Symposium: ovarian tumors of borderline malignancy.
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Female↗
Biomedical subjects
E G Silva
Publications and source records attributed to E G Silva.
Uterine neoplasms in patients treated with tamoxifen.
Since 1985, when Killackey originally described three cases of endometrial carcinoma in patients receiving tamoxifen, there have been several reports confirming or denying the relationship between tamoxifen and endometrial carcinoma. Our study of 15 patients treated for breast carcinoma with tamoxifen found that papillary serous carcinoma was the most common tumor in this group of patients. Several other retrospective studies reported a high incidence of high-grade endometrioid adenocarcinoma or high-risk variants of endometrial carcinoma in patients receiving tamoxifen.
Antineoplastic Agents, Hormonal↗
Salvage chemotherapy for refractory transitional cell carcinoma of the ovary (TCC).
OBJECTIVE: Transitional cell carcinoma (TCC) of the ovary is reportedly more sensitive to first-line chemotherapy and has a better prognosis than the more common serous carcinoma. The purpose of this study was to determine the responsiveness of refractory ovarian TCC to salvage chemotherapy. METHODS: Thirty-three patients with refractory TCC who received either platinum drugs or taxanes as salvage chemotherapy at our institution were identified through a retrospective review. Clinical information was abstracted from the medical records, and patient characteristics and response rates were determined. Pathologic sections from all cases were reviewed. RESULTS: The median age of the 33 patients was 53 years (range, 39-71 years). FIGO stage distribution among patients included 1 stage II and 32 stage III. Twenty-six tumors (79%) were classified as TCC-predominant (> 50% of the tumor having the TCC pattern), and seven tumors (21%) were classified as non-TCC predominant (< 50% of the tumor having the TCC pattern). Twenty-four platinum-sensitive patients received salvage platinum therapy (cisplatin, carboplatin, or other platinum analogs) on 27 separate occasions (three patients were treated twice) either as single agents (n = 20) or in combination (n = 7). In 21 of the 27 instances, patients had measurable disease and were evaluable for response. There were nine (43%) complete responses and six (29%) partial responses; in six instances, no response was observed. The overall response rate was therefore 72%. Thirteen patients, of whom 12 had measurable disease, received taxanes (paclitaxel in 10, docetaxel in 2, and paclitaxel+cisplatin in 1). There were partial responses in six (50%) and no response in six. Only one of the responders received high-dose paclitaxel (250 mg/m2). CONCLUSIONS: Our findings suggest that TCC may remain more chemosensitive than more common epithelial tumors in the refractory setting. The relative influences of tumor biology and treatment, however, remain undetermined.
Adult↗
Surgical therapy of T1 and T2 vulvar carcinoma: further experience with radical wide excision and selective inguinal lymphadenectomy.
Radical wide excision and selective inguinal node dissection provide a more conservative and less morbid surgical option for women with vulvar carcinoma than en bloc radical vulvectomy with bilateral inguinofemoral lymphadenectomy. We have expanded our initial experience with this approach to 76 patients with T1 (n = 33) and T2 (n = 43) squamous carcinomas with invasion > 1 mm and clinically negative groin nodes treated between 1978 and 1994. Lateral tumors (n = 53) were more frequent than midline lesions (n = 23). Tumors were excised with a measured gross margin of 2 cm, and dissection was carried to the deep perineal fascia. The mean largest tumor dimension was 26 mm; the mean depth of invasion was 4.4 mm. Superficial inguinal lymphadenectomy, unilateral or bilateral depending on lesion location, was performed. Perioperative complications occurred on the vulva in 8% of cases and in the groin in 11%. Delayed complications, all related to groin treatment, were seen in 29%. The median follow-up interval was 38 months. Seven patients (9%) had inguinal lymph node metastases identified at their primary operation. Most received additional therapy; one has died of disease. Nine women (12%) developed recurrent disease in the vulva: all were controlled by additional resection. Four (5%) developed recurrence in a previously negative groin: three of these are dead of disease. Actuarial 4-year survival is 81%. Radical wide excision and selective inguinal lymphadenectomy can be safely offered to women with T1 and T2 vulvar cancers. Patients with known positive nodes or vulvar failure can be salvaged by further therapy. Women with unanticipated groin failure usually die of disease. These experiences are similar to those observed in more radically resected patients.
Adult↗
Prolonged oral etoposide for refractory advanced uterine leiomyosarcoma.
