Chen Ck

Risk factors for recurrence in patients with stage IB, IIA, and IIB cervical carcinoma after radical hysterectomy and postoperative pelvic irradiation

Objective To identify risk factors for cancer recurrence in patients with stage IB, IIA, and IIB cervical carcinoma after abdominal radical hysterectomy with pelvic lymph node dissection and postoperative pelvic irradiation. Methods One hundred and eighty-seven patients with cervical carcinoma stage IB (n = 63), IIA (n = 43), and IIB (n = 81) disease who received abdominal radical hysterectomy with pelvic lymph node dissection and postoperative pelvic irradiation were followed-up for 2–10 years. The histologic type, grade, lymphovascular tumor emboli, tumor size, invasion sites, deep cervical stromal invasion, and pelvic lymph node metastases were assessed for correlation with cancer recurrence. Results Recurrence occurred in 45 cases (24%), of whom 40 had died of the disease at the 5-year follow-up period. Univariate proportional hazards analysis revealed that the significant risk factors were adenocarcinoma, bulky tumor size (4 cm or greater), lymphovascular tumor emboli, deep cervical stromal invasion, and lymph node metastases, especially iliac nodal metastases and bilateral nodal metastases. Multivariate proportional hazards analysis showed that bulky tumor size (hazard ratio 2.34), tumor emboli (hazard ratio 2.74) and iliac nodal metastases (hazard ratio 5.31) remained significant risk factors. In contrast, no deaths occurred in the other 142 cases who did not have recurrence. Conclusion This retrospective study suggests that stage IB, IIA, and IIB cervical carcinoma cases with the above-mentioned pathologic factors are at higher risk of recurrence after abdominal radical hysterectomy with pelvic lymph node dissection and postoperative pelvic irradiation.

Synchronous primary carcinomas of the endometrium and ovary

Objectives: Synchronous carcinomas of the endometrium and ovary may indicate either independently developing neoplasms or metastatic disease. The clinical implications and prognosis of these two categories are quite different. The objectives of this study were to identify and evaluate the empirical criteria and significant therapeutic implications. Method: The National Taiwan University Hospital Cancer Registry records and pathological reports from 1977 to 1994 were reviewed. Empirical criteria were used to identify synchronous primary cancers. Results: A total of 322 patients had endometrial cancer and 421 patients had ovarian cancer in our Cancer Registry records. Eleven patients had simultaneous cancer involvement of both the endometrium and ovary. Six cases fulfilled the criteria of synchronous primary carcinomas of the endometrium and ovary. Of these, five were alive and free of disease for 35–144 months (median 94.2 months). The disease‐free survival rates between patients with synchronous primary and metastatic cancers of different histologic types showed a statistically significant difference (P = 0.013). No statistical significance was noted for different histologic types (P > 0.5). Conclusions: The empirical criteria used here were useful in identifying synchronous primary cancers of the endometrium and ovary. The favorable clinical outcome may relate to early detection of early‐stage disease and low‐grade malignancy with an indolent growth rate. Surgical management with or without adjuvant therapy has a satisfactory outcome in our experience.

Adenomatoid tumor of the female genital tract

Objective: To remind gynecologists of the diagnosis of adenomatoid tumor of the female genital tract, a pathology which is often mistaken for leiomyoma, and in addition to warn of the malignant appearance of adenomatoid tumor. Materials and methods: During the study period from January 1988 to May 1994, the clinical features and pathologic findings of 25 cases of adenomatoid tumor of the female genital tract were reviewed at the National Taiwan University Hospital. Results: The age of the patients ranged from 26 to 55 years with a median of 41 years. Adenomatoid tumor was an incidental finding during the surgical treatment of myoma (16 cases), cervical intraepithelial neoplasm (two cases), invasive cervical cancer (one case), adnexal cyst (five cases), and pregnancy with myoma (one case). Twenty‐three cases had tumors in the uterine corpus and two in the fallopian tubes. Twenty percent of the patients had multiple tumors. Their sizes ranged from 1.0 to 8.0 cm. The case with the largest tumor measuring 8 cm in diameter is presented in detail. Its histologic, immunohistochemical and ultrastructural characteristics strongly support the mesothelial origin of adenomatoid tumor. Conclusion: Some different results were obtained than those hitherto reported in the literature, such as younger age, frequency of multiple tumors, and fewer cases accompanied by leiomyomas.

