Papillary serous carcinoma of the uterus: increased risk of subsequent or concurrent development of breast carcinoma.

OBJECTIVE: Some women with endometrial cancer may be at increased risk for developing breast cancer. The histologic type of endometrial cancer associated with synchronous or subsequent breast cancer has not been clearly established. Our purpose was to determine if a certain histologic type of endometrial cancer was associated with an increased risk of synchronous or subsequent breast cancer. METHODS: The University of Iowa Hospitals and Clinics tumor registry was queried to ascertain all patients with the diagnosis of uterine cancer from January 1, 1983, to December 31, 1994. Statistics were performed utilizing SPSS for Windows version 9.0 (SPSS Inc., Chicago, IL), including Student's t tests and chi(2) tests. RESULTS: Five hundred ninety-two patients had endometrial adenocarcinoma during the study period. Five hundred thirty-six women had endometrioid adenocarcinoma, 23 women had papillary serous carcinoma (UPSC), 21 women had adenosquamous carcinoma, 10 women had clear-cell carcinoma, and 1 woman each had mucinous or squamous carcinoma. Twelve patients had previously been diagnosed with breast carcinomas. Twenty-five patients were diagnosed with breast cancer either concurrently or subsequent to their diagnosis of endometrial cancer. Synchronous or subsequent breast cancers developed in 3.2% of patients with endometrioid carcinoma and in 25% of patients with UPSC (P < 0.001). CONCLUSION: Patients with UPSC have an increased risk of development of breast cancer as compared to patients with endometrioid adenocarcinoma of the uterus.

Ovarian function after surgical treatment for cervical cancer.

OBJECTIVE: Our previous analysis found a high rate of early menopause in cervical cancer patients with ovarian transposition (OT) compared to a group that underwent radical hysterectomy (RH) alone. The current study evaluates ovarian function in the same group for a prolonged follow-up period and analyzes predictive factors for early menopause. METHODS: One hundred two cervical cancer patients were treated with RH and/or lymphadenectomy and ovarian preservation from 1982 to 1989. A retrospective chart review was conducted, followed by a survey to determine the time of menopause. RESULTS: Eighty-three patients underwent RH and 19 patients underwent a staging laparotomy. Eighty procedures included OT. Twenty-six patients received postoperative radiation therapy. The mean follow-up for premenopausal patients was 87.0 months. The average age of menopause for the 13 nonradiated patients without unilateral oophorectomy (UO) or OT was 50.6 years. After OT without radiation therapy, 98.0% of patients retained ovarian function for a mean of 126 months with menopause at a mean of 45.8 years. When OT and radiation therapy were added, 41% retained ovarian function for a mean of 43 months and a mean age at menopause of 36.6 years. A multivariate analysis of nonradiated patients correlated age at diagnosis and a combination of OT procedure and UO with earlier ovarian failure. CONCLUSIONS: RH with bilateral ovarian preservation and without OT does not significantly reduce the age of menopause. The addition of UO or OT to this treatment reduces ovarian function appreciably. The addition of radiation therapy after OT dramatically shortens ovarian function.

Asymptomatic lung carcinoma presenting with a large vulvar lesion.

OBJECTIVE: Metastases to the vulva are infrequent, accounting for less than 10% of vulvar tumors. Vulvar metastases from lung carcinoma have been reported in two other cases. METHODS: A case of lung carcinoma metastatic to the vulva is reported. RESULTS: A 71-year-old woman was referred to The University of Iowa Hospitals and Clinics with a lung nodule on chest x-ray and a 12-cm, necrotic, left vulvar mass. A lung biopsy showed poorly differentiated carcinoma, and a palliative resection of the vulvar mass showed metastatic lung carcinoma. The patient died from sepsis on postoperative day 10. CONCLUSIONS: Lung carcinoma metastatic to the vulva is rare and portends a poor prognosis.

Docetaxel extravasation causing significant delayed tissue injury.

PURPOSE: Docetaxel is a relatively new taxane that has not been associated with significant tissue injury after extravasation. We present a case of a patient who had grade 4 tissue toxicity after extravasation of docetaxel infused through a peripheral intravenous site. CASE REPORT: A 71-year-old female was being treated for recurrent ovarian cancer with docetaxel and carboplatin. Shortly after the docetaxel infusion began, she experienced docetaxel extravasation into the dorsum of her left hand. The infusion was halted, and then the administration was continued in a peripheral intravenous site in the other upper extremity. Erythema was noted by the patient on the dorsum of her left hand 6 days after infiltration. The following day, the patient noted severe pain, decreased function, and blistering along with increased erythema. The patient presented to the gynecology oncology clinic 11 days after the extravasation injury occurred. Conservative management was undertaken, and over the next 4 weeks the patient had resolution of the skin changes and full return of function. CONCLUSION: Docetaxel can cause significant delayed tissue injury if extravasation occurs.

Hematogenous skin metastases from cervical cancer at primary presentation.

OBJECTIVE: Cutaneous metastasis from carcinoma of the uterine cervix is an uncommon occurrence. The majority of cases are diagnosed as recurrent carcinoma. This is believed to be the first report of hematogenous skin metastases present at the diagnosis of cervical carcinoma. METHODS: A case of a patient with cutaneous manifestations at the time of cervical carcinoma diagnosis is presented. RESULTS: Two lesions on the patient's hand occurred at points of recent skin puncture. These were biopsy-proven metastases from her primary cervical carcinoma. CONCLUSION: Skin metastases from cervical carcinoma are rare and represent a poor prognostic sign.

