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Uterine serous carcinoma (USC) is an aggressive tumor that represents only 10% of endometrial cancer cases but accounts for a disproportionate number of deaths due to uterine cancer. Advances in the development of specific c-kit receptor-targeted drugs have promoted its potential therapeutic application as a target in tumor-related diseases. The aim of the present study was to evaluate imunohistochemical expression of c-kit in USC tissue in order to assess whether positive cases can be candidates for targeted therapy.C-kit expression assessment by immunohistochemistry was performed on deparaffinized sections of paraffin-embedded tissue blocks of confirmed consecutive available USC uterine specimens of patients diagnosed from 2000 to 2014. Sections of gastrointestinal stromal tumor (GIST) tissue known to contain c-kit served as positive controls.Immunohisto- chemical c-kit staining was not observed in any of 31 USC tissue samples examined. Intense staining was observed in the sections of GIST tissue.The present results may indicate that primary USC is not a candidate for c-kit targeted therapy.

To assess the prevalence of leiomyomas in patients with endometrial carcinoma (EC) and the association of their presence with clinico-pathological variables and with survival.A retrospective chart review was conducted of all endometrial carcinoma (EC) patients diagnosed and treated in the present institution between 2002 and 2008. Selected clinical data were abstracted from medical records. Pathological data such as the presence of myomas (any size), tumor grade, depth of myometrial invasion presence of lymphovascular space involvement (LVSI), and the presence of metastases, are based on the original pathology report.Coexisting myomas were found in 74 (56.9%) of 130 EC patients diagnosed during the study period. No significant difference with regard to age, histological type, stage, grade, depth of myometrial invasion, LVSI, lymph node involvement, and presence of metastases (other than lymph node involvement) was found between patients without and with myomas. There was also no significant difference in survival of EC patients without and with coexistent myomas.The present data seem to indicate that the presence of myomas does not affect clinico-pathological variables of EC patients nor their survival.

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.The study group included all Israeli Jewish patientsor = 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.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.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.

The aim of this paper was to review currently available data regarding the results of a more conservative, patient-tailored surgical approach in selected cases of early invasive uterine squamous cell carcinoma (SCC). A PubMed search of investigations in the English language published from January 2000 to September 2012 containing the terms conservative surgery, conservative treatment, trachelectomy, parametrectomy, lymphadenectomy, sentinel lymph node biopsy and fertility sparing surgery in combination with SCC was made. Conization only is optimal for women with stage Ia1 disease mainly in tumors without lymph vascular space involvement (LVSI). In stage Ib1 patients interested to maintain reproductive capacity, vaginal or abdominal radical trachelectomy are the procedures of choice. Patients with small tumors (2 cm), no deep invasion, no LVSI, and negative pelvic nodes are at very low risk of parametrial involvement and parametrectomy may be omitted in them. Such patients may benefit from less radical surgery and may be candidates for simple hysterectomy, simple trachelectomy, or conization with pelvic lymphadenectomy. Sentinel lymph node (SLN) biopsy is apparently a good predictor of node metastases and allows the performance of lymphadenectomy only in SLN positive cases. Thus lymphadenectomy may also be omitted in some patients. In young women with locally advanced tumors, neoadjuvant chemotherapy followed by fertility-sparing surgery may also be a feasible treatment. A more conservative, patient-tailored surgical approach in selected cases of early SCC is possible resulting in lower morbidity and preservation of fertility without compromising the outcome.

Expression of insulin-like growth factor-I (IGF-I), its receptor and IGF-binding proteins (IGFBPs) by ovarian cancer cells and its mitogenic effect on these cells in vitro, suggest that IGF-I may have a role in regulation of human ovarian cancer. We have recently shown IGFBP-2 to be markedly elevated in malignant ovarian cyst fluid in vivo. To identify the origin of increased IGFBP-2 in these cyst fluids, the gene expression and protein content of IGFBP-2 were investigated in 14 malignant and four benign epithelial ovarian neoplasms. IGFBP-2 mRNA was detected in all ovarian specimens and was 2- to 30-fold higher in malignant than in benign neoplasms. Within the malignant tissues IGFBP-2 mRNA levels correlated with the aggressiveness of the tumour and were higher in invasive tumours than in those with borderline pathology. Southern blot analysis revealed no amplification of IGFBP-2 gene in the DNA samples from ovarian tumours regardless of their nature. IGFBP-2 was the major binding protein in tissue extracts, as measured by both Western ligand blotting and immunoblotting, and was significantly higher in malignant than in benign neoplasms. These findings were further supported by immunohistochemical detection of IGFBP-2 in tumour sections. Our data suggest that increased local production by the tumour in vivo is responsible for the increased IGFBP-2 levels in the cyst fluid bathing the ovarian malignancy. This may represent an autocrine regulatory mechanism for IGF-I proliferative effect of ovarian cancer. Images Figure 2 Figure 1 Figure 3 Figure 5 Figure 6

