Sidney A. Coleman

Extended field irradiation for cervical cancer based on surgical staging

Abstract Surgical staging was done in 355 patients with carcinoma of the cervix. Periaortic node biopsies, peritoneal cytology, and/or biopsy were obtained to determine the need of extended field irradiation. Forty-one patients received extended field irradiation. On review, 38 of these patients were shown to have cancer in the periaortic nodes or peritoneal cavity. Of these patients, 5 have survived longer than 5 years, 3 with metastatic cancer in the periaortic nodes and 2 in the peritoneal cavity. Irradiation to extended fields was 4500 rad or less for the first 17 patients. Since then 5100 rad has been delivered at the rate of 850 rad per week. The incidence of bowel complications was not excessive, utilizing a suture technique to exclude small bowel from the pelvis. Control of the cancer occurred in one patient with massive metastatic periaortic disease. A safe and effective dosage level for radiation therapy has been established with the described limited surgical exploration.

Familial ovarian hyperthecosis: A study of two families☆☆☆

Abstract Two families containing 41 women with hirsutism and/or oligomenorrhea were studied. Ovarian histology of eight demonstrated hyperplasia of theca cells in atretic follicles, a paucity of primordial and developing follicles, and stromal hyperplasia. Elevated levels of androstenedione and/or testosterone and luteinizing hormone (LH) were found. Estradiol and follicle-stimulating hormone (FSH) were low. Following bilateral ovarian wedge resection, the LH and FSH levels of the proband of Family I were normal. Three men of Family I had low plasma testosterone and an abnormally high LH/FSH ratio similar to that of the women. Conclusions were: (1) Ovarian hyperthecosis can be inherited; (2) the inheritance is consistent with an autosomal dominant pattern, but X-linked inheritance cannot be ruled out if the males are excluded; (3) the abnormal LH/FSH ratio can serve as a biochemical marker; (4) ovarian wedge resection corrected the abnormal LH/FSH ratio in one case; and (5) ovarian hyperthecosis may be a type of gonadal dysgenesis.

Cervical cytology: A randomized comparison of four sampling methods

OBJECTIVE The purpose of this study was to compare smear quality and endocervical cell recovery of four cervical smear sampling devices. STUDY DESIGN Two thousand fifteen patients undergoing routine cervical smears at the University of Tennessee Obstetrics and Gynecology clinics were randomly assigned to a cotton swab-spatula, Cytobrush-spatula, Cervex-Brush, or Bayne Pap Brush. The cytopathology laboratory, blind to method, used specific criteria to grade smears as being optimal, adequate, marginal, or inadequate. Statistical analysis was by the chi 2 and analysis of variance tests. RESULTS No statistical differences occurred among the groups for nonpregnant patients. For pregnant patients smear quality was improved with both Cytobrush-spatula and Bayne Pap Brush versus cotton swab-spatula (p = 0.0301 and 0.0004, respectively); cotton swab-spatula had fewer endocervical cells than the Cytobrush-spatula (p = 0.0001), Cervex-Brush (p = 0.0288), and Bayne Pap Brush (p = 0.0081). CONCLUSIONS The cotton swab-spatula and Cytobrush-spatula appear to be the most effective screening methods for nonpregnant and pregnant patients, respectively.

Polycystic Ovarian Disease, Maturation Arrest of Spermiogenesis, and Klinefelter’s Syndrome in Siblings of a Family with Familial Hirsutism *

A family with hirsutism in five generations in which polycystic or bilaterally enlarged ovaries were documented in three different sibships of two generations is described. Two brothers of one of the women with polycystic ovaries had a low or low-normal plasma follicle-stimulating hormone level and one of these had oligospermia due to maturation arrest of spermiogenesis. A third brother had Klinefelters syndrome. Other abnormal features in the family included precocious adrenarche, beardless males, eunuchoidism, and prepubertal grand mal seizures.

Cervical cancer occurrence in Memphis and Shelby County, Tennessee, during 25 years of its cervical cytology screening program.

This review of the cytologic history of 430 women with histologically proved invasive cancer of the uterine cervix indicates that several significant subgroups can be defined. One major subgroup consists of 142 patients or 33% of the total group in whom invasive cancer developed within 1 to 5 years, with an average of 2.6 years, after one or more negative cytologic findings. This appears to be a significant proportion of the occurrence of invasive cervical cancer and warrants consideration in the recommendation of screening intervals. The second major subgroup, consisting of 88 patients (20.5%), had a delay in diagnosis averaging 9.9 years after the first abnormal cytologic finding. In some of these patients either the cytologic examination results reverted to negative for a period or the biopsy material did not confirm the cytologic abnormalities. The disease progressed to invasion. These findings appear to bear out the importance of close follow-up of patients with any abnormal cytologic finding in the intraepithelial neoplasia category even though intermittent cytologic studies may appear negative.

The long‐term course of carcinoma in situ of the uterine cervix

The malignant potential of carcinoma in situ (CIS) of the uterine cervix has been the subject of great controversy. Despite refinements and additions to knowledge in this area, few reports on the long‐term course of the disease have appeared in the past decade. Recent developments in diagnostic and therapeutic techniques coupled with changes in the patient population with this disease have prompted renewed interest in conservative management. Results of long‐term observation of a group of patients followed initially without ablative therapy are reported. The data indicate that CIS of the uterine cervix is not the inevitably progressive disease that it has been considered to be. Unequivocal invasive cancer develops in only a small percentage of cases and can be controlled, if not cured, by current therapeutic modalities. The intraepithelial lesion, however, tends to persist despite conization, and eventually requires ablative therapy in most cases. Conservative procedures should be regarded as temporizing, at least until their long‐term benefits can be recorded.