Equal care ensures equal survival for African-American women with cervical carcinoma.

BACKGROUND: [corrected] It was the purpose of this study to investigate whether race is an independent prognostic factor in the survival of patients with cervical carcinoma in a health care system with minimal racial bias, and few barriers to access to care. METHODS: Records for patients with a diagnosis of invasive cervical carcinoma from 1988 to 1999 were obtained from the Automated Central Tumor Registry for the United States Military Health Care System. Clinical data including race, age at diagnosis, histology, grade, stage, socioeconomic status, treatment modality, and survival also were obtained. Survival analysis was performed with Kaplan-Meier survival curves. RESULTS: One thousand five hundred fifty-three patients were obtained for review. Sixty-five percent of patients were Caucasian, and 35% were minorities. Of the minorities, 29% were African Americans (AAs). Mean age of diagnosis was similar among AAs and Caucasians, 44 and 42 years, respectively. There was no statistically significant difference between the distribution of age, stage, grade, or histology between Caucasians and AAs. Forty-six percent of patients were treated with surgery and 56% with radiation therapy, with no difference in type of treatment between the Caucasian and AA groups. Five- and 10-year survival rates for Caucasians and AAs were 75%, and 76%, and 64% 65% (P = 0.59), respectively. CONCLUSIONS: In an equal access, unbiased, nonracial environment, race is not an independent predictor of survival for patients with cervical carcinoma. This study has shown, for the first time to the authors' knowledge, that when they receive equal treatment for cervical carcinoma, AA women's survival can approach that of their nonminority counterparts (75% at 10 years).

Asymptomatic intussusception of the appendix due to endometriosis.

We present the case of a 29-year-old woman with an asymptomatic intussuscepted appendix found incidentally during surgical evaluation for a pelvic mass in a patient with endometriosis. This case represents the rare nature of this presentation and the need to fully evaluate the gastrointestinal tract in patients with endometriosis.

Evaluation of routine antepartum and postpartum blood counts.

OBJECTIVE: To evaluate routine screening 28-week, admission and postpartum complete blood counts (CBCs) during a six-month period on the labor and delivery service and to correlate the laboratory data with clinical characteristics of the patients, to determine if routine CBCs are necessary in evaluating blood loss in low-risk patients and to determine whether routine admission screening for thrombocytopenia is necessary prior to epidural placement is necessary in low-risk patients. STUDY DESIGN: Laboratory data form all patients were obtained from a centralized computer system. Clinical characteristics were obtained from the medical record. RESULTS: Blood loss was determined by a change in hematocrit on admission and postpartum, and the mean of this data was used for analysis. First, the data reflected common clinical assumptions about delivery blood loss. The mean change in hematocrit for operative deliveries (7.93 +/- 5.10, 6.19 +/- 4.42; forceps and cesarean, respectively) was higher than that of spontaneous vaginal deliveries (4.31 +/- 3.78). Forcep deliveries had a larger decrease in hematocrit than repeat or primary cesarean sections combined, although it was not statistically significant (P = .04). More extensive vaginal lacerations were associated with larger decreases in hematocrit. There was a low percentage of patients requiring transfusion (1.3%) during the study period. All these patients had an estimated blood loss of > 1500 mL and delivery circumstances that would alert the clinician to the possibility of transfusion. Second, our data showed that the 28-week platelet count is predictive of the admission platelet count, with a regression coefficient of. 71. CONCLUSION: Often clinical assessment of blood loss, including history and physical examination, will predict the results of routine screening CBCs, and we question the need for routine screening of blood loss in uncomplicated deliveries. Our data on the 28-week and admission platelet counts support other authors' data showing that this screen is not necessary prior to epidural placement in low-risk patients.

Granulosa cell tumor of the ovary associated with antecedent tamoxifen use.

BACKGROUND: Increased attention has been focused recently on the estrogenic effects of tamoxifen. Review of the literature reveals an association between tamoxifen use and gynecologic tumors. CASE: A 52-year-old postmenopausal woman was treated with tamoxifen for stage II estrogen receptor-positive breast carcinoma. Her aspartate transaminase and alanine transaminase levels increase markedly after 6 months of tamoxifen use. After an additional 17 months of elevated serum transaminases, the patient was found to have a stage Ic granulosa cell tumor of the ovary. CONCLUSION: Patients with tamoxifen-induced liver dysfunction may be at increased risk for granulosa cell tumors because of alterations in tamoxifen metabolism.

Highly elevated CA125 and tubo-ovarian abscess mimicking ovarian carcinoma.

Elevated serum CA125 levels may be caused by any condition which produces peritoneal irritation as well as by the presence of various malignancies. This report of a case with atypical presentation of tubo-ovarian abscess and CA125 level of 1,160 U/ml serves to re-emphasize cautious operative planning in patients desirous of reproductive capability in the face of findings highly consistent with probable malignancy. This is the highest reported serum CA125 level in a reproductive age woman with well-documented reversible benign disease.

Bilateral giant primary ovarian leiomyomas. A case report.

The majority of ovarian leiomyomas are found incidentally during pathologic review of ovaries removed for other reasons. A 21-year-old woman, a virgin whose only symptom was abdominal discomfort of several months' duration, was found to have a large abdominopelvic mass, an elevated CA-125 level and ascites. Surgical exploration revealed the presence of large, bilateral ovarian neoplasms with a normal-appearing uterus. Since no normal ovarian tissue was identifiable, a bilateral oophorectomy and right salpingectomy were performed, preserving the uterus for assisted reproductive techniques. Histopathologic review confirmed benign giant primary ovarian leiomyomas with only microscopic foci of intermixed normal ovarian tissue.

Analysis of fine-needle aspirates for HPV by PCR may be useful in diagnosis of metastatic gynecologic malignancies.

Human papillomavirus (HPV) DNA has been shown by molecular hybridization studies to persist in both recurrent and metastatic disease in tumors of the female genital tract. We report here the use of the polymerase chain reaction to identify HPV DNA in material from fine-needle aspirates (FNA) of recurrent or metastatic lesions to document the primary malignancy arising in the lower genital tract. Fine-needle aspirates of suspected recurrent or metastatic tumors were obtained from nine patients with carcinoma of the lower genital tract and five patients with malignancies that have not been associated with HPV. DNA was extracted from the FNA and tissue block, when available, and amplified with HPV 6, HPV 16, and HPV 18 specific primers. In eight of the nine tumors from the lower genital tract, HPV DNA was identified in both the primary and metastatic lesions. In every case the HPV genotype was identical. One cervical carcinoma and five non-HPV associated tumors were negative for papillomavirus DNA. This study demonstrates that molecular hybridization techniques can be useful in identifying the source of a metastasis and have the potential to diagnose the presence of metastatic disease by detecting HPV DNA even when the cytologic criteria are equivocal.