Papillary serous and clear cell carcinoma limited to endometrial curettings in FIGO stage 1a and 1b endometrial adenocarcinoma: treatment implications.

OBJECTIVE: The aim of this study was to review the significance of papillary serous and clear cell carcinoma in Stage 1a and 1b adenocarcinoma of the endometrium where this histological subtype is confined to the endometrial curettings and is absent in the hysterectomy specimen. METHODS AND MATERIALS: Three hundred twenty patients with Stage 1a or 1b adenocarcinoma of the endometrium without lymphovascular space invasion or evidence of FIGO Grade 3 histology demonstrated in the hysterectomy specimen were referred to the British Columbia Cancer Agency, Vancouver Clinic, between January 1992 and July 1995. These charts were retrospectively reviewed. RESULTS: On pathology review, eight patients were found to have evidence of papillary serous or clear cell carcinoma confined to the uterine curettings. Five patients also had Grade 1 or 2 endometrioid adenocarcinoma without lymphovascular space involvement seen in the hysterectomy specimen. All patients were managed expectantly. None of these 8 have recurred with a median follow-up of 3 years. CONCLUSION: A clinical dilemma arises when there is evidence of papillary serous or clear cell carcinoma limited to the endometrial curettings where there is no associated adverse pathological features seen in the hysterectomy specimen. In our series of patients treated expectantly, it appears that a small bulk of aggressive disease seen only in the curettage specimen does not adversely impact disease-free survival.

Combined hyperthermia and irradiation in the treatment of superficial tumors: results of a prospective randomized trial of hyperthermia fractionation (1/wk vs 2/wk).

From December 1984 to December 1989, 240 superficially located recurrent/metastatic malignant lesions (173 patients) were enrolled in a prospective randomized study of one versus two hyperthermia fractions per week. In the majority of patients, the dose of radiation therapy was less than 4000 cGy over 4 to 5 weeks. Stratification was by tumor size, site, and histology. The goal of the hyperthermia sessions were 42.5 degrees C for 45-60 min minimum intra-tumor measured temperature. Hyperthermia was given after radiation within 30-60 min. External applicators, both microwave (over 90% of treatments) and ultrasound, were used. Overall, complete response rate in 222 evaluable lesions was 56.3% (125/222) with a minimum follow-up of 6 months and a maximum follow-up of 52 months. The complete response rate for once a week versus twice a week hyperthermia group was 54.7% and 57.8%, respectively. The severe complication rate was 18% (41/222). There was no difference between the two treatment arms. Cox regression analyses were performed to study the prognostic significance of patient characteristics, tumor characteristics, and treatment parameters. Detailed analysis and results are presented.

An animal model of prophylactic cranial irradiation: histologic effects at acute, early and delayed stages.

Wistar rats (body wt. 200 g) were subjected to a fractionated course of radiation similar to that used in prophylactic brain irradiation for small cell carcinoma of the lung (2000 cGy in 5 fractions over 5 days with 60Co). Effects of this regimen were assessed by histologic examination of brain sections at 1 week, 1 month and 6 months post-irradiation. With conventional stains there were no apparent differences between control and irradiated brains at any of the post-irradiation intervals. Immunohistochemistry for neurotransmitter synthetic enzymes tyrosine hydroxylase and glutamate decarboxylase, as well as histochemistry for acetylcholinesterase, failed to uncover any changes in the irradiated animals. Immunohistochemistry for glial fibrillary acidic protein, an astrocyte marker, also showed no differences in the irradiated groups. However, an antibody against a major histocompatibility complex, class II antigen (OX-6) revealed a microglial response in grey and white matter beginning at 1 month and increasing up to the 6 month post-irradiation interval. The neuroanatomical basis for this microglial response was suggested by the results of silver stains for nerve axons, which revealed axonal loss in striatal white matter bundles in a pattern implicating vascular insufficiency.

Effects of balloon volume and position on the pressure volume curve of the lung.

Pressure-vol. (PV) curves of the lung were obtained in 2 groups of normal subjects using different esophageal balloon vols. and balloon positions. The PV curves were fitted to the exponential V = A - Be-KP. Transpulmonary pressures at different %S of total lung capacity and specific compliance were calculated. Variation in balloon vol. over the range 0.2-2.0 ml had no effect on the shape of the PV curve, as reflected by the exponential constant K, or specific compliance. Transpulmonary pressures were significantly different when the balloon vol. was 0.2 ml. With the balloon positioned at 8 or 12 cm from the gastro-esophageal junction there was no change in PV curve parameters but transpulmonary pressures and K were significantly altered at the 4 cm position. We conclude that, for clinical purposes, exact positioning of the esophageal balloon and use of the precise resting balloon vol. are not critical. Highly reproducible measurements of the elastic properties of the lung may be obtained using an esophageal balloon with a vol. of 0.6-1.0 ml and a position 8-12 cm from the gastro-esophageal junction.

Characterization of BSp73, a spontaneous rat tumor and its in vivo selected variants showing different metastasizing capacities.

BSp73 arose spontaneously (1979) as intraperitoneal nodules together with ascites. Histologically, the nodules were classified as adenocarcinoma of the pancreas. During serial transplantation of ascites cells to a subcutaneous site, two variants appeared--one fast-growing, nonmetastasizing, the other slowly growing and metastasizing via the lymphatic system to the lung. From the in vivo selected variants as well as from the parental tumor, two types of tissue cultured cell lines were established. These differed in morphology, adherence to plastic, susceptibility to detachment by trypsin, and, above all, in the ability to metastasize upon reinjection into syngeneic recipients. From differences in growth kinetics in vivo it has to be concluded that variant cell types coexisted in the parental tumor in the form of precursors, which adopted their characteristic features (irreversibly) after a shift in the environment.

5-Methoxypsoralen, an ingredient in several suntan preparations, has lethal, mutagenic and clastogenic properties.

Many furocoumarins found in several species of plant are potent photosensitizing agents known to cause lethal and mutagenic effects in a wide range of organisms, from viruses to man. Their role in the aetiology of cancer is debatable, but work has focused on the PUVA (psoralen-UVA) treatment of psoriasis with 8-methoxypsoralen (8-MOP) and near UV radiation. Bergaptene (5-methoxypsoralen, 5-MOP) is a major constiutent of oil of bergamot, and might be expected to have qualitatively similar photosensitizing properties to 8-MOP. Although 5-MOP is widely used as a stimulus to melanin deposition in several suntan preparations surprisingly little is known about its basic photobiology. We report here that 5-MOP has the expected properties of other biologically active furocoumarins. These properties include lethal and mutagenic photosensitization of bacteria, 'dark' induced frameshift mutagenesis in bacteria, and lethal and clastogenic effects on mammalian cells in tissue culture.