Parameters of differentiation and proliferation in adult granulosa cell tumors of the ovary.

We evaluated parameters of cell differentiation and proliferation to improve prognostication of ovarian adult granulosa cell tumors. Recurrent tumors (n = 10, REC group) and nonrecurrent tumors (n = 30, NED group) were compared in terms of cellular atypia, nuclear area, p53 overexpression, ploidy, DNA index, mitosis count, S-phase fraction, and nucleolar organizer region number and area per cell. Cellular atypia was significantly more frequent in REC than NED tumors (50% versus 13%; P = .03). Mean nuclear area was significantly larger in the REC than in the NED group (44 microm2 versus 36 microm2; P = .006). Mitotic count was significantly higher in REC than NED tumors (mean of 4.8 versus 1.7; P = .004). S-phase fraction and ploidy did not predict outcome: neither did nucleolar organizer region numbers and area per cell, or p53 overexpression. Cellular atypia and mitotic count may help in determining the prognosis of adult granulosa tumors of the ovary. The histochemical parameters evaluated did not provide additional information.

Secondary ion mass spectrometry of zeolite materials: observation of abundant aluminosilicate oligomers using an ion trap.

Oligomeric oxyanions were observed in the secondary ion mass spectra (SIMS) of zeolite materials. The oxyanions have the general composition AlmSinO2(m+n)H(m-1)(-)(m+n = 2 to 8) and are termed dehydrates. For a given mass, multiple elemental compositions are possible because (Al + H) is an isovalent and isobaric substitute for Si. Using 18 keV Ga+ as a projectile, oligomer abundances are low relative to the monomers. Oligomer abundance can be increased by using the polyatomic projectile ReO4- (approximately 5 keV). Oligomer abundance can be further increased using an ion trap (IT-) SIMS; in this instrument, long ion lifetimes (tens of ms) and relatively high He pressure result in significant collisional stabilization and increased high-mass abundance. The dehydrates rapidly react with adventitious H2O present in the IT-SIMS to form mono-, di-, and trihydrates. The rapidity of the reaction and comparison to aluminum oxyanion hydration suggest that H2O adds to the aluminosilicate oxyanions in a dissociative fashion, forming covalently bound product ions. In addition to these findings, it was noted that production of abundant oligomeric aluminosilicates could be significantly increased by substituting the countercation (NH4+) with the larger alkali ions Rb+ and Cs+. This constitutes a useful tactic for generating large aluminosilicate oligomers for surface characterization and ion-molecule reactivity studies.

Phase II trial of oral etoposide in recurrent or refractory endometrial adenocarcinoma: a southwest oncology group study.

Oral etoposide has activity in a wide variety of tumors and is well tolerated. Therefore, the efficacy of oral etoposide was assessed as a treatment of metastatic endometrial cancer. To be eligible for this group-wide Southwest Oncology Group trial, patients had to have histologically proven metastatic or recurrent endometrial carcinoma; no previous cytotoxic therapy; and adequate renal, hepatic, and hematologic function, and they had to have given informed consent. Therapy consisted of oral etoposide, 50 mg daily on days 1-21 on a 28-day schedule. Therapy was continued in the absence of toxicity or disease progression. Forty-four eligible women, with a median age of 68 years (range 38-84 years) were treated. Radiotherapy had been delivered to 33 and hormomal therapy to 21. The median duration of therapy was 69 days (range 7-510 days). The treatment was well tolerated. Only one patient had grade 4 neutropenia, and a second had grade 4 anemia. Three patients had grade 3 nausea. One complete and five partial responses (14%) were observed. An additional four patients had unconfirmed responses. Tumor regressions were noted in nodes, bone, and visceral organs. While oral etoposide has only a modest level of activity when used in chemonaive patients, the minimal toxicity of this drug makes it a candidate for use in combination chemotherapy.

Ultrastructural interactions in the microvasculature of human endometrial adenocarcinoma.