The case of a patient with a uterine leiomyosarcoma (LMS) that rapidly recurred in the pelvis following primary surgery is reported. The tumor was refractory to conventional multiagent chemotherapy that included intravenously administered etoposide (VP-16). Etoposide was then administered orally in a prolonged schedule; this resulted in a sustained partial response with palliation of symptoms. Thus, prolonged oral administration of etoposide may have antitumor activity against LMS despite that tumor's resistance to short-term infusion schedules of etoposide.
Administration, Oral↗
Combined cisplatin and carboplatin chemotherapy for treatment of advanced epithelial ovarian cancer.
PURPOSE: The primary goal of this trial was to evaluate the clinical activity and the toxicity of a combination of cisplatin and carboplatin for women with advanced-stage epithelial ovarian cancer. PATIENTS AND METHODS: Fifty-one consecutive evaluable patients with untreated stage III and IV epithelial ovarian cancer received 360 mg/m2 carboplatin on Day 1 and 50 mg/m2 cisplatin on Day 2 administered intravenously every 28 days for six cycles. Drug doses were adjusted for hematologic toxicity based on nadir counts during the prior therapy course. Dose levels included 300-400 mg/m2 carboplatin and 50-75 mg/m2 cisplatin. Second-look surgery was optional. Endpoints were clinical response, surgical response, progression-free survival, and survival. RESULTS: Of 8 patients with measurable disease, 3 (37.5%) had a clinical compete response, and 3 (37.5%) had a clinical partial response, for an overall clinical response rate of 75%. Of 39 patients who began chemotherapy with abnormal serum levels of CA 125, 31 (79%) achieved normalization of CA 125 at the completion of chemotherapy. Thirteen patients underwent second-look laparotomy. Of these, 7 (54%) had a pathological compete response, and 2 (15%) had a partial response. The median progression-free survival was 14 months, and the overall median survival was 32.5 months. Neutropenia and thrombocytopenia were the main dose-limiting toxicities. In addition, 9 patients developed grade 2 and 3 developed grade 3 ototoxicity. CONCLUSION: This regimen is very active against advanced-stage epithelial ovarian cancer. The degree of ototoxicity observed is worrisome, but such toxicity may be ameliorated by limiting the dose of cisplatin and increasing the dose of carboplatin.
Adolescent↗
Ovarian malignant mixed müllerian tumors treated with platinum-based chemotherapy.
OBJECTIVE: To characterize the clinical course of patients diagnosed with ovarian malignant mixed müllerian tumors treated with platinum-based chemotherapy. METHODS: Thirty-six patients received this treatment at The University of Texas M. D. Anderson Cancer Center in the period 1979-1993. The mean age was 59 years. Stage distribution was as follows: stage IA, one (3%) patient; stage IIIB, two (5.5%); stage IIIC, 21 (58%); and stage IV, two (5.5%). Ten (28%) patients were unstaged. Chemotherapy regimens included cisplatin, doxorubicin, and cyclophosphamide in 16 patients; cisplatin-ifosfamide in five; cisplatin-cyclophosphamide in four; carboplatinum in three; cisplatin-doxorubicin in three; and various other combinations in the remaining five. RESULTS: Of 16 patients evaluated for clinical response, seven (44%) had a complete response and four (25%) had a partial response, for a total clinical response rate of 69%. Nine patients were evaluated for surgical response: five (56%) had a complete response and one (11%) had a partial response, for a total surgical response rate of 67%. The median survival for the cohort was 18 months. At the time of this analysis, five (14%) patients were alive and disease-free, 25 (69%) had died of disease, five (14%) were alive with disease, and one had been lost to follow-up. CONCLUSION: This study suggests that the clinical course of patients with ovarian malignant mixed müllerian tumors treated with platinum-based chemotherapy is similar to the clinical course experienced by patients with high-grade epithelial carcinoma of the ovary.
Adult↗
Histiocytic reaction in pelvic peritoneum associated with oxidized regenerated cellulose.
The authors present five cases of an unusual inflammatory reaction in pelvic peritoneal tissues associated with oxidized regenerated cellulose, a topical hemostatic agent. The findings were observed in specimens from five women who had been treated with oxidized regenerated cellulose during abdominal surgery. Histologically, the lesion was characterized by collections of large cells beneath the mesothelial surface, with small bland nuclei and abundant granular basophilic cytoplasm that stained bright red with mucicarmine. Immunohistochemical studies demonstrated that these cells stained positive for KP1 (CD68) confirming their histiocytic nature, and negative for cytokeratin and S-100 protein excluding the diagnoses of carcinoma and granular cell tumor respectively. Although unlikely, the mucicarmine positivity may be misinterpreted, leading to a erroneous diagnosis of adenocarcinoma. To avoid misdiagnosis, pathologists need to be aware of this lesion.
