[Prognosis value of p53, C-erB-2 and Ki67 proteins in ovarian carcinoma]

The prognosis in ovarian carcinoma remains poor. We need to identify patients who are less likely to respond to treatment. In order to evaluate the prognostic value of C-erb-B2, p53 and Ki 67 expression and correlate these markers with classic prognostic factors, we studied paraffin-embedded tumor tissue from 81 patients with epithelial ovarian cancer and made a quantitative evaluation of C-erb-B2, p53 and Ki 67 expression by immunohistochemistry. The results were: age 5.4 +/- 15(22-88); 66% with normal physical activity; 48.2% with residual disease < 2 cm; initial stage--42% and advanced stage--58%. Age, performance status, residual disease and stage were correlated with 2 and 5 years survival. Positive immunostaining: p53--87%, C-erb B-2--51% and Ki67--100%. P53 and C-erb B-2 were associated with residual disease and stage; patients with no C-erbB-2 staining had a significantly better survival. A direct and significant correlation was found between p53 and Ki67 and between C-erb B-2 and p53. We conclude that these markers have a high expression in ovarian carcinoma and p53 and C-er B-2 correlate with stage and residual disease. Although C-erb B-2 was associated with better survival, it was not found to be an independent prognostic factor.

[Factors of recurrence of intraepithelial lesions of the uterine cervix]

MATERIAL AND METHODS

A retrospective study (1994-1996) of 282 cases of intraepithelial lesions treated in the Gynecology Services of Coimbra University Hospitals and subsequent follow-up (9-45 months). The following parameters were evaluated as recurrence factors: the patient's age, lesion degree, associated HPV infection, treatment type, safety margin in the ablative treatments and interval free of illness.

RESULTS

Of the 282 cases, 72.4% (N = 204) corresponded to HSIL and 27.6% (N = 78) to LSIL. The patients' mean was 36.3 +/- 9.1 [19-67] years. The most commonly used treatment types were the LLETZ (large loop excision of the transformation zone) (76.9%) followed by CO2 LASER vaporization (16%) and finally cold-knife conization (7.1%). The safety margins were determined in 184 cases and, on average, were of 3.2 +/- 2.4 [1-10] mm. Forty-four recurrences occurred (15.6%) of which 75% corresponded to HSIL lesions (N = 33) and 25% (N = 11) to LSIL. From the total number of recurrences the association to HPV infection was found in 24 of the cases (54.5%) and 75% of these (N = 19) corresponded to HSIL. The average age in the recurrence group was 38.2 +/- 8.7 [21-53] years and 35.9 +/- 9.2 [19-67] years in the group without recurrences (p > 0.05). In the LSIL group treated with CO2 LASER (N = 32) the recurrence rate was 15.6% versus 13.3% in the group treated with LLETZ (N = 45). In the HSIL that were treated with CO2 LASER vaporization (N = 13) the recurrence rate was 23%; in those treated with LLETZ (N = 172) there were 16.2% recurrences and in the group submitted to cold-knife conization (N = 19) that rate was 10.5%.

CONCLUSIONS

The total rate of recurrence was 15.6% with the greatest incidence of lesions associated to HPV (p > 0.05). Regarding the particular case of the HSIL, a great number of recurrences with the destructive treatments (CO2 LASER) was observed when compared to the ablative treatments (cold-knife conization or LLETZ).

[Thoracic endometriosis]

Endometriosis was first described by Russel more than one-hundred years ago and still remains a clinical entity of difficult comprehension, with totally aberrant symptomatology, particularly in extra-genital situations. The present article describes a clinical case of recurring right-sided catamenial pneumothorax in a 45 year-old caucasian woman. In her last episode of right chest pain the X-ray film showed, besides the presence of a pneumothorax, a nodular image, later identified by CT scan as being a transdiaphragmatic hernia with hepatic content. The patient was then submitted to diagnostic and therapeutic thoracotomy and the diaphragmatic endometriosis was confirmed. Finally, a total hysterectomy with bilateral salpingo-ophorectomy was performed and the patient's condition remained uneventful with combined hormone therapy. The clinical presentation, pathogenesis, and therapeutic resolution of this nosological entity are briefly discussed.

[Wertheim-Meigs procedure. 10-year results]

Wertheim-Meigs hysterectomy is used in the treatment of cervical cancer, but since 1988 we have also used it to stage and treat endometrial carcinoma. To evaluate the morbidity of Wertheim Meigs hysterectomy as well as node invasion incidence and its correlation with other prognostic factors, the authors made a retrospective study of 112 patients, from October 1986 to March 1996. Among the 112 cases evaluated, 52% had cervical carcinoma and 48% had endometrial carcinoma; mean ages were 45 +/- 10 and 60 +/- 8 years (p < 0.005). FIGO stage distribution was: I-94.8 and 33.3%; II-5.2 and 51.9%; III-0 and 13%; IV-0 and 1.8%, for cervical and endometrial carcinoma. Hemorrhagic and traumatic accidents happened in 24.3% and 1.7% respectively. We had 15.5% early post operative complications and 1.7% late post operative ones. The mean duration of surgery and hospitalization was 163 +/- 29 minutes and 10 +/- 5 days. Pelvic lymphadenectomy was performed in 70% of patients and para-aortic nodes were also excised in the other 30%. The mean number of lymphatic nodes excised were 17 +/- 9. Pelvic node invasion was found in 9% and in 3.7% of para-aortic ones. When we studied endometrial cancer, we found a positive correlation between external myometrium invasion and lymphovascular invasion and positive node (p < 0.05). From the data available we may conclude that the complication rate of Wertheim Meigs is quite important, even though all but one complication were transitory. It may be possible to make a better selection of patients who need this surgical procedure by correct evaluation of risk factors.