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The FIGO staging system has undergone many modifications since it first appeared in about the middle of the previous century. Due to the use of modern diagnostic tools, namely computed tomography, magnetic resonance imaging, positron emission tomography, sentinel lymph node biopsy and neoadjuvant chemotherapy, certain gynecological cancer cases cannot be allocated to a specific stage if one wishes to adhere strictly to FIGO requirements. In these circumstances such cases actually remain unstaged. This should prompt appropriate modifications of the current FIGO staging system so that it fulfills its aims., (© 2017 Nordic Federation of Societies of Obstetrics and Gynecology.)

Objective: To assess cyclooxygenase-2 (COX-2) expression in the carcinomatous and sarcomatous elements of uterine carcinosarcoma., Design: Retrospective study., Setting: Medical center., Sample: Twenty-seven consecutive uterine specimens with carcinosarcoma., Methods: COX-2 expression assessment by immunohistochemistry was performed on deparaffinized sections of paraffin-embedded tissue blocks. Analysis of all stained tissue sections was done by means of light microscopy counting 10 high power fields with a minimum of 1,000 cells per slide. Analysis of the stained tissue sections was done by pathologists blinded to the clinical data and the follow-up course of the malignancy., Main Outcome Measures: Staining of more than 10% of the cells was considered positive. Staining intensity was graded on a 0-3 scale. A scoring index was calculated by multiplying the intensity grade by the percentage of stained cells and considered low when it was < or =1 and high when it was >1. COX-2 expression was associated with prognostic factors and survival., Results: COX-2 immunohistochemical staining was positive in 74% of the carcinomatous component of carcinosarcoma and a high staining score was observed in 48.2%. Staining parameters were significantly lower in the sarcomatous component. No significant association between COX-2 expression with stage, grade, depth of myometrial invasion, lymphvascular involvement or with survival was observed., Conclusions: COX-2 is expressed in a high percentage of uterine carcinosarcoma, but does not seem to be associated with prognostic factors or survival.

Objective: To assess the trend over time of the relative frequency and incidence of adenocarcinoma (AC) in Israeli Jewish women., Design: Register study., Setting: Israel National Cancer Registry., Population: All cases of histologically proven invasive cervical cancer diagnosed during two time periods: 1961-1971 and 2002-2004., Methods: Calculation of frequencies and incidence rates and comparison by the chi2 test and by the Poisson regression model, respectively., Main Outcome Measures: Frequency and incidence of AC., Results: There were a total of 532 women with a diagnosis of cervical cancer during the first and 434 women during the second period (incidence 4.2 and 4.7/100,000, respectively). The total incidence rates and frequency rates of AC during the two periods were statistically not different. The frequency rate of AC during the second period was significantly higher in the 20-29 and the 40-49 age groups and in the North African born than in the other ethnic groups., Conclusions: Our study indicates that except in certain age and ethnic groups, the frequency and incidence of AC has not significantly altered in Israel over the time periods studied.

Objectives: To determine the incidence of ovarian malignant tumors in childhood and adolescence, to ascertain the frequency distribution of the various tumor types and to assess time trends in Israel on a nationwide basis., Methods: The study group included all Israeli Jewish patients < or = 19 years old with histologically confirmed ovarian malignancies, diagnosed in Israel from 1970 to 1994. Data were obtained from the Israel Cancer Registry. The effects of age at diagnosis and period of diagnosis were analyzed using the Poisson regression., Results: Among the 82 patients identified, the most frequent tumors (72.0%) were of germ cell origin and among those about one third were dysgerminomas. Epithelial tumors were diagnosed in 26.6% of the patients and most of these were borderline malignancies. The incidence rate (IR) for the total group of ovarian malignancies in the 0-19 age group was 0.52 and for ages 5-19 it was 0.71 per 100,000. After adjustment for age, a significant linear trend for a decrease of germ cell tumors over time was found, stemming from a decrease of dysgerminomas. A significant trend for increase in the IRs with age was also found. In addition, a steep rise in the age specific IRs of epithelial borderline tumors was noted in the last 5 year period., Conclusions: The IRs of ovarian malignancies in childhood and adolescence in Israel, as in other countries, is very low as compared to adults and the most common tumors are of germ cell origin while malignant epithelial tumors are very rare. A time period effect in the germ cell tumors that resulted from an inexplicable significant decrease in the age specific IRs of dysgerminomas, was observed. A significant increase in borderline tumors was also noted and may be attributed to greater awareness of pathologists to this entity.

Background: Endothelins, potent stimulators of smooth muscle tissue activity, were recently shown to also function as mitogens for numerous cell types. The authors investigated the properties of endothelin-1 (ET-1) receptors in human endometrial tissue compared with human endometrial carcinoma tissue., Methods: Tissue samples from 13 patients with endometrial carcinoma and from 12 women undergoing hysterectomy due to uterus myomatous were obtained immediately after surgical removal. Binding properties of the endothelin receptors were studied using 125I-labeled ET-1., Results: A significant difference was demonstrated between binding properties of ET-1 receptors of these two groups. The mean maximal density (Bmax) value of the normal endometrial samples was 2029 +/- 341 fmol/mg protein, whereas that of the neoplastic samples was 356 +/- 121 fmol/mg protein. No differences were found, however, between the mean dissociation constant (Kd) values of these groups., Conclusions: These results might be compatible with the increased blood flow that characterizes malignant endometrial tissue. However, they do not indicate an important mitogenic role for ET-1 in the development of endometrial cancer.

