Primary malignant melanoma of the vagina: long-term remission following radiation therapy

OBJECTIVE

To describe the characteristics and clinical course of patients with primary vaginal melanoma treated at three large Austrian institutions.

METHODS

The medical records of 14 patients treated at the Departments of Obstetrics and Gynecology of the Universities of Graz and Vienna and the Salzburg Women's Hospital between 1982 and 1996 were reviewed.

RESULTS

The median age at diagnosis was 73 years. Presenting symptoms included vaginal bleeding in all patients. Three of seven patients (43%) with tumors < or = 3 cm survived longer than 5 years compared to none of seven patients with a tumor size > 3 cm. Three of nine patients (33%) who received radiotherapy either in addition to surgical excision or as primary treatment, survived for 5 years. Other potential prognostic factors such as age, location, FIGO stage, depth of invasion, Chung level, histology, cell type, mitotic count, vessel involvement, ulceration, p53 accumulation, type of surgery, type of radiotherapy, or chemotherapy did not seem to correlate with the patients' outcome. The median overall survival was 10 months (range 1-153). The 5-year disease-free and overall survival rates were 14 and 21%, respectively. All three long-term survivors recurred locally.

CONCLUSION

All three patients who had long-term survival had lesions < or = 3 cm and received either primary radiotherapy (n = 2) or adjuvant radiotherapy after complete excision of the primary lesion (n = 1). In view of the poor overall survival rates, regardless of treatment, radiotherapy may be a limited valuable alternative or adjunct to surgery in patients with primary malignant melanoma of the vagina < or = 3 cm in diameter.

A case of parathyroid carcinoma visualized on Tc-99m-sestamibi scintigraphy

Recent studies indicate that Tc-99m-Sestamibi (MIBI, DuPont Pharma) is a useful tracer for detecting parathyroid adenomas. We present a patient with focal Tc-99m-MIBI uptake in parathyroid carcinoma which has only been described once before (1). Tc-99m-MIBI scintigraphy may be considered for diagnosing pathological parathyroid tissue. But presently the histopathological examination only allows the differentiation between adenoma and carcinoma.

Bradydysrhythmia-related presyncope secondary to pheochromocytoma

Pheochromocytoma endures as a life-threatening disorder. In the absence of systemic hypertension, diagnosis may be difficult. We present a 46-year-old normotensive male with a history of presyncope. One of these episodes could be documented, and revealed symptomatic bradycardia suspicious of sinus node arrest. Due to hints of an elevated sympathetic tone (Schellong test, circadian blood pressure pattern without diurnal rhythm) 24-h urinary catecholamine concentrations were measured and found increased. MIBG-scintigraphy and abdominal-computed tomography indicated the location of the pheochromocytoma. After removal of the tumour, no further episodes of presyncopes or bradydysrhythmias were observed.

Ossifying fibromyxoid tumor misdiagnosed as follicular neoplasia. A case report

BACKGROUND

Fine needle aspiration of an ossifying fibromyxoid tumor (OFMT) at a prethyroidal location is initially misinterpreted as follicular neoplasia. Though the histopathologic criteria have been analyzed in detail, no experience with the cytologic features of OFMT is reported in the literature.

CASE

A 50-year-old male presented clinically with a recurrent goiter. Aspiration cytology (Giemsa stained) was characterized by a predominant fine fibrillary, pink matrix and moderate cellularity. The nuclei were eccentrically located, round to oval and slightly plemorphic, with fine chromatin. Focally, mild nuclear crowding and a few rosettelike structures were present.

CONCLUSION

The cytologic features were consistent with a soft tissue tumor of probably neurogenic origin, like OFMT. Differential diagnosis in this particular location not only included follicular thyroid neoplasms but also neurofibroma, neuroma, chondroma and, less likely, neuroepithelial tumors. However, since some diagnostic criteria of OFMT, like the nodular growth pattern and mature bone, can be found only histologically, the diagnostic value of aspiration cytology seems to be limited.

[Vaginal ultrasound in perityphlitic abscess]

A 21 year-old woman presented with an encapsulated mass involving the right ovary, tube and caecum. On transvaginal sonography a 15 mm-target structure was surrounded by irregular, echo-poor formations suggestive of an inflamed appendix and a perityphlitic abscess. Transvaginal sonography is of diagnostic value in differentiating an appendiceal abscess from a right-sided tubo-ovarian abscess.

