Faculty Bibliography

We retrospectively reviewed the cases of 51 patients with borderline ovarian tumors seen over a 9-year period. Half of these tumors were manifested by abdominal distention and pain; the remainder were found incidentally at the time of surgery planned for other reasons. Overall survival is excellent, but proper surgical staging reveals that approximately 15% of patients have metastasis beyond the ovaries, most commonly to the omentum, peritoneum, and retroperitoneal lymph nodes.

This study analyzed cervical squamous intraepithelial lesions (SILs) in pregnant women for human papillomavirus (HPV) using in situ hybridization analysis. HPV DNA was detected in 77% (23/30) of low-grade SILs as compared to 89% of such lesions in nonpregnant women. The detection rate in high-grade SILs was 41% (9/22) compared to 70% in nonpregnant women. Analysis by the polymerase chain reaction showed that the detection rates were similar (96-100%) for low- and high-grade lesions in pregnant and nonpregnant women, which demonstrates that in situ negative tissues indeed contained HPV DNA. Low-grade SILs contained a heterogeneous group of at least 14 different HPV types, whereas most high-grade SILs contained HPV 16. We concluded that cervical SILs in pregnant women are invariably associated with HPV. Further study is needed to determine which of several possible variables, such as the age of the lesion and the viral copy number, may explain the apparent decreased detection rate of HPV by in situ hybridization in SILs during pregnancy.

The purpose of this study was to analyze the HPV types and histological margins of cervical squamous intraepithelial lesions (SILs) treated by cold-knife conization and to correlate this with recurrent disease. Of 203 cone biopsies done for SILs primarily because the entire lesion could not be visualized at colposcopy, follow-up information was available for 85 cases. Of these 85 cases, biopsy-proven recurrences were documented for 10 (12%) women. In the SILs which recurred after conization, the lesion was noted on the surgical margin in 7/10 (70%) cases. In contrast, SILs that did not recur after cold-knife conization were detected on the surgical margin in only 12% of cases. In 7 of the recurrences, the HPV type detected in the pretreatment SIL was the same as that detected in the SIL that occurred after conization. In the other 3 recurrences, one of either the primary or recurrent SILs was HPV positive and the other corresponding lesion HPV negative. It is concluded that detection of a SIL on the surgical margin is a marker for recurrent disease and that recurrences are often associated with the same HPV type as that noted in the pretreatment SIL.

Five versus ten cycles of cyclophosphamide, doxorubicin, and cisplatin (CAP) were compared in advanced ovarian carcinoma by a prospective randomized study of 78 patients, 41 receiving 5 cycles (CAP5) and 37 receiving 10 cycles (CAP10) of chemotherapy. Patients were stratified by histologic grade and size of residual disease. Cyclophosphamide, 600 mg/m2, doxorubicin, 40 mg/m2, and cisplatin, 100 mg/m2, were administered every 4 weeks for 5 or 10 cycles. Second-look laparotomy was performed to evaluate response and plan further therapy. CAP5 patients found a second-look laparotomy to have partially responded to chemotherapy were treated with 5 additional cycles of CAP. CAP10 was more toxic than CAP5 with respect to myelosuppression, hospital admissions for nadir fever, median elevation of creatinine, and degree of peripheral neuropathy. Median follow-up is 64 months. CAP5 and CAP10 were equivalent in surgically documented complete responses (34 versus 35%) and survival (P = 0.41). Twelve partial responders to CAP5 received additional CAP chemotherapy; one complete response resulted. We conclude that CAP5 is preferable to CAP10 in treatment of advanced ovarian cancer as it is equally effective and less toxic.

