Migrant women and cervical cancer: background of a prevention study.

The study was scheduled in order to organize a program of prevention against cervical cancer in female migrants in Rome, and therefore to facilitate access to appropriate preventive oncological facilities for discriminated women. Moreover, the study will also investigate the risk factors and social conditions (HPV-subtypes, sexual behavior, smoking habits) of such women since their migration to Italy. This is scientific and cultural background of a longitudinal, observational study on the cervical cancer risk in Roman migrant population. By means of a mother language questionnaire (with the presence of a cultural mediator) it will be possible to achieve data on social conditions and the new life-style. An HPV-testing (HC2) combined with Pap-test (with further genotype distribution) will be performed in all women enrolled in the study. Further diagnostic/therapeutic decisions will depend on the results of both tests. Scientific results are expected in the next two years, but an increasing of cancer prevention awareness among female migrant populations is expected from the beginning of the program. The present study was aimed at culturally appropriate intervention strategies to limit the disparities that migrants usually suffer in most of the developed Western nations in respect to the native counterparts.

Endometrial biopsy by means of the hysteroscopic resectoscope for the evaluation of tumor differentiation in endometrial cancer: a pilot study.

AIMS: To assess the diagnostic accuracy of endometrial biopsy by means of the hysteroscopic resectoscope (EBHR) in evaluating tumor differentiation in patients with endometrial cancer. METHODS: Between January and December 2005, all the women with a diagnosis of endometrioid adenocarcinoma of the uterus, when admitted to hospital, were enrolled for this study. Patients eligible for surgical treatment underwent a preoperative work-up consisting in pelvic magnetic resonance imaging (MRI) and EBHR. In all patients submitted to a hysterectomy, a comparison between pre- and postoperative tumor grade was carried out. RESULTS: 42 women were enrolled in the study. Hysteroscopic biopsy was carried out in 39 patients (mean age 62.5 years, range 33-79; FIGO stage I: 34, stage II-IV: 5). No complication related to hysteroscopy was observed. The preoperative tumor grade by hysteroscopy correlated with the final grade in 97.1% of cases. No patient had positive peritoneal washing and after a median follow-up of ten months no intraperitoneal tumor relapse was observed. CONCLUSION: EBHR is a very accurate diagnostic procedure for assessing the preoperative tumor grade in patients with endometrial cancer.

Primary leiomyosarcoma of the fallopian tube: a case report.

A primary leiomyosarcoma (LMS) arising from the left fallopian tube in a perimenopausal 48-year-old woman is reported. Primary tubal LMS is an uncommon, exceedingly rare neoplasm, accounting for only a few reported cases so far. To our knowledge, the present case is the 17th tubal LMS reported in the English-language literature. The diagnosis is usually made at the time of laparotomy for a pelvic or adnexal mass or other gynaecological indications. As in ovarian neoplasms, the mainstay of treatment is represented by debulking surgery consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, random biopsies, peritoneal washing and excision of all the abdominal tumour masses. Although the approach is radical, the clinical behaviour is very poor. The role of adjuvant radio- or chemotherapy still remains unsolved.

Analysis of chromosomes 3, 7, X and the EGFR gene in uterine cervical cancer progression.

The aim of this study was to investigate the possible role of genetic alterations in the genesis and progression of cervical carcinomas. We analysed the 3, 7, X aneusomy of chromosomes and the status of the epidermal growth factor receptor (EGFR) gene by fluorescence in situ hybridisation (FISH) analysis. Polysomy of chromosomes 3 and X defined the transition from high-grade squamous intraepithelium lesions (HSIL) to cervical carcinoma. Chromosome 7 monosomy and polysomy did not show any statistical significant differences between the groups examined. When we compared the chromosomal aneusomies in all of the specimens using the Kruskal-Wallis test, significant differences (P = 0.0001, P = 0.0001 for chromosomes 3 and X, respectively) were observed. Using a ratio of the EGFR gene signals and chromosome 7 centromeric signals, no samples showed gene amplification. Our results demonstrate the importance of chromosomal 3 and X aneusomies in the development and progression from HSIL to cervical carcinoma, highlighting their usefulness as genetic markers for identifying SILs at high-risk of progression.

Role of pelvic lymphadenectomy in the management of stage I endometrial cancer: our experience.

OBJECTIVES: To estimate the prognostic value of pelvic-node removal on survival of patients affected by endometrial carcinoma at presurgical FIGO Stage I. METHODS: A retrospective analysis was performed on a total of 111 patients recruited from 1990 to 1996 at the S. Carlo di Nancy Hospital. Thirty-nine (35%) of them underwent a total hysterectomy and bilateral salpingo-oophorectomy with removal of the vaginal cuff (group 1), while 72 (65%) underwent a total hysterectomy combined with pelvic lymphadenectomy (group 2). Prognostic features including tumor grade, depth of myometrial invasion and histologic subtype. Survival rates were calculated with Cox and Kaplan analyses. RESULTS: Overall survival rate at five years was 91.2%. The survival rate of group 1 and group 2 was 89% and 92.8%, respectively which is not statistically significant. Stage, grade, histotype, age at diagnosis, and presence of positive lymph nodes did not show any significant prognostic value on survival probability. CONCLUSIONS: The survival rate for patients submitted to lymphadenectomy (group 2) was the same of patients who did not undergo this treatment (group 1). Nevertheless, pelvic lymphadenectomy in endometrial carcinoma at presurgical FIGO stage I was worthwhile as it allowed correct staging to be performed. The prediction of nodal disease based only on preoperative investigations (such as TC, NMR) is often inaccurate.

