Pelvic Spread Research Articles

Does Gas Insufflation during Gynecologic or Urologic Oncologic Laparoscopy Cause Dissemination of Malignant Cells

<h3>Study Objective</h3> To investigate whether benign or malignant cells are found in evacuated gas during laparoscopy for gynecological or urological malignancies. <h3>Design</h3> Observational prospective study. <h3>Setting</h3> Academic, tertiary medical center. <h3>Patients or Participants</h3> A total of 30 patients were included; 15 underwent laparoscopic staging due to uterine adenocarcinoma and 15 had laparoscopic nephrectomy due to suspected renal cell carcinoma. <h3>Interventions</h3> All gas evacuated during laparoscopy was passed through a filter in order to capture any aerosolized cells formed during surgery. After surgery, the filter was rinsed backwards with 50 CC of normal saline. The fluid was collected, centrifuged and sent for cytological evaluation. Filter ability to capture malignant cells was proved by filtering ascites fluid of an ovarian cancer patient through the filter. The primary outcome was the rate laparoscopic surgeries in which the filtered sample was positive for malignant or benign cells. <h3>Measurements and Main Results</h3> No benign or malignant cells were identified in evacuated gas during laparoscopic surgeries in all but one case. This case of malignant adenocarcinoma had a clear, macroscopic extra-uterine pelvic spread and malignant adenocarcinoma cells were identified in the cytology examination of the fluid collected. <h3>Conclusion</h3> In contrast to previous concerns, in all cases where the tumor was confined to its' organ, we found no evidence of benign or malignant cell spread in the gas evacuated from the abdominal or retroperitoneal cavity during laparoscopy. The single event of malignant cells from aerosolized gas was in a case with a macroscopic, extra-organ involvement. Our study confirms the safety of performing laparoscopic surgery for gynecologic and urologic malignancies with regard to aerosolized gas. The explanation for malignant cells found in evacuated gas could be both aerosolization of cells or cells that adhered to surgical instruments. The clinical significance of this finding in the setting of macroscopic, extra-organ tumor spread is unclear.

A Locally Advanced Endometrioid Adenocarcinoma Arising from Vaginal Endometriosis: Management and Review of the Literature

Endometrioid adenocarcinoma associated with endometriosis at extrauterine or extraovarian localization is a rare entity. Often presenting with local spread without nodal and distant metastasis, this entity has no specific staging system nor treatment guidelines. In the case of nodal and distant spread, the treatment decision requires personalization. In this article, we present the diagnosis and surgical and systemic treatment of a 56-year-old woman diagnosed with an endometriosis-associated advanced endometrioid adenocarcinoma of the vagina with nodal involvement. Following an extensive review of the scarce data reported to guide the treatment choices in this rare setting, we proposed a multidisciplinary treatment with laparoscopic surgical cytoreduction, four cycles of adjuvant chemotherapy with carboplatin and paclitaxel, and radiotherapy with brachytherapy. Due to an anaphylactic reaction on the first administration, paclitaxel was replaced with nab-paclitaxel. Despite many negative prognostic factors, the patient is free from relapse after 48 months. We report the case of a locally advanced endometrioid adenocarcinoma associated with endometriosis of the vagina, with pelvic nodal spread, and the relevant literature review of similar cases.

CT diagnosis of ilioinguinal lymph node metastases in melanoma using radiological characteristics beyond size and asymmetry.

BackgroundDiagnosis of lymph node (LN) metastasis in melanoma with non-invasive methods is challenging. The aim of this study was to evaluate the diagnostic accuracy of six LN characteristics on CT in detecting melanoma-positive ilioinguinal LN metastases, and to determine whether inguinal LN characteristics can predict pelvic LN involvement.MethodsThis was a single-centre retrospective study of patients with melanoma LN metastases at a tertiary cancer centre between 2008 and 2016. Patients who had preoperative contrast-enhanced CT assessment and ilioinguinal LN dissection were included. CT scans containing significant artefacts obscuring the pelvis were excluded. CT scans were reanalysed for six LN characteristics (extracapsular spread (ECS), minimum axis (MA), absence of fatty hilum (FH), asymmetrical cortical nodule (CAN), abnormal contrast enhancement (ACE) and rounded morphology (RM)) and compared with postoperative histopathological findings.ResultsA total of 90 patients were included. Median age was 58 (range 23–85) years. Eighty-eight patients (98 per cent) had pathology-positive inguinal disease and, of these, 45 (51 per cent) had concurrent pelvic disease. The most common CT characteristics found in pathology-positive inguinal LNs were MA greater than 10 mm (97 per cent), ACE (80 per cent), ECS (38 per cent) and absence of RM (38 per cent). In multivariable analysis, inguinal LN characteristics on CT indicative of pelvic disease were RM (odds ratio (OR) 3.3, 95 per cent c.i. 1.2 to 8.7) and ECS (OR 4.2, 1.6 to 11.3). Cloquet’s node is known to be a poor predictor of pelvic spread. Pelvic LN disease was present in 50 per cent patients, but only 7 per cent had a pathology-positive Cloquet’s node.ConclusionAdditional CT radiological characteristics, especially ECS and RM, may improve diagnostic accuracy and aid clinical decisions regarding the need for inguinal or ilioinguinal dissection.