OBJECTIVE: The aim of this study was to assess the association of diagnosis and treatment delay with established prognostic factors and survival. STUDY DESIGN: The study group comprised 181 consecutive patients with endometrial carcinoma diagnosed between 1970 and 1986, whose records contained details with regard to diagnosis delay; 174 of them also contained details with regard to treatment delay. RESULTS: The significant prognostic factors that we found, namely, age, clinical stage, grade, depth of myometrial invasion, and histologic type, are in line with those of other studies. However, no significant correlation was found between the duration of delay and these prognostic factors or with survival. CONCLUSION: We conclude that delay of diagnosis (

The aim of the study was to assess whether COX-2 expression in epithelial ovarian carcinoma (EOC) tissue can distinguish between platin-sensitive and platin-resistant tumors.Clinical and histological data were obtained from medical records of EOC patients diagnosed between the years 1995 and 2005. Patients in complete clinical remission for6 months after discontinuation of first-line chemotherapy were considered to be platin-sensitive. Survival ofor = 2 and5 years after diagnosis was considered as short- and long-term survival, respectively. Immunohistochemistry staining was performed on deparaffinized sections of tissue blocks obtained at first surgery. The intensity of staining and the percentage of stained cells was assessed by two pathologists blinded to clinical data and a scoring index was calculated.Among 79 patients a positive stain (10% of cells stained) was observed in 61 (77.2%). No statistically significant association between distribution of platin sensitivity and immunohistochemical COX-2 staining parameters was observed, although the rate of long-term survival was significantly higher among platin-sensitive then among platin-resistant/unresponsive patients.Immunohistochemically determined COX-2 expression in EOC is not associated with platin sensitivity and survival.

In order to allot an ovarian malignancy to FIGO Stage I, in addition to abdominal exploration and the basic operation, it is also necessary to do peritoneal washings for cytological examination, random peritoneal biopsies (including diaphragmatic assessment) and omental and retroperitoneal lymph node assessment.The aim of the study was to assess the accuracy of surgical staging of ovarian carcinoma classified as Stage I in Israel.Included were all patients with histologically confirmed epithelial ovarian carcinoma (EOC) classified as Stage I in a data base of a nationwide incidence case control epidemiological study of ovarian carcinoma conducted in Israeli Jewish women during the period 1994-1999. Surgical staging data of these patients were retrieved from pathological reports, and from clinical records when available.A total of 182 EOC patients were classified as Stage I. About 86% of the patients underwent hysterectomy and bilateral salpingo-oophorectomy. The most commonly performed staging procedure was omental assessment (85.2%) while peritoneal biopsy was the least common one (34.1%). In 17 (9.3%) of the patients none of the staging procedures were done and only 34 (18.7%) had optimal staging.Although the data are from a decade ago, they seem to indicate the need for an increased awareness of the necessity for accurate surgical staging of tumors apparently confined to the ovaries since it can identify a group of patients who require surgical therapy alone and who can be spared the complications, inconvenience and cost of adjuvant chemotherapy.

The aim of the present study was to assess the effect of platin sensitivity on long-term survival of Stage III epithelial ovarian cancer (EOC) patients.The records of all histologically confirmed Stage III EOC and PPC patients diagnosed during 1995-2006 were reviewed. A comparison of selected characteristics was made between long-term (5 years) and short-term (3 years) survivors.Among 58 Stage III patients, 20 had long-term and 18 short-term survival. The rate of platin sensitive patients in long-term survivors was significantly higher than in short-term survivors (95.0% vs 27.8%, p0.001). The sensitivity and specificity of platin sensitivity for long-term survival was 95% and 72.2%, respectively, and the positive and negative predictive value was 79.2% and 92.8%, respectively. No statistically significant difference between the groups was found with regard to other selected characteristics.The rate of platin sensitive patients was significantly higher among long-term survivors than among short-term survivors but the specificity and positive predictive value of platin sensitivity for long-term survival prediction were relatively low precluding its practical clinical use.

