[Primary tubal cancer].
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Antigens, Neoplasm↗
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Feasibility of laparoscopic management of presumed stage I endometrial carcinoma and assessment of accuracy of myoinvasion estimates by frozen section: a gynecologic oncology group study.
INTRODUCTION: To assess laparoscopic management of presumed stage I endometrial cancer, and to compare gross, frozen, and paraffin section methods measuring myoinvasion. PATIENTS AND METHODS: Eligible patients underwent laparoscopic exploration. Patients with preoperative grade 1 histology underwent laparoscopic-assisted vaginal hysterectomy and bilateral salpingo-oophorectomy (LAVHBSO). Pelvic and periaortic lymph node sampling (PPANS) was performed for deep (> or =50%) myoinvasion confirmed by frozen section. Patients with preoperative grade 2 or 3 histology without evidence of extrauterine metastasis underwent PPANS + LAVHBSO. RESULTS: Of 50 eligible patients selected, LAVHBSO was successfully completed in all but five. There was one trocar bowel perforation. Myoinvasion depth was correlated between paraffin section and gross estimate, and between paraffin and frozen section estimate, in 89 and 90% of cases, respectively. Myoinvasion was underestimated by gross versus paraffin in three of five discrepancies, and by frozen versus paraffin section in one of three discrepancies. CONCLUSIONS: Laparoscopic surgical staging for early stage endometrial cancer is feasible. Gross/frozen section methods correlate with paraffin section to measure myoinvasion. Tumor grading and gross/frozen section myoinvasion estimates can guide operative management.
Adult↗
The role of routine pelvic lymph node sampling in patients with stage I endometrial carcinoma: second thoughts.
BACKGROUND AND METHODS: The cases of 245 patients diagnosed during 1980-1989 with stage I endometrial carcinoma were retrospectively reviewed in order to assess the contribution of lymph node sampling (LNS) to both course of treatment and outcome. The 183 women treated by gyneco-oncologic surgeons had undergone the standard surgical procedure of total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO) and pelvic lymph node sampling (LNS). Sixty-two other women, treated by gynecologists, received only TAH and BSO. Of women who had received TAH+BSO+LNS, 105 (57.4%) were referred for adjuvant radiotherapy on the basis of one or any combination of high grade histology (G2 or G3), myometrial invasion to a depth of 50% or more and LNS positivity. Of the group who had not had LNS, 37 (59.7%) likewise received adjuvant radiotherapy but on the bases of histology and/or depth of invasion. RESULTS AND CONCLUSIONS: Recurrence and survival over a mean follow-up period of 7.5 years (range 5-15 years) showed no significant differences between the patients who underwent LNS and those who did not. Of 43 recurrences, six were among 'low risk' women (those with both minimal invasion and low grade histology), suggesting a special need among this group for the additional staging information which LNS may provide.
Carcinoma↗
The ultrastructure of a poorly differentiated adenocarcinoma of the human tuba uterina.
A poorly differentiated adenocarcinoma of the human oviduct was studied by light and transmission electron microscopy. Cells contained abundant mitochondria, bound and free ribosomes, prominent Golgi's bodies and aggregates of membrane-bound dense bodies. The small glandular lumina with numerous microvilli were generally devoid of cilia and contained secretory material. The neoplasm was ultrastructurally similar to poorly differentiated ovarian serous carcinomas.
Adenocarcinoma↗
Primary adenocarcinoma of the endometrium associated with genital tuberculosis. A case report.
BACKGROUND: Adenocarcinoma of the endometrium is a common tumor of the female reproductive tract, and tuberculosis accounts for only about 1% of postmenopausal metrorrhagia. Tuberculosis of the fallopian tubes is the most frequent location; that of the cervix is the most uncommon. CASE: A case of primary adenocarcinoma of the endometrium was diagnosed after curettage in a 58-year-old, postmenopausal woman complaining of a bloody vaginal discharge. A laparotomy was performed, and histologic examination of the uterus disclosed an endometrial carcinoma, grade 2/3, with extension to both tubes. The tumor was associated with an extensive granulomatous reaction, with numerous tubercles composed of epithelioid cells, multinucleate giant cells of Langhans and central necrosis type. These granulomas were seen close to the carcinoma in the endometrium and tubes and far from the neoplasm in sections of the cervix, myometrium and lymph nodes. CONCLUSION: The association of endometrial adenocarcinoma with genital tuberculosis is extremely rare. Moreover, similar granulomas may appear in the surrounding stroma of the tumor. For these reasons a diagnosis of genital tuberculosis associated with this neoplasm should be made with caution.
