L.F. Carson

Transvaginal color flow Doppler sonography in the assessment of gestational trophoblastic disease.

The aim of this study was to evaluate the blood flow characteristics of the uterine artery and intratumoral vessels in patients with GTD. Twelve patients with GTD were evaluated with TVS, and 11 also had CFD sonography performed. Spectral analysis of both uterine artery and samples intratumoral and intramyometrial vessels revealed systolic frequencies and PI that were significantly higher in the uterine artery than in sampled intratumoral vessels (P < 0.05). Uterine artery PI correlated significantly with age (P = 0.043), uterine size (P = 0.003), and beta‐HCG titer (P = 0.03). Intratumoral PI correlated significantly with uterine size (P = 0.05). Intratumoral PI did not correlate with patient age, the shape or orientation of the uterus, presence or absence of subendometrial halo, endometrial thickness or echogenicity, or impression of myometrial invasion. Regression analysis of beta‐HCG titers on uterine artery and intratumoral PI revealed a linear association. TVS and color flow Doppler sonography are useful in the assessment of patients with GTD. The PI is strongly associated with prognosis and correlates with beta‐HCG titers.

Gray scale and color flow Doppler characterization of uterine tumors.

The aim of this study was to investigate gray scale and color flow characteristics of a group of patients with a suspected uterine pathologic condition. One hundred and twenty‐two consecutive patients at the Womens Cancer Center, University of Minnesota, undergoing transvaginal sonography and color flow Doppler imaging for suspected uterine corpus abnormality made up the study group. After gray scale morphologic assessment, color flow Doppler imaging of the tumor and uterus was performed, including the ipsilateral uterine artery. Malignant tumors were confirmed pathologically in all 35 patients who had them. In comparing patients with benign versus malignant tumors, gray scale morphologic assessment confirmed that malignant uterine tumors (31 endometrial cancers and four sarcomas) were more likely to have a thickened echoic endometrium (P = < 0.0001), be enlarged (P = 0.004), to be retroverted (P = 0.02), and to lack a subendometrial halo (P < 0.0001). Patients with four benign and 13 malignant tumors demonstrated increased flow when assessed by CFD. The calculated sensitivity of increased color flow in predicting malignancy was 39%, with a specificity of 92%, a positive predictive value of 77%, and a negative predictive value of 71%. No difference existed between the benign and malignant groups for the systolic, diastolic, and mean velocities and for the calculated pulsatility index and resistive index in both sampled uterine and intramyometrial or tumor vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Borderline and invasive epithelial ovarian tumors in young women

Objective: To review the occurrence, morbidity, and mortality of borderline and invasive epithelial ovarian tumors in young women. Methods: We conducted a 15-year retrospective review of the case records of the Womens Cancer Center, University of Minnesota, and the JL McKelvey Tumor Registry. Results: We identified 67 patients under age 40 with borderline or invasive epithelial ovarian tumors. Fifty patients (75%) had borderline tumors and 17 (25%) had invasive tumors. The mean age at presentation was 31 years (range 14-39) for the borderline group and 34 years (range 23-39) for the invasive group. Pelvic pain and a palpable mass, present for less than 6 months, were the predominant presenting symptom and sign. There was no difference in the age at menarche between the patients with borderline (mean 12 years) and invasive tumors (mean 13 years). Fiftyseven patients were optimally cytoreduced to less than 2.0 cm after primary surgery. Thirty-five patients underwent second-look laparotomy, 15 of which were positive for tumor. A minority of patients in both groups had stage I tumors (17 in the borderline and one in the invasive group). Among patients with borderline tumors, there was no difference between “very young” and “young” patients in the stage at presentation or outcome. Similar proportions of patients presented with early- and late-stage disease. Three very young women (14%) and five young women (17%) have died. Among patients with invasive tumors, no difference existed between young and very young patients for stage at presentation, whereas grade and outcome differed significantly between the age groups (P < .05). Very young patients were more likely to present with grade 1 lesions, whereas patients aged 30-40 years were more likely to have grade 2 or 3 tumors (P < .05). Three (100%) of the very young patients have died, whereas seven (50%) of the young patients aged 30-40 years have died. The median survival of patients with borderline tumors was 36 months (range 2.0-150.5), significantly different from those with invasive tumors, whose median survival was 21 months (range 2.9-89.7) (P < .001). Conclusion: Borderline and invasive epithelial ovarian tumors are encountered in young women. Despite the implication of the term “borderline,” such tumors are associated with considerable morbidity and mortality.

Serum levels of macrophage colony‐stimulating factor in patients with ovarian cancer undergoing second‐look laparotomy

peritoneal macrophage-conditioned media from 33 women with or without endometriosis were studied for their effects on an endometrial carcinoma cell line, ECC1. The media from six of six stage III/IV cases demonstrated a mitogenic effect, which was blocked by an antibody to epidermal growth factor recep tor. However, the conditioned media from seven of nine stage I/II cases and 14 of 18 normal women did not show a mitogenic effect. The difference between stage III/IV and the other two groups was significant (P < 0.01). The incorporation of tritium-thymidine wsa three times higher with the media from stage III/IV cases, as compared with that of controls. When purified cytokines were tested in the tritium-thymidine uptake assay, only epidermal growth factor-transforming growth factor-a was mitogenic on ECC-1, whereas tumor necrosis factor, interleukin-I, and platelet-derived growth factor had no effect. Thus peritoneal macrophages in patients with endometriosis may play an important role in progression of endometriosis, and the noted effects could be mediated by epidermal growth factor or a related growth factor.

Surgical intervention following multimodality therapy for advanced cervical cancer

Three hundred sixty-one patients with FIG0 stage 111 and IV ovarian cancer were treated with cis-platinum combination chemotherapy in a Danish multicenter trial. Primary surgery was performed at 58 different departments, 32% of the patients were operated at a department associated with an oncologic center, 50% at a general gynecologic department, and 18% at a general surgical department. Complete pathologic response and longterm survival were similar for patients operated on in the different departments. Patients who underwent radical surgery or optimal debulking had a 10% risk of progression during chemotherapy and a 5-year survival of 46”/. Patients who underwent suboptimal debulking and exploratory laparotomy had a 40% risk of progression during chemotherapy and a 5-year survival of 14%. Complete pathologic response showed an insignificant difference between radical surgery and optimally tumor reduction (57%) versus 41”/) and a signifEant difference between suboptimal tumor reduction and exploratory laparotomy (19% versus 6%). Patients secondarily tumor reduced had a survival rate superior to that of patients not secondarily tumor reduced (25% versus 4% at 4 years).