Christopher Dalrymple

Human papillomavirus deoxyribonucleic acid as a prognostic indicator in early-stage cervical cancer: A possible role for type 18☆

OBJECTIVE Our purpose was to determine the prognostic significance of human papillomavirus deoxyribonucleic acid in cervical cancers. STUDY DESIGN The polymerase chain reaction was used to detect human papillomavirus deoxyribonucleic acid types 6, 11, 16, 18, 31, 33, 52, or 58 in tumors from 148 patients (equal numbers of whom were disease free or had relapses) surgically treated for stage IB or IIA cancers in a major Australian hospital. Cox regression modeling was used to assess the effect of human papillomavirus status on tumor recurrence, taking into account patient age, clinical stage, histologic node status, and type of tumor. RESULTS Seventy of 74 (95%) of the recurring tumors and 62 of 74 (84%) of the nonrecurring tumors were human papillomavirus deoxyribonucleic acid positive. The rates of positivity of types 16 and 18 were 64% versus 31% in the recurrers and 65% versus 14% in the nonrecurrers. Human papillomavirus type 18 positivity was associated with a greater risk of recurrence than was type 16 positivity (hazard ratio 1.8; p = 0.03). Clinical stage, nodal metastasis, and young age (< or = 35 years) also had adverse effects on relapse (hazard ratio for each approximately 2). CONCLUSION Human papillomavirus type 18 positivity is a risk factor for tumor recurrence in surgically treated cervical cancer.

Malignant mixed mullerian tumour of the ovary: Prognostic factor and response of adjuvant platinum-based chemotherapy

Objectives: The purpose of the present study was to analyse retrospectively the data of a series of patients presenting to our unit with malignant mixed mullerian tumour (MMMT) of the ovary to identify the prognostic factors and relate them to survival. The role of platinum‐based chemotherapy in the adjuvant treatment of this tumour was also evaluated.

Reflectance confocal microscopy for diagnosis of mammary and extramammary Paget’s disease

Background  Paget’s disease is an intraepidermal adenocarcinoma that is difficult to diagnose clinically as it mimics inflammatory or infectious diseases. As a consequence, it may be clinically misdiagnosed resulting in a delay in appropriate management. Reflectance confocal microscopy allows the visualization of the upper layers of the skin and mucosa at cellular resolution. Paget’s disease is characterized histologically by the presence of neoplastic cells scattered throughout all layers of the epidermis in a pattern similar to that also observed in melanoma (and termed Pagetoid spread).

The site of infection and ethnicity of the patient influence the biological pathways to HPV-induced mucosal cancer

High-risk human papillomaviruses are the causative agents of cervical cancer and are also believed to be aetiologically involved in a subset of squamous cell carcinomas of the head and neck region, especially the tonsil. Cervical cancers arise through disruption of the pathways of p53 and the product of the retinoblastoma gene by the human papillomavirus oncoproteins E6 and E7. It is generally assumed that the same pathways are involved in human papillomavirus-induced carcinogenesis at other mucosal surfaces. However, the patterns of expression of cell cycle proteins targeted by human papillomavirus E6 and E7 in cancers from different anatomic sites have been inconsistent, due to either biologic or technological factors. In this study, 73 human papillomavirus, 16-positive cervical squamous cell carcinomas (35 from Australian and 38 from Chinese women) were analysed for the expression of p53, pRb, p16INK4A, p21CIP1/WAF1, p27KIP1 and cyclin D1 by semiquantitative immunohistochemistry. Cervical cancers from Chinese women were found to be significantly more likely to overexpress p53, pRb, p21 and p27 than their Australian counterparts. These findings were compared with those from 31 human papillomavirus 16-positive tonsillar squamous cell carcinomas, all of Australian origin, tested using the same methodology. Comparisons of the tonsillar and combined cervical data showed that tonsillar cancers were significantly more likely to be p53-positive, whereas cervical cancers were significantly more likely to overexpress pRb, p16 and p27. When the tonsillar data were compared with cervical data from Australian women, the associations for p53 and pRb remained. These findings represent new evidence that the molecular pathways to human papillomavirus-induced mucosal cancer may be influenced by anatomic location and ethnicity.