Lymph Node Mapping in Patients with Penile Cancer Undergoing Pelvic Lymph Node Dissection.

A map of pelvic lymph node metastasis in patients with penile cancer helps to clarify the pattern of pelvic spread and define the reasonable limits of dissection, and it has not been established. We aim to provide an accurate map of lymph node metastasis in patients with penile cancer and determine the reasonable extent of pelvic lymph node dissection. We enrolled patients with penile cancer undergoing pelvic lymph node dissection (128) at our institution from 1999 to 2018. The numbers of removed lymph nodes and positive lymph nodes at 10 distinct regions were recorded. The chi-square and Fisher exact tests were used. The median number of pelvic lymph nodes retrieved was 18 (IQR 10-30), with the majority being from the external iliac package (43.0%) and obturator package (31.9%). Pelvic lymph node metastasis was present in 57/128 (44.5%) patients. The median number of positive pelvic lymph nodes removed was 2 (IQR 1-4), with the majority being from the external iliac package (50.0%) and obturator package (36.6%). Advanced T-stage was related to higher risk of pelvic lymph node metastasis, which was present in 30.3%, 44.2%, 59.0% and 58.3% of patients with pT1, pT2, pT3 and pT4, respectively. Notably, 2 patients had crossover metastasis from 1 inguinal region to the contralateral pelvic region. We present a detailed map of pelvic lymph node metastasis in patients with penile carcinoma. The external iliac and obturator packages appear to be most commonly involved. Optimal pelvic lymph node dissection may extend to the common iliac artery, including common iliac, external iliac, internal iliac and obturator lymph nodes. Extranodal extension in inguinal nodes may not be as important as previously thought.

2018 FIGO Staging System for Uterine Cervical Cancer: Enter Cross-sectional Imaging.

Imaging plays a central role in the 2018 International Federation of Gynecology and Obstetrics staging system for uterine cervical cancer. The revision calls for a more precise measurement of primary tumor size, best assessed with imaging. Evaluation for abdominopelvic retroperitoneal lymphadenopathy, either with imaging alone or with pathologic analysis, is now also part of staging. Choice of modality depends on the technology available within the practice setting. In high-resource settings, pelvic MRI (to assess tumor size and central pelvic spread) and torso fluorodeoxyglucose PET/CT (to assess lymphadenopathy and distant metastases) are used to assign stage and to plan therapy. In lower-resource settings, analogous modalities are pelvic US and chest radiography. Although imaging is already a part of pretreatment planning in some high-resource settings, its incorporation into assigning stage is a new development.

Clonality, Heterogeneity, and Evolution of Synchronous Bilateral Ovarian Cancer.

Synchronous bilateral ovarian cancer (SBOC) represents a relatively frequent occurrence and clinically relevant diagnostic dilemma. Delineation of its clonal architecture, genetic heterogeneity, and evolutionary trajectories may have important implications for prognosis and management of patients with SBOC. Here, we describe the results of next-generation whole-exome or whole-genome sequencing of specimens from 12 SBOC cases and report that bilateral tumors from each individual display a comparable number of genomic abnormalities and similar mutational signatures of single-nucleotide variations. Clonality indices based on tumor-specific alterations supported monoclonal origins of SBOC. Each of the ovarian lesions was nevertheless oligoclonal, with inferred metastatic tumors harboring more subclones than their primary counterparts. The phylogenetic structure of SBOC indicated that most cancer cell dissemination occurred early, when the primary carcinoma was still relatively small (<100 million cells). Accordingly, the mutation spectra and mutational signatures of somatic variants exhibited pronounced spatiotemporal differences in each patient. Overall, these findings suggest that SBOCs are clonally related and form through pelvic spread rather than independent multifocal oncogenesis. Metastatic dissemination is often an early event, with dynamic mutational processes leading to divergent evolution and intratumor and intertumor heterogeneity, ultimately contributing substantially to phenotypic plasticity and diverse clinical course in SBOC. Cancer Res; 77(23); 6551-61. ©2017 AACR.