The purpose of the present report is to review the various management options of endometrial carcinoma with cervical involvement. A Medline literature search for publications dealing with endometrial carcinoma (EC) with cervical involvement and treatment was made. Although many publications deal with EC with cervical involvement there is a lack of prospective controlled trials. Only one prospective randomized phase III trial has been published. The inaccuracies of clinical staging, the scarcity of reports with surgically staged patients, the multiple types of cervical involvement and prognostic indicators and the remarkable variations in treatment render it difficult to compare outcome results between publications. The small number of patients in many of these studies and their retrospective uncontrolled nature add to this difficulty. There are conflicting reports with regard to factors affecting outcome, also complicating the management issue of endometrial carcinoma with cervical involvement and comparison of treatment results. The optimal management of EC with cervical involvement remains to be established.

The main aims and requirements of any staging system are: to determine the anatomical extent of disease, to allow uniform reporting of treatment results, comparison of their efficacy and pooling of data from various institutions. It should be based on the mode of spread of the neoplasm, take into consideration prognostic risk factors and be of prognostic value. A critical review of the FIGO staging system for ovarian carcinoma indicates that these aims and requirements are not entirely fulfilled. Following are some examples. It does not include exact recommendations for comprehensive surgical staging in apparently early ovarian cancer and staging is therefore not performed uniformly. The presence of parenchymal liver and lung metastasis may be facilitated by modern imaging devices. However, according to FIGO rules only simple X-ray procedures are allowed preoperatively. The correlation between increasing stage and survival is inconsistent and sometimes contrary to that expected. Many known prognostic factors are not included in the present staging system. Although the aims of data pooling and of uniform reporting of treatment results have been achieved, the validity of some comparisons are questionable in view of the variations in staging. The intent of this review was not to belittle the major contribution of staging to research, understanding and management of ovarian carcinoma, but to highlight its deficiencies. New data have accumulated since the FIGO staging system of ovarian carcinoma has been adopted and should prompt consideration of modifications such as incorporation of modern diagnostic procedures and of some established prognostic markers and reshuffling of certain substages.

Since several investigations did not demonstrate the presence of altered p53 in endometrial hyperplasias, it has been concluded that these alterations constitute a relatively late event in endometrial carcinoma. The aim of the present study was to assess the presence of p53 in the tissue adjacent to endometrial carcinoma in attempt to elucidate the relationship between these tissues.New slides were prepared from paraffin-embeded tissue blocks of 49 endometrial endometrioid carcinoma hysterectomy specimens so that in each case tumor tissue and adjacent uninvolved endometrium were represented. Immunohistochemical staining for p53 detection was then performed.In 43 of the 49 hysterectomy specimens evaluated, the tissue adjacent to the endometrial carcinoma was non hyperplastic and in six it was hyperplastic. Positive immunohistochemical staining was found in 22 (44.9%) of endometrial carcinomas and in eight (16.3%) of the adjacent tissues. A statistically significant higher percentage of hyperplastic adjacent tissues than non-hyperplastic adjacent tissues were immunohistochemically p53 positive (50.0% vs 11.3%; p = 0.047).Our findings may indicate that p53 alterations are not necessarily a late event in endometrial endometrioid carcinogenesis. Since a large proportion of tissues adjacent to endometrial carcinoma do not show p53 alterations, other early cellular events may also play a role.

