Characteristics of patients with rapidly growing cervical cancer.

Between April 1983 and December 1990, 387 newly diagnosed cervical cancer cases were managed at our institution. We retrospectively reviewed 59 of those cases, which were identified as having developed within 3 years of the patients' last normal Pap smear. Squamous cell carcinoma was found in 45 patients, and 33 had poorly differentiated lesions. Six cases had typical histology. However, 27 cases (82%) had distinctive histologic features that have not been previously described in rapidly progressive cervical cancer. Thirty-seven patients had surgical treatment; 7 (19%) died of disease. Twenty-two patients had radiation; 10 (45%) died of disease. Patients who have invasive cervical cancer after a recent normal Pap smear may have unusual histologic types, and some with early-stage disease may have better outcome if treated with radical surgery.

Patterns of failure of bulky-barrel carcinomas of the cervix.

OBJECTIVE(S): This retrospective study was conducted to analyze the hypothesis that radiation therapy followed by extrafascial hysterectomy would improve survival in patients with bulky-barrel cervical carcinomas. STUDY DESIGN: Forty-three patients with bulky-barrel carcinomas of the cervix were treated over a 14-year period. The majority of these were treated with approximately 4000 cGY external beam, followed by brachytherapy, followed by extrafascial hysterectomy. RESULTS: Forty-seven percent of all patients are dead of disease; 2.3% are alive with disease. Of the total patients, 35% had diseased paraaortic nodes, and 80% of these are dead of disease. Of the patients dead of disease, 80% had distant metastases. Delayed complications included: vesicovaginal fistulas (n = 3), surgery for bowel obstruction (n = 3), rectovaginal fistula (n = 1), and vaginal vault necrosis (n = 3). CONCLUSION: These data do not support an improvement in survival of patients with bulky-barrel-shaped lesions treated with irradiation plus adjunctive hysterectomy.

Cytology and DNA flow cytometry of peritoneal washings in gynecologic patients.

Peritoneal washing cytology, widely used in the management of gynecologic malignancy, entails several difficulties in interpretation. Quantitative DNA analysis by flow cytometry (FCM) holds promise as a more objective method fo diagnosis of malignancy. We performed traditional cytologic examination and single-parameter FCM DNA analysis on peritoneal washings from 136 gynecologic laparotomies, compared these results with the final pathologic findings, and analyzed sources of error. A total of 50 laparotomies were performed for benign disease. Another 86 were performed for cervical, endometrial, and ovarian carcinomas and various other cancers. In the benign group, cytology had one false suspicious but no false positive results, and FCM showed only diploid cells. In the cancer cases, cytology had five suspicious and 13 positive results and one false negative from laboratory error. On review, 16 washings contained confirmed cancer cells. FCM, performed in 13 of these cases, was diploid in 10 and aneuploid in only 3. In six of the diploid cases, visual cell counts showed that tumor cells were present in concentrations of 2.5% or less of total cells. In the remaining four diploid cases, a second DNA determination was obtained by FCM of nuclei retrieved from paraffin blocks of the tumors. These nuclei were diploid by FCM in three of the tumors and aneuploid in only one. Single-parameter DNA FCM was too insensitive to be helpful in our material.

A clinical-pathologic study of mixed müllerian tumors of the uterus over a 16-year period--the Medical College of Georgia experience.

From 1972 through 1987, 40 patients at the Medical College of Georgia were assessed with a diagnosis of mixed müllerian tumors which constituted 3.5% of all female genital tract malignancies. The mean patient age was 65.3 years; 60% of the patients had stage I disease. Of those patients with clinical stage I disease, more advanced disease was found at celiotomy in 33%. Retroperitoneal nodes were positive for malignancy in 35% of 20 patients who underwent node sampling. Cell washings were positive in 12%, and 9% had omental metastases. Forty-seven percent had homologous tumors; 53% of tumors were heterologous. Relatively poor prognosis was associated with large tumor volume, vascular invasion, nodal metastases, and disease outside the uterus. The overall survival rate was 32%; 14 of 24 patients with stage I disease are dead of disease. Of patients dead of disease, 92.5% had distant metastases. Adjuvant therapy with a combination of VP-16, cisplatin, and irradiation was beneficial in four high-risk patients.

Adenoid cystic carcinoma of the cervix in women under age 40.

Adenoid cystic carcinoma of the cervix, traditionally associated with a poor prognosis, occurs in postmenopausal patients in the vast majority of cases reported. Only four cases have been reported in women less than age 40, and none in women less than age 30. Three new cases of adenoid cystic carcinoma of the cervix are reported in women aged 24, 27, and 38 years. All three patients were treated with radical pelvic surgery; lymph node metastases and vascular involvement were prominent. Adjuvant chemotherapy with cisplatin was used in two patients, one of whom has had long-term survival. A review of the literature is also presented.

Solid ovarian teratoma with neuroglial metastases to periaortic lymph nodes and omentum.

We have described a 16-year-old girl who had a unilateral adnexectomy for a solid ovarian teratoma, grade 0. Periaortic nodes and omentum contained grade 0 neuroglial metastases.

Neuroendocrine carcinoma of the uterine cervix complicated by pregnancy: case report and review of the literature.

A case report of neuroendocrine carcinoma of the cervix complicating pregnancy is presented. This represents the fourth reported case. Clinical staging was FIGO IB, and treatment consisted of radical surgery and aggressive chemotherapy. Electron microscopy confirmed the diagnosis of neuroendocrine carcinoma. The pregnancy-associated cases and a review of neuroendocrine cervical carcinoma are discussed.

Intrauterine hydrosalpinx.

An unusual case of intrauterine hydrosalpinx is reported. The tube was greatly dilated and formed a large intramyometrial cyst. It was thought to be a leiomyoma with cystic degeneration but was shown to be a true cyst lined by tube-type epithelium. Because it simulated a neoplasm owing to its large size, the term " endosalpingoma " is proposed. The differential diagnosis with myometrial cysts is discussed.

Recurrent purulent triaditis in a patient with congenital x-linked agammaglobulinemia.

A patient with congenital x-linked agammaglobulinemia, who had two separate episodes of an apparent bacterial purulent hepatic triaditis in the absence of any known local predisposing factors, is presented. These episodes may reflect the increased susceptibility of an immunodeficient patient to bacterial infections. This case demonstrates the need to consider hepatic involvement in the work-up of fevers of undetermined origin in immunodeficient patients, even in the absence of any radiologic or sonographic evidence of mechanical biliary tract obstruction.

Neoplasia at the site of ureterosigmoidostomy.

An increased incidence of neoplasia at the site of ureterosigmoidostomy must be considered in patients being evaluated for or who have undergone this procedure. A case of mucinous adenocarcinoma 24 years following bilateral ureterosigmoidostomy is reported. This patient had bilateral hydroureteronephrosis, which led to left nephroureterectomy and right cutaneous ureterostomy. Mucinous adenocarcinoma was diagnosed only after the edematous, protruding and inflamed cutaneous ureterostomy stoma was biopsied. To our knowledge this is the first reported case of transfer of such a malignancy to the skin at the time of cutaneous ureterostomy. We recommend that ureterosigmoidostomy be performed only in patients with a limited life expectancy who agree to long-term followup. This followup should be frequent, complete and continue for the remainder of the patient's life. We consider the tendency for development of neoplasia at the ureterosigmoid anastomosis to be a relative contraindication to ureterosigmoidostomy. However, with proper patient selection and followup, ureterosigmoidostomy is still a remarkably satisfactory method of urinary diversion.