Adenocarcinoma↗
Low-stage clear-cell carcinoma of the endometrium.
Clear-cell carcinoma (CCC) of the endometrium is a relatively rare malignancy that is considered to be one of the most aggressive types of endometrial carcinoma. To evaluate the behavior of low-stage (stages I and II) CCC of the endometrium, we retrospectively reviewed 17 such cases seen at The University of Texas M.D. Anderson Cancer Center from 1963 to 1990. Patients' ages ranged from 52 to 81 years. Fifteen cases were pure CCC, and two cases were predominantly CCC with a focus of endometrioid adenocarcinoma FIGO grade I. All patients have been followed-up for at least 3 years. At the time of the study, six patients were alive without disease, one patient was alive with disease, five had died of other causes, and five had died of disease. The estimated survival rate was 71%. Estimated 5-year survival rates for endometrioid adenocarcinoma FIGO grade III and uterine papillary serous carcinoma are 73 and 39%, respectively. We conclude that patients with low-stage CCC of the endometrium have a survival rate similar to that of patients with endometrioid adenocarcinoma FIGO grade III and better than that of patients with uterine papillary serous carcinoma of similar stages.
Adenocarcinoma, Clear Cell↗
Endometrioid carcinoma of the ovary with a prominent spindle-cell component, a source of diagnostic confusion. A report of 14 cases.
Fourteen endometrioid carcinomas of the ovary with a prominent component of spindle-shaped epithelial cells are reported. Eleven were initially misdiagnosed as sexcord stromal tumors, malignant mesodermal mixed tumors, tumors of probable wolffian origin, or metastatic carcinomas. All of the tumors, however, had one or more features establishing them as endometrioid carcinomas, including (a) glands typical of endometrioid adenocarcinoma, (b) foci of squamous differentiation, and (c) an adenofibromatous component. Six cases were examined immunohistochemically, and the epithelial nature of the spindle cells was supported by immunostaining for keratin and epithelial membrane antigen. The patients ranged in age from 42 to 89 years (mean, 61). Four cases were stage I, five stage II, and three stage III. Follow-up information was available in seven cases. Five patients were free of disease at 8, 11, 32, 56, and 103 months, and two patients were alive with disease at 10 and 20 months. The age of the patients, clinical presentation, tumor stage, and gross appearance were similar to those of typical endometrioid carcinomas. It is important that this tumor be distinguished from other ovarian neoplasms with a spindle-cell component because of differences in treatment and prognosis.
Adult↗
Uterine leiomyosarcoma with clear cell areas.
An unusual case of a uterine leiomyosarcoma with a clear cell component in an 82-year-old woman who presented with vaginal bleeding and a mass protruding through the cervix is reported. Histologic examination of the biopsy sample showed only pleomorphic clear tumor cells and necrosis. Because the patient had a history of a breast carcinoma, and a computed tomography scan of the abdomen showed a renal cyst, these lesions created some problems in the differential diagnosis of the patient's clear cell neoplasm. The patient was treated with a hysterectomy, and examination of the uterus showed an epithelioid leiomyosarcoma with areas of clear cells. Four months after surgery, the patient presented with a vaginal recurrence, which was resected. Twelve months later, the patient had no evidence of recurrence.
Aged↗
Salvage surgery for chemorefractory ovarian germ cell tumors.
This study was undertaken to determine whether secondary surgical debulking is beneficial for patients with malignant ovarian germ cell tumors (OGCT). Twenty patients with OGCT treated at our institution between 1975 and 1992 were retrospectively identified and analyzed. Survival was analyzed using the life-table methods of Kaplan and Meier and the statistical significance of various perioperative factors was tested by both the log-rank and the Wilcoxon tests. Histologic tumor type included 8 immature teratomas, 6 mixed tumors, 5 endodermal sinus tumors, and 1 dysgerminoma. After primary surgery, all patients received chemotherapy--non-platinum-based in 12 patients, platinum-based in 5, and both types in 3 patients. Treatment failure was classified as progression in 14 patients, persistence in 3, and recurrence in 3. Salvage surgery consisted of exploratory laparotomy and tumor debulking in 18 patients, inguinal lymphadenectomy in 1, and thoracotomy and wedge resection in 1. Sixteen patients subsequently received salvage chemotherapy. At the time of analysis, 11 patients were alive disease-free, 1 was alive with tumor, 6 had died of tumor progression, and 2 had died of treatment-related complications. Survival of patients with immature teratoma who underwent salvage surgery was significantly better than survival of those with other tumor cell types (P = 0.006). In conclusion, although the role of secondary debulking in chemorefractory OGCT remains undetermined, it may have some benefit for a select group of patients, particularly those with immature teratoma.