The purpose of the present report was to assess the conversion rate from laparoscopy to laparotomy due to adnexal malignancy and to identify factors that might assist in the selection of the appropriate operative approach in patients with suspicious adnexal masses.A retrospective review of the medical records of women who underwent laparoscopy due to ultrasonically complex adnexal masses. Ninety-five consecutive patients fulfilling these criteria, were identified. A comparison of patients with benign tumors who had laparoscopy only to those with invasive malignancies in whom laparoscopy was converted to laparotomy was performed.Malignancy was diagnosed in 18 (18.9%) patients. In 13 patients with malignancy (two borderline and 11 invasive), comprising 72.2% of the malignancies and 13.7% of the total group with complex adnexal masses, the laparoscopy was converted to laparotomy. Age of more than 50 years and a serum CA125 level above 35 U/ml were significantly more common in the malignant than in the benign group (90.9% vs. 15.6% and 63.6% vs. 11.6%, respectively; p0.0001 and p0.003, respectively). When both factors were present, the sensitivity and specificity for malignancy were 73.3% and 93.2%, respectively, and the positive and negative predictive values 73.3% and 95.6%, respectively.When an ultrasonically complex adnexal mass is encountered, predictive factors for malignancy should be taken into account before the mode of intervention is chosen. The conversion from laparoscopy to laparotomy because of an invasive malignant tumor is acceptable, if it is performed immediately and a gynecologic oncologist is on stand-by.

PURPOSE: To study the role of BRCA mutations in ovarian cancer survival. PATIENTS AND METHODS: Blood samples and specimens of ovarian tumors (whenever blood samples were not available) at the time of the primary surgery were obtained in the course of a nationwide case-control study of women with ovarian cancer in Israel. The three common BRCA mutations in Israel (185delAG, 5382insC, and 6174delT) were analyzed with a multiplex polymerase chain reaction to amplify the exons containing the three mutations using fluor-labeled primers in a single reaction. Because each mutation is a small insertion or deletion, they can be detected as length polymorphisms. Patients were followed for up to 5 years (range, 20 to 64 months). Statistical analysis was performed using the Kaplan-Meier method and the log-rank test. Stepwise Cox regression analysis was used for determination of independent prognostic factors. RESULTS: This report is based on 896 blood or tumor specimens analyzed for the presence of the BRCA mutations. Of these, 234 women (26.1%) were found to be positive. A significant difference in survival pattern was found between BRCA1/BRCA2 carriers and noncarriers among the women with invasive ovarian cancer (median survival, 53.4 months v 37.8 months; 3-year survival, 65.8% v 51.9%, respectively). These differences were independent of age at diagnosis or stage of the disease. CONCLUSION: Our data indicate that the survival of patients with ovarian cancer is affected by BRCA germline mutation, at least in the early years after diagnosis.

The incidence of cervical neoplasia in Israeli Jewish women is persistently lower, while that of vulvar carcinoma is comparable to that in other populations. The aim of the present investigation was to assess the prevalence of HPV and of immunohistochemically detected mutant p53 in Israeli Jewish women with cervical and vulvar neoplasia compared with other populations. Tissue sections from formalin-fixed paraffin-embedded blocks of ten patients with CIN III, 29 with invasive squamous cell carcinoma, three with adenocarcinoma and 14 with invasive vulvar carcinoma, were examined for the presence of HPV 16 and HPV 18 DNA by PCR amplification, and for mutant p53 protein by immunohistochemical staining. HPV negative cases were re-examined with a sensitive primer. HPV DNA was detected in eight patients with CIN III and in 23 patients with invasive squamous carcinoma. In the remaining cervical squamous neoplasia tissue analysis with the sensitive primer could not be done. HPV DNA was also detected in two patients with adenocarcinoma and in nine (64.2%) patients with vulvar carcinoma. Positive p53 immunohistochemical staining was found only in one CIN III patient, in six (20.7%) squamous carcinoma and in 11 (78.6%) vulvar carcinoma patients. Of the p53 immunohistochemical staining positive tissues, two with cervical carcinoma and six with vulvar carcinoma were also HPV-positive. The prevalence of HPV and of positive p53 immunohistochemical staining in our series of Israeli Jewish women with cervical and vulvar neoplasia is similar to that in other populations, suggesting that the etiological factors are probably also alike.

Four patients with hypersensitivity reaction to carboplatin of variable severity, after previous uneventful cisplatin and carboplatin treatment, are described. Skin testing performed in two of the patients suggests a cross-reaction with cisplatin but was negative with carboplatin in one of them. The mechanism of hypersensitivity reaction to carboplatin is poorly understood and the issue of retreatment with carboplatin is controversial. Physicians should be aware of the possible hypersensitivity reaction to carboplatin and appropriate precautions should be taken.