Novel imaging techniques in gynaecological cancer

To describe the added value of novel functional MRI techniques towards detection, staging, characterization, response monitoring and prognostication in gynaecological cancer. Functional MRI including diffusion-weighted imaging (DWI)-MRI and dynamic contrast-enhanced (DCE)-MRI adds structural, hemodynamic and physiological information to anatomical MRI. In endometrial and cervical cancer, the addition of DWI-MRI and DCE-MRI improves tumour detection as well as staging of uterine and extra-uterine pelvic spread. Quantitative assessment of DWI and DCE-MRI reflecting tissue properties of biological aggressiveness or treatment resistance may enable the prediction of risk of extra-uterine or extra-ovarian disease spread, predict risk of recurrence and assess treatment response. DWI shows high accuracy for detecting peritoneal metastases and allows for comprehensive staging of (recurrent) ovarian cancer following the clinical development of whole body DWI-MRI. The added value of DWI/DCE-MRI for characterization and staging of gynaecological malignancy is becoming increasingly established and may improve treatment stratification. Ongoing multicentre studies are expected to further consolidate its use in clinical routine. Quantitative evaluation of functional MRI may help in prognostication and risk stratification.

EP29.12: Pelvic pathology diagnosed with transvaginal ultrasound

Throughout the world, transvaginal ultrasound (TVU) is considered a fundamental tool for gynecological work-up. TVU was initially adopted only to investigate pathologies of female genital tract, but currently TVU is also used to evaluate the extension of pathologies into the pelvis, outside the uterus or ovaries (oncological conditions and endometriosis). Moreover TVU can visualise structures that cannot be classified as gynecological pathologies but rather as pelvic pathologies. The aim of this study is to relate our experience with pelvic pathologies and our attempts to interpret those new US findings properly in order to achieve the correct diagnosis. We reviewed our case series and we selected cases of 1 pelvic schwannomas, 2 cases of GIST (gastrointestinal stromal tumours), 4 cases of post-operative urinoma, 1 case of bowel cancer, 1 case of cyst of sacral roots, 1 case of ectopic spleen, 1 case of pelvic lymphoma, 1 case of metastasys of pancreatic cancer; one case of pelvic recidive of Vater papilla tumour; one case of pelvic spread of melanoma; 1 case of chorincarcinoma arising from ectopic tubal pregnancy; 1 case of bowel volvulus. At TVU, pelvic schwannomas appeared as rounded masses, with a semi-solid structure having a regular border and intralesional hyperechoic areas. GISTs at ultrasound can show a hyperechoic core due to mixoid degeneration or leiomyomas or microcystis into the mass. Urinoma is a “pelvic pseudocyst” due to ureteral injury and is identified mainly on colour Doppler examination. Other lesions appear like a solid mass with irregular borders with eterogeneous echogenicity, highly vascularised at power Doppler investigation. Bowel volvulus was suspected by abnormal morphology of visceral wall, by intestinal contents and by clinical symptoms. Not only can the genital tract be visualised during TVU, but with this imaging method it is possible to visualise other pathological conditions as well, including those unrelated to gynecology.

Improvements to the FIGO staging for ovarian cancer: reconsideration of lymphatic spread and intraoperative tumor rupture

