Stage IB Tumors Research Articles

Cervical cancer associated with pregnancy: Results of a multicenter retrospective Korean study (KGOG-1006)

The objective of the study was to analyze the characteristics of cervical cancer associated with pregnancy. Forty patients with cervical cancer associated with pregnancy were retrospectively identified between 1995-2003. Three controls for each case were matched on the basis of age, stage, histology, and date of treatment. Sampling of cervical cytology after the second trimester was the most common cause of delayed diagnosis. Among 12 patients who delayed treatment for fetal maturity, 2 died of disease. There was no difference in overall survival between pregnant and nonpregnant patients with stage Ib tumors. In contrast to nonpregnant patients, the depth of stromal invasion was not correlated with the incidence of lymph vascular space involvement and lymph node metastasis in pregnant patients. Thorough evaluation is warranted before deciding whether to delay treatment until fetal maturity. Pregnancy does not adversely affect the prognosis of early-stage cervical cancer significantly.

The treatment of early stage cervical cancer: An assessment of pre-operative factors

To assess the pre-operative clinical factors of a group of early stage cervical cancer patients and correlate them to the risk for adjuvant radiotherapy using GOG 92 and 109 criteria. A retrospective chart review of cervical cancer patients treated at the Saint Louis University Division of Gynecologic Oncology between the years 1989 and 2004 was performed. The results were compared with chi-squared testing and multivariable regression analysis. A p-value of 0.05 was considered significant. One hundred and thirty-one cervical cancer patients underwent exploration for radical hysterectomy during the study time period. Five patients had stage IA1 disease, 6 patients had stage IA2 disease, 98 patients had stage IB1 disease, 20 patients had stage IB2 disease and one patient had stage IIA disease. No patient with stage IA1 or IA2 disease met criteria for adjuvant radiotherapy. The patients with stage IB1 tumors who were 45 years of age or younger and had tumors up to 2 cm in diameter had a low (14%) likelihood for treatment with adjuvant radiotherapy. The patients with stage IB1 tumors who were older than 45 years of age with tumors larger than 2 cm in diameter and the patients with stage IB2 tumors both had a high likelihood for adjuvant radiotherapy (77% and 90% respectively). In our study group, the stage of cervical cancer and a combination of tumor diameter and patient age was found to stratify early stage cervical cancer patients by likelihood for adjuvant radiotherapy.

Mesonephric adenocarcinoma of the cervix: A case report and review of the literature

Malignant mesonephric tumor arising in the uterine cervix is an exceedingly uncommon variant of cervical adenocarcinoma with only 30 well-documented cases in the literature. We present a case of a 54-year-old woman with postmenopausal vaginal bleeding who was found to have a stage IB mesonephric adenocarcinoma of the cervix. At present there is no consensus on a standardized treatment protocol for malignant mesonephric tumors of the cervix. The present case suggests that a favorable outcome may be achieved for patients with stage IB tumors with aggressive initial therapy.

Lessons from ovarian cancer patients with more than 10 years survival

15059 Background: Purpose of this retrospective study is to explore predictive factors for long-term survival in patients with primary epithelial ovarian carcinoma. Methods: Total 161 patients treated from March 1983 to December 1994 at the National Defense medical College hospital were enrolled in this study. Profiles and characteristics of patients with long-term survival were retrospectively examined. Results: All patients with stage IA-B or IIA-B survived more than 10 years although 2 of patients with stage IA and IB tumor were dead of primary disease and one patient was dead of other disease after more than 10 years follow-up. More than half of patients with stage IC, IIC or IIIA-B survived more than 10 years, while 10-years’ survival rates of patients with stage IIIC or IV were only 10% with marked increase of death by primary disease. All patients with stage I or IIA-B without residual tumor after initial surgery survived more than 10 years. Although long-term survival rates of patients with stage IIC or IIIA-B were higher in patients without residual tumor after initial surgery, 6 out of 7 patients with stage IIIC or IV had residual tumor. Analysis of 70 patients with stage III or IV ovarian cancer revealed that residual tumor size, histologic types and response to initial chemotherapy affected significantly long-term survival. Conclusions: We demonstrated that predictors for long-term survival were stage, residual tumor size after initial surgery, histology and response to initial chemotherapy. [Table: see text] No significant financial relationships to disclose.

