3 distinct regions of chromosome-6 are targets of loss of heterozygosity in human ovarian carcinomas

We performed mapping studies of allelic deletions on chromosome 6 in 52 ovarian carcinomas using 20 polymorphic markers assigned to various regions of both chromosomal arms. Loss of heterozygosity was seen in 28 (55%) tumors. The allelic losses, however, did not involve the whole chromosome in 18 of those tumors, allowing further localization of the targeted chromosomal region(s). Three different chromosomal regions appeared involved based on the distribution of partial deletions, 2 on the long arm and one on the short arm. One of the 2 regions on the long arm was confined to band 6q27 whereas the other was between the Arg1 and estrogen receptor loci. The targeted region on the short arm was bounded by the D6S89 and D6S248 loci. These results suggest the presence of at least 3 different tumor suppressor genes important for the control of ovarian tumorigenesis on chromosome 6.

Neoplasia associated with atypical glandular cells of undetermined significance on cervical cytology

The clinical importance of atypical glandular cells of undetermined significance (AGUS) on cervicovaginal smear has not been well defined. Between January 1990 and April 1996, 127 smears were reported as showing AGUS changes by the cytopathology division at the University of Massachusetts Medical Center. The medical records of these women were reviewed: 17 women were excluded because of previous hysterectomy or gynecologic cancer, 85 were biopsied, 16 were followed by repeat smears, and 9 were lost to follow-up. Forty-four women had negative biopsies or cervicitis. There were 15 endometrial lesions: 10 hyperplasias (2 with atypia) and 5 adenocarcinomas. Twenty-five women had cervix lesions including 3 endocervical atypias, 12 low-grade cervical intraepithelial neoplasia (CIN), 6 high-grade CIN, one adenocarcinoma in situ, and 3 invasive adenocarcinomas. One patient had ovarian cancer. Two of the 16 women followed by repeat pap smear eventually had a cancer diagnosis: one with cervix cancer and one with colon cancer. We were unable to identify a subgroup of women with AGUS who were at increased risk for serious pathology when we compared multiple demographic variables, symptoms, or the presence of coexistent squamous abnormalities on cervical cytology. The mean age of the 15 women with endometrial lesions was 59.9 years, which was significantly older than those patients with cervix lesions who had a mean age of 38.9 years. The presence of AGUS on cervical cytology is a marker for significant gynecologic neoplasia and should be investigated with colposcopically directed biopsies, endocervical curettage, and, in older women, endometrial biopsy.

Death from anaphylaxis to cisplatin: a case report

A patient with a history of ovarian carcinoma that had responded well to cisplatin was treated with platinum agents for a recurrence. She had a seizure while receiving carboplatin and was switched to cisplatin. The patient was premedicated with antihistamines and steroids. After approximately 400 micrograms of cisplatin she went into anaphylactic shock and could not be resuscitated. The reported frequency of hypersensitivity reactions to cisplatin is between 1 and 20%. Premedication with steroids and antihistamines, single-agent chemotherapy, and slow rate of infusion are of help in preventing these reactions. All of these precautions were unsuccessful in preventing refractory anaphylaxis in this patient.

Histologically benign or low-grade malignant tumors adjacent to high-grade ovarian carcinomas contain molecular characteristics of high-grade carcinomas

It is presently not clear if ovarian carcinomas arise de novo or from benign precursors (cystadenomas) and if high-grade malignant tumors (carcinomas) develop from preexisting low-grade carcinomas. The presence of allelic losses on chromosome 11p15.5 distinguishes high-grade ovarian carcinomas from either low-grade carcinomas or cystadenomas. We therefore examined the distribution of such losses in different parts of heterogeneous tumors showing mixed histological grades or showing adjacent large histologically benign neoplasms. The results showed that all neoplastic areas, including those that were histologically benign or compatible with low-grade carcinomas, contained allelic losses at the above locus. This suggests that the morphologically less aggressive portions of these heterogeneous tumors were not typical cystadenomas or low-grade carcinomas and contained molecular abnormalities indicative of at least a predisposition to the high-grade carcinoma phenotype.

Conservative management of adnexal torsion

OBJECTIVES

Our purpose was to evaluate morbidity in patients who underwent conservative therapy, ovarian cystectomy, for adnexal torsion compared with those who underwent salpingo-oophorectomy and to determine predictive factors associated with the ability to perform conservative surgery.

STUDY DESIGN

A retrospective review of all women < 40 years old with adnexal torsion treated between May 1, 1989, and Dec. 31, 1991, was performed. All potentially viable adnexa were untwisted, and cystectomies were performed unless the adnexa failed to reperfuse.

RESULTS

Ninety-four women were studied, and of these 61 (65%) received ovarian cystectomies and 33 (35%) underwent salpingo-oophorectomy. No thromboembolic complications or increase in postoperative morbidity was seen. Patients requiring salpingo-oophorectomy had more preoperative fevers and leukocytosis, larger masses, and higher degrees of torsion.

CONCLUSION

Conservative surgery with untwisting of the adnexa followed by cystectomy can be performed in reproductive-age women with adnexal torsion who have potentially viable adnexa.

Metastatic gestational trophoblastic disease: a comparison of prognostic classification systems

The records of 53 consecutive patients with metastatic gestational trophoblastic disease (MGTD) treated at the University of Southern California/Los Angeles County Medical Center since 1970 were analyzed. Forty-eight were evaluable for this study. Treatment during the study period was based predominantly on the NIH good-prognosis-poor-prognosis system, employing single-agent therapy (methotrexate or actinomycin D) for the good-prognosis patients and methotrexate, actinomycin D, cyclophosphamide (MAC) for the poor-prognosis patients. The overall survival rate was 83.3%. The study patients were retrospectively classified according to the FIGO, NIH, and WHO systems to test each system's accuracy in predicting outcome and the appropriateness of single-agent or multiagent chemotherapy as the initial treatment in each category. None of the systems as currently used is clearly superior to the others. Analysis of the WHO scoring system showed that 21 of the 25 (84.0%) study patients with a point score less than 8 were treated primarily with a single-agent regimen. All of 21 of these patients achieved a complete sustained remission although 3 (14.3%) required multiagent chemotherapy. The 4 patients in this point category whose initial therapy was a multidrug regimen were also cured. The 23 patients in the WHO high-risk category (greater than 7) had treatment initiated with combination chemotherapy. There were no deaths among the 11 patients in the 8-12 point group, although 3 (27.3%) were salvaged by alternate multiagent chemotherapy after failing on MAC. There were 8 deaths in the 12-patient greater than 12 point WHO category (66.7%). On the basis of this analysis we recommend that the WHO scoring system be utilized for reporting results of treatment for MGTD, but the risk categories should be redefined: low, less than 8 points; medium, 8-12 points; high, greater than 12 points.

Computed tomography of lymphogranuloma venereum mimicking cervical cancer

A case of lymphogranuloma venereum involving the cervix as a primary site is discussed. The patient's clinical presentation and findings on tomography were suggestive of carcinoma of the cervix. The differential diagnosis of retroperitoneal pelvic lymphadenopathy is discussed.