Posthysterectomy carcinoma of the fallopian tube presenting as vaginal adenocarcinoma: a case report.

The clinical and pathological features of a case of adenocarcinoma of the fallopian tube with a unique presentation are described. The 68-year-old patient presented with vaginal bleeding 25 years after a vaginal hysterectomy. Pelvic examination revealed a 0.5-cm nodule of tumor involving the mucosa of the vaginal apex. At laparoscopy, the left fallopian tube was dilated and adherent to the vaginal vault. Pathological examination of the upper vaginectomy and bilateral salpingo-oophorectomy specimen revealed a primary papillary adenocarcinoma of the left fallopian tube that had invaded directly into the mucosa of the vaginal apex. Vaginal involvement, either at the time of presentation or subsequently in the course of the disease, is very rare in patients with carcinoma of the fallopian tube.

Radiation treatment of carcinoma of the vulva, 1950-1980.

A retrospective study of all patients with carcinoma of the vulva treated by radiation therapy at the A. Maxwell Evans Clinic of the Cancer Control Agency of British Columbia, between 1950 and 1980, is reported. Sixty-eight patients, representing 30% of all referred patients with vulvar cancer, were analyzed for survival, recurrence patterns, complications, and clinical features. This group is companion to a series of patients treated with operation reported in 1979. The data confirm a major role for radiation therapy both in palliation and in combined radiotherapy-operation. For 13 cases, radiotherapy with curative intent was used in combination with operation resulting in a 5-year actuarial survival of 92%, with acceptable posttreatment morbidity. The advantages of preoperative radiotherapy, particularly for posterior vulvar lesions, are suggested by the data, and the need for a reappraisal of the role of radiotherapy in vulvar carcinoma is stressed.

Radical hysterectomy in the treatment of cervical cancer.

Two hundred and forty-one patients were treated with radical hysterectomy at our institution between 1949 and December, 1978. The corrected 5-year survival rate for all patients with squamous cell carcinoma of the cervix was 73%. Seventeen percent of patients with occult invasive carcinoma had positive lymph nodes at the time of operation. The corrected 5-year survival rate for patients with Stage IB carcinoma who had positive nodes was 66%. Operations for recurrent or persistent disease after radiotherapy resulted in a 5-year survival rate of 54%. Current indications for radical hysterectomy and lymphadenectomy at our center are discussed.

PIP: This study reports the center's experience (Cancer Control Agency of British Columbia or CCABC and the Vancouver General Hospital) with 241 patients (aged 20 to 71+) who had undergone radical hysterectomy for invasive cancer during the period 1949 through 1978, and how this experience has led to the center's current indications for use of such surgical procedural procedure. Approximately 50% of the patients were aged 40 years or less, and 2/3 were under the age of 51; this suggests that most patients have long life expectancy if they could be cured of their disease. All but 15 patients had primary cervical carcinoma (Table 2). 76% of the patients had squamous cell carcinoma of the cervix. Of the 226 cervical cancers, 81.9% were squamous cell and 12.4% were adenocarcinoma. 5.6% had a mixed adenosquamous carcinoma. Diagnosis of cervical cancer correlated closely with the presence or absence of lymph node involvement at time of operation. Tables were also provided to present data on 5-year survival rates of patients with positive lymph nodes and squamous cell carcinoma; various treatment methods and results by stage for the 137 patients with squamous cell carcinoma of the cervix; 10, 15 and 20 year survival rates by stage for patients with squamous cell carcinoma; postoperative complications in 241 patients, and effect of radiotherapy on rate of development of fistulas. The data shows that radical hysterectomy was not a commonly performed procedure in this institution during the past 3 decades, and the encouraging 52% survival rate for patients managed with radical hysterectomy for recurrence or persistence of cancer after radiotherapy indicates the need for frequent, careful follow-up of patients with early stages of cancer. Current indications for radical hysterectomy and lymphadenectomy at CCABC are discussed.

Squamous carcinoma of the vulva: results of treatment, 1938 to 1976.

Clinical data on 264 patients with squamous cell carcinoma of the vulva seen between 1938 and 1976 are reported. Two hundred and four patients were "eligible" for 5 year assessment for a 55% survival rate. Patients treated with radical vulvectomy and bilateral lymphadenectomy had a corrected 5 year survival rate of 86% if the lymph nodes failed to show metastatic disease. Twenty-eight percent of the patients treated with lymphadenectomy had lymph node metastasis at the time of surgery. The presence of lymphatic metastasis appeared to be the most significant prognostic factor. The results obtained have led to a degree of individualization in current treatment policies, together with a re-evaluation of the possible role of radiotherapy.