Carmel J. Cohen

Placental and fetal involvement by maternal malignancy: A report of rectal carcinoma and review of the literature

A case of maternal adenocarcinoma of the rectum with extensive intervillous involvement is presented and the western world’s literature is reviewed. Detectable fetal involvement by maternal malignancy is rare, although maternofetal transmission of malignant cells is probably more frequent than realized. The factors affecting transmission of tumor to the fetus are: (1) tumor cell type, (2) maternal arterial dissemination, (3) intervillous sequestration, (4) transvillous passage, (5) fetal dissemination, and (6) fetal response.

Treatment of advanced endometrial adenocarcinoma with cis-dichlorodiammine platinum (II) after intensive prior therapy

Abstract Four of thirteen patients with advanced endometrial adenocarcinoma had an objective response to treatment with cis -dichlorodiammine platinum (II) by high-dose infusion after failing prior intensive combination chemotherapy. The median duration of response was 4 months and there were no unusual toxic reactions. The previous therapy included adriamycin, cyclophosphamide, 5-fluorouracil with progestins, or melphalan, 5-fluorouracil, and progestins.

Carcinoid of the uterine cervix. A case report with light and electron microscopic studies

The case of a 33‐year‐old woman with primary carcinoid of the uterine cervix is reported. Primary carcinoid tumor is well known to occur in organs such as the gastrointestinal tract, lung and gonads. However, its occurrence in the uterine cervix is rare. To our knowledge, primary carcinoid of the uterine cervix has not been reported from the United States, although it has been well documented by non‐American authors. Light microscopically, the tumor was characterized by formation of solid nests, trabeculae and glands. The cells therein showed argyrophil granules but were negative for argentaffin reaction. Electron microscopy revealed the presence of numerous neurosecretory granules and microfilaments. On the basis of light microscopic ultrastructural and cytochemical properties, the tumor is believed to arise from the normal argyrophil cell of the cervix and is regarded as an endocrine tumor, a member of the group of neoplasms called apudomas. Cancer 43:535–538, 1979.

Chemotherapy of advanced and recurrent endometrial carcinoma with cyclophosphamide, doxorubicin, 5-fluorouracil, and megestrol acetate

Abstract Twenty-nine patients with advanced or recurrent endometrial adenocarcinoma were treated with a combination of cyclophosphamide, doxorubicin, 5-flucrouracil, and megestrol acetate. Thirteen patients had objective responses. The median duration of survival for responders has been 11 months. Myelosuppression was the main side effect. There were no instances of cardiotoxicity.

Chemotherapy of squamous cell carcinoma of the vulva: A review

Abstract A review of published experience with chemotherapy for the treatment of recurrent or metastatic squamous cell carcinoma of the vulva found data for nine different drugs used as single agents. Only 75 patients have been treated. Bleomycin produced responses in 19 out of 31 patients, adriamycin in 4 out of 6 patients, and methotrexate in 2 out of 5 patients. Seven patients with squamous cell carcinoma of the vulva were treated with five different combination chemotherapy regimens. Responses only occurred with regimens which contained bleomycin and methotrexate.

Histologic screening for endometrial cancer

Abstract The techniques available for histologic sampling of endometrial tissue are reviewed and their relative accuracy is discussed. A newer modification of the suction curettage is described, and experience in screening 120 patients is presented. In 98 patients the correlation between the histology obtained by suction curettage and subsequent formal sharp curettage under anesthesia is compared. An absolute correlation of over 95% is demonstrated and the discrepancies are explained. No cancers or cancer precursors were missed. The technique is considered useful and accurate for screening patients at risk for endometrial cancer.

Endometrial Cancer: Factors Influencing the Choice of Treatment'

Abstract Patients at high risk for the development of endometrial carcinoma are identified. The spectrum of endometrial cancer precursors is defined. Proof of adenomatous hyperplasia as a cancer precursor is offered. A therapeutic guide is proposed which considers the patients age, her fertility status, the severity of her cancer precursor, or the virulence of her established cancer. By individualized planning, the patient can be treated optimally, receiving adequate therapy for cure and avoiding therapeutic penalties when unnecessary.

Leukocyte migration enhancement as an indicator of immunologic enhancement

Leukocyte migration studies were performed on 19 cancer patients and 24 control subjects. Amniotic fluid (AF) as well as autologous plasma (PL) were investigated. No difference in the migration pattern between patients and control subjects was observed with AF, but cancer patients showed significant leukocyte migration enhancement (LME) with PL when compared to control subjects (p less than 0.04). Among 18 cancer patients with persistent disease only three did not show significant LME. All three represented specifically immunodepressed states. None of the untreated group of cancer patients failed to show LME with autologous PL. It is concluded that, as in pregnancy, an immunologic active factor is present in PL of cancer patients which induces a specific subpopulation of leukocytes and thereby LME. The possible mechanism of activation is briefly discussed. Through the detection of LME leukocyte migration may become of importance for the early detection of malignancy and monitoring of treatment success.

A blocking factor in amniotic fluid causing leukocyte migration enhancement

Amniotic fluid was found to cause significant leukocyte migration enhancement during the second and third trimester of pregnancy and in the early postpartum period when compared to the migration area obtained with an ovarian tumor homogenate antigen (p less than 0.01), choriocarcinoma spent medium (p less than 0.01), and placental pool homogenate (p less than 0.01). Only borderline significance (p less than 0.1) was obtained when migration enhancement with AF was compared between pregnant and nonpregnant female control patients, indicating minimal unspecific activity of AF. Migration enhancement with autologous amniotic fluid was slightly larger than with homologous amniotic fluid, but the difference did not reach significance (p less than 0.4). None of the control antigens caused migration enhancement; placental pool homogenate in concentrations above 4 mg. per cent caused migration inhibition but did not in lower concentrations. The enhancing effect of AF could be abolished by dilution but not by addition of excessive antibody to estrogen of HCG. It is suggested that a blocking factor is present in AF preventing recognition of fetoplacental antigen by the maternal immune system. Thus in vitro leukocyte migration enhancement may correlate to in vivo graft enhancement.

Chemosensitivity testing with cis-platinum(II) diamminedichloride: I. A new concept in the treatment of carcinoma of the cervix

Abstract A relatively simple, clinically applicable approach for determining the in vivo sensitivity of squamous cell carcinoma of the cervix to cis -platinum(II) diamminedichloride (DDP) is described. Histologic and cytologic characteristics in sequential cervical biopsies were employed to evaluate the sensitivity of tumor to platinum therapy. The remarkable similarity in histologic response of squamous cell carcinoma of the cervix when treated by platinum or radiation therapy suggests that this system might help to identify the patient who would most benefit from systemic platinum chemotherapy, just as it has been useful in identifying patients who can benefit from radiation therapy.