RESUMO
OBJECTIVE: Determine the utility of a clinical calculator to predict the benefit of chemotherapy in stage IA uterine papillary serous cancer (UPSC). PATIENTS AND METHODS: Data were collected from NCDB from years 2010-2014. Based on demographic and surgical characteristics, a clinical score was developed using the random survival forest machine learning algorithm. RESULTS: Of 1,751 patients with stage IA UPSC, 1,012 (58%) received chemotherapy and 739 (42%) did not. Older age (HR 1.06), comorbidities (HR 1.31), larger tumor size (HR 1.27), lymphovascular invasion (HR 1.86), positive peritoneal cytology (HR 2.62), no pelvic lymph node dissection (HR 1.51), and no chemotherapy (HR 2.16) were associated with poorer prognosis. Compared to no chemotherapy, patients who underwent chemotherapy had a 5-year overall survival of 80% vs. 67%. To better delineate those who may derive more benefit from chemotherapy, we designed a clinical calculator capable of dividing patients into low, moderate, and high-risk groups with associated 5-year OS of 86%, 73%, and 53%, respectively. Using the calculator to assess the relative benefit of chemotherapy in each risk group, chemotherapy improved the 5-year OS in the high (42% to 64%; p < 0.001) and moderate risk group (66% to 79%; p < 0.001) but did not benefit the low risk group (84% to 87%; p = 0.29). CONCLUSION: Our results suggest a clinical calculator is useful for counseling and personalizing chemotherapy for stage IA UPSC.
Assuntos
Algoritmos , Cistadenocarcinoma Papilar/tratamento farmacológico , Cistadenocarcinoma Seroso/tratamento farmacológico , Aprendizado de Máquina , Neoplasias Uterinas/tratamento farmacológico , Idoso , Cistadenocarcinoma Papilar/patologia , Cistadenocarcinoma Papilar/cirurgia , Cistadenocarcinoma Seroso/patologia , Cistadenocarcinoma Seroso/cirurgia , Feminino , Humanos , Estadiamento de Neoplasias , Nomogramas , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgiaRESUMO
PURPOSE: To evaluate oral topotecan as single-agent, second-line therapy in patients with ovarian cancer previously treated with a platinum-based regimen. PATIENTS AND METHODS: Patients (N = 116) received oral topotecan 2.3 mg/m2 daily for 5 days every 21 days. Eligibility criteria included histologic diagnosis of International Federation of Gynecology and Obstetrics stage III or IV epithelial ovarian cancer, bidimensionally measurable disease, prior platinum-containing chemotherapy, age > or = 18 years, performance status < or = 2, and life expectancy > or = 12 weeks. RESULTS: Overall response rate was 21.6% (25 of 116 patients). Median duration of response was 25.0 weeks; median time to response was 8.4 weeks. Median time to progression was 14.1 weeks; median survival was 62.2 weeks. Grade 4 neutropenia was experienced by 50.4% of patients in 13.4% of courses administered. Grade 4 thrombocytopenia was experienced by 22.1% of patients in 5.1% of courses. Grade 3 or 4 anemia was experienced by 29.2% of patients in 8.5% of courses. Most frequent nonhematologic toxicities were predominantly (> 90%) grade 1 or 2 and included nausea, alopecia, diarrhea, and vomiting. CONCLUSION: Second-line oral topotecan administered at 2.3 mg/m2 for 5 days every 21 days demonstrated activity in patients with progressive or recurrent ovarian cancer after first-line platinum-based chemotherapy. This activity was comparable to that seen in previous studies with intravenous topotecan. Grade 4 neutropenia was less frequent with oral topotecan than previously reported for intravenous topotecan. Oral topotecan is an active, tolerable, and convenient formulation of an established agent for the second-line treatment of advanced epithelial ovarian cancer and may also facilitate exploring prolonged treatment schedules.
Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Ovarianas/tratamento farmacológico , Topotecan/uso terapêutico , Administração Oral , Adulto , Idoso , Antineoplásicos/efeitos adversos , Resistencia a Medicamentos Antineoplásicos , Feminino , Doenças Hematológicas/induzido quimicamente , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Compostos Organoplatínicos/uso terapêutico , Neoplasias Ovarianas/patologia , Taxa de Sobrevida , Topotecan/efeitos adversosRESUMO
PURPOSE: To characterize mRNA expression and protein production of the cytokine MGSA/gro in human retinal pigment epithelial (RPE) cells and to determine whether expression of MGSA/gro is modulated by serum and the cytokines interleukin 1 beta (IL-1 beta), tumor necrosis factor alpha (TNF alpha), or transforming growth factor beta (TGF beta) mediators implicated in proliferative vitreoretinopathy (PVR). METHODS: Reverse-transcription polymerase chain reaction was used to determine the steady-state mRNA expression of three forms of MGSA/gro, alpha, beta, and gamma, by cultured human RPE cells in the presence or absence of recombinant IL-1 beta, TNF alpha, or TGF beta, or when serum-starved cells were re-fed with medium containing serum. Immunocytochemistry was used to characterize RPE cell-associated MGSA/gro protein, and immunoprecipitation of MGSA/gro from cell-conditioned medium was used to demonstrate MGSA/gro secretion. RESULTS: MGSA/gro mRNA was expressed minimally under basal conditions. Expression for all three forms of MGSA/gro mRNA was induced in a dose- and time-dependent manner after exposure to IL-1 beta, to a lesser extent after exposure to TNF alpha, but not after exposure to TGF beta. Serum induced MGSA/gro alpha and gamma transcripts, but not beta transcripts. Cell-associated MGSA/gro was identified on RPE cells grown in the absence of cytokines, but MGSA/gro was not secreted under these conditions. Exposure to IL-1 beta did not consistently cause increased cell-associated MGSA/gro; however, IL-1 beta induced secretion of MGSA/gro in a time-dependent manner. CONCLUSION: MGSA/gro is produced by human RPE in response to mediators implicated in PVR. Because MGSA/gro is a pleiotropic modulator of cell proliferation and inflammation, it may contribute to the intraocular wound healing response that characterizes PVR.
Assuntos
Quimiocinas CXC , Fatores Quimiotáticos/metabolismo , Substâncias de Crescimento/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular , Proteínas de Neoplasias/metabolismo , Epitélio Pigmentado Ocular/metabolismo , Proteínas Sanguíneas/farmacologia , Células Cultivadas , Quimiocina CXCL1 , Fatores Quimiotáticos/genética , Citocinas/farmacologia , Eletroforese em Gel de Poliacrilamida , Regulação da Expressão Gênica/efeitos dos fármacos , Substâncias de Crescimento/genética , Humanos , Técnicas Imunoenzimáticas , Proteínas de Neoplasias/genética , Reação em Cadeia da Polimerase , RNA Mensageiro/metabolismo , Proteínas Recombinantes/farmacologiaRESUMO
Tubal metaplasia is a benign endocervical lesion. There may be confusion, however, in distinguishing tubal metaplasia from endocervical gland dysplasia on Papanicolaou smear. We present a case in which a cervical smear diagnosis initially reported as endocervical atypia was corrected to a diagnosis of tubal metaplasia upon cytologic review, thus altering patient management. The presence of terminal bars and cilia are the most helpful features in the cytologic recognition of tubal metaplasia. The evaluation of endocervical gland dysplasia suggested by Papanicolaou smear may include diagnostic conization; therefore, to prevent unnecessary intervention, it is important to distinguish endocervical gland dysplasia from tubal metaplasia.
