Adverse affects of paclitaxel and carboplatin combination chemotherapy in epithelial gynecologic cancer

OBJECTIVE

To evaluate the adverse affects of paclitaxel and carboplatin combination chemotherapy.

DESIGN

Descriptive cross sectional study

MATERIAL AND METHOD

Patients with epithelial cancer of the ovary, fallopian tube and peritoneum treated with paclitaxel and carboplatin combination chemotherapy at Chiang Mai University Hospital between August 2003 and August 2004.

RESULTS

Of 224 evaluable cycles in 63 patients treated with paclitaxel (175 mg/m2) and carboplatin (AUC 5), grade 3 and 4 neutropenia occurred in 37.1% or 41.3% of patients. 4.8% of patients experienced febrile neutropenia. Grade 3 and 4 leukopenia occurred in 8.6% of courses and 12.6% of patients. Grade 3 anemia occurred in 5.2% of courses and 9.5% of patients. Grade 3 thrombocytopenia occurred in 2.8% of courses and 9.6% of patients. The nonhematologic adverse affects were rare, however, some adverse events may be potentially life threatening.

CONCLUSION

Adverse affects of paclitaxel and carboplatin combination chemotherapy are acceptable and manageable in the majority of patients.

Clear-cell adenocarcinoma of the female genital tract: Presence of Hyaline stroma and tigroid background in various types of cytologic specimens

Hyaline basement membrane-like stromal material and tigroid background are distinctive cytologic features observed in Diff-Quik (DQ)- or Giemsa-stained smears of clear-cell adenocarcinoma (CCA) of the female genital tract. However, it is uncertain how often these features are present in different types of cytologic specimens, and which type of preparation is optimal for this diagnosis. We therefore reviewed the cytologic features of CCA in three types of specimens, including 15 scrape cytology specimens, 7 fine-needle aspiration (FNA) specimens, and 15 peritoneal cytology specimens, with emphasis on the features observed in DQ-stained smears. The cell morphology in scrape cytology specimens and FNA specimens was comparable, whereas in peritoneal cytology specimens, the cytoplasm was better preserved. Most tumor cells had fragile cytoplasm containing variable amounts of fine vacuoles, and round nuclei with distinct or prominent nucleoli. Hyaline stroma was present in 93% of scrape cytology specimens, 71% of FNA specimens, and 80% of peritoneal cytology specimens. Tigroid background was observed in 47% of scrape cytology specimens, 43% of FNA specimens, but in none of the peritoneal cytology specimens. Formation of a tigroid background may be prevented by the abundant fluid content in peritoneal cytology specimens. Hyaline stroma and tigroid background were uncommonly seen in scrape smears from other types of primary ovarian tumors, mainly juvenile granulosa cell tumor and yolk sac tumor. However, the additional presence of papillary structures allows CCA to be readily distinguished from these other tumors. We propose that scrape cytology offers the best approach for the intraoperative cytologic diagnosis of CCA.

Ruptured mature cystic teratomas mimicking advanced stage ovarian cancer: a report of 2 cases study

Spontaneous rupture of mature cystic teratoma is uncommon. Chronic rupture of teratomas may result in granulomatous peritonitis. In rare cases, the clinical presentation and the intraoperative findings may mimic those of advanced stage ovarian cancers. Two cases of ruptured mature cystic teratomas mimicking malignancy are reported in 50- and 53-year-old patients. Both presented with abdominal distension and weight loss. Elevation of serum CA-125 (233 unit/ml) was detected in one case. Intraoperatively, nodular thickening of the omentum with marked peritoneal adhesion was observed in both cases. Ascites of 1500 ml was present in one case. Pathologic examination in both cases showed ovarian mature cystic teratomas with peritoneal granulomatous inflammations response to the released tumor content. Both patients were followed for 44 and 12 months and were free of symptoms without additional treatment other than surgery. Intraoperative pathologic consultation can help confirm the benign diagnosis and unnecessary major operation for malignancy can be avoided.

A "See and Treat" approach for high grade squamous intraepithelial lesion on cervical cytology

OBJECTIVE

To examine the final histologic findings as well as to correlate colposcopic and histologic findings in patients who had a high-grade squamous intraepithelial lesion (HGSIL) on the Pap smear and underwent colposcopy followed by LEEP on the "See and Treat" basis without intervening colposcopically directed biopsy.

MATERIAL AND METHOD

The medical records of patients with HGSIL on cytology who underwent LEEP without prior cervical biopsy at Chiang Mai University Hospital over a 5-month period were reviewed. The authors summarized the final LEEP histologic results and correlated colposcopic and histologic findings in these patients.

