Groin dissection practices among gynecologic oncologists treating early vulvar cancer

318

Citaiions from fhe liternffrre / Infemational/offmal

Risks for transmission insemination McKee

T.A.;

Avery

of hepatitis

S.; Majid

C virus during artificial

A.; Brinsden

of Gynecology & Obstetrics 55 (1996) 313-321

ONCOLOGY

P.R.

GBR FERTIL STERIL 1996 66/l (161-163) Objective: To identify risks of hepatitis C virus transmission by semen from infected donors. Design: Case report. Setting: Assisted fertility clinic. Patients: Hepatitis C virus-infected semen donor and recipients of his donations. Intervention: Testing for hepatitis C virus by serology and polymerase chain reaction. Main Outcome Measures: Detection of hepatitis C virus antibodies and vital RNA. Results: Hepatitis C virus RNA was detected in the semen donation before but not after purification; none of the recipients of the donors samples were found to have antibodies to hepatitis C virus. Conclusions: Hepatitis C virus RNA can be detected in semen donations from infected donors; purification of donations before insemination significantly reduces the amount of viral RNA in the semen pellet.

Birth of healthy children after preimplantation diagnosis of common aneuploidies by polar body fluorescent in situ hybridization analysis Verlinsky I’.; Cieslak J.; lvakhnenko V.; Lifchez A.; Strom C.; Kuliev A.; Freidine M.; White M.; Wolf G.; Moise J.; Valle J.; Kaplan B.: Ginsberg N.

USA FERTIL STERIL 1996 66/l (126-129) Objective: To perform preimplantation diagnosis of common aneuploidies by polar body analysis and fluorescent in situ hybridization technique using probes specific for chromosomes X, 18, and 13/21. Design: The first and/or second polar bodies were removed and studied by fluorescent in situ hybridization to detect and avoid fertilization and transfer of oocytes with common aneuploidies. Setting: The Reproductive Genetics Institute’s IVF program at Illinois Masonic Medical Center. Patients: One hundred and ninety-three couples of advanced maternal age (34 to 46 years) undergoing IVF treatment volunteered to be part of a clinical trial on preimplantation polar body c’iagnosis of common aneuploidies. Interventions: Using micromanipulation procedures, the first and second polar bodies were removed after their extrusion from the oocytes. Main Outcome Measure: Fluorescent in situ hybridization signals specific for chromosomes X, 18, and 13/21. Results: In 235 IVF cycles performed in 193 couples, 1293 oocytes were biopsied and subjected to fluorescent in situ hybridization analysis, with fluorescent in situ hybridization results available in 993 oocytes (76.8%). Of 993 oocytes with fluorescent in situ hybridization results, 665 (67%) were predicted to be normal based on the chromosomes studied; 460 embryos resulting from these oocytes were transferred in 187 treatment cycles, resulting in I2 births of healthy children and I8 ongoing pregnancies after confirmation of the polar body diagnosis by chorionic villus sampling or amniocentesis. Concluslon: Polar body fluorescent in situ hybridization analysis may be used for preimplantation diagnosis of common aneuploidles in IVF pattents of advanced maternal age.

Adenocarcinoma biopsy margins

in situ of the cervix:

Wolf J.K.; Levenback Mitchell M.F.

C.; Malpica

A.;

Significance Morris

M.;

of cone Burke

T.;