OBJECTIVES: Our purpose was to study the ultrastructural morphology of the microvasculature of human endometrial adenocarcinoma and to determine the effect of this malignancy on cell-to-cell communication between the components of the microvasculature and with the other tissue compartments of human endometrium. Methods. Multiple cases of human endometrial adenocarcinoma were studied and graded by light microscopy. Six cases of Grade I and six cases of Grade II were selected. Two blocks per case were studied ultrastructurally. RESULTS: In contrast to our expectation that the ultrastructure of tumor vessels would suggest a great deal of proliferation and new vessel formation, we found that tumor vessels displayed a high degree of cellular differentiation, in the form of numerous and varied cell-to-cell contacts, and large amounts of protein production. CONCLUSIONS: The morphology of the microvasculature of endometrial adenocarcinoma suggests an active rather than passive role in tumor vessels.

An update of a phase II study of paclitaxel in advanced or recurrent squamous cell cancer of the cervix.

UNLABELLED: Thirty-two evaluable patients with squamous cell cancer of the cervix were treated with i.v. paclitaxel 250 mg/m2 over 3 h every 21 days. They received standard premedications and granulocyte colony stimulating factor (G-CSF) support (5 micrograms/kg/day). Median (range) age was 49 (29-81) years and performance status Zubrod was 1 (0-2). One patient had a complete response and seven patients had a partial response (25%, 95% CI 8-38%). The median survival was 7.3 months. Granulocytopenia was brief and non-cumulative. G-CSF was used for a median (range) of 8 (1-15) days per cycle. IN CONCLUSION: paclitaxel is active in patients with squamous cell cancer of the cervix and is well tolerated in this dose schedule with G-CSF support.

Prognostic factors in adult granulosa cell tumor of the ovary.

BACKGROUND: The clinical course of adult granulosa cell tumor of the ovary is characterized by indolent growth tending toward late recurrence. A variety of clinical and pathologic parameters have previously been evaluated for prognostication with inconclusive results. METHODS: The clinical records and tumor sections of 70 patients with adult granulosa cell tumors of the ovary were reviewed. Patients with recurrent tumors (REC) (n = 19) were compared with patients who remained without disease (NED) (n = 51). RESULTS: Significant differences in stage and tumor size were noted between the two groups; however, after logistic regression analysis, only stage remained statistically significant. Pathologic evaluation revealed that Call-Exner bodies occurred more frequently in tumors of the NED patients. Cellular atypia and high mitotic rates were more frequent in the REC group; however, after logistic regression analysis, only atypia remained statistically significant. When early (< 10 years) and late recurring tumors (> 10 years) were compared, statistically significant differences were again noted: early recurring tumors had fewer Call-Exner bodies, higher mitotic rates, and higher degrees of atypia; late recurring tumors were similar to tumors in the NED patients. CONCLUSIONS: Tumor stage and, to a lesser extent, tumor size are the only clinical parameters of prognostic importance in adult granulosa cell tumors. Cellular atypia and, to lesser extents, mitotic rate and the absence of Call-Exner bodies are the only significant pathologic prognosticators. It is difficult to predict early recurrences and impossible to predict late recurrences using these clinical and pathologic parameters.

The nuclear channel system in endometrial adenocarcinoma exposed to medroxyprogesterone acetate.

The nuclear channel system (NCS), giant mitochondria and subnuclear glycogen form a triad of ultrastructural features observed in normal human endometrial epithelium in response to progestational steroids. Both the giant mitochondria and subnuclear glycogen have been described in endometrial adenocarcinoma, but the NCS has not. This article reports the development of the NCS in adenocarcinoma treated with medroxyprogesterone acetate. Previous studies suggest that the NCS in normal tissue is a response to the acyl group in the 17-beta position of the D-ring of some progestational steroids, such as medroxyprogesterone acetate. Medroxyprogesterone acetate was administered to 12 postmenopausal women with endometrial adenocarcinoma. Hysterectomies were performed 8 to 20 days after treatment. Pretreatment specimens were also obtained on 8 of the 12 patients. Using standard electron microscopy procedures, light microscopy on plastic semithin sections was first used to confirm the presence of tumor. Thin sections of malignant endometrium were prepared and evaluated ultrastructurally for progestational alterations. Abnormal giant mitochondria and subnuclear glycogen were found both before and after treatment. The third element of the triad, the NCS, was not observed in any of the available pretreatment biopsies, but was seen in three of the treated specimens. Thus it appears that the NCS is a response to the given progesterone therapy.

Static secondary ionization mass spectrometry detection of cyclohexylamine on soil surfaces exposed to laboratory air.

