Serous carcinoma of the fallopian tube presenting as axillary lymphadenopathy.

Serous carcinoma originating in the fallopian tube usually presents at an advanced stage with extensive pelvic disease. Palpable axillary lymphadenopathy as the initial presentation of primary fallopian tube cancer without extensive extratubal spread in the pelvis is very uncommon. We report a case of a woman with a high-grade serous carcinoma of fallopian tube origin whose initial clinical presentation was palpable axillary lymphadenopathy. On histopathologic evaluation of her primary tumor, only minimal extension to the ipsilateral ovary was identified, with no other pelvic involvement. No additional supradiaphragmatic involvement was identified on imaging. Although the primary route of spread of tubal cancer is primarily through the direct exfoliation of the cells onto the adjacent surfaces in the peritoneal cavity, less commonly, lymphatic spread can result in distant metastasis, preceding intraperitoneal extension.

Diffuse laminar endocervical glandular hyperplasia: a case report.

BACKGROUND: Diffuse laminar endocervical glandular hyperplasia is extremely rare with only 14 cases reported in the literature. Diffuse laminar endocervical glandular hyperplasia is a benign lesion that is easily confused with malignancy. CASE REPORT: We present a 22-year-old woman referred to our gynecologic oncology service with a 2.0 x 4.0-cm exophytic cervical mass. Colposcopic-directed cervical biopsies were diagnosed as adenocarcinoma, suggestive of minimal deviation adenocarcinoma. Computed tomographic scans of the abdomen and the pelvis failed to reveal any metastatic foci. A radical abdominal hysterectomy with pelvic and para-aortic lymph node sampling was performed without complications. Final pathology revealed diffuse laminar endocervical glandular hyperplasia. CONCLUSIONS: Diffuse laminar endocervical glandular hyperplasia is an uncommon histological type of pseudoneoplastic glandular lesions that may be found in the cervix, and this entity should be considered in the differential diagnosis of a potentially malignant endocervical glandular lesion.

Endometrial cancer--current state of the art therapies and unmet clinical needs: the role of surgery and preoperative radiographic assessment.

Endometrial carcinoma is the fourth most common cancer among women in the United States. Surgical pathologic staging has been the standard of care since 1988, which consists of analysis of collected peritoneal fluid, hysterectomy/oophorectomy, and pelvic and para-aortic lymphadenectomy. In 2005, it was further recommended that essentially all women with endometrial cancer who choose to undergo surgery have pelvic and para-aortic lymph node analysis. Despite this recommendation, there still remains controversy as to whether all patients with endometrial cancer should undergo full lymph node dissection. In this review, we assess the evidence surrounding this controversy and conclude that women with endometrial cancer should undergo complete lymphadenectomy at the time of surgery. Furthermore, we evaluate the evidence regarding laparoscopic surgical staging as a safe and effective alternative to the more invasive traditional laparotomy. Finally, for those patients who a gynecologic oncologist is not readily available to perform a complete lymph node dissection, we evaluate the various imaging studies and their utility as preoperative triage modalities.

Changes in embryonic development and hatching in Chionoecetes opilio (snow crab) with variation in incubation temperature.

Water temperature affects the distribution, movement, and reproductive potential of female snow crab, Chionoecetes opilio. Ovigerous females of C. opilio from the eastern Bering Sea were held at five temperatures (-1, 0, 1, 3, and 6 degrees C) in the laboratory while their embryos developed from gastrula to hatching. The duration of incubation increased by 105 d (30%) with decreasing temperature; however, a switch to a 2-year duration of embryo incubation was not observed. For females held at 6, 3, and 1 degrees C, their embryos underwent a short period of diapause late in development; no diapause was observed for embryos of females held at 0 or -1 degrees C. Successful extrusion of a subsequent clutch and hatch timing comparable with that observed in the eastern Bering Sea indicated that temperatures of 0 to 3 degrees C may be optimal for multiparous female reproduction. We demonstrated that a switch from 1-year to 2-year reproduction cannot be triggered by changing the thermal regime after several months of embryonic development. The timing of female movement from colder to warmer waters may be important for maintaining population reproductive potential during the recent phase of warming and contraction of cold-water biomes in the Bering Sea.

Sustained response to bevacizumab in refractory well-differentiated ovarian neoplasms.

BACKGROUND: Bevacizumab has demonstrated activity against a variety of solid tumors, including ovarian carcinoma. However, there have not been reproducible prognostic features associated with its activity. CASES: One patient each with recurrent, refractory well-differentiated serous-endometrioid ovarian carcinoma, micropapillary serous carcinoma of the ovary, and primary peritoneal micropapillary serous carcinoma were treated with single agent bevacizumab (15 mg/kg [DOSAGE ERROR CORRECTED] intravenously every 3 weeks). All three have had dramatic sustained responses of 15, 15, and 22 months' duration. CONCLUSION: Bevacizumab may have significant activity against well-differentiated ovarian carcinoma and micropapillary serous carcinomas of the ovary or peritoneum. Since these tumors are generally indolent and not responsive to adjuvant therapy, further investigation is warranted.

Is there a difference in survival for IA1 and IA2 adenocarcinoma of the uterine cervix?

OBJECTIVE: The goal of this study was to determine if International Federation of Obstetrics and Gynecology (FIGO) subdivision into IA1 versus IA2 is predictive of survival differences for early invasive adenocarcinoma. METHODS: The Surveillance, Epidemiology, and End-Results (SEER) Public-Use Database was used to identify all cases of IA1 and IA2 adenocarcinoma diagnosed between 1983 and 1997. A systematic literature search (MEDLINE 1966-2000) was used to identify all previously published cases. Stage, depth of invasion, node status, therapy, and survival were analyzed using Fisher's exact and log-rank tests. RESULTS: In SEER, 560 cases were identified: 200 IA1, 286 IA2, and 74 localized. Simple hysterectomy was performed in 272 (48.6%) and radical hysterectomy in 210 (37.5%). Positive lymph nodes were found in 3 of 197 (1.5%) who underwent lymphadenectomy, 2 of whom died. The censored survival by stage (mean follow-up 51.6 months) was not significantly different (P = 0.77) for IA1 versus IA2 (98.5% vs 98.6%). Combining these data with all other published series of early cervical adenocarcinoma, 1170 cases were identified, including 585 IA1, 358 IA2, and 227 "others," with less defined early disease. Of 531 (45.4%) who underwent lymphadenectomy, 15 (1.28%) had one or more positive nodes; of these, 11 (73.3%) recurred or died. For IA1 versus IA2 disease, there were no significant differences in the frequency of positive lymph nodes, recurrence, or death. However, "others," those with less well-defined lesions, or larger than IA2, were at increased risk. CONCLUSION: Early invasive adenocarcinoma (IA1 and IA2) has an excellent prognosis and conservative surgery may be appropriate. Since current FIGO staging definitions do not distinguish high- from low-risk disease, individualization of therapy based on pathology review, risk assessment, and patient preference is recommended.