Adenosarcoma in a patient with vaginal endometriosis.

BACKGROUND: Adenosarcoma in a patient with extraovarian endometriosis is a rare event and can be easily overlooked. CASE: A woman with a history of endometriosis underwent multiple resections of a vaginal mass and medical treatment for presumed recurrent endometriosis. Eventually, a vaginal adenosarcoma was diagnosed. CONCLUSION: The possibility of adenosarcoma should be considered if an enlarging mass occurs at the site of extraovarian endometriosis.

Multimodality therapy for carcinoma of the Bartholin gland.

OBJECTIVE: The aim of this study was to report the value of chemoradiation in the management of cancers of the Bartholin gland. METHODS: Primary treatment consisting of 45-46 Gy teletherapy radiation to the vulva, pelvis, and groins in combination with 50 mg/m(2) of cisplatin and 1000 mg/m(2)/day of 5-fluorouracil for 5 days during the first and fifth weeks of irradiation was delivered, followed by interstitial implant or excision. RESULTS: Two patients were free of disease at 30 and 59 months following therapy. Both patients required myocutaneous flap closure, one after excision of tumor after radiation and one after radionecrosis at the implant site. CONCLUSIONS: Primary chemoradiation may allow continence-sparing therapy for women with primary carcinoma of the Bartholin gland.

Smoking, obesity, and survival in squamous cell carcinoma of the vulva.

One hundred thirty-six patients with invasive squamous cell carcinoma of the vulva were studied retrospectively to determine prognostic factors for survival. In the regression analysis, three variables were statistically significantly related to survival: smoking history, tumor size, and node status. Smokers had a 6.3 times greater risk than nonsmokers, node positivity imparted an 8.3 times greater risk than node negativity, and for each 1-cm increase in the size of the tumor, the risk of death increased by 46%. A relative decrease in survival in smokers was observed, despite a younger age and fewer positive nodes at diagnosis compared to nonsmokers. Increased surveillance in these patients may be warranted.

Differential response of cervical intraepithelial and cervical carcinoma cell lines to transforming growth factor-beta 1.

Transforming growth factor-beta 1 (TGF-beta 1) is a potent inhibitor of epithelial cell proliferation. It has been proposed that loss of sensitivity to growth inhibition by TGF-beta 1 may be an important step in the development of cervical carcinoma, but it remains unclear whether this represents an early or a late event. We compared the sensitivity to TGF-beta 1 of nontumorigenic human papillomavirus deoxyribonucleic acid (HPV DNA)-positive cell lines derived from cervical intraepithelial neoplasia (CIN), of newly established cervical carcinoma cell lines, of nontumorigenic HPV DNA-transfected cervical cell lines, and of normal ectocervical cells. There is a dose-dependent inhibition of DNA synthesis by TGF-beta 1 in the CIN cell lines and the HPV DNA-transfected cell lines. The carcinoma cell lines are resistant to the growth inhibitory effects of TGF-beta 1. The CIN cell lines are significantly more sensitive than the carcinoma cell lines (P < 0.001), but significantly less sensitive than normal cervical cells (P < 0.05). A CIN cell line which contains HPV 31b DNA is more sensitive to TGF-beta 1 at early passage than at late passage (P < 0.05). There are no differences in the sensitivity to the growth inhibitory effects of TGF-beta 1 between subclones of this cell line that have different episomal HPV DNA content, population-doubling time, or differentiation characteristics. Both normal and abnormal cervical epithelial cells were able to secrete latent TGF-beta 1 or TGF-beta 2. We conclude that resistance to growth inhibition by TGF-beta 1 is likely to be a late event in the development of cervical carcinoma; it is not the mere consequence of immortalization by HPV genes acquired following transfection in vitro or infection in vivo.

Salvage mitomycin/5-fluorouracil after platinum-based therapy for women with advanced ovarian cancer and related gynecologic malignancies.

PURPOSE: to determine response rates, survival, and toxicity of a regimen of mitomycin-C and 5-fluorouracil in patients previously treated with platinum-based combinations for ovarian cancer and related gynecologic malignancies. PATIENTS AND METHODS: retrospective chart review of all cases of persistent or recurrent ovarian, fallopian tube, and peritoneal carcinoma treated with mitomycin-C 7 mg/m2 followed by continuous infusion of 5-fluorouracil 600 mg/m2/day over 4 days. RESULTS: 26 patients were treated after a median of 2 prior platinum-based regimens, 22 with ovarian cancer, 3 with peritoneal cancer, and one with fallopian tube cancer. Only 2 patients completed 6 or more cycles. 2 patients had partial responses (8%); no complete responses were seen. 24 patients died a median of 3 months after the initiation of therapy, while 2 patients were alive 4 and 8 months after beginning therapy. All deaths were attributable to disease, not complications of treatment. 8 patients required dose modification or treatment delay for toxicity. Nine patients required a total of 11 unscheduled admissions. CONCLUSIONS: toxicity attributable to mitomycin-C/5-fluorouracil therapy of ovarian cancer is acceptable, but responses are few. More effective alternative should be sought.

