Stage I serous papillary carcinoma of the endometrium.

From 1973 to 1987, 16 patients with International Federation of Gynecology and Obstetrics (FIGO) Stage I serous papillary endometrial carcinoma were evaluated and treated at the University of Kentucky Medical Center (Lexington, KY). All patients were 60 years of age or older, and all were postmenopausal. Patients were treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and paraaortic lymph node sampling, and 38% were noted to have more extensive disease than appreciated clinically. Nine patients were given adjuvant postoperative radiation. Seven patients (44%) developed recurrent cancer with liver, lung, and upper abdomen being the most common sites of spread. Prognosis was most directly related to the presence of lymph vascular space invasion and the depth of myometrial penetration. No patient with serous papillary carcinoma confined to the endometrium developed recurrent cancer. In contrast, the recurrence rate of patients having myometrial invasion was 70% (P less than 0.03). Hormonal therapy was of limited value in the treatment of recurrent disease. This data suggests the need for adjuvant systemic therapy in the treatment of patients with Stage I serous papillary carcinoma of the endometrium who have myometrial invasion.

Immunohistochemical localization of tumor markers in epithelial ovarian cancer.

Immunohistochemical determinations of carcinoembryonic antigen, alpha-fetoprotein, human chorionic gonadotropin (hCG), and human placental lactogen (hPL) were performed on tissue sections from 137 epithelial ovarian cancers. Fewer than 25% of serous cystadenocarcinomas contained detectable amounts of any marker. Carcinoembryonic antigen was present in over 50% of tumors, and was noted most frequently in mucinous, endometrioid, and clear cell carcinomas. hPL was demonstrated in 30% of endometrioid carcinomas but was rarely present in other cell types. Both alpha-fetoprotein and hCG were noted in fewer than 10% of all major cell types of epithelial ovarian cancer. Forty-five patients had serial determinations of plasma levels of carcinoembryonic antigen at the time of regular follow-up visits. Serial plasma levels of carcinoembryonic antigen accurately predicated recurrence in nine of 16 patients whose tumors contained carcinoembryonic antigen, in contrast to two of 16 patients whose tumors were devoid of antigen.

Immature teratoma of the ovary.

Four cases of immature teratoma of the ovary are presented and the recent literature is reviewed. The majority of these tumors were confined to one ovary at the time of diagnosis, and more than 75% occurred in women under 25 years of age. The two most important prognostic parameters were stage of disease and histologic grade. Optimal survival occurred when surgical tumor debulking was followed by combination chemotherapy. The addition of hysterectomy with contralateral adnexectomy did not improve the survival of patients with disease confined to one ovary. Similarly, postoperative radiation therapy was not shown to be beneficial in patients with this disease. Analysis of presently available data suggests that patients with teratocarcinoma of the ovary should be treated with tumor excision followed by at least 12 courses of chemotherapy with vincristine, actinomycin D, and cyclophosphamide. alpha-Fetoprotein may be useful as a biochemical marker of disease status in selected patients.

Microinvasive carcinoma of the cervix.

One hundred seventy-seven patients with squamous cell carcinoma that invaded the cervical stroma to a depth of 5.0 mm or less were the subjects of this investigation. Fifty-one patients were treated primarily by vaginal hysterectomy, 42 by total abdominal hysterectomy, and 84 by radical hysterectomy with pelvic lymphadenectomy. In 52 patients with lesions that invaded the cervical stroma to a depth of 3.0 mm or less, 984 lymph nodes were examined and none contained metastatic tumor. Conversely, lymph node metastases were present in three of 32 patients with lesions that had stromal invasion of 3.1 to 5.0 mm. After therapy, all patients were followed up from 2 to 14 years, and none was lost to follow-up. Among 145 patients with lesions that invaded the stroma to a depth of 3.0 mm or less, only two developed recurrences, both of which were intraepithelial. Among the 32 cases of carcinoma that invaded the stroma 3.1 to 5.0 mm, there were three invasive recurrences, and two deaths.

Carcinoembryonic antigen in carcinoma of the uterine cervix: antigen distribution in primary and metastatic tumors.

Immunohistochemical staining for carcinoembryonic antigen (CEA) was performed on primary tumors and regional lymph nodes from 100 patients undergoing radical hysterectomies and pelvic lymphadenectomies for invasive carcinoma of the uterine cervix. Antigen staining was present in 82% of keratinizing squamous carcinomas as compared with 50% in nonkeratinizing tumors. Seventeen patients with CEA-producing cervical cancer had regional lymph nodes metastases, all of which stained positively for CEA. Conversely, antigen could not be detected in lymph nodal metastases from primary tumors devoid of CEA. The pattern and intensity of CEA staining in primary tumors and their metastases were similar in all cases. Antigen was present in highest concentrations in the cytoplasm and tumor cell membrane of all tissues examined and isolated nuclear staining was absent. The clinical implications of these findings are discussed.

Therapeutic implications of patterns of recurrence in cancer of the uterine cervix.