USA OBSTET GYNECOL 1996 88/l (82-86) Objective: To evaluate the treatment and outcome of patients with adenocarcinoma in situ of the cervix, with special emphasis on cone biopsy margins. Methods: Sixty-one women with adenocarcinoma in situ of the cervix treated between April 1984 and December 1993 were identified. Medical records and histologic material were reviewed. Mixed lesions with both adenocarcinoma in situ and squamous cervical intraepithelial neoplasia (GIN) were included. Results: The mean age of the patients was 35.9 years. Fifty-five of the 61 (90%) patients had cone biopsies, and 44 of these 55 (80%) subsequently had hysterectomies. Eight women (13%) had associated invasive cancer. Among 50 patients in whom the status of the margins was confirmed, 23 (46%) had positive margins and 27 (54%) had negative margins. Of 23 women with positive margins, 19 had hysterectomies and 10 of the 19 (53%) had residual disease in the uterus. Of 27 patients with negative cone margins, 21 had hysterectomies, and 7 of the 21 (33%) had residual disease in the uterus. Two women with negative margins who did not have hysterectomies developed recurrent disease. Fifty-five of the total series of 61 patients followed-up for a median of 57 months (range 17-132) had no evidence of disease at last follow-up. Conclusion: Women with adenocarcinema in situ of the cervix often have residual disease in the uterus, regardless of whether the margins on cone biopsy are positive or negative.

Groin dissection practices treating early vulvar cancer Levenback C.; Morris M.; Wolf J.K.; Wharton J.T.

among Burke

gynecologic T.W.;

oncologists

Gershenson

D.M.;

USA GYNECOL ONCOL 1996 62/l (73-77) Objective: To survey the surgical practice of gynecologic oncologists regarding the extent of groin dissection for early vulvar cancer. Methods: A 14-item questionnaire was developed and presented to the Annual Meeting of the Felix Rutledge Society. Gynecologic oncologists were asked to describe in descriptive, categorical, and visual terms the groin procedure that they perform as part of management of early vulvar cancers. Three ink-line drawings were created by a medical illustrator for the purpose. Fifty returned surveys were evaluable. Results: The most commonly performed procedures were removal of the lymph nodes above the cribriform fascia and those medial to the femoral vein (40%), removal of lymph nodes above the cribriform fascia (34%), and removal of all nodes above and below the cribriform fascia (22%). Respondents performing the first procedure termed it ‘superficial inguinal lymphadenectomy’ (40%). ‘in-

Citations from the literature /International

Journal of Gynecology & Obstetrics 55 (1996) 313-321

guinal femoral lymphadenectomy’ (25%), and a variety of other names (35%). Respondents performing the second two procedures were much more consistent in the figure and name that they matched with their description of the nodes removed. When respondents were asked to match the figures with categorical definitions based on their understanding of the literature, the figure depicting Scarpa’s triangle following removal of the superficial inguinal and medial femoral nodes was named superficial inguinal lymphadenectomy by 24% despite the fact that the femoral vein was clearly visible and labeled. Conclusions: We conclude that (1) among this group of gynecologic oncologists superficial inguinal and medial femoral lymphadenectomy is the most commonly performed procedure for women with early vulvar cancer and that the procedure is frequently called superficial inguinal lymphadenectomy; (2) publications and protocols on this topic must provide complete descriptions of procedures performed, and investigators must assure that individual surgeons are performing the same procedure; and (3) treatment results with superficial inguinal and medial femoral lymphadenectomy are poorly described and a fertile area for further study. Association of allele-specific HLA expression and histopathologic progression of cervical carcinoma Van Driel W.J.; Tjiong M.Y.; Hilders C.G.J.M.; Trimbos B.J.; Fleuren G.J. NLD GYNECOL ONCOL 1996 62/l (33-41) Immunohistochemical studies have shown that loss of HLA expression is observed in cervical carcinomas but not in premalignant CIN lesions, indicating that downregulation of HLA is linked to tumor progression. The present study was performed to investigate whether the degree of HLA expression in cervical cancer correlates with more advanced disease as defined by histopathological features. Frozen tissue sections from 49 patients with squamous carcinoma of the cervix FIG0 stage IB to IIB were stained with HLA class I monomorphic, locus- and allele-specific monoclonal antibodies. Histological data indicative of local disease, i.e. depth of invasion, tumor size, stage, and systemic spread of the disease, such as tumorpositive lymph nodes, were collected by reviewing the histological slides. Univariate analysis revealed that loss of HLA-A locus and AZ-allele expression showed a positive, significant correlation with both presence of tumor-positive lymph nodes (P = 0.04 and 0.02, respectively) and the number of lymph nodes involved (both P = 0.04). These results strongly support the idea that, specifically in an immunogenic cancer type such as cervical cancer, tumor cells escape immunosurveillance and gain growth advantage by allele-specific downregulation of the HLA-A2 molecule. In view of the development of immunotherapeutical interventions in cancer, upregulation of HLA class I molecules may prove to be a useful additional tool in the combat against immunogenic tumors. Lymphatic spread of cervical cancer: An anatomical pathological study based on 225 radical hysterectomies systematic pelvic and aortic lymphadenectomy