Growth and differentiation of human papillomavirus type 31b positive human cervical cell lines.

Human papillomavirus (HPV) containing cell lines derived from human cervical intraepithelial neoplasia (CIN) can offer valuable insights into the role of HPV in cervical neoplasia and can help in the understanding of the cellular changes that fuel the progression toward malignancy. We describe the growth and differentiation properties of an epithelial cell line established from a CIN I lesion. The cell line, designated as CIN 612, contains predominantly episomal copies of HPV 31b deoxyribonucleic acid (DNA). In vitro differentiation in a collagen raft system, growth characteristics, and episomal HPV DNA content of the CIN 612 cell line and two of its subclones were analyzed. Early passage CIN 612 cells differentiate in a manner which resembles the original low-grade intraepithelial lesion. On further passage, these cells exhibit increasingly poor differentiation in vitro. Two subclones with different growth characteristics and morphology were identified. A more rapidly growing, poorly differentiated subclone contains less episomal copies of viral DNA compared to a slower growing and better-differentiated subclone. Cell populations with similar growth characteristics yet different ploidy were observed. The CIN 612 cell line with its episomal copies of viral DNA shows promise for the development of an in vitro culture system for HPV 31b. The isolation of subclones with consistently different growth and differentiation properties in vitro creates an opportunity to identify the cellular events that lead to the progression from low-grade to high-grade cervical neoplasia.

Scalene lymph node biopsy in the preoperative evaluation of patients with recurrent cervical cancer.

From 1982 to 1987, 24 patients with recurrent carcinoma of the cervix underwent scalene lymph node biopsy prior to exploration for exenteration. Patients with palpable nodes were excluded from the study. There was no significant morbidity associated with the procedure. None of the 24 patients was found to have metastases to the scalene lymph nodes. From this study it would seem unjustifiable to perform this procedure on all patients undergoing evaluation for exenteration.

Plasma oxytocin in human pregnancy and parturition.

Oxytocin concentrations were determined in serial peripheral plasma samples collected from clinically normal women during pregnancy and labor. Measurable concentrations of this hormone were detected in all maternal plasma samples during pregnancy, but there were wide differences in values between patients. Serial samples from individual patients revealed a pattern of gradual rise of oxytocin levels with advancing gestation and the increase in concentration was statistically significant. There were no significant differences in oxytocin levels at any stage of labor, with or without epidural analgesia. Oxytocin levels at the onset of the second stage did not differ statistically from those at crowning. Comparison of cross-sectional data showed no significant difference between the mean oxytocin concentration in early labor and in late pregnancy. Oxytocin surges occurred, but not in a regular pattern. Plasma oxytocin concentration did not increase after pelvic examination, sweeping of the membranes, low amniotomy or after cervical vibration. After spontaneous vaginal delivery, umbilical arterial plasma levels of oxytocin were consistently higher than plasma concentrations from the umbilical vein. The fetal arterio-venous difference was less pronounced at elective cesarean section. At spontaneous vaginal delivery, with and without epidural anesthesia, plasma levels from the umbilical artery were significantly higher than the maternal levels. After vaginal delivery, oxytocin levels in cord plasma were significantly higher than at elective abdominal delivery. Some methodological aspects with regard to blood sampling and to plasma oxytocin radioimmunoassay procedures are discussed. From the results presented it is concluded that the human fetus can be an important source of oxytocin and that neurohumoral birth reflexes described in animals do not occur systematically in man.

Endocervical prostaglandin E2 gel for preinduction cervical softening.

A single, endocervical application of a new commercial preparation of prostaglandin E2 (PGE2) gel, 0.5 mg of PGE2 in 2.5 ml (3 g), was evaluated for preinduction cervical softening. Safety and efficacy were assessed in a comparison with a 2.0 mg PGE2 vaginal tablet and placebo in normal nulliparous women at term, with low Bishop scores. Treatment was administered in randomized, double blind fashion. Overall success, defined as a progression in Bishop score of at least 3 points within 12 hours, was achieved in 22/40 (55%) of the gel group, 15/41 (37%) in the tablet treated women, and 8/40 (20%) in those receiving placebo. Of interest was the observation that of women with very unfavorable induction features (Bishop score 0-2), the cervical gel treatment resulted in a 6/8 (75%) success rate compared with 2/13 (15%) success for the vaginal tablet and 0/17 (0%) for placebo. In as much as a very low incidence of side effects accompanied this treatment scheme, expanded multi-center testing is recommended.