Synchronous of breast and vulvar Paget's disease: a case report.

BACKGROUND: Synchronous Paget's disease of breast and vulva is extremely rare and has only been reported in the literature in one other case. CASE: A 58-year-old postmenopausal woman was found to have crusting, bleeding, and discharge from left nipple, as well as vulvar pruritis at the same time. Biopsy of breast lesion demonstrated Paget's disease with an underlying foci of ductal carcinoma in-situ that required total mastectomy of left breast with sentinel node biopsy and breast reconstruction. For vulvar symptoms, the patient was initially diagnosed with dermatitis and topical ointment was prescribed. However, her symptoms persisted for the next several months, and she underwent vulvar biopsy that demonstrated Paget's disease. She underwent partial vulvectomy. Multiple episodes of recurrent vulvar Paget's disease were noted in the postoperative course that medical therapy with Imiquimod and a second partial vulvectomy was performed. CONCLUSION: Synchronous of breast and vulvar Paget's disease is presented. There was a delay in diagnosing vulvar Paget's disease in this experienced case. While coincidence of breast and vulvar Paget's disease is likely, ectopic mammary tissue in vulvar as well as secondary metastasis from a focal lesion of breast Paget's disease needs to be carefully evaluated whenever the patient complains of vulvar symptoms in the setting of breast Paget's disease.

Contemporary management of ovarian cancer.

Major advances in treatment for epithelial ovarian cancer have occurred over the last decade, giving hope to patients and families. Surgery remains a cornerstone of therapy. In early-stage epithelial ovarian cancer, a meticulous staging procedure should be performed to aid in determining patients who require appropriate adjuvant therapy and patients who can be monitored. The patient with advanced epithelial ovarian cancer significantly benefits from aggressive cytoreductive surgery and chemotherapy, affording the patient higher rates of complete response and partial response. In the new millenium, new therapeutic modalities should enhance the current response rates.

Large-scale serial analysis of gene expression reveals genes differentially expressed in ovarian cancer.

Difficulties in the detection, diagnosis, and treatment of ovarian cancer result in an overall low survival rate of women with this disease. A better understanding of the pathways involved in ovarian tumorigenesis will likely provide new targets for early and effective intervention. Here, we have used serial analysis of gene expression (SAGE) to generate global gene expression profiles from various ovarian cell lines and tissues, including primary cancers, ovarian surface epithelia cells, and cystadenoma cells. The profiles were used to compare overall patterns of gene expression and to identify differentially expressed genes. We have sequenced a total of 385,000 tags, yielding >56,000 genes expressed in 10 different libraries derived from ovarian tissues. In general, ovarian cancer cell lines showed relatively high levels of similarity to libraries from other cancer cell lines, regardless of the tissue of origin (ovarian or colon), indicating that these lines had lost many of their tissue-specific expression patterns. In contrast, immortalized ovarian surface epithelia and ovarian cystadenoma cells showed much higher similarity to primary ovarian carcinomas than to primary colon carcinomas. Primary tissue specimens therefore appeared to be a better model for gene expression analyses. Using the expression profiles described above and stringent selection criteria, we have identified a number of genes highly differentially expressed between nontransformed ovarian epithelia and ovarian carcinomas. Some of the genes identified are already known to be overexpressed in ovarian cancer, but several represent novel candidates. Many of the genes up-regulated in ovarian cancer represent surface or secreted proteins such as claudin-3 and -4, HE4, mucin-1, epithelial cellular adhesion molecule, and mesothelin. Interestingly, both apolipoprotein E (ApoE) and ApoJ, two proteins involved in lipid homeostasis, are among the genes highly up-regulated in ovarian cancer. Selected serial analysis of gene expression results were further validated through immunohistochemical analysis of ApoJ, claudin-3, claudin-4, and epithelial cellular adhesion molecule in archival material. These experiments provided additional evidence of the relevance of our findings in vivo. The publicly available expression data reported here should stimulate and aid further research in the field of ovarian cancer.

Cavitational ultrasonic surgical aspiration for the treatment of vaginal intraepithelial neoplasia.

OBJECTIVE: The aim of this study is to determine whether cavitational ultrasonic surgical aspiration (CUSA) is effective and safe for treating vaginal intraepithelial neoplasia (VAIN). METHODS: We conducted a retrospective chart review of 46 patients who were treated with CUSA for VAIN in a single gynecologic oncology practice between 1981 and 1999. RESULTS: At initial presentation, 39% of treated patients had grade I VAIN, 20% had grade II, and 41% had grade III. The mean duration of follow-up from initial CUSA treatment was 21 months. Twenty-nine patients (63%) were initially treated with CUSA, 7 patients (15%) with laser vaporization, 7 patients (15%) with surveillance by Papanicolaou smear, 1 patient (2%) with partial vaginectomy, 1 patient (2%) with 5-fluorouracil, and 1 patient (2%) with loop excision. Patients initially treated with CUSA had a higher percentage of grade III VAIN at diagnosis (48%) than did patients initially treated with other methods (29%). A significantly greater proportion of patients initially treated with CUSA had no recurrence of VAIN (66%) compared with patients initially treated with other methods (0%) (P < 0.0001). A significantly greater proportion of patients who were treated for recurrent disease with CUSA had no further recurrence (52%) compared with patients treated for recurrent disease with other methods (9%) (P < 0.001). No patient treated with CUSA reported adverse effects; 7 patients treated with other methods reported dysuria, burning, and pain. CONCLUSION: These initial data suggest that CUSA is a safe and effective method for treating VAIN and may be an appropriate treatment for many patients.