RESULTS

Of 55 patients who had a see-and-treat LEEP, 53 patients (96%) had a high-grade intraepithelial lesion or higher. There were 11 patients (20%) who had invasive squamous cell carcinoma. Of 4 patients with a low-grade lesion on colposcopic examination, all had a high-grade lesion or higher on final histology. Forty-four patients (96%) with high-grade impression on colposcopy had high-grade or more severe lesion on the final histologic diagnosis.

CONCLUSION

For patients with a high-grade lesion on the Pap smear, LEEP according to the "See and Treat" approach appeared to be a reasonable alternative to conventional colposcopically directed biopsy, especially in low resource settings.

Role of prophylactic oophorectomy at the time of hysterectomy in ovarian cancer prevention in Thailand

AIM

To determine the impact of prophylactic oophorectomy on ovarian cancer prevention in Thai women by estimating the magnitude of reduction in ovarian cancer incidence in Thailand if the procedure was routinely offered.

METHODS

A database of 752 women with epithelial ovarian cancer treated at Chiang Mai University Hospital between January 1990 and December 2001 was reviewed in an attempt to identify those who had hysterectomy performed for indications other than ovarian and corpus cancer with conservation of one or both ovaries prior to diagnosis of ovarian cancer. Pertinent clinical and pathologic data of the women in this subset were further reviewed in detail.

RESULTS

Of 752 ovarian cancer patients, 13 (1.73%) had hysterectomy performed prior to the diagnosis of ovarian cancer with only one woman (0.13%) having had a hysterectomy at the age of 45 or above. The mean interval between the hysterectomy and the diagnosis of ovarian cancer was 9.9 years (range 2-25 years). Considering the rate of prior hysterectomy at age 45 or beyond of 0.13% and the annual national ovarian cancer incidence of 1252 cases, an estimated one to two cases of ovarian cancer could be prevented annually if prophylactic bilateral oophorectomy at the time of hysterectomy in a woman age 45 or beyond were routinely offered in Thailand.

CONCLUSION

Prophylactic oophorectomy at the time of hysterectomy in general Thai population as a preventive measure for subsequent ovarian cancer should not be recommended without complete knowledge of patients' socioeconomic background and propensity to comply with hormone replacement therapy regimens.

Comparison of oral versus intravenous ramosetron in prevention of acute cisplatin-induced emesis: a randomized controlled trial

OBJECTIVE

To compare the antiemetic efficacy of a single oral versus intravenous (i.v.) ramosetron, a new class of selective 5-HT3 receptor antagonists, in gynecologic cancer patients receiving high-dose cisplatin.

METHOD

Between February 2003 and July 2003, 109 patients with gynecologic cancer scheduled to receive single agent cisplatin chemotherapy at a dose of 75 mg/m2 were randomized to receive either 0.2 mg oral (51 cases) or 0.3 mg i.v. (58 cases) ramosetron 1 h and 30 min respectively before chemotherapy. Patients were evaluated for 24 h after chemotherapy. The number of nausea and vomiting including adverse events were recorded every 6 h.

RESULTS

51 and 58 patients received oral and i.v. ramosetron respectively. Both groups were similar regarding age, performance status, body mass index and diagnosis of gynecologic cancer. 95 per cent of cases were cervical cancer. Antiemetic effect was significantly higher in the oral group when compared with the i.v. group during the first 6 hours and during the period of 18 to 24 hours after administration of cisplatin chemotherapy. Overall in 24 h, patients receiving oral ramosetron experienced no emesis slightly higher than that of the i.v. group (55% and 36% respectively, p = 0.05). Adverse events were mild and transient and were not significantly different in both groups, except tiredness which was more frequent in the i.v. group.

CONCLUSION

Oral ramosetron at a dosage of 0.2 mg is as effective as 0.3 mg of intravenous ramosetron in prevention of acute emesis in patients receiving 75 mg/m2 of cisplatin chemotherapy.

A prospective randomized study comparing retroperitoneal drainage with no drainage and no peritonization following radical hysterectomy and pelvic lymphadenectomy for invasive cervical cancer

OBJECTIVE

To evaluate the postoperative morbidity and lymphocyst formation in invasive cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy (RHPL) with no drainage and no peritonization compared with retroperitoneal drainage and peritonization.

