Conservative management of primary cervical lymphoma using combination chemotherapy: a case report.

A 22-year-old nulligravida presented with a stage IE/IIIB primary malignant lymphoma of the cervix which measured 8 cm in diameter. In order to preserve reproductive potential, a 12-week course of methotrexate with leucovorin rescue, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin was administered. One month later a 4-cm-diameter left parametrial mass was excised at laparotomy; no tumor was detected in the specimens obtained. Menses resumed after an additional 6 months. The patient was clinically disease-free at the 33-month follow-up.

Adenocarcinoma of the small intestine presenting as an ovarian mass. A case report.

A case of primary adenocarcinoma of the small intestine presented as an abdominopelvic mass. The only site of secondary involvement was the left ovary. Postoperatively six courses of 5-fluorouracil, cisplatin and adriamycin were administered. At the 31-month follow-up there was no evidence of recurrent disease.

Vinblastine, cisplatin, cyclophosphamide, bleomycin, doxorubicin, and etoposide in the treatment of small cell carcinoma of the ovary.

This report presents five adolescent girls and adult women with small cell carcinoma of the ovary (SCCO) who were treated with a polychemotherapy regimen consisting of vinblastine, cisplatin, cyclophosphamide, bleomycin, Adriamycin (doxorubicin), and etoposide (VPCBAE). Two patients had Stage IA, one Stage IIC, and two Stage IIIA disease. Initial therapy consisted of unilateral salpingo-oophorectomy in two cases and total abdominal hysterectomy and bilateral salpingo-oophorectomy in three cases. Three patients remained clinically free of disease after six courses of VPCBAE and the two patients who had measurable pelvic disease before the administration of chemotherapy had objective responses. Four patients died of disease from 11 to 18 months after initial laparotomy. One patient is alive and disease-free at 29 months. The VPCBAE combination appears to be effective in select cases of SCCO. A study of the efficacy of VPCBAE in a larger group of patients with SCCO seems to be indicated.

Pelvic exenteration in clear cell adenocarcinoma of the vagina and cervix.

Pelvic exenteration was performed in 29 of 527 cases of vaginal and cervical clear cell adenocarcinoma (CCA). Exenteration was the initial therapy in 21 cases (1 stage I, 15 stage II, 3 stage III, 1 stage IV, and 1 unknown stage) and was undertaken in 8 cases for central failure after primary radiotherapy. Of the 78 patients with stage II vaginal CCA, the 9 treated with primary exenteration were compared with the 69 who had other modalities of therapy; no significant difference in the survival experience was noted between the two groups. Among the 96 patients with stage II cervical CCA the survival experience was less favorable for those who underwent primary exenteration (n = 5) than for those who were treated with other varieties of therapy (n = 91). Of the 34 patients with central treatment failure, 8 had exenteration and 26 had other forms of therapy. The overall 5- and 8-year actuarial survival rates for the exenteration group (100 and 60%) do not differ significantly from those for the nonexenteration group (71 and 56%). Primary exenteration was used more frequently in the 1970s but has been predominantly reserved for the treatment of recurrent disease during the past decade. Survival statistics after exenteration for central failure are more favorable in cases of vaginal and cervical CCA than in cases of cervical squamous carcinoma.

A case report of three synchronous stage I malignant neoplasms.

A patient with three synchronous, Stage I neoplasms of the ovary, kidney, and lung, who underwent resection of all lesions at the same operative procedure, is presented. The incidence of multiple primary malignancies and the prognosis for Stage I cancers of the ovary, kidney, and lung are reviewed.

Comparison of the quantity of estrogen receptors in human endometrium and myometrium by steroid-binding assay and enzyme immunoassay based on monoclonal antibodies to human estrophilin.

