Minimal deviation adenocarcinoma of the cervix in a patient with a high-grade cervical squamous intraepithelial lesion: case report and review of the literature.

Minimal deviation cervical adenocarcinoma, otherwise known as adenoma malignum, is a rare and particularly well differentiated type of cervical adenocarcinoma, and is often misdiagnosed because of its benign-looking histological features. Adenoma malignum represents only 1-3% of all cervical adenocarcinomas. The Papanicolaou smear as well as punch biopsies can fail in the detection of adenoma malignum. We present the case of a 55-year-old woman diagnosed as having microinvasive minimal deviation of the adenocarcinoma cervix, after conisation for a high-grade cervical squamous intraepithelial lesion. The patient was referred for an abnormal pap smear to our colposcopy clinic where the punch biopsies performed failed to diagnose the disease. The consequent cone biopsy because of CIN3, provided us with a definite diagnosis of adenoma malignum. Subsequently, the patient underwent a radical hysterectomy and pelvic lymph node dissection. The histologic examination was normal. Coexistence of a squamous intraepithelial lesion with adenoma malignum is extremely uncommon.

Primary melanoma of the vagina: a case report.

Primary malignant vaginal melanoma is a rare vaginal tumour accompanied by an extremely high risk of local recurrence, distant metastasis and a small survival rate. Due to the fact that vaginal melanoma is quite uncommon there is lack of powerful prospective studies in the literature, thus the treatment choice remains controversial. An 85-year-old woman with a primary malignant vaginal melanoma located on the left lateral aspect of the distal vagina, with the greatest diameter almost 5 cm, was referred to our clinic. There was not any sign of local or distant metastasis identified. According to the most recently published data in the international literature, we decided along with the patient to perform conservative dissection of the tumor with free surgical margins as the appropriate mode of therapy. Radiotherapy, chemotherapy or radical extirpation cannot increase the survival time, even if there is a local or distant spread of melanoma.

A retrospective study of 32 borderline ovarian tumours: the experience of a non-specialized centre.

BACKGROUND: We evaluated the clinical features and treatment of patients with borderline ovarian tumors. METHODS: This was a retrospective review of the charts of 32 patients with borderline ovarian tumours that underwent surgery at the Department of Obstetrics and Gynaecology, Tzaneio General Hospital of Piraeus, over a 14-year period (1/1990-12/2003). RESULTS: Of the patients 62.5% were pre- or peri-menopausal. Mean age was 41.6 years. Five patients (15.63%) had undergone pelvic surgery (caesarean section not included) for unrelated reasons prior to the diagnosis of borderline tumour. Mean follow-up was 71.37 months and all patients showed up for their scheduled appointment during the first trimester of 2004. Pain was the presenting symptom in 37.5% (12/32) of patients. Twenty patients were diagnosed either by ultrasound (12.5%, 4/32) or during unrelated surgeries (50%, 16/32) and reported no relevant symptoms at the time of diagnosis. Treatment was conservative, comprised of either cystectomy (3/32), unilateral salpingo-oophorectomy (13/32), and unilateral salpingo-oophorectomy with myomectomy (1/32). Abdominal hysterectomy with bilateral salpingo-oophorectomy was performed in 15 patients for unrelated conditions (uterine pathology). Mucinous borderline tumours were identified in 11 patients (34.38%), serous borderline tumours in 17 patients (53.12%), and nonserous-mucinous borderline tumours in four patients (12.5%). Omentectomy was performed in two cases, biopsy of the controlateral ovary was performed in five cases and peritoneal washing in eight cases. Restaging surgery was performed at the Metaxa Anticancer Piraeus Hospital in 11 patients (34.38%). One patient who did not undergo a restaging operation had a recurrence of the disease. CONCLUSION: Suboptimal staging remains a major problem during the initial operation in non-specialized centres in gynaecologic malignancies.