Robert L. Ehrmann

Invasive cervical carcinoma in young women

Abstract Twenty-seven (24.5%) of the 110 newly diagnosed cases of invasive cervical cancer at the Boston Hospital for Women from January 1975 through June 1978 were 35 years of age or younger. Twenty-five of these young patients (93%) had Stage I cervical cancer and 2 had Stage II disease. Seven (26%) of these patients had cervical adenocarcinomas. All young patients with Stage I disease are presently clinically free of tumor. Fifteen of the young patients (55.5%) had reportedly negative cervical cytology smears prior to the detection of a symptomatic cervical malignancy. The cervical smears from 10 of the patients with reportedly negative cervical cytology were reexamined at the Boston Hospital for Women, and our review demonstrated missed cervical neoplasia in 5 cases and unsatisfactory technique for adequate interpretation in 2 cases. Abnormal cervical cytology precipitated the diagnosis of invasive cervical cancer in only 37% of the young patients. All suspicious and symptomatic cervical lesions in young women should be promptly biopsied regardless of prior reassuring cervical cytology.

Stage III adenocarcinoma of the endometrium: two prognostic groups.

Abstract Between July 1968 and December 1976, 26 patients with surgical-pathologic Stage III adenocarcinoma of the endometrium were treated at the Joint Center for Radiation Therapy. In 15 patients, extrauterine disease was confined to the ovary and/or fallopian tube (Group A). In 11 patients, disease extended beyond these organs to the vagina or other pelvic structures (Group B). Treatment included a combination of radiation therapy and surgery in all but one patient, who was treated by radiation therapy alone. The median follow-up was 65 months and the median time to relapse 9 months. The actuarial relapse-free 5-year survival for all Stage III patients was 54%; it was significantly different ( P = 0.01) for Group A (80%) and Group B (15%). The nature of extrauterine involvement in surgical-pathologic Stage III adenocarcinoma of the endometrium is of major prognostic significance.

Radiation therapy in stage II ovarian carcinoma. The influence of histologic grade

Between September 1968, and December 1975, 40 patients with Stage II epithelial tumors of the ovary were treated at the Joint Center for Radiation Therapy. Thirty‐six patients had undergone a total abdominal hysterectomy and bilateral salpingo‐oophorectomy (BSOH) with attempted total removal of disease, and all patients received postoperative pelvic irradiation. The five‐year actuarial relapse‐free survival rate is 66% and the overall survival rate 70% for the entire group of patients. The histology was reviewed in all cases and graded for the percentage of solid vs. papillary or glandular tumor in the specimen. Of the 36 patients treated with a BSOH, 18 had well‐differentiated tumors defined as containing less than a 10% solid architectural pattern. There have been no relapses in this group of patients. In contrast, 9 of 18 patients with moderately or poorly differentiated tumors containing a 10% or more solid pattern have relapsed; five diffusely in the abdomen, two in the pelvis, and two in the lungs or pleura. It appears that a BSOH followed by pelvic irradiation is sufficient treatment for Stage II patients with well‐differentiated tumors showing less than a 10% solid pattern. In contrast, patients with less well‐differentiated tumors have a high risk of relapse outside of the pelvis and need additional treatment. Alternative treatment options are discussed.

Clear cell carcinoma of the uterine endocervix with an in situ component

In the past all clear cell carcinomas of the female genital tract were thought to arise from mesonephric remnants. Recently increasing evidence has related their origin to müllerian rather than mesonephric epithelium. One of the main reasons that has been advanced to support their mesonephric origin has been their occurrence in the uterine cervix and vagina, sites of mesonephric remnants. However, no clear evidence for mesonephric origin of clear cell carcinoma of the cervix and vagina has been ever provided. In contrast, there is substantial evidence that diethylstilbestrol‐related clear cell carcinomas of the cervix and vagina are müllerian in origin. We report here a case of an exophytic clear cell carcinoma with an in situ component, involving the endocervical epithelium. The in situ lesion clearly indicates müllerian origin of the tumor, which occurred in the absence of prenatal exposure to diethylstilbestrol. This supports the general agreement that clear cell carcinomas of the cervix are müllerian in origin, whether diethylstilbestrol‐related or not. Cancer 42:2435–2438, 1978.

Malignant hemangioendothelioma of the uterus.

Abstract In the entire world literature, there are only seven reported cases of malignant hemangioendothelioma arising in the uterus. An eighth case, reported here, was a 17-year-old girl who lived for 8 years after curettings and subsequent hysterectomy revealed malignant hemangioendothelioma of the endometrium with extension to the left ovary. Pelvic recurrences were temporarily controlled with chemotherapy, X-ray treatment, and repeated surgery. However, the patient eventually succumbed to massive growth of malignant hemangioendothelioma in the pelvis, with extension into the inferior vena cava and left external iliac vein. Growth within blood vessel lumens was also striking in the surgical specimens of recurrent tumor. Microscopically, the important diagnostic feature was the presence of numerous capillaries lined by malignant endothelial cells.

Microscopic appearance of the human fallopian tube following a reanastomosis procedure.

Microscopic evaluation of a human fallopian tube following end-to-end anastomosis over a polyethylene stent was performed 10 days after the initial surgical procedure. The stent was removed on the 3rd postoperative day. Examination of the excised tube revealed a patent lumen without any evidence of mucosal compromise. The submucosa adjacent to the anastomotic site revealed a mild polymorphonuclear leukocytic infiltration, although a marked inflammatory response was observed around the 5-0 chromic sutures used in the reanastomosis. This case and recent animal studies suggest that early removal of the stent does not appear to jeopardize the patency of the tube and may be preferable to removal after 3 to 4 months.

Radiation Therapy in Stage II Ovarian Carcinoma. The Influence of Histologic Grade

Between September 1968, and December 1975, 40 patients with Stage II epithelial tumors of the ovary were treated at the Joint Center for Radiation Therapy. Thirty-six patients had undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy (BSOH) with attempted total removal of disease, and all patients received postoperative pelvic irradiation. The five-year actuarial relapse-free survival rate is 66% and the overall survival rate 70% for the entire group of patients. The histology was reviewed in all cases and graded for the percentage of solid vs. papillary or glandular in the specimen. Of the 36 patients treated with a BSOH, 18 had well-differentiated tumors defined as containing less than a 10% solid architectural pattern. There have been no relapses in this group of patients. In contrast, 9 of 18 patients with moderately or poorly differentiated tumors containing a 10% or more solid pattern have relapsed; five diffusely in the abdomen, two in the pelvis, and two in the lungs or pleura. It appears that a BSOH followed by pelvic irradiation is sufficient treatment for Stage II patients with well-differentiated tumors showing less than a 10% solid pattern. In contrast, patients with less well-differentiated tumors have a high risk of relapse outside of the pelvis and need additional treatment. Alternative treatment options are discussed.