Correlation between MRI and histopathologic findings in stage I cervical carcinomas: influence of stromal desmoplastic reaction

Although the effectiveness of magnetic resonance imaging (MRI) in depicting cervical carcinoma has been reported, whether MRI can detect early-stage or stage IB "occult"-type cervical carcinoma remained undetermined. We examined the correlation between MRI and pathologic findings in 38 stage I (IB 28 cases, IA 10 cases) cervical carcinoma patients, with special reference to the influence of desmoplastic stromal reaction around the tumor. The results demonstrated that the tumor was detected by MRI in none of stage IA patients but in 21 (75%) stage IB patients. The image was clearly demonstrated in 15 of 18 (83%) tumors of more than 2 cm in diameter and in 6 of 10 (60%) tumors of 2 cm or less. The tumor image was evident in 21 of 22 (95%) tumors with prominent (>200 micron) stromal reaction but in none of 6 tumors with minimal (</= 200 micron) stromal reaction. These findings suggest that MRI is not useful for the detection of stage IA tumors. In stage IB tumors, however, the stromal reaction rather than the size of the tumor may influence the tumor's image in MRI.

Free peritoneal tumour cells are an independent prognostic factor in curatively resected stage IB gastric carcinoma

Several studies have shown that the cytological detection of free peritoneal tumour cells (FPTCs) in patients with gastric cancer indicates the presence of metastatic disease. The immunocytochemical detection of FPTCs, especially in early-stage tumours, has not been examined comprehensively. Peritoneal lavage was performed in 351 patients before curative resection of a gastric carcinoma between 1987 and 2001, and an adequate sample was obtained from 346 patients. FPTCs were detected immunocytochemically using Ber-EP4 antibody. Median follow-up time was 70 months. FPTCs were detected in the lavage fluid of 74 patients (21.4 per cent) and correlated with increasing pathological tumour depth (pT) and lymph node (pN) status (P < 0.001). The 5-year overall survival of patients with FPTCs was significantly worse than that of patients without FPTCs (35 versus 71.9 per cent; P < 0.001). FPTCs were present in 14 (8.5 per cent) of 164 patients with stage IA or IB tumours. Although the detection of FPTCs had no prognostic significance for stage IA tumours, the presence of FPTCs in those with stage IB tumours was associated with a worse prognosis (P < 0.001). Multivariate analysis identified the presence of FPTCs as an independent prognostic factor in the whole cohort and in the stage IB subgroup. Detection of FPTCs is associated with poor prognosis even in patients with early-stage gastric cancer and should be used for risk-group stratification.

The Fragile Histidine Triad Gene: A Molecular Link Between Cigarette Smoking and Cervical Cancer

Smoking is an epidemiologic risk factor for cervical cancer. The fragile histidine triad (FHIT) gene is a tumor suppressor gene that is altered in 80% of tobacco-associated lung cancers. We hypothesized that reduced FHIT protein expression, homozygous deletions (HD) or hemizygous deletions (HemiD) and microsatellite alterations (MA) at the FHIT/FRA3B locus occur more commonly in cervical cancers of smokers than nonsmokers. Archival tissues of 58 patients with stage IA1 to IB2 squamous cell carcinoma of the cervix were identified. FHIT protein expression was studied with immunohistochemistry. Laser capture microdissection was used to isolate tumor and normal DNA. HD/HemiD of FHIT exons 4 and 5 were analyzed by monoplex real-time PCR. MA at FHIT/FRA3B were studied with multiplex nested PCR with three fluorescently labeled microsatellite markers (D3S1300, D3S1312, and D3S1480). Eighteen of 26 tumors from smokers (69%) and 13 of 32 nonsmokers (41%; P < 0.05) showed loss of FHIT protein expression. Thirty-seven stage IB tumors yielded sufficient DNA for analyses. HD or HemiD of both exons tested occurred in 8 of 17 smokers (47%) and 2 of 20 nonsmokers (10%; P < 0.05). MA at more than two sites were found in 11 of 17 tumors of smokers (65%) and 6 of 20 nonsmokers (30%; P < 0.05). Mean composite genomic FHIT alteration scores were significantly higher for tumors of smokers versus nonsmokers (0.67 versus 0.40; P < 0.02). Loss of FHIT expression, HD, HemiD, and MA at the FHIT/FRA3B locus occur significantly more commonly in cervical cancers of smokers. These findings suggest that the tumor suppressor gene FHIT may represent a molecular target in cigarette smoking-associated cervical carcinogenesis.