Assuntos
Tubas Uterinas/citologia , Teste de Papanicolaou , Displasia do Colo do Útero/patologia , Esfregaço Vaginal/normas , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Metaplasia , Displasia do Colo do Útero/classificação , Displasia do Colo do Útero/diagnósticoRESUMO
OBJECTIVE: To understand growth regulation of the endometrium by studying the effect of interleukin-1 beta (IL-1) on human endometrial stromal cell proliferation in vitro. METHODS: Endometrial stromal cells from human endometrium were separated and purified and placed in culture. Fresh and first- and sixth-passage cells were incubated with IL-1 (0.025, 0.25, and 2.5 ng/mL) for 24, 48, and 72 hours, respectively. Proliferation as a function of DNA synthesis was assessed by measuring 3H-thymidine incorporation. Experiments were then repeated in the presence of indomethacin to determine whether IL-1 effects were dependent upon prostaglandin synthesis. We evaluated overall growth by adding IL-1 to cell cultures of sixth-passage stromal cells every 3 days and by performing cell count studies. RESULTS: Interleukin-1 beta significantly inhibited 3H-thymidine uptake in freshly explanted endometrial stromal cells at all doses in a dose-dependent manner; a 44% inhibition was seen at 2.5 ng/mL IL-1 after 72 hours of incubation. In first- and sixth-passage cells, 3H-thymidine uptake was inhibited only at intermediate and high doses of IL-1. Cell count studies showed that sixth-passage cells were significantly inhibited by IL-1 after 23 days of growth (22%; P less than .01). Adding indomethacin did not affect inhibition of growth. CONCLUSION: Interleukin-1 beta inhibits growth of normal human endometrial stromal cells in vitro and does not appear to be mediated by arachidonic acid metabolites. This inhibition of growth may be important for maintenance of a normal endometrial phenotype.
Assuntos
Endométrio/efeitos dos fármacos , Interleucina-1/fisiologia , Divisão Celular/efeitos dos fármacos , Células Cultivadas , DNA/biossíntese , Endométrio/citologia , Feminino , Humanos , Indometacina/farmacologia , Interleucina-1/farmacologia , Timidina/metabolismo , TrítioRESUMO
OBJECTIVE: To determine if an elevated score on the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is associated with mortality of acutely ill gynecologic oncology patients. METHODS: Gynecologic oncology patients admitted to the surgical intensive care unit (ICU) were identified from the ICU data base. Their admission APACHE II score and type of gynecologic cancer were also extracted from the data base. Charts were reviewed to determine the disease status and reason for admission to the surgical ICU. Patient mortality was correlated with APACHE II scores. RESULTS: Forty-five gynecologic oncology patients were admitted to the surgical ICU from June 1988 to January 1992. They had a mean age of 62 years and various cancers: ovarian (24), cervical (16), and endometrial (five). The mean APACHE II score was 12 (range 2-26). Eight of 45 (18%) patients died. There was a significant correlation between APACHE II scores and mortality; patients with an APACHE II score of 20 or greater had a 78% risk of death compared to a 3% risk if the score was less than 20 (P < .001, chi 2 test). CONCLUSION: Elevated APACHE II scores are associated with mortality in acutely ill gynecologic oncology patients.
Assuntos
APACHE , Neoplasias do Endométrio/mortalidade , Mortalidade Hospitalar , Neoplasias Ovarianas/mortalidade , Neoplasias do Colo do Útero/mortalidade , Adulto , Idoso , Estado Terminal , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Pessoa de Meia-Idade , Neoplasias Ovarianas/cirurgia , Período Pós-Operatório , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Neoplasias do Colo do Útero/cirurgiaRESUMO
OBJECTIVE: To determine whether acetic acid visualization of the cervix can identify cervical dysplasia and improve detection of lesions missed by Papanicolaou test screening. METHODS: During a 2-year period, patients attending family planning clinics for regular gynecologic examinations had acetic acid applied to the cervix, followed by gross visualization without magnification. Patients with suspicious acetowhite lesions and normal Papanicolaou tests were referred for colposcopic evaluation. Findings from these examinations and corresponding biopsy results were analyzed retrospectively. RESULTS: Eighty-five women were referred for colposcopy because of abnormal acetowhite areas on the cervix. Thirteen patients (15%) had cervical intraepithelial neoplasia (CIN) (nine CIN I, four CIN II), 22 (26%) had koilocytosis, and 16 (19%) had benign histologic findings. In total, 51 patients had suspicious lesions at colposcopy for which biopsies were performed, and 34 (40%) had normal colposcopic examinations. CONCLUSIONS: Acetic acid visualization of the cervix can detect dysplasia otherwise missed by Papanicolaou test screening. However, further refinements in technique are required to decrease false-positive findings and unnecessary referrals for colposcopy.
