Aggressive "breast-like" adenocarcinoma of vulva.

A case of vulvar adenocarcinoma seen in a 42-year-old woman is reported. The tumor involved the right labium majus and diffusely spread into the surrounding soft tissues as well as the inguinal lymph nodes and was histologically composed of nests, cords, and tubular formations recalling an aggressive duct carcinoma of breast. Likewise, tumor cells exhibited positivity for common breast tumor markers, such as epithelial membrane antigen, carcinoembryonic antigen, and glandular keratins. The possible origin of the neoplasm from mammary ectopic tissue in vulva or from vulvar skin adnexa is briefly discussed.

Cancer incidence in Turin: the effect of migration.

AIMS AND BACKGROUND: Studies on migrant populations have been of great value in clarifying the role of environmental factors in cancer occurrence. Most of them consider migrants from other countries or continents. Turin, the target territory of this study, was an important area of internal migration initially from the East, and more recently from southern Italy. METHODS: The study compared incidence rates (age-standardized) of the native population, of the migrants and incidence rates of the Cancer Registries located in the four main areas of origin. RESULTS: Overall incidence rates in migrants from southern Italy were intermediate compared with those of the stable populations of the South and the North. The same effect was not true for people from the North-East, who migrated in earlier decades. In this population, migration towards lower-incidence areas did not reduce cancer incidence. Migrants from the South showed a significant increase in intestinal, breast, and tobacco-related tumors compared to the stable southern population. No effect of migration was found for cancer of the mouth, pharynx, esophagus, stomach or corpus uteri. Incidence of liver cancer in migrant southern males was significantly different from the stable and the native north-western population. CONCLUSIONS: The results, based on incidence data, validated previous findings based on mortality data on the effect of Italian internal migrations and showed that migrants underwent changes in some environmental exposures. In particular, migrants from the South to the North of Italy came into contact with new risk factors, with an increase in occurrence of cancer.

Cytological typing of primary lung cancer: study of 100 cases with autopsy confirmation.

In order to assess the accuracy of bronchial aspiration cytology in typing lung cancer, tissue sections from 100 autopsy cases of lung cancer were compared with the cytology features observed in the same patients prior to death. There was 100% accuracy in the cytology of small-cell carcinoma; 90% in squamous-cell carcinoma; 70% in adenocarcinoma; and 50% in undifferentiated large-cell carcinoma. The observed discrepancies probably reflect intrinsic tumor properties rather than problems attributable to either the bronchial aspiration method or cytology interpretation, especially in cases involving advanced lung carcinoma. Because the highest accuracy rate was in detecting small-cell carcinoma, it is recommended that only the distinction between small-cell and non-small-cell forms be made on cytologic grounds and that further categorizations only be rendered in cases with unquestionable cytomorphological features.

The changing epidemiology of gynaecological cancer in Trieste: a fifteen-year case study.

The peculiarity of the geopolitical situation of the City of Trieste makes it a good observatory for surveillance of diseases. The Authors describe the changing patterns of gynaecological neoplasias in Trieste during a fifteen-year time span.

Breast carcinoma metastasizing to the uterus.

Metastases from mammary carcinoma represent the principal cause of exitus in 45% of subjects dead from this neoplasia. Also if they are not frequent, uterine metastases from mammary carcinoma are not very rare to find at the autopsy (2-15% as various Authors report). In this study, the Authors present 17 cases (1 bioptic and 16 autoptic cases) of uterine metastases from breast carcinoma. The histological examination confirms a more frequent involvement of the uterine corpus, with infiltration of the myometrium. When the endometrium is affected, generally the neoplasia infiltrates the stroma, preserving the glandular architecture. In one case, the uterine metastases was associated with a fibroleiomyoma. The clinical symptomatology (metrorrhagia in 3 of 17 cases) was poor because, as we have said above, generally the neoplasia infiltrates the myometrium.

Ovarian tumours: anatomohistopathological contribution to their interpretation.

The data resulting from an epidemiological and anatomopathological study on ovarian tumours in the Trieste province are presented. 970 cases of ovarian neoplasms diagnosed in the Institute of Pathological Anatomy and Histology of Trieste University over the 1969-1985 period were analyzed: 66.7% were benign and 33.3% were malignant. The crude incidence of benign ovarian tumours was 24.2/100,000 and that of malignant tumours was 12.1/100,000. The incidence rate of the latter standardized on the world population was 6.5/100,000. It is a low level, which does not increase over time. Benign ovarian tumours affect all age groups, while malignant tumours are more frequent among elderly women. In addition, the distribution by age group varies according to the histological type. Among benign tumours, the most frequent are the epithelial ones (over 50% of the total), followed by tumours of germinal origin (27.5%), tumours of the ovarian stroma (21.6%) and those of ovarian non-specific tissues (0.8%). Among malignant neoplasms, epithelial ones are 94.4%, germinal tumours 2.8%, stromal tumours 1.8% and sarcomas 0.9%.

