H. Pickel

Nongenital cancers metastatic to the ovary

Abstract We review our experience with 82 patients with nongenital cancers metastatic to the ovary. All patients were referred for evaluation of an ovarian mass. The patients had primary carcinoma of the breast ( n = 28), colon ( n = 23), stomach ( n = 22), pancreas ( n = 7), or gallbladder ( n = 2). The overall actuarial 5-year survival rate was 10%. Five-year survival in patients with metastatic colon cancer was significantly higher (23%) than that in patients with metastatic cancer of the breast, stomach, gallbladder, or pancreas, all of whom died within 58 months ( P p = 0.003). Five-year survival in patients with disease limited to the pelvis was significantly higher than that in those with abdominal spread (22% vs 6%; P 2 cm in diameter was 18% or 4%, respectively ( P = 0.002). This pattern applied mainly to differences in patients with primary cancer of the breast or colon ( P

Abdominopelvic computed tomography in the preoperative evaluation of suspected ovarian masses

To evaluate the efficacy of computed tomography (CT) in 175 patients scheduled to undergo surgery for a suspected ovarian mass, we compared preoperative CT findings with the findings at surgery and histology. At surgery, 115 patients were found to have epithelial ovarian malignancies (20 stage 1, 7 stage II, 50 stage III and 38 stage IV) while 60 had benign pelvic tumors. CT findings were suggestive of malignancy in 4 (7%) of 60 patients with benign tumors and suggestive of benign disease in 3 (3%) of 115 patients with malignant ovarian tumors; 30% of all scans were inconclusive. The sensitivity of CT for predicting pelvic or para-aortic lymph node involvement in 42 patients who underwent lymphadenectomy was 62 and 70%, respectively; the specificity was 100%. The results of this series suggest that the routine use of CT in the preoperative evaluation of patients does not seem justified.

In vitro chemosensitivity testing in the treatment of ovarian carcinoma.

SummaryIn vitro chemosensitivity to cisplatinum, adriamycin, cyclophosphamide, and 5-fluorouracil was investigated in 58 cases of ovarian carcinoma using Volms short-term test. These in vitro results were retrospectively correlated with the relapse-free interval. Operative treatment in all patients (FIGO stage I (5), III (43), IV (10)) comprised maximum debulking procedure including hysterectomy, adnexectomy, omentectomy, pelvic and in most cases additionally paraaortic lymphadenectomy. Subsequently, all patients were treated with the cisplatinum-epirubicin-cyclophosphamide regimen. 33/58 tumors (66%) were sensitive in vitro (inhibition of nucleic acid precursor incorporation of more than 45% as compared to untreated controls). The median relapse-free interval of patients with sensitive tumors was significantly longer than that of those with resistant carcinomas (30.3 versus 22.6 months, respectively;P<0.05). Histopathological evaluation showed the majority of serous cystadenocarcinomas to be sensitive (26/33=79%,P<0.05).

Messerkonisation versus Loop-Excision – klinische und histomorphologische Ergebnisse

In einer prospektiv randomisierten Studie wurden die histomorphologischen und klinischen Ergebnisse der Messerkonisation (n = 52) und der Loop-Excision (n = 38) miteinander verglichen. Alle PrApa

Efficacy of Adjuvant Carboplatinum-Epirubicin Chemotherapy in Advanced Ovarian Cancer after Radical Surgery

Postoperatively, 13 patients with stage III ovarian cancer received a combination of carboplatin and epirubicin (PE) at 300 and 60 mg/m2 respectively. The results of the 13 patients receiving the PE regimen were retrospectively compared to those of 24 patients who received the conventional PAC schedule (cisplatin, Adriamycin and cyclophosphamide at a dosage of 50, 50 and 750 mg/m2, respectively). All 37 patients had undergone radical debulking surgery including pelvic and paraaortic lymphadenectomy. At 8 months, relapse-free rates of 42.2 and 79.2% were observed in the PE and PAC groups, respectively. This difference was highly significant (p = 0.011). The data suggest that the PE combination has less antineoplastic activity than the PAC schedule and thus cannot be recommended in the adjuvant treatment of advanced ovarian cancer.

