Quintuple primitive malignant neoplasms. A case report.

The authors describe the case of a patient who developed during 31 months, five malignant tumours, three synchronous and two metachronous. The primitive origin and the long interval of time between the occurrence of each tumour, allow to set them in the group of Multiple Primitive Malignant Neoplasm. The authors, reviewing the classifications and the pathogenesis of these tumours, underline the importance of the follow-up in oncology patients and emphasize the role of nosographic setting in order to plan the most suitable therapeutic approach.

Diagnosis and survey of abnormal/atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions: a retrospective study.

The new Bethesda System (BS) terminology has opened a series of problems about the Abnormal/Atypical Squamous Cells of Undetermined Significance (ASCUS) and Low-Grade Squamous Intraepithelial Lesion (L-SIL) categories, particularly on their treatment and follow-up. Moreover in these field a non negligible portion of lesions progress to High-Grade Lesion (H-SIL). With the aim of comparing the data, we examined samples observed in our Ambulatories with 6-12 months follow-up. We observed retrospectively 11.197 Pap test from January 1995 to June 1997, mostly first visits. All received a Pap test, colposcopy and gynaecological examination. Biopsy and histological standard examinations were performed when necessary. Alterations classified as mild epithelial abnormalities, of both ASCUS and L-SIL categories, were observed in 146 cases: 78 ASCUS and 68 L-SIL. Of these 48 were CIN 1/mild dysplasia (25 HPV associated) and 20 were HPV lesions, according to BS. All the cases with persistent ASCUS and L-SIL underwent a second control. In these 45 cases we observed 2 new cases of H-SIL and one of L-SIL; so 82.3% and 30.7% of ASCUS and L-SIL regressed to negatives. In the stable group 11.8% and 60.4% were ASCUS and L-SIL. Moreover 5.9% of ASCUS and 4.8% of L-SIL progressed to H-SIL. No cases of invasive cancer were observed. Our data show that ASCUS and L-SIL diagnosis can identify 6% and 4.8% of H-SIL respectively. In addition 17-18% of ASCUS were stable or progressed. These two categories, as already demonstrated in other studies, are mostly at risk.

Intraperitoneal chemotherapy with mitoxanthrone in ovarian cancer.

AIMS AND BACKGROUND: Ovarian carcinoma remains confined to the peritoneal cavity for the greater part of its natural history, so intraperitoneal (i.p.) administration of chemotherapy could result in greater total drug exposure of the tumor and minimize systemic antiblastic drug side effects. The aim of this study was to evaluate the therapeutic efficacy and toxic effects of intraperitoneal mitoxanthrone in patients affected by ovarian carcinoma with macroscopic absence of disease or minimal residual disease. METHODS: Ten patients were enrolled (stage II and III) who had been previously treated with neoadjuvant systemic chemotherapy (CDDP or CBDCA + CTX) and radical surgery resulting in macroscopic absence of disease or minimal residual disease (< 1 cm). Mitoxanthrone (25 mg/m2) was instilled in 2 liters of normal saline every four weeks for 2-4 cycles. RESULTS: A total of 26 courses was administered; two patients discontinued i.p. therapy, one for chemoperitonitis and another for bowel perforation requiring catheter removal. Of the 10 patients receiving i.p. chemotherapy, 7 are alive at 5 years from radical surgery, and 3 had relapses at 13, 14 and 57 months, respectively, from radical surgery. CONCLUSIONS: Intraperitoneal mitoxanthrone appears to be an effective second-line therapy in ovarian cancer; it is well tolerated as far as toxic effects are concerned, allowing cost reduction and improved patient compliance. For those cases requiring a limited number of peritoneal accesses traditional percutaneous systems have a more favorable cost/benefit ratio.