Well-Differentiated villoglandular adenocarcinoma of the uterine cervix: a report of 15 cases including two with lymph node metastasis.

Well-differentiated villoglandular adenocarcinoma is a recently described subtype of cervical adenocarcinoma. The tumor of this type is reported to have distinct clinicopathologic features and excellent prognosis. However, lymph node metastases of this tumor have been described in few reports. Fifteen cases of well-differentiated villoglandular adenocarcinoma treated at Maharaj Nakorn Chiang Mai Hospital were retrospectively reviewed for both clinical and histopathological features. All patients underwent radical hysterectomy with pelvic lymphadenectomy. In the cases with lymph node metastasis, adjuvant radiation therapy was also given. The patients ranged in age from 22 to 53 years (mean, 39.3). Fourteen patients were FIGO stage IB and one was stage IIA. All patients had exophytic friable cervical masses. Tumor size known in 14 cases ranged from 1.5 to 4 cm (mean, 2.3). Eleven tumors (73.3%) were confined to the inner third of the cervical stroma with 9 of these (60%) showing only superficial invasion (depth < or = 3 mm). The tumors invaded deeply to the middle third in 3 cases (20.0%), and to the outer third in one (6.7%). Lymphatic invasion was observed in 3 cases, two of them had pelvic lymph node metastasis. Both patients had tumors involving deeper than the inner third of the cervical wall. The follow-up duration ranged from 21 to 144 months (mean, 67.5). Four of thirteen cases without nodal metastasis were lost to follow-up 36 to 59 months after surgery. All patients showed no evidence of disease at the last visit. Presence of lymphatic invasion and deep stromal involvement appeared to be the risk factors for lymph node metastasis of well-differentiated villoglandular adenocarcinoma.

Comparison of short versus long duration of ampicillin and gentamicin for radical hysterectomy.

Prophylactic antibiotic therapy for radical hysterectomy is still controversial. Although the efficacy of antibiotics have been demonstrated, there remains the question of duration of administration. In this study, we retrospectively reviewed 95 patients who underwent radical hysterectomy and pelvic lymphadenectomy for cervical cancer at our institute. The management was uniform except for the duration of antibiotic administration. Group I (34 cases) had ampicillin and gentamicin for 3 days while group II (61 cases) had the same regimen for 7 days. No significant difference was found in terms of postoperative infection (2.9% in group I and 1.6% in group II) or febrile morbidity (32.4% versus 50.8%). Other factors such as the patients' age, body weight, preoperative hemoglobin level, amount of blood loss and blood transfused, operative time, duration of retroperitoneal drain and duration of suprapubic cystostomy. Only operative time had a significant influence on febrile morbidity regardless of the duration of antibiotics administered. In conclusion, the antibiotic administration gave a radical hysterectomy and pelvic lymphadenectomy a very low incidence of postoperative infection. Longer duration of treatment did not appear to lessen postoperative infection nor febrile morbidity. Shorter duration of antibiotic administration needs further evaluation.

Granulosa cell tumor of the ovary.

From January 1984 to December 1994, 36 women with granulosa cell tumors of the ovary were treated at Maharaj Nakorn Chiang Mai Hospital, which accounted for 5.8 per cent of all 620 ovarian malignancies treated at this institute. Twenty patients were in stage I, 2 in stage II, 11 in stage III and the remaining 3 cases were in stage IV. Most patients had unilateral ovarian involvement while 6 (16.7%) had bilateral involvement. The diameter of the tumor ranged from 4 to 30 cm with the median of 14 cm. Treatment consisted of hysterectomy and bilateral salpingo-oophorectomy followed by chemotherapy in most cases. To date 10 patients have no evidence of disease while 9 died of the disease, others were lost to follow-up. The 5-year survival was 94 per cent in the early stages compared to 25 per cent in advanced stages. The overall survival rate was 62.7 per cent for all stages.