The recently developed enzyme immunoassay for estrogen receptors is more simple to perform with quality assurance than conventional steroid-binding assays with radioactive labeled estrogen. However, it is not known how well the results of the two assays agree for normal human uterine samples. We compared enzyme immunoassay (Abbott estrogen receptor enzyme immunoassay) and steroid-binding assay of normal human endometrium and myometrium. Low-salt, "cytosol" estrogen receptor determinations were performed by dextran-coated charcoal assay, and high-salt, "nuclear" estrogen receptors were measured by controlled pore glass bead assay. Results showed excellent correlation (p less than 0.0001) for cytosol estrogen receptor of endometrium (r = 0.95) and myometrium (r = 0.79) and also for a smaller number of nuclear estrogen receptors of myometrium (p less than 0.01, r = 0.69). Good agreement between steroid-binding assay and enzyme immunoassay was seen for estrogen receptors of both proliferative and secretory phase samples. Thus the data indicate that the simpler estrogen receptor enzyme immunoassay is useful to measure estrogen receptor in the normal uterus. Furthermore, with this sandwich assay, there is no evidence for the existence of significant quantities of receptor fragments that do not bind estrogen.

Hydroxyurea and etoposide: in vitro synergy and phase I clinical trial.

L1210 murine leukemia cells were treated with hydroxyurea (10-200 microM) for 24 hours and/or etoposide (0.17-3.4 microM) for 2 hours. Combination treatments used a fixed molar hydroxyurea:etoposide ratio of 58.9:1, and drug-drug interactions were quantitated according to the median effect principle. Hydroxyurea and etoposide were antagonistic at low doses at which the survival fraction was greater than 0.5 and synergistic at higher doses at which the survival fraction was less than 0.25. In a phase I clinical trial, 19 patients were treated with the two drugs at one of three dose levels. The dose-limiting toxic effect was myelosuppression. Doses of 100 mg of etoposide/m2 per day by continuous infusion and 500 mg of hydroxyurea orally every 4 hours, both for 3 days, are recommended for phase II trials.

An evaluation of stage II vaginal clear cell adenocarcinoma according to substages.

Of the 76 cases of stage II vaginal clear cell adenocarcinoma reviewed, the lesion involved the vesicovaginal and/or rectovaginal septa (IIc) in 19, the paravaginal/parametrial tissues without extension onto the pelvic sidewall (IIb) in 8, and the subvaginal tissue without paravaginal/parametrial or septal infiltration (IIa) in 36; the substage could not be determined in 13 cases. The three substage groups were similar with regard to maternal hormone history, greatest tumor diameter, depth of invasion, cross-sectional tumor area, location of the lesion in the vagina, predominant histologic pattern and cell type, mitoses, grade, lymph node status, and treatment modality. Actuarial survival rates at 5 and 10 years for all patients with stage II vaginal clear cell adenocarcinoma were 83 and 62%, respectively. The recurrence and survival experiences for the three substage groups were similar. The data available do not suggest any clinical benefit to categorizing cases of stage II vaginal clear cell adenocarcinoma into substages.

Infertility among daughters either exposed or not exposed to diethylstilbestrol.

Infertility was examined among 343 diethylstilbestrol-exposed and 303 unexposed daughters whose mothers participated in an evaluation of diethylstilbestrol use during pregnancy 35 years ago. Of the married individuals who were not using contraception and who were actively trying to conceive, a greater proportion of diethylstilbestrol-exposed women than unexposed subjects experienced primary infertility (33% versus 14%, p less than 0.001). Among those with primary infertility, abnormal hysterosalpingograms were observed in 46% of the diethylstilbestrol-exposed group and in none of the unexposed group (p less than 0.02), while tubal abnormalities were found in 42% of the exposed and in none of the unexposed (p = 0.02). First pregnancies were achieved by 40 (58%) women exposed to diethylstilbestrol and 18 (64%) unexposed subjects. Twenty-four (60%) of the exposed women and 15 (83%) of the unexposed individuals who conceived had a live-born infant who survived. The estimated cumulative rate of first pregnancy was 16% for the exposed group and 36% for the unexposed group at 12 months after the diagnosis of primary infertility (p less than 0.05).