Five hundred twenty-six patients with invasive cervical cancer, treated at the University of Kentucky from 1964 to 1976, were followed 2--12 years after therapy. One hundred and sixty patients (31%) developed tumor recurrence. Recurrent cancer was noted with 1 year after therapy in 58% of patients and within 2 years of treatment in 76% of patients. Only 6% of patients with recurrent cervical cancer survived 3 or more years. Stage of disease, cell type, lesion size, and the presence of lymph vascular space invasion by tumor cells were all shown to be prognostically significant. The addition of extrafascial hysterectomy to radiation therapy significantly decreased the incidence of recurrence in stage IB cervical tumors 5 cm or more in diameter. Analysis of this data suggests that radical hysterectomy and pelvic lymphadenectomy is as effective as irradiation only in the treatment of large cell squamous carcinomas 2 cm or less in diameter.

Therapy of endodermal sinus tumor of the ovary.

Endodermal sinus tumor of the ovary can be differentiated histologically and immunohistochemically from ovarian embryonal cell carcinoma. A case report of a patient with endodermal sinus tumor is presented in which a long-term remission was achieved by unilateral adnexectomy and combination chemotherapy. Review of the current literature indicates that tumor removal followed by combination chemotherapy with vincristine, actinomycin D, and cyclophosphamide is the most effective method of therapy for this highly malignant ovarian neoplasm. The addition of hysterectomy with contralateral ovariectomy or radiation therapy does not appear to significantly improve the survival of patients with this tumor. Serial plasma determinations of alpha fetoprotein provide biochemical monitoring of response to therapy and may be useful in predicting occult tumor recurrence.

Carcinoembryonic antigen in carcinoma of the uterine cervix. 2. Tissue localization and correlation with plasma antigen concentration.

Immunoperoxidase staining for carcinoembryonic antigen (CEA) was performed on the tumors of 241 patients with invasive carcinoma of the cervix. Positive tissue staining indicative of a CEA concentration of at least 3 microgram/gm was present in 154 tumors (63%) as opposed to 0 of 30 specimens of normal cervix (p less than .001). Plasma CEA values were obtained at the time of tissue staining on all patients. Plasma CEA concentration was related more directly to total tumor burden (tumor CEA content x extent of disease) than to tumor CEA concentration alone. Progressively rising plasma CEA levels predicted recurrent disease in over 80% of patients whose tumors stained positively for CEA. In contrast, serial plasma CEA values correlated positively with clinical disease status in only 28% of patients whose tumors were devoid of CEA. Immunoperoxidase staining of tissue specimens identifies those patients whose tumors contain high levels of CEA and who therefore should benefit most from subsequent plasma antigen determinations.

Correlation between retinal and pelvic vascular status: a determinant factor in patients undergoing pelvic irradiation for gynecologic malignancy.

The degree of arteriolar sclerosis in pelvic vessels has previously been shown to be related to the incidence of radiation-related enteric and genitourinary injury. Retinal vessel changes were compared to pelvic vascular changes in 48 patients, half of whom were either diabetic or hypertensive. There was an absolute correlation between retinal vessel changes and bowel or cervicovaginal vessel changes in 74% of the cases, and only one patient had a marked (more than one grade) discrepancy between retinal and pelvic vascular status. The findings of this investigation suggest that funduscopic examination of the retina can provide useful information concerning the extent of vascular disease in structures normally present in the field of pelvic irradiation.

Carcinoembryonic antigen in carcinoma of the uterine cervix. 1. The prognostic value of serial plasma determinations.

Plasma carcinoembryonic antigen (CEA) determinations were obtained prior to therapy in 300 patients with invasive carcinoma of the uterine cervix followed at the University of Kentucky Medical Center from 1971 to 1976. Carcinoembryonic antigen levels were elevated (greater than 2.5 ng/ml) in 48% of cervical cancer patients, and varied directly with stage of disease and histologic differentiation of the tumor. Plasma CEA levels were more commonly elevated in patients with endocervical adenocarcinoma than in those with squamous cell carcinoma, but were not related to vascular invasion in the specimen or regional lymph nodal morphology. Two hundred and four patients had 2 to 15 (mean = 5) follow-up plasma CEA determinations after treatment. Thirty patients had progressively increasing plasma CEA levels following therapy, of which 29 developed recurrent cervical cancer. A progressive rise of plasma CEA preceded the clinical diagnosis of recurrence by 1 to 23 months (mean = 6 months) in 13 of these patients, and occurred at the same time or after the clinical diagnosis of recurrence in 16 cases. Patients with progressively rising plasma CEA levels following therapy for cervical cancer should be extensively evaluated to rule out the presence of occult recurrence.

Capillary phase in angiography.

The capillary phase is discussed on the basis of primary serial magnification and subtraction. It is suggested that the term 'intermediate phase' better expresses the angiographic appearance in between the arterial and venous phases than the term 'capillary phase'. The intermediate phase is further divided into the precapillary, capillary and postcapillary subphases and anatomic correlations are discussed. Some physiologic and pathologic aspects of the intermediate phase are considered.

B-Mode sonography as a screening procedure for asymptomatic carotid bruits.

Sixty-five B-mode carotid sonograms were obtained at random on patients undergoing cerebral arteriography. A 5 mHz transducer was used. The results were correlated with magnified cervical carotid arteriograms obtained on these patients. B-mode sonography was accurate in evaluating the carotid arteries for surgical stenosis in 72 per cent of the cases. The feasibility of using B-mode sonography as a screening test in patients with asymptomatic carotid bruits is discussed.