Bruce Patsner

Predictive value of preoperative serum CA 125 levels in clinically localized and advanced endometrial carcinoma

Serum CA 125 levels were measured preoperatively by standard radioimmunometric techniques in 89 patients with primary endometrial carcinoma before definitive surgical staging and resection. Fifty-seven of 58 (98%) patients with clinical and surgical Stage I or II disease had normal preoperative serum CA 125 levels. All eight patients with clinically advanced endometrial cancer (International Federation of Gynecology and Obstetrics Stage III or IV) had elevated CA 125 levels before surgery. Twenty of 23 patients (87%) with clinical Stage I or II endometrial cancer who were found to have extrauterine spread of disease during staging laparotomy had elevated preoperative serum CA 125 levels. Thus preoperative CA 125 levels were elevated in 28 of 31 patients (90.3%) with surgically staged endometrial adenocarcinoma with extrauterine disease and may play a useful role in detecting those patients with clinically localized endometrial cancer who have occult extrauterine spread of disease.

The value of preoperative serum CA 125 levels in patients with a pelvic mass

Serum CA 125 measurements were obtained before operation in 250 consecutive patients admitted with the diagnosis of a pelvic mass. We examined and operated on all patients. Elevated preoperative serum CA 125 levels were more predictive of malignancy in postmenopausal than in premenopausal women (0.86 vs 0.67), but normal levels did not preclude malignancy in either group. Possible limitations of routine measurement of serum CA 125 in the work-up of patients with a pelvic mass are discussed.

Ovarian metastases from stage IB adenocarcinoma of the cervix

At the time carcinoma of the cervix is treated by radical surgery, it is believed that ovarian preservation is possible, and will prevent surgical menopause, with its risks of osteoporosis, vaginal dryness, and “hot flashes.” However, the data originally used to justify ovarian preservation was based on clinical experience with squamous cell carcinoma of the cervix. Little if any data exist to justify this treatment rationale in patients with adenocarcinoma of the cervix. Two patients who presented with clinical Stage IB adenocarcinoma of the cervix, subsequently underwent radical surgical treatment. Pathologic review of the operative specimens revealed microscopic metastasis to the ovaries in both patients. It is suggested that ovarian preservation at the time of radical surgical treatment for adenocarcinoma of the cervix has not had its safety established, and that sacrificing the ovaries and providing hormonal replacement postoperatively may be a safer course.

Herpetiform cutaneous metastases following negative second look laparotomy for ovarian adenocarcinoma

SummaryCutaneous metastases from gynecologic malignancy are rarely reported, and when present are invariably accompanied by intraperitoneal disease. In the present case extensive metastases to the skin of the abdomen, groin, thigh and perineum appeared six weeks following extensive “second look” laparotomy which revealed no evidence of intraperitoneal or retroperitoneal disease. The appearance of cutaneous metastases was preceded by only a one month history of leg swelling, erythema, and a markedly elevated serum CA-125. Problems in the differential diagnosis and management of this clinical situation are discussed.

Use of serum CA-125 in monitoring patients with uterine sarcoma: a preliminary report

Elevated preoperative serum CA‐125 levels were present in three of four patients (75%) with Stage I uterine sarcoma found to have extrauterine spread of disease at laparotomy as well as five of seven (71%) patients with clinically advanced and recurrent uterine sarcoma. Serial levels during chemotherapy inconsistently reflected response to treatment and proved to have limited clinical value.

Comparison of serum CA-125 and lipid-associated sialic acid (LASA-P) in monitoring patients with invasive ovarian adenocarcinoma

Twenty-seven patients with frankly invasive nonmucinous invasive adenocarcinoma of the ovary were monitored using a serial CA-125 and lipid-associated sialic acid (LASA-P) levels prior to cytoreductive surgery, during chemotherapy, before second-look surgery or disease progression, and during subsequent follow-up. All levels were measured using previously described techniques. Serum LASA-P levels correlated well with CA-125 levels during all phases of treatment with no significant difference in predictive value of elevated or normal levels. LASA-P levels, thus, offer another, possibly less expensive, method of monitoring patients with invasive ovarian adenocarcinoma during therapy and in predicting the likelihood of a positive second-look laparotomy.

Primary invasive ovarian adenocarcinoma with brain and placental metastases: A case report

A case of primary ovarian adenocarcinoma during pregnancy with both placental and central nervous system metastases is reported.

Morbidity and mortality of stapled anastomoses on a gynecologic oncology service: A retrospective review

The Gynecologic Oncology Division performed 167 operations requiring intestinal resection during the period July 1, 1980 to May 30, 1989. Stapling instruments were utilized in 155 procedures and resulted in 204 anastomoses. Major morbidity occurred in 36 (23%) patients, including 17 (11%) deaths and (4.5%) fistulas. Minor morbidity, such as ileus and atelectasis, occurred in 46 (30%) patients. Intestinal surgery is required in approximately 10% of gynecologic oncology procedures, and is associated with significant major and minor morbidity, particularly in obstructed patients.

High-grade pelvic sarcoma after radiation therapy for low-grade endometrial stromal sarcoma

A high-grade heterologous pelvic sarcoma arose in a 60-year-old woman 15 years after she received whole-pelvic radiation for a low-grade endometrial stromal sarcoma. This complication must be considered in determining therapy for low-grade endometrial sarcomas, which are usually inherently of indolent biological behavior.

Cholecystectomy accompanying major abdominal surgery for gynecologic cancer

In a 66-month period 950 major abdominal operations were performed for known or suspected gynecologic malignancy. Thirty-five patients (3.6%), of whom 29 had proven gynecologic malignancy, underwent cholecystectomy for cholelithiasis known from prior evaluation or found incidentally during abdominal exploration. All cholecystectomies were performed through the original incision with no direct operative morbidity or mortality. Cholecystectomy accompanying gynecologic cancer surgery appears to be well tolerated if performed expeditiously, and avoids the potential of postoperative cholecystitis in this select group of patients.