Hector M. Tarraza

Stage IE primary malignant lymphomas of the uterine cervix.

The experience of the authors with primary non‐Hodgkins lymphoma of the uterine cervix from 1980 to 1986 included five Ann Arbor Stage IE cases successfully managed by meticulous staging and radiation therapy. The clincopathologic features of the patients are described and compared with 38 previously reported Stage IE cases. When all 43 patients were evaluated, the median age was 40 years of age (range, 20 to 80 years of age) and 77% were premenopausal. Most patients (74%) reported abnormal vaginal bleeding, although approximately 20% were asymptomatic. The primary cervical tumors were typically of large size, with half exceeding 4 cm in diameter. Using the International Federation of Gynecology and Obstetrics (FIGO) system for staging cervical cancer, stage distribution was 44% Stage I, 42% Stage II, 12% Stage III, and 2% Stage IV. Histologically, approximately 70% were of the diffuse, large cell type (Working Formulation). External beam radiation therapy supplemented by brachytherapy or hysterectomy was used for 76% of the patients reviewed. There was only one treatment failure among the 28 patients whose treatment included radiation and whose cases were followed for at least 2 years. This experience and a review of the literature indicate that most cases of primary lymphoma of the uterine cervix are Ann Arbor Stage IE, and can be cured with traditional combinations of surgery and radiation therapy after careful evaluation.

Extragenital malignant mixed mullerian tumor: Review of the literature

A case of extragenital malignant mixed mullerian tumor (MMMT) of the heterologous type 11 years after treatment of a Stage I ovarian neoplasm in a 65-year-old patient is described. There was no evidence of a histologic relationship between these two neoplasms. This case represents the 10th report of an extragenital MMMT. The medical literature and histogenesis of this rare tumor are discussed.

Carcinosarcomas and mixed müllerian tumors of the fallopian tube

Four cases of carcinosarcoma and mixed müllerian tumors of the fallopian tube are presented. Each patient presented with abnormal bleeding and a pelvic mass. All underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, staging, and cytoreduction. Disease was limited to the pelvis in two patients, analogous to FIGO stage IIB ovarian carcinoma; the other two patients had upper abdominal disease, analogous to FIGO stage III. The primary tumors were intraluminal and papillary. There were equal amounts of carcinoma and sarcoma in three tumors; in one, sarcoma constituted only a small intraluminal focus. The sarcoma was predominantly homologous, with foci of heterologous elements present in three tumors. Adjuvant therapy consisted of pelvic radiation in two patients. One patient died of inanition within one year of diagnosis. The other patient, who had the small focus of sarcoma within a stage IIB carcinoma, had an 11-year disease-free interval before retroperitoneal recurrence of carcinoma. Two patients received chemotherapy. A stage IIB patient, after pelvic radiation, received Cytoxan and Adriamycin; she is clinically free of disease after 6 years. A stage III patient lived over 3 years after treatment with multiple agents; she responded to Cytoxan and cis-platinum before suffering a systemic relapse and death.

Vulvar leiomyomatosis in a patient with esophagogastric leiomyomatosis: Review of the syndrome

A case of vulvar leiomyomatosis in a young adult with a history of esophagogastrectomy as a child for esophagogastric leiomyomatosis is presented. The steroid receptor profile of the tumor is described. Therapy with a combination of gonadotropin suppression and surgery was undertaken. The literature pertaining to this rare combination is discussed.

Papillary villoglandular carcinoma of the cervix

Three cases of papillary villoglandular carcinoma of the cervix are presented. Each patient was multiparous and presented with abnormal vaginal bleeding. The mean age at presentation was 35 years (range 28-42 years). All patients were staged as FIGO IB and underwent radical Wertheim hysterectomy and bilateral pelvic lymphadenectomy. Disease was limited to the cervix in two patients and extended to involve the lower uterine segment in one patient. There was no evidence of microscopic spread to the lymph nodes. Previous reports that examined patients with papillary villoglandular carcinoma of the cervix found them to have a favorable prognosis. Treatment implications are discussed.

GYNECOLOGIC CAUSES OF THE ACUTE ABDOMEN AND THE ACUTE ABDOMEN IN PREGNANCY

Evaluation of a female patient who presents with an acute abdomen must always consider surgical and gynecologic disorders. Laparoscopy and pelviscopy have had a major impact on the surgical approach in gynecology. Most acute abdomens can now be approached laparoscopically. Certain conditions that are discussed require the traditional laparotomy. Preservation of reproductive capability has a major impact on the wellness of a woman.

Combination chemotherapy in advanced adenocarcinoma of the fallopian tube

Abstract Advanced adenocarcinoma of the fallopian tube has a poor prognosis, with 5-year survival rates commonly less than 20%. Since 1980, we have managed 12 patients with disseminated tumor with combination chemotherapy following surgical cytoreduction. Analogous to the International Federation of Gynecology and Obstetrics staging of ovarian carcinoma, 3 patients were classified in Stage II, 8 in Stage III, and 1 in Stage IV. Ten patients received cisplatin-containing regimens. The 3 Stage II patients, without measurable disease after primary surgery, had an indeterminate response to chemotherapy. In Stages III–IV there were 4 complete responses (3 confirmed by second-look laparotomy) and 2 partial responses, for an overall response rate of 67%. Disease progressed in 2 patients and was stable in 1 patient. After median follow-up of 3.5 years, 4 of the Stage III–IV patients have no evidence of disease, 1 is alive with disease, and 4 are dead.

The Central America Gynecologic Oncology Education Program (CONEP): Improving gynecologic oncology education and training on a global scale

• 85% of cervical cancer cases occur in developing countries where it is the first or second cause of cancer-related death.

Flow cytometric DNA analysis versus cytology in the evaluation of peritoneal fluids

The use of flow cytometric DNA analysis as an adjunct to cytology in peritoneal fluid evaluation was studied. One hundred ninety-five fluids from 193 gynecologic patients were subjected to both DNA analysis and cytologic examination. It was found that 117/195 (60%) had invasive malignancies (50 ovarian, 48 endometrial, 17 cervical, and 2 miscellaneous); 34/117 (28%) patients with malignancies were positive by cytology, and 10/117 (8.5%) were positive (aneuploid) by DNA analysis. Of 34 cytologically positive cases, 7 (21%) were DNA positive, 25 (74%) were DNA negative, and in 2 (6%) insufficient cells were obtained. Only 3 fluids (3%) from malignancies were positive by flow cytometry and negative by cytology (1 stage I ovarian cancer, 1 stage I endometrial cancer, and 1 stage III ovarian cancer). No false-positive cytology and one probable false-positive flow result was obtained. If only those patients with histologically documented peritoneal involvement are considered, 29/43 (65%) had positive cytology and 8/43 (19%) had a positive flow result. We conclude that: (1) the high false-negative rate of flow cytometry (79%) versus cytology in this study may be related to a high percentage of diploid cancers, specimen preparation, or histogram interpretation, and (2) flow cytometry rarely adds to cytologic evaluation and is probably best reserved for use only in selected cases.

Invasive squamous cell carcinoma of the vagina in a diethylstilbestrol-exposed woman

A case of invasive squamous cell carcinoma of the vagina in a diethylstilbestrol (DES)-exposed patient is described. Histologic evidence indicates that the invasive lesion arose in dysplastic vaginal adenosis. The medical literature regarding squamous cell neoplasia in DES-exposed patients is discussed.