Alexander Sedlis

Carcinoma of the Fallopian Tube

Carcinoma of the fallopian tube is the least frequent tumor of the female genital tract. It may occur at any age but is more common in the sixth decade. The tumor involves both tubes in 26 per cent of cases. The spread is by direct extension to peritoneum. The symptoms include metrorrhagia, leukorrhea, abdominal pain, singly or in combination. The diagnosis is difficult but could be made more frequently if the causes of abnormal bleeding were thoroughly investigated by means of cytology and endometrial curettage. Treatment is by resection of the tumor, total hysterectomy, and bilateral salpingo-oophorectomy followed by chemotherapy. The 5-year survival rate is 38 per cent.

Glassy cell cervical carcinoma

Abstract Glassy cell cervical carcinoma is a poorly differentiated variety of adenosquamous tumor comprising 1.2% of cervical cancers. It is clinically significant because its biologic behavior is different from that of other cervical cancers, being extremely malignant and poorly responsive to both radiation and surgery. There appears to be a close temporal relationship of this tumor to pregnancy. The clinical-pathological features of seven cases of glassy cell cervical carinoma are reviewed. The development of invasive glassy cell carcinoma through a state of cervical intraepithelial neoplasia has not been noted in our series by cytohistologic evidence. This may depict extreme virulence of this tumor with rapid progression to invasion. Cytology of these lesions, at the time of diagnosis of invasion, is strikingly similar to their histologic appearance. Its biologic behavior suggests that treatment should be more aggressive, possibly including radical surgery, and postoperative irradiation.

Effect of intrauterine stainless steel ring on endometrial structure and function

Abstract 1. 1. Endometrial biopsies were obtained on selected days of the secretory phase before and after insertion of an intrauterine stainless steel ring in 91 fertile women. 2. 2. Hysterectomy specimens from 10 women with intrauterine stainless steel rings in situ were also studied. 3. 3. The tissue was evaluated by standard histological methods as well as P.A.S., Alcian blue, toluidine blue, and alkaline phosphatase technique. 4. 4. There was no evidence of pregnancy or abortion and no increase in incidence of chronic inflammation. 5. 5. There was no disturbance of endometrial function as evidenced by normal cyclic changes and normal glycogen and alkaline phosphatase activity. 6. 6. Failure of depolymerization of mucopolysaccharides of the ground substance was indicated by the persistence of Alcian blue staining during days 22 to 24 in 75 per cent of the postinsertional specimens. 7. 7. The absence of tissue reaction demonstrate the inertness and suitability of stainless steel as a material for intrauterine devices. 8. 8. Biochemical study of endometrial gland secretions was initiated. To date, endometrial mucus specimens obtained from 34 women before and after insertions have been examined for total proteins and carbohydrates. The small number of postinsertional samples examined have shown no significant difference with controls.

Cylindroma of the cervix.

Abstract The first cylindroma of the cervix is reported. The patient also had squamous cell carcinoma of the cervix and basal cell carcinoma of the bridge of the nose. The exact histogenesis of cervical cylindromas still remains to be elucidated. It is urged that the original term, “cylindroma,” be limited to those lesions fulfilling Billroths criteria.

Endometrial leukocytes in patients using intrauterine contraceptive devices

Abstract Cytologic examination of endometrial washings was performed on 36 women using intrauterine contraceptive devices (IUDs) and 11 control subjects. The leukocyte count was done on cytologic preparation using Millipore filters. The count was significantly higher in the study group than in the control group. The observed difference was independent of the cycle day. Presence of the leukocytes in the endometrial fluid together with previously shown endometrial infiltration and low intrauterine pH indicates that the inflammatory process accompanies the presence of the IUD.

Efficacy of a rapid cell spectrophotometer in screening for cervical cancer

A carefully controlled double‐blind study of the usefulness of a new device as an aid in screening for cervical cancer was carried out. The device measures and displays multiple spectrophotometric properties of cells in liquid suspension at rapid rates. The results of a test involving cervical swab and vaginal wash specimens from 1155 patients are presented. Cytologic smears, obtained concurrently with samples for the device and processed by the Papanicolaou technique, were independently evaluated. Biopsy results on those patients considered by cytology to have cancer were used in evaluating the device. Forty‐five per cent of the swab samples were readable by the device; of these it selected 35%, which included 85% of the readable cases with cancer. With vaginal wash samples 50% of the known cancers were missed. These results reflect the efficiency of the cell, sampling procedure as well as the performance of the device itself; inefficient sampling procedures account for the low percentage of readable swab samples and for some of the cases that were missed with these samples, as well as the poor results obtained with the vaginal wash samples.

