A case report of an ovarian lipoma.

BACKGROUND: Ovarian lipomas are a rare entity, with most being described as part of a teratomatous origin. This is a case report of a lipoma of an ovary not associated with a teratoma or an hyperandrogenic state. CASE: A 66-year-old female underwent an exploratory laparotomy and a left ovarian tumor measuring about 7 to 8 cm was removed. Microscopic examination demonstrated a pattern of proliferation of benign adipose tissue with focal areas of fibrovascular septae and no other tissue of different origin. CONCLUSIONS: A MEDLINE search did not reveal any well-documented cases of a pure ovarian lipoma. The cases reported were associated with teratomas, lipid cell tumors, and lipoleiomyomas. Thus, it appears that lipomas of the ovary are rare, but can occur.

Long-term follow-up of potentiation of radiotherapy by cis-platinum in advanced cervical cancer.

Between January 1982 and January 1983 all patients with advanced cervical cancer were randomized into three groups: radiotherapy only (group I), radiotherapy plus weekly cis-platinum (group II), and radiation plus twice-weekly cis-platinum (group III). Better initial central control was observed in group III patients. Long-term survival was similar in the three groups. Potentiation of radiotherapy with cis-platinum failed to show any significant improvement in long-term survival.

A randomized study of high-dose versus low-dose cis-platinum combined with cyclophosphamide in the treatment of advanced ovarian cancer. Hong Kong Ovarian Carcinoma Study Group.

A randomized clinical study of patients with advanced epithelial ovarian cancer after debulking surgery showed that high-dose (120 mg/m2) cis-platinum (DDP) in combination with cyclophosphamide (600 mg/m2) had a significantly higher response and survival rate than the low-dose DDP (60 mg/m2) and cyclophosphamide combination. The 3-year actuarial survival rate of the high-dose group was 60% and that of the low-dose group was 30%. Though moderate to severe marrow toxicity was evident in 80% of the patients in the high-dose group and 40% of the low-dose group, no serious sepsis or death developed as a result of the marrow depression. Mild neurotoxicity was observed in 55% of the patients in the high-dose group and only 20% in the low-dose group. Mild nephrotoxicity was seen in 25 and 17% of patients in the high- and low-dose groups, respectively. It was concluded that the 120 mg/m2 dose DDP and cyclophosphamide combination should be used in the treatment of carcinoma of the ovary in spite of its toxicities. However, it should only be used in institutions with supportive facilities in the management of patients with severe marrow depression.

Primary retroperitoneal sarcoma in the female pelvis. A report of three cases.

Retroperitoneal sarcoma can occur in the female pelvis and be confused with other pelvic masses. Its diagnosis depends on an awareness of its occurrence. Aggressive surgery to completely excise the tumor determines survival.

Primary oral etoposide therapy in gestational trophoblastic disease. An update.

Sixty patients who developed persistent or metastatic gestational trophoblastic disease (GTD) received primary oral etoposide therapy (VP 16-213). Twelve patients had metastatic GTD. Fifty-nine patients achieved biochemical remission. One patient had marked nausea and vomiting and the therapy was switched to a methotrexate/folinic acid regimen. Three patients developed relapse of GTD, giving a relapse rate of 5.1%. Etoposide is an active drug against choriocarcinoma. Its use should not be restricted to drug-resistant GTD.

The management of intractable lymphocyst following radical hysterectomy.

Six cases of intractable lymphocyst occurred in a series of 108 patients undergoing radical hysterectomy, an incidence rate of 5.6%. The complexities of pelvic lymphocyst are illustrated by their unusual presentation and problems in their management. Large lymphocysts should initially be treated by percutaneous catheter drainage before resorting to peritoneal marsupialization.

Etoposide, methotrexate, and bleomycin in drug-resistant gestational trophoblastic disease.

Nine patients with gestational trophoblastic disease resistant to multiagent chemotherapy, CHAMOCA, received methotrexate, bleomycin, and etoposide (VP 16-213) combination therapy. Eight patients achieved complete remission. There was no drug-related death. The importance of vigilant search and prevention of sepsis was emphasized. Alternative combination chemotherapy for drug-resistant choriocarinoma was discussed.

Cervical intraepithelial neoplasia treated by perilesional injection of interferon.

Twelve patients with cervical intraepithelial neoplasia (CIN) were studied by colposcopy and cervical smears to elucidate the local response to interferon alpha and beta given by perilesional injections and to assess long-term disease remission. In all patients, local inflammatory response was seen and persisted throughout the treatment period. Selective toxic effect was evident by exfoliation of increasing proportion of degenerate to viable dyskaryotic cells, while the normal epithelial cells appeared unaffected, and by the progressive regression of the lesion. Interferon alpha induced complete remission in six of seven (85.7%) patients but three had recurrence 12 to 24 months later, while interferon beta induced complete remission in only two of five (40%) patients.

Modified Bagshawe's regimen in high-risk gestational trophoblastic disease.

Fifty patients with high-risk gestation trophoblastic disease received primary multiagent chemotherapy (CHAMOMA). Forty-one patients (82%) achieved sustained completed biochemical remission. The importance of recognizing the high-risk factors and the effectiveness of primary multiagent chemotherapy are demonstrated.

Hepatic metastases in gestational trophoblastic disease.

From 1975 to 1983, 195 patients were treated for persistent or metastatic gestational trophoblastic disease. Fifteen patients with liver metastases were analyzed. All were treated with chemotherapy alone, none received hepatic irradiation, and no patient bled from her hepatic metastases. Thus, the need for prophylactic hepatic irradiation to prevent hemorrhage is doubtful. The good results obtained in the studied patients emphasize the significance of using vigorous primary multiagent chemotherapy in high-risk gestational trophoblastic disease patients.

