[Vaginal cancer in a woman with a family history of ovarian cancer]. / Hüvelyrák kialakulása egy családi petefészekrák terheltség miatt veszélyeztetett asszonyban.

The proband was referred to familial ovarian cancer surveillance because two of her sisters died of carcinoma of the ovary. Her third sister succumbed of cervical cancer and her brother had acute myeloblastic leukaemia. Her second brother is alive and healthy. None of her parents and their sibs suffered of malignant disease. The offspring of the proband's sibs are young and appear to be normal. During surveillance she developed a stage I vaginal cancer. Following preoperative brachytherapy she underwent a radical hysterectomy and bilateral salpingoophorectomy with pelvic lymphadenectomy, and she is free of disease during 2 years of follow-up. The authors are not aware of any similar case.

The value of ultrasound in preoperative assessment of the myometrial and cervical invasion in endometrial carcinoma.

This study was undertaken to determine the accuracy of ultrasonography in depicting the depth of myometrial invasion and cervical involvement in women with adenocarcinoma of the endometrium. During the past 2 years, pelvic ultrasound using abdominal and vaginal probes was carried out as part of routine preoperative work-up in 69 consecutive patients with carcinoma of the endometrium. Fifty-eight patients were primarily operated on; the remaining 11 had preoperative intracavitary irradiation followed by surgery at the referral hospital. All patients underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and staging laparotomy. A Hitachi EUB 450 ultrasound machine with a high-resolution 6.5-MHz transvaginal transducer was used to assess the intrauterine extension of the tumor. Myometrial extension was measured from the endometrial-myometrial interface to the deepest edge of the tumor extension into the myometrium and was categorized as 0%, < 50%, or > 50% myometrial invasion. Cervical involvement was determined based on irregular echogenicity of the tumor in the cervix of the uterus. Sixty-three of 69 patients had no cervical involvement on ultrasound, whereas the cervix was negative in 60 subjects on pathological examination; i.e., there were 3 false-negative and no false-positive results. The correlation was highly significant (P < 0.001). Of these, the endocervix was involved in 5 cases (stage IIa) and there were 4 patients with stage IIb disease. All 3 false-negative cases were stage IIa, with microscopical involvement in 2 patients. In the third case histology demonstrated disease extending low to the inner cervical os and was considered involvement of the cervix. The inner half of myometrium was involved in 28 patients and the outer half in 31, and there was no myometrial invasion in 10 cases. The corresponding values for ultrasound were 29, 31, and 9, respectively; i.e., there was only 1 false-positive and no false-negative results. The correlation is highly significant (P < 0.001). Sonography revealed irregular interface between the endometrium and myometrium, giving the appearance of measurable myometrial involvement in the only woman with a false-positive result. Our results indicate that transvaginal sonography correctly predicts endometrial and cervical involvement in endometrial carcinoma. In evaluating these factors, ultrasound using transvaginal probes is probably more accurate than intraoperative gross evaluation or frozen section analysis. Preoperative knowledge of these variables allows the gynecologists an appropriate consultation in terms of extended surgery and to select those patients who might benefit from referral to gynecologic oncology centers.

Transvaginal sonographic characterization of ovarian disease: evaluation of a new scoring system to predict ovarian malignancy.

With the advent of high-frequency transvaginal ultrasonography, new opportunities are presented to better define ovarian lesions. The goal of this study was to develop a scoring system using transvaginal sonographic characterization of pelvic/ovarian lesions. Our purpose was to maximize the discrimination between benign and malignant entities. Transvaginal sonographic pelvic images of 143 patients were correlated with surgical findings or histopathology. Of 281 ovaries, 108 had benign lesions (30 endometriomas, 24 teratomas, 21 simple cysts, and 33 other abnormalities) and 20 had malignancies. The scoring system devised was useful in distinguishing benign from malignant masses, with a specificity of 83%, sensitivity of 100%, and positive and negative predictive values of 37 and 100%, respectively. Further experience and refinements of this method of scoring should maximize the benefit of high-resolution transvaginal sonography of ovarian lesions.

CA 125 levels in patients with hypoestrogenic ovarian failure.

The source of CA 125 in the sera of women is not known. Serum CA 125 concentrations were measured in 36 women with hypoestrogenic ovarian failure of whom 30 had hyper-(group A), 6 had hypo- or normogonado-tropic amenorrhea (group B). Group A consisted of 16 women with streak gonad syndrome, 6 with rudimentary ovary syndrome, 5 with premature menopause syndrome and 3 with gonadoblastoma. Serum CA 125 levels were normal in 34 patients irrespective of the presence of associated sex chromosome anomalies, and their mean values did not differ significantly from those of the 9 age-matched controls. We also measured normal CA 125 values in 2 females with müllerian agenesis. These data indicate that the derivatives of müllerian ducts do not contribute significantly to the presence of CA 125 in the sera of nonmenstruating adult women, and that the abnormalities of the X chromosome do not seem to influence CA 125 levels.

Early pregnancy loss, premature and low birth weight delivery, and increased maternal lymphocyte cytotoxicity.

Lymphocytes of 628 pregnant women were tested for natural cytotoxic activity to human embryonic fibroblast cells. The data were analyzed with regard to previous obstetric history, symptoms occurring during the present gestation, and the outcome of pregnancy. The normal rate of cytotoxicity during pregnancy was established by determining cytotoxic activity of the lymphocytes from 56 healthy pregnant women. The values higher than the mean + 2 SD of the "normal" (greater than or equal to 40%) were considered as high. Increased cytotoxicity was associated with the occurrence of previous spontaneous and missed abortions, as well as with bleeding and uterine contractions during the present pregnancy observed at the time of the test. In 15 out of 35 cases resulting in spontaneous abortion and 15 out of the 34 pregnancies resulting in missed abortion, cytotoxic activity of the lymphocytes during pregnancy was higher than normal. Similarly, in 38 and 32.7% of the pregnancies resulting in preterm (n = 121) or low birth-weight deliveries (n = 101) respectively, we found increased lymphocyte cytotoxicity, in contrast to that being found in 5.4% of uncomplicated normal pregnancies. These data suggest that at least some pregnancy failures might be immunologically mediated.