Comparison of relative forced expiratory volume of one second with dynamic magnetic resonance imaging parameters in healthy subjects and patients with lung cancer

To assess relative forced expiratory volume in one second (FEV1/vital capacity (VC)) in healthy subjects and patients with a lung tumor using dynamic magnetic resonance imaging (dMRI) parameters. In 15 healthy volunteers and 31 patients with a non-small-cell lung carcinoma stage I (NSCLC I), diaphragmatic length change (LE1) and craniocaudal (CC) intrathoracic distance change within one second from maximal inspiration (DE1) were divided by total length change (LE(total), DE(total)) as a surrogate of spirometric FEV1/VC using a true fast imaging with steady-state precession (trueFISP) sequence (TE/TR = 1.7/37.3 msec, temporal resolution = 3 images/second). Influence of tumor localization was examined. In healthy volunteers FEV1/VC showed a highly significant correlation with LE1/LE(total) and DE1/DE(total) (r > 0.9, P < 0.01). In stage IB tumor patients, comparing tumor-bearing with the non-tumor-bearing hemithorax, there was a significant difference in tumors of the middle (LE1/LE(total) = 0.63 +/- 0.05 vs. 0.73 +/- 0.04, DE1/DE(total) = 0.66 +/- 0.05 vs. 0.72 +/- 0.04; P < 0.05) and lower (P < 0.05) lung region. Stage IA tumor patients showed no significant differences with regard to healthy subjects. dMRI is a simple noninvasive method to locally determine LE1/LE(total) and DE1/DE(total) as a surrogate of FEV1/VC in volunteers and patients. Tumors of the middle and lower lung regions have a significant influence on these MRI parameters.

若年性鼻咽腔血管線維腫における病期分類別手術法の検討

Juvenile nasopharyngeal angiofibromas (JNAs) are benign tumors that occasionally invade the pterygopalatine fossa, infratemporal fossa, or middle cranial fossa. Several surgical approaches have been used based on the location of the tumor, including transpalatal, transmaxillary, and lateral rhinotomy, midfacial degloving, and Le Fort type I osteotomy. We reviewed 4 cases of JNA that had been treated by resection in the Department of Otolaryngology of Kagoshima City Hospital and 31 cases of JNA reported in the Japanese literature between 1990 and 2003. We analyzed the outcome of the surgical treatment of JNA in these cases to identify the surgical approaches that were most effective in removing tumors at several different stages. Radkowski staging showed that 17 (48.6%), 2 (5.7%), 4 (11.4%), 9 (25.7%) and 3 (8.6%) patients had stage IA, IB, IIA, IIC, and IIIA tumors, respectively. A transpalatal approach was employed in 11 cases (31.4%), a transmaxillary approach in 9 cases (25.7%), a transnasal approach in 6 cases (17.1%), and other approaches, (25.7%). The recurrence rate was, 5% in the stage I cases, 38% in the stage II cases, and 33% in the stage III cases. The transpalatal approach was followed by a high recurrence rate in the cases of stage II and higher stage. Several factors are critical when choosing the surgical approach to JNA: adequate exposure of the tumor, ability to control bleeding, prevention of postoperative facial deformity, and avoidance of interference with growth of the face.

Magnetic resonance imaging in the diagnosis of benign and malignant pelvic tumors