METHODS

Between July 1999 and May 2000, 100 patients with stage IA-IIA cervical cancer undergoing RHPL in Chiang Mai University Hospital were prospectively randomized to receive either no peritonization and no drainage (Group A = 48 cases) or retroperitoneal drainage and peritonization (Group B = 52 cases). Perioperative data and morbidity were recorded. Transabdominal and transvaginal sonography were performed at 4, 8 and 12 weeks postoperatively to detect lymphocyst formation.

RESULTS

Both groups were similar regarding age, size and gross appearance of tumor, tumor histology and stage. There was no difference between groups in respect of operative time, need for blood transfusion, intraoperative complications, hospital stay, number of nodes removed, nodal metastases, and need for adjuvant radiation and chemotherapy. Asymptomatic lymphocysts were sonographically detected at 4, 8 and 12 weeks postoperatively in 3 (6.8%), 2 (4.6%), and 3 (7.7%) of 44, 43, and 39 patients, respectively in Group A, whereas none was found in Group B (P = 0.2). No significant difference was found in term of postoperative morbidity in the two groups.

CONCLUSION

Routine retroperitoneal drainage and peritonization after RHPL for invasive cervical cancer can be safely omitted.

Well-differentiated villoglandular adenocarcinoma of the uterine cervix: cytomorphologic observation of five cases

We retrospectively examined the cytologic findings of well-differentiated villoglandular adenocarcinoma (VGA) treated in our hospital. Cervical smears of four cases and a touch preparation of another case of VGA formed the materials for the study. The cytologic features were correlated with the histomorphology of VGA. Architecturally, long slender papillae and cohesive branching epithelial sheets with smooth borders and a lack of feathery edge were observed. Crowding and overlapping of nuclei were noted. The nuclei were uniform, small, and round to oval-shaped, with evenly distributed granular chromatin. Nucleoli were absent or inconspicuous. Mitoses were occasionally seen in all but one case. As the features of VGA are distinctive, the diagnosis could be possible on cytological grounds. Examination of cervical smears would be helpful for an early diagnosis of VGA or to suggest the coexistence of other neoplastic components.

Cytology of small-cell carcinoma of the uterine cervix in serous effusion: a report on two cases

Cytologic features of 2 cases of small-cell carcinoma of the uterine cervix in the body fluid are described. Case 1 was a 34-yr-old woman with a stage IIA cervical tumor. Pleural effusion developed 6 mo after initial diagnosis. Case 2 was a 38-yr-old woman with a stage IB tumor. Ascites was detected 11 mo after hysterectomy. Histologically, both cervical tumors were indistinguishable from small-cell carcinoma of oat-cell type in the lungs or other sites. Cytologically, the tumor cells in the pleural effusion of case 1 had characteristic features of small-cell carcinoma, including nuclear molding. However, almost all tumor cells in the ascites of case 2 showed a single-cell pattern mimicking malignant lymphoma. Mitotic figures and karyorrhetic bodies were occasionally seen. Nuclear molding was rarely identified. Small-cell carcinoma should be included in the differential diagnosis of malignant effusions containing lymphoma-like cells.

Reasons for improper simple hysterectomy in patients with invasive cervical cancer in the northern region of Thailand

OBJECTIVE

To determine the reasons for improper simple hysterectomy in the presence of invasive cervical cancer.

METHODS

The medical records of 70 patients who had undergone simple hysterectomy in the presence of invasive cervical cancer and were referred to Chiang Mai University Hospital between January 1991 and December 1998 were reviewed.

RESULTS

Approximately half of the patients presented with abnormal vaginal bleeding. Failure to perform a Papanicolaou smear before the operation accounted for 35.4%. Normal pelvic examination in which no gross invasive tumor was observed accounted for 59%. The most common indications for inappropriate operation was cervical dysplasia. The reasons for inappropriate simple hysterectomy included lack of preoperative cervical cytology (22.8%), incomplete evaluation of cervical dysplasia or microinvasion on biopsy (21.4%), false-negative cervical cytology (18.6%), failure to perform an endocervical curettage following conization (8.6%), emergency hysterectomy (8.6%), failure to perform indicated conization (5.6%), errors in colposcopic examination (4.3%), incomplete evaluation of an abnormal cervical cytology (1.4%), failure to perform endocervical currettage following loop conization (1.4%), failure to review slide (1.4%), failure to check the pathology report (1.4%), failure to biopsy a gross cervical lesion, and skipped lesion in upper part of the endocervix (1.4%). One case of invasive disease was missed for unknown reason.

CONCLUSION

Most cases of inappropriate hysterectomy resulted from deviation from guideline for cervical cancer detection. Preoperative Papanicolaou smear and strict adherence to the well-established diagnostic protocol for patients with an abnormal smear are advised to prevent such occurrence.