Percutaneous lymph node aspiration in patients with gynecologic tumors.

Sixty-one patients with gynecologic malignancies had percutaneous transperitoneal lymph node aspiration performed by a flexible 8-inch needle guided to the nodes under monoplanar fluoroscopy. Of the patients who had malignant cells aspirated from pelvic and periaortic lymph nodes, 64% died or are alive with disease. Only 30% who had negative cytologic testing died or are alive with disease. Of the patients who had malignant cells aspirated from periaortic nodes, 69% died or are alive with disease whereas only 8% with negative cytologic testing died or are alive with disease. We believe that therapy such as extended field irradiation can be given on the basis of these results.

Outpatient therapy: success and failure with dysplasia and carcinoma in situ.

Between 1971 and 1980, 385 patients with colposcopic biopsy-proved cervical intraepithelial neoplasia were treated by either the colposcopist or the referring physician by means of cryosurgery, electrocautery, or biopsy excision. All were observed for a minimum of 1 year, 220 between 1 and 2 years, 50 between 3 and 4 years, and 23 for 4 or more years. Therapy failed in 29 in the first year ("failures" proved by tissue examination). The failure rate among the 35 patients with carcinoma in situ was 20%, a rate significantly higher than that seen in 108 patients with severe dysplasia (7 or 6.5%) or in mild and moderate dysplasia (4.4% and 8.5%, respectively). There were 10 "recurrences" seen among those observed for more than 1 year after treatment. In eight instances the histologic severity of the recurrence was more severe than that of the original lesion. The comparative efficacy of cryosurgery and electrocautery and the success and failure rates for the colposcopists and other therapists who had not viewed the lesions prior to therapy are examined.

Follow-up study of male and female offspring of DES-exposed mothers.

This follow-up study presents the effects of DES on the genital tract of male and female offspring of mothers who were part of a double-blind, placebo-controlled investigation during 1951 and 1952 aimed at determining the effect of DES on pregnancy. Epididymal cysts, hypotrophic testes, and capsular induration were the more common genital lesions found in 25% of 163 DES-exposed males as compared to 6% in 168 control males. Semen analysis data on 39 subjects of the DES-exposed group and 25 subjects of the control group showed that 26% of the DES-exposed group produced an ejaculate volume under 1.5 ml; no such cases were observed in the control group. The average values for sperm density ant total motile spermatozoa per ejaculate, although in the normal range, were more than two times lower in the DES-exposed group as compared to the controls. A quality score of greater than 10 ("severely pathologic semen") was found in 28% of the DES-exposed group as compared to 0 in the control group. An association of pathologic semen quality with physical abnormalities was found only in the DES-exposed group. Two cases of azoospermia, one without genital abnormalities on physical examination and one with bilateral hypotrophic testes were observed so far in the DES-exposed group. Eighteen percent of 229 DES-exposed female patients had irregular menstrual cycles (oligomenorrhea) as compared to 10% of 136 controls. The history of pregnancy revealed a lower incidence of pregnancy in the DES-exposed group (18%) than in the control group (33%). Circumferential ridges of the vagina and cervix were seen in 40% of 229 DES-exposed females but in none of 136 controls. Colposcopic findings in the vagina revealed adenosis in 66.8% of the DES-exposed females and in 3.6% of the control group. Dysplastic lesions were more prevalent in the vagina and cervix of the DES-exposed subjects. No cases of cancer were observed in either the male or female offspring.

Cytologic findings in female and male offspring of DES treated mothers.

Data on vaginal, cervical, and endocervical samples and urine specimens of 84 female offspring exposed to diethylstilbestrol in utero and 43 controls have been presented. The colposcopic and histopathologic findings were correlated with the cytologic findings. Our preliminary findings indicate that the cytologic technique is reliable as screening test for vaginal epithelial changes in the DES-exposed females provided the sampling procedure is adequate. In 79 male patients, 42 DES-exposed and 37 controls, the pre-massage urine, the prostatic fluid, the post-massage urine and aspirate of cysts of the epididymis when existing were examined by cytologic techniques. No tumor cells were found in the cytologic specimens of the exposed and unexposed male and female offspring.