Faculty Bibliography

Background/UNASSIGNED:While the combination of a pelvic mass, very high serum level of CA-125, chest adenopathy, and ascites is concerning for advanced-stage ovarian cancer, the etiology of such a presentation can be due to disseminated pelvic tuberculosis. Case/UNASSIGNED:The patient was diagnosed with disseminated pelvic tuberculosis and multidrug therapy was initiated. Conclusion/UNASSIGNED:Pelvic tuberculosis can mimic advanced-stage ovarian cancer; thus obtaining a tissue sample may be beneficial to more appropriately direct treatment and planning for neoadjuvant therapies given the ineffectiveness of extensive surgical procedures in treating pelvic tuberculosis commonly employed in the treatment of advanced-stage ovarian cancer.

It has been suggested that urokinase plasminogen activator (uPA) in cancer cells is upregulated by the p185 kD form of the HER-2/neu oncogene. This study was performed to see if the extracellular domain of HER-2/neu, the p105 fraction, which is found in the circulation, has any regulatory influence on uPA in patients with cervical cancer. Levels of uPA and p105 HER-2/neu were determined in blood from age-matched controls and patients with early and advanced cervical cancer. In the patients with cervical cancer, samples were obtained before treatment only. No significant increase in either uPA or HER-2/neu was seen in the patients before their treatment for cervical cancer. Additionally, correlation analysis of circulating uPA and HER-2/neu against each other in both the controls and cervical cancer indicated no relationship except in early stage disease. It appears that circulating uPA and HER-2/neu are not altered in patients with cervical cancer, either early or advanced stages. The upregulation of uPA by HER-2/neu seen in cancer cells in vitro appears to occur in vivo in early stage cervical cancer.

BACKGROUND: Abdominal pregnancy is a rare obstetric emergency, occurring in 1 in 10,000 pregnancies. CASE: An 18-year-old woman, gravida 3, para 1, presented for evaluation of an abnormal level of maternal serum alpha-fetoprotein. Transabdominal ultrasound examination revealed absence of amniotic fluid with limited imaging ability. Transabdominal amnioinfusion was done to better visualize the fetus. A small uterus was seen in the pelvis, and an abdominal pregnancy was identified with the placenta attached anteriorly over the right pelvic sidewalls. After delivery of the fetus, the placenta was left in situ. The patient recovered postoperatively and was doing well a year after the procedure. A 12 x 10-cm mass remains over the right pelvic sidewall without detectable Doppler blood flow. CONCLUSION: State-of-the-art imaging and prenatal diagnostic techniques allowed correct diagnosis, adequate preparation and optimal management of this dangerous condition.

OBJECTIVE: To evaluate circulating HER-2/neu in cervical cancer patients prior to and following treatment. METHODS: Controls, and patients with either cervical dysplasia or cancer taken from an active gynecologic oncology service were evaluated for the expression of HER-2/neu in serum by ELISA before and following surgery, radiation, chemotherapy or combinations thereof. The resulant data was then evaluated for significance by either ANOVA or non-parametric testing. RESULTS: Mean differences were noted for patients with cervical cancer compared to controls. Patients with a good response to the chemotherapy indicated an increase in the serum oncogene, while those not responding either had no marked change or decreased the level of serum HER-2/neu. CONCLUSIONS: As serum HER-2/neu is a membrane bound portion of the intact molecule, these results suggest that due to the induction of cell death and breakdown, the liberation of this fraction (increased levels in the serum), is a viable indicator of response to treatment in some patients. A more detailed examination of this possibility along with expanded correlation with tissue expression is required.

Introduction. Epilepsy is an heterogenous collection of neurological disorders that have in common a transient and recurrent hypersynchronous activation of large populations of neurons in distinct focal areas or in the entire brain. Development. Research into the cellular mechanisms of epilepsy focuses on understanding: 1. The alterations on cellular and network excitability, and 2. The mechanisms of hypersynchronization. Several different animal models exist that mimic different types of focal and generalized epilepsy in humans. Hypothesis derived from such models is helping to design more effective therapies

The goal of immunotherapy is to eliminate tumors by generating tumor-specific cytotoxic T lymphocytes (CTLs) in patients or by adoptively transferring ex vivo-activated CTLs into patients. Clinical trials have shown that tumor-specific CTLs often disappear before tumors are completely eliminated. In this study, the authors show that CTLs specific for cervical tumor cells undergo apoptosis after they are co-cultured with cervical tumor cells. The established cervical tumor cell lines and cervical cancer tissues express CD95 (Fas/Apo-1) ligand. The tumor cell-induced T-cell apoptosis can be blocked by an inhibitory anti-CD95 (APO-1/Fas) antibody, indicating that tumor cells induce apoptosis of CTLs through CD95-CD95 ligand interaction. Addition of interleukin-2 (IL-2) and IL-7 into the culture rescues the CTL from tumor cell-induced apoptosis. The rescued T cells retain their full antitumor cytotoxicity. These data suggest that human cervical tumor cells might actively down-regulate a cellular immune response by inducing apoptosis of specific T cells during immunotherapy. Local use of IL-2 and IL-7 as adjuvants may promote survival of the CTL and, thus, enhance the efficacy of immunotherapy.

A variety of cytokines have been identified to play a role in ovarian cancer. In this pilot study, we sought to determine whether transforming growth factor-alpha (TGF-alpha) was detectable in the serum and ascites of women with advanced stage epithelial ovarian cancer. TGF-alpha was measured using an enzyme-linked immunosorbent assay and was present in 18 of 25 control sera. Prior to treatment for stage III or IV epithelial ovarian cancer, 18 patients had undetectable serum levels of TGF-alpha, while 18 had values ranging from 10.6 to 531.7 pg/ml. The group with undetectable levels had a 6-month greater median survival; detectable TGF-alpha might be a negative prognostic indicator. In a separate group undergoing second-look laparotomy, differences in median TGF-alpha values versus controls and the primary study group approached significance. TGF-alpha was detected in significantly more control peritoneal fluid samples than in patient ascites. A larger study is warranted.