A case report of an ovarian lipoma.

BACKGROUND: Ovarian lipomas are a rare entity, with most being described as part of a teratomatous origin. This is a case report of a lipoma of an ovary not associated with a teratoma or an hyperandrogenic state. CASE: A 66-year-old female underwent an exploratory laparotomy and a left ovarian tumor measuring about 7 to 8 cm was removed. Microscopic examination demonstrated a pattern of proliferation of benign adipose tissue with focal areas of fibrovascular septae and no other tissue of different origin. CONCLUSIONS: A MEDLINE search did not reveal any well-documented cases of a pure ovarian lipoma. The cases reported were associated with teratomas, lipid cell tumors, and lipoleiomyomas. Thus, it appears that lipomas of the ovary are rare, but can occur.

Ileus of the colon with cecal dilatation and perforation.

Segmental dilatation of the colon without obstruction is an unusual but recognizable entity, distinct from mechanical obstruction and paralytic ileus. Cases of ileus of the colon with cecal dilatation following delivery and gynecologic surgery are collected from the literature, and 3 recent cases are presented: 1 following cesarean section and 2 following abdominal hysterectomy. The etiology of this condition is still obscure and the clinical features are deceptive. The occurrence of this entity in obstetric and gynecologic patients is by no means a rarity and warrants a familiarity with and early recognition of this entity on the part of the physician in order to avoid serious sequelae.

Multiple primary neoplasms of the anogenital region.

The anogenital region, comprising the cervix, vagina, vulva, perineum, and anus, has the potential for the development of multicentric and multiple primary malignancies. Fifteen patients with 3 or more primary neoplasms in this region are presented. Awareness of the existence of these tumors as a regional disease and the possible long intervals between successive malignancies are emphasized. The presence of a vulvar neoplasm should arouse suspicion of a synchronous primary tumor elsewhere in the region. Conversely, sequential neoplasms occur more commonly after an initial cervical primary neoplasm and should be anticipated.

Pelvic abscess complicating embolic therapy for control of bleeding cervical carcinoma and simultaneous radiation therapy.

Embolization therapy for control of bleeding has an important therapeutic role in gynecologic malignancies. This is the first report of a pelvic abscess as a sequela of embolic treatment for bleeding cervical cancer in a patient simultaneously receiving radiotherapy. Other complications of transcatheter embolizationare reviewed. Methods of preventing complications when embolization and radiation are combined are discussed.

Hepatic metastases in gestational trophoblastic disease.

From 1975 to 1983, 195 patients were treated for persistent or metastatic gestational trophoblastic disease. Fifteen patients with liver metastases were analyzed. All were treated with chemotherapy alone, none received hepatic irradiation, and no patient bled from her hepatic metastases. Thus, the need for prophylactic hepatic irradiation to prevent hemorrhage is doubtful. The good results obtained in the studied patients emphasize the significance of using vigorous primary multiagent chemotherapy in high-risk gestational trophoblastic disease patients.

Postmenopausal uterine bleeding of nonorganic cause.

Eighty-nine patients with postmenopausal uterine bleeding were studied focusing on the nonorganic causes of bleeding. Atrophic endometrium was found in 82%, proliferative endometrium in 7%, and secretory endometrium in 1% of patients. Carcinoma was uncommon, found in only 7% of patients. Hysteroscopy was an invaluable adjunct to dilatation and curettage in diagnosing bleeding due to atrophic endometrium as 42% of such cases yielded no tissue on curettage. The clinical entity of bleeding atrophic endometrium is discussed.

Fine needle aspiration of para-aortic and pelvic lymph nodes showing lymphangiographic abnormalities.

Fifty-six fine needle aspirations of lymphangiographically abnormal pelvic and para-aortic lymph nodes were performed in 50 patients at The University of Michigan between January 1, 1977, and May 31, 1980. Fine needle aspiration was used both in the initial evaluation of patients with gynecologic malignancies and in the investigation of persistent and recurrent malignant disease. The overall diagnostic accuracy of fine needle aspiration was 74.0%. Fine needle aspiration yielded diagnostic cytologic specimens; it was safe and well tolerated, and in some instances it permitted the diagnosis of lymph node metastasis without laparotomy.

Multiple primary neoplasms of the ovary and uterus.

Multiple primary neoplasms arising in the ovary and uterus were analyzed in 55 patients: 49 synchronous and 6, metachronous. When they occurred synchronously, 74.5% of the ovarian carcinomas and 93.6% of the uterine carcinomas were stage I lesions. The endometrial carcinomas were invariably well differentiated and superficial. It was the stage of the ovarian carcinomas that determined the prognosis of these patients. Ways of their identification as separate neoplasms are discussed. The potential to develop further neoplasms in the gastrointestinal tract and breasts should be borne in mind.

Primary retroperitoneal sarcoma in the female pelvis. A report of three cases.

Retroperitoneal sarcoma can occur in the female pelvis and be confused with other pelvic masses. Its diagnosis depends on an awareness of its occurrence. Aggressive surgery to completely excise the tumor determines survival.

Exfoliative cytology in the evaluation of interferon treatment of cervical intraepithelial neoplasia.

