Use of a leucocyte filter to remove tumour cells from intra-operative cell salvage blood.

SUMMARY: The intra-operative blood loss of 50 consecutive gynae-oncology patients undergoing surgery for endometrial, cervical or ovarian cancer was cell salvaged and filtered. In each case blood samples were taken from the effluent tumour vein, a central venous line, the cell saver reservoir, the cell salvage re-transfusion bag after processing but before filtration and from the cell salvage re-transfusion bag after processing and filtration. Samples were examined using immunohistochemical monoclonal antibody markers for epithelial cell lines. Viable, nucleated malignant cells were detected in 2/50 central venous samples, 34/50 reservoir samples and 31/50 unfiltered cell salvaged samples. After passage through a Pall RS leucocyte depletion filter no remaining viable, nucleated malignant cells were detected in any sample. The clinical risks of cell salvage in these circumstances should be reviewed in the light of the risks of allogeneic blood transfusion.

Exenterative pelvic surgery--eleven year experience of the Swansea Pelvic Oncology Group.

AIMS: To review indications for surgery and outcomes of patients with complex locally advanced pelvic malignancies treated by a multidisciplinary Pelvic Oncology Group. PATIENTS AND METHODS: Between March 1992 and March 2003, 130 patients were jointly assessed in a monthly clinic involving urological, gynaecological, colorectal and plastic surgeons, an oncologist and nurse specialists. Seventy-six patients proceeded to exenterative surgery. RESULTS: Rectal carcinoma and gynaecological cancers were the two most common indications for surgery. Median follow-up was 14 months (range 1-120 months). There were no deaths within 30 days of surgery. The morbidity rate was 28%. Predicted 5 years survival was 53% in cases with clear histological margins and no lymph node metastasis. CONCLUSION: With careful patient selection and multi specialty care pelvic exenteration is a safe and effective option in the treatment of complex locally advanced pelvic malignancy.

Inhibin is more specific than calretinin as an immunohistochemical marker for differentiating sarcomatoid granulosa cell tumour of the ovary from other spindle cell neoplasms.

AIMS: To describe a case of recurrent sarcomatoid adult granulosa cell tumour (AGCT) of the ovary and to evaluate the usefulness of two ovarian sex cord stromal markers (inhibin and calretinin) in separating sarcomatoid AGCT from true sarcomas. METHODS: A 72 year old woman presented with a recurrent sarcomatoid AGCT in the sigmoid colon mesentery, which histologically mimicked a malignant gastrointestinal stromal tumour (GIST). This index case and 79 sarcomas (32 GISTs, 28 leiomyosarcomas, 15 endometrial stromal sarcomas (ESSs), including one with sex cord-like areas, and four undifferentiated uterine sarcomas) were immunostained using antibodies to inhibin and calretinin. RESULTS: The recurrent sarcomatoid AGCT expressed diffuse, strong cytoplasmic immunoreactivity with inhibin and focal but strong nuclear and cytoplasmic positivity with calretinin. Focal, weak cytoplasmic inhibin expression limited to sex cord-like areas was present in one ESS. None of the other sarcomas expressed inhibin. Focal, strong calretinin immunoreactivity was identified in 11 leiomyosarcomas and one GIST. The case of ESS with sex cord-like areas showed strong immunoreactivity for calretinin limited to the sex cord-like areas. CONCLUSIONS: Inhibin is a useful immunomarker to distinguish sarcomatoid AGCT from other spindle cell neoplasms that may enter into the differential diagnosis. Calretinin appears to be less specific than inhibin.

Clinical experience with cell salvage in obstetrics: 4 cases from one UK centre.

We present 4 cases in which cell salvaged blood was used in maternity patients, including three caesarean sections and one post-partum haemorrhage. All patients were monitored for a minimum of 24 h on either a general Intensive Care Unit (ICU) or specialised obstetric High Dependency Unit (HDU). Postoperative complications are discussed, with particular emphasis on whether the transfusion of cell salvaged blood was a contributory factor. Cell salvage in obstetrics is being used in a haphazard and individual manner and our only present outcome indicators are case reports. We consider the argument for and against cell salvage in obstetrics, and suggest guidelines to reflect current best practice in the use of the machine and filters.

Is tamoxifen associated with high-risk endometrial carcinomas? A retrospective case series of 196 women with endometrial cancer.

Tamoxifen therapy is associated with an increased risk of endometrial cancer. There is controversy regarding the incidence of high-grade endometrial malignancies associated with tamoxifen therapy. This retrospective study assesses pathological features of endometrial malignancy in patients with and without a history of tamoxifen therapy. This is a retrospective case analysis from a district general hospital. The cases were identified from the pathology database and the medical notes reviewed. The period of the study was January 1994 to December 2001. One hundred and ninety six women with endometrial cancer were identified. 20 patients had a history of breast cancer being treated with adjuvant tamoxifen therapy and developed subsequently endometrial cancer. The histology in women who had not taken tamoxifen showed: adenocarcinoma (97.1%), 1.7% had mixed mullerian tumour. Women in the tamoxifen-treated group had: adenocarcinoma (85%), sarcoma (5%), mixed mullerian tumour (5%). In this study the tamoxifen-treated group of patients developed endometrial malignancies with a higher incidence of poor prognostic malignancies (p = 0.01). Further research is needed to analyse the precise tumour types and pathophysiology.

A comparative study of the assessment of cervical intraepithelial neoplasia in women having large loop excision of the transformation zone.

Findings on Papanicolaou (Pap) smear and colposcopically directed punch biopsy show discrepancies when compared with findings on loop excision specimens and this situation creates management problems. We performed a comparative assessment of cervical intraepithelial neoplasia (CIN) in 100 consecutive women who had large loop excision of the transformation zone (LLETZ) with a view to developing a local protocol that would be safe, avoid delay and minimise over-treatment. Agreement between Pap smear and LLETZ was 62% with 21% overcall and 17% undercall at Pap smear; there was no significant correlation (Spearman's rank correlation coefficient 0.17 P > 0.05). The agreement between punch biopsy and LLETZ was 61% with 25% overcall and 15% undercall at punch biopsy; there was a slight agreement over chance (kappa=0.20) and there was a weak but significant correlation (Spearman's rank correlation coefficient=0.26; P = 0.047). Colposcopic impression of 'highly abnormal'lesions agreed with high grade lesions on LLETZ in 83% of cases. The problem of undercall suggests that defaulters with apparent low grade dyskaryosis need to be pursued to colposcopy as vigorously as defaulters with high grade dyskaryosis. The lack of significant correlation between cervical cytology and LLETZ finding suggests that the smear-to-colposcopy waiting interval should not be strictly based on the degree of dyskaryosis.

Omentopexy for reconstruction of the perineum following a radical vulvectomy: a case report.

Colorectal surgeons have used omentum based on the left gastric epiploic vessels after any major operation in the pelvis(1). Omental flaps reach very well into the pelvis by the retrocolic route and have been used in the past for better and quicker healing of perineal defects following abdominoperineal resections(2,3). Omentum has excellent healing properties, which can be, used even as free flaps(4).