Xp22.2-3 loss of heterozygosity is associated with germline BRCA1 mutation in ovarian cancer.

OBJECTIVE: X-Chromosome loss of heterozygosity (LOH) occurs in approximately 40% of ovarian cancers. We have previously demonstrated an association between nonrandom X-chromosome inactivation and germline BRCA1 mutation. The current study examines the association between X-chromosome LOH and BRCA1 mutation. METHODS: Ninety tumor DNA (81 ovary, 5 fallopian tube, 4 primary peritoneal) and matched peripheral blood mononuclear cell DNA samples were examined for LOH with 11 X-chromosome microsatellite DNA markers. RESULTS: Tumor DNA demonstrated frequent LOH at the Xp22.2-3 region (37.7% at DXS6807). Loss of heterozygosity on Xp was twice as common in tumor DNA from germline BRCA1 mutation carriers (9/14 vs 19/67, P = 0.02). In four evaluable samples, Xp22.2-3 LOH preferentially occurred from the active X allele. CONCLUSIONS: Our data support the hypothesis that an Xp22.2-3 gene product interacts with or modifies the expression of BRCA1 in some hereditary ovarian cancers.

BRCA1 mutations in familial ovarian cancer.

BRCA1 mutation research in ovarian and breast cancer 17q21-linked families has yielded a large number of germline sequence variations. Somatic mutations have been uncommonly reported. We screened 81 probands with primary ovarian, peritoneal, or fallopian tube carcinoma for BRCA1 mutations. The study group was intentionally biased by the inclusion of 29 probands with a family history of ovarian and/or breast carcinoma, 13 probands diagnosed on or before age 45, seven individuals with a metachronous breast cancer and 51 tumors with BRCA1 LOH. Tumor and/or germline DNA was screened by modified techniques of single-strand confirmation polymorphism analysis, and abnormal banding patterns were sequenced to confirm mutations. Twenty-one (25.9%) BRCA1 sequence variations were identified. Eight mutations were somatic including seven null mutations. Apart from classical hereditary ovarian/breast cancer, a family history of ovarian/breast cancer defines a subset of ovarian cancer individuals with a significant likelihood of either a germline or a somatic BRCA1 gene sequence variation.

A case of severe hidradenitis suppurativa contributing to a death and a review of the literature.

OBJECTIVE: Our aim was to report a fatal complication of hidradenitis suppurativa and a review of the literature. MATERIALS AND METHODS: A case of severe hidradenitis suppurativa obscuring the diagnosis and precluding the treatment of a ruptured sigmoid diverticulum is presented. RESULTS: We describe a 48-year-old woman who had a long history of untreated hidradenitis suppurativa with extensive vulvar involvement and poor nutritional status. The advanced state of her disease on initial presentation led directly to her death. CONCLUSION: Although it is a treatable disease, hidradenitis suppurativa can lead to systemic sequelae severe enough to contribute directly to death.

A novel technique for gynecologic oncology surgery in the presence of abdominal wall mesh prosthesis.

Incisional herniae are relatively frequent complications of abdominal incisions. Hernia repair techniques have taken advantage of the strength provided by prosthetic mesh grafts. Subsequent surgery in these patients must incorporate a strategy for managing the mesh material. The goals are adequate exposure for surgery and a closure that restores wound strength. The current technique describes lateral dissection of the mesh prosthesis allowing for retraction of the mesh and adherent bowel, providing excellent surgical exposure. The mesh is reattached to the abdominal wall during closure. This technique allowed for staging procedures in a case of endometrial cancer and a case of ovarian cancer.

Chemotherapy in pregnancy.

There is limited information concerning the effects of chemotherapy administered during pregnancy, which consists mostly of case reports and small series. The National Cancer Institute maintains a registry of neonates exposed to chemotherapy but there are currently only several hundred cases. When chemotherapy is used during embryogenesis, there is an increased rate of spontaneous abortions and major birth defects. The risk of fetal malformations when chemotherapy is administered during the second and third trimesters is probably not greater than the background rate. Use in the second and third trimesters may increase the risk of premature birth, fetal growth restriction, maternal and fetal myelosuppression, and still births.

Polyarteritis nodosa of the vagina mimicking vaginal carcinoma.

A case report is presented in which a patient is found to have an ulcerated vaginal mass that is histologically diagnosed as polyarteritis nodosa (PAN). Treatment with colchicine brought about sustained regression of the disease Approximately 34 cases of PAN involving the female genital tract have been published in the world literature. This represents the first report of vaginal involvement by a lesion of PAN.

The use of chemotherapeutic agents during pregnancy.

The information available concerning the effects of chemotherapy administered during pregnancy is limited and consists of case reports and small series. A registry has been established at the National Cancer Institute, but there are currently only several hundred cases of neonates exposed to chemotherapy registered. All clinicians who care for women receiving chemotherapy during pregnancy should report those experiences to the National Cancer Institute to increase the data base. When chemotherapy is used during the embryogenesis period in the first trimester there is an increased rate of spontaneous abortion and major birth defects. The most toxic chemotherapeutic agents administered during pregnancy are methotrexate and aminopterin and should be avoided when possible, particularly during the first trimester. Pregnancy-related physiologic changes should be kept in mind when dosing and administering cytotoxic chemotherapy. The risk of fetal malformation when chemotherapy is administered during the second and third trimesters is probably not greater than background rate, but there may be a greater risk of stillbirth, fetal growth restriction, premature birth, and maternal and fetal myelosuppression. Breastfeeding should be avoided in women receiving chemotherapy.