Extramammary Paget's disease found by abnormal vulvar brush sampling.

INTRODUCTION: Doctors are usually reluctant to perform a vulvar biopsy on a patient with non-specific chronic vulvitis--especially because of the rarity of vulvar malignancy in young women--until the lesion is suspected of being malignant. Therefore, most cases of extramammary Paget's disease (EMPD) were originally misdiagnosed as chronic and recurrent vulvar lesions. Late diagnosis of invasive lesions occurring in elderly females have resulted in cases of death. CASE: A 37-year-old patient showed an extended lesion on the vulva and perineum. In addition, abnormal cells were found from a vulvar scrape smear, and a following punch biopsy was used to diagnose and determine the extension of the disease. CONCLUSION: Diagnosis and demarcation of EMPD remain difficult due to the multifocal lesions and subtle nature of the disease. Brush sampling taken from suspicious areas can be a guide for multiple biopsies to demarcate the lesion before major surgery. A brush biopsy is presented as a first-step method to detect vulvar malignancy.

[Diagnosis and treatment of cervical dysplasia].

Between 1981 and 1986, 219 patients with cervical dysplasia were treated at the Kyushu University Hospital. All patients were diagnosed by cervical smear, colposcopy, and cervical biopsy and/or endo cervical curettage. They have been followed for more than one year (average 37 months). Of the 219 patients, 63 had mild dysplasia, 99 had moderate dysplasia, and 57 had severe dysplasia. One hundred and forty patients were treated with carbon dioxide laser. The remission rate was 95.0% after one treatment and 98.6% after two treatments. The laser therapy is effective, but a certain rate of recurrence is to be expected. Recently, 23 patients were treated with the cryotherapy and the remission rate was 83%.

[Evaluation of paraaortic lymph node metastasis in patients with primary epithelial carcinoma of the ovary].

From 1979-1986, 110 patients with an ovarian cancer have been treated at Kyushu University Hospital. Sixty-eight of these patients with untreated primary adenocarcinoma of the ovary underwent a paraaortic lymph node (PAN) biopsy at the time of their initial surgery. Twenty-two of these 68 patients were found (32.4%) to have a positive PAN. Microscopic PAN metastases were present in 4 patients, who, macroscopically, seemed to have the disease confined to the pelvis. The incidence of a positive PAN was seen to correlate with the clinical stage and degree of differentiation of the primary tumor. Positive PANs were more frequent in cases of a serous rather than a mucinous carcinoma. All 5 patients with a metastatic adenocarcinoma originating from the stomach or the colon had a positive PAN. It thus has been concluded that a PAN evaluation is important for the management of ovarian cancer.