of the cervix

Cell cycle phase specific chemotherapeutic agents may be less effective treatment for metastatic or recurrent cervical carcinoma because most solid tumors contain very low cell growth fractions. Maximum therapeutic advantage may be accomplished through the use of a multiple drug protocol whose schedule is based on phase specificity of drug action and tumor cell kinetics. Preliminary data indicate that administration of a synchronizing agent, followed by cell kinetics analysis using flow microfluorometry techniques, allows a second agent to be scheduled at a time in the cell cycle when it would be most effective. These observations are based on the clinical response of 11 patients treated with kinetics-directed regimens (derived from direct kinetics measurements) or kinetics-based protocols (derived from empirical or historical data).     

Intraarterial cis-platinum in the management of squamous cell carcinoma of the uterine cervix

Intraarterial cis-platinum was infused by hypogastric artery catheters in nine patients with squamous cell carcinoma of the uterine cervix. The dose of cis-platinum was 120 mg/m² and the infusion was repeated at 4-week intervals. Six patients had pelvic recurrences following radiation therapy and three had large-volume, primary cancers not amenable to conventional therapy. Three patients experienced partial tumor regression (greater than 50% reduction in measured diameters persisting for 3 months), while six had progressive disease. Five patients achieved substantial palliation. Toxicity was similar to that seen with systemic administration. There were no significant catheter complications.     

Arterio-enteric fistula following pelvic radiation: a case report.

Two cases of arterial perforation into the small bowel are reported. Etiology was not determined in one case, but surgical trauma leading to localized infection in the irradiated tissue seemed responsible in the other. After the initial episode of hemorrhage, there was a symptom-free interval before its reappearance and vascular collapse. This is believed to be due to the distensibility of the large bowel. The site of arterial perforation was determined pre-operatively in one case by selective arteriography. Review of the recent literature relevant to transcatheter arterial embolization suggests that it may have potential in management of the arterio-enteric fistula as an alternative to or an aid in surgical correction by stabilizing the patient in a favorable condition.     

The prognostic significance of tumor emboli in lymphatic or vascular spaces of the cervical stroma in Stage IB squamous cell carcinoma of the cervix

The presence of tumor emboli in lymphatic or vascular spaces within the cervical stroma in squamous cell carcinoma of the cervix has been reported by several authors to be associated with a decrease in 5-year survival. In a 10-year review of 124 radical hysterectomies for Stage IB squamous cell carcinoma of the cervix at the University of Michigan from 1970 to 1980 the presence of tumor emboli in the cervical stroma without other known risk factors did not significantly alter the 3- and 5-year survival. With the potential risks and lack of proved benefit the use of adjuvant radiotherapy or chemotherapy in this setting is not recommended.     

Primary transitional cell carcinoma of the fallopian tube associated with primary carcinomas of the ovary and endometrium

A patient with primary transitional cell carcinoma of the fallopian tube, primary endometrial adenocarcinoma, and primary endometrioid carcinoma of the ovary is reported. The clinical picture was similar to that of adenocarcinoma of the fallopian tube, but the mode of spread was somewhat different and more aggressive. The patient was treated with surgery and a combination of internal and external radiotherapy.     

Urinary undiversion: use in management of radiation induced bladder fistula.

Urinary undiversion was attempted and successful in two patients. The indication for prior diversion in both patients was extensive bladder fistula following pelvic radiation for cancer of the uterine cervix. Function of the urinary system has been essentially normal in both patients during the follow-up period of 6 months to 2.5 years. Review of the literature relevant to reconstruction of the urinary system in adults following previous ileal conduit formation revealed very scanty data, particularly after pelvic radiation. Reported methods are described. Although the experience is limited, ileocystostomy with undiversion of the ileal conduit after pelvic radiation appears not only feasible, but very rewarding for selected highly motivated patients.     

An international system for the education of students of medicine and other health professionals in human reproduction. The FIGO teaching manual: A status report

An analysis of the effectiveness of FIGO's Teaching Manual on Human Reproduction is reported on the basis of answers to a questionnaire received from 100 heads of teaching departments, chiefly of obstetrics and gynecology. These represented 32 countries widely distributed throughout the developing countries of the world. The most significant finding was the evidence of the very large number of medical and other students that could be reached through the principle of placing superlatively good teaching material in the hands of key educators in their native country. Additional answers to the questionnaire provided information on the way courses were organized about the material and suggestions as the useful changes, possible expansion of subject matter, and the felt need for an updated edition.     

Wide local excision in the treatment of vulvar carcinoma in situ: a reappraisal

A retrospective study of 56 patients treated for carcinoma in situ of the vulva over a 24-year period has shown a relative increase in the occurrence of this neoplasm. Only 6.7% of patients in the first 14 years of the study period were less than 35 years of age, as compared with 29.3% in the last decade. In the earlier years of the study, simple vulvectomy was the primary treatment, and 81.3% of the patients were disease-free at 5 years. Wide local excision, used in the later years, resulted in a rate of 46.2% with no evidence of disease. Involvement of surgical margins played a significant role in this increased incidence of recurrence. Only one patient, originally treated by simple vulvectomy, later developed early stromal invasion. A wide local excision technique should be strongly considered as initial management of this multifocal neoplasm. Close follow-up is mandatory. Recurrence of disease may be treated with appropriate wide excision.     

The occurrence of adenocarcinoma in endometriosis of the rectovaginal septum during progestational therapy.

A patient is presented who developed adenocarcinoma in endometriosis of the rectovaginal septum during a second course of hormonal therapy. Malignant transformation in an area of endometriosis during sex steroid therapy has not been previously reported. The rectovaginal septum is recognized as probably the most common site of malignant transformation in extraovarian foci of endometriosis.     

Positive lymph nodes in vulvar squamous carcinoma

Retrospective evaluation of 52 patients with positive lymph nodes at the time of curative primary surgery for invasive squamous carcinoma of the vulva reveals that those patients with three or less unilaterally positive groin nodes have an excellent prognosis. When more than three groin nodes are positive, or when bilateral groin nodes are present, there is a significant decrease in survival and a significant increase in positive pelvic node metastases. No cases of positive deep pelvic nodes were noted when the groin nodes were negative. Primary involvement of the clitoris followed a stepwise spread to the groin nodes and then to the deep pelvic nodes with no evidence of primary metastases to the deep pelvic nodes without groin node involvement.     

Lymphoma of the ovary: Report of twenty new cases and update of previous series

Ovarian lymphoma is a rare entity. This review of 55 cases, including 35 that were previously reported, updates and reclassifies the cases from the Ovarian Tumor Registry and the Gynecologic Pathology Laboratory. The problems of differential diagnoses are stressed.