J.Donald Woodruff

The ovarian mesothelioma

Abstract Neoplasms arising from the surface or lining cells of the ovary are classically referred to under such general terms as cystadenocarcinoma, papillary carcinoma, and undifferentiated cancer. Evidence is presented in this discussion to support the thesis that such lesions are mesotheliomas, and that such a thesis can be defended embryologically, histologically, and clinically.

The contemporary challenge of carcinoma in situ of the vulva

Abstract The incidence of “histologically acceptable” in situ cancer of the vulva is increasing. Nevertheless, certain features of such neoplasms raise questions as to (1) the accuracy of the diagnosis, (2) the proper therapy for the individual case, (3) the relationship between viral disease and these neoplasms, and (4) possible means of differentiating the benign proliferating lesion from true malignancy. This study of 44 cases of vulvar in situ carcinoma addresses itself to these issues.

Ovarian teratomas: Relationship of histologic and ontogenic factors to prognosis☆

Abstract Ninety-seven cases of ovarian teratoma, exclusive of the struma ovarii, dermoid cysts, and special malignancies composed of only one element, from the files of the Emil Novak Ovarian Tumor Registry of the American Gynecological Society have been reviewed. Prognosis has been correlated with the degree of differentiation of the tumor elements, since the usual criteria for malignancy are not applicable in most of these lesions. Approximately 75 per cent of the patients were under the age of 26 years. Rapid growth and poor salvage rates were noted in the patients with embryonal teratomas. Tumors in patients over the age of 30 years contained more mature tissue. Irradiation, in a small group, seemed to be ineffective as an adjunctive therapy, except in those lesions made up largely of dysgerminoma. Generally, chemotherapy has been felt to be valueless in these lesions, but “triple therapy” seems to have modified the growth patterns in 2 patients and needs further study.

Multiple malignancy in the upper genital canal

Abstract The concomitant finding of multiple sites of malignant alteration in the upper genital canal (fundus, tube, and ovary) is a frequent and historically well-documented occurrence. Among the study group, there were 118 secondary carcinomas in the Fallopian tube, and 397 cases classified as primary ovarian, endometrial, or tubal cancers. Study revealed that in numerous instances, the pattern of the neoplasm in the separate organs was similar enough to make determination of the primary site impossible and to suggest that a proportion of these cases represented multicentric foci of origin rather than metastatic disease.

Hormone activity of the common ovarian neoplasm

Abstract 1. 1. In 7 of 12 postmenopausal patients with ovarian neoplasms, there was suggestive clinical and pathologic evidence of estrogen activity. Only 1 of 7 tumors (a granulosa thecoma) was a well-recognized hormone producer. 2. 2. Although increased maturation of the vaginal epithelium, elevated urinary estrogen excretion, and endometrial proliferation in this series offered evidence to suggest estrogen production, correlation of the findings in these areas was equivocal. 3. 3. Parallel histochemical studies of the ovarian tumors and the normal ovary have demonstrated corresponding positive findings in the theca of the mature follicle and the periepithelial stroma of the tumor. The proliferating granulosa and the tumor epithelium were similarly reactive. 4. 4. The similarity of the periepithelial stroma of the tumor, to the theca of the developing follicle suggests the possibility that the mechanical stimulation of the proliferating epithelium or granulosa may be a factor in the activation of the mesenchyme to estrogen production.

Role of stroma in regeneration of endometrial epithelium

Abstract Sections of menstruating endometria were studied by various techniques to determine the process by which the surface was re-epithelialized. Although the stumps of remaining glands projected over the surface, this residual epithelium seemed a metabolically inactive and unlikely source of a young growing cell. In many instances, the hyperchromatic stromal cells appeared to project between gland stumps and take part in the re-epithelization by a process simulating metaplasia. Metabolically this stroma-type cell compared favorably with the small, “dark” indifferent cell which is noted at the stromoepithelial border and from which the gland epithelium may reproduce.

The role of the “indifferent” cell of the tubal epithelium

Abstract The indifferent cell of the tubal epithelium is a specific variety and is recognized by simple histologic study. By use of acridine orange fluorescence and incubation with H 3 -thymidine this cell appears to be metabolically more active than the commonly described varieties of the tubal epithelium. In conditions demonstrating increased proliferation of the epithelium, e.g., salpingitis, increase in metabolically active cells corresponds to the increase in the numbers of indifferent cells. It is postulated that this indifferent cell is the cell from which the mature epithelial cell, and possibly even the stroma, regenerates.

Epithelioid leiomyosarcoma of the uterus.

Uterine epithelioid leiomyosarcoma is an unusual smooth muscle neoplasm. It is distinguished on cytoarchitectural grounds from the majority of leiomyosarcomas that arise in the uterus. Three cases of this atypical lesion are presented and the pathologic features are discussed. One patient is alive with no evidence of disease at 3.5 years, one patient has persistent disease at 4 years, and the third patient died of disease at 8 months. Fundamental differences in biologic behavior of this subset of uterine smooth muscle tumors cannot be discerned.

Pregnancy Outcome Following Uterotubal Implantation: A Comparison of the Reamer and Sharp Cornual Wedge Excision Techniques *

The present study reviews the pregnancy outcome in 52 patients treated with uterotubal implantation for intramural or isthmic obstruction. Twenty-six patients were treated with the sharp cornual wedge technique, four of whom conceived for a pregnancy rate of 15%. Within this group, 20 patients had the isthmic portion and 6 patients had the ampullary portion of the fallopian tube implanted into the uterus. The pregnancy rates were 15% and 17%, respectively. An additional 26 patients were treated by the reamer technique, 11 of whom (42%) conceived. Of the 26 patients treated with the reamer technique, 15 had the isthmic portion of the fallopian tube implanted into the uterus and 11 patients had the ampullary portion of the fallopian tube implanted. Pregnancy rates were 27% and 64%, respectively. Over-all, 52 patients were treated with uterotubal implantation, 15 of whom conceived for a pregnancy rate of 29%. Eight patients (15%) had pregnancies which resulted in living children. The reamer technique (implanting the ampullary portion of the fallopian tube) appeared to give the best results in achievement of pregnancy, although this did not reach a level of statistical significance. Adhesion formation involving the fallopian tube and ovary noted at the time of uterotubal implantation was categorized according to a classification based on the extent and the site of the adhesion formation. Pregnancy was less likely to occur in those patients with fixation of the ovary and tube and obliteration of the cul-de-sac (P

Mesonephroid carcinoma of the ovary: A study of 95 cases from the Emil Novak Ovarian Tumor Registry

Abstract Ninety-five cases of mesonephroma of the ovary from the Emil Novak Ovarian Tumor Registry were examined in order to better delineate the clinicopathologic features of this tumor. The majority of patients were in the perimenopausal age group and 51% were nulliparous. Of the 95 patients 68% had tumor confined to the ovary (F.I.G.O. Stage I), in 19% tumor was limited to the pelvis (Stage II), 11.6% had widespread abdominal metastases (Stage III), and only one patient had extra-abdominal extension at the time of initial evaluation (Stage IV). Five-year survival was 43% overall, 63% Stage I, 17% Stage II, and no survivors in Stages III or IV. Salvage in Stage I cases was not affected by histologic grade, stromal proliferation, relative percentage of “clear cells,” or extent of surgery (total hysterectomy with bilateral salpingo-oophorectomy vs unilateral adnexectomy). Endometriosis was demonstrated in only 9.5% of cases and ascites was seen in 8.4%. The authors believe the tumor to be of mesothelial origin and propose that it be called mesonephroid carcinoma of the ovary.