OBJECTIVES/OBJECTIVE:We attempted to determine the clinical usefulness of a preoperative platelet count for predicting malignancy in patients presenting with a pelvic mass. Additionally, in patients in whom a preoperative serum CA 125 level was also determined, the clinical usefulness was compared. STUDY DESIGN/METHODS:A retrospective review of charts of 241 patients presenting with a pelvic mass was carried out. The patients were then divided by pathologic diagnosis into group 1, benign disease (n = 102), and group 2, invasive (n = 121) or borderline (n = 18) malignancies. Thrombocytosis (platelet count greater than 400,000/microliters) was present in 16% (n = 16) of patients in group 1 and in 56% (n = 78) of patients in group 2 (p less than 0.0001). Of the 241 patients, 130 also had preoperative serum CA 125 levels measured. Elevated values of serum CA 125 (greater than 35 U/ml) occurred in 14% (n = 8) of group 1 and in 81% (n = 60) of group 2 (p less than 0.0001). The chi 2 test was used to analyze results of data. RESULTS:Statistically significant differences in preoperative platelet count and serum CA 125 values were found between group 1 and group 2 patients. The specificity and positive predictive value for thrombocytosis (84% and 83%) compared well with those for serum CA 125 (86% and 88%). The combined use of the tests resulted in specificity of 96% and positive predictive value of 95%. CONCLUSIONS:Preoperative platelet count is a test that is rapidly available and easily obtained. The test results may be of value in planning the original management of women presenting with a pelvic mass.

The purpose of this study was to correlate the histological findings and clinical information for vulvar precancers and cancers with the detection of human papillomavirus (HPV). Forty-five squamous cell lesions (twenty-two high-grade squamous intraepithelial lesions (SILs) and twenty-three invasive cancers) were analyzed for HPV DNA after amplification by the polymerase chain reaction. HPV DNA was noted in 13/22 (59%) high-grade SILs and 7/23 (30%) invasive cancers. For the invasive cancers, HPV DNA was detected in 0/13 that had substantial keratinization compared to 7/10 with minimal keratinization. Adjacent SIL was noted in 6/7 (86%) HPV-positive cancers compared to 1/16 (6%) in the HPV negative group. The mean age of the two groups was equivalent. The rate of metastases (3/7, 43%) for the HPV-positive group was higher than that for the HPV-negative (4/16, 25%) group. We conclude that vulvar cancers, unlike squamous cell carcinoma of the cervix, which is associated with HPV DNA in most cases, can be differentiated into two groups on the basis of histological findings and presence of HPV DNA.

Three patients with ovarian cancer who developed gastric outlet obstruction due to loculated ascites in the lesser omental sac are presented. Surgical decompression was utilized, in one case with significant morbidity. Percutaneous drainage under CT or ultrasound guidance allows palliation and avoids potential morbidity and prolonged hospitalization and can be repeated if the condition recurs.

Nucleolar Organizer Regions (NORs) code for ribosomal RNA and are thought to be an accurate representation of the percentage of cells in S-phase. NORs are associated with nonhistone nucleoproteins, which can be stained with silver (AgNORs). An increased number of AgNORs has been observed in many malignancies. AgNORs were counted in three groups of patients with endometriosis (Group I), atypical endometriosis (Group II), and clear cell or endometrioid carcinomas (Group III) to assess the malignant potential of atypical endometriosis. Each group consisted of 10 patients. Mean AgNOR counts were 5.83 (Group I), 7.68 (Group II), and 15.42 (Group III). The results were analyzed and were significantly different for all groups (P less than 0.05 for Groups I and II, P less than 0.02 for Groups II and III, and P less than 0.01 for Groups I and III). A critical AgNOR count of 8.20 was calculated utilizing AgNOR counts from Group I. Three of the four patients with AgNORs greater than 8.20 and atypical endometriosis developed a malignancy. AgNOR counts provide useful information, represent an inexpensive test which can be obtained from fixed tissue, and may aid in clinical management of patients with atypical endometriosis.

Thirty-four women with genuine stress incontinence and low urethral closure pressure were studied pre- and postoperatively. A modified Burch retropubic urethropexy was performed in 29 patients with a cure rate of 78%, improvement in 7%, and failure in 15%. The modified Stamey procedure was performed in 5 patients with significant pelvic floor relaxation with a cure rate of 40% and improvement in 60%. If urethral mobility is present, traditional anti-incontinence procedures appear to be a reasonable alternative in patients with low urethral pressure.