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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This review discusses recent papers on endometrial carcinoma variants, immunohistochemical studies, and prognostic indicators. The aggressive nature of uterine papillary serous carcinoma is confirmed, even in the absence of myometrial or vascular invasion, with a comprehensive review of the histology, clinical presentation, and proposed treatment protocols. The possible etiologic role of radiation in the development of uterine papillary serous carcinoma is alluded to. The virulence of endometrial carcinomas with trophoblastic differentiation, endometrial carcinomas with a malignant giant cell component, and clear cell carcinomas of the endometrium is documented. A series of immunohistochemical studies is presented suggesting that uterine carcinosarcomas are metaplastic carcinomas derived from a common stem cell and that a shared histogenesis of endometrial stromal tumors and uterine mesoderm exists. Immunohistochemical techniques may clarify diagnostic problems of uterine tumors and their metastases and differentiate mucinous tumors of endometrium from endocervical origin. Staining of both carcinoembryonic antigen and ferritin in neoplastic endometria may be helpful in their differentiation from hyperplasias in curettage specimens. Significant prognosticators in endometrial carcinoma are depth of myometrial invasion and lymphovascular space involvement with greatest prognostic information provided by the depth of myometrial invasion above DNA index.
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PMID:Malignant endometrial pathology. 150 78

Fallopian tumor carcinoma and papillary serous carcinoma of the peritoneum are rare tumors that usually mimic advanced ovarian cancer. The current treatment for these tumors is similar to that for ovarian cancer with approximately an 80% response rate, but only a 20% 5-year survival. Uterine sarcomas are probably the most lethal of the gynecologic malignancies, with frequent recurrence and death despite apparent early diagnosis and aggressive therapy. Gestational trophoblastic tumors, on the other hand, are usually curable, even when widely metastatic disease is present. The clinical features, staging, and current treatment of each of these tumors is reviewed.
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PMID:Rare gynecologic malignancies. 165 1

A prospective, routine histologic assessment of the omentum during primary surgery was conducted on 84 women with stage I endometrial carcinoma between February 1986 and June 1989. The purpose of the study was to determine the true incidence of omental involvement in early endometrial cancer and to detect risk variables associated with such metastases. Omental metastases were found in 7 (8.3%) of 84 patients with stage I endometrial carcinoma. A majority of the metastases (five) consisted of microscopic disease. Factors statistically significantly associated with omental metastasis were adnexal spread, cul-de-sac implantation, papillary serous carcinoma, a positive retroperitoneal lymph node and grade 3 tumor. The study indicated that silent metastases to the omentum frequently are neglected clinically in patients with stage I endometrial carcinoma during primary surgery and that a routine omental biopsy should be part of the procedure. Furthermore, for patients with high-risk variables, a complete omentectomy ought to be considered.
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PMID:Stage I endometrial carcinoma. Role of omental biopsy and omentectomy. 177 22

Eleven women with Stages III and IV epithelial ovarian carcinomas were entered into a protocol consisting of concurrent whole abdominal radiotherapy and intraperitoneal cisplatin followed by additional intraperitoneal cisplatin. The entire abdomen received 20 Gy in 20 fractions with no renal or hepatic shielding. Intraperitoneal cisplatin dosage was 20 mg/m2 weekly during radiation and 90 mg/m2 monthly thereafter for an additional three courses. Patients with Stages IIIC and IV had a median survival of 18 months and a two-year actuarial survival of 32%. Primary failure sites were the abdomen, pleura, and lymph nodes. Acute toxicity during radiotherapy was comparable to patients treated with radiation alone. No chronic renal, hepatic, or enteric complications were observed. Although the protocol did not have substantial efficacy in advanced disease, its toxicity was moderate enough to consider its use in less advanced cancers with peritoneal metastases. In particular, the protocol can be considered for women with ovarian cancer with no gross residuum and for women with papillary serous carcinoma of the uterine corpus.
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PMID:The integration of whole abdominal radiotherapy and intraperitoneal cisplatin into the primary management of advanced ovarian carcinoma. 186 63

