Malignant ovarian neoplasms. The place of conservative surgery.

Even though radical surgery is the treatment of choice in malignant neoplasms, a conservative approach may be considered in young patients who wish to preserve fertility, provided well-defined criteria are met and survival is not jeopardized. Unilateral, stage I, borderline (BT), germ cell (OGCT), sex cord stromal tumors, and grade I epithelial cancer can be treated with unilateral salpingoophorectomy (USO). If bilateral ovarian involvement is present, bilateral salpingoophorectomy (BSO) and preservation of the uterus can be considered. Cystectomy is rarely practiced, because of published contraindications, in borderline tumors. Complete surgical staging is mandatory in all cases regardless of the type of surgery (USO or BSO). Conservative management of more advanced disease is considered in a few BT and OGCT cases, provided it can be combined with successful cytoreduction. Adjuvant chemotherapy is necessary in almost all OGCT and epithelial cancers, although its role in BT and sex cord tumors is unspecified yet. Current knowledge suggests that conception is possible after conservative management for malignant ovarian neoplasms and chemotherapy does not cause obvious genetic malformations in the newborn.

"Butterfly" operation vs triple incision technique in vulvar cancer. a comparison of morbidity and clinical outcome.

Two groups (group A = 25 cases and group B = 34 cases) of vulvar cancer patients, treated with a modified "butterfly" operation (MBO = group A) and a triple incision (TI = group B) technique, were evaluated retrospectively. The aim was to compare the two operative methods, regarding perioperative morbidity and clinical outcome. The histopathologic and clinical characteristics of the patients were comparable, in the two groups. The hospitalization period was significantly shorter in group B (TI), both when primary (22 vs 34 days, p < 0.01) or secondary (41 vs 55 days, p < 0.05) healing occurred. Local recurrences were quite similar in number (A = 5/25, B = 6/34) and were successfully treated. No relapses in the remaining skin bridges were observed in group B. The overall survival was similar in the two groups (A = 64%, B = 63%). However, LN positive cases had a better (p < 0.05) survival when treated by MBO (48% vs 23%).

Pelvic lymphocysts after radical hysterectomy and lymphadenectomy.

Five cases (5.5%) of lymphocysts were diagnosed and treated, among 80 type III modified radical hysterectomies performed for cervical cancer St. Ia2-IIa, in the last 6 years. Identification was initially made by palpation and confirmed by CT or US, in 4/5 cases in the first 2 postoperative months. Pelvic pain, fever and pressure symptoms were the most common clinical findings. A conservative approach was successful in 4/5 cases. Spontaneous regression was observed in one, while needle aspiration under radiologic guidance with (1/3) or without (2/3) tube insertion was applied in the rest. Conservative treatment failed in the last case presenting with a 12 cm cyst. An intestinal fistula developed, necessitating partial resection of the ileus and marsipulization. The complicated course of this patient's disease may indicate that a more aggressive treatment is warranted for large persisting cysts located in the irradiated field.

Chromosome aberrations and expression of ras and myc oncogenes in leiomyomas and a leiomyosarcoma of the uterus.

Twenty eight leiomyomas and one leiomyosarcoma were cytogenetically analysed and also examined for ras and myc oncoprotein expression. Chromosome alterations were found in seven leiomyoma cases. In four of them 12q14-15 was involved. P21 product of H-ras and P62 product of c-myc genes were detected in paraffin embedded parallel tissue sections. A high expression of H-ras was apparent in most tumors. C-myc expression was weak or negative in most leiomyomas with normal karyotype while on the contrary in three out of seven cases with abnormal cytogenetic findings the gene product stained moderately positive. Considerable chromosome abnormalities and oncogene overexpression were also identified in the leiomyosarcoma.