Gynaecology meets neurology: Paraneoplastic cerebellar degeneration

Paraneoplastic syndromes (PNS) are defined as a constellation of symptoms involving non-metastatic systemic effects which accompany malignant disease. Gynaecological tumours can manifest a variety of paraneoplastic sequelae including neurologic, haematopoietic, vascular, rheumatologic, dermal and endocrine disorders. Neurologic paraneoplastic phenomena occur in less then 1:20 0000 of the population per year. Cerebellar degeneration is a rare and frequently devastating paraneoplastic syndrome which can be associated with gynaecological malignancies amongst others. Despite this rarity, over 50% of those patients over the age of 50 with subacute cerebellar degeneration will be associated with a paraneoplastic phenomena. Overall 90% of all paraneoplastic cerebellar degeneration (PCD) is associated with either lymphoma, lung, breast, or ovarian cancers. The two cases reported here demonstrate the marked variation in clinical outcomes, salient points in workup and treatment for patients with this difficult clinical scenario.

Pyoderma gangrenosum of the vulva

Primary non-trophoblastic tumours of the placenta reported to date are chorioangioma and teratoma, both of which are extremely rare. A case of teratoma in a term placenta is reported.

Patient satisfaction with inpatient care provided by the Sydney Gynecological Oncology Group

Purpose: Patient satisfaction with the provision of hospital oncology services can have a significant impact on their overall treatment experience. Aims: To assess patient satisfaction with the inpatient hospital services in the gynecological oncology setting using the IN-PATSAT32 questionnaire developed by the European Organization for Research and Treatment of Cancer (EORTC). Methods: A modified version of the IN-PATSAT32 questionnaire with additional 16 items was administered to 52 adult surgical inpatients admitted with the Sydney Gynecological Oncology Group. All participants were provided with an information leaflet regarding the survey and written consent obtained. Results: A high response rate (100%) from patients with varied social, ethnic, and educational backgrounds confirmed the acceptability of the survey. Standard of medical care provided, frequency of doctors’ visits, exchange of information with doctors, friendliness of the staff, and state of the room ranked highly (>95%) on the patient satisfaction scales. Problems were identified with ease of access to and within the hospital, quality of food, and exchange of information with other hospital staff. Conclusions: Overall the satisfaction with inpatient care was rated very highly in most areas. Deficiencies in certain elements of provision of medical care to the patients were identified and steps have been taken to improve upon these shortcomings.

A prospective study assessing patient satisfaction at a large tertiary gynecologic oncology/dysplasia unit.

Background: Patient satisfaction is an important quality assurance measure in the delivery of health care. We conducted a prospective study to assess patient satisfaction at a large tertiary oncology/dysplasia unit. Aims: To assess current patient satisfaction at a large tertiary oncology/dysplasia unit and identify potential areas for improvement. Methods: This was a prospective study of patients attending a tertiary oncology/dysplasia unit. Patients were invited to participate and, if they agreed, were given a validated questionnaire to complete at the end of their consultation. Descriptive statistics were then used to analyze the data and identify potential areas of improvement. Results: One hundred eighty-seven patients were recruited, and 96% of patients were satisfied with the overall level of care received. Significant positive features of the service included helpfulness of the staff, cleanliness of the facility, and measures implemented to respect patient privacy. Lack of patient parking, waiting times in the clinic, difficulties in contacting the service, and locating the building were identified as areas for improvement. Conclusion: Patients attending our facility were largely satisfied with the overall level of care received. Nonclinical factors including parking, waiting times, and access to the service were identified as areas for improvement.

Outcome of cervical intraepithelial neoplasia 2 diagnosed by punch biopsy in 131 women

Aim:  To study the outcome of biopsy‐diagnosed cervical intraepithelial neoplasia (CIN) 2 in patients treated by loop electrosurgical excision procedure (LEEP) or cold knife cone biopsy (CKC).

Recurrence after treatment for high-grade dysplasia: Should we modify our post-treatment surveillance protocols?

A cohort of women, having undergone an excisional procedure for high‐grade cervical dysplasia, was studied to identify those patients who developed recurrent high‐grade cervical dysplasia post‐treatment. We have confirmed that recurrent histologically confirmed high‐grade cervical dysplasia is uncommon after complete excision and appears not to occur within the first 6 months post‐treatment. Post‐treatment surveillance protocols should incorporate these findings.