Ovarian carcinoma metastatic to the breast is uncommon. We report a rare occurrence of ovarian carcinoma that initially presented as a breast mass. Complete examination revealed bilateral ovarian tumors with widespread peritoneal and abdominal disease. One of the ovarian tumors was a papillary serous tumor of low malignant potential, and the other was a well-differentiated papillary serous carcinoma. Although the neoplasm within the breast resembled serous ovarian carcinoma with psammoma bodies, the initial presentation and the presence of an apparent intraductal component created a potential for its misdiagnosis as a primary breast carcinoma. Using DNA flow cytometry, we demonstrated the relationship between the breast, lymph node, and peritoneal metastases and the serous carcinoma, thereby supporting the histologic diagnoses.
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PMID:Well-differentiated serous ovarian carcinoma presenting as a breast mass: a case report and flow cytometric DNA study. 200 37

Reviewed are 37 patients with the diagnosis of uterine papillary serous carcinoma. Clinically, 19 patients presented as stage I, 9 as stage II, 1 as stage III, and 8 as stage IV. Four of 18 patients with clinical stage I disease who underwent surgery had pelvic metastases and five had disease spread beyond the pelvis. Three of nine clinical stage II patients had intraabdominal metastases. At least 50% myometrial invasion was found in 43% of the 30 hysterectomy specimens, and lymphatic invasion in the myometrium was demonstrated in 78% of the specimens. Each of the 15 patients with surgical stage I or II disease received local radiation therapy: 10 are alive and of these 9 are disease-free. Each of nine clinical stage II patients received intense radiation therapy and hysterectomy; seven are alive and of these four are disease free. The five-year survival for combined surgical stages I and II patients was 45%. The three-year survival for combined surgical stages III and IV was 11%. Thirteen patients have been treated with combination chemotherapy, 11 with cis-platinum-based combinations. Nine of these patients are dead; four are alive, with three of these having progressive disease.
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PMID:Uterine papillary serous carcinoma. 379 10

A case of metastatic uterine papillary serous carcinoma with a complete response to chemotherapy is reported. The patient presented with vaginal, pelvic, and lymph node metastases 11 months after primary surgical resection was performed. A complete response to cyclophosphamide, Adriamycin (doxorubicin), and cisplatin was achieved. In this histologic pattern of endometrial adenocarcinoma, which behaves clinically like epithelial ovarian cancer, combination chemotherapy can offer significant response and palliation.
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PMID:Uterine papillary serous carcinoma. Complete response to combination chemotherapy. 404 Apr 19

Thirty patients with uterine papillary serous carcinoma were treated with intravenous cisplatin, doxorubicin, and cyclophosphamide (CAP) chemotherapy, a combination with proven efficacy against ovarian carcinoma. Nineteen patients were given CAP as an adjuvant soon after surgery. Eleven patients were treated after recurrence or failure of other first-line therapy. Of the patients treated adjuvantly, 11 (58%) were alive without evidence of disease with a median follow-up of 24 months. Eight patients (42%), all with metastatic disease at diagnosis, were dead of disease (DOD) with a median survival of 14 months. In the salvage group, all patients were DOD with a median survival of 21 months from diagnosis and a median survival from initiation of CAP of 7 months. Toxicity was observed in all patients, and there was one treatment-related death from cardiotoxicity. In the salvage group there were two partial responses and one complete response (response rate = 27%). We conclude that intravenous CAP was ineffective in the treatment of metastatic or recurrent uterine papillary serious carcinoma, but deserves study as an adjuvant in patients without metastatic or with only microscopic extrauterine disease.
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PMID:Intravenous cisplatin, doxorubicin, and cyclophosphamide in the treatment of uterine papillary serous carcinoma (UPSC). 811 50

