Racial differences in tumor grade among women with endometrial cancer.

Black women with endometrial cancer have more advanced disease and less favorable tumor grade than do white women. This study evaluated whether racial differences in tumor grade could be explained by hormone-related factors and other putative determinants of grade. Subjects included 207 white and 81 black postmenopausal women diagnosed with primary cancer of the uterine corpus between 1985 and 1987.

Pap smear histories in a medical clinic: accuracy of patients' self-reports.

Women using the medical clinic of a public hospital were interviewed about their Pap smear histories to assess the accuracy of self-reported smears and to identify groups in need of further screening. Interview data from 263 women were compared with cytology files and hospital records. In spite of considerable agreement between patient report and record, patients reported significantly more recent smears than were documented.

Selection for percutaneous nephrostomy in gynecologic cancer patients.

For patients with gynecologic cancers who present with ureteral obstruction, it is often difficult to determine whether intervention with nephrostomy tube is appropriate. This study was designed to determine if evaluation prior to percutaneous nephrostomy could accurately predict patients who would benefit from intervention. Twenty-two gynecologic cancer patients with bilateral ureteral obstruction were evaluated.

Colposcopic evaluation of human immunodeficiency virus-seropositive women.

To determine the effect of human immunodeficiency virus (HIV) infection on cervical histology, 32 known HIV-seropositive women underwent cervical colposcopic evaluation. All had cervical cytology, colposcopically directed biopsy, and T-cell studies performed. Thirteen of 32 patients (41%) had cervical intraepithelial neoplasia (CIN).

Diagnostic imaging of gynecological diseases: the clinician's view.

The introduction of ultrasonography, computerized tomography, and magnetic resonance imaging has led to tremendous progress in the diagnostic evaluation of gynecologic diseases. Refinements in these techniques have allowed the gynecologist to diagnose unsuspected pathology, define disease and its extent, and select the most appropriate treatment despite limitations in specificity experience and cost. Practically the most appropriate imaging modalities are: ultrasonography for adnexal masses, computerized tomography for advanced cervical cancers, and magnetic resonance imaging for corpus cancers and selected cervical cancers.

The fallacy of the screening interval for cervical smears.

One hundred seventy-four women with invasive cervical carcinoma were interviewed about their cervical smear histories to assess the accuracy of self-reporting and to relate the smear history with patient and tumor characteristics. Patients reported significantly more frequent, more recent, and more normal smears than were documented in medical records. The interval between onset of cancer symptoms and previous smear correlated directly with advanced stage.

Adjunctive radiation after radical hysterectomy in stage IB squamous cell carcinoma of the cervix.

The clinical-pathologic records of 178 women with stage IB squamous cell carcinoma treated by radical hysterectomy and pelvic node dissection were reviewed to assess prognostic factors and outcome in relation to adjunctive pelvic radiation. Among 32 women with pelvic nodes metastases, 19 treated with adjunctive radiation had longer recurrence-free intervals and more extrapelvic metastases than 13 nonirradiated women. However, among irradiated women recurrences were more rapidly fatal, so that the survival of the two groups was similar.

Cervix and breast cancer incidence in immigrant Caribbean women.

Cervix and breast cancer incidence in 1978-82 was computed for immigrant and United States-born Black women in Brooklyn, New York. Compared to the national SEER (Surveillance, Epidemiology and End Results) rates, US-born and Haitian women had high rates of invasive cervical cancer, while English-speaking Caribbean immigrants had an average rate. However, while US-born women had an average rate of carcinoma in situ of the cervix, both immigrant groups had low rates.

Superficially invasive squamous cell carcinoma of the cervix.

A series of 117 women with histologically defined, superficially invasive (1-5 mm) squamous cell carcinoma was evaluated to determine important histomorphologic variables, frequency of pelvic lymph node metastases, and outcome. Radical or modified radical hysterectomy with pelvic node dissection was usually performed for women with more than 1 mm invasion, whereas more conservative surgery was used when invasion was 1 mm or less. Depth of stromal invasion was the most important variable in predicting pelvic lymph node metastases.

Predictive value of computerized tomography in the presurgical evaluation of primary carcinoma of the cervix.

To determine the predictive value of abdominal-pelvic CT scan in assessing pelvic and paraaortic node metastases in untreated cervical carcinoma, the preoperative CT scans of 61 patients were compared with the gross and microscopic surgical findings. Although 75% of enlarged pelvic nodes on CT contained metastases, and 97% of patients with negative pelvic nodes had negative CT scans (specificity = 97%), histologically positive pelvic nodes were often missed on CT scan (sensitivity = 25%). For paraaortic nodes the CT scan had a specificity of 100% and a sensitivity of 67%.