Adenocarcinoma↗
Prognostic significance of fallopian tube cytology: a study of 99 endometrial malignancies.
The purpose of the study was to relate fallopian tube lavage-cytology (tubal washings) from patients treated for endometrial malignancies with other recognized prognostic factors and also with patient survival. In 99 patients the following prognostic variables were analyzed: patient age, peritoneal washing cytology (PW), endometrial tumor grade, depth of myometrial invasion, myometrial vascular involvement, cervical stromal infiltration and peritoneal metastases. The association between tubal washings and preoperative hysteroscopy was also examined. Of the 99 patients with endometrial malignancy, 18 experienced their first tumor recurrence or died from tumor during the follow-up period (median 53 months, range 5-137 months). The remaining 81 patients were disease-free on their last visit or died from unrelated causes. Detailed statistical analysis revealed a complex inter-relationship between the variables but no independent prognostic significance for tubal washings. Furthermore, the absence of any statistical association between hysteroscopy and survival suggests that preoperative hysteroscopy has no deleterious effect. Although the small number of patients in this study limits any definitive conclusion, the analyzed data suggest that tubal washing cytology plays no useful role in the current management of patients with endometrial malignancies.
Adenocarcinoma, Clear Cell↗
A scanning and transmission electron microscopic study on an unusual pelvic tumor a case report.
A portion of a pelvic mass removed from a 38-year-old female, read out on frozen section as a papillary carcinoma with psammoma bodies, was submitted to the EM lab for routine processing. Transmission electron microscopy reveals the tumor mass to be composed of cuboidal and columnar epithelial cells with short apical microvilli and numerous sites of cellular attachments. That portion of the tumor processed for scanning electron microscopy, showed cells similar to those described above but an additional cell line containing numerous cilia were found scattered randomly throughout the entire sample. This finding prompted additional study of the original light and transmission samples to determine the nature of this neoplasm. Gross, microscopic, transmission and scanning micrographs will be presented to illustrate the merits of using multiple microscopic capabilities in the differential diagnosis of unusual tumors.
Adult↗
Phase I study of 90Y-labeled B72.3 intraperitoneal administration in patients with ovarian cancer: effect of dose and EDTA coadministration on pharmacokinetics and toxicity.
The tumor-associated glycoprotein 72 (TAG-72) antigen is present on a high percentage of tumor types including ovarian carcinomas. Antibody B72.3 is a murine monoclonal recognizing the surface domain of the TAG-72 antigen and has been widely used in human clinical trials. After our initial encouraging studies (M. G. Rosenblum et al., J. Natl. Cancer Inst., 83: 1629-1636, 1991) of tissue disposition, metabolism, and pharmacokinetics in 9 patients with ovarian cancer, we designed an escalating dose, multi-arm Phase I study of 90Y-labeled B72.3 i.p. administration. In the first arm of the study, patients (3 pts/dose level) received an i.p. infusion of either 2 or 10 mg of B72.3 labeled with either 1, 10, 15, or 25 mCi of 90Y. Pharmacokinetic studies demonstrated that concentrations of 90Y-labeled B72.3 persist in peritoneal fluid with half-lives >24 h after i.p. administration. In addition, 90Y-labeled B72.3 was absorbed rapidly into the plasma with peak levels achieved within 48 h, and levels declined slowly thereafter. Cumulative urinary excretion of the 90Y label was 10-20% of the administered dose which suggests significant whole-body retention of the radiolabel. Biopsy specimens of bone and marrow obtained at 72 h after administration demonstrated significant content of the label in bone (0.015% of the dose/g) with relatively little in