Diagnostic validity of the Vabra Curettage. Compared study on 172 patients who underwent Vabra Curettage and the fractional curettage of the uterine cavity.

The authors report 172 cases of patients who had to undergo a curettage of the uterine cavity and an endometrial sampling with Vabra Curettage. In 80.8% of the cases, the histologic diagnosis of the material removed with Vabra Curettage was comparable with that of the uterine curettage. In 8.7% of the sampling, the histologic diagnosis of the tissue removed with the "suction technique" was easier. In 10.5% of the cases, the diagnosis was more reliable in the samplings taken away with uterine curettage. In this last group, nevertheless, the endometrial tissue removed with Vabra curettage allowed us to exclude the presence of an adenocarcinoma or of an atypical hyperplasia. Only in 1.2% of the specimens, the Vabra Curettage did not allow us to exclude an endometrial pathology (for lack of material). On account of the increased incidence of endometrial carcinoma, the tolerability of the method proposed, its low cost, the Authors advocate a large-scale use of this method for a prevention program directed at the high-risk population for this carcinoma.

Correlation between cervical intraepithelial neoplasia and invasive cervical carcinoma on the basis of their frequency in the Province of Trieste (1977-1986).

The Authors report the results of a study on the diffusion of CIN and of invasive carcinoma of the portio in the Trieste population over the 1977-1986 decade. In order to achieve this aim all the bioptical specimens analyzed in the Institute of Pathological Anatomy and Histology of Trieste University were reviewed. Over this period 313 cases of CIN 1-2, 314 cases of CIN 3 and 289 of invasive carcinoma were diagnosed. The average age for CIN 1-2 lesions was 33.5 (range 17-78), for CIN 3 39.9 (range 18-81) and for invasive carcinoma 58.6 (range 26-89). The distribution by age group was markedly different in the three types of lesion dealt with, showing a substantial presence of preinvasive lesions under the age of 50. During the period considered a significant decrease in the incidence of invasive carcinoma was not recorded, in contrast with other reports. This datum may be explained by the fact that the number of women undergoing cyto-oncological screening has not increased over the last decade.

Cancer of the endometrium in the province of Trieste: epidemiological considerations.

The Authors examined the epidemiological behaviour of endometrial carcinoma in the Province of Trieste from 1969 to 1980. In this period a European standard incidence of 14.33(0)/0000 was recorded. The most affected age group is 60 to 69, and the average age is 64 years. A clear increasing trend of this kind of neoplasia was recorded. This increase mainly occurs in younger age groups than those which presently are most affected.

Recurrence incidence in follow-up of patients affected by condylomatosis of the uterine cervix with VCE (viral cytopathic effect).

The frequent association of HPV lesions with cytological and/or hystological alterations of CIN in the uterine portio and in the lower genital tract suggests their possible role in the genesis of precancerous lesions of the cervix. In the systematic cytological screening, condylomatous lesions present an incidence varying from 0.52% to 1.5%. With the aim of verifying the incidence rate of condylomatosis of the portio, in the population of the women followed in the Colpocytological Service of obstetrics and gynaecology (Institute for Childhood of Trieste), the authors have performed a retrospective analysis on 17273 colpocytological examinations and have found 72 cases (0.41%) with cytological and/or histological evidence of viral-cytopathic effect produced by HPV. These patients have undergone various treatments of this pathology and have performed a follow-up. In some patients 12 cases, treated only with antiflogistic therapy or no therapy, 50% of these has shown a complete regression of viral infection in the first control after 4 months. In these patients, it is suggestive to suppose that a good immunological reactivity has brought the patient to recovery. For that, in their next work, the Authors will investigate the immunological responsiveness of patients affected by HPV lesions of the cervix.

[Endometrial hyperplasia in the province of Trieste]. / Le iperplasie dell'endometrio nella provincia di Trieste.

1103 cases of endometrial hyperplasia were diagnosed between January 1, 1978 and December 31, 1987 at the Department of Anatomy and Pathological Histology of the University of Trieste. Of these, 58% were cases of cystic glandular hyperplasia, 38% of adenomatous hyperplasia and 4% of atypical hyperplasia. Subdividing the period examined into two five-year periods, it was found that the rate of incidence of endometrial hyperplasias was more than doubled, this increase having been caused above all by cases of cystic hyperplasia. Distribution by age classes of subjects suffering from different hyperplastic forms suggests that cystic glandular hyperplasia is not a precursor of the adenomatous form, whereas the latter and atypical hyperplasia might constitute a continuous spectrum of potentially precancerous lesions.

