Hazel Gore

Adenocarcinoma of the cervix: I. Clinical evaluation and pathologic features

A series of 137 patients with primary adenocarcinoma of the cervix is presented with emphasis on clinical and histologic features. Adenocarcinoma has several distinct histologic patterns that may occur in a pure form but often occur (44%) in combinations of two or more patterns. Mixtures of adenocarcinoma and squamous cell carcinoma occur in one third of the patients and squamous intraepithelial neoplasia occurs in one tenth. Transmission electron microscopy is helpful in classifying poorly differentiated tumors. Preliminary recurrence/survival data suggest that the identification of patterns and subpatterns has no prognostic significance, nor is there evidence that adenocarcinoma (or adenosquamous carcinoma) metastasizes earlier, metastasizes more frequently, or is more radioresistant. For most patients, treatment may be the same as that for squamous cell carcinoma but a few selected patients with bulky central lesions may benefit from combined therapy consisting of whole-pelvis irradiation and conservative hysterectomy.

Analysis of prognostic features in adenocarcinoma of the cervix

Uncertainties regarding the clinical behavior and management of women with primary adenocarcinoma of the cervix persist. A series of 162 patients was evaluated with emphasis on histopathology, clinical features, treatment, and survival. Sixty-seven patients underwent radical hysterectomy alone, 65 patients underwent radiation therapy alone, while the remainder were treated with combined surgery and radiotherapy. When compared to a matched series of squamous cell carcinoma patients, no statistical differences in survival could be demonstrated. Clinical stage (P less than 0.001) and lesion size (P less than 0.001) were the most important prognostic factors for the entire series. Patients with adenocarcinoma of varied histologic patterns were compared to patients with adenosquamous lesions and no statistical difference in survival could be demonstrated. Multivariate analysis of those women with Stage I adenocarcinoma of the cervix identified risk groups based on tumor grade, lesion size, and patient age. Patients in the low risk group had a 5-year survival of 89.5% while patients in the intermediate and high risk groups had 5-year survival rates of 68.4 and 37.3%, respectively. In patients with Stage I well-differentiated lesions survival was excellent, independent of lesion size.

Normal Uterine Cervix: Characterization of Isolated Lymphocyte Phenotypes and Immunoglobulin Secretion

PROBLEM: Isolation of viable cervical lymphocyte populations and characterization of their function in healthy tissue is necessary to understand immunity in the genital tract.

Hormonal contraception and trophoblastic sequelae after hydatidiform mole (A Gynecologic Oncology Group study)

A prospective randomized study was undertaken to determine whether the administration of oral contraceptives after the evacuation of a hydatidiform mole affects the human chorionic gonadotropin serum level in a way that leads to an increased frequency in the diagnosis of postmolar trophoblastic disease. Between 1981 and 1988, 266 patients were randomly assigned to either oral contraceptives or barrier contraception after evacuation of a hydatidiform mole. Patients were followed up until serum levels of human chorionic gonadotropin were normal or until specific criteria for the diagnosis of postmolar trophoblastic disease were met. Twenty-three percent of patients receiving oral contraceptives had postmolar trophoblastic disease, whereas those using a barrier method had a rate of 33%. The median time to spontaneous regression in the oral contraceptives group was 9 weeks, whereas the median time to regression in the barrier group was 10 weeks. Twice as many patients in the barrier group became pregnant in the immediate follow-up period. We conclude that oral contraceptives are the preferred method of contraception after evacuation of a hydatidiform mole.

CD8+ T lymphocytes are recruited to neoplastic cervix.

