Long-term survival of patients with recurrent endometrial stromal sarcoma: a multicenter, observational study.

OBJECTIVE: The aim of this study was to evaluate the clinical behavior and management outcome of recurrent endometrial stromal sarcoma (ESS). METHODS: A retrospective review of charts of 10 patients with recurrent ESS was performed and relapse-free interval, relapse site, treatment, response to treatment, duration of follow-up and clinical outcome extracted. Survival outcome measures used were post-relapse survival which was defined as the time from first evidence of relapse to death from any cause. Living patients were censored at the date of last follow-up. RESULTS: The median age and median relapse-free interval at the time of initial relapse were 51.5 years and 66.5 months, respectively. The number of relapses ranged from one to five. Sixteen surgical procedures for recurrent disease included nine (56.0%) complete resections. There was no statistically significant difference between initial recurrent tumors and second/subsequent recurrent tumors in the rate of complete surgery (44.4% vs. 71.4%, respectively, p=0.36). Of the eleven evaluable occasions when hormonal therapy was used for recurrent disease, disease control was achieved in eight (72.7%). There was no difference between initial recurrent tumors and second/subsequent recurrent tumors in disease control rate by hormonal therapy (85.7% vs. 50.0%, respectively, p=0.49). The 10-year post-relapse survival rate was 90.0% and the overall median post-relapse survival 119 months (range, 7 to 216 months). CONCLUSION: Post-relapse survival of patients with ESS can be expected to be >10 years when treated by repeated surgical resection and hormonal therapy or both.

Modulation of microvascular permeability in the preovulatory rat ovary by an ovulatory gonadotropin stimulus.

OBJECTIVE: To characterize the size selectivity of the rat ovarian vasculature and its changes after gonadotropin induction of ovulation. DESIGN: Experimental study. SETTING: Obstetrics and Gynecology Department. ANIMAL(S): Immature, female Sprague-Dawley rats. INTERVENTION(S): Rats were pretreated with equine chorionic gonadotropin, and ovaries were retrieved either 48 hours later or at any of several time points during ovulation induced by hCG. Fluorescein isothiocyanate-labeled Ficoll was injected 10 minutes before ovarian sampling, and the distribution of Ficoll was measured in plasma and ovarian extracts. MAIN OUTCOME MEASURE(S): The Ficoll data were analyzed according to a two-pore model to acquire information on small (rS) and large (rL) pore radii as well as the number of large pores reflected by the large pore fraction of the hydraulic conductance (LpS%) at each periovulatory time interval. RESULT(S): Before hCG, rS and rL were 54.7 ± 1.2 Å (mean ± SEM) and 149.3 ± 5.3 Å, respectively. At this preovulatory stage, LpS% was 7.1% ± 3.2%. Stimulation with hCG caused close to a three-fold increase in LpS% at 2 and 4 hours (20.9% ± 1.8% and 20.7% ± 2.5%, respectively) and approximately 15% enlargements of rS and rL. Thus, the change in LpS% represents a dramatic increase in the number of large pores and not an increased size of preexisting large pores, since the small and large pore radii changed in parallel. CONCLUSION(S): These results indicate that capillary permeability of the ovarian blood-follicle barrier is modulated by gonadotropin, mainly through increased numbers of large pores, similar to a classical inflammatory response.

Nitric oxide regulates ovarian blood flow in the rat during the periovulatory period.

BACKGROUND: The aim of this study was to characterize the roles of nitric oxide (NO) on the rat ovarian blood flow (OBF) during the preovulatory period. METHODS AND RESULTS: Immature Sprague-Dawley rats were primed with pregnant mares' serum gonadotrophin (PMSG, 15 IU) and given hCG (15 IU) 48 h later. The ovary was exposed 48-56 h after PMSG, a laser Doppler probe was attached to the ovarian surface and OBF was measured at two time periods: preovulatory (PO) 48 h after PMSG and ovulatory (OV) 6-8 h after hCG. A non-selective NO synthase inhibitor, N(G)-nitro-L-arginine methyl ester (L-NAME), was injected i.v. (4 and 10 mg/kg) or intrabursally (1 mg/kg). Intravenous administration of L-NAME to OV rats rapidly increased blood pressure and reduced OBF by 30%, which returned to the pretreatment level within 30 min. L-NAME given into the ovarian bursa of both PO and OV rats did not affect blood pressure and reduced OBF by nearly 40%, which remained low throughout the experiment. Intravenous injection of hCG to PO rats increased OBF to 116.1% at 5 min and 133.5% at 30 min in relation to the pretreatment level. When L-NAME was given intrabursally, subsequent hCG injection was without effect. CONCLUSIONS: These results indicate that locally produced NO is important for the maintenance and increase of rat OBF during the preovulatory period.