Exaggerated placental site (EPS) is classified as a non-neoplastic trophoblastic lesion, and histologically it consists of endometrial and myometrial invasion of intermediate trophoblasts and syncytiotrophoblasts and it differs morphologically from placental site trophoblastic tumors and placental nodules. The purpose of this report is to increase physicians' awareness of this lesion.A 48-year-old woman with post-molar rising betahCG titers and a clinical diagnosis of non-metastatic trophoblastic disease underwent hysterectomy. Final histopathology showed exaggerated placental site--a lesion often unfamiliar to clinicians.It is suggested that operative hysteroscopy may be useful in the diagnosis and management of EPS.

To assess characteristics of an Israeli group of nulliparous teenagers and to compare selected variables of their course and outcome of pregnancy with controls.Hospital records of 46 consecutive nulliparous teenagers younger than 17.5 years who delivered during a ten-year period and 84 matched adult controls were reviewed.The majority of the teenagers were older than 15 years, married and most were born in Israel or in the former Soviet Union with no obvious socio-economical deprivation. The rate of prenatal follow-up, hypertensive disorders, type of analgesia during labor and mode of delivery were similar in teenagers and controls. A statistically non-significant higher rate of anemia (hemoglobin, 10 gr%), preterm delivery and low birth weight were observed in teenagers. Only the rate of induction of labor and the rate of a hemoglobin level higher than 12 gr% were significantly lower in teenagers.The course and outcome of pregnancy were in most respects similar in this group of nulliparous teenagers and matched adult controls.

To assess the prevalence of thrombocytosis (plateletsor = 400,000 microliters) in ovarian cancer of epithelial origin as compared to benign controls consisting of benign ovarian cysts of epithelial origin and to correlate it with prognostic factors of ovarian cancer and survival.Hospital records of 82 consecutive patients with ovarian carcinoma, 12 with low malignant potential tumors and 70 with invasive carcinoma, and of 32 patients with benign cysts of epithelial origin were reviewed. The clinical data and preoperative platelet counts were recorded.The prevalence of thrombocytosis in invasive ovarian carcinoma of epithelial origin was significantly higher than in benign controls (24.3% vs 2.9%; p = 0.006). No statistically significant correlation was found between thrombocytosis with age, grade and residual disease. A statistically non-significant excess of thrombocytosis was found among patients with advanced disease, but the survival of patients with thrombocytosis was significantly less favorable (p = 0.04).Thrombocytosis is significantly more prevalent in ovarian cancer patients than in benign controls and has a statistically significant correlation with poorer survival. The prevalence of thrombocytosis in ovarian carcinoma and its significance in various studies is inconsistent and should be elucidated in large prospective studies.

Hospital records of 46 girls under the age of 17 years, hospitalized for lower genital tract problems in 1986-95 were reviewed. The most common conditions were results of unintentional injuries (43.5%), imperforate hymen (28.2%) and infections (19.6%). The median age for unintentional injuries was significantly lower than for other conditions (7.0 vs 11.4; p0.001). Most injuries were external and occurred during outdoor activities. Mean volume of estimated bloody fluid drained in those with imperforate hymen was greater when the diagnosis was made after the age of 12 (783 vs 433; not significant). It has been suggested that hematocolpos and hematometra should be prevented, but the possible unfavorable sequelae have not been documented. The relative order of frequency of the various diagnostic groupings and the diagnoses of labial adhesions and imperforate hymen are specific for the age of the study group.

There is an impression that the prevalence of cervical squamous cell carcinoma (SCC) among new immigrants from the former Soviet Union, is higher than among Israeli residents. Etiologically, SCC is associated with human papilloma virus infection (HPV). The purpose of the present study was to assess the prevalence of cervical HPV infection in new immigrants from the Soviet Union and in Israeli residents as indicated by the presence of koilocytosis in hysterectomy specimens. The study group consisted of 304 women (60 new immigrants and 244 Israeli residents who underwent hysterectomy for benign reasons). The original histological slides of the cervix were reviewed with special attention to the presence of koilocytosis. The two study subgroups differed, as expected, with regard to some characteristics, but koilocytosis was not present in any of the cervical specimens of new immigrants nor of residents. Although the study subgroups may be too small or selective, our findings do not support a possible higher HPV infection rate among new immigrants, yet may indicate a low reservoir of HPV in new immigrants and residents, in line with the low SCC incidence in Israeli women.