The fate of cervical dysplasia

Abstract A total of 168 patients with cervical dysplasia were followed for from 6 weeks to 5 years. In 71 women (42 per cent), a regression of dysplasia was observed. In 59 patients (35 per cent), dysplasia persisted. Progression to or coexistence with carcinoma in situ was found in 30 women (18 per cent). In 8 patients (6 per cent), an invasive carcinoma has finally developed. In view of these findings it is recommended that the treatment of moderate or severe dysplasia should be sharp knife conization. Hysterectomy should be considered in older women and those of high parity.

Endometrial Enzyme Histochemistry in Oral Contraceptive Therapy

Alkaline phosphatase (ALP) activity of endometrial tissue secretion and of the luminal border of the glandular epithelium in 40 women using no contraception was greatest during the secretory phase of the cycle indicating that ALP facilitates secretion across the cell membrane. Among 36 women following a combined estrogen-progesterone contraceptive regime luminal border and secretion ALP activity was greatest in the early cycle while ALP activity of the glandular epithelium base was negative throughout the cycle. Among 93 women receiving sequential therapy ALP activity in the three tissue components rose with addition of progesterone. Acid phosphatase (ACP) activity of the glandular epithelium base and luminal border was slight during endogenous and exogenous estrogen phases and rose after endogenous or exogenous progesterone stimulation or during the exhaustion phase of combined therapy. ACP may be related to cellular regressive phenomena. Activity of beta glucuronidase (BGC) which perhaps catalyzes the synthesis or hydrolysis of conjugated glucuronides a site of estrogen action was absent during combined therapy present during estrogen administration on the sequential regime and present in the proliferative phases of untreated women. The activities of succinic dehydrogenase involved in the Krebs cycle and lactic dehydrogenase a DPN-linked enzyme in the glycolytic system appeared inconstant and at low levels in treated women. Women on sequential therapy had lower SDH activity than expected from histological examination. Two patterns of enzyme behavior arose after daily chlormadinome therapy in 45 women: changes to those observed with combined therapy suggesting non-ovulation and patterns like those in untreated women suggesting ovulation. Enzyme activity apparently reflected total cellular function rather than specific estrogen or progesterone stimulation.

Cervical biopsy versus conization

The accuracy of a punch biopsy diagnosis of cervical neoplasia in patients with abnormal cytologic findings is assessed. Cervical punch biopsies were performed in 859 patients, and 258 had subsequent cold‐knife conizations. Invasive carcinoma was diagnosed in 189 patients by the initial cervical biopsy. Carcinoma in situ was noted in 194 patients, and this diagnosis was confirmed by conization in 75% of the cases. Pathology of a lower rank was found in 17%, microinvasion in 6%, and frank invasion in 2%. Dysplasia was diagnosed by biopsy in 246 patients. Of the cold‐knife conizations performed in 66 cases of dysplasia, 40% confirmed the dysplastic lesion, 40% revealed carcinoma in situ, 10% chronic cervicitis, 3% microinvasion and 2% invasive carcinoma. A comparative analysis of the biopsy, conization and hysterectomy findings is presented. Multiple cervical punch biopsies from properly selected sites aided by Schiller stain and including an adequate area of the squamocolumnar junction are useful as the initial diagnostic procedure in women with abnormal cytology or suspicious cervical lesions. Conization is indicated if biopsy or cytology findings raise suspicion of a higher rank of neoplasia. All patients with carcinoma in situ and severe dysplasia on biopsy must have subsequent conizations performed. The postmenopausal female with any degree of dysplasia on biopsy and patients with repeated abnormal cytologic findings despite negative biopsy results must also undergo conization.

Impact of a cytologic screening program on a gynecologic malignancy service

A comprehensive cytologic screening program has been instrumental in the increased case finding and decreased mortality of patients with cervical cancer in a high risk population. In the 7 years of operation, 94,778 smears have been examined and 2327 atypical, 529 suspicious, and 133 positive cytologic examinations have resulted. During this period, there has been a reversal of the former predominance of invasive: in‐situ lesions, and an associated redistribution in the stage of tumor exhibited. The multiple impact of an efficient cancer control program on a gynecologic malignancy service has necessitated modification in the therapy of cervical malignancy, in subsequent patient follow‐up, and in the training program.