SOCIETY OF GYNECOLOGIC
residual ovarian cancer following first-line chemotherapy. Morbidity is significant, though acceptable, in view of the lack of other effective therapy. Gland Atypia and Viral Infections of the Endocervix. JOSEPH BUSCEMA, M.D., Department of Obstetrics/Gynecology, Johns Hopkins Hospital, Baltimore, Maryland 21205.
Evidence for human papilloma virus (HPV) infection is sought in cases previously identified as endocervical atypia and “adenocarcinoma in situ” (AIS). Ninety cases diagnosed as endocervical atypia or AIS were histologically reviewed and classified into three categories: (a) early invasive adenocarcinoma; (b) atypical mucus-secreting epithelium; and (c) alterations attributed to HPV infection. The first group (endocervical atypia or AIS) contained 17 patients (18.9%); the second (early invasive carcinoma) comprised I1 patients (12.2%); and the third group (changes attributed to HPV) consisted of 62 patients (68.9%). Histologic features which classified this latter subset included prominent nuclear alterations, including hyperchromatic nuclei, “smudged” nuclei with loss of nuclear detail, matranuclear inclusion bodies, and multinucleation. Similar histologic alterations have been identified in stratified epithelium in the female genital tract in association with HPV. Immunohistochemical staining techniques (peroxidase-antiperoxidase) (PAP) were employed in selected cases. These techniques demonstrated the presence of HPV in epithelium previously classified on H&E staining as having features of viral infection. In summary, a role for HPV infection in the genesis of endocervical atypia is elucidated. Alterations seen in association with HPV in stratified epithelium in the female genital tract are identified in the endocervix. Immunohistochemical confirmation of HPV is also rendered. 13. Nutritional Status of Patients with Cervix Cancer. JAMESW. ORR, JR., M.D., KATHLEEN WILSON, R.D., CYNTHIA BODIFORD, R.D., ANNIE CORNWELL, R.D., KATHRYN L. HONEA, M.D., KENNETH D. HATCH., M.D., AND HUGH M. SHINGLETON, M.D., Department of Obstetrics/Gynecology,
University of Alabama, Birmingham, Alabama 35294. The incidence and impact of nutritional deficiencies as they relate to the etiology of cancer, and the risk of treatment complications in women with gynecologic cancer, is undetermined. In an attempt to determine the frequency of nutritional deficiencies and the effects of treatment, 78 patients (median age: 49 years) with newly diagnosed cervix cancer (Stage I: 47 patients) were prospectively evaluated. Prior to treatment, anthropometric measurement of triceps skinfold (x = 22.8 ? 9.4 mm), midarm muscle circumference (x = 23.1 + 3.4 cm), and weight/height ratio (x = 127.9 ? 29.9) were performed. Biochemical evaluation included serum albumin (x = 3.8 + 0.6 g/dl), total iron binding capacity (x = 3.8 2 0.6 g/dl), serum zinc (x = 84.3 r I6 pg/dl), serum copper (x = 160 2 40 pg/dl), and total lymphocyte count (x = 2200 t 250/mm”). Pretreatment determination of vitamin levels included plasma folate (x = 4.4 * 2.8 rig/ml); red blood cell folate (x = 252 ? 107 rig/ml), vitamin A (x = 46.4 2 13.4 pg%), Bu (x = 427 2 214 pgiml), C (x = 0.53 2 0.3 mg%), p-carotene (x = 101 2 58 pg%), riboflavin (x = 1.3 ? 0.2) thiamine (x = I.1 + 0.1). and vitamin B, (x = I.6 ? 0.3). Abnormally low values (less than 1 SD) of anthropometric measurements were present in 10 to 15% of women. Serum biochemical studies were abnormal in I3 to 30% of patients. Individual serum vitamin levels were abnormal in 4 to 31% of patients screened. Evidence of protein calorie malnutrition (marasmus, kwashiorbor) was present in 13% of patients. These deficiencies were stage and age related. In 40 patients treated surgically, repeat assessment at 5 days indicated a significant decrease in some anthropometric measurements (triceps skinfold, midarm muscle circumference) as well as biochemical analysis (total iron binding capacity, albumin, vitamin A, p-carotene). This information suggests that a significant number of women with untreated cervix cancer have measurable nutritional deficiencies. Additionally, treatment can accentuate these abnormalities. 14. Wound Healing Study. BYRON J. MASTERSON, M.D., DAVID SOWA, B.S., AND NANCY NEALON, M.D., Department of Obstetrics and Gynecology, University of Louisville School of Medicine, Louisville, Kentucky 40292. This comparative study assessed tissue response to injury and heat-induced necrosis caused by the electrosurgical scalpel (ESU), the hemostatic Shaw scalpel, the CO? laser, and a standard cold