Magnetic resonance imaging (MRI) is an accepted imaging method for diagnosing diseases of the female pelvis. This review article describes the role of MR imaging for the diagnosis of benign and malignant pelvic tumors. Sagittal T2-weighted fast spin echo sequences can be effectively applied to diagnose leiomyomas of the uterus and provide exact pretreatment measurements of size and localization. In the diagnostic work-up of endometrial carcinoma, fat-saturated, T1-weighted gradient echo sequences make it possible to determine precisely how deep myometrial infiltration extends and what tissue should be included in preoperative treatment planning. In cervical cancer staging, MRI permits both assessment of local tumor extent and determination of tumor volume for planning and monitoring radiotherapy. The usefulness of MRI in cervical cancer staging is, however, limited since not all early-stage cancer (FIGO stage IA and small stage IB tumors) can be detected. Hence, it appears that the use of MRI as a screening method for cervical cancer cannot be recommended. MRI can distinguish between benign and malignant ovarian tumors with high sensitivity and specificity. Standard and fat-saturated T1-weighted sequences usually can diagnose teratomas with a specificity of 100 %. Axial fat-saturated, contrast enhanced T1-weighted spin echo sequences are useful in the staging of malignant ovarian tumors since they facilitate evaluation of their internal structure and will disclose peritoneal metastases. Besides staging of ovarian cancer, MRI can be applied for localization and for monitoring treatment response.

The bioenergetic signature of lung adenocarcinomas is a molecular marker of cancer diagnosis and prognosis.

The aim of this study was to investigate the mitochondrial bioenergetic signature of lung adenocarcinomas as a prognostic marker of cancer progression. For this purpose, a series of 90 lung adenocarcinomas and 10 uninvolved lung samples were examined for quantitative differences in protein expression using two-dimensional polyacrylamide gel electrophoresis. The beta subunit of the mitochondrial H(+)-ATP synthase (beta-F1-ATPase) and heat shock protein 60 (Hsp 60), and the glycolytic glyceraldehyde-3-phosphate dehydrogenase (GAPDH), used to define the bioenergetic cellular (BEC) index, were identified using mass spectrometry and specific antibodies. Correlations of the expression level of the protein markers and of the BEC index were established with the clinicopathological information of the tumors and the follow-up data of the patients. The expression of beta-F1-ATPase is significantly reduced in lung adenocarcinomas in the absence of significant changes in the expression of Hsp 60 and of a major GAPDH isoform. Cross-validation analysis using the beta-F1-ATPase/Hsp 60 ratio and GAPDH expression as predictor variables revealed a classification sensitivity of 97.3%. The beta-F1-ATPase/Hsp 60 ratio is significantly higher in well differentiated and bronchioloalveolar tumors than in moderate or poorly differentiated and in bronchial-derived tumors. The BEC index of T1 tumors was significantly higher than that of T2 tumors. Likewise, stage IA tumors had a higher BEC index than stage IB tumors. Kaplan-Meier survival analysis using the BEC index as predictor of survival revealed that within tumors of the same size or stage I or with no lymph node metastasis (N0) the patients bearing 'low' BEC index tumors had a significant worse prognosis. We conclude that the bioenergetic signature of lung adenocarcinomas is altered, further providing a relevant marker for the diagnosis and classification of lung adenocarcinomas, and for the prognosis of lung cancer patients.

Papillary squamous cell carcinoma of the uterine cervix: an immunophenotypic appraisal of 12 cases

Objective The objective was to evaluate the role of human papillomavirus (HPV) in the pathogenesis of papillary squamous cell carcinoma (PSCC) of the cervix and to determine cell proliferative activity and p53 abnormalities in these rare variants of cervical cancer. Methods Twelve examples of PSCC of the cervix were diagnosed between 1990 and 1999. Formalin-fixed paraffin sections of each tumor were stained by immunoperoxidase method using antibodies to p53 gene product (CM-10) and Ki-67 (MIB-1). In situ hybridization for HPV DNA (ENZO) was used to detect specific sequences of DNA shared by most types of genital HPV, followed by confirmatory PCR analysis. The nuclear staining for Ki-67 was graded as minimal (<10% of cells), moderate (between 10 and 50% of cells), and high (>50% of cells). Results Fifty-percent of the tumors showed presence of HPV DNA. Three tumors (25%) showed nuclear accumulation of p53. Moderate and high proliferative activity was observed in four and eight of tumors, respectively. Eight patients presented with stage IB1 tumor (67%), 3 with stage IA1 tumor (25%), and 1 with stage IIIA tumor (8%). Eleven patients (92%) were alive as of last contact with a mean follow-up of 34.2 months (range: 5 days to 84 months). Conclusion In this series of patient, PSCC of the uterine cervix had a low rate of HPV DNA in their genome and a low rate of p53 gene abnormality. These genotypic differences may explain the differences between the clinical behavior of PSCC and the common types of squamous cell carcinomas of the cervix.