Uterine rupture secondary to a malignant mixed mesodermal (mullerian) tumor: a case report.

A case of uterine rupture resulting from tumor penetration of the myometrium in a patient with malignant mixed mesodermal tumor is described; the first in the literature known to the authors. Notable features include rapid progression of disease, hemoperitoneum, and diffuse intraoperative bleeding controlled by radiographic embolization.

Stented versus nonstented transverse colon conduits: a comparative report.

Postoperative urinary tract complications were evaluated in 75 women who underwent urinary diversion with formation of a transverse colon conduit after radiation for gynecologic cancer. Urinary stents were placed at the ureterocolonic junction in 37 women, while no stents were used in 38 women. Leaks or fistulae developed in 18% of the nonstented group but in only 3% of the stented group (P less than 0.

Human papillomavirus and lower genital neoplasia in renal transplant patients.

Lower genital cytopathology was evaluated in 105 immunosuppressed renal transplant recipients. Evidence of human papillomavirus infection was found in 17.5% and of lower genital neoplasia in 9.

Complications of combined radical hysterectomy and pelvic radiation.

Long-term gastrointestinal (GI) and urinary tract (UT) complications were evaluated in 48 women treated by radical hysterectomy (RH) and pelvic node dissection (PND) and in 25 women who received 5000-5400 rad of external pelvic radiation (RT) after RH-PND. No major complications developed in the surgery-only group, but the 5-year minor GI complication rate was 4% and the 5-year minor UT complication rate was 10%. In 9 patients receiving RT at 200 rad/day, one major GI complication (13%) and one major UT complication (14%) developed.

Cervical cancer in immigrant Caribbean women.

At a public hospital serving the low-income community in Brooklyn, New York, invasive cervical cancer (ICC) was diagnosed in more advanced stages in Haitian and English-speaking Caribbean immigrants than in US-born Black women. In Brooklyn as a whole, only Haitians had more advanced ICC. Fewer Haitians had preinvasive cancer or ICC detected by a Pap test.

Screening for cervical and breast cancer among Caribbean immigrants.

The yield of abnormal Pap tests was 13.3/1000 women screened; the yield of breast cancer was 2.2/1000 women examined.

Multiple primaries among gynecologic malignancies.

Seventy-eight synchronous or metachronous tumors among 2362 patients followed by the Downstate Gynecologic Tumor Registry are reviewed. Significant synchronous tumor pairs include cervix (invasive and in situ)-ovary, cervix (in situ)-uterus, cervix (in situ)-kidney, endometrium-ovary, endometrium-rectosigmoid, and ovary-breast. Significant metachronous pairs include cervix (invasive and in situ combined)-lung, cervix (invasive and in situ combined)-upper alimentary tract, and cervix (invasive)-rectosigmoid.

Vascular invasion in Stage I carcinoma of the cervix.

Vascular invasion was identified as an important prognostic variable for all lesion sizes in 138 patients with Stage I cervical carcinoma. A matched pairs analysis, controlling for lesion size and extracervical spread, showed that vascular invasion was significantly associated with poor outcome. Regression analysis also indicated that vascular invasion contributed prognostic information beyond that available from lesion size and extracervical spread.

Concurrence of malignant and benign heterologous mixed tumors of the uterus.

A large polypoid uterine mas was composed to two distinct and separate parts: a malignant mixed müllerian tumor (MMMT) and a benign mixed mesenchymal tumor (BMMT). It was considered a collision of two neoplasms rather than a malignant degeneration of the BMMT. Malignant transformation of benign mesenchymal uterine tumors is a controversial concept which is difficult to prove or disprove.

5-fluorouracil/chemosurgery for intraepithelial neoplasia of the lower genital tract.

Sixteen patients with lower genital intraepithelial neoplasia were treated by 5-fluorouracil (5-FU)/chemosurgery: colposcopically directed excision of neoplastic epithelium pretreated with topical 5-FU. 5-FU loosens the neoplastic epithelium, facilitating its removal from the underlying stroma in a safe, minimally traumatic fashion. 5-FU/chemosurgery was undertaken in patients with vaginal neoplasia or those with lower genital neoplasia who were immunosuppressed or had a neoplastic syndrome, because conventional methods are often difficult or inadequate for these problems.