Local interferon injection in four patients with cervical intraepithelial neoplasia (CIN) regularly elicited progressive regression of the lesions. The response was observed with exfoliative cytology after each injection, guided by colposcopic examination. The cytologic changes showed a cytocidal effect mainly on the dyskaryotic cells, preceded by cellular degeneration not unlike that of nonspecific inflammation and accompanied by an increase in neutrophil infiltration. The cytologic response was closely correlated with partial or complete clinical regression based on the absence of viable or degenerated dyskaryotic cells in the cervical smears. Three patients showed complete clinical regression after treatment. One patient showed recurrent viable dyskaryotic cells when the dosage was reduced, and treatment was suspended temporarily although her lesion had regressed completely after five injections. Clinical recurrence was noted one week after viable dyskaryotic cells reappeared in her smears. These observations suggest that cytology may be a useful means of monitoring interferon treatment in CIN.

High-dose cis-platinum in combination with adriamycin in the treatment of ovarian carcinoma.

Although promising potential of high dose cis-platinum in the treatment of ovarian carcinoma has been reported (6,7), a combination of adriamycin (60 mg/m2) and high dose cis-platinum (100 mg/m2) in 9 patients with advanced or recurrent ovarian carcinoma revealed no improved response compared to 13 patients receiving adriamycin (60 mg/m2) and cis-platinum (60 mg/m2). In addition to increased marrow toxicity, there is suggestion of synergism of cis-platinum to adriamycin cardiotoxicity. The efficacy of other agent/agents in combination with high dose cis-platinum should further be investigated.

Concurrent radiochemotherapy in the treatment of gynaecologic neoplasms.

Chemotherapy with adriamycin and/or cisplatinum in standard dosages concurrent with full radiation produced an accelerated local-regional tumour control leading to complete response in 12 of 14 patients who had advanced primary or recurrent gynaecologic neoplasms. The continuation of chemotherapy thereafter did not however prevent the development nor arrest progression of metastases outside the irradiated field. Epidermitis and myelosupression were the enhanced side effects but were tolerable and manageable. Radiochemotherapy can be applicable in situations where rapid shrinkage of the tumour bulk is required. Its other useful potentials deserve further evaluation.

Coexistent squamous cell carcinoma and adenocarcinoma of the uterine cervix.

The clinical and pathological features of 20 patients with coexistent squamous cell carcinoma and adenocarcinoma of the uterine cervix have been analyzed. Various combinations of in situ and invasive carcinomas were found. Located adjacent to each other and at times intermingling, these lesions probably originated from the subcolumnar reserve cells of the transformation zone. They are early lesions and may be precursors of adenosquamous and mucoepidermoid carcinomas of the cervix. The diagnosis of these double carcinomas depends upon being aware that the two entities may coexist in the same cervix. Treatment is conventional, and the prognosis is not worsened by the presence of the two types of neoplasms.

Modified Bagshawe's regimen in high-risk gestational trophoblastic disease.

Fifty patients with high-risk gestation trophoblastic disease received primary multiagent chemotherapy (CHAMOMA). Forty-one patients (82%) achieved sustained completed biochemical remission. The importance of recognizing the high-risk factors and the effectiveness of primary multiagent chemotherapy are demonstrated.

Primary oral etoposide therapy in gestational trophoblastic disease. An update.

Sixty patients who developed persistent or metastatic gestational trophoblastic disease (GTD) received primary oral etoposide therapy (VP 16-213). Twelve patients had metastatic GTD. Fifty-nine patients achieved biochemical remission. One patient had marked nausea and vomiting and the therapy was switched to a methotrexate/folinic acid regimen. Three patients developed relapse of GTD, giving a relapse rate of 5.1%. Etoposide is an active drug against choriocarcinoma. Its use should not be restricted to drug-resistant GTD.

Use of oral VP16-213 as primary chemotherapeutic agent in treatment of gestational trophoblastic disease.

Thirty-seven patients with persistent or metastatic gestational trophoblastic disease were treated with oral etoposide (VP16-213). All responded well and achieved permanent remission. The hematologic toxicity was mild. Alopecia was present in all patients. Etoposide is an effective drug against trophoblastic disease. In patients who have received chemotherapy for long periods oral etoposide would eliminate the problem of venous access.

The assessment of radio-response of cervical carcinoma by colposcopy.

Ninety-four patients with invasive carcinoma of the cervix were investigated for radio-response during treatment using colposcopy and serial biopsies. In 31 patients, the results were further correlated with pathological examination of the Wertheim hysterectomy specimen. It is established that colposcopy can be as reliable as biopsy in predicting radio-response and can be employed complementary to serial biopsies and clinical examinations. The colposcopic features of cervical carcinomas undergoing irradiation are described.

Cervical-vaginal bacterial flora in patients with cervical carcinoma treated with irradiation and febrile morbidity during intracavitary radium therapy.

The cervical-vaginal bacterial flora of 57 patients with invasive carcinoma of the cervix were found to be identical to those reported in studies of different population groups, except for a lower frequency of anaerobic bacteria. Radiation suppressed significantly both the aerobic and anaerobic bacteria. Following 4,000 rads of external irradiation, 47.4% of the cervical cultures were bacteriologically sterile. During the first and second radium treatment, 21% and 25.5% of the patients respectively developed fever of 38 degrees C or more, the cause of which could not definitely be established. The significance of fever during radium treatment is discussed.