Allograft reconstruction after resection of malignant tumors of the scapula.

The oncologic and functional outcomes of six patients who had scapular allograft reconstruction after scapulectomy for malignant tumors were reviewed. Five patients had Stage IIB and one patient had Stage IB tumors. Total scapulectomy was done in five patients, and partial scapulectomy (glenoid and neck) was done in one patient. Frozen glycerolized scapular allografts were implanted and fixed with plates and screws. The scapular muscles were reattached to the allograft. Tendon reconstruction to replace the excised muscles was done in two patients. The patients were followed up for an average of 3.8 years (range, 2-6 years). Cosmesis, elbow, and hand function were good in all patients. There were no infections, nonunions, or shoulder dislocations. One patient fractured the body of the allograft after a fall. One patient had local recurrence and had scapulectomy 5 years postoperatively. Two patients died 3 and 5 years postoperatively with lung metastases but with functioning grafts. The mean functional result using the Musculoskeletal Tumor Society functional score was 82 (range, 77-87). In this series, scapular allograft reconstruction restored cosmesis, shoulder stability, and function. Preservation or reconstruction of rotator cuff muscles is recommended.

Concurrent Cisplatin-based Chemotherapy plus Radiotherapy for Cervical Cancer – a Meta-analysis

Purpose : To evaluate the role of concurrent cisplatin plus radiotherapy in the treatment of cervical cancer.Methods : A systematic review of randomized trials of cisplatin administered concurrently with external beam radiotherapy versus radiotherapy without cisplatin for cervical cancer was combined with a meta-analysis of results abstracted from published reports of the trials.Results : Pooled survival rates from eight randomized trials that evaluated the role of cisplatin, alone or in combination with other chemotherapy agents, administered concurrently with external beam radiotherapy to patients with cervical cancer demonstrated a statistically significant effect in favour of cisplatin-based chemotherapy plus radiotherapy compared with radiotherapy without cisplatin (relative risk [RR] of death, 0.74; 95% confidence interval [CI], 0.64 to 0.86). The pooled RR of death among the six trials that enrolled only women with locally advanced cervical cancer was 0.78 (95% CI, 0.67 to 0.90). The pooled relative risk for the two trials in high-risk early-stage disease also demonstrated a statistically significant benefit for the addition of cisplatin-based chemotherapy to radiotherapy (RR=0.56; 95% CI, 0.41 to 0.77).Conclusion : This meta-analysis confirms that treatment with concurrent cisplatin-based chemotherapy plus radiotherapy improves overall survival over various controls in women with locally advanced cervical cancer, large stage IB tumours (prior to surgery) and high-risk early-stage disease (following surgery). The variation in control treatments and the quality of their delivery among the randomized trials makes interpretation difficult. Nonetheless, the meta-analysis supports the use of concurrent cisplatin with radical radiotherapy in the treatment of cervical cancer.

PAS-positive loops and networks as a prognostic indicator in cutaneous malignant melanoma.

Recently, microvascular channels, as detected by PAS histochemistry, were positively correlated with poor prognosis in uveal malignant melanoma. Since uveal melanomas are not penetrated by lymphatic vessels, while cutaneous melanomas are, the question arises as to whether these loops and networks are also of prognostic relevance in cutaneous melanoma. Histochemically and immunohistochemically detected loops and networks in 100 cases of cutaneous malignant melanoma were correlated with the occurrence of metastasis in a 10-year follow-up study. To detect these patterns, the significance of various methods (PAS reaction with/without nuclear counterstain, anti-laminin immunohistochemistry) was investigated. The presence of loops and networks was a highly significant prognostic marker (p<0.0001) for metastasis in cutaneous malignant melanoma. The presence of these patterns proved to have higher prognostic relevance for metastasis than Breslow's tumour thickness, especially for stage IB and stage IIA tumours (intermediate thickness/risk). PAS reaction without nuclear counterstain proved to be the best method to detect these patterns. Compared with the conventional staging of Breslow's tumour thickness, and especially so for stage IB and IIA melanomas, the determination of PAS-positive loops and networks in cutaneous malignant melanoma provides additional prognostic information.