Rapid modification of aggressiveness of a primary non-Hodgkin lymphoma of uterine cervix.

Primary malignant lymphoma of the uterine cervix is an extremely rare condition, with only about 100 cases reported in international literature. The diagnosis can be difficult, as stated by some authors finding only 10 up to 40% of cases of cervical lymphoma diagnosed by positive cytology. We present a case of primary malignant lymphoma of the cervix in a 57 year old woman treated at the Department of Gynecological Oncology at the Regina Elena Cancer Institute in Rome, with a sudden and unfavorable outcome.

Analysis of the prognostic factors of endometrial carcinoma. A retrospective study of 144 patients.

One hundred and fourty-four patients with endometrial carcinoma who had undergone surgery as primary treatment were retrospectively studied from January 1980 to September 1990 for the purpose of correlating the survival rate with known or presumed prognostic factors. The patients averaged 63.1 years of age (range 32-88 years); 106 were classified as having Stage I disease, 10 Stage II, 16 Stage III and 2 Stage IV. Histology confirmed pure adenocarcinomas in 77%, adenosquamous carcinoma in 3.5%, clear cell carcinomas in 2.5% and serous papillary in 17%. Surgical treatment consisted of extrafasial hysterectomy with pelvic lymphadenectomy up to the aortic bifurcation in 69 patients (48%), Wertheim's hysterectomy in 10 (7%), simple or vaginal hysterectomy in the remaining 65 patients (45%). Five-year survival rate in all the case series was 74.3% whereas for patients with Stage I carcinoma it was 79.9%. Different prognostic factors were correlated in a multivariate analysis with the outcome of the disease. Myometrial invasion presented a mortality ODDS RATIO (OR) of 3.18 (95% CI 1.25-8.06), for histologic grade OR 4.33 (95% CI 1.74-10.74) and for stage (2-3 vs 1) OR of 2.73 (95% CI 1.09-6.83) demonstrating a high significance, whereas pregnancy, excess body weight, age and histotype were not considered as relevant factors for prognosis. For age we found mortality OR 2.54 (95% CI 0.75-8.59) for women greater than 55y.

Acute urethral obstruction due to condylomata acuminata.

Urethral obstruction is a rare disease in women, and even more uncommon is the occurrence of acute urethral obstruction due to condylomata. This case report describes the course of one such case, unique for its progressive clinical evolution, the primary involvement of the lower urinary tract in the absence of either an obvious primary site or a history of sexual intercourse for more than 15 years, and its successful treatment with cryotherapy.

Weekly cis-platinum as third line chemotherapy in advanced ovarian carcinoma. Phase II study.

It is difficult to find effective chemotherapy combination as third line treatment in epithelial ovarian cancer. In this paper the therapeutic response was evaluated of weekly administration of cis-platinum as third line chemotherapy, for a minimum of 6 cycles, on 8 patients, aged 41-72 years, with advanced ovarian carcinomas who had already undergone surgery and first and second line chemotherapy. All patients received from surgery and first and second line chemotherapy. 5 out of 8 patients responded to chemotherapy (PR + CR 62.5%). One had clinical and CT scan confirmed complete response lasting 12 weeks; in 2 patients partial response consisted of intestinal recanalization following sub-occlusion due to tumor relapse; one patient manifested disease progression during therapy, which was subsequently suspended after 4 cycles, whereas another patient had stable disease. As far as side effects are concerned, in one patient the cycle was postponed for grade I myelotoxicity, neurotoxicity occurred in 6 patients, grade I and II gastrointestinal toxicity occurred in all patients. Nephrotoxicity was never observed. In conclusion the cisplatinum weekly administration appears to be less toxic and more easily administered. The type of response suggests this dosage regimen (dose intensity 40/mg sqm/week) has a different mechanism of action and the total dose could have a greater tumoricidal effect.

Transvaginal bladder neck suspension: a safer method.

A new modification of transvaginal technique of bladder neck suspension is described. Its main merit is its safety. The ligature-carrying needles are inserted from below rather than above. It virtually eliminates bladder injury. Our experience with 29 cases and a follow-up of six to thirty months shows that this technique is as successful as other similar procedures in controlling genuine stress incontinence.

Endometrial carcinoma. Clinical and pathological correlations with survival and surgical treatment.

From 1978 to 1985 a total of 151 patients were treated for endometrial carcinoma. Of these, 25 patients underwent extrafascial abdominal hysterectomy and pelvic lymphadenectomy, 25 were treated according to Wertheim procedure and pelvic lymphadenectomy and 32 underwent intrafascial abdominal hysterectomy; 62 women underwent vaginal surgery, 7 of whom according to Shauta. A correlation between the degree of myometrial invasion, histological grading, hystological type and stage of the tumor showed no statistically significant difference. The 5-year actuarial survival rate was found to be 76.5%. A comparison between survival and age of patients showed a significant difference in the survival (p less than .01) of the group less than 55 years as compared to the older age group. As far as the surgical treatment instituted is concerned, no statistical difference in survival was found between patients operated vaginally and those operated abdominally (p greater than .05). The site of recurrences were