Assuntos
Acetatos , Colo do Útero/patologia , Displasia do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Ácido Acético , Adulto , Colposcopia , Feminino , Humanos , Programas de Rastreamento/métodos , Teste de Papanicolaou , Estudos Retrospectivos , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço VaginalRESUMO
OBJECTIVE: To determine the impact of margin status on disease recurrence and the incidence of occult cancer in women diagnosed with vulvar intraepithelial neoplasia (VIN) III and treated with surgical excision. METHODS: Between 1989 and 1995, 73 women were diagnosed preoperatively with VIN III by vulvar biopsy and were treated with surgical resection. Patients were examined postoperatively, and recurrence was diagnosed when a biopsy of suspicious lesions confirmed VIN III. RESULTS: The mean age was 45 years; 81% of the patients were white, and 18% were black. Eighty-two percent of the women had used tobacco, 56% had prior cervical dysplasia, and 37% had prior genital warts. An underlying squamous vulvar cancer was found in 22% of patients at initial treatment for VIN III. Fifty-nine women had follow-up of at least 7 months. Of these, 66% (39 of 59) had positive surgical margins, 31% (18 of 59) had negative margins and 3% had unknown margins (two of 59). With positive margins, 46% (18 of 39) suffered recurrent disease; with negative margins, only 17% (three of 18) had recurrent disease (P = .03). Multifocal disease and a history of genital warts also correlated with VIN III recurrence (P = .03 for both). CONCLUSION: A significant number of women diagnosed initially with VIN III on a vulvar biopsy harbored occult vulvar cancer. Recurrences were almost threefold higher when margins were positive for residual VIN III. We conclude that surgical resection is an appropriate method of treatment of VIN III for both diagnostic and therapeutic purposes.
Assuntos
Carcinoma in Situ/patologia , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Vulvares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma in Situ/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Vulvares/cirurgiaRESUMO
From October 1995 to March 1997, a phase II trial of topotecan was carried out in chemotherapy-naive women with advanced, persistent, or recurrent uterine leiomyosarcomas. Thirty-six patients were entered. Median age was 53 years. Performance status was 0 (50%) in 18, 1 (36%) in 13, and 2 (14%) in 5. Most patients, 33 (92%), had undergone prior surgery, and 8 (22%) prior radiation therapy. Topotecan, 1.5 mg/m2. was administered intravenously daily for 5 days, every 3 weeks, until progression of disease or adverse affects prohibited further therapy. Patients received 1 to 13 courses with a median of 3 courses. The most frequent grade 4 adverse effects were neutropenia in 28 (78%), leukopenia in 8 (22%), thrombocytopenia in 3 (8%), and anemia in 3 (8%). Complete response was seen in 1 (3%), partial response in 3 (8%), stable disease in 12 (33%), and increasing tumor in 20 (56%). Thus topotecan at this dose and schedule does not appear to have major activity in uterine leiomyosarcomas.
Assuntos
Antineoplásicos/uso terapêutico , Leiomiossarcoma/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Topotecan/uso terapêutico , Neoplasias Uterinas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia/induzido quimicamente , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Estudos de Coortes , Progressão da Doença , Esquema de Medicação , Feminino , Humanos , Injeções Intravenosas , Leucopenia/induzido quimicamente , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neutropenia/induzido quimicamente , Indução de Remissão , Trombocitopenia/induzido quimicamente , Topotecan/administração & dosagem , Topotecan/efeitos adversosRESUMO
Acute fatty liver of pregnancy is associated with complications that can influence antepartum management and necessitate delivery. To date, liver biopsy has been regarded as the "gold standard" for diagnosis. Radiologic evaluation of the liver has been suggested as a less invasive means of diagnosing this entity. Five patients with acute fatty liver of pregnancy underwent ultrasonography; three underwent concomitant computed tomography (CT) of the liver. The liver appeared to be normal in all the patients undergoing CT evaluation and all undergoing ultrasonography except one. Normal liver examinations are not unusual findings in patients with acute fatty liver of pregnancy.
