William J. Hoskins

Radical hysterectomy and pelvic lymphadenectomy for Stage IB carcinoma of the cervix: 21 years experience

From September 1971 through December 1982, 153 patients with Stage IB carcinoma of the cervix underwent radical hysterectomy and pelvic lymphadenectomy at two of the teaching hospitals of the Uniformed Services University of the Health Sciences. Records were retrospectively analyzed and independent pathologic review was performed. All surgical procedures were performed by fellows or senior residents under the direct supervision of the gynecologic oncology staff of the Walter Reed Army Medical Center or the Naval Hospital, Bethesda, Maryland. In this series, IB carcinoma was defined as squamous carcinoma clinically confined to the cervix with invasion greater than 5 mm from the basement membrane or any adenocarcinoma confined to the cervix. The average age of the patients was 38.3 years. The histologic types were squamous in 72%, adenocarcinoma in 16%, and adenosquamous in 10.5%. The mean operating time was 5 hr and 40 min with an average blood loss of 1800 cc. There were two ureterovaginal and two vesicovaginal fistulae for an overall fistula rate of 2.6%. Actuarial survival for these 153 patients is 84%. This extends the previous series of R. C. Park, W. E. Patow, R. E. Rogers, and E. A. Zimmerman, Obstet. Gynecol. 41, 117-122 (1973) of 122 cases collected from 1961 to September 1971 to 275 cases. In comparing the two time periods, no significant differences were found in operative technique or complications, but there was a change in the incidence of adenocarcinoma and mixed cell types and a difference in survival. A relatively higher incidence of more aggressive tumors may indicate the need for different therapeutic approaches in the future.

Epithelial Ovarian Carcinoma of Low Malignant Potential

The records of 94 patients with epithelial ovarian carcinoma of low malignant potential were examined. These records were contributed by Walter Reed Army Medical Center, Naval Hospital, Bethesda, MD, and Naval Hospital, Portsmouth, VA. A review of microscopic sections from each of the 94 tumors confirmed that these were lesions of low malignant potential. The tumors occurred in patients of a younger age than that generally described for invasive epithelial ovarian carcinoma. Forty-seven of 94 patients had stage I disease. The corrected five- and ten-year survival rates were 95 and 87%, respectively. Adjunctive postoperative therapy may not influence survival.

The second-look surgical reassessment for epithelial ovarian carcinoma☆

The second-look surgical reassessment is currently being performed on most patients with epithelial ovarian carcinoma after first-line chemotherapy if they are clinically free of disease. Ninety-six patients who underwent such procedures at Walter Reed Army Medical Center and the Naval Hospital, Bethesda, from January 1974 through May 1982 are reviewed. The grade of tumor, stage of disease, and amount of residual tumor remaining after initial surgery are predictive of the findings of the surgical reassessment. While a surgical reassessment is beneficial in evaluating response to therapeutic modalities under protocol investigation, its use should be individualized.

Nonsquamous cancer of the vagina

This report retrospectively analyzes 48 cases of primary vaginal cancer treated at Walter Reed Army Medical Center and the Naval Hospital, Bethesda, from 1962 through 1983. There was an unusually high number of uncommon histologic types. Nine patients had an adenocarcinoma, 5 had a sarcoma, 3 had a melanoma, 2 had an adenosquamous carcinoma, 1 had a lymphoma, and 1 had a carcinoid tumor. The remaining 27 patients had a squamous cell carcinoma. This represents a 43% prevalence of nonsquamous lesions. Nonsquamous cancer of the vagina occurred in patients at an earlier age than squamous cell carcinoma. Presenting symptoms, the location of the tumor within the vagina, and survival rates were similar for both groups. The clinical characteristics and treatment of the patients with nonsquamous tumors are discussed.

Adenoid cystic carcinoma of the cervix uteri: report of six cases and review of the literature.

Abstract Six cases of adenoid cystic carcinoma of the uterine cervix are presented. The clinical course of the patients and the pathologic findings are presented in detail. Thirty-seven cases previously reported in the literature are reviewed and analyzed. The six new cases presented in this manuscript are compared to the previously reported cases. The aggressive nature of this unusual carcinoma is illustrated and the necessity for aggressive therapy in order to control the disease process is discussed.

Percutaneous nephrostomy for ureteral obstruction in patients with gynecologic malignancy

Reversible ureteral obstruction is not an infrequent complication of gynecologic malignancy or its treatment. In the past, open nephrostomy has been the standard method of management in such patients. This paper discusses the nonoperative technique of percutaneous nephrostomy which allows placement of either an external nephrostomy tube or an internal ureteral stent under local anesthesia. Six illustrative cases are presented and the indications and technical aspects of the procedure are discussed.

Intranasal Retraction of Nasogastric Feeding Tube: Case Report and Suggestion for Design Modification

A 61-year-old black woman was admitted with intermittent small bowel obstruction following multiple therapies for recurrent ovarian carcinoma. Conservative enteric therapy with central hyperalimentation was begun prior to surgical intervention. After approximately 3 wk without resolution, surgical bypass of the obstructed area was performed for palliation. With the return of bowel function, continuous enteral feeding was utilized. During placement of enteral feeding tube, the proximal end spontaneously retracted into the patients nasal cavity with associated patient distress. After some difficulty, the feeding tube was removed. Simple design modification of the proximal portion of the nasogastric feeding tube should prevent such complication. The addition of wings to the proximal end should be considered as a modification to prevent similar occurrences.