Potentiation of radiotherapy by cis-dichlorodiammine platinum (II) in advanced cervical carcinoma.

Forty-five patients with Stages II and III cervical carcinoma were randomized to receive either radiation or cis-dichlorodiammine platinum (II) (cis-DPP) with radiation. Cis-DPP was administered in bolus injections of 25 mg/m2 at weekly intervals until completion of radium application. Complete response was noted in 11/20 (55%) patients in the radiochemotherapy group compared to 5/25 (20%) patients in the radiation group (P less than 0.025). No enhanced toxicities were observed with the addition of cis-DPP to radiation. The combined use of cis-DPP and radiotherapy offers promising potential in improving local-regional control of advanced cervical carcinoma.

Postmenopausal uterine bleeding of nonorganic cause.

Eighty-nine patients with postmenopausal uterine bleeding were studied focusing on the nonorganic causes of bleeding. Atrophic endometrium was found in 82%, proliferative endometrium in 7%, and secretory endometrium in 1% of patients. Carcinoma was uncommon, found in only 7% of patients. Hysteroscopy was an invaluable adjunct to dilatation and curettage in diagnosing bleeding due to atrophic endometrium as 42% of such cases yielded no tissue on curettage. The clinical entity of bleeding atrophic endometrium is discussed.

Ovarian dysfunction in patients with gestational trophoblastic neoplasia treated with short intensive courses of etoposide (VP-16-213).

The effect of oral Etoposide (VP-16-213) on the ovarian function in 22 patients with residual gestational trophoblastic disease was studied by serial weekly measurement of serum follicle stimulating hormone (FSH), 17 beta-estradiol (E2), progesterone (P) and prolactin (PRL), and monitoring of the menstrual patterns during and after drug treatment. Multiple courses of VP-16-213 at a dosage of 200 mg/m2 X 5 days were given 1 week apart. Following an average dose of 5.0 gm, five young patients developed transient ovarian failure for a mean period of 2.4 months and two elderly patients developed permanent ovarian failure (total incidence, 7/22, 31.8%) as evidenced by hypergonadotropic, hypoestrogenic amenorrhea. In addition, two patients each developed anovulatory cycles and hypomenorrhea. VP-16-213 should therefore be regarded a potent gonadotoxic drug and these hitherto unreported side effects should be recognized when the drug is used in menstruating females.

Methotrexate with citrovorum factor rescue in gestational trophoblastic disease.

Thirty-three patients with gestational trophoblastic disease treated with methotrexate alone and 68 similar patients treated with methotrexate and citrovorum factor rescue were analyzed. Both groups showed a comparable sustained biochemical remission rate. The group treated with methotrexate and citrovorum factor however showed a shorter interval to induction of remission (p less than 0.05). Contrary to previous reports, the methotrexate and citrovorum factor regimen failed to protect the patients against the development of hepatic toxicity, the incidence of hepatic toxicity being significantly higher in the group treated with methotrexate and citrovorum factor.

Puerperal ovarian vein thrombophlebitis.

A 16 year old Chinese female with puerperal ovarian vein thrombophlebitis following uneventful vaginal delivery is reported. This infrequent, but potentially fatal, complication in the febrile postpartum patient may present as a surgical emergency. Non-invasive diagnostic procedures and conservative treatment with heparinization and antibiotics have been suggested. However, early exploratory laparotomy for ovarian vein or caval ligation may be life-saving if the diagnosis is in doubt or the response to conservative treatment is unsuccessful.

Intravaginal application of leukocyte interferon gel in the treatment of cervical intraepithelial neoplasia (CIN).

Leukocyte interferon gel (1 X 10(6) units) was applied twice daily by a vaginal applicator to areas of cervical intraepithelial neoplasia (CIN) in 7 patients. A partial response was obtained in 3 patients and complete response in 2 patients. This suggests that leukocyte interferon gel can be used to treat CIN.

Concurrent radiochemotherapy in the treatment of gynaecologic neoplasms.

Chemotherapy with adriamycin and/or cisplatinum in standard dosages concurrent with full radiation produced an accelerated local-regional tumour control leading to complete response in 12 of 14 patients who had advanced primary or recurrent gynaecologic neoplasms. The continuation of chemotherapy thereafter did not however prevent the development nor arrest progression of metastases outside the irradiated field. Epidermitis and myelosupression were the enhanced side effects but were tolerable and manageable. Radiochemotherapy can be applicable in situations where rapid shrinkage of the tumour bulk is required. Its other useful potentials deserve further evaluation.

Use of oral VP16-213 as primary chemotherapeutic agent in treatment of gestational trophoblastic disease.

Thirty-seven patients with persistent or metastatic gestational trophoblastic disease were treated with oral etoposide (VP16-213). All responded well and achieved permanent remission. The hematologic toxicity was mild. Alopecia was present in all patients. Etoposide is an effective drug against trophoblastic disease. In patients who have received chemotherapy for long periods oral etoposide would eliminate the problem of venous access.

The assessment of radio-response of cervical carcinoma by colposcopy.

Ninety-four patients with invasive carcinoma of the cervix were investigated for radio-response during treatment using colposcopy and serial biopsies. In 31 patients, the results were further correlated with pathological examination of the Wertheim hysterectomy specimen. It is established that colposcopy can be as reliable as biopsy in predicting radio-response and can be employed complementary to serial biopsies and clinical examinations. The colposcopic features of cervical carcinomas undergoing irradiation are described.