Assuntos
Fígado Gorduroso/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Tomografia Computadorizada por Raios X/normas , Biópsia , Diagnóstico Diferencial , Estudos de Avaliação como Assunto , Fígado Gorduroso/patologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/patologia , UltrassonografiaRESUMO
Five percent 5-fluorouracil (5-FU), an antineoplastic agent, is often applied to the lower genital tract in the treatment of vaginal and vulvar human papillomavirus infections. Little is known regarding possible teratogenic effects from its topical use in pregnancy. Five cases of antenatal lower genital tract 5-FU use were correlated with pregnancy outcome. Topical 5-FU was applied up to 16 weeks' gestation. Intravaginal doses ranged from 1 to 2.5 g; one patient applied 5-FU to the vulva. Antenatal ultrasound performed on four patients did not show any fetal structural abnormalities. One patient underwent antenatal genetic amniocentesis that detected a 47,XXX complement of chromosomes. All the pregnancies continued without complications and with subsequent term delivery of healthy infants. The unwitting vaginal and vulvar use of 5-FU in pregnancy did not result in significant morbidity or mortality; expectant management of such pregnancies should be considered.
Assuntos
Fluoruracila/efeitos adversos , Doenças dos Genitais Femininos/tratamento farmacológico , Papillomaviridae , Complicações Infecciosas na Gravidez/tratamento farmacológico , Resultado da Gravidez , Infecções Tumorais por Vírus/tratamento farmacológico , Anormalidades Induzidas por Medicamentos/diagnóstico , Anormalidades Induzidas por Medicamentos/epidemiologia , Administração Intravaginal , Adolescente , Adulto , Feminino , Fluoruracila/administração & dosagem , Idade Gestacional , Hospitais Universitários , Humanos , Michigan/epidemiologia , Gravidez , Diagnóstico Pré-Natal , Wisconsin/epidemiologiaAssuntos
Técnicas de Apoio para a Decisão , Neoplasias Ovarianas/tratamento farmacológico , Educação de Pacientes como Assunto/métodos , Participação do Paciente/métodos , Preferência do Paciente , Idoso , Vias de Administração de Medicamentos , Feminino , Nível de Saúde , Humanos , Saúde Mental , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Medidas de Resultados Relatados pelo Paciente , Assistência Centrada no Paciente , Qualidade de Vida , Fatores SocioeconômicosRESUMO
Two patients at 22 weeks' gestation underwent extensive cervical dilation with laminaria tents for elective abortion but continued their pregnancies instead. Both had normal deliveries. For the unusual patient who chooses not to carry out an abortion initiated with cervical dilation, successful pregnancy is possible and therapeutic intervention such as cervical cerclage seems inadvisable.
PIP: 2 patients at 22 weeks' gestation underwent extensive cervical dilation with laminaria tents for elective abortion but continued their pregnancies instead. Case 1 was 23 years old, gravida, 4, para, 1, elective abortions 2. She was a heroin addict. 12 laminaria tents were inserted over 2 days, and were apparently expelled on the 3rd day, with no effect on the pregnancy. After 37 weeks' gestation without prenatal care, she gave birth to a healthy 2790g female with Apgar scores of 8 and 8, and with no labor or postpartum complications. Case 2 was 27 years old, gravida 6, para 3, spontaneous abortions 2. She desired termination because of her home situation, and had 17 small tents placed over 2 days, but on the day of the scheduled abortion, she changed her mind. The tents were removed, and she was given oral erythromycin. At 40 weeks' gestation, she was spontaneously delivered of a 3080g male with Apgar scores 9 and 9. In both patients, the cervical dilation of 2-3cm, normally worrisome at this gestation, returned to normal within 1 week. For the unusual patient who chooses not to carry out an abortion initiated with cervical dilation, successful pregnancy is possible. Therapeutic intervention such as cervical cerclage seems inadvisable. Antibiotic treatment and referral for prenatal care seems the best course, and patients should be warned about the possibility of amniotitis and premature labor.
