Marta A. Crispens

Response and survival in patients with progressive or recurrent serous ovarian tumors of low malignant potential

OBJECTIVE To evaluate the response to therapy and survival of patients with progressive or recurrent serous ovarian tumors of low malignant potential. METHODS Fifty‐three patients with progressive or recurrent serous ovarian tumors of low malignant potential were identified. Response was assessed and progression‐free and overall survival were analyzed. The influence of clinicopathologic factors on survival was determined. RESULTS In 49 patients with known histology of progression or recurrence, 36 (73%) had low‐grade serous carcinoma, and 13 (27%) had serous ovarian tumors of low malignant potential. Forty‐five patients received nonsurgical therapy and had an evaluable response. There were six (13%) patients with a complete response and six (13%) patients with a partial response. The median time to first progression or recurrence was 5.6 years. Median survival from diagnosis of first recurrence was 7.7 years. Median survival from initial diagnosis was 21 years. Nineteen (36%) patients are dead of tumor. Patients who recurred with low‐grade serous carcinoma were more likely to die of tumor than those with serous ovarian tumors of low malignant potential (47% versus 0%, P = .045). Optimal cytoreduction was associated with improved survival (P = .007). CONCLUSION Patients with progressive or recurrent serous ovarian tumors of low malignant potential have a long interval from diagnosis to progression and from progression to death, resulting in extended overall survival. Recurrence as low‐grade serous carcinoma and failure to achieve optimal secondary cytoreduction were adverse prognostic factors. There were few responses to nonsurgical therapy.

Contrast-Enhanced Transvaginal Sonography of Benign Versus Malignant Ovarian Masses : Preliminary Findings

Objective. The aim of this prospective study was to evaluate differences in contrast enhancement and contrast enhancement kinetics in benign versus malignant ovarian masses with pulse inversion harmonic transvaginal sonography. Methods. Seventeen consecutive patients with 23 morphologically abnormal ovarian masses (solid or cystic with papillary excrescences, focally thickened walls, or irregular solid areas) smaller than 10 cm received a microbubble contrast agent intravenously while undergoing pulse inversion harmonic transvaginal sonography. The following parameters were assessed in all tumors: detectable contrast enhancement, time to peak enhancement (wash‐in), peak contrast enhancement, half wash‐out time, and area under the enhancement curve. Tumor histologic analysis was used to distinguish benign from malignant ovarian tumors. Results. Fourteen benign masses and 9 malignancies were studied. There was a statistically significant difference in the peak enhancement (mean ± SD, 23.3 ± 2.8 versus 12.3 ± 3.9 dB; P < .01), half wash‐out time (139.9 ± 43.6 versus 46.3 ± 19.7 seconds; P < .01), and area under the enhancement curve (2012.9 ± 532.9 versus 523.9 ± 318 seconds−1; P < .01) in malignant masses compared with benign disease. There was no statistically significant difference in the time to peak enhancement (26.1 ± 6.3 versus 24.9 ± 7.6 seconds; P = .07). Conclusions. Overall, our data showed a significant difference in the contrast enhancement kinetic parameters between benign and malignant ovarian masses.

Dioxin may promote inflammation-related development of endometriosis

Laboratory and population-based studies suggest that exposure to environmental toxicants may be one of several triggers for the development of endometriosis. We discuss evidence that modulation of the endometrial endocrine-immune interface could mechanistically link toxicant exposure to the development of this disease.

Diagnostic Parameters to Differentiate Benign From Malignant Ovarian Masses With Contrast-Enhanced Transvaginal Sonography

Objective. The aim of this study was to evaluate diagnostic parameters to differentiate between benign versus malignant ovarian masses using contrast‐enhanced transvaginal sonography (TVS). Methods. Thirty‐three consecutive patients with 36 morphologically abnormal ovarian masses (solid or cystic with papillary excrescences, focally thickened walls, or irregular solid areas) smaller than 10 cm received a microbubble contrast agent intravenously while undergoing pulse inversion harmonic TVS. The following parameters were assessed: presence of contrast enhancement, time to peak enhancement, peak contrast enhancement, half wash‐out time, and area under the enhancement curve (AUC). Tumor histologic analysis was used to distinguish benign from malignant ovarian tumors. Results. Twenty‐six benign masses and 10 malignancies were studied. Of all examined criteria, an AUC of greater than 787 seconds−1 was the most accurate diagnostic criterion for ovarian cancer, with 100.0% sensitivity and 96.2% specificity. Additionally, peak contrast enhancement of greater than 17.2 dB (90.0% sensitivity and 98.3% specificity) and half wash‐out time of greater than 41.0 seconds (100.0% sensitivity and 92.3% specificity) proved to be useful. Conclusions. Our data suggest that the AUC, peak enhancement, and half wash‐out time had the greatest diagnostic accuracy for contrast‐enhanced TVS in differentiation between benign and malignant ovarian masses.