To determine the role of BRCA1 185delAG mutation in ovarian carcinogenesis.Genetic testing of a subset of cases from an ongoing study of ovarian cancer and of controls.A community-based case-control incidence study.Seventy-nine patients with ovarian cancer, 62 hospitalized women without cancer (controls), and 120 healthy women participating in a fragile X screening program (also controls), examined for the presence of germline BRCA1 185delAG mutation.Polymerase chain reaction-amplified BRCA1 exon 2 fragments generated from patients' and controls' blood samples, analyzed by heteroduplex gel shift assay and direct sequence analyses.The 185delAG mutation was detected in 38.9% (7/18) of ovarian cancer patients with familial history, and 13.1% (8/61) of family history-negative ovarian cancer cases. Only 1 carrier was detected among the 120 healthy controls, and none in the hospital controls. A significant difference in mutation carrier rates between family history-negative cases and control groups of 120 and 62 subjects was identified (Fisher exact test, P=.001 and P=.003, respectively). The median age (+/-SE) at disease diagnosis was lower among both familial and family history-negative mutation carriers, as compared with mutation-negative, family history-negative cases--50 (+/-1.4) vs 60.5 (+/-3.5) years old, respectively (hazard ratio, 1.68; 95% confidence interval, 0.94-3.01).Our data are preliminary but suggest that BRCA1 185delAG germline mutation is frequent in Israeli ovarian cancer patients, irrespective of family history, and may confer an early-onset phenotype of ovarian cancer

The aim of the study was to determine the presenting symptoms of endometrial carcinoma (EC) patients and to assess their possible correlation with some of the standard prognostic factors and with survival. A review of the presenting symptoms of 181 EC patients indicated that 69.6% presented with postmenopausal bleeding while the remaining women presented with irregular bleeding (21.0%), abdominal pain (3.9%) and other (5.5%) symptoms. A significantly (p0.001) higher percentage of patients presenting with abdominal pain and other symptoms were diagnosed with advanced stage disease and they had a lower survival than those presenting with post-menopausal or irregular bleeding. Patients presenting with irregular bleeding had a significantly (p = 0.002) better survival than those presenting with postmenopausal bleeding. However, this effect disappeared once age was accounted for in a multivariate analysis. Our findings indicate that the type of presenting symptoms may occasionally serve as a preliminary prognostic indicator.

We performed this study to assess the feasibility and effectiveness of ultrasound-guided drainage and ethanol instillation for the treatment of pelvic peritoneal cysts. Six women had pelvic peritoneal cysts after previous pelvic surgery; when the cysts recurred after simple drainage, the patients underwent transvaginal ultrasound-guided drainage and instillation of 20-30 mL of ethanol into the cyst cavity. All patients except one presented with abdominal pain. All cysts had clinical and ultrasonic benign characteristics. Drainage and ethanol instillation were performed successfully in all patients without severe side effects or complications. After a mean follow-up time of 13.6 months, a recurrence was found in only one patient, who was successfully retreated. These preliminary results indicate that transvaginal ultrasound-guided fluid drainage and ethanol instillation is an effective treatment for pelvic peritoneal cysts.

To assess the impact of surgical staging on treatment modification and outcome in endometrial carcinoma (EC) patients.Two groups of histologically confirmed clinical Stage I and II EC patients, diagnosed during two time periods (1976-1984 and 1985-1991), were retrospectively compared. Sixty-five patients diagnosed during the first period were staged only clinically and treated according to a protocol based on this staging system. Fifty-six patients diagnosed during the second period were staged surgically and treatment was modified according to surgical pathological findings.The findings based on the surgical staging spared radiotherapy in some patients and prompted additional treatment in others. The morbidity and survival were similar in the two groups.Surgical pathological findings in EC patients may modify management and contribute to prognostic significance. No effect on postoperative morbidity or on actuarial survival was demonstrated.

We assessed the efficacy of short term intraperitoneal treatment with cisplatin (200 mg/m2) and etoposide (300 mg/m2) in 21 ovarian carcinoma patients who were in complete clinical remission after completion of postoperative cisplatin based chemotherapy. Second-look laparotomy was done in 17 patients prior to intraperitoneal chemotherapy and in 10, minimal residual disease was found. The mean follow-up was 24 (range 9-54) months. The projected overall survival 54 months after diagnosis was 60% and the median PFI 26 months. The median survival and PFI of patients with minimal residual disease at second-look laparotomy was only 27 and 18 months respectively. In all patients with relapse the recurrence was intraperitoneal. The combination intraperitoneal chemotherapy schedule used does not seem to be more effective for ovarian carcinoma patients who are clinically in complete remission than the intraperitoneal treatment with cisplatin alone reported in other series.

