Serum neuron-specific enolase levels in patients with small cell carcinoma of the uterine cervix.

Serum neuron-specific enolase (NSE) is a tumor marker for neuroendocrine tumors or tumors of neuroepithelial origin. While the clinical application of NSE in small cell lung cancer has been established, its role in small cell carcinoma of the uterine cervix is unknown. We examined serum NSE in six patients with cervical small cell carcinoma and 13 patients with cervical squamous cell carcinoma. Elevated serum NSE was noted in four of six patients (67%) with small cell carcinoma, but none of the 13 patients with squamous cell carcinoma. An extremely high NSE serum level (154.7 ng/mL) was found in one patient with recurrence of small cell carcinoma, suggesting its correlation with disease extension. Although further studies to evaluate its relevance to prognosis, treatment effect, and early detection of recurrence are in progress, this preliminary result seems promising.

Methotrexate treatment for cervical pregnancy: experience of four cases.

Although cervical pregnancies account for a very small number of the ectopic pregnancies, they sometimes result in a tragic outcome due to the difficulty of surgical treatment and subsequent intractable hemorrhage. We report our experience with four cases of cervical pregnancy which were treated successfully with methotrexate. All four patients had a history of a previous abortion and two had previously had a cesarean section. High-resolution transabdominal and transvaginal color Doppler ultrasound was used for diagnosis, and the serial beta-human chorionic gonadotropin levels were checked to monitor the therapeutic effect. Hysterectomy was avoided, and the reproductive capability of these patients was preserved. Chemotherapy was well tolerated except for mild stomatitis in one case and a transient elevation of liver enzymes in another case. One patient delivered a healthy female infant two years after treatment. In conclusion, previous curettage and a low segment cesarean section may contribute to the development of a cervical pregnancy. Fortunately, methotrexate therapy offers an effective nonsurgical treatment for this potentially catastrophic condition.

Serum squamous cell carcinoma antigen in gynecologic malignancies with special reference to cervical cancer.

Squamous cell carcinoma (SCC) antigen was measured by double-antibody radioimmunoassay in the sera of 113 patients with gynecologic malignancies and 30 controls. The mean serum SCC antigen level was 9.24 ng/ml in those with cervical squamous cell carcinoma, 2.15 ng/ml in those with other gynecologic malignancies, and 1.25 ng/ml in controls. With a cutoff value of 2.23 ng/ml (2 SD above the mean of the control group), the rate of SCC antigen elevation was 54% in cervical cancer (78), 14% in vulvar or vaginal cancer (7), 22% in ovarian cancer (18), and 10% in endometrial cancer (10). In cervical squamous cell carcinoma, the rates of elevated SCC antigen level increased with disease advancement in stages 0, I, II, III, and IV, by 13, 50, 53, 78, and 100%, respectively. In early-stage cervical squamous cell carcinoma, SCC antigen was not sensitive enough for screening. However, if elevated, serum SCC antigen levels decreased rapidly after successful surgical treatment. One case with a serum SCC antigen level above 65 multiples of the cutoff value had widespread cancer and postoperative recurrence. In the advanced case, the sensitivity was much higher. In the recurrent case, the positive rate was 73%. Serum SCC antigen level is useful in predicting the prognosis and monitoring the course of cervical squamous cell carcinoma, especially in the detection of a recurrence.