bcl-2 is one of a family of genes that control the apoptotic threshold of a cell. bcl-2 protein and its anti-apoptotic homologue, mcl-1, with the pro-apoptotic protein, bax, are thought to function by forming homo-and heterotypic dimers that then control the progression to apoptosis. p53 is also involved as a down-regulator of bcl-2 and a promoter of bax. To determine the effect of these apoptotic mechanisms, we used immunohistochemistry to determine the prognostic significance of the expression of bcl-2, mcl-1, bax and p53 in primary and recurrent cervical cancer. Tissues from 46 patients with primary cervical cancer and 28 women with recurrent carcinoma were stained for bcl-2, mcl-1, bax and p53. Kaplan-Meier survival analysis was performed using the log-rank test for differences between groups. In the primary disease group, positive staining for bcl-2 was associated with a better 5-year survival (bcl-2 +ve, 84% vs bcl-2 -ve, 53%, P = 0.03). Positive staining for p53 was associated with a survival disadvantage (p53 +ve, 4-year survival 38% vs p53 -ve, 4-year survival 78%, P= 0.02). mcl-1 and bax staining were not useful as prognostic indicators in primary disease. No marker was prognostic in recurrent disease. Positive bcl-2 staining defines a group of patients with primary disease with a good prognosis. p53, an activator of the bax promoter, identifies a group with a worse outcome. In recurrent disease, none of the markers reflected prognosis.

Aims-To examine long term survival of women with primary and recurrent cervical carcinoma in relation to (1) excretion of -core (a urinary metabolite of human chorionic gonadotrophin ( hCG)) and (2) hCG immunostaining of the tumours, to determine the suitability of these markers for assessing prognosis. Methods-This was a prospective observational study undertaken in a gynaecological oncology centre: 57 women with primary cervical cancer and 42 with recurrent disease were recruited between January 1990 and September 1992. Kaplan-Meier survival analysis with the log rank test was used to assess survival diVerences with survival rate given per year of follow up. Results-In primary disease, the four year survival for the -core negative group was 79%, compared with 14% for the -core positive group (p = 0.001). This was still significant for early stage disease or squamous lesions alone. In recurrent disease, -core positivity was not prognostically significant. Immunohistochemistry was of no prognostic significance in either group. Conclusions--core excretion appears to be useful in assessing prognosis of primary cervical cancer but not of recurrent disease. A large prospective study of urinary -core in early stage cervical cancer is needed to determine whether it can be used as an index for modifying treatment. (J Clin Pathol 1998;51:685-688)

A 77-year-old woman presented with an abdominal swelling and underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy for a left ovarian tumor. This was an ovarian mature cystic teratoma in which had developed a sebaceous cell carcinoma. This is a rare form of ovarian malignancy whose behavior is poorly documented. The treatment and follow-up of this case are discussed.

No abstract