Is total abdominal hysterectomy with bilateral salpingo-oophorectomy adequate for new FIGO Stage I endometrial carcinoma?

Objective The new FIGO staging for endometrial cancer cases complies with other forms of surgical staging and correlates better with clinical outcomes because it includes prognostic factors. This study was done to investigate whether total abdominal hysterectomy with bilateral salpingo‐oophorectomy (TAH + BSO) is adequate for new FIGO Stage I endometrial carcinoma.

Immunoelectrophoretic Differentiation Of Alpha-Fetoprotein In Disorders With Elevated Serum Alpha-Fetoprotein Levels Or During Pregnancy

Our study aims to make differential diagnosis by immunoelectrophoresis for some common conditions with elevated levels of serum alpha-fetoprotein (AFP). One hundred and nine cases with elevated AFP levels were included in this study: yolk sac tumor (n = 8), hepatocellular carcinoma (n = 26), gastric cancer (n = 12), chronic hepatitis (n = 27) and normal pregnancy (n = 36). Lectin agarose gel electrophoresis, antibody-affinity blotting, and immunoreaction were used to identify the specific patterns of AFP in the respective conditions. The results showed that there were three possible bands: L1, L2 and L3. Yolk sac tumor produced a prominent L2 band and a light L3 band. Hepatocellular carcinoma produced a prominent L1 band and a light L3 band. Gastric cancer produced only an L1 band. Chronic hepatitis had a light L1 band and a pronounced L3 band. In pregnancy, the AFP pattern is similar to that of hepatocellular carcinoma. Immunoelectrophoresis is a useful method facilitating the differentiation of AFP origins.

Cryptococcal infection of the vagina

Background: Cryptococcal infection is opportunistic and occurs most commonly in immunocompromised patients. Meningitis is the most frequent manifestation and causes marked morbidity and mortality. Other sites are less common. We report a case of vaginal cryptococcal infection. Case: A 72-year-old patient who had undergone resection of the colon for cancer 9 years earlier was noted to have a suspicious lesion on the right vaginal wall after an abnormal Papanicolaou test. Biopsy of the lesion showed findings compatible with cryptococcal infection. Serial examinations revealed no evidence of systemic infection or immunocompromised condition. Empirical treatment was tried with fluconazole. Follow-up colposcopy showed almost complete disappearance of the vaginal lesion, and histologic section and culture of the tissue failed to reveal cryptococcus. Conclusion: Cryptococcal infection is rare, especially in a patient with no evidence of an immunocompromised condition. The preliminary result of fluconazole treatment was satisfactory. However, further follow-up and evaluation are needed to confirm the effectiveness of fluconazole in our patient. (Obstet Gynecol 1993;81:867–9)

TREATMENT OF MENOPAUSAL FLUSHES WITH ORAL CLONIDINE

Abstract Clonidine, an alpha 2 -adrenergic agonist, has been shown to ameliorate hot flushes by decreasing noradrenergic activity in the blood vessels. The effectiveness of low doses of oral clonidine in reducing the number of episodes, duration, and intensity of menopausal flushes was evaluated in 25 Chinese women. The 15 menopausal women in the treatment group (mean age, 49.8 ± 1.4 years) took one 25-μg tablet of clonidine twice daily for 3 weeks. If symptoms did not improve after 1 week, the dose was increased to 2 tablets twice daily and then to 2 tablets three times daily. The 10 menopausal patients in the control group (mean age, 47.1 ± 2.3 years) took no medication. The frequency, duration, and intensity of hot flushes were significantly decreased after the second week of clonidine treatment. Neither blood pressure nor pulse rate changed significantly during clonidine therapy. Adverse effects were minimal. Only one patient each reported nausea, dizziness, and dry mouth, and these side effects disappeared spontaneously during the treatment period. Because estrogen replacement therapy is contraindicated in menopausal women with or at high risk for endometrial or breast cancer, low-dose clonidine treatment provides a nonhormonal alternative for relieving menopausal flushes in this patient population, as well as in menopausal women in general.