Adolescent↗
High-stage endometrioid carcinoma of the ovary. Prognostic significance of pure versus mixed histologic types.
We retrospectively reviewed 80 cases of endometrioid carcinoma of the ovary: 68 pure endometrioid tumors and 12 predominantly endometrioid carcinomas (> 50%) mixed with either papillary serous or undifferentiated carcinoma. Each group had 11 cases of stage III or IV tumors, which were studied to determine whether the overall prognosis was affected by grade, histology, number of mitoses, residual tumor after surgery, and patient's age. Prognosis was significantly affected only by a mixed histologic pattern. The 5- and 10-year survival rates and the median survival time for pure endometrioid carcinomas were much better than those for mixed endometrioid carcinomas (63% and 45% and > 86 months versus 8% and 0% and 18 months, respectively). Recurrent tumors in cases of mixed endometrioid carcinoma were pure serous or undifferentiated carcinomas, whereas those in cases of pure endometrioid carcinoma were either endometrioid or high-grade carcinoma. Our results show that the presence of even a small component of serous or undifferentiated carcinoma in an otherwise predominantly endometrioid carcinoma significantly affects the prognosis. Thus pathologists should thoroughly sample all endometrioid carcinomas, especially high-stage tumors, to ensure that no serous or undifferentiated component is present.
Carcinoma, Endometrioid↗
Micropapillary variant of transitional cell carcinoma of the urinary bladder. Histologic pattern resembling ovarian papillary serous carcinoma.
Eighteen cases of transitional cell carcinoma (TCC) of the urinary bladder containing a micropapillary component (MPC) (> 90%, three cases; 50-90%, nine cases; < 50%, six cases) are presented. The patients' mean age was 66.6 years (range, 47-81 years) with a male predominance (male-to-female ratio of 5:1). The MPC was part of the surface noninvasive TCC in 16 cases and part of the invasive portion of the TCC in all 18 cases. Eight patients had metastases, each with a predominant (> or = 50%) MPC in the metastases; local recurrence was documented in one case, and the tumor was locally invasive into pelvic structures in three cases. Histologically, the surface MPC comprised slender, delicate filiform processes or small papillary clusters of tumor cells, whereas the deep MPC was composed of infiltrating tight clusters of micropapillary aggregates that were often present within lacunae. Vascular-lymphatic invasion was consistently present in the micropapillary areas. The cytologic features of the MPC were those of grade 3 TCC. A concurrent TCC in situ was identified in 10 cases, noninvasive papillary TCC component in all cases, and glandular differentiation of the invasive TCC in five cases. The initial stage at presentation was usually high stage: one patient with stage A, nine with stage B, six with stage C, and two with stage D. Follow-up data (mean, 44.8 months; range, 6-96 months) indicated that four patients were alive with disease, seven patients were dead of disease, and there was no evidence of disease in seven patients. In five cases, DNA ploidy analyzed by static image analysis showed nondiploid indices within the micropapillary TCC component, and in three cases the DNA index of the MPC (noninvasive, invasive, or at metastatic site) exceeded the DNA index of the noninvasive papillary TCC. In conclusion, the presence of a MPC in TCC is associated with high-grade and high-stage TCC with a tendency to vascular invasion. Our data suggest that a surface MPC in bladder biopsy specimens is a poor prognostic histologic feature and, if the biopsy does not contain muscularis propria, deeper biopsies should be recommended to determine the presence of muscle invasion.
Aged↗
Ovarian involvement by serous surface papillary carcinoma.