marrow (0.005% of the dose/g). The maximal tolerated dose was determined to be 10 mCi because of hematological toxicity and platelet suppression. This typically occurred on the 29th day after administration and was thought to be a consequence of the irradiation of the marrow from the bony deposition of the radiolabel. In an effort to suppress the bone uptake of 90Y, patients were treated with a continuous i.v. infusion of EDTA (25 mg/kg/12 h x 6) infused immediately before i.p. administration of the radiolabeled antibody. Patients (3 pts/dose level) were treated with doses of 10, 15, 20, 25, 30, 35, 40, or 45 mCi of 90Y-labeled B72.3 for a total of 38 patients. EDTA administration resulted in significant myeloprotection, which allowed escalation to the maximal tolerated dose of 40 mCi. Dose-limiting toxicity was thrombocytopenia and neutropenia. Studies of plasma and peritoneal fluid pharmacokinetics demonstrate no changes compared with patients without EDTA pretreatment. Cumulative urinary excretion of the radiolabel was not increased in patients pretreated with EDTA compared with the untreated group. However, analysis of biopsy specimens of bone and marrow demonstrated that bone and marrow content of the 90Y label was 15-fold lower (<0.001% injected dose/g) than a companion group without EDTA. Four responses were noted in patients who received 15-30 mCi of 90Y-labeled B72.3 with response durations of 1-12 months. These results demonstrate the myeloprotective ability of EDTA, which allows safe i.p. administration of higher doses of 90Y-labeled B72.3 and, therefore, clearly warrant an expanded Phase II trial in patients with minimal residual disease after standard chemotherapy or for the palliation of refractory ascites.
Adult↗
[Bilateral tube carcinoma with unusual involvement of the endometrium].
Report on a case of bilateral, primary carcinoma of the fallopian tube with extensive implantation metastasis of the endommetrium. To judge by the morphological structure of the tumor in the fallopian tubes and in the endometrium, by the nature of the spreading in the mucosa of the uteruscorpus and by the morphology of the intramural fallopian tube sections, the neoplasm is, in differential diagnostic terms, demarcated by a corpus carcinoma of the uterus.
Adolescent↗
[Diagnosis and treatment of adnexa tumors in childhood and adolescence].
From 1968 to 1988, 47 children and adolescents, their ages ranged from a few days to 21 years, were treated for tumors of the ovary in the hospital for children and adolescents and the surgical department of the University of Erlangen-Nürnberg. In 33 cases ovarian cysts were found, 14 patients suffered from a neoplasm of the ovary. 8 of the neoplasms were benign cystic and solid teratomata, 4 were of epithelial origin and 2 identified as juvenile granulosa cell tumors. There was a follow up in all patients with tumors ranging up to 19 years.
Adolescent↗
[Estrogen and progesterone receptors in malignant ovarian neoplasms].
Estrogen receptors (ER) and progesterone receptors (PR) were evaluated in 173 primary ovarian cancers and in 6 ovarian metastases. In epithelial ovarian carcinomas 63% had ER and 46% PR. Almost all granulosa cell tumours were receptor-positive, while sarcomas, dysgerminomas, and teratomas lacked ER and PR. Both receptors were found less often in tumours of the histological grade I than in those of grade II and III. During the development of metastases and during chemotherapy there was a loss of PR in 27% and 53% of the cases, respectively, while the amount of ER remained more or less constant. In addition to ovarian cancers ER and PR were present in carcinomas of the fallopian tube as well. ER-negative and especially PR-negative tumours seemed to respond better to chemotherapy than receptor-positive carcinomas. The possible significance of ER and PR with regard to the success of an endocrine treatment is discussed.
Carcinoma↗
Infarcted adenomatoid tumor: a report of five cases of a facet of a benign neoplasm that may cause diagnostic difficulty.