Pelvic lymphadenectomy in operative treatment of ovarian cancer

From the end of 1979 to September, 1985, radical pelvic lymphadenectomy was performed at the Graz Clinic in 123 cases of Stages IA to IV ovarian cancer following maximum debulking procedure. In 97 patients lymphadenectomy was done primarily. In 26 it was performed during a follow-up operation to chemotherapy. The frequency of pelvic node involvement was 61.8% in the total material and 78.0% in 82 cases of Stage III disease only; 75.0% positive nodes were found in Stage III after chemotherapy. Aortic nodes were positive in 41.4%, but only when pelvic nodes were also positive. The 5-year actuarial survival rate for Stage III disease was 53.0% after pelvic lymphadenectomy compared with 13.0% without. In cases with negative nodes the survival rate was 74.7%; with positive nodes the survival rate was 45.9%.

Viability and adhesion of hysteroscopically disseminated endometrial cancer cells in vitro

accuracy of 90.0% was seen. Likelihood ratios for a result that showed abnormal endometrium increased the post-test probability more than 6 fold. There was a significantly greater inability to insert a curette for the conventional curettage and likewise a greater need for cervical dilatation. One adverse event after the curettage was noted (0.2%). Conclusion: Endometrial biopsy is a useful diagnostic procedure for the detection of endometrial cancer. It is highly accurate but must be used with an understanding of its limitations.

Lymphadenectomy in stage I ovarian cancer

The p53 tumor suppressor gene frequently is altered in gynecolugic cancers Berchuck A.; Kohler M.F.; Marks J.R.; Wiseman R.; Boyd J.; Bast R.C. Jr. USA AM J OBSTET GYNECOL 1994 170/l I (246-252) Mutation of the p53 tumor suppressor gene, often accompanied by overexpression of mutant p53 protein, is the most frequent molecular genetic event described thus far in human cancers. In adenocarcinomas of the ovary and endometrium, p53 overexpression is seen in approximately 10% to 15% of early and 40 to 50% of advanced cancers. Similar to many other types of human cancers, ovarian and endometrial cancers that overexpress p53 protein contain mutations in conserved regions of the p53 gene. These mutations are predominantly transitions, which suggests that they arise spontaneously rather than being caused by carcinogen exposure. Alteration of the p53 gene does not appear to be a feature of endometrial hyperplasias or benign or borderline ovarian tumors. Although mutation and overexpression of p53 rarely occur in cancers of the cervix, vulva, and vagina, it has been shown that human papillomavirus E, oncoproteins bind to and inactivate p53 protein. Studies of the p53 gene have begun to provide insight into the molecular pathogenesis of gynecologic cancers.

Die Computertomographie in der präoperativen Abklärung von Ovarialtumoren

Es existieren nur wenige Studien uber den Wert der Computertomographie (CT) in der praoperativen Diagnostik von Tumoren, bei welchen klinisch der Verdacht auf ein Malignom des Ovars bestand. Ziel der vorliegenden Arbeit war es, die Ergebnisse des praoperativen CT-Befundes mit jenen bei der Laparotomie bzw. der Histologie des Operationspraparates zu korrelieren.

Experience with stromal tumors and germ-cell tumors of the ovary

Thirty patients with tumors of the ovarian stroma (28 granulosa cell tumors, two androblastomas) and 12 women with germ-cell tumors (nine dysgerminomas, two teratomas, one endodermal sinus tumor) were treated at the Department of Obstetrics and Gynecology of the University in Graz between 1972 and 1989. Of the 28 patients with granulosa-cell tumors, 24 (86%) had stage I disease, 27 were primarily treated by surgery, and seven (25%) developed a recurrence (three stage I, three stage III and one stage IV). There were three recurrences in the peritoneal cavity and two in the paraaortic nodes; six of the seven patients died of recurrent disease. Four of nine patients with stage I dysgerminomas developed recurrences, two of which were located in the para-aortic nodes. Three patients with recurrence after stage Ia disease are currently alive without evidence of disease; one patient with stage Ib disease died 11 months after a paraaortic recurrence. Wider use of cytostatic combinations and careful surgical staging, including lymphadenectomy, may improve the survival of patients with stromal or germ-cell tumors.