and with

319

Benedetti-Panici P.; Maneschi F.; Scambia G.; Greggi S.; Cutillo G.; D’Andrea G.; Rabitti C.; Coronetta F.; Capelli A.; Mancuso S. ITA GYNECOL ONCOL 1996 62/l (19-24) To assess the patterns of lymphatic spread in cervical carcinoma, radical hysterectomy with systematic lymphadenectomy was performed in 66 patients FIG0 stage IB-IIA < 4 cm, and 159 patients stage IB-IIA > 4 cm to stage IV. The latter patients were treated with neoadjuvant chemotherapy (NACT). Parametria were evaluated by the giant section technique in 109 patients. In 40 of these, the superficial and deep layers of the vesicouterine ligament, the sacrouterine ligament, and the distat part of the cardinal ligament were separately evaluated. The median number of nodes removed was 48 pelvic (range 20-107) and 22 aortic (range 7-64). Positive nodes were found in I4 (21%) stage IB-IIA <4 cm and in 38 (23%) NACTtreated patients, all having pelvic node metastasis. Aortic nodes were involved in 2 (3%) and 5 (3%) patients, respectively. Solitary metastases were found in the superficial obturator (21% of stage IB-IIA < 4 cm and 31% of NACT-treated positive node patients, respectively), external iliac (7 and 3%. respectively), and common iliac nodes (7 and 3%, respectively). Parametrial nodes were found in 59% of giant sections (8% metastatic). The superficial and deep layers of the vesicouterine ligament, the uterosacral ligament, and the distal part of the lateral parametrium revealed the presence of nodes in 33% (no metastatic nodes), 24% (3% metastatic), 5% (no metastatic nodes), and 70% (5% metastatic) of patients, respectively. Overall, parametrial nodes were positive in 12% of stage IB-IIA c: 4 cm and 7% of NACT-treated patients. The diameter of node metastasis was < 10 mm in more than 80% of positive nodes. In conclusion, parametrial nodes were mainly located in the cardinal and vesicouterine ligaments, both being a potential site of metastasis. The superficial obturator, external iliac, common iliac, paracaval, intercavoaortic, and paraaortic nodes were the groups more frequently involved. These data may be useful for tailoring radical hysterectomy and lymphadenectomy according to the primary tumor and the surgeon’s intent. DNA index reflects the biological behavior of ovarian carcinoma stage I-IIa Schueler J.A.; Trimbos J.B.; Burg M.V.D.; Cornelisse C.J.; Hermans J.; Fleuren G.J. NLD GYNECOL ONCOL 1996 62/l (59-66) The prognostic significance of histologic grade, morphometric analysis, and DNARow cytometry was evaluated in 64 patients with well-differentiated (group A) and 30 patients with moderately and poorly differentiated (group B) early-stage (FIG0 stages Ia, lb, Ic, and Ila) epithelial ovarian cancer. The extent of the well-defined staging procedure was assessed strictly in every patient. Of 94 patients, 13 had recurrent ovarian cancel (5 from group A and 8 from group B) and 12 of these patients died. A significant difference was found between groups A and B for 5-year disease-free survival (91% versus 75%), the