Joseph Menczer

Massive Hyperstimulation and Borderline Carcinoma of the Ovary: A Possible Association

Abstract. A patient with persistent ovarian cysts subsequent to clomiphene‐induced severe hyperstimulation was found to have borderline ovarian carcinoma. Since several endocrine and epidemiological studies implicate hormonal factors in the genesis of ovarian tumors, a possible association between ovarian hyperstimulation and neoplasia is suggested.

Outpatient endometrial sampling with the Pipelle curette

This study compares outpatient endometrial sampling using the Pipelle endometrial sampling curette with conventional dilation and curettage (D&C) in patients with abnormal uterine bleeding. Endometrial sampling with the Pipelle curette was performed in 172 and D&C in 97 women. No complications were encountered with either of these procedures. One hundred and seventy (98.8%) of the Pipelle aspirations attempted were successfully completed. Sufficient material for histological assessment was obtained in 154 (90.6%) of the women who underwent Pipelle endometrial sampling and in only 66 (68%) of those who underwent D&C (p < 0.0001). In postmenopausal women, adequate specimens were obtained in 74 of 88 (84.1%) by Pipelle and in only 22 of 48 (45.8%) by D&C. In 45 cases the histologic diagnosis of the endometrium obtained by Pipelle sampling was compared with the one of endometrium obtained by D&C or hysterectomy performed shortly thereafter. The diagnosis was identical in 43 (95.5%) cases. Endometrial sampling with the Pipelle was well tolerated causing occasionally only slight discomfort.

Immediate and late outcome of vaginal myomectomy for prolapsed pedunculated submucous myoma.

&NA; During a 10‐year period, vaginal myomectomy was attempted in 46 women with a symptomatic prolapsed pedunculated submucous myoma. The procedure was successful in 43 and failed in three patients, necessitating an abdominal operation. Vaginal myomectomy for this condition was simple and quick, and the postoperative course was usually uneventful. Only 8.8% of 34 patients with a median follow‐up of 5.5 years required a repeat vaginal myomectomy, and only 5.9% needed a hysterectomy. Vaginal myomectomy is recommended as the initial treatment of choice for prolapsed pedunculated submucous myoma, except in those cases in which other indications necessitate an abdominal approach.

Possible role of mumps virus in the etiology of ovarian cancer.

Eighty‐four ovarian cancer (OCa) patients and 84 controls with nonmalignant conditions matched by age and ethnic origin were interviewed with regard to clinical mumps history and their sera were tested for complement fixation (CF) mumps antibodies. OCa patients differed from the controls in the response to past mumps infection in two respects: 1) They appeared to be more likely to have developed subclinical mumps as evidenced by a lower rate of clinical mumps history in the presence of serological evidence of similar infection rates among those with positive and those with negative clinical mumps history. 2) They tended to present lower persistent mumps CF antibody titers. These results may be interpreted to indicate that an immunological incompetence enables the development of OCa possibly through a direct etiologic role of mumps virus.

The effect of diagnosis and treatment delay on prognostic factors and survival in endometrial carcinoma

OBJECTIVEnThe aim of this study was to assess the association of diagnosis and treatment delay with established prognostic factors and survival.nnnSTUDY DESIGNnThe study group comprised 181 consecutive patients with endometrial carcinoma diagnosed between 1970 and 1986, whose records contained details with regard to diagnosis delay; 174 of them also contained details with regard to treatment delay.nnnRESULTSnThe significant prognostic factors that we found, namely, age, clinical stage, grade, depth of myometrial invasion, and histologic type, are in line with those of other studies. However, no significant correlation was found between the duration of delay and these prognostic factors or with survival.nnnCONCLUSIONnWe conclude that delay of diagnosis (< 1 year) and of treatment of < 4 months do not compromise survival of patients with endometrial cancer.

Adenocarcinoma of the uterine cervix in Jewish women: a distinct epidemiological entity.

