Richard J. Stock

Prognostic relevance of carbonic anhydrase-IX in high-risk, early-stage cervical cancer: a Gynecologic Oncology Group study.

OBJECTIVES This study aimed to determine whether carbonic anhydrase-IX (CA-IX) was associated with progression-free survival (PFS) and overall survival (OS) in women with high-risk, early-stage cervical cancer treated with adjuvant pelvic radiotherapy with or without radiosensitizing chemotherapy. METHODS CA-IX expression was detected using an immunohistochemistry assay and categorized as low when <or=80% of tumor cells exhibited CA-IX staining and high when >80% tumor cells display CA-IX staining. Associations between CA-IX expression and clinical characteristics, angiogenesis marker expression, and clinical outcome were evaluated. RESULTS High CA-IX expression was observed in 35/166 (21.1%) of cases. CA-IX expression was not associated with age, race, stage, cell type, grade, positive margins, parametrial extensions, positive lymph nodes, or lymphovascular space invasion but was associated with tumor size categorized as <2 , 2-2.9 , or >or=3 cm (high expression: 4.7% vs. 23.2% vs. 32.5%, P=0.003) and cervical invasion confined to the inner two-thirds compared with the outer third of the cervix (high expression: 6.1% vs. 23.7%, P=0.028). CA-IX expression was not associated with immunohistochemical expression of p53, CD31, CD105, thrombospondin-1, or vascular endothelial growth factor-A. Women with high versus low CA-IX expression had similar PFS (P=0.053) and significantly worse OS (P=0.044). After adjusting for prognostic clinical covariates, high CA-IX expression was an independent prognostic factor for PFS (hazard ratio [HR]=2.12; 95% confidence interval [CI]=1.13-3.95; P=0.019) and OS (HR=2.41; 95% CI=1.24-4.68; P=0.009). CONCLUSIONS Tumor hypoxia measured by immunohistochemical expression of CA-IX is an independent prognostic factor for both PFS and OS in high-risk, early-stage cervical cancer.

Recurrent carcinoma in situ of the vagina following split-thickness skin graft vaginoplasty☆

A patient who developed squamous cell carcinoma in situ in a split-thickness skin graft neovagina is presented. This is the third reported case in the English literature of a patient previously treated for carcinoma in situ of the vagina who later developed an identical lesion in the graft. Management of this neoplasm is discussed, and follow-up for patients with neovaginas is emphasized.

Patterns of failure of bulky-barrel carcinomas of the cervix

OBJECTIVE(S: This retrospective study was conducted to analyze the hypothesis that radiation therapy followed by extrafascial hysterectomy would improve survival in patients with bulky-barrel cervical carcinomas. STUDY DESIGN: Forty-three patients with bulky-barrel carcinomas of the cervix were treated over a 14-year period. The majority of these were treated with approximately 4000 cGY external beam, followed by brachytherapy, followed by extrafascial hysterectomy. RESULTS: Forty-seven percent of all patients are dead of disease; 2.3% are alive with disease. Of the total patients, 35% had diseased paraaortic nodes, and 80% of these are dead of disease. Of the patients dead of disease, 80% had distant metastases. Delayed complications included: vesicovaginal fistulas ( n = 3), surgery for bowel obstruction ( n = 3), rectovaginal fistula ( n = 1), and vaginal vault necrosis ( n = 3). CONCLUSION: These data do not support an improvement in survival of patients with bulky-barrel—shaped lesions treated with irradiation plus adjunctive hysterectomy.

Occurrence of malignant peritoneal mesothelioma after surgery and irradiation for cervical cancer

Mesothelioma of the peritoneal cavity after irradiation is rare, and the diagnosis is sometimes difficult to establish. The following case is a report of a mesothelioma occurring 9 years after radiation therapy for carcinoma of the cervix. In this patient, who had a hysterectomy and bilateral oophorectomy 7 years prior to the mesothelioma diagnosis, the histologic, histochemical, and ultrastructural findings were all consistent with a diagnosis of malignant peritoneal mesothelioma. It is believed that this case is one of the first well-documented cases of peritoneal mesothelioma in a female who was treated by pelvic irradiation for another neoplasm.

Mammographic localization and biopsy: the experience of a gynecologic oncology group.

From 1976 through 1986, two hundred eighty or 9% of all breast biopsies performed by a private gynecologic oncology group were for mammographically suspicious but occult breast lesions. Sixteen percent were found to be malignant. There has been improvement in mammographic techniques, and localization procedures have evolved to the current use of hooked-wire needles, which allow for the excision of smaller amounts of tissue and use of outpatient surgery facilities. Recently, the cancers encountered have been more often carcinoma in situ rather than invasive lesions. With the current increase in mammographic screening, there needs to be a continuing evolution in diagnostic modalities.

Patterns of failure of bulky‐barrel carcinomas of the cervix

OBJECTIVE(S) This retrospective study was conducted to analyze the hypothesis that radiation therapy followed by extrafascial hysterectomy would improve survival in patients with bulky-barrel cervical carcinomas. STUDY DESIGN Forty-three patients with bulky-barrel carcinomas of the cervix were treated over a 14-year period. The majority of these were treated with approximately 4000 cGY external beam, followed by brachytherapy, followed by extrafascial hysterectomy. RESULTS Forty-seven percent of all patients are dead of disease; 2.3% are alive with disease. Of the total patients, 35% had diseased paraaortic nodes, and 80% of these are dead of disease. Of the patients dead of disease, 80% had distant metastases. Delayed complications included: vesicovaginal fistulas (n = 3), surgery for bowel obstruction (n = 3), rectovaginal fistula (n = 1), and vaginal vault necrosis (n = 3). CONCLUSION These data do not support an improvement in survival of patients with bulky-barrel-shaped lesions treated with irradiation plus adjunctive hysterectomy.

EVALUATION OF SEQUELAE OF TUBAL LIGATION

An evaluation was made of 268 patients undergoing elective sterilization with respect to the ensuing development of menorrhagia, pelvic pain, and the need for gynecologic surgery. Preoperative and follow-up postoperative questionnaires of patients undergoing laparoscopic sterilization were compared, and additional data were drawn from clinical records and operative reports to substantiate real changes. A study of the cases puts the incidence of menorrhagia at 6%, pelvic pain at 6%, and necessary subsequent gynecologic surgery at 4%.