[Diagnostic value of combined vaginal ultrasound and hysteroscopy in peri- and postmenopausal bleeding]

OBJECTIVE

Is it possible to reduce the rate of curettages by using ultrasound and hysteroscopy?

METHODS

Transvaginal sonography, hysteroscopy, and dilation and curettage were performed in 103 patients with menometrorrhagia or postmenopausal bleeding. The patients were divided into three groups, depending on the ultrasound findings.

RESULTS

All 9 cases with cancer of the endometrium were found in group 3. 1 of the 9 carcinomas was not detected by hysteroscopy.

CONCLUSIONS

We believe that dilation and curettage is necessary in symptomatic women with an endometrial thickness < 4 as well as > 4 mm. Prospective studies have to clear the question of whether endometrial carcinomas can be detected by hysteroscopy in cases with an endometrium < 4 mm thick.

[Non-granulomatous prostatitis: MRI image with endorectal surface coil ("Endo-MRI")]

Inflammatory conditions of the prostate are often difficult to distinguish from early stages of prostate cancer with imaging techniques. The use of an endorectal surface coil in MRI of the prostate gland has been reported to provide superior resolution and better imaging of details than MRI with a body coil in the diagnosis of early prostate cancer. We report a 34-year-old patient with nonspecific non-granulomatous prostatitis in whom T2-weighted endorectal surface coil magnetic resonance imaging (ESCMRI) showed a region of markedly decreased signal intensity in the periphery of the gland. The low signal intensity of the lesion, its sharp demarcation from the normal part of the peripheral zone of the prostate and the marked bulge of the surface contour without capsular breach of the organ were interpreted as evidence of a bioptically proven benign inflammatory condition.

The impact of geographical, clinical, dietary and radiation-induced features in epidemiology of thyroid cancer

Cancer of the thyroid accounts for less than 1% of all cancers recognised each year, but the incidence is rising. Much of the early work of the epidemiology and aetiology of thyroid cancer was based on the assumption that thyroid cancer can be treated as an entity. The recognition that two distinct types of endocrine cell occur within the thyroid has made it clear that any discussion of the aetiology and epidemiology of thyroid malignancies must take into account the histological classification of these tumours. Moreover, there are difficult problems to be considered when comparing thyroid cancer incidence across tumour registries, because of a lack of standardisation or morbidity data collection, difficulties in histological diagnosis, varying rates of diagnosis of occult papillary carcinoma, and prevalence and techniques of autopsies. So far only a relatively small proportion of thyroid cancer cases can be explained with adequate certainty as regards epidemiology and aetiology. As in cancer in general, the aetiology and epidemiology of thyroid cancer in detail remains unknown in the majority of cases.

[Synovial recesses and bursae of the lumbosacral joint]

There are four types of cavities of the lumbosacral joints. Type A: The synovial membrane is all around attached to the margin of the articular facet of the superior articular process of the sacrum. Type B: The synovial membrane extends to the posterior surface of the sacrum forming a recess at the root of the superior articular process; this recess communicates widely with the cavity of the joint. Type C: The synovial membrane also forms a recess similar to that of type B, but the gap of communication is narrowed by a fibro-adipose meniscoid. Type D: The synovial membrane is attached in the same way as described in type A; besides a synovial bursa non communicating with the cavity is found at the root of the superior articular process. We have found 43% showing type A, 33% type B, 16% type C and 8% type D. The recesses and bursae described above enable the inferior articular process of the fifth lumbar vertebra to slide at the posterior surface of the sacrum, thus avoiding a painful rubbing during dorsiflexion of the lumbar spine. The existence of these sliding facilities does not depend on the range of the lumbosacral angle nor on the quality of the lumbosacral intervertebral disc.