Cytomegalovirus infection of the uterine cervix in a patient with acquired immunodeficiency syndrome.

A case of cytomegalovirus infection of the cervix in a young woman with acquired immunodeficiency syndrome (AIDS) was proved by light microscopy, viral culture, and immunohistochemistry.

Evaluation of bolus cis-platinum and continuous 5-fluorouracil infusion for metastatic and recurrent squamous cell carcinoma of the cervix.

The combination of cis-platinum and 5-fluorouracil has been reported to act synergistically with improved response rates in squamous cell carcinomas of the head and neck. The activity of bolus cis-platinum and continuous infusion of 5-fluorouracil in 24 patients with recurrent and metastatic squamous cell carcinoma of the cervix was evaluated. Twelve patients were stage I, 3 were stage II, 5 were stage III, and 4 were stage IV cervical carcinomas. Among the 24 patients, there were 4 complete and 8 partial responses (50%). The overall median response was 24 weeks. The overall cumulative survival was 55% at 40 weeks and 40% at 1 year after beginning this regimen. Complications included 4 patients who developed leukopenia, 3 thrombocytopenia, 11 stomatitis, 14 nephrotoxicity, 4 peripheral neuropathy, and 6 ototoxicity. The combination of cis-platinum and continuous infusion of 5-fluorouracil appears to have useful activity in patients with recurrent or metastatic squamous cell carcinoma of the cervix.

Local therapy in stage I clear cell adenocarcinoma of the vagina.

Of the 219 cases of Stage I vaginal clear cell adenocarcinoma reviewed, 176 had conventional therapy and 43 underwent local therapy. The two groups appear to be similar with respect to symptoms, stage, location of the lesion in the vagina, greatest tumor diameter, surface area, depth of invasion, predominant histologic pattern, grade, and number of mitoses; nonetheless, firm conclusions cannot be drawn because of missing data. Actuarial survival rates at 5 and 10 years for the local therapy group (92% and 88%, respectively) were essentially equivalent to those for the conventional therapy group (92% and 90%, respectively), however, the recurrence experience after local therapy was less favorable. Local therapy consisted of vaginectomy in nine cases, local excision alone in 17 cases, and local irradiation (with or without local excision) in 17 cases. The subgroup of patients receiving local irradiation had a recurrence experience as favorable as that of the conventional therapy group and more favorable than that of either the subgroup treated with vaginectomy or local excision alone. The data suggest that when employed, local therapy should include local irradiation.

An evaluation of squamous cell carcinoma antigen in patients with cervical squamous cell carcinoma.

In a prospective study, serum concentrations of squamous cell carcinoma antigen, a subfraction of tumor antigen (TA-4), were determined by radioimmunoassay from healthy donors, pregnant women, and subjects with various benign and malignant gynecologic diseases. Ninety-six percent of 99 healthy persons including all 52 female controls, the 15 pregnant patients, and all 23 subjects with benign gynecologic tumors, had squamous cell carcinoma antigen levels less than 2.0 ng/ml. Seven of 51 (14%) patients with cervical intraepithelial neoplasia and 16 of 24 (67%) patients with cervical squamous cell carcinoma had squamous cell carcinoma antigen levels greater than 2.0 ng/ml. Declining and rising levels of squamous cell carcinoma antigen, which were determined sequentially in nine cases of cervical carcinoma that were associated with elevated pretreatment levels of squamous cell carcinoma antigen, correlated with regression and progression of the disease. Serial serum levels of squamous cell carcinoma antigen provide a noninvasive means of monitoring the effects of individual therapy in patients with cervical squamous cell carcinoma.

Poorly differentiated (small cell) carcinoma of the ovary in young women: evidence supporting a germ cell origin.