SOCIETY OF GYNECOLOGIC
scalpel and its effect on wound healing. A serial evaluation of cutaneous incisions in pigs was made at Postincisional Days 1, 4, 7, 14, and 22. Microscopic studies of biopsy specimens evaluated completion of epithelial migration, average residual scar widths, and zone of thermal necrosis. A tensiometric study assessed “wound breaking strength.” Analysis of the histologic preparations revealed consistent differences at any time period. The average residual scar width was least with the standard cold scalpel. The scar was greater in increasing order for the Shaw, the ESU, and the CO2 laser for each time period. Completion of epithelial migration occurred during Day 1 for the standard cold scalpel, between Days 1 and 4 for the Shaw scalpel, and between Days 4 and 7 for the ESU and CO2 laser. The lateral thermal necrotic zone was absent for the standard cold scalpel and evident with increasing density for the Shaw scalpel, ESU, and CO, laser, respectively. The tensiometric evaluation revealed no significant differences (P > 0.05) for the first 7 days of wound healing, regardless of the incisional instrument. The standard cold scalpel had significantly (P < 0.01) more breaking strength on Day 14 than all other incisional instruments. At Day 22, a highly significant difference (P < 0.001) existed between the standard cold scalpel and both the ESU and the Shaw scalpel. Thermal injury, induced to varying degrees by the thermal knives, clearly delays the wound healing process. of Bulky, Barrel-Shaped Stage IB Carcinoma of the Uterine Cervix with Irradiation Alone or in Combination with Surgery. HOLLY GALLION, M.D., J. R. VAN NAGELL, JR., M.D., E. S. DONALDSON, M.D., M. B. HANSON, M.D., E. J. PAVLIK, PH.D., J. YONEDA, M.D., AND Y. MARUYAMA, M.D., Department of Obstetrics and Gynecology, University of Kentucky Medical
Center, 800 Rose Street, Lexington, Kentucky 40536. The therapy of all patients with bulky (>4 cm diameter), barrel-shaped stage IB carcinoma of the cervix treated at the University of Kentucky Medical Center between 1962 and 1980 was reviewed. Seventy-five patients were followed for a minimum of 24 months after completion of therapy (mean 53 months), and none were lost to follow-up. The mean age of patients was 47 years (range 25 to 68 years). All patients received a combination of approximately 4000 rad whole pelvis radiation followed by an additional 1000 rad to the pelvic sidewalls. Intracavitary therapy delivering an additional 2000 rad to point A was then given. Thirty-two patients were treated with radiation alone and 43 patients received radiation followed by extrafascial hysterectomy. Recurrence was noted in 15 of 32 patients (47%) treated by radiation alone versus 7 of 43 (16%) in patients treated by radiation and extrafascial hysterectomy (P < 0.05). In patients treated by radiation therapy alone, there were 6 pelvic recurrences, 4 recurrences in both pelvic and extrapelvic sites, and 5 extrapelvic recurrences. Of the 7 patients who developed recurrent disease after combination therapy, there was only one isolated pelvic recurrence. There were no major operative complications in patients treated with radiation and surgery. In the group treated with combined therapy, those patients with microscopic residual tumor in the hysterectomy specimen had a recurrence rate of 36% (5/14) as opposed to only 7% (2/29) in those patients whose specimens were negative for residual disease. Analysis of these data suggests that the addition of extrafascial hysterectomy to radiation therapy is beneficial in the treatment of patients with stage IB bulky, barrel-shaped cervical cancer.
Recurrence Treatment method Radiation Radiation and extrafascial hysterectomy
Pelvic and Extrapelvic
Recurrence rate significantly (P < 0.05) reduced in patients treated by combination therapy.