[Condyloma and intraepithelial cervical neoplasms. Epidemiological contribution to their interpretation]. / Condiloma e neoplasie cervicali intraepiteliali. Contributo epidemiologico alla loro interpretazione.

The frequency of condylomatous lesions and of intraepithelial neoplasms of the cervix (CIN) and their possible association in the female population of Trieste have been evaluated. The analysis was carried out on the basis of biopsy samples of the uterine cervix examined at the Department of Pathological Anatomy and Histology of the University of Trieste in the period between 1-1-1983 and 31-12-1987. In the five-year period considered, 272 papillomavirus lesions and 451 cases of CIN were diagnosed. The condylomatous infections were associated with CIN in 48% of cases. An association with CIN 1-2 was encountered in 32.4% and with CIN 3 in 15.4% of cases. CIN 1-2 was associated with condylomatous lesions in 35.2% and CIN 3 in 20.9%. The average age of patients with cervical condyloma was 29.5 years, while that of patients suffering from CIN 1-2 and CIN 3 was respectively 31.9 and 38.7 years. The patients who presented the association between the two pathologies were younger than those suffering from CIN alone: the average age was in fact 28.7 years among women suffering from CIN 1-2 and viral infection and 35.7 in those with condyloma and CIN 3. In the five years examined, a marked tendency was encountered towards an increase in both pathologies examined and this was seen exclusively in the associated lesions.

[Cervical cytologic screening in the province of Trieste]. / Lo screening citologico cervicale nella provincia di Trieste.

The frequency of the Pap test and the incidence of dysplastic and neoplastic lesions of the uterine cervix in the province of Trieste from 1/7/85 to 30/6/88 have been analysed. Over this period, the annual frequency of screening was 11% of the resident female population, with considerable differences from one age class to another. In the age group between 15 and 29, in which CIN 1 incidence is at its maximum, the frequency of screening is much lower than it is among subjects of average age. It is considered that it would be more advisable to detect the cervical lesion in the earliest stage and so bring forward performance of the first Pap test to a younger age.

[Effect of hysterectomy and ovariectomy on the incidence of malignant neoplasms of the female genital tract]. / Effetto dell'isterectomia e dell'ovariectomia sull'incidenza delle neoplasie maligne dell'apparato genitale femminile.

The true risk population for uterine and ovary cancer have been studied, according to the prevalence of histerectomy and oophorectomy in the Trieste area female population. The calculation of the females at risk for these tumors permits to recalculate the incidence rates that are usually underestimated. This adjustment increases the rates in all genital tract tumors from 14% to 18%, but does not modify the relative frequency per age groups or the incidence in the temporal trends. An exception is represented from the uterine corpus cancer in which the correction of the population modifies the temporal trend for the age group over 60 years. The incidences tend in fact to increase significantly more after the adjustment.

Coding criteria of bladder cancer: effects on estimating survival.

The aim of this study is to evaluate the consistency between routine methods for coding urinary bladder tumours in eight Italian cancer registries and the European Network of cancer registries (ENCR) criteria. Furthermore, it aims to evaluating the impact of the discordance on survival data. Eight cancer registries took part in the study: Ferrara, Florence, Macerata, Ragusa, Romagna, Sassari, Turin and Varese. The first 100 cases of neoplasm of the urinary bladder incident in the years 1993-1994 were identified from the files of each registry. The original pathology reports were made available. A working group considered eligible to the study 699 cases of microscopically confirmed transitional carcinoma (ICD-O morphology code 812-813). Using the ENCR criteria, each of these was classified according to morphology code (8120 vs. 8130) and behaviour (1/ uncertain, /2 non-invasive, 3/ invasive). Information of tumour behaviour was classified as follows: (i) present, when expressly stated in the original report, (ii) deducible, when not expressly stated but suggested by the pathologist's description, and (iii) absent, when impossible to determine on the basis of the original pathology report. The working group classification of tumour behaviour and the classification of the registry of origin were compared. There was a full concordance in the case of complete agreement on the morphology code, and partial concordance when only the invasive or non-invasive behaviour code was agreed upon. As much as 92.5% cases were microscopically confirmed. Tumour behaviour was expressly stated in the original report of 69.2% cases, not stated but suggested by the pathologist's description in 21.2% cases, and impossible to determine in 9.6%. Agreement between the panel and the registry of origin was complete in 71.2% cases and partial in 12.3% while there was a complete discordance in 16.5% cases. The panel interpreted as non-invasive 111 cases coded as invasive by the registry of origin. Conversely, it was estimated that 24% cases included in incidence data were non-invasive. This article discusses the impact of misclassification on survival data.