Prognostic significance of malignant cervical cytology in patients with endometrial cancer.

OBJECTIVE: To determine the prognostic importance of malignant cervical cytology before surgical stating in patients with endometrial cancer. METHODS: Between September 1987 and August 1993, 164 patients with endometrial cancer had preoperative cervical cytology examined before surgical staging, which included pelvic and para-aortic lymphadenectomy. RESULTS: Ninety-four patients (57.3%) had normal cervical cytology, 21 (12.8%) had atypical cytology suspicious for malignancy, and 49 (29.9%) had malignant cytology on preoperative cervical cytology. Statistically significant associations were found between cervical cytology and histopathology (P = .017), tumor grade (P = .001), cervical metastases (P < .001), surgical stage (P = .035), pelvic lymph node metastases (P = .016), and para-aortic lymph node metastases (P = .006). Patients with malignant cytology were more likely to have non-endometrioid histology, poorly differentiated malignancies, higher surgical stage, and cervical, pelvic lymph node, and para-aortic lymph node metastases. Patients with malignant cervical cytology had a 3.5 times higher prevalence of pelvic lymph node metastases and a five times higher prevalence of para-aortic lymph node metastases than patients with normal cytology. No association was found between preoperative cervical cytology and the depth of myometrial invasion, adnexal metastases, omental metastases, or malignant pelvic peritoneal cytology. CONCLUSIONS: Patients with endometrial cancer and malignant preoperative cervical cytology are at marked risk for extrauterine metastases, including pelvic and para-aortic lymph node metastases. Such patients should be considered for primary surgical staging, including pelvic and para-aortic lymphadenectomy.

Angiosarcoma of the liver in a rural population. Four cases diagnosed in a 29-month period.

Angiosarcoma of the liver has recently been publicized because of its association with polyvinyl chloride (PVC) polymerization workers. Four cases of this rare tumor have been observed at the Marshfield Clinic within a 29-month period. There are no factories that manufacture PVC products in the immediate area, nor were any of the victims ever involved in such manufacturing work. Thus, it is possible that other factors may be related to this cluster of the disease.

The coin lesion story: update 1976. Twenty years' experience with thoracotomy for 179 suspected malignant coin lesions.

We reviewed 179 patients who had undergone thoracotomy and resection of a suspected malignant coin lesion of the lung over the past 20 years to see if a policy of early thoracotomy was therapeutically valid. The average diameter of all lesions was 1.6 cm; the average diameter of 27 malignant lesions (15 percent) was 1.8 cm. Follow-up of the 27 patients with malignant neoplasms was 100 percent. The present survival rate of the 19 patients with primary lung cancer is 89 percent (17/19). Of 12 cases of primary lung cancer followed for five years, ten (83 percent) survived. The five-year survival of the eight patients with metastatic lesions was 25 percent (2/8). There were no postoperative deaths and few serious postoperative complications (four patients or 2 percent). Very small primary lung cancers detected and treated early do have the same poor prognosis as larger primary cancers.

Open pulmonary biopsy. Nineteen-year experience with 416 consecutive operations.

Four hundred and sixteen open pulmonary biopsies through limited thoracotomies are reported. Tissue sufficient for diagnosis was obtained in all cases. Case selection, operative technique, spectrum of diagnoses, complications, and comparisons with other techniques are defined. Diagnoses by category were as follows: occupational, 105 patients (25 percent); neoplastic disease, 80 patients (19 percent); specific histologic diagnosis, (ie, sarcoidosis), 70 patients (17 percent); specific infection, 23 patients (6 percent); vascular diagnosis, 16 patients (4 percent); and nonspecific pulmonary disease, 122 patients (29 percent). Pneumothorax, minor in most cases, was the most common complication. It occurred in 97 (23 percent) of the patients, but only 24 (6 percent) required the placement of a chest tube. Pleural effusion occurred in 106 patients (25 percent) and was minor. Hemothorax occurred in two (0.5 percent) and superficial wound infection in three (0.7 percent). Overall mortality was 4.5 percent (19 patients). Only two deaths (0.4 percent) were related to the procedure. Open pulmonary biopsy remains our diagnostic method of choice in diffuse lung disease of undetermined etiology.