C. H. Buckley

A prospective study of conization of the cervix in the management of cervical intraepithelial glandular neoplasia (CIGN)—a preliminary report

Objective To assess the efficacy of cervical conization as primary management of cervical intraepithelial glandular neoplasia (CIGN).

Pathological prognostic indicators in cervical cancer with particular reference to patients under the age of 40 years

Summary. The presence of lymph node metastases in patients with cervical cancer is an important predictor of death and recurrence of disease. Lymph node metastases are more common in patients with mucus‐secreting carcinomas than in women with pure squamous carcinomas even in what appears, clinically, to be early stage disease: such neoplasms are more frequent in women under the age of 40 years. The recognition of mucus secretion in a carcinoma and the detection of vascular permeation adjacent to the primary neoplasm identifies the patient at greatest risk of having pelvic lymph node metastases.

Is needle aspiration of ovarian cysts adequate for diagnosis

Fishbourne I 1 , Rochat R W Khan A K R: Islam R (1982) Steiilization-attributable dcaths in Banglade5h Int J G~naecol ObJret 20, 149-154 Mchta P V (1989) A total of 250 1 3 6 ldparoscoplc stcrilimtions by a single operdtor Rr J Obster Gynaecol96, 10241034 Woodfoid b P (1988) Decontuminutron (~f Insrrurnenrs and Appliances L‘xd i n the Vuginu Depnrtmciit of Health, Reference EL(88) (MB) 210 plus Annex, 8 December 1988 ensuring that his unsurpassed skills are passed on to future surgcons. John Guillehaud Medical Director, Margaret Pyke Centre 15 Buiemaii’~ Buildings Soho Square, London WI V 5TW

Type I and Type II estrogen and progesterone binding sites in endometrial carcinomas: their value in predicting survival.

A simple and inexpensive immunocytochemical technique has been used to demonstrate estrogen (EB) and progesterone binding sites (PB) in endometrial carcinoma. Tumors were considered as being ‘binding-site’ rich if more than 40% of the component epithelial cells were positive for hormone binding sites (HB). By this criterion, over half of the adenocarcinomas studied were HB rich. Significantly higher 5- and 10-year survival rates were found in women whose tumors were HB rich compared with those whose neoplasms were HB poor, and a similar trend was established for patients with a combined EB rich/PB rich status versus that of EB poor/EB poor. This beneficial effect of a rich Type I and Type II receptor site status on survival, however, was shown only to a limited extent for EB. These results were independent of adjuvant treatment and of all clinical and histopathological features of known prognostic importance, save tumor differentiation. It is concluded that the immunocytochemical determination of HB status in formalin-fixed paraffin-embedded tissues adds significantly to the prognostic information available for endometrial adenocarcinoma.

c-erbB-3 proto-oncogene expression in uterine cervical carcinoma.

Over-expression of epidermal growth factor receptor (EGFR) and c-erbB-2, in uterine cervical carcinomas, is associated with a worsened prognosis. A third member of this proto-oncogene family, c-erbB-3, has now been identified and its over-expression has been described in a variety of carcinomas. In this immunohistochemical study we have shown that c-erbB-3 is widely expressed in cervical carcinomas, but we have found no association between its over-expression and lymph node status or clinical outcome. In a similar study examining the expression of EGFR and c-erbB-2 it was possible to demonstrate an association between over-expression and a worse prognosis. We conclude, therefore, that it is unlikely that demonstration of c-erbB-3 over-expression will be of any value as a prognostic indicator in carcinoma of the uterine cervix.

c-erb-2 oncogene expression in Stage I epithelial ovarian cancer

Subjects included in Group 0 required a significantly higher (P < 005: analysis of variance test (ANOVA)) number of units of allogeneic blood (36) than those enrolled in the ABT programme (seven in Group P, six in Group H). Autologous blood fulfilled the need for transfusion in 38/51 (74.5 %) patients in Groups P and H, was insufficient in seven (1 3.7 YO), and was unnecessary in six (1 1-7 YO). Only 24/104 units of available autologous blood were not reinfused. With a minimum follow up of 24 months, among nodenegative patients no recurrence was observed in 22 patients in Group P, three were observed among 17 in Group H, one was observed among 21 in Group 0 and one among nine in Group N.

