Imaging features of thoracic metastases from gynecologic neoplasms.

Gynecologic malignancies are a heterogeneous group of common neoplasms and represent the fourth most common malignancy in women. Thoracic metastases exhibit various imaging patterns and are usually associated with locally invasive primary neoplasms with intra-abdominal spread. However, thoracic involvement may also occur many months to years after initial diagnosis or as an isolated finding in patients without evidence of intra-abdominal neoplastic involvement. Thoracic metastases from endometrial carcinoma typically manifest as pulmonary nodules and lymphadenopathy. Thoracic metastases from ovarian cancer often manifest with small pleural effusions and subtle pleural nodules. Thoracic metastases to the lungs, lymph nodes, and pleura may also exhibit calcification and mimic granulomatous disease. Metastases from fallopian tube carcinomas exhibit imaging features identical to those of ovarian cancers. Most cervical cancers are of squamous histology, and while solid pulmonary metastases are more common, cavitary metastases occur with some frequency. Metastatic choriocarcinoma to the lung characteristically manifests with solid pulmonary nodules. Some pulmonary metastases from gynecologic malignancies exhibit characteristic features such as cavitation (in squamous cell cervical cancer) and the "halo" sign (in hemorrhagic metastatic choriocarcinoma) at computed tomography (CT). However, metastases from common gynecologic malignancies may be subtle and indolent and may mimic benign conditions such as intrapulmonary lymph nodes and remote granulomatous disease. Therefore, radiologists should consider the presence of locoregional disease as well as elevated tumor marker levels when interpreting imaging studies because subtle imaging findings may represent metastatic disease. Positron emission tomography/CT may be helpful in identifying early locoregional and distant tumor spread.

Attributes of successfully matched versus unmatched obstetrics and gynecology fellowship applicants.

OBJECTIVE: We sought to determine the attributes of successful and unsuccessful fellowship applicants of the American Board of Obstetrics and Gynecology Inc (ABOG)-approved fellowship programs and to identify salient differences between subspecialty applicants. STUDY DESIGN: Anonymous questionnaires were completed by obstetrics and gynecology fellowship applicants using a web-based survey after match day of 2012. Fellowship applicant practices were evaluated and included importance of prematch preparations, interview process, networking practices, and postmatch reflections. RESULTS: A total of 327 fellowship applicants applying to programs accredited by the ABOG were surveyed, and 200 completed the survey (61% response rate). A comparison between prematch educational preparations pursued by applicants showed that matched applicants were more likely to come from allopathic medical schools (94%), attain membership in Alpha Omega Alpha and/or Phi Beta Kappa (27%), and receive a letter of recommendation from a nationally known subspecialist (77%) than unmatched applicants (P = .03, .005, and .007, respectively). Applicants to reproductive endocrinology and infertility were more likely than female pelvic medicine and reconstructive surgery to be members of academic honor societies (P = .008). Research publication was common among matched subspecialist applicants, with over half publishing 1-3 peer-reviewed manuscripts prior to matching. Applicants to gynecologic oncology did more visiting electives than any other specialty applicants (P < .001). CONCLUSION: Successful obstetrics and gynecology fellowship applicants have superior prematch preparations, strong letters of recommendation from leaders in their field of interest, and multiple research publications. These data will guide applicants to a critical self-analysis before deciding to apply.

Aggressive small cell carcinoma of the ovary, hypercalcemic type with hypercalcemia in pregnancy, treated with conservative surgery and chemotherapy.

BACKGROUND: Small cell carcinoma of the ovary, hypercalcemic type is a rare and aggressive malignancy found in reproductive-age women. CASE: We report a 22-year-old pregnant woman found to have symptomatic paraneoplastic hypercalcemia associated with small cell carcinoma of the ovary, hypercalcemic type. She was primarily treated with conservative surgery and chemotherapy secondary to desired pregnancy. She died of the disease 10 months from primary diagnosis. CONCLUSIONS: Small cell carcinoma of the ovary, hypercalcemic type is a very aggressive type of ovarian malignancy with a poor prognosis.