ObjectiveTo evaluate the improvement in prognosis prediction with reassignment of International Federation of Gynecology and Obstetrics (FIGO) stages for ovarian carcinoma.MethodsThis was a retrospective study of patients with epithelial ovarian, fallopian tube, and primary peritoneal cancers. Sub-staging criteria used in stage reassignment were defined as follows: surgical spillage (IC1), capsule rupture before surgery or tumor on the surface (IC2), and positive cytology results (IC3); microscopic (IIB1) and macroscopic (IIB2) pelvic spread; microscopic extrapelvic spread (IIIA1) and retroperitoneal lymph node (LN) metastasis without extrapelvic spread (IIIA2); and supraclavicular LN metastasis (IVA) and other distant metastasis (IVB). Survival outcomes associated with the current and reassigned stages were compared.ResultsOverall, 870 patients were eligible for analysis. The median follow-up period was 45 months (range, 0 to 263 months). The 5-year overall survival rates (5YSRs) according to the current staging were 93.5% (IA), 82.5% (IC), 75.0% (IIB), 74.5% (IIC), 57.5% (IIIA), 54.0% (IIIB), 38.5% (IIIC), and 33.0% (IV). The 5YSRs of patients with IC1, IC2, and IC3 after sub-staging were 92.0%, 85.0%, and 71.0%, respectively (p=0.004). Patients who were reassigned to stage IIIA2 had a better 5YSR than those with extrapelvic tumors >2 cm (66.3% vs. 35.8%; p=0.005). Additionally, patients with newly assigned stage IVA disease had a significantly better 5YSR than those with stage IVB disease (52.0% vs. 28.0%; p=0.015).ConclusionThe modified FIGO staging for ovarian carcinoma appears superior to the current staging for discriminating survival outcomes of patients with surgical spillage, retroperitoneal LN metastasis without extrapelvic peritoneal involvement, or distant metastasis to supraclavicular LNs.

Upstaging pathologic stage I ovarian carcinoma based on dense adhesions is not warranted: A clinicopathologic study of 84 patients originally classified as FIGO stage II

FIGO stage II ovarian cancer comprises 8% of ovarian cancers. It is a common but not universal practice to upstage densely adherent pathologic stage I tumors to stage II. FIGO guidelines are not clear, and data supporting this practice are sparse. We retrospectively reviewed patients with stage II ovarian cancer and grouped them based upon histologic evidence of extraovarian extension. Tumors densely adherent to extraovarian structures but without histologic tumor outside the ovary were considered pathologic stage I. All others were considered surgical-pathologic stage II. Three histologic patterns of extraovarian tumor involvement were identified. Eighty-four patients were studied. Twenty-four patients had pathologic stage I disease and 60 had histologic evidence of extraovarian pelvic spread and were surgical-pathologic stage II. The 5-year survival for stage I was 100%, and the median survival was not reached. The 5-year survival for those with surgical-pathologic stage II disease was 56.8% and the median survival was 73 months. There were no differences observed based upon pattern of extraovarian spread. The survival difference between pathologic stage I and surgical-pathologic stage II was significant (p<0.001). There were no differences seen in 5-year survival among surgical-pathologic stage II patients with serous, endometrioid or clear cell histologies (64.5%, 64.8% and 64.3% respectively). These retrospective data suggest that the practice of upstaging densely adherent pathologic stage I tumors to stage II may not be warranted. Cell type is not a prognostic factor in stage II.

Evaluation of a New Technique for Determining Sex of Adult White-Winged Doves (Zenaida asiatica)

Abstract Previous studies have shown that determining sex of adult white-winged doves (Zenaida asiatica) by cloacal characteristics is highly reliable (90%), while using plumage characteristics and body weights are less so. The drawback of the cloacal technique is that the procedure requires use of a modified nasal speculum to probe the cloacal area, which could possibly cause injury to the bird. We hypothesized that females have a wider pelvis than males for the passage of eggs, which should be quantifiable, thereby providing a means of separating adult males and females. We measured pelvic spread (distance from tip to tip of pelvis) of adults (n = 249). Additionally, body masses were taken for a subset (n = 215) of the doves. Sex was positively determined by either cloacal examination of live birds or gonad examination of dead birds. Mean pelvic spread of males was significantly less than that of females. Whole body mass was not correlated with pelvic spread for either sex. Accuracy of the pelvic sp...

The Abandoned Radical Hysterectomy for Cervical Cancer: Clinical Predictors and Outcomes

Objective. Cervical cancer patients who had an abandoned radical hysterectomy were evaluated for preoperative clinical predictors, complication rates, and outcomes. Study Design. IRB approval was obtained for this retrospective analysis and chart review was performed. Results. From 268 women with early-stage (IA2 to IIA) cervical cancer, 19 (7%) had an abandoned hysterectomy for finding grossly positive lymph nodes (84%) or pelvic spread of tumor (16%). No clinical characteristics clearly identified women preoperatively at risk of having an abandoned hysterectomy. In the abandoned group, 26% suffered major morbidities, compared to 34% in the completed group (OR 0.69, [CI 0.16–2.57], P = .789). Thirty-seven percent recurred in the abandoned group, compared to 18% in the completed group (P = .168). Overall survival in the abandoned group was 73% versus 80% in the completed group (P = .772). Conclusion. The practice of abandoning a planned radical hysterectomy for unexpected metastatic disease may not worsen the outcome.

