Dan Beck

Involvement of the central nervous system by ovarian carcinoma

Ovarian carcinoma rarely metastasizes to the central nervous system (CNS). Of 110 patients with epithelial ovarian carcinoma treated at the Northern Israel Oncology Center between the years 1979 and 1985, only five (4.5%) had CNS involvement. The median age of the patients was 54.5 years. All of them had treatment with cisplatin and Adriamycin (doxorubicin). The median duration from diagnosis to the development of brain involvement was 17 months. The median survival time was 28 months from diagnosis of carcinoma and 2 months from diagnosis of CNS disease. The increased incidence of this kind of metastasis in patients achieving local control of their advanced disease suggests that a change in the pattern of metastatic spread or the prolonged survival permits occult CNS metastases to become apparent. A routine computerized axial tomography (CAT) scan of the brain should therefore be performed on patients with ovarian carcinoma with prolonged survival.

Uterine artery flow velocity waveforms and color flow imaging in women with perimenopausal and postmenopausal bleeding. Correlation to endometrial histopathology.

We performed Doppler studies of the uterine artery in 85 women with postmenopausal and perimenopausal bleeding. Sixty‐six women had non‐malignant changes and 19 women had malignant changes on histologic examination of the endometrium. Uterine fibroids were detected in 30 women. When malignant changes were detected in the endometrium, uterine artery resistance index was always below 0.83. The mean uterine artery resistance index was significantly lower in the group of women with pathologic changes of the endometrium (RI = 0.77±0.03) compared to the group with non pathologic changes (RI=0.85±0.08 p<0.01), excluding the women with uterine fibroids. The lowest mean resistance index in the uterine artery was observed in the group of women with uterine fibroids (RI = 0.60 ± 0.09 p< 0.001). In five of six patients with endometrial carcinoma blood vessels were detected around the myometrium by using color flow imaging. Their RI was always less than 0.5. In five patients, blood vessels were detected in uterine fibroids but their RI was always more than 0.5. All six women with endometrial carcinoma but only seven of 13 women with endometrial hyperplasia, had endometrial thickness greater than 5 mm. Doppler velocimetry of the uterine artery carries a high sensitivity (100%) in detecting pathological changes of the endometrium in patients presenting with postmenopausal or perimenopausal bleeding. The presence of high resistance in this vessel, may allow a more conservative approach in this group of patients.

Mullerian adenosarcoma of the uterine cervix

The management of cervical adenosarcoma in a 14-year-old girl is described. The tumor had an exceptionally violent biological nature and did not respond to a variety of customary and unorthodox therapeutic measures. These included conventional intravenous chemotherapy, radiation therapy, surgery, intraarterial chemotherapy, colostomy, and peritoneovenous shunt for untreatable ascites. The patient died within 16 months of diagnosis. This is the fifth case of cervical adenosarcoma in the English literature. This tumor usually has a better prognosis and none of the previous four cases succumbed to the disease. The unusual virulence of the present case is discussed and the literature reviewed.

The modulating effect of human chorionic gonadotropin on lymphocyte blastogenesis

Human chorionic gonadotropin (HCG) produced by fetal trophoblastic cells was suggested to play a role in the suppression of maternal lymphocyte response against the fetal allograft. Reports supporting this concept have demonstrated a suppressive effect of crude HCG on lymphocyte blastogenesis. However, similar doses of purified hormone preparations were unable to inhibit lymphocyte stimulation with mitogens. A modulating influence of phenol-free and immunoglobulin-free HCG preparation on lymphocyte blastogenesis is presented. Enhanced lymphocyte stimulation with various mitogens occurred in cultures supplemented with HCG at low doses. On the other hand, higher hormone concentration exerted an inhibitory effect on lymphocyte blastogenesis. An increase in lymphoid cell concentrations was demonostrated in cultures supplemented with the hormone preparation. These observations are compatible with the suggested role of HCG in the maternal tolerance toward a histoincompatible fetus.

Consolidation radiation therapy following cytoreductive surgery, chemotherapy and second-look laparotomy for epithelial ovarian carcinoma: long-term follow-up.

Background From 1979-1987, 139 stage IC-IV ovarian cancer patients who had undergone cytoreductive surgery received 6-11 cycles of cisplatin and adriamycin. Study design Eighty-four clinically complete responders underwent second-look laparotomy, and 60 of them received consolidation abdominal irradiation. The patients were then followed for a median follow-up of 39 months. Results Five- and 10-year actuarial survival for all patients was 43% and 24%, for no residuum at primary surgery, 80% and 35%, for residual tumor <2 cm, 45% and 35%, and for residual tumor >2 cm, 20% and 4%. Median survival for stage III-IV patients negative at second-look laparotomy was 72 months in irradiated compared to 25 months in non-irradiated patients (P = 0.14) and 77 months in irradiated patients with microscopic disease at second-look laparotomy. Median survival in patients with macroscopic disease at second-look laparotomy was 23.5 months if irradiated compared to 18 months if not (P = 0.05). Conclusions Consolidation whole abdominal irradiation in advanced stages of ovarian cancer may be of value in patients with negative or microscopic disease at second-look laparotomy. Unfortunately, despite the initial survival advantage observed in irradiated patients, owing to late recurrences there was no significant difference in their long-term survival probability.

Growing Teratoma Syndrome Treated by Interferon alpha-2β: Case Report and Literature Review

A 14-year old girl was diagnosed as suffering from an immature teratoma. As removal of the teratoma was technically unfeasible, the patient was started on interferon α 2β, 3 MU/day, 5 days per week. On this therapy, the growth of the teratoma was stopped and the patient has been well for the past 50 months. She continues to be treated with interferon α 2β, with almost no side effects and no restrictions of her everyday activities, with a good quality of life. She is able to attend school regularly, travels abroad frequently, and participates fully in everyday activities normal for her age and social conditions. Her Karnofsky performance status is 100. This case demonstrates the efficacy of interferon α 2β therapy in certain instances of growing teratoma syndrome, even when the tumorous mass is initially quite large.

Increased Alpha-Fetoprotein Levels in Mixed Mesodermal Tumor of the Ovary

2 Cases of mixed mesodermal tumor of the ovary with elevated peripheral levels of alpha-fetoprotein (alpha-FP) were studied. The morphology of these tumors is presented. The finding of hyaline droplets of alpha-FP is of special interest. The histogenesis of the tumor was reappraised in light of the increased level of the marker.

Successful Surgical Management of a Severe Case of Starch Peritonitis

A severe case of starch peritonitis is presented where surgical intervention and resection of the major granuloma abruptly improved the patients condition. The theoretical basis of the syndrome and the treatment are discussed.