The clinical and pathologic features, including immunohistochemistry and electron microscopy, of six cases of poorly differentiated carcinoma of the ovary (small cell carcinoma) are presented. These tumors occurred in six young patients ranging in age from 10 to 24 years. Two patients had hypercalcemia. All tumors were unilateral, and four patients had advanced stage disease at presentation. Histologic features included sheets, nests, and cords of cells in a fibrous stroma, focal microcysts, and a dimorphic population of small and large cells. Eosinophilic, hyaline globules occurred in five cases, intercellular basement membrane-like substance in two cases, and glycogen in all cases. Five of six cases stained strongly for cytokeratin and vimentin; intracytoplasmic laminin was identified in three cases; and three cases were believed to show faint positivity for alpha-1-antitrypsin. Stains for alpha-fetoprotein were negative. Ultrastructural examination of two cases showed granular material in dilated rough endoplasmic reticulum, intermediate filaments, intracytoplasmic dense globules, maculae adherens, and extracellular basement membrane-like material. All of the cases proved rapidly fatal despite various therapies, as did a histologically similar testicular tumor that was admixed with seminoma and teratoma. We interpret these findings to indicate that this ovarian cancer is most likely of germ cell origin, and it may be related to yolk sac tumor, although it is clearly distinct from the classical yolk sac tumor.

Clear cell adenocarcinoma (CCA) of the vagina and cervix in association with pregnancy.

The effect of pregnancy on patients with CCA of the vagina and cervix was evaluated based upon a review of 503 cases. Eighty-five had been pregnant (24 at diagnosis), 408 had never been pregnant, and the pregnancy history was unavailable in 10 cases. All of the 24 patients pregnant at diagnosis were over 16 years of age; 14 were in the first trimester, 6 in the second, and 4 in the third trimester. By FIGO criteria, 15 were stage I, 7 stage II, and 2 were stage III. The 24 pregnant and 408 never pregnant (age corrected) cases were compared with regard to maternal hormone history, symptoms, stage, location, predominant histologic or cell type, greatest tumor diameter, surface area, depth of invasion, grade, and number of mitoses. No significant differences were detected. Twelve of the 24 pregnant patients had radical hysterectomy with or without irradiation (9 stage I, 3 stage II); of the 7 treated by local therapy (5 stage I, 2 stage II), 3 required additional therapy due to persistent disease; 4 had radiotherapy alone (1 stage I, 2 stage II, and 1 stage III); one had teletherapy followed by exenteration (stage III). Six of the 24 died 2 to 12 years after diagnosis (1 stage I, 3 stage II, 2 stage III). Eighteen are alive at 1 to 17 years. The overall 5 and 10 year actuarial survival rates (age adjusted) for the group pregnant at diagnosis (86 and 68%) do not differ significantly from the never pregnant group. Pregnancy does not seem to adversely affect the outcome of CCA. Guidelines are presented to treat pregnant patients with CCA.

Treatment of uncomplicated meconium ileus via T-tube ileostomy.

There are many treatment modalities for uncomplicated meconium ileus. However, for neonates with intestinal obstruction unrelieved by nonoperative measures we advocate T-tube ileostomy with postoperative irrigation of the intestine utilizing pancreatic enzyme. Our series includes 11 infants with uncomplicated meconium ileus who underwent T-tube ileostomy 24--96 hr after birth. Of the 7 females and 4 males only 2 infants failed to pass meconium. One infant required reexploration for persistent obstruction and 1 infant, the only death encountered, had overwhelming pulmonary infection and intracranial hemorrhage. The remaining 9 infants passed meconium between the 1st and 11th postop days. The T-tube was removed by pulling it out between the 10th and the 14th postop day with the T-tube tract closing spontaneously in all patients. Our experience with T-tube ileostomy suggests that resection of dilated but viable ileum is not necessary for prompt intestinal function in the neonate. With the use of pancreatic enzyme irrigation, the tenacious meconium in these patients can be rapidly liquified and expelled per rectum or T-tube and the necessity of mechanical removal during the operative procedure avoided.