Pure ovarian choriocarinoma mimicking ectopic pregnancy in true hermaphroditism

Ovarian choriocarinoma is a rare tumor and has not been described before in a true hermaphrodite condition. A 23-year-old karyotype 46XX parous female was admitted to hospital because of amenorrhea, irregular vaginal bleeding, an adnexal mass, and an increased beta-hCG serum level. Ectopic pregnancy was suspected three times and exploratory laparoscopy done each time removing the right ovarian mass and local pelvic and omental spread. Final pathology revealed a true hermaphrodite state with testicular tissue with distinct tubules, ovarian tissue with follicles, and ovarian choriocarinoma with necrosis and hemorrhage. She received chemotherapy followed by radical pelvic surgery.

Neoadjuvant chemoradiation for rectal cancer: A 5-year institutional experience at Sparrow Hospital

14601 Continued efforts to improve local control and to maximize sphincter preservation in patients with rectal carcinoma led to consideration of preoperative chemoradiation. The purpose of this retrospective study is to examine clinical outcomes and find out which prognostic factors are related to survival in patients treated with neoadjuvant chemoradiation in Sparrow Hospital from 1998–2003. Forty two patients with biopsy proven rectal carcinoma without evidence of extra pelvic spread were treated in this fashion. Radiation therapy was administered for a total dose of 5.00 cGy. Chemotherapy used was 5-FU in 37 patients, and in combination with leucovorin in additional 5 patients. Surgical treatments performed were abdominoperineal resection (23 pts), low anterior resection in 13 pts., transanal excisions (2 pts), 2 patients had only exploratory laparotomy and for 2 patients records were not available. Cox proportional hazards regression techniques were used to estimate survival rates. Univariate and multivariate Cox proportional hazards analyses were used to evaluate relationship between risk factors and the survival. The SAS system (V9.1.3, Cary NC) was used for all analyses. Out of 42 patients analyzed 25 were males and 17 females. Mean age was 65 years (range 31 - 85). Median follow-up time was 57 months with a range from 7 to 98 months. After the surgery 4 patients had complete response, 12 were stage I, 10 stage II, 12 patients stage III, one patient had metastatic disease and for 2 patients records were inadequate. Analysis of disease free survival showed actuarial 5-year disease free survival to be 59%. Actuarial 5-year overall survival was 67%. Median overall survival was still not reached, while median disease-free survival is 78 months . Univariate and multivariate analyses showed that only postoperative stage was associated significantly with overall survival. Specifically, there was an increase in the risk of mortality of just over 3-fold for each increment in post-operative stage. In conclusion, in the community settings preoperative chemoradiation seem to provide good overall and disease free survival for patients with rectal cancer. Postoperative stage appears to be the most important prognostic factor for the survival. No significant financial relationships to disclose.

Neoplastic lumbosacral radiculoplexopathy in prostate cancer by direct perineural spread: An unusual entity

Neoplastic lumbosacral plexopathy occurs with some abdominal and pelvic malignancies. Patients present with severe pain radiating from the low back down to the lower extremities, and this progresses to weakness. Neoplastic lumbosacral plexopathy is virtually always associated with known malignancy or obvious pelvic metastatic disease. Uncommonly, prostate cancer can present as a lumbosacral plexopathy occurring through direct pelvic spread. We describe two cases of lumbosacral radiculoplexopathy from infiltrative prostate cancer without evidence of other pelvic or extraprostatic spread. The probable etiology of tumor spreading along prostatic nerves into the lumbosacral plexus (i.e., perineural spread) is discussed as are the potential mechanisms for this unusual mode of cancer dissemination.

Bilateral pelvic ganglioneuroma: clinico-pathological findings: a case report

Ganglioneuroma is a rare benign neurogenic tumor originating from the autonomic nervous system, and is considered the benign counterpart of neuroblastoma, lacking the immature neuroblastic cells. A case of pelvic ganglioneuroma with bilateral pelvic spread is described.