We describe five cases in which adenomatoid tumors showed extensive necrosis, presumably due to infarction, and posed diagnostic difficulty. The tumors occurred in four males (three with epididymal tumors and one with an intratesticular tumor) and one female (with a parafallopian tube tumor) 35 to 44 years of age. Two of the men presented with acute scrotal pain simulating epididymitis, and two with a palpable mass. The parafallopian tube tumor was an incidental finding. The tumors were solitary, grossly well-circumscribed, uniformly solid masses that ranged in size from 1.1 to 3.5 cm. Microscopically, they were all characterized by central necrosis with pale mummified adenomatoid tumor identified at least focally but often overshadowed by nondescript necrotic tissue. Viable adenomatoid tumor was identified in all cases but was minor in amount in two of them. The necrosis was surrounded by a florid reactive process of fibroblasts and myofibroblasts that had plump nuclei often with prominent nucleoli, and occasional mitoses. Two of the epididymal cases had adjacent rete testis showing epithelial hyperplasia with hyaline globule formation. The microscopic appearance often suggested the possibility of a malignant neoplasm because of: 1) blurring of the normal relatively easily identifiable junction between adenomatoid tumor and adjacent tissue; 2) irregular pseudo-infiltration of fat by reactive tissue and adenomatoid tumor; 3) paucity of typical adenomatoid tumor due to the infarction and the fact that viable tumor usually showed a solid pattern; and 4) atypia of the associated reactive cells. This unemphasized feature of adenomatoid tumors may potentially lead to more aggressive therapy than warranted if it is not correctly interpreted.
Adenomatoid Tumor↗
Application of the CO2 laser to infertility surgery.
In addition to use of the CO2 laser in gynecologic surgery for the treatment of pelvic, vaginal and vulvar neoplasms, it has been more recently applied to the treatment of infertility. The advantages afforded by the laser over conventional techniques are discussed. The authors' clinical experience in the surgical treatment of infertility, with emphasis on endometriosis and microtubal surgery, are described, and use of the new electro-pulsed laser in infertility surgery is evaluated.
Carbon Dioxide↗
Endometrioid carcinoma of the oviduct.
Endometrioid carcinoma is a malignant tumor which microscopically resembles endometrial adenocarcinoma, but arises from extrauterine sites, most commonly the ovary. Although its association with endometriosis has received considerable discussion, it appears that most of the malignant endometrioid tumors arise de novo. We present a case of endometrioid carcinoma which is outstanding for its primary site in the oviduct and for its histologic appearance, which incorporated a close interplay between both stromal and epithelial elements. The neoplasm was found incidentally, when the woman presented with postmenopausal bleeding due to adenomatous hyperplasia of the endometrium. The patient presented with a stage I, grade I tumor which did not invade the wall of the oviduct. Twelve years following a TAH-BSO and postoperative radiation, the tumor recurred, requiring additional surgery and chemotherapy. The patient is currently disease free, 2 years from her recurrence.
Adenocarcinoma↗
Adenocarcinoma of the uterine tube: potential for lymph node metastases.
A clinicopathologic study of 15 cases of primary adenocarcinoma of the uterine tube occurring over a 12-year period is presented. The mean age of the patients was 54.8 years. Predominant symptoms were abnormal bleeding, abnormal vaginal discharge, and pelvic pain. Abnormal vaginal cytology was noted in two instances (13%). A pelvis mass was detected in two thirds of patients. The neoplasm was bilateral in three instances (20%). Lymph nodes were involved in eight cases (53%), and metastatic spread to the para-aortic nodes was present in five (33%). The most common primary treatment was total abdominal hysterectomy and bilateral salpingo-oophorectomy. Various combinations of adjuvant radiation therapy and chemotherapy were also employed. Six patients (40%) are alive without evidence of recurrent cancer. It is concluded that lymphatic spread, especially to the para-aortic nodes, is a major pattern of disseminaton for adenocarcinoma of the uterine tube. The presence of tumor in capillary-like spaces bears a strong relationship to lymph node metastases, and the para-aortic nodes are a frequent site of involvement even when the disease is apparently limited to the tube.
Adenocarcinoma↗
Malignant mixed müllerian tumor of the oviduct.
Malignant mixed müllerian tumor is an uncommon gynecologic neoplasm, especially in the oviduct, where fewer than 30 have been described. We report two additional cases which clinically mimicked carcinoma of the oviduct. Both patients were postmenopausal and had the chief complaint of abdominal pain associated with increased abdominal girth. Presurgical vaginal cytologies were negative and both diagnoses were made only with histologic examination of tissues removed at surgery. As most of the cases from the literature involved low-parity women, the high parity of these women is unusual. Unfortunately both presented with stage III disease and died of recurrent disease 18 and 12 months following surgery.