Assuntos
Aborto Induzido/métodos , Laminaria , Gravidez , Alga Marinha , Adulto , Dilatação , Feminino , HumanosRESUMO
Pelvic exenteration is one of the most radical procedures in the repertoire of gynecologic oncology procedures. Postoperative complications include sepsis, hemorrhage, formation of adhesions resulting in bowel obstruction, and fistulas resulting from large denuded pelvic surfaces. To date there is no clear consensus as to the best way to cover the pelvis after the destructive phase of an exenteration. Herein, we present a different approach to pelvic coverage by placement of a 300 cc saline breast implant. Use of a saline-filled breast implant to fill the pelvis represents a possible approach to addressing the denuded pelvic space created during extensive gynecologic surgery.
Assuntos
Implantes de Mama , Exenteração Pélvica/métodos , Cloreto de Sódio , Adulto , Idoso , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Feminino , Neoplasias dos Genitais Femininos/cirurgia , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/prevenção & controle , Exenteração Pélvica/efeitos adversos , Diafragma da PelveRESUMO
In the United States, endometrial carcinoma is the most common gynecologic malignancy, and accounts for 4,900 deaths per year in the United States. While this disease has relatively good cure rates, there is motivation to describe other determinants, which may help in the treatment of this disease. Attempts have been made to correlate hormone receptor status with disease-free intervals and survival in patients with endometrial carcinoma. The weight of evidence seems to support that of the two hormone receptors, progesterone is the more significant predictor of patient outcome. If hormone receptors are to be used in the management of endometrial carcinoma, they should be determined by immunohistochemistry. In the adjuvant setting, patients with progesterone positive tumors are more amenable to treatment with progestational agents than are patients with receptor negative tumors. Future areas of research include the use of tamoxifen and selective estrogen receptor modulators in the chemoprevention and treatment of endometrial carcinoma.
RESUMO
Eighteen women with abnormal cervical cytologic findings and unsatisfactory colposcopic examinations underwent cervical dilatation with Dilapan (Gynotech), a hygroscopic dilator. Dilatation exposed the entire squamocolumnar junction, converting an unsatisfactory colposcopic examination into a satisfactory one and avoiding cervical conization in 17 of the patients.
Assuntos
Biópsia/métodos , Colo do Útero/patologia , Colposcopia/métodos , Dilatação/instrumentação , Colposcópios , Colposcopia/efeitos adversos , Falha de Equipamento , Feminino , HumanosRESUMO
Uterine serous carcinoma (USC) has a propensity for extrauterine spread, and some suggest that this disease be staged as an ovarian cancer, and thus include omental sampling. However, given the primary organ involved, the staging recommendations do not include omental sampling. The aim of this study is to evaluate the role of omental sampling during the surgical staging of USC. We retrospectively identified cases of USC at our institution from January 1990 to June 2000 and abstracted surgical procedures, stage, and sites of metastasis. Fisher's exact test was used to calculate sensitivity, specificity, and positive and negative predictive value. We identified 65 women with USC, of which 52 underwent omental evaluation. Thirty four of the omentums were visually normal and benign on histologic review. Two were visually negative and histologically positive for metastatic serous carcinoma. The remaining 16 specimens were grossly involved with histologic confirmation of disease. The sensitivity of a visually negative omentum is 0.89 (P < 0.0001). Microscopic omental metastasis from USC is rare. When the omentum is involved, thereby upstaging the patient to stage IVB disease, the disease is generally diagnosed by gross visualization. We conclude that omental sampling does not need to be included in the routine surgical staging of USC.
