Current management of stage I adenocarcinoma of the endometrium.

OBJECTIVE: This study was undertaken to assess the current management and outcome of patients with stage I adenocarcinoma of the endometrium. METHODS: One hundred thirty-five patients with stage I adenocarcinoma of the endometrium were treated with hysterectomy, bilateral salpingo-oophorectomy, and surgical staging. Patients were then stratified into high risk or low risk groups based on grade, depth of myometrial invasion, and the presence or absence of lymph-vascular space invasion. Postoperative treatment was then individualized based on risk assessment. RESULTS: Sixteen of 135 patients (12%) underwent postoperative adjuvant pelvic radiation. The remaining patients were treated with observation following surgery. Actuarial survival at three years was 97%. CONCLUSIONS: Surgical staging of endometria cancer provides critical information with regard to the extent of cancer and prognosis. When cancer is confined to the uterine corpus, histopathologic findings can be used to assess individual patient risk; high risk patients may then be selected for postoperative radiation. Relatively few patients will require adjuvant treatment and overall survival appears excellent

Lymphoceles following second-look laparotomy for ovarian cancer

In patients treated for ovarian cancer it is crucial to distinguish recurrent malignancy from a benign process. Presented herein is a patient who developed bilateral pelvic lymphoceles following a second-look laparotomy for ovarian cancer. Indications for surgical intervention are discussed and the preferred surgical approach is outlined.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27389/1/0000420.pd

Pelvic irradiation for stage II ovarian carcinoma

Over a 20-year period, 34 patients with FIGO stage II ovarian carcinoma were treated with postoperative pelvic irradiation at the University of Michigan. Complications of radiation treatment were minimal. The overall actuarial disease-free 5-year survival was 53%. This was not significantly different for substages IIA, IIB, or IIC. Patients with well-differentiated tumors had a significantly better survival than patients with moderate or poorly differentiated tumors (P < 0.05). The implications for managing stage II ovarian carcinoma are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27444/1/0000484.pd

Stage IB carcinoma of the cervix with lymph node metastases

From January 1, 1946, through January 1, 1986, at the University of Michigan, 60 patients were treated with Stage IB (FIGO) carcinoma of the cervix with lymph node metastases. Clinical variables were examined with regard to long-term survival. Prognostically significant variables were (1) highest level of lymph node involvement and (2) tumor histology. Patients with common iliac or periaortic node involvement had an actuarial survival at 5 years of 14%; 5-year survival for patients with only pelvic node involvement (external iliac, hypogastric, or obturator) was 68%. Patients with adenocarcinoma or adenosquamous histology had an actuarial survival at 5 years of 16%; 5-year survival for patient with squamous cell carcinoma was 71%. Overall survival for all patients with lymph node involvement was 61%. For patients undergoing radical hysterectomy as primary treatment, postoperative adjuvant radiotherapy did not significantly improve survival.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27087/1/0000078.pd

Squamous cell carcinoma of the vulva in a patient with androgen insensitivity syndrome

The first case of squamous cell carcinoma of the vulva in a patient with androgen insensitivity syndrome is described.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28491/1/0000287.pd

Clinicopathologic features of ovarian mixed mesodermal tumors and carcinosarcomas

Over a 27-year period there were 15 patients treated at the University of Michigan Medical center for carcinosarcomas or mixed mesodermal tumors of the ovary. Overall median survival was 11 months. Median survival was 4 months in patients with carcinosarcomas and 13 months in patients with mixed mesodermal tumors (P = 0.066). Patients with a chondrosarcomatous element had a significantly longer median survival than patients with mixed mesodermal tumors lacking cartilaginous differentiation (P = 0.031). The presence of a rhabdomyosarcomatous element did not affect survival. The size of the primary tumor, presence of ascites, FIGO stage, and degree of initial resection (optimal versus suboptimal) did not affect survival. There was no difference in survival between patients receiving postoperative chemotherapy and patients undergoing postoperative irradiation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28069/1/0000512.pd