ToliicIV distinguish normal cervical lymphocyte populations from phenotypes recruited to the cervix in response to cervical neoplasia, lymphocytes were isolated from normal and neoplastic cervix. A portion of the cervical transformation zone was obtained from 19 patients with pathologically confirmed cervical intraepithelial neoplasia and from 20 patients with normal cervices undergoing hysterectomy for benign indications. Mononuclear cells were harvested from cervical tissue using a serial, multienzymatic digestion procedure and enriched by density gradient centrifugation. Isolated cell populations were stained with surface marker-specific monoclonal antibodies and analyzed by fluorescent activated cell sorter to determine the percentage of B cells, total T cells, CD4+ T cells, CD8+ T cells, and natural killer (NK) cells. The distribution of circulating peripheral blood lymphocyte phenotypes was similar for both patients with neoplasia and normal controls. A marked disparity in the proportions of NK cells and T cells was demonstrated among lymphocyte phenotypes infiltrating the cervix. The percentage of CD4+ T cells and NK cells was significantly depressed (P=0.04,P=0.03, respectively) in dysplastic tissue as compared to normal cervical tissue. In contrast, the proportion of CD8+ T cells was significantly increased in the dysplastic tissue (P=0.0001). Analysis of immunocompetent cells in the circulation appears to have little correlation with immunocytes present in the dysplastic epithelium. The depression in the proportion of CD4+ T lymphocytes and NK cells at the cervical squamocolumnar junction reflects a local recruitment of CD8+ T cells to the site of neoplasia in the cervix.

Tumor recurrence and survival in stage Ib cancer of the cervix

CLINICAL RECORDS OF 371 WOMEN WITH CARCINOMA of the cervix, Stage IB, treated in the decade 1969–1979 were reviewed. Cancer recurred in 67 women (18.1%). A group of 171 patients treated by radiation, including 25 who were surgically staged prior to treatment, was compared to 200 patients treated by radical abdominal hysterectomy and pelvic node dissection, including 35 who had postoperative whole pelvis radiation. A multi-factorial analysis included time to recurrence, site of recurrence, treatment for recurrence, and survival after recurrence. Pathology review and clinicopathological correlation included tumor configuration, histologic type, size of tumor in greatest dimension, and rate of node metastases in patients undergoing either radical hysterectomy or surgical staging procedures. Lesion size was found to be the most accurate predictor of disease-free survival; this was true whether the patient was treated by surgery or radiation and was not significantly affected by the tumor histology. Nodal metastases were associated with increasing size of lesions and predicted high recurrence rates. Node metastasis rates were not affected by the histology of the tumor.

Immunohistochemistry of the blood group A, B, H isoantigens and Oxford Ca antigen as prognostic markers for stage IB squamous cell carcinoma of the cervix

Currently, there is lack of a histologic classification of squamous cell carcinoma of the cervix that correlates significantly with patient survival. This study investigated the survival predictive value of two immuno‐histochemical markers, the blood group A,B,H isoantigens and the Oxford Ca antigen, on conventional histologic sections of tumor tissues from 85 surgically treated patients with Stage IB squamous cell cervical cancer. The results indicated that the two antigens are two distinct markers, neither of which correlates with tumor grade. The expression of the A,B,H isoantigens is significantly related to patient survival after adjustment for the depth of stromal invasion of the tumor, whereas the Oxford Ca antigen has no survival predictive value.

Coexisting intraductal breast carcinoma and metastatic choriocarcinoma presenting as a breast mass.

Identifying choriocarcinoma in breast tissue is a rare phenomenon. This report describes an unusual case of metastatic choriocarcinoma presenting as a breast mass and coexisting with an intraductal breast carcinoma. This is the first documented case of a choriocarcinoma metastatic to the breast that has responded to chemotherapy.

Human chorionic gonadotropin-secreting large cell carcinoma of the lung detected during follow-up of a patient previously treated for gestational trophoblastic disease

Abstract A patient is presented whose large cell carcinoma of the lung was detected by an elevated β subunit human chorionic gonadotropin (HCG) titer 2 years after undergoing chemotherapy and remission for metastatic trophoblastic disease. The secretion of HCG was low (3.48 to 14.18 mIu/ml) and intermittent. Roentgenologic appearance of the lesion occurred 4 months after secretion of HCG was detected. HCG-producing tumors of nontrophoblastic origin should be considered when low titers are detected after complete remission of trophoblastic disease.

Lymph node metastasis in cancer of the cervix: A preliminary report

Accurate assessment of lymph node metastasis in cervical cancer is imperative to treatment plan. A histologic sampling method is suggested in which surgically excised lymph nodes are dissected at multiple levels before paraffin embedding. This approach proves to be a more sensitive procedure than the current bisection method in detecting metastasis.