Since the wide acceptance of serous carcinoma as a distinct subtype of endometrial carcinoma, almost all endometrial carcinomas with psammoma bodies have been classified as such. We describe eight cases of endometrioid endometrial adenocarcinoma with psammoma bodies and discuss their clinicopathologic features. The patients ranged in age from 37 to 79 years. Psammoma bodies were present in the curettage material in three and in the hysterectomy specimens in all cases. The tumors were well to moderately differentiated with at least focal squamous metaplasia. Four of eight cases also showed a focal villoglandular architecture. Inflammation and necrosis were present in all cases, and four had features of pyometra. Deep myometrial invasion was present in six cases. Diffuse lymphatic invasion was present in six, and one showed perivascular lymphocytic infiltrate in the absence of myometrial invasion. The tumors metastasized to lymph nodes in four of eight cases. One case showed intranodal psammoma bodies in the absence of endosalpingiosis or tumor. Intra-abdominal recurrence was present in only one case and was endometrioid with rare psammoma bodies. All patients are alive, six with no evidence of disease, one with stable periaortic lymphadenopathy, and one with progressive disease. This report suggests that endometrioid endometrial carcinoma may rarely be associated with psammoma bodies, the formation of which is most likely due to inflammation and necrosis. It also suggests that endometrioid carcinoma with psammoma bodies has a higher surgical stage and is more likely to have lymphatic invasion and lymph-node metastases and hence require surgical staging. The pattern of spread appears to be different from uterine papillary serous carcinoma, and the rate of survival is similar to stage-matched endometrioid carcinoma without psammoma bodies.
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PMID:Endometrioid endometrial adenocarcinoma with psammoma bodies. 913 Sep 86

The clinical and pathologic features of 17 cases of papillary serous adenocarcinoma of the cervix (PSCC) were studied in women who ranged in age from 26 to 70 years. There was a bimodal age distribution, with one peak occurring before the age of 40 years and the second peak after the age of 65. The presenting symptoms were abnormal vaginal bleeding (11 patients), abnormal exfoliative cervical cytology (four patients), or watery vaginal discharge (two patients). On pelvic examination, eight patients had a polypoid or exophytic cervical mass and two patients had an ulcerated or indurated cervix; no abnormality was detected in seven patients. Two tumors were stage Ia, 12 were stage Ib, two were stage II, and one was stage III. Nine patients were treated by radical hysterectomy and one by simple hysterectomy; six of these patients received postoperative radiotherapy. The other patients received primary radiotherapy. On microscopic examination, all of the tumors had a complex papillary architecture with epithelial stratification and tufting. Six tumors were grade 2/3 and 11 were grade 3/3. All of the tumors had >10 mitotic figures per 10 high-power fields. An intense acute and chronic inflammatory infiltrate was typically present within the cores of the papillae and in areas of stromal invasion. Occasional psammoma bodies were present in three cases. Five of 12 tumors stained positively for p53, with six and nine of 12 tumors, respectively, immunoreactive for carcinoembryonic antigen and CA-125. Seven tumors were mixed with another histologic subtype of cervical adenocarcinoma, most commonly low-grade villoglandular adenocarcinoma. Fifteen patients were followed from 6 months to 11 years (mean 56 months). Six patients died of extensive metastases within 5 years of diagnosis; an additional patient experienced tumor recurrence with malignant ascites 2 years after diagnosis. The most common metastatic sites were pelvic and periaortic lymph nodes; other sites included cervical lymph nodes, lung, peritoneum, liver, and skin. Eight patients were alive without evidence of tumor at last follow-up. Age <65 years, stage >I, tumor size >2 cm, tumor invasion >10 mm, the presence of lymph node metastases, and elevation of serum CA-125 were associated with a poor prognosis. Tumor grade or composition (pure or mixed) did not correlate with patient outcome. Papillary serous adenocarcinoma of the cervix resembles microscopically its counterparts elsewhere in the female genital tract and peritoneum. The tumors can behave aggressively with supradiaphragmatic metastases and a rapidly fatal course when diagnosed at an advanced stage, but the outcome for patients with stage I tumors is similar to that of patients with cervical adenocarcinomas of the usual type.
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PMID:Papillary serous carcinoma of the uterine cervix: a clinicopathologic study of 17 cases. 942 24


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