Fallopian Tube Neoplasms↗
Adenomatoid tumor of the genital tract: evidence of mesenchymal cell origin.
The objective of this study was to re-examine the histogenesis of adenomatoid tumors. This benign neoplasm is characterized by gland-like structures with a pseudodinfiltrative pattern, usually involving fibromuscular tissue at a certain distance from an overlying surface mesothelium. Twenty cases of adenomatoid tumors and four cases of reactive submesothelial lesions, characterized by marked proliferation of subserosal mesenchymal cells, were reviewed. Nineteen of twenty adenomatoid tumors, including lesions with ill-defined borders, showed no connection with surface mesothelium. At the periphery of small tumors, isolated glands, clusters of epithelioid cells and single epithelioid, and spindled cells showing no connection to adjacent glands or cell clusters were identified. The tumor cells shared features with reactive subserosal stromal cells including an infiltrative pattern and histochemical and immunohistochemical properties. The differences between adenomatoid tumors and reactive submesothelial tissue are quantitative in nature: predominant amount of spindled cells in reactive submesothelial lesions, and predominant amount of gland-like structures in adenomatoid tumors. It is proposed that adenomatoid tumors arise from pluripotent mesenchymal cells that differentiate toward submesothelial cells and eventually mesothelial cells. This differentiation is probably induced by the adjacent submesothelial cells.
Adenomatoid Tumor↗
Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 Mutation.
CONTEXT: Women with BRCA1 or BRCA2 mutation are often advised to undergo preventive oophorectomy. The effectiveness of this intervention has not been prospectively evaluated in a large cohort. OBJECTIVES: To estimate the incidence of ovarian, fallopian tube, and primary peritoneal cancer in women who carry a deleterious mutation in BRCA1 or BRCA2. To estimate the reduction in risk of these cancers associated with a bilateral prophylactic salpingo-oophorectomy. DESIGN, SETTING, AND PARTICIPANTS: Women known to carry a BRCA1 or BRCA2 mutation were identified from an international registry between 1992 and 2003. A total of 1828 carriers at 1 of 32 centers in Canada, the United States, Europe, and Israel completed questionnaires at baseline and follow-up. Participants were observed from the date of study entry until: diagnosis of ovarian, fallopian tube, or peritoneal cancer; death; or the date of the most recent follow-up. INTERVENTION: Participants were divided into women who had undergone bilateral prophylactic oophorectomy and those who had not. MAIN OUTCOME MEASURE: The incidence of ovarian, peritoneal, and fallopian tube cancer was determined by survival analysis. The risk reduction associated with prophylactic salpingo-oophorectomy was evaluated by a time-dependent survival analysis, adjusting for covariates. RESULTS: After a mean follow-up of 3.5 years, 50 incident ovarian, fallopian tube, and peritoneal cancer cases were reported in the cohort. Of the 1828 women, 555 (30%) underwent a bilateral prophylactic salpingo-oophorectomy prior to study entry, 490 (27%) underwent the procedure after entering the study, and 783 (43%) did not undergo the procedure. There were 32 incident cancers diagnosed in women with intact ovaries (1015/100,000 per year). Eleven cancer cases were identified at the time of prophylactic oophorectomy and 7 were diagnosed following prophylactic oophorectomy (217/100,000 per year). The estimated cumulative incidence of peritoneal cancer is 4.3% at 20 years after oophorectomy. The overall (adjusted) reduction in cancer risk associated with bilateral oophorectomy is 80% (multivariate hazard ratio = 0.20; 95% confidence interval, 0.07-0.58; P = .003). CONCLUSION: Oophorectomy is associated with reduced risk of ovarian and fallopian tube cancer in high-risk women, although there is a substantial residual risk for peritoneal cancer in BRCA1 and BRCA2 mutation carriers following prophylactic salpingo-oophorectomy.
Adult↗