The use of paclitaxel and cisplatin in a patient with epithelial ovarian cancer and human immunodeficiency virus.

OBJECTIVE: Several spots exist of human immunodeficiency virus (HIV)-positive patients developing epithelial ovarian cancer. The optimal chemotherapeutic regimen has been unclear due to potential immunotoxicity from chemotherapy in these already immunocompromised patients. This is the first report of paclitaxel-based combination chemotherapy in an HIV-positive patient with ovarian cancer. METHOD: A 39-year-old woman with HIV was diagnosed with poorly differentiated serous carcinoma. She underwent optimal cytoreductive surgery and received six courses of paclitaxel and cisplatin. RESULTS: The patient experienced a complete clinical response to therapy with no adverse effect on surrogate markers for human immunodeficiency virus (CD4 count, beta2 microglobulin, neopterin, p24 antigen, and viral load). CONCLUSION: Paclitaxel- and platinum-based chemotherapy, the standard of care for adjuvant chemotherapy in advanced ovarian carcinoma, is appropriate therapy for ovarian cancer patients with HIV. There is no evidence that the paclitaxel/cisplatin regimen is associated with progression of HIV or increased chemotherapy-associated morbidity.

Extraovarian granulosa cell tumor.

OBJECTIVE: The aim of this study was to report a case of extraovarian granulosa cell tumor and to describe its relevance to the histologic origin of granulosa cell tumors and to clinical practice. METHODS: The clinical course and histopathology of the case were reviewed, and a literature search for other reported cases was performed. RESULTS: A 67-year-old woman presented with postmenopausal bleeding and a pelvic mass. Laparotomy revealed a 16-cm mass arising from the right pelvic sidewall, filling the pelvis, and involving the bladder and rectosigmoid colon. Both ovaries appeared normal and were separate from the mass. Pathologic examination revealed granulosa cell tumor. A literature search revealed no recently reported cases of extraovarian granulosa cell tumor. CONCLUSIONS: Granulosa cell tumors can arise in locations other than the ovary and may be derived from the mesenchyme of the genital ridge. Women who have undergone oophorectomy may have the potential to develop granulosa cell tumors.

Vulvar porokeratosis: case report and review of the literature.

We report the first case of vulvar porokeratosis that occurred in a 39-year-old woman with a 30-year history of vulvar pruritus and disfiguring vulvar lesions. Ultrasonic surgical aspiration resulted in resolution of her pruritus and excellent cosmesis. Light microscopy revealed characteristic cornoid lamellae and electron microscopy confirmed the diagnosis of vulvar porokeratosis.

Adequacy of conization margins in adenocarcinoma in situ of the cervix as a predictor of residual disease.

In this retrospective analysis, 18 patients with adenocarcinoma in situ (AIS) of the cervix diagnosed on cervical conization between April 1988 and June 1994 were identified. The margins of all specimens were assessed for disease involvement. If hysterectomy or repeat conization was performed, the presence of AIS in the specimen was ascertained. Eleven of 18 conizations (61%) had AIS with negative margins of resection. Two of these 11 patients (18%) were followed conservatively and have had negative Pap smears for a mean of 1.7 years. The remaining 9 patients (82%) were treated by hysterectomy, with 4 (44%) showing residual AIS in the final surgical specimen. Six of the 18 conizations (33%) had positive margins for AIS. Five of these patients (83%) were treated with hysterectomy and one patient was treated with a repeat conization. Three of the five hysterectomy specimens as well as the repeat conization specimen (67%) contained residual AIS. One conization (6%) had margins that could not be assessed. The absence of residual AIS in the final surgical specimen was not predicted by the negative margin status on the conization.

Report of three new cases of squamous carcinoma of the endometrium with emphasis in the HPV status.

Primary squamous cell carcinoma of the endometrium is exceedingly rare. Only 31 cases that fulfill Fluhmann's criteria have been reported in the literature. We report three cases of primary squamous cell carcinoma of the endometrium. In two of the three cases, estrogen receptor (ER) and progesterone receptor (PR) status were analyzed. Only one case contained ER/PR. Additionally, in situ hybridization was performed to determine the presence of human papillomavirus (HPV) in these cases. HPV was not detected in these three cases of primary squamous cell carcinoma of the endometrium.

Formation of the triple-stranded polynucleotide helix, poly(A.A.U).

A polynucleotide helical structure containing two strands of poly(A) and one of poly(U) is reported. As shown by spectroscopic observations, the complex only forms when the poly(A) strands are of Mr between 9000 and 50,000 (degree of polymerization congruent to 28-150), whereas the size of the poly(U) strand has no effect. This limitation may explain why poly(A.A.U) was not seen in previous investigations. The potential of the poly(A) tails of mRNA for formation of this triple helix and of A.A.U or/and A.A.T triplet formation to contribute to the binding of specific RNA strands to gene-encoding nucleic acid double helices are noted.