Assuntos
Cistadenocarcinoma Papilar/secundário , Omento/patologia , Neoplasias Peritoneais/diagnóstico , Neoplasias Uterinas/patologia , Idoso , Idoso de 80 Anos ou mais , Cistadenocarcinoma Papilar/cirurgia , Feminino , Humanos , Prontuários Médicos , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , North Carolina/epidemiologia , Omento/cirurgia , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/cirurgia , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias Uterinas/cirurgiaRESUMO
Management of advanced-stage uterine serous carcinoma (USC) is uncertain, and postsurgical therapeutic options swing between radiation and chemotherapy. The aim of this study is to evaluate the utility of radiotherapy compared to platinum-based chemotherapy in women with advanced-stage USC. We retrospectively identified cases of USC at our institution. Survival distributions were calculated by the Kaplan-Meier method. Two-tailed t-tests were used to compare time to progression and time to death. We identified 24 women diagnosed with either stage III or IV USC. Time to progression for women receiving radiotherapy was 5.3 months as compared with 12.4 months for women receiving chemotherapy (P = 0.01). Mean time to death for the radiotherapy group was 8 months compared to 18 months in the chemotherapy group (P = 0.04). Kaplan-Meier survival curves were significantly different between the two groups (P = 0.01). While radiotherapy appears to control USC recurrences in the pelvis, the disease often recurs distantly. When compared to radiotherapy, platinum-based chemotherapy appears to increase disease-free survival and time to death in women with advanced-stage USC.
Assuntos
Cistadenocarcinoma Seroso/terapia , Recidiva Local de Neoplasia/terapia , Neoplasias Uterinas/terapia , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Cistadenocarcinoma Seroso/mortalidade , Cistadenocarcinoma Seroso/patologia , Intervalo Livre de Doença , Feminino , Humanos , Prontuários Médicos , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , North Carolina/epidemiologia , Estudos Retrospectivos , Análise de Sobrevida , Neoplasias Uterinas/mortalidade , Neoplasias Uterinas/patologiaRESUMO
A mutation in codon 12 of the H-ras oncogene has been implicated in the pathogenesis of cervical cancer. To determine if mutational activation of H-ras is an early event in carcinogenesis, we looked for the presence of codon 12 H-ras mutation in precancerous cervical dysplasia. We analyzed cervical DNA from 63 normal patients and 72 patients with biopsy-proven cervical dysplasia [CIN I (48), CIN II (9), CIN III (15)]. HPV typing was performed on these samples by Viratype and analysis and polymerase chain reaction (PCR). To detect H-ras codon 12 mutation, DNA was isolated and amplified by PCR with primers for H-ras. A unique restriction site for MspI contained within the wild-type ras PCR product allows discrimination between unmutated and mutated sequences. Restriction enzyme analysis with MspI was performed on PCR products to distinguish between wild-type and mutated sequences. HPV 16 or 18 was present in 33% of CIN I, 56% of CIN II, and all CIN III samples. No codon 12 mutations were detected in any sample. We conclude that while HPV is associated with cervical dysplasia and its prevalence increases in more advanced lesions, it is unlikely that H-ras codon 12 mutations are an early occurrence in the progression of precancerous lesions to cervical carcinoma.
Assuntos
Códon , Genes ras , Mutação , Displasia do Colo do Útero/genética , Cocarcinogênese , DNA de Neoplasias/genética , Feminino , Humanos , Papillomaviridae/patogenicidade , Reação em Cadeia da Polimerase , Neoplasias do Colo do Útero/etiologiaRESUMO
Pulmonary effusions associated with ovarian cancer indicate advanced disease. Although many patients tolerate these effusions, some are symptomatic and manifest respiratory distress. Therapeutic sclerosis of the pleural cavity is successful in some patients; however, not all patients are relieved of respiratory symptoms. We present two symptomatic patients in whom sclerosis was unsuccessful or not an option; their respiratory symptoms were relieved with placement of pigtail catheter chest tubes that allowed discharge from the hospital and management at home. Catheters were easy to manage at home and there were no infectious complications.