Tissue evaluation of immune markers in endometrial and cervical carcinomas.

Major histocompatibility complex (HLA system) class II molecules including HLA-DR antigens, associate with peptides, which are derived from antigens, for presentation to T4 lymphocytes. Functional and adhesion assays have shown that CD4 molecule interacts with HLA class II molecules, leading to enhanced responses of T4 cells. In the present study, we examined the tissue expression of HLA-DR antigens and the quantitative variance of T4 lymphocytes in a series of 50 "endometrioid" adenocarcinomas of the endometrium and 35 cervical squamous-cell carcinomas. A three-step avidin-biotin immunoperoxidase staining method was applied. As primary antibodies, we used the TAL.1BS monoclonal antihuman HLA-DR alpha (alpha) chain antibody and the OPD4 mouse antihuman antibody; the latter mainly identifies benign T4 lymphocytes. Twenty-four percent (24%) of women with endometrial cancer were high immune responders, while the relative percentage in women with cervical cancer was 40%; the respective tumours were of early clinical and surgical stages. HLA-DR determinants were predominantly expressed in membranes of stromal cells, mainly histiocytes, usually around HLA-DR+ lymphoid cells, as well as on endothelial cells. Greater numbers of OPD4+ aggregated lymphocytes were observed when the tumour stroma was rich in HLA-DR+ cells. Epithelial elements, either cancerous or benign, were seldom HLA-DR+. In those samples, positive immunolabelling was often confined in the intercellular space and did not seem to activate an effective host immune response against neoplastic cells. High expression of HLA-DR molecules in professional antigen presenting stromal cells may be used as a lymphocyte activation marker in endometrial and cervical carcinomas. This activation appears to be an early event in the evolution of invasive endometrial and cervical carcinomas.

Mid-trimester termination of pregnancy by dilatation and evacuation.

The object of this study was to evaluate the feasibility and safety of Dilatation and Evacuation (D&E) as a method of termination of pregnancy in the second trimester. We conducted a retrospective analysis of 61 cases. The mean age of women was 25.6 years (range 1545) and the majority of terminations were performed for social reasons. Twelve women (20%) had at least one previous termination of pregnancy. The median gestational age was 16 weeks (range 1322). Except for three multiparous women, they all had Cervagem vaginal pessaries preoperatively and the mean operative time was 26.6 minutes. Most of the operations were performed under ultrasound guidance, but there was no increased risk of complications in the rest of the group. One multiparous woman suffered uterine perforation and severe haemorrhage, for which she underwent hysterectomy. One in four women tested positive for chlamydia infection. Evacuation of retained products of conception (ERPC) was required in four cases. No postoperative analgesia was required in 43% of women and most of the rest required only mild non-opiate analgesia. Except for two women, all were discharged from the hospital either on the same or the day after the operation. This retrospective study shows that surgical evacuation in the second trimester of pregnancy is a quick and well tolerated method of termination, although there is a risk of perforation and hysterectomy.

Tuberculous peritonitis: part of the differential diagnosis in ovarian cancer.

We report a case of tuberculous peritonitis in a young woman who was initially thought to have ovarian cancer. We emphasize the misleading raised CA 125 levels and radiologic pictures and the importance of frozen-section analysis for definitive diagnosis to avoid unnecessary surgery.