Continuous infusion of low-dose 5-fluorouracil and radiation therapy for poor-prognosis squamous cell carcinoma of the uterine cervix

Ten patients with squamous cell carcinoma of the cervix metastatic to periaortic lymph nodes were treated with external-beam radiation therapy and synchronous infusion of intravenous 5-fluorouracil (5-FU) chemotherapy at doses of 350 mg/m2/day. The overall response rate was 90% with four complete responses (CR) and five partial responses (PR). The median duration of response was 11.8 months for CRs and 3.6 months for PRs. Toxicity was tolerable, with gastrointestinal symptoms and myelosuppression being noted most frequently. No patient experienced life-threatening toxicity. Median survival was 7.6 months, with only one patient being alive and free of disease at 2 years. In this pilot study we were unable to demonstrate a beneficial effect of continuous infusion of low doses of 5-FU chemotherapy concurrent with radiation therapy when compared to conventional radiotherapy in patients with advanced squamous cell carcinoma of the cervix.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30181/1/0000566.pd

The ASTRO-H X-ray Observatory

The joint JAXA/NASA ASTRO-H mission is the sixth in a series of highly successful X-ray missions initiated by the Institute of Space and Astronautical Science (ISAS). ASTRO-H will investigate the physics of the high-energy universe via a suite of four instruments, covering a very wide energy range, from 0.3 keV to 600 keV. These instruments include a high-resolution, high-throughput spectrometer sensitive over 0.3-2 keV with high spectral resolution of Delta E < 7 eV, enabled by a micro-calorimeter array located in the focal plane of thin-foil X-ray optics; hard X-ray imaging spectrometers covering 5-80 keV, located in the focal plane of multilayer-coated, focusing hard X-ray mirrors; a wide-field imaging spectrometer sensitive over 0.4-12 keV, with an X-ray CCD camera in the focal plane of a soft X-ray telescope; and a non-focusing Compton-camera type soft gamma-ray detector, sensitive in the 40-600 keV band. The simultaneous broad bandpass, coupled with high spectral resolution, will enable the pursuit of a wide variety of important science themes.Comment: 22 pages, 17 figures, Proceedings of the SPIE Astronomical Instrumentation "Space Telescopes and Instrumentation 2012: Ultraviolet to Gamma Ray

The Quiescent Intracluster Medium in the Core of the Perseus Cluster

Clusters of galaxies are the most massive gravitationally-bound objects in the Universe and are still forming. They are thus important probes of cosmological parameters and a host of astrophysical processes. Knowledge of the dynamics of the pervasive hot gas, which dominates in mass over stars in a cluster, is a crucial missing ingredient. It can enable new insights into mechanical energy injection by the central supermassive black hole and the use of hydrostatic equilibrium for the determination of cluster masses. X-rays from the core of the Perseus cluster are emitted by the 50 million K diffuse hot plasma filling its gravitational potential well. The Active Galactic Nucleus of the central galaxy NGC1275 is pumping jetted energy into the surrounding intracluster medium, creating buoyant bubbles filled with relativistic plasma. These likely induce motions in the intracluster medium and heat the inner gas preventing runaway radiative cooling; a process known as Active Galactic Nucleus Feedback. Here we report on Hitomi X-ray observations of the Perseus cluster core, which reveal a remarkably quiescent atmosphere where the gas has a line-of-sight velocity dispersion of 164+/-10 km/s in a region 30-60 kpc from the central nucleus. A gradient in the line-of-sight velocity of 150+/-70 km/s is found across the 60 kpc image of the cluster core. Turbulent pressure support in the gas is 4% or less of the thermodynamic pressure, with large scale shear at most doubling that estimate. We infer that total cluster masses determined from hydrostatic equilibrium in the central regions need little correction for turbulent pressure.Comment: 31 pages, 11 Figs, published in Nature July