Najmosama Nikrui

Fusions of Human Ovarian Carcinoma Cells with Autologous or Allogeneic Dendritic Cells Induce Antitumor Immunity

Human ovarian carcinomas express the CA-125, HER2/neu, and MUC1 tumor-associated Ags as potential targets for the induction of active specific immunotherapy. In the present studies, human ovarian cancer cells were fused to human dendritic cells (DC) as an alternative strategy to induce immunity against known and unidentified tumor Ags. Fusions of ovarian cancer cells to autologous DC resulted in the formation of heterokaryons that express the CA-125 Ag and DC-derived costimulatory and adhesion molecules. Similar findings were obtained with ovarian cancer cells fused to allogeneic DC. The fusion cells were functional in stimulating the proliferation of autologous T cells. The results also demonstrate that fusions of ovarian cancer cells to autologous or allogeneic DC induce cytolytic T cell activity and lysis of autologous tumor cells by a MHC class I-restricted mechanism. These findings demonstrate that fusions of ovarian carcinoma cells and DC activate T cell responses against autologous tumor and that the fusions are functional when generated with either autologous or allogeneic DC.

Borderline tumors of the ovary: correlation of frozen and permanent histopathologic diagnosis

Objective To evaluate the correlation between the diagnosis of borderline tumor of the ovary by frozen and permanent pathology. Methods All pathology reports with diagnoses of borderline tumor of the ovary between 1980 and 1998 at Massachusetts General Hospital were reviewed. Univariate and multivariable logistic regression models were constructed for patient age, tumor size, histology, presence of bilateral or extraovarian disease, and concurrent diagnosis of endometriosis or endosalpingiosis. Results We reviewed 140 cases. The average age of patients was 52.3 years. Eighty tumors were serous, 47 mucinous, 11 mixed, and two endometrioid. The mean diameter overall was 13.7 cm (range 1–70 cm), 10.2 cm for serous, and 20.1 cm for mucinous. Diagnoses of borderline tumors by frozen and permanent pathology were consistent in 60% of cases. Frozen section interpreted a benign lesion as malignant (overdiagnosed) in 10.7% of cases, and interpreted a malignant lesion as benign (underdiagnosed) in 29.3%. No variable was a significant predicator of overdiagnosis. In univariate analysis, underdiagnosis was more likely for other types of tumors than serous (P < .001), tumors larger than 20 cm (P = .039), and tumors confined to the ovaries (P = .009). When all variables were included in a multiple regression model, only histology was a significant predictor of underdiagnosis (P = .039). Conclusion Frozen or permanent pathology reports of diagnoses of borderline tumor were consistent 60% of the time, whereas the positive predictive value of borderline by frozen section was 89.3%. Tumors other than serous are more likely to be misinterpreted.

Survey of clinical behavior of patients with borderline epithelial tumors of the ovary

Abstract The present study analyzes the anatomical, pathological, and clinical elements in 62 cases of low potential malignancy of the ovary (25 mucinous, 36 serous, and 1 endometrioid) from the Massachusetts General Hospital record room files from 1962 to 1979. Twenty-two serous tumors were stage I, six were stage II, four were stage III, and four were recurrent. Among mucinous tumors twenty-one were stage I, one was stage III, one was stage IV, and two were recurrent. Four patients had ascites; one patients tumor was ruptured at surgery. The majority of cases were in stage I. The average age was 54.5 years. Thirty-seven percent of the cases were nulligravida. An abdominal mass was the most frequent finding and increased abdominal girth was the most frequent symptom. All of the patients were treated by excision of the tumor with or without hysterectomy. Chemotherapy followed surgery in 16 patients and radiation was used in 10 cases following surgery. Only 1 patient with early disease died of tumor. Five-year survival was 91.4% among serous and 80.7% among mucinous. Ten-year survival was 83.2% for serous and 73.4% mucinous.

Sonographic Morphology of the Normal Menstrual Cycle

Sequential gray-scale sonograms were obtained during 20 menstrual cycles in 16 normal female volunteers. Hormonal and physical parameters of an ovulatory cycle were correlated with morphological changes in the ovaries, uterus, and cul-de-sac as seen on the sonogram. Ovarian cysts of two sizes were observed, corresponding chronologically and morphologically to Graafian follicles and corpora lutea. Small amounts of free pelvic fluid were demonstrated in many women at ovulation. A characteristic uterine appearance is seen prior to menstruation and is related to hormonal influences on the uterus. These findings emphasize the importance of recognizing normal physiological changes when interpreting gynecologic sonograms.

Condyloma Acuminatum of the Bladder and Ureter: Case Report and Review of the Literature

We report on a 56-year-old woman with extensive condyloma acuminatum of the external genitalia and vagina, with spread to and diffuse involvement of the urethra, bladder and distal ureters. A chronic course, failure to respond to conservative measures and evidence of malignant transformation led to radical surgical treatment.

Ten-year follow-up of a phase 2 study of dose-intense paclitaxel with cisplatin and cyclophosphamide as initial therapy for poor-prognosis, advanced-stage epithelial ovarian cancer.

The objective of this study was to assess activity and toxicity in patients with newly diagnosed, advanced‐stage epithelial ovarian cancer (EOC) who were receiving dose‐intense paclitaxel, cyclophosphamide, cisplatin, and filgrastim delivered with a flexible dosing schedule.