Laparoscopic prophylactic oophorectomy was performed on four women who belonged to ovarian cancer prone families. The procedure was of short duration with an uncomplicated intra- and postoperative course and required only brief hospitalization. These merits may outweigh those of prophylactic oophorectomy performed by laparotomy during which hysterectomy is usually also performed. When prophylactic oophorectomy is contemplated, operative laparoscopy should also be considered.

In a previously published study we compared the outcome probability within 3 years after diagnosis in two groups of advanced 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 after reexploration three courses of introperitoneal cisplatin chemotherapy with systemic thiosulfate protection (IP) group). In the present study the outcome of the same patients is compared after they have all been followed for at least 5 years or till death. A clear trend towards a more favorable, through statistically not significant, 5 year survival was observed (68%), in the IP group, vs 39% in the RT group (p = 0.07). In patients with a negative second-look laparotomy, the respective 5 year survival rates were 92% and 60% (p = 0.08). While the duration of the progression-free interval was similar in both treatment groups the survival after diagnosis of recurrence was significantly better in the IP group (41% vs 0%, p = 0.03).

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.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.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.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.

To assess the feasibility of using cytologic examination of ovarian cyst fluid for distinguishing between benign and malignant tumors.Cyst fluid was aspirated at surgery in 83 women with benign and 35 women with malignant (25 invasive and ten borderline) ovarian tumors and submitted for routine cytologic examination.The specificity of the cytologic examination was 100%, but the sensitivity and negative predictive value were only 26 and 76%, respectively.The low sensitivity and negative predictive value of cytologic cyst fluid examination preclude its use for the distinction between benign and malignant ovarian tumors.

To assess the feasibility of using cyst fluid CA 125 levels to distinguish between benign and malignant ovarian cystic neoplasms.CA 125 levels were measured in ovarian cyst fluid and in serum obtained at surgery in 44 women with ovarian cystic tumors of epithelial origin (25 benign, 12 malignant, and seven borderline).The median cyst fluid CA 125 level in malignant neoplasms (671 U/mL) was higher than in benign tumors (175 U/mL), and 86% of the malignant tumors contained levels higher than 100 U/mL in the cyst fluid, compared with only 62% of the benign tumors. However, these differences were not statistically significant.Cyst fluid levels of CA 125 cannot be used to distinguish between benign and malignant ovarian cysts of epithelial origin.

The outcome after fluid aspiration from 41 sonographically benign-appearing ovarian cysts was assessed. The considerable probability of recurrence was significantly higher after ultrasound-guided aspiration than following aspiration via laparoscopy (54% versus 30%, respectively, at 36 months). Although all the recurring cysts were benign, the concern with malignancy and the high recurrence rate seem to indicate that fluid aspiration from sonographically benign-appearing cysts by either method is not the management of choice.

Effective second line chemotherapy schedules for recurrent ovarian carcinoma are not available. The combination of cisplatin and VP-16 given as a single dose in such patients gave inconsistent results. Since VP-16 is a dose-schedule dependent drug it was given in this pilot study as a continuous 72 hour infusion at a dose of 100 mg/m2/day. No objective response was observed among 7 patients with refractory or recurrent ovarian carcinoma who received a median of 3 treatment courses.

Primary cytoreductive surgery in the treatment of advanced ovarian carcinoma is widely accepted and practiced. Its value has however never been established by controlled trials and the concept is therefore not unchallenged. Data with regard to the benefit of interval and secondary debulking are limited and often conflicting. Prospective randomized studies specifically designed to elucidate the controversies relevant to cytoreductive surgery are warranted.

Among 114 women with early spontaneous abortions, low beta-human chorionic gonadotropin levels and no ultrasonographically demonstrable residual tissue in the uterine cavity, 68 underwent uterine curettage, and 46 were managed conservatively. No complications, such as bleeding or infection, were observed in either group, and the probability of conception, outcome of subsequent pregnancies and rate of subsequent abortions were similar. Curettage offers no advantage over conservative management in selected patients with early abortions.