Patellar tumors.

Pain in the anterior knee has become synonymous with patella chondromalacia. However, pain also is the first sign of a tumor of the patella. Tumors of the patella are rare, but they often are mistaken for other benign lesions. Benign tumors of the patella are more frequent than malignant tumors (73% versus 27%). The most common benign neoplasms are giant cell tumor and chondroblastoma. Margin of the lesion, cortical involvement, trabecular pattern, and type of the matrix are important features for a radiographic diagnosis. Bone scans, computed tomography scans, and magnetic resonance images are used for staging of the tumor before surgery. Curettage only should be considered for patients with Stage 1 or Stage 2 benign lesions. Patellectomy is indicated for patients with Stage 3 aggressive benign tumors and for patients with Stage IA malignant tumors. A patellectomy with excision of involved soft tissues is used in patients with Stage IB tumors, whereas in patients with Stage IIA tumors, an extensive patellectomy is indicated. In patients with Stage IIB tumors, an extraarticular resection of the knee is preferred when there is a small soft tissue involvement, but amputation is necessary when there is a large soft tissue mass.

Cervical tumor control evaluated with ICRU 38 reference volumes and integrated reference air kerma

Purpose: The purpose of this investigation was to evaluate the relationship of ICRU 38 reference volumes and integrated reference air kerma to primary cervical tumor control. Materials and methods: This retrospective study includes 1253 women with carcinoma of the uterine cervix treated with radiotherapy. Patients were treated from 1959 to 1993 at the Mallinckrodt Institute of Radiology. There were 39 women with stage Ia disease, 211 with stage Ib1, 88 with stage Ib2, 580 with stage 2, and 335 with stage 3 disease. Most patients with stage Ia disease were treated with low dose rate brachytherapy alone. All other patients were treated with external irradiation and low dose rate brachytherapy. External irradiation doses ranged from 8.2–63.8 Gy to the whole pelvis and an additional parametrial boost to deliver a total of 65–75 Gy to Point P depending on tumor stage. Low dose rate brachytherapy was delivered to the primary tumor with doses ranging from 40×10 4–60×10 4 Gy cm 2 (integrated reference air kerma; IRAK). Isodose reference volumes (60–160 Gy) and point A doses were determined for all patients. Tumor control was defined as control of the primary cervical cancer with or without failure at other pelvic or distant sites. Results: The mean 60 Gy volume was calculated to be 139.5 cm 3 for stage Ia, 200.4 cm 3 for stage Ib1, 270.9 cm 3 for stage Ib2, 235 cm 3 for stage 2, and 293.4 cm 3 for stage 3. No patient with stage Ia disease had a failure in the cervix. For stage Ib1 tumors the mean 60 Gy volume was 219.1 cm 3 for those who failed in the cervix and 199.9 cm 3 for those who did not fail ( P=0.73). For stage Ib2 tumors the mean 60 Gy volume was 354.4 cm 3 for those who failed and 260.2 cm 3 for those who did not fail ( P=0.004). The mean 60 Gy volume was 249.3 cm 3 for those with stage 2 disease who failed and 233.8 cm 3 for those who did not fail ( P=0.02). For patients with stage 3 cancer the mean 60 Gy volume was 321.6 cm 3 for those who failed and 287.3 cm 3 for those who did not fail ( P=0.20). Reference volumes from 70–160 Gy were not statistically different within each stage for those who failed in the cervix compared to those who did not fail. Cervical recurrences by clinical stage did not have statistically significant differences for mean IRAK except for stage II disease ( P=0.001). Conclusion: Analysis of the 60–160 Gy reference volumes and IRAK failed to demonstrate a consistent positive increasing correlation of these values to primary cervical tumor control.