Pituitary hyperplasia after goserelin (LHRH-analogue) therapy

A 78-year-old male was treated with goserelin (Zoladex) for 16 months for metastasizing prostate carcinoma. This therapy is clinically equivalent to orchidectomy, as the application of the luteinizing hormone-releasing hormone (LHRH)-analogue Zoladex causes suppression of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) by down-regulation of pituitary receptors. Consequently, testicular androgen production is inhibited and testosterone levels are decreased to castration levels. In the present case we found diffuse, partially nodular hyperplasia of growth hormone (GH) and adrenocorticotropin (ACTH) producing cells in the anterior pituitary gland at autopsy. As Zoladex reduces pituitary receptors for releasing hormones (RH), a globally increased hypothalamic secretion of RH might be responsible for the ACTH- and the GH-cell hyperplasia. We cannot exclude that Zoladex may cause not only adenomas in rat pituitary glands as reported previously, but also a (nodular) hyperplasia of the pituitary gland in man.

[Anatomy of the anterior serratus flap]

The vascular territory of the serratus anterior muscle was investigated by injection studies in cadavers. The overlying skin and the ribs were stained only partially. The skin gets its blood supply by so called rami cutanei laterales originating from the intercostal system. The serratus fascia and the muscle can be transplanted safely on its pedicle, the thorakodorsal vessels. The main indication are the muscle transplantation for reconstruction of facial paralysis and as gliding tissue.

[Presence of islands of fatty tissue in struma]

We examined 929 surgically obtained thyroid glands derived from 791 female and 138 male patients and found intrathyroidal adipose tissue in 18 cases (1.94%). Only the thyroid glands of middle aged and older women (mean age 51 years) were affected, as well as in the case of follicular adenomas and nodular and diffuse hyperplasia. With respect to localization in the interstitial connective tissue, as well as between thyroid follicles, interstitial, parenchymatous and mixed types are proposed. In addition to sex and age there is a high correlation with obesity, which is suggestive of hormonal influences. Knowledge of the presence of intrathyroidal fat tissue is of interest to the pathologist since it may lead to erroneous interpretations of histological and cytological specimens of the thyroid gland. In conclusion, not one case of hypothyroidism was detected amongst the 18 cases investigated in this study.

Isolation and characterization of factors from wheat germ that exhibit eukaryotic initiation factor 4B activity and overcome 7-methylguanosine 5'-triphosphate inhibition of polypeptide synthesis

Three highly purified preparations (preparations I, II-1, and II-2) have been obtained from wheat germ and shown to support in vitro polypeptide synthesis directed by capped or uncapped mRNAs in a eukaryotic initiation factor 4B (eIF-4B)-deficient system. The three preparations differ, however, in polypeptide composition and in the ability to overcome the inhibitory effect of 7-methylguanosine 5'-triphosphate (m7GTP) on in vitro polypeptide synthesis. Preparation I contains two polypeptides (Mr = 80,000 and 28,000), which are present in a 1:1 molar ratio and are associated in a high molecular weight complex. Preparation II-1 contains two major polypeptides (Mr = 220,000 and 26,000) and preparation II-2 also contains two major polypeptides (Mr = 110,000 and 26,000). Preparations II-1 and II-2 are high molecular weight complexes; neither contains detectable amounts of a Mr 80,000 or a Mr 50,000 component. Preparations II-1 and II-2 both overcome m7GTP inhibition, whereas preparation I does not. These findings raise several questions with regard to the identity of eIF-4B and its relationship to cap recognition factors.

The signal peptide of pro-opiomelancortin: validation of a specific radioimmunoassay

The N-terminus portion of the POMC leader sequence (signal peptide) was synthesized, and an antiserum was raised against it. A radioimmunoassay was developed which is effective at a dilution of 1:500,000, and sensitive at less than 1 fmole/tube. Since leader sequences often exhibit structural homologies, and since synthetic peptides are not readily available, we resorted to an unusual procedure to establish specificity. This involved extraction of pituitary RNA, cell-free translation to produce the pre-prohormones, and purification by B-END and signal antibody affinity columns. The eluates were then tested by SDS gel electrophoresis and by multiple immunoprecipitations. All results showed that the signal antibody captured a single molecular species, approximately 30,000 in MW, which was also captured by the B-END column, and was immunoprecipitable by B-END and ACTH antisera. It therefore appears that this antibody selectively measures the POMC leader sequence and should be valuable in measuring the newly synthesized pre-prohormone.