Background: The optimal management of patients with ovarian carcinoma who are in complete clinical remission after completion of postoperative cisplatin-based chemotherapy has not been established., Methods: In this study, the outcomes of two groups of such patients were compared. One group of 25 patients underwent a second-look laparotomy and subsequently received three courses of intraperitoneal chemotherapy (IP group). The other group of 12 patients was not reexplored and received no additional treatment (NT group)., Results: A trend for better survival in the IP group was found compared with the NT group. There was no difference in the duration of the progression-free interval., Conclusions: More effective treatment for the consolidation of complete clinical remission in patients with ovarian carcinoma is needed.

Protein carboxylmethyltransferases (PCMT), enzymes that methylate free carboxyl groups of proteins, are involved in functional modification of various proteins including those of age-damaged proteins and the oncogenic ras proteins. Several species of PCMT are associated with these modifications. By using western blot analysis and specific antibodies raised against one type of PCMT, a 30-kilodalton (KD) cytosolic enzyme from Torpedo electric organ was identified in human erythrocytes and endometrium. The high specificity of the antibodies made it possible to compare levels of immunoreactive 30-KD PCMT protein in normal human endometria and endometrial carcinomas. Assays done on samples from 23 patients indicated the average levels of immunoreactive 30-KD PCMT in endometrial carcinomas was one fifth that of normal endometrium. The sensitivity of the assay was 83%, and its specificity was 90%. These results suggest that levels and activity of the 30-KD PCMT may be downregulated to maintain the phenotypic expression of the endometrial carcinoma. These assays may be used to assist in the detection of endometrial carcinomas.

A patient with persistent ovarian cysts subsequent to clomiphene-induced severe hyperstimulation was found to have borderline ovarian carcinoma. Since several endocrine and epidemiological studies implicate hormonal factors in the genesis of ovarian tumors, a possible association between ovarian hyperstimulation and neoplasia is suggested.

Sera from 16 Jewish patients with histologically confirmed adenocarcinoma of the uterine cervix (AUC) and 32 control subjects matched by age and ethnic origin were examined for herpesvirus type 1 (HSV-1) and type 2 (HSV-2) neutralizing antibodies. Titers were determined by means of the quantitative plaque reduction neutralization test on VERO cell monolayers, using HSV-1 strain VR3 and HSV-2 strain. Significantly increased levels of antibodies against both virus strains were found in the AUC patients as compared with the controls. The trends in the AUC series resembled those in a previous similar case-control study of squamous cell carcinoma of the uterine cervix (SUC). Thus, the previously observed association between HSV-2 and SUC is true for AUC as well, despite differences in the clinical and epidemiologic characteristics of the two malignancies.

Uterine anomalies were demonstrated by hysterosalpingography (HSG) in 4 of 5 diethylstilbestrol (DES) exposed young women with fertility disturbances. The anomalies included malformed uterine cavities and cervical incompetence. It is suggested that HSG in DES exposed women with fertility disturbances be performed early in the process of infertility investigation and cerclage should be considered when uterine anomalies are demonstrated. Tubal pregnancy should be ruled out by ultrasonography early during pregnancy in DES-exposed women.

The current study compares the outcome within 3 years after diagnosis in two groups of histologically confirmed Stage II-IV ovarian carcinoma patients in complete clinical remission with minimal or no residual disease at second-look laparotomy, performed after completion of cisplatin-based combination chemotherapy. One group (n = 18) received after reexploration abdominopelvic irradiation (RT group), the other, diagnosed during a later period (n = 19), received three courses of intraperitoneal cisplatin chemotherapy with systemic thiosulfate protection (IP group). The two groups were comparable with regard to age, stage at diagnosis, histologic category, grade of differentiation, size of residual tumor after the initial operation, and rate of negative second-look laparotomy. The overall survival probability after diagnosis was significantly better in the IP group, the maximal difference being observed at 36 months: 76.6% versus 44.4% in the RT group (P = 0.04). This difference was mainly evident in patients with a negative second-look laparotomy in whom the respective survival probabilities were 100% versus 70% (P = 0.04). Survival was significantly shorter (P less than 0.01) in patients with a positive second-look, and there was a nonsignificant trend for better survival in the IP group. Significantly improved probability of progression-free interval after diagnosis was also found in the IP group, the maximal difference being observed at 22 months: 78.3% as compared to 50.9% in the RT group (P = 0.04). This difference was again limited to patients with negative second-look, the respective values being 100% versus 60% (P = 0.05). Our retrospective data suggest an apparent advantage to intraperitoneal cisplatin treatment in these patients which should be further explored for definite evaluation.

During an 11-year period, 532 Jewish women with invasive cancer of the uterine cervix were diagnosed in Israel. Of these, 441 (82.9%) had squamous cell carcinoma (SUC) and 52 (9.8%) had adenocarcinoma (AUC). Different characteristics were noted for these two histological categories with regard to age, ethnic distribution, and chronological time trends. The ratio between AUC and SUC differed considerably between the various ethnic groups, ranging from about 1:6 in the Asian and European born to less than 1:14 in the North African. This indicates that the relatively higher incidence of AUC in Israeli Jewish women is limited to those ethnic groups that have a low risk for cervical cancer. The different patterns of SUC and AUC in the population support the contention of a varying etiology.

Eighty-four ovarian cancer (OCa) patients and 84 controls with nonmalignant conditions matched by age and ethnic origin were interviewed with regard to clinical mumps history and their sera were tested for complement fixation (CF) mumps antibodies. OCa patients differed from the controls in the response to past mumps infection in two respects: 1) They appeared to be more likely to have developed subclinical mumps as evidenced by a lower rate of clinical mumps history in the presence of serological evidence of similar infection rates among those with positive and those with negative clinical mumps history. 2) They tended to present lower persistent mumps CF antibody titers. These results may be interpreted to indicate that an immunological incompetence enables the development of OCa possibly through a direct etiologic role of mumps virus.