J.D. Woodruff

Retroperitoneal lymphatic involvement with epithelial ovarian tumors of low malignant potential

A comprehensive understanding of retroperitoneal lymphatic involvement is lacking in tumors of low malignant potential. This study was undertaken to evaluate retroperitoneal lymphatic involvement in patients with ovarian tumors of low malignant potential. One hundred seventy-one patients were diagnosed with epithelial ovarian tumors of low malignant potential between 1979 and 1989. Thirty-four (20%) of these patients underwent surgical staging which included lymph node sampling. The stage distribution was Stage I in 17 patients (50%), Stage II in 4 patients (12%), and Stage III in 13 patients (38%). The histology of the tumors was serous in 26 patients (76%), mucinous in 7 patients (21%), and seromucinous in 1 patient (3%). The incidence of retroperitoneal lymphatic involvement was 21%. The occurrence of positive pelvic and para-aortic nodes was 17 and 18%, respectively. Patients with localized intraperitoneal disease were upstaged in 22% of the cases based on retroperitoneal lymphatic involvement. Four of twenty-one patients (19%) with intraperitoneal disease confined to the ovary and two of six patients (33%) with intraperitoneal disease confined to the pelvis were upstaged to Stage III as a result of retroperitoneal lymphatic disease. Although the nodal status of patients did not significantly affect survival, those patients with localized intraperitoneal disease and nodal involvement had a higher incidence of recurrence which was statistically significant (P = 0.025). Accordingly, retroperitoneal lymph node sampling at the time of initial laparotomy may provide valuable prognostic information regarding recurrence in patients with tumors of low malignant potential.

The origin and clinical behavior of the parovarian tumor.

This study of 132 benign parovarian cysts and eight parovarian neoplasms demonstrated that the majority of such lesions are of paramesonephric or mesothelial origin. Furthermore, adnexal neoplasms, not histologically associated with the tube or ovary, may arise in such parovarian structures or de novo from the pelvic mesothelium.

Secondary malignancies in benign cystic teratomas

Abstract Seventeen cases of secondary malignancy arising in benign cystic teratomas are described. All 17 cases contained elements of the preexisting benign cystic teratoma. Thirteen contained invasive squamous cell carcinoma alone. In situ squamous cell carcinoma was seen in 1 case. Three cases displayed invasive squamous cell carcinoma plus a mixed mesodermal tumor, a carcinoid in struma ovarii in thyroid tissue, and a follicular adenoma in thyroid tissue, respectively. These neoplasms occurred in women in the fifth decade of life and treatment in most cases was a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Survival was dependent upon clinical stage at the time of diagnosis and therapy.

Proliferative and malignant Brenner tumors. Review of 47 cases

The Brenner tumor has been promoted as a relatively rare benign ovarian neoplasia. During the past three decades, the recognition of “malignant” and “proliferating” variants has produced controversy and conflict as to the histopathologic criteria for definite diagnosis of these lesions and, more importantly, as to their relationship to “the controversial ovarian tumor.” The opportunity to study 47 cases of malignant and proliferative Brenner tumors is the subject of this article. Histopathologic criteria for diagnosis, histogenesis, and clinical significance of these unique tumors are discussed.

Investigation of ovarian neoplasia of low malignant potential for human papillomavirus

Recent in situ hybridization studies have suggested the presence of human papillomavirus type 6 (HPV-6) DNA in ovarian cancer cells. An association between HPV and ovarian neoplasia of low malignant potential (LMP) has not been previously identified. Paraffin-embedded tissue blocks from 24 patients with LMP ovarian tumors were screened for human papillomavirus DNA. The patients ranged in age from 18 to 73 years. Corresponding microscopic slides from each tissue block were reviewed to confirm the histopathologic diagnosis. For identification of HPV genome, deparaffinized sections were subjected to the polymerase chain reaction to achieve amplification of DNAs of HPV types 6, 11, 16, and 18. For each HPV type, a 120-base-pair region of the E6 gene was targeted for amplification. Human papillomaviral DNA was not detected in the tissue specimens subjected to polymerase chain reaction. These results suggest that HPV types 6, 11, 16, and 18 are not likely to play a role in LMP ovarian tumors. These results do not totally exclude possible contributions of other HPV types.

Surgical emergencies of the uterine adnexae during pregnancy

During the 5‐year period 1976–1980, seven cases of emergent surgical disease of the adnexae during pregnancy were encountered. The incidence of 1:1832 deliveries approximated that of appendicitis (1 : 1603 deliveries) during the same period. There were three cases of adnexal torsion, two ruptured ovarian cysts with hemorrhage, one heterotopic pregnancy, and one ruptured endometrioma. The right side was more commonly the site of the pathology, and abdominal pain the only consistent presenting symptom. Fever, tachycardia, and leukocytosis were inconsistent findings. Culdocentesis was positive in two cases. Four desired pregnancies were carried successfully to term postoperatively.

Mucinous cystadenocarcinoma of the ovary.

