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Objective: To analyse the effect of differentiation on disease-free survival (DFS) and overall survival (OS) in patients with stage I adenocarcinoma of the endometrium., Patients and Methods: From 1979 to 1995, 350 patients with FIGO stage IA-IC with well (G1), moderately (G2) or poorly (G3) differentiated tumors were treated with surgery and high dose-rate brachytherapy with or without external radiation. Median age was 65 years (39-86 years)., Results: The 5-year DFS was 88+/-3% for the G1 tumors, 77+/-4% for the G2 tumors, and 67+/-7% for the G3 tumors (P=0.0049). With regard to the events contributing to DFS, the 5-year cumulative percentage of local relapse was 4.6% for the G1 tumors, 9.0% for the G2 tumors, and 4.6% (P=0.027) for the G3 tumors. Cumulative percentage of metastasis was 1.4, 6.3 and 7.2% (P<0.001), respectively, whereas percentages of death were 6.0, 7.9 and 20.7% (P<0.001). The 5-year OS was 91+/-3, 83+/-4 and 76+/-7%, respectively (P=0.0018). In terms of multivariate hazard ratios (HR), the relative differences between the three differentiation groups correspond to an increase of 77% of the risk of occurrence of either of the three events considered for the DFS (HR=1.77, 95% CI [0.94-3.33]), (P=0.078) for the G2 tumors and of 163% (HR=2.63, 95% CI [1.27-5.43]), (P=0.009) for the G3 tumors with respect to the G1 tumors. The estimated relative hazards for OS are, respectively, in line with those for DFS: HR=1.51 (P=0.282) for the G2 tumors; and HR=3.37 (P=0.003) for the G3 tumors., Conclusion: Patients with grade 1 tumors are those least exposed to either local relapse, metastasis, or death. In contrast patients with grade 2 tumors seem to be at higher risk of metastasis, whereas patients with grade 3 tumors appear at higher risk of death. Since we have looked at the first of three competing events (local relapse, metastasis and death), this suggests that patients with grade 3 tumors probably progress to death so fast that local relapse, if any, cannot be observed.

Paraneoplastic cerebellar degeneration is a well-defined clinical entity typically associated with ovarian or breast carcinoma. Serum or CSF of these patients has been shown to contain autoantibodies against the cytoplasm of Purkinje cells. These antibodies have been referred to as anti-Yo. We report the case of a 67-year old woman with ovarian adenocarcinoma presenting with subacute cerebellar dysfunction. Her serum was found to react with the cytoplasm of Purkinje cells and HeLa cells. On Western blot analysis a 60 to 70 kD reaction was obtained. This suggests the presence of a classical anti-Yo antibody.

The clinico-pathological features of one rare case of an ovarian tumor of probable Wolffian origin are reported. This tumor arises within the rete ovarii and is predominantly cystic on gross examination. Microscopically these cysts are lined by flattened epithelial cells and are separated by solid areas formed by large tubular glands. It is difficult to recognize this type of tumor on frozen section and to distinguish it from adenocarcinoma of the ovary. Surgery can be limited to total hysterectomy and bilateral salpingo-oophorectomy. No adjuvant therapy is necessary.

A patient who was 61 years of age had obstruction of the thoracic duct by metastases from an adenocarcinoma of the endometrium together with a carcinosarcoma of the tube. She developed chylous ascite. The diagnostic approach and the treatment has been reviewed by the authors.