Cyclohexylamine (CHA) is a common indoor air contaminant, which rapidly adsorbs to aluminosilicate soil samples. Static secondary ion mass spectrometry was used to study soil samples exposed to both CHA and CHA-d 11, and the results showed (1) abundant [M+H](+) and fragment ions that originated from CHA, (2) an initial concentration of CHA equivalent to approximately 0.2 monolayer, and (3) a possible exchange reaction where excess CHA-d 11 displaces CHA originally adsorbed to the surface. CHA was not removed from the surface by prolonged exposure to vacuum conditions (5×10(-7) torr), which indicates that CHA strongly adsorbs to aluminosilicate surfaces and should be expected as an endogenous surface contaminant where the chemical is used as a corrosion inhibitor.

Static secondary ionization mass spectrometry analysis of tributyl phosphate on mineral surfaces: Effect of Fe(II).

The static secondary ionization mass spectrometry (SIMS) spectrum of tri-n-butyl phosphate (TBP) on a variety of basalt and quartz samples is affected by the chemical composition of the mineral surface. When TBP is adsorbed on Fe(II)-bearing surfaces, the compound undergoes concomitant H(-) abstraction and reduction, followed by the elimination of two C4H8 molecules to form an ion at m/z 137(+). When TBP is adsorbed to quartz or other nonreducing surfaces, it merely undergoes protonation and elimination of three C4H8 molecules to form H4PO 4 (+) . When TBP is adsorbed to Fe(III)-bearing surfaces, it undergoes H(-) abstraction and elimination of two C4H8 molecules, to form an ion at m/z 153(+). These conclusions are supported by model studies that employed FeO, Fe203, TBP, and tributyl phosphite. The results show that the SIMS spectrum is very sensitive to the mode of TBP adsorption on the mineral surface.

Experience with the Groshong long-term central venous catheter.

A study of the Groshong catheter in a gynecologic oncology population is presented, describing the catheter's ease of insertion, and patient acceptance and compliance in catheter care. From December 1985 through November 1987, 72 Groshong catheters were inserted in 67 patients. The Groshong differs from conventional Hickman-type catheters in design and maintenance. Thirty-two of 72 catheters (44%) were inserted under local anesthesia. The remaining catheters were inserted under general anesthesia at the time of major gynecologic procedures. None of the cases required fluoroscopy. The insertion technique is less traumatic than conventional approaches because of a stainless steel tunneling device. The median duration of use was 191 days. There were no cases of pneumothorax or catheter occlusion. Catheter removal was required in four cases with skin infection unresponsive to local therapy and in two cases with bacteremia. One patient developed thrombosis of the right subclavian vein but was treated without catheter removal. One patient with a skin infection at the exit site accidentally dislodged her catheter. The overall complication rate was 11% (8 of 72 cases).

Preoperative radiotherapy for early endometrial carcinoma.

A retrospective study was undertaken to compare the use of one versus two preoperative radium systems for early endometrial carcinoma. The charts of 73 patients treated between 1977 and 1980 were reviewed. No difference was noted between the two groups when compared for stage, grade, depth of myometrial invasion, and histologic type of tumor. One of thirty-eight (2.6%) patients in the one-radium group developed an isolated central recurrence; there were no central recurrences in the two-radium group. Total duration of therapy and total hospitalization for the one-radium versus the two-radium group were 17.6 and 15.3 days versus 77.0 and 17.3 days, respectively. Follow-up ranged from 48 to 84 months. Corrected survival figures are comparable to 94.6% for the one-radium group versus 100% for the two-radium group. These data suggest comparable effectiveness and morbidity between the two treatment regimens, with the single-radium application more efficient and cost effective.

Perineal hernia repair using human dura.

A patient developed a large perineal hernia and prolapse of a myocutaneous neovagina 13 months after total pelvic exenteration for recurrent squamous cell cancer of the cervix and gracilis myocutaneous vaginal reconstruction. The neovagina was removed and the pelvic floor defect was repaired with preserved human dura. Twelve months postoperatively, the patient remained asymptomatic. Current and potential uses for human dura allografts are discussed.

Nucleolar canalicular structure in extrauterine endometriosis.

Under the influence of progesterone the unique intranuclear structure known as the nucleolar canalicular structure (NCS) develops in the human endometrium. This organelle was not described previously outside the uterus. In this report the cases of two patients in whom the NCS appeared in extrauterine endometriosis are presented.