Reports of 78 cases of mucinous cystadenocarcinoma of the ovary were collected from the Emil Novak Ovarian Tumor Registry and the files of the Gynecologic Pathology Laboratory of the Johns Hopkins Hospital between the years 1942 and 1966. Two-year and 5-year followups were available for 91 and 83% of the cases, respectively. The prognosis was related to the most aggressive area of the tumor as the histologic grade was based on the maximum number of mitoses per high-powered field. In view of the clinical and histopathologic differences between these lesions and the serous and endometrioid varieties, it is suggested that each tumor be considered on its own merits in order to offer an accurate prognosis.

GYNECOLOGYProliferative and malignant Brenner tumors: Review of 47 cases

The Brenner tumor has been promoted as a relatively rare benign ovarian neoplasia. During the past three decades, the recognition of “malignant” and “proliferating” variants has produced controversy and conflict as to the histopathologic criteria for definite diagnosis of these lesions and, more importantly, as to their relationship to “the controversial ovarian tumor.” The opportunity to study 47 cases of malignant and proliferative Brenner tumors is the subject of this article. Histopathologic criteria for diagnosis, histogenesis, and clinical significance of these unique tumors are discussed.

Histogenesis of the broad ligament adrenal rest.

Broad ligament adrenal rests are well known. A case of adrenal rest external to the surface of the broad ligament and adjacent to the fallopian tube is reviewed, with specific emphasis on its histogenesis. The rest is associated with a foreign body, and it is suggested that it has arisen as a secondary development of celomic epithelial metaplasia.

Long-term follow-up of serous ovarian tumors of low malignant potential

Long-term follow-up of serous ovarian tumors of low malignant potential Leake J.F.; Currie J.L.; Rosenshein N.B.; Woodruff J.D. USA GYNECOL ONCOL 1992 47/2 (150-158) The biologic behavior of serous tumors of low malignant potential (LMP) is of significant interest, yet most large series lack extended follow-up. This study consists of 200 patients: 106 patients were diagnosed with serous tumors of LMP at our institution between 1979 and 1984 and an additional 94 patients were identified in the referred tumor registry. The patients ranged in age from 6 to 98 years (median, 34 years). The stage distribution was Stage I in 135 patients (67.5%) Stage II in 24 patients (12%), and Stage III in 41 patients (20.5%). Follow-up information from 4 to 27 years (median, 10 years; mean, 11.2 years) revealed 155 patients (77.5%) were alive without further evidence of disease and 11 patients (5.5%) died of unrelated conditions without recurrent tumor. Thirty-four patients (17%) developed recurrent neoplasms at 6 to 145 months (median, 26 months). Patients with Stage III disease developed recurrent neoplasms more commonly (54%) than did patients with Stage I or II disease (6 and 17%, respectively). Following treatment of recurrence, 15 patients are free of disease, 6 patients are alive with disease, and 13 (6.5% overall) patients have died of disease 1 to 15 years (median, 5 years) after their initial diagnosis. Mortality was also stage dependent: 0.7, 4.2, and 26.8% of patients with Stages I, II, and III disease, respectively, died secondary to tumors of LMP. Clinical life table analysis demonstrated 5-, IO-, and 15-, and 20-year survival rates for all stages of 97, 95, 92, and 89%, respectively. These findings confirm the excellent prognosis for patients with serous tumors of LMP, even when long-term follow-up is extended to 20 years. Additionally, these data suggest that those with more advanced or recurrent disease can enjoy extended survival. Age at last full-term pregnancy and risk of breast cancer Kalache A.; Maguire A.; Thompson S.G. GBR LANCET 1993 34118836 (33-36) Age at first full-term pregnancy (FTP) has long been thought to be the major reproductive risk factor in breast cancer but a Norwegian study suggested that age at last FTP might be more important. In Norway ‘high parity’ means 4 or more deliveries. Does this finding hold in an area with a much broader distribution of parity? Data from a case-control study done in 1980-82 in Fortaleza and Recife, two cities in Brazil’s impoverished north-east, have been used to explore further the influence of age at last FTP. The cases were 509 women with histologically diagnosed breast cancer who were matched with hospital controls for age and area of residence. The analysis was based on case-control pairs interviewed by the same person. High breast cancer risk was associated with low parity; after adjustment for parity, breast cancer risk was related both to late age at first FTP (odds ratio [OR] 1.21 for each 5 year increase, p = 0.008) and to late age at last FTP (OR 1.24, p = 0.0007). However, multivariate analysis revealed that the effect of age at last FTP dominated that of age at first FTP: once age at last FTP was taken into account the effect of age at first FTP was no longer significant (OR 1.08, p = 0.38) while the association with parity became more striking. These results challenge the view that age at first FTP is the principal reproductive variable related to breast cancer risk. Moreover, they suggest that high parity is protective independent of ages at first and last FTP. Given recent worldwide reductions in fertility rates, breast cancer incidence may be expected to increase. Balancing that may be the willingness of some women to complete their families by, say, age 35 if they were to be told that this might reduce their risk of breast cancer.