Clinical Outcome of 38 Patients With Juxtacortical Osteosarcoma

Thirty-eight patients presented with previously untreated, predominantly low-grade juxtacortical osteosarcoma. There were 12 (32%) men and 26 (68%) women with a mean age of 28.9 years. The most common sites of tumor were the distal femur (n = 28) and proximal tibia (n = 5). Twenty-five patients presented with Stage IB tumors. Twelve had Stage IIB, which although it was predominantly low-grade, had an area of high grade tumor, so the tumors were considered dedifferentiated. One patient had Stage III tumor. All patients were alive at 6.75 years' average followup. Negative but close margins were achieved in all but two patients (range, 1-80 mm). Intramedullary extension was seen in 17 (44.7%) patients, and the adjacent cortex was involved in 27 (71.1%) patients. There was no statistically significant difference between tumor size, site, radiographic appearance, cortical or intramedullary extension, grade, resection margin, or pretreatment duration of symptoms and local recurrence. Intramedullary extension of tumor does not seem to increase the risk of metastatic disease. Dedifferentiation of predominantly low-grade juxtacortical osteosarcoma in not previously treated tumors is uncommon. Based on these data, close but negative margins may be adequate in achieving local disease control and preventing metastases in these patients.

Papillary squamous cell carcinoma of the uterine cervix: an immunophenotypic appraisal of 12 cases

Objectives: To evaluate the potential role of human papillomavirus (HPV) in the pathogenesis of papillary squamous cell carcinoma (PSCC) and to determine cell proliferative activity and p53 abnormalities in these rare variants of cervical cancer with the propensity for late recurrence, metastasis, and overall favorable prognosis.Methods: Twelve cases of PSCC were diagnosed between 1990 and 1998. Formalin-fixed paraffin sections of each tumor were stained by standard ABC immunoperoxidase method using antibodies to p53 gene product (CM-10) and Ki-67 (MIB-1). In situ hybridization and polymerase chain reaction for HPV common DNA (ENZO) was used to detect DNA shared by most genital HPV-16. The nuclear reactions for HPV and p53 were recorded as either negative or positive. Staining for Ki-67 was graded as minimal (<10% of cells), moderate (10–50%), and high (>50%).Results: The average age of the patients was 46. Eight patients presented with stage IB1 tumor (67%), three patients with stage IA1 tumor (25%), and one patient with stage IIIA tumor (8%). Three tumors (25%) showed nuclear accumulation of p53. Moderate and high proliferative activity was observed in four (33%) and eight (66%), respectively. No HPV DNA was detected by in situ hybridization, yet 50% were detected by polymerase chain reaction. Eleven patients (92%) were alive as of last contact with a mean follow-up of 15 months (range, 5 days–84 months).Conclusions: PSCCs of the uterine cervix are proliferatively active tumors. They differ from the usual squamous cell carcinomas by the low rate of HPV DNA incorporation into genome and p53 gene abnormality. These phenotypic and genotypic differences may explain the more benign clinical course of PSCC, compared with the typical cervical squamous cell carcinomas of the cervix.

Magnetic resonance imaging of cervical cancer in pregnancy

Zanetta G, Pellegrino A, Vanzulli A, Di Lelio A, Milani R, Mangioni C. Magnetic resonance imaging of cervical cancer in pregnancy. Int J Gynecol Cancer 1998; 8: 265–269. Six subjects with cervical cancer in pregnancy underwent magnetic resonance imaging (MRI) for the evaluation of the tumoral invasion. Three subjects with early stage IB tumors had no evidene of parametrial invasion or lymph nodal metastases. Two were followed until term and underwent cesarean section/radical hysterectomy. One subject underwent an excision of the tumor during pregnancy and delivered vaginally. Three subjects had locally advanced tumors with macroscopic lymph node metastases. Two of them received neoadjuvant chemotherapy followed by radical surgery, whereas one underwent radical hysterectomy after maturation of the pulmonary function of the fetus. Five of the subjects had an interval of more than two months between diagnosis and delivery and underwent a repeat MRI. In all but one subject a good correlation was observed between the staging based on the final MRI and the histopathological findings. All three subjects with a diagnosis of lymph node metastases at MRI had confirmed metastases at surgery. MRI allowed for tailored treatment planning. With a median follow-up of 42 months (range 23–57) from definitive treatment, four women are alive without tumor and one is alive with distant recurrence. Five infants were born without handicaps or malformations. One fetus died during pregnancy. MRI provides important information for the management of cervical cancer in pregnancy, either when an aggressive or an expectant policy is chosen. An expectant management, consisting of simple observation, of early cervical cancer does not seem to affect progression. Neoadjuvant chemotherapy in pregnancy deserves further investigation.