The accuracy of frozen pathology at time of hysterectomy in patients with complex atypical hyperplasia on preoperative biopsy.

OBJECTIVE: The purpose of this work was to estimate the accuracy of frozen pathologic analysis, compared with final pathological diagnosis in patients with a preoperative diagnosis of endometrial complex atypical hyperplasia (CAH). STUDY DESIGN: We performed a retrospective review of frozen and final pathology in patients with a preoperative diagnosis of CAH from January 1987 through August 2004. Clinical and pathological information was obtained from patient charts. RESULTS: We identified 23 of 41 patients with diagnosis of CAH who had a frozen section. Nine of the frozen pathology results (39.1%) correlated with the final pathological diagnosis. In 14 of 23 of the cases (60.8%), the frozen and final pathology reports disagreed. Eight of 14 patients initially diagnosed with CAH by frozen section (57%) were diagnosed with endometrial adenocarcinoma on final pathology. CONCLUSION: Our data suggest that intraoperative frozen analysis of the endometrium is not a reliable indicator of final pathology in patients with a preoperative diagnosis of CAH.

Differential expression of interleukins IL-13 and IL-15 in normal ovarian tissue and ovarian carcinomas.

OBJECTIVE: To determine the temporal and spatial expression of interleukins (IL)-13 and IL-15 in ovarian carcinoma compared to normal ovarian tissue. METHODS: Quantitative RT-PCR, ELISA and immunohistochemistry. RESULTS: Q-RT-PCR, ELISA and immunohistochemical analysis indicates that IL-13 and IL-15 mRNA and protein are expressed in normal ovary at various phases of the menstrual cycle with immunoreactive proteins detected in granulosa/theca and luteal cells and to a lesser extent in stromal cells and surface epithelial cells. Compared to normal ovary, ovarian carcinoma expresses elevated levels of IL-13 and IL-15 mRNA, with higher IL-13 expression in primary vs. metastatic tumors. IL-13 and IL-15 protein expression was also higher in the tumor tissues compared to ascites. In normal ovary, ovarian tumors and ascites, the ratio of IL-13/IL-15 favored IL-13. Immunoreactive IL-13 and IL-15 proteins were localized primarily in the tumor cells and infiltrated inflammatory cells with increased intensity with disease stage. CONCLUSION: Normal ovary and ovarian tumors express IL-13 and IL-15 and pattern of their expression in carcinomas suggests that these cytokines may function in various ovarian cellular activities including inflammatory/immune responses that are integrated cellular events taking place in normal ovary and ovarian tumors.

Small cell undifferentiated (neuroendocrine) carcinoma of the uterine cervix.

BACKGROUND: Small cell undifferentiated (neuroendocrine) carcinoma of the cervix is a rare and agressive tumor. Most medical centers have little experience with this tumor. The purposes of our study were to evaluate our experience and compare our findings with those reported in current literature. STUDY DESIGN: Fifteen patients with small cell undifferentiated carcinoma of the cervix were treated between 1977 and 1997. Clinical data including age, pregnancy history, tumor stage, recurrence, type of therapy, presenting symptoms, location of metastasis, and survival were studied. RESULTS: The ages of patients ranged from 20 to 83 years, with a mean of 47 years. Two patients were nulliparous, 2 primiparous, and 11 multiparous. Five patients (33%) were stage I, three (20%) stage II, one (7%) stage III, and six (40%) stage IV at diagnosis. Five patients (33%) progressed without response to treatment, and seven (47%) experienced a recurrence of their cancer, on average after 15 months. Treatments included surgery, radiation, chemotherapy, or a combination of them. Extrapelvic metastases developed in five patients with stage I or stage II disease. Three patients (20%) developed brain metastasis. Tumor lysis syndrome was encountered in one patient. Thirteen patients died of their disease, one remained alive 80 months after diagnosis, and one was lost to followup. CONCLUSIONS: Our experience with this rare and aggressive tumor raises the question of increased incidence of central nervous system metastases with small cell undifferentiated carcinoma. Present therapy has not significantly improved outcomes. Tumor lysis syndrome is a possible risk when treating these patients.