During an 11‐year period, 532 Jewish women with invasive cancer of the uterine cervix were diagnosed in Israel. Of these, 441 (82.9%) had squamous cell carcinoma (SUC) and 52 (9.8%) had adenocarcinoma (AUC). Different characteristics were noted for these two histological categories with regard to age, ethnic distribution, and chronological time trends. The ratio between AUC and SUC differed considerably between the various ethnic groups, ranging from about 1:6 in the Asian and European born to less than 1:14 in the North African. This indicates that the relatively higher incidence of AUC in Israeli Jewish women is limited to those ethnic groups that have a low risk for cervical cancer. The different patterns of SUC and AUC in the population support the contention of a varying etiology.

Abdominopelvic irradiation for stage II–IV ovarian carcinoma patients with limited or no residual disease at second-look laparotomy after completion of cisplatinum-based combination chemotherapy

Abdominopelvic irradiation was given to 18 stage II-IV ovarian carcinoma patients who completed cisplatinum-based combination chemotherapy, were in complete clinical remission, and who underwent second-look laparotomy. The survival as well as the progression-free interval (PFI) was significantly longer in patients with a negative second-look laparotomy than in those with limited residual disease at this operation. Abdominopelvic irradiation was not effective in patients with limited residual disease at second-look laparotomy (3 year survival--34.3% and median PFI from second-look laparotomy--4.8 months). Even in patients with a negative second-look laparotomy the median PFI was only 13 months from this operation and the 3-year survival was 87.5%. The results were similar to other comparable series in which no treatment was administered to patients with a negative second-look laparotomy.

Intraperitoneal cisplatin chemotherapy versus abdominopelvic irradiation in ovarian carcinoma patients after. Second‐look laparotomy

The current study compares the outcome within 3 years after diagnosis in two groups of histologically confirmed Stage II‐IV ovarian carcinoma patients in complete clinical remission with minimal or no residual disease at second‐look laparotomy, performed after completion of cisplatin‐based combination chemotherapy. One group (n = 18) received after reexploration abdominopelvic irradiation (RT group), the other, diagnosed during a later period (n = 19), received three courses of intraperitoneal cisplatin chemotherapy with systemic thiosulfate protection (IP group). The two groups were comparable with regard to age, stage at diagnosis, histologic category, grade of differentiation, size of residual tumor after the initial operation, and rate of negative second‐look laparotomy. The overall survival probability after diagnosis was significantly better in the IP group, the maximal difference being observed at 36 months: 76.6% versus 44% in the RT group (P = 0.04). This difference was mainly evident in patients with a negative second‐look laparotomy in whom the respective survival probabilities were 100% versus 70% (P = 0.04). Survival was significantly shorter (P < 0.01) in patients with a positive second‐look, and there was a nonsignificant trend for better survival in the IP group. Significantly improved probability of progression‐free interval after diagnosis was also found in the IP group, the maximal difference being observed at 22 months: 78.3% as compared to 50.9% in the RT group (P = 0.04). This difference was again limited to patients with negative second‐look, the respective values being 100% versus 60% (P = 0.04). Our retrospective data suggest an apparent advantage to intraperitoneal cisplatin treatment in these patients which should be further explored for definite evaluation.

Thrombotic thrombocytopenic purpura in pregnancy

Summary. A 20 week primigravida with intrauterine fetal death and the rare occurrence of thrombotic thrombocytopenic purpura (TTP) in pregnancy is presented. Aprotinin has been used to overcome uterine inertia non‐responsive to oxytocin stimulation. TTP was successfully treated with repeated plasmaphereses. The literature is briefly reviewed and the complexity and importance of the differential diagnosis specific to the pregnant patient is discussed.

UTERINE ANOMALIES IN DIETHYLSTILBESTROL‐EXPOSED WOMEN WITH FERTILITY DISORDERS

Abstract. Uterine anomalies were demonstrated by hystero‐salpingography (HSG) in 4 of 5 diethylstilbestrol (DES) exposed young women with fertility disturbances. The anomalies included malformed uterine cavities and cervical incompetence. It is suggested that HSG in DES exposed women with fertility disturbances be performed early in the process of infertility investigation and cerclage should be considered when uterine anomalies are demonstrated. Tubal pregnancy should be ruled out by ultrasonography early during pregnancy in DES‐exposed women.