Of 207 women who underwent midtrimester induced abortion with intraamniotic prostaglandin F 2 alpha instillation, 30 (14.5%) had had one or more previous uterine operations. Multivariate analysis showed no correlation between a previous uterine operation and the hospitalization length, procedure complication rate or length of the injection-delivery interval (IDI). The IDI was similar in patients with and without a previous uterine operation. No case of uterine rupture occurred. Intraamniotic prostaglandin instillation for midtrimester abortion induction seems to be an effective procedure without severe complications in women with previous uterine operations.Of 207 women who underwent midtrimester induced abortion with intraamniotic prostaglandin (PG) F2alpha instillation, 30 (14.5%) had 1 or more previous uterine operations. Multivariate analysis showed no correlation between a previous uterine operation and the hospitalization length, procedure complication rate, or length of the injection-delivery interval (IDI). The IDI was similar in both patients with and without a previous uterine operation. No case of uterine rupture occurred. Intraamniotic PG instillation for midtrimester abortion induction seems to be an effective procedure without severe complications in women with previous uterine operations.

A consistently higher rate of abnormal cervical cytology, colposcopic and histologic findings in 89 DES exposed Israeli Jewish women was found as compared to 318 women in a control group. This trend however reached statistical significance for abnormal colposcopic and histologic findings only in the 25-34 age group. The higher rate of abnormal findings can be attributed to DES exposure and not to an excess of other risk factors in the study group. Routine cytologic and colposcopic examination is recommended for DES exposed Israeli Jewish women who are otherwise at low risk for development of cervical neoplasia.

Among two hundred and twenty-one patients admitted with the diagnosis of pelvic inflammatory disease (PID), 6 had an underlying malignancy. The rate of underlying malignancy was 1.4% in premenopausal patients and 42.8% in postmenopausal patients. This difference was statistically significant, p less than 0.001. In postmenopausal patients presenting with a pelvic inflammatory process pelvic malignancy should be highly suspected and thorough examination made.

Three patients with primary breast carcinoma and metastases to the endometrium presented with postmenopausal bleeding. All patients had locally advanced breast cancer at the time of diagnosis, and all developed other distant metastases concomitantly or shortly after the diagnosis of endometrial involvement. The treatment of breast carcinoma metastatic to the endometrium is palliative. Distinguishing metastatic carcinoma from primary endometrial carcinoma is of great practical clinical significance, since in the latter surgical intervention is indicated.

PURPOSE: Case-control and cohort studies have established that gynecologic surgeries reduce the risk of developing ovarian cancer. It is not clear whether these surgeries also reduce risk in BRCA1 and BRCA2 mutation carriers. We studied Jewish women with incident ovarian cancer and tested for an Ashkenazi founder mutation (185 delAG and 5382insC in BRCA1 and/or 6174delT in BRCA2) to assess risk of ovarian cancer following gynecologic surgery. METHODS: Cases were identified in a population-based case-control study between 1994 and 1999. Controls were selected from the Central Population Registry and were matched to the cases based on age (within 2 years), area of birth, and place and length of residence in Israel. Excluding subjects reporting a bilateral oophorectomy, we tested 840 cases and 751 controls for the founder mutations. There were 244 (29%) cases that tested positive for BRCA1 and BRCA2, and 13 (1.7%) controls that tested positive. We used conditional logistic regression to estimate odds ratios (ORs) for developing ovarian cancer following selected gynecologic surgeries. RESULTS: Overall, gynecologic surgeries reduced the risk of ovarian cancer by 45% compared to women never having a gynecologic surgery (odds ratio (OR) = 0.55, 95% Confidence Interval (95% CI) = 0.44–0.70) after adjusting for age, ethnicity, parity, and oral contraceptive use. The risk estimate for BRCA1 and BRCA2 mutation carriers with a gynecologic surgery compared to the controls was also protective (OR = 0.51, 95% CI = 0.32–0.81). CONCLUSION: Israeli women who are carriers or non-carriers of mutations in BRCA1 and/or BRCA2 appear to benefit from a reduced risk of ovarian cancer following a gynecologic surgery.

A case of parovarian serous tumor of borderline malignancy inadvertently found during cesarean section in a 27-year-old multigravida is reported. Seventeen months after diagnosis there is no clinical evidence of disease. The histologic appearance of the tumor was identical with that of tumors of ovarian origin, however, whether its biologic behavior is similar as well is not known.