Management of high-grade stage I adenocarcinoma of the endometrium: hysterectomy following low dose external beam pelvic irradiation

Sixty-eight patients with FIGO stage I, grade 2 or 3 adenocarcinoma of the endometrium were treated according to a protocol involving 10 Gy external pelvic irradiation, prompt hysterectomy with surgical staging, and postoperative therapy individualized according to surgical-pathologic findings. Five-year survival for the entire group was 78%, 87% for those with grade 2 disease, and 59% for those with grade 3 disease. For patients whose disease was found to be confined to the uterus, surgical stage I, the 5-year survival was 98%. Patients with surgical stage I, grades 2 and 3 disease had 97 and 100% probabilities of surviving 5 years, respectively. Five-year disease-free probability was 96% for all patients with surgical stage I carcinoma, 97% for patients with grade 2 disease, and 94% for patients with grade 3 disease. Myometrial penetration influenced survival; no patient with less than 50% myometrial penetration died or suffered a relapse, while only 40% of patients with deeper penetration survived 5 years. Twenty-three percent of patients with surgically confirmed disease spread beyond the corpus survived 5 years; 29% remained disease-free at this interval. Ten of the 68 patients developed recurrences, none has had a known pelvic recurrence. Two major complications, one requiring surgery, were seen, both in patients receiving postoperative external beam irradiation. The rationale behind low-dose, preoperative external pelvic irradiation is described, and an approach to high-grade, FIGO stage I adenocarcinoma of the endometrium is outlined.

Sarcomas of the uterine corpus: prognostic factors and treatment.

Twenty-eight patients with sarcomas of the uterine corpus were followed at least 22 months or until death. All underwent laparotomy, eleven had radiation therapy, and six had chemotherapy. Three year actuarial survival was 24%, and three year actuarial local control was 36%. Multivariate analysis demonstrated that, as with sarcomas at other sites, the most important factors influencing survival were grade (P = 0.020) and stage (P = 0.022). For local control, multivariate analysis indicated the most important factors to be stage (P = 0.001) and radiation TDF (P = 0.01). Of 21 failures, 16 involved the pelvis, seven involved the upper abdomen, and 11 involved distant sites. The importance of both local and distant disease control is emphasized.

Low‐dose preoperative radiation therapy for adenocarcinoma of the endometrium. A pilot study

A pilot study using low‐dose preoperative radiation therapy, i.e., 10 Gy in 3 to 4 days as an adjuvant preoperative procedure for grade 2 or 3 (FIGO classification) endometrial carcinoma, was done. The concept of low‐dose preoperative radiation therapy is to administer treatment, either surgical or radiotherapeutic, postoperatively according to the surgical and pathologic findings, allowing identification of those patients with previously undiagnosed extensive metastatic disease outside the pelvis found at laparotomy in whom routine pelvic radiation therapy is futile, as well as those patients with relatively low risk of recurrence who may not require further radiotherapy. Forty‐four patients with clinical Stage I, grade 2 or 3 with adenocarcinoma of the endometrium were entered into the pilot study. Following surgery, 68% remained Stage I by pathologic examination, and in the remaining patients the stages were changed to II in seven, III in three, and IV in four. Postoperative treatment was administered according to extent of the disease found at surgery. The 4‐year actuarial probability of survival rate for the entire group of patients with clinical Stage I disease was 80%; corresponding disease‐free rate was 77%. For the Stage I disease confirmed by pathologic examination, the corresponding rate was 96%. The rates for Stages II through IV, as shown by pathologic findings at laparotomy, were 53% and 42%, respectively. In this pilot study, a treatment policy for clinical Stage I, grade 2 or 3 adenocarcinoma of the endometrium using low‐dose preoperative radiation therapy is recommended.

Uterine leiomyosarcoma and endometrial stromal sarcoma: Lymph node metastases and sites of recurrence

Platlnmn-baaed ckemotkerapy of l&k-risk stage I epithelial ovariaa cancer followiag camprehensive surgical staging Rubin SC.; Wong G.Y.C.; Curtin J.P.; Barakat R.R.; Hakes T.B.; Hoskins W.J. USA OBSTET GYNECOL 1993 82/l (143-147) Objective: To determine the long-term outcome in patients with high-risk stage I epithelial ovarian cancer treated with adjuvant platinum-based chemotherapy following comprehensive surgical staging. Methods: We conducted a retrospective review of 62 patients with stage IA and IB (grades 2 or 3) and stage IC (all grades) epithelial ovarian cancer treated with platinum based chemotherapy following comprehensive surgical staging. Clinicopathologic correlations were performed using diseasefree survival as the end point. Results: The mean patient age was 47 years. The distribution by stage was IA in 19 (31%), IB in four (6%), and IC in 39 (63%). Eighty percent of the patients had grade 2 or 3 tumors. The distribution by cell type was as follows: clear cell 22 (35%). endometrioid 15 (24%), mutinous I I (18%). serous eight (13%), and undifferentiated six (10%). The patients underwent an average of six cycles of platinumbased therapy. With a median follow-up of 40 months among survivors, 15 patients (24%) have relapsed, at a median interval of 22 months from diagnosis. Relapses occurred primarily in the peritoneal cavity and retroperitoneal lymph nodes. No patient has been rendered free of disease after relapse. Patients with grade 3 tumors had an increased risk of relapse as compared to those with grade I or 2 tumors (46 vs. 8%; P = .002). Patients with clear-cell tumors had a higher risk of relapse than those with other cell types (41 vs. 15%; P = 0.05). There was no statistically significant relationship between risk of recurrence and substage. None of 11 patients with stage IA, grade 2 disease had recurrence. Actuarial 5-year disease-free survival for the entire group of 62 patients was 73%. Conclusion: Platinum-based chemotherapy for high-risk stage I ovarian cancer does not appear to improve survival over that previously reported with non-platinum regimens.