Serous surface papillary carcinoma (SSPC) is a multicentric peritoneal tumor that can spare or minimally involve the ovaries and has been reported to be more aggressive than the usual form of serous carcinoma of the ovary (SCO). From 360 serious ovarian carcinomas, we selected 87 cases with high histological grade, clinical stage III, residual disease after the first operation, similar chemotherapeutic regimens, and at least a 4-year follow-up period. Of these, 33 patients had SSPC in which the tumors were smaller than 10 mm (ovaries not enlarged), and 54 had SCO in which the tumors were larger than 5.0 cm. The 33 cases with SSPC were then subdivided according to tumor size: (a) 17 patients had SSPC characterized by tumors that were smaller than 5.0 mm in largest dimension and that involved only the ovarian surface or showed minimal superficial invasion of the ovarian cortex (maximum depth, 3 mm); (b) 16 patients had SSPC characterized by tumors that measured 5.1 to 10 mm and involved the ovarian surface, cortex, and/or medulla. The subdivision of the SSPC into small and large types was found to be of no clinical statistical significance; thus, the two groups were recombined as a single group. The difference in length of survival between SSPC and SCO at 24 months (39% versus 32%, respectively) and the median survival times (SSPC = 17 months and SCO = 18 months) were not statistically significant. However, the 48-month survival rate (SSPC = 28% and SCO = 9%), was statistically significant (p = 0.027).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Malignant neoplasms of the uterine corpus in patients treated for breast carcinoma: the effects of tamoxifen.
We reviewed the clinical history and pathology material of 72 patients seen at the M. D. Anderson Cancer Center who developed malignant neoplasms of the uterine corpus after being treated for breast carcinoma with either tamoxifen or other therapeutic regimens. The purpose of this study was to investigate the type of malignant tumors seen in the uterus, their association with endometrial polyps or hyperplasia, and their possible relationship to tamoxifen treatment. This study shows that in patients treated for breast carcinoma, the uterine malignancies are characterized by several features: (a) a previously unreported high incidence of clear cell carcinoma (14 cases) and leiomyosarcoma (12 cases); (b) seven of 12 leiomyosarcomas with unusual features, such as epithelioid (5), tubular (1), and myxoid features (2); (c) a higher incidence of serous carcinoma (45% in patients treated for > or = 12 months); (d) endometrial polyps associated with carcinoma more often than endometrial hyperplasia.
Adenocarcinoma, Clear Cell↗
Benign retroperitoneal cysts of müllerian type: a clinicopathologic study of three cases and review of the literature.
Benign retroperitoneal cysts (RPCs) of müllerian type may present as a pelvic mass in a perimenopausal or postmenopausal woman, and thus clinically can mimic an ovarian malignancy. We report three women, aged 73, 45, and 68 years, who presented with large RPC masses ranging from 8 to 17 cm in diameter. Histologically, the cysts were lined by benign müllerian-type epithelium: serous epithelium in two patients and mucinous epithelium in one patient. A malignant component was not present in any of the cases. Preoperative diagnosis in two patients was ovarian carcinoma based on clinical and computerized tomography findings. Two patients are alive without evidence of disease 44 and 56 months following surgical excision, whereas one patient died of perioperative complications unrelated to the cystic lesion. Similar previously reported cases and their possible pathogenetic mechanisms are discussed. Although the müllerian type of RPCs behave in a benign manner, a malignant component has to be searched for. Thus, complete excision with careful histologic examination rather than drainage or marsupialization is recommended.
Aged↗
Role of Ca(+)-dependent K-channels in the membrane potential and contractility of aorta from spontaneously hypertensive rats.
1. Contractile responses to KCl and membrane potentials were determined in aortic rings from spontaneously hypertensive rats (SHR), normotensive Wistar rats (NWR) and Wistar Kyoto rats (WKY) both in the absence and in the presence of the Ca(2+)-dependent K-channel blockers, apamin and tetraethylammonium (TEA). 2. Compared to NWR, aortic rings from WKY and SHR were less reactive and their Ca2+ uptake after stimulation with K+ was decreased. 3. Smooth muscle cell membrane potentials were higher in aortae from SHR and WKY than in NWR aortae, whereas SHR had higher K+ and lower Na+ intracellular activities than WKY and NWR, suggesting overactivity of the Na+/K+ pump in the hypertensive animals. 4. Treatment with apamin caused depolarization of WKY and SHR aortae, and increased their contractile responses to the same level as those of the NWR. Treatment with TEA also caused depolarization of aortae from WKY and SHR, but in the SHR the depolarization induced by TEA was smaller than that produced by apamin and the contractile responses to KCl did not reach the level of those of aortae from NWR. 5. It is concluded that overactivity of Ca(2+)-dependent K-channels in aortae of WKY and SHR contributes to their higher membrane potentials and lower responsiveness to vasoconstrictor stimuli. In SHR, an overactive Na+/K+ pump is also present, and the contribution of apamin-sensitive Ca(2+)-dependent K-channels to the membrane potential and reactivity appears to be more relevant than that of TEA-sensitive channels.
Animals↗