Anatomy of the retroperitoneum

•. The retroperitoneum is a complex compartment, the anatomy of which has yet to be fully validated.•. The retroperitoneum lies between the posterior parietal peritoneum in front and the transversalis fascia behind.•. It is nominally divided into three spaces by the perirenal fascia: the anterior pararenal space, the perirenal space and the posterior pararenal space.•. The anterior pararenal space communicates across the midline. Superiorly it extends to the dome of the diaphragm and hence to the mediastinum. Inferiorly it communicates with the pelvis and below the inferior renal cone with the posterior pararenal space.•. The perirenal space extends across the midline. It abuts the bare area of the liver on the right and the subphrenic space on the left, with mediastinal communication via the diaphragmatic hiatae. In disease the perirenal space is usually closed inferiorly, preventing pelvic spread.•. Within the fat surrounding the kidney in the perirenal space there is a network of thin septae that conta...

A PLEA FOR INCIDENTAL APPENDECTOMY IN PEDIATRIC PATIENTS WITH MALIGNANCY

The evaluation of right lower quadrant (RLQ) abdominal pain in pediatric patients with malignancy can be difficult. However, since the mortality rate from peritoneal infections in these patients is very high, the differential diagnosis of RLQ peritoneal irritation, mainly of acute appendicitis (AA) versus neutropenic enterocolitis (NE), is crucial. Three cases of pediatric patients with malignancy demonstrating these difficulties are represented to enlighten this problem. The first patient died of multiorgan failure after operation for perforated appendicitis without generalized peritonitis. The second had a severe life-threatening postoperative complication because of delayed diagnosis of acute appendicitis. The third patient with malignant pelvic spread, underwent an unnecessary abdominal exploration for suspected AA. In all these cases and probably in many others, the clinical outcome could have been different if a previous incidental appendectomy had been performed during the primary abdominal operation. Incidental appendectomy in oncologic patients is recommended to facilitate the differential diagnosis of RLQ pain and to exclude the diagnosis of AA.

Extragenital malignant mixed Mullerian tumor

Reports of extragenital malignant mixed Mullerian tumor (MMMT) type though extremely rare have increased. This represents the 15th reported case of MMMT outside the female reproductive tract. A 68-year-old black woman presenting with abdominal pain, increasing abdominal girth, and a provisional diagnosis of ovarian carcinoma, underwent exploratory laparotomy, total abdominal hysterectomy, omentectomy and cytoreductive surgery. Surgery and histology revealed MMMT of heterologous type in the pelvic peritoneum, with no tumor in the genitalia and no foci of endometriosis. Despite surgical debulking leaving residual tumor of less than 1 cm followed by aggressive systemic chemotherapy, the patient died of disease within 2 months. Increasing exploratory surgery may account for the increase in reports of extragenital MMMT. Aggressive tumor debulking and multiagent systemic chemotherapy is of limited efficacy since extragenital MMMT, like uterine MMMT with pelvic spread, has short survival.

Natural history of patients with pulmonary metastases from uterine cancer

Endometrial cancer is the most common female genital cancer and approximately 90% of the cases are diagnosed while they are still confined to the uterus. However, the natural history and treated course after the development of pulmonary metastasis (PM) have not been studied systematically in a large series of patients. Between 1962 and 1992, 100 patients (6%) with PM were identified by computerized search of the medical records from 1.665 patients admitted to our hospitals with the diagnosis of uterine cancer. The median age of the patients was 65.5 years (range: 42-87 yrs). The usual histologic types of the uterine neoplasms were 59 adenocarcinomas (59%), 21 sarcomas, and 14 adenosquamous carcinomas. Of the 83 patients with reported tumor grade, 11 had Grade 1 tumor, 12 Grade II, and 60 Grade III. Lung metastases were found at the time of diagnosis of the primary tumor in 22 patients. Hemoptysis was the first symptom of 3 of the 22; the majority had no respiratory symptoms. In the remaining 78 patients with PM appearing after primary therapy, the mean interval time between primary diagnosis and PM was 29.4 months, whereas between PM and death was 15.7 months. Of all patients with lung metastases, 75% did not survive 1 year; however 6% survived more than 5 years after diagnosis of metastatic disease. Patients with isolated PM had prolonged survival (36.1 mos, P=0.001), whether treated medically or with pulmonary resection. Progestin therapy was given to 39 patients, with complete response consisting of radiographic resolution of all disease in 6 patients (15%) and prolonged stabilization in an additional 5 (13%). The histologic grade of the primary tumor was predictive of clinical response to progestine therapy. Asymptomatic pulmonary metastases represent a common site of extra pelvic spread of disease. The majority of patients with PM (75%) do not survive 1 year. Low grade uterine tumors are more likely to respond to progestin therapy and do so for extended periods of time.