Cervical carcinoma: a hazard model in early stage disease

The 235 patients with stage IB/IIA cervical carcinoma treated by Wertheims hysterectomy, as a primary procedure, at St Marys Hospital, Manchester between 1975 and 1989 inclusive, form the basis of this study. Using Coxs regression model, four variables were shown to have independent prognostic significance. These were: (1) lymphatic permeation (adjacent to the tumor); (2) tumor volume; (3) being pregnant at diagnosis and (4) lymph node metastases. A heuristic model was formulated which was based upon these four factors and by using this information it was possible to separate the patients into four distinct prognostic groups. It is suggested that this model may prove useful in identifying those patients at a higher risk of dying of disease and who would benefit from early adjuvant systemic therapy.

The role of postoperative alkylating agent therapy in early-stage epithelial ovarian cancer

Forty‐six patients with early (Stage I and II) ovarian cancer referred as free of residual disease after primary surgery, selected for high‐risk features, were treated with adjuvant single‐agent alkylating therapy comprising either intravenous cyclophosphamide (1 g/m2) in 36 patients, or oral melphalan (0·2 mg/kg daily for 5 days) in eight. Cyclophosphamide was repeated every 3 weeks for 10 cycles and melphalan every 6 weeks for 12 cycles. With a median follow‐up of 36+ months, 18 patients have relapsed. The actuarial 5‐year relapse‐free survival was 48% and the overall 5‐year survival was 54%; median survival was 84 months. Pretreatment FIGO stage was the single most important predictor of relapse‐free and overall survival duration. For patients with Stage IA and IB tumours the 5‐year actuarial relapse‐free survival was 89%; for patients with stage 1C and II (all substages), the 5‐year relapsefree survival was 24% (P=0·001). For this latter group adjuvant single alkylating agent therapy was not adequate and alternative therapeutic regimens are required. The problem of suboptimal primary surgical staging is also addressed.

An immunohistochemical study of steroid binding by endornetrial glandular epithelial cells throughout the menstrual cycle

An immunohistochemical technique was used to demonstrate oestrogen and progesterone binding by endornetrial glandular epithelial cells at various stages of the menstrual cycle. A cross‐section of steroid binding sites, including low affinity, concentration dependent Type 11 and III binding sites, were demonstrated but only in cells which contain the classical high affinity receptor. The technique demonstrated both free binding sites and receptor‐hormone complexes within the cytoplasm but was poorly effective in demonstrating nuclear complexes. Oestrogen binding sites were shown to reach a peak during the late proliferative and early secretory phases of the cycle: oestrogen binding capacity remained high during the mid and late secretory phases. Progesterone binding capacity rose progressively throughout the proliferative and early secretory phase.

An immunohistochemical study of the incidence and significance of carcinoembryonic antigen in malignant endometrium

In an immunohistochemical study of the presence of carcinoembryonic antigen (CEA) in endometrial carcinomas, it was found that CEA was detectable in 92 of 171 neoplasms, an incidence of 53.8%. The antigen was unrelated to important prognostic variables, both clinical and histopathologic, and overall there was no difference in survival rates between CEA-positive and CEA-negative endometrial neoplasms during the 10-year follow-up period. CEA-negative carcinomas did, however, confer longer survival in certain subgroups of patients: those with adenocarcinomas arising from a hyperplastic endometrium, those with neoplasms of poor differentiation, and those who, in addition to surgery, received irradiation treatment. It is suggested that immunoperoxidase staining for CEA may provide an independent method for predicting radiosensitivity in endometrial carcinomas, and also may be indicative of prognosis within some forms of this malignancy.