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Chorionepithelioma treated with stilbestrol
814
SELECTET)
He found negative smears high incidence of IF.2 per special series of cases.
Am. J. Oh.
ABSTRACTS
in 263 women and positive cent. He does not mention
smears whether
in
51 this
cases, series
8i Gynec. April, 1949
au unusualI\ represents
a
Among the 51 positive cases were 35 cervical carcinomas, all confirmed by biopsies. In 33 cases of this subgroup the indication for biopsy was made by the prebiopsy smear, providing thus a 5.72 per cent error. Seven of nine adenocarcinomas of the endometrium suspected by smear were confirmed by curettage, an error of 12.23 per cent. In addition, the author found perfect agreement of the smear reports in two vulva1 carcinomas, one clitoral carcinoma, and one case of uterine sarcoma. The over-all percentage of error for the entire series was 2.22 per cent, an unusually low figure, or 7 cases from the series of 314 cases. When divided into “false positives” and “false negatives” (8.9 per cent) the final corrected percentage was 5.59 per cent. Among the cervical carcinomas were 12 cases of Grade I lesions (League of Nations classification). Schtirbu concludes the Papanicolaou prebiopsy procedure represents as valuable a contribution as the biopsy, periodic pelvic examinations, and eolposcopic studies toward earlier detection of genital malignancy and the ultimate reduction of mortality rates in uterine cancer. CL-41~ E. FOLSOME.
Kullander, 19,
8. :
Ohorionepithelioma
Treated
With
Stilbestrol,
The
Lancet,
page
944,
June
1948.
Nineteen months after expulsion of a hydatid mole, a 20-year-old multipara was found to have chorionepithelioma, with two deposits in an enlarged uterus, theca lutein cysts of the ovaries, and small metastatic deposits in the lungs. After removal of the internal genitals, she was given a total of 3,400 mg. of stilbestrol by mouth and 18,500 mg. parenterally, until her death five months later. The possible beneficial effects of this treatment were shown by: (a) clinical improvement on initiating therapy, (b) reduction of gonadotrope titer following the initiation or large increase of stilbestrol dosage, (c) reduction in size of vaginal and lung metastases on increasing the dosage, and (d) rapid increase in gonadotrope titer and enlargement of vaginal metastasis on temporarily stopping stilbestrol administration. IRVING I,. FRANK.
Pund,
Edgar cinoma Aug.,
IL, Dick, Fred, Jr., and Cardwell, 33. 5. Jr.: The Pathology of the Cervix. The Status of Preinvaaive Cancer, South.
of Early M.
J.
41:
Car711,
1948.
Incipient preinvasive carcinoma of the cervix has come into the realm of diagnostic possibility since the introduction of the Papanicolaou smear for cytologic study. There were 86 cases of preinvasive carcinoma, 28 of which were discovered before hysterectomy, and 69 uteri in which routine pathologic examination inadvertantly made the diagnosis. Diagnosis depends entirely upon cytologic detail, namely : nuclear hyperchromatism, increase in the nuclear-cytoplasmic ratio, variations in nuclear size and absence of polarity. The cells in preinvasive carcinoma resemble in all respects the cells of invasive carcinoma. The incidence runs between 1.5 per cent and 3.9 per cent in large numbers of uteri studied following hysterectomy for various causes. cell
Preinvasive proliferation
carcinoma normally
is seen occurring
in a disproportionate in pregnancy may
number of pregnant uteri. Basal make differential diagnosis difficult.
Preinvasive carcinoma seems to remain preinvasive for an average of six years. It is possible that some may never progress to the invasive stage. However, the diagnosis demands immediate hysterectomy because such treatment should be followed by 100 per cent cure. A discussion of this paper by Dr. Emil Novak suggests that there is not unanimity of opinion regarding the pathologic criteria for the diagnosis of preinvasive carcinoma. WILLIAM BICKERS.
SELECTET)
He found negative smears high incidence of IF.2 per special series of cases.
Am. J. Oh.
ABSTRACTS
in 263 women and positive cent. He does not mention
smears whether
in
51 this
cases, series
8i Gynec. April, 1949
au unusualI\ represents
a
Among the 51 positive cases were 35 cervical carcinomas, all confirmed by biopsies. In 33 cases of this subgroup the indication for biopsy was made by the prebiopsy smear, providing thus a 5.72 per cent error. Seven of nine adenocarcinomas of the endometrium suspected by smear were confirmed by curettage, an error of 12.23 per cent. In addition, the author found perfect agreement of the smear reports in two vulva1 carcinomas, one clitoral carcinoma, and one case of uterine sarcoma. The over-all percentage of error for the entire series was 2.22 per cent, an unusually low figure, or 7 cases from the series of 314 cases. When divided into “false positives” and “false negatives” (8.9 per cent) the final corrected percentage was 5.59 per cent. Among the cervical carcinomas were 12 cases of Grade I lesions (League of Nations classification). Schtirbu concludes the Papanicolaou prebiopsy procedure represents as valuable a contribution as the biopsy, periodic pelvic examinations, and eolposcopic studies toward earlier detection of genital malignancy and the ultimate reduction of mortality rates in uterine cancer. CL-41~ E. FOLSOME.
Kullander, 19,
8. :
Ohorionepithelioma
Treated
With
Stilbestrol,
The
Lancet,
page
944,
June
1948.
Nineteen months after expulsion of a hydatid mole, a 20-year-old multipara was found to have chorionepithelioma, with two deposits in an enlarged uterus, theca lutein cysts of the ovaries, and small metastatic deposits in the lungs. After removal of the internal genitals, she was given a total of 3,400 mg. of stilbestrol by mouth and 18,500 mg. parenterally, until her death five months later. The possible beneficial effects of this treatment were shown by: (a) clinical improvement on initiating therapy, (b) reduction of gonadotrope titer following the initiation or large increase of stilbestrol dosage, (c) reduction in size of vaginal and lung metastases on increasing the dosage, and (d) rapid increase in gonadotrope titer and enlargement of vaginal metastasis on temporarily stopping stilbestrol administration. IRVING I,. FRANK.
Pund,
Edgar cinoma Aug.,
IL, Dick, Fred, Jr., and Cardwell, 33. 5. Jr.: The Pathology of the Cervix. The Status of Preinvaaive Cancer, South.
of Early M.
J.
41:
Car711,
1948.
Incipient preinvasive carcinoma of the cervix has come into the realm of diagnostic possibility since the introduction of the Papanicolaou smear for cytologic study. There were 86 cases of preinvasive carcinoma, 28 of which were discovered before hysterectomy, and 69 uteri in which routine pathologic examination inadvertantly made the diagnosis. Diagnosis depends entirely upon cytologic detail, namely : nuclear hyperchromatism, increase in the nuclear-cytoplasmic ratio, variations in nuclear size and absence of polarity. The cells in preinvasive carcinoma resemble in all respects the cells of invasive carcinoma. The incidence runs between 1.5 per cent and 3.9 per cent in large numbers of uteri studied following hysterectomy for various causes. cell
Preinvasive proliferation
carcinoma normally
is seen occurring
in a disproportionate in pregnancy may
number of pregnant uteri. Basal make differential diagnosis difficult.
Preinvasive carcinoma seems to remain preinvasive for an average of six years. It is possible that some may never progress to the invasive stage. However, the diagnosis demands immediate hysterectomy because such treatment should be followed by 100 per cent cure. A discussion of this paper by Dr. Emil Novak suggests that there is not unanimity of opinion regarding the pathologic criteria for the diagnosis of preinvasive carcinoma. WILLIAM BICKERS.