Intraperitoneal Chemotherapy for Ovarian Cancer: Overview and Perspective

Intraperitoneal (IP) chemotherapy has theoretical, pharmacologic, and clinical advantages over intravenous (IV) chemotherapy in women with optimally debulked epithelial ovarian cancer confined to the abdominal cavity. Consistent, statistically significant improvements in both progression-free and overall survival have been demonstrated in three large phase III trials conducted in the United States during the past 10 years. Nevertheless, concerns over IP drug distribution and systemic absorption, technical challenges of IP catheter placement and the incidence of IP catheter-related complications, and the clinical relevance of these studies have limited the adoption of IP therapy in ovarian cancer. Current interest in the evaluation of molecularly targeted therapies should build on the progress that has been made through the use of IP chemotherapy in women with optimally debulked ovarian cancer.

Development and prevention of postsurgical adhesions in a chimeric mouse model of experimental endometriosis

OBJECTIVE To examine the impact of a recent surgery on development of endometriosis-related adhesions in a chimeric model and to determine the therapeutic efficacy of pioglitazone (PIO). DESIGN Human endometrial biopsies were maintained in E(2) with or without PIO for 24 h before intraperitoneal injection into immunocompromised mice also treated with or without PIO at multiple time points after peritoneal surgery. The presence and extent of adhesions were examined in animals relative to the initial establishment of experimental endometriosis. SETTING Medical school research center. PATIENT(S) Endometrial biopsies for experimental studies were provided by normally cycling women without a medical history indicative of endometriosis or adhesions. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Examination of the development of endometriosis-related adhesions in an experimental model. RESULT(S) Without therapeutic intervention, injection of E(2)-treated human endometrial tissue into mice near the time of peritoneal surgery resulted in multiple adhesions and extensive endometriotic-like disease. In contrast, PIO treatment reduced adhesive disease and experimental endometriosis related to surgical injury. CONCLUSION(S) The presence of human endometrial tissue fragments in the peritoneal cavity of mice with a recent surgical injury promoted development of both adhesive disease and experimental endometriosis. Targeting inflammation and angiogenesis with PIO therapy limited the development of postsurgical adhesions associated with ectopic endometrial growth.

Sonographic depiction of intratumoral vascularity with 2- and 3-dimensional color Doppler techniques.

The purpose of this study was to describe patterns seen on 2‐ and 3‐dimensional color Doppler sonographic depiction of intratumoral vessels and to correlate these patterns to histopathologic findings in an attempt to assess their clinical importance.

Retroperitoneal fibrosis secondary to actinomycosis with no intrauterine device

BACKGROUND: Actinomycotic pelvic infection usually occurs in the presence of an intrauterine device. It can result in pelvic inflammatory disease, tubo-ovarian abscess, and retroperitoneal fibrosis. CASE: A 35-year-old multipara who had never used an intrauterine device presented with a 5-month history of progressively worsening, colicky, right-sided abdominal pain, dysuria, weight loss, and constipation. She was found to have retroperitoneal fibrosis. The diagnosis of actinomycotic pelvic infection was made at laparotomy. CONCLUSION: Actinomycosis may be considered in the differential diagnosis of women with retroperitoneal fibrosis, even when there is no history of an intrauterine device.

Treatment of cervical dysplasia with large loop excision of the transformation zone: Is endocervical curettage necessary?

Endocervical curettage (ECC) is done during most colposcopic examinations. To evaluate the need for routine ECC, we reviewed the records of all new patients seen in the colposcopy clinic at our institution from July 15, 1992, to April 15, 1993. During the study period, ECC was done in 341 patients with an adequate colposcopy. Only one case of mild dysplasia was discovered after ECC in the 123 patients referred for evaluation of cervical intraepithelial neoplasia (CIN) I or atypia seen on Pap smear. ECC specimens were positive for dysplastic cells in only 3 of 203 patients (1.4%) in whom biopsy revealed CIN I or atypia, and Pap smears for all 3 patients were suggestive of more severe lesions. Routine ECC during the initial colposcopic examination adds expense and may cause significant patient discomfort. ECC can be safely omitted in patients with CIN I on referral Pap smear and before large loop excision of the transformation zone for treatment of more severe lesions.

Experimental endometriosis in immunocompromised mice after adoptive transfer of human leukocytes

OBJECTIVE To develop a chimeric human/mouse model of experimental endometriosis for the examination of the role of human immune cells in this disease. DESIGN Laboratory-based study. SETTING University-affiliated medical center. PATIENT(S) Healthy women undergoing volunteer endometrial biopsies and blood donation. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) In vivo analysis of the impact of the adoptive transfer of human immune cells into immunocompromised mice receiving autologous human endometrium. RESULT(S) Similar to our previous data using nude mice, human endometrial tissue fragments injected intraperitoneally into rag2gamma(c) mice readily established experimental disease. However, in this study, we found a statistically significant reduction in the severity of peritoneal disease in rag2gamma(c) mice which also received adoptive transfer of human immune cells compared with mice that did not receive immune cells. Our studies indicate that human immune cells readily track into the ectopic lesions established in mice. CONCLUSION(S) The ability of immune cells from disease-free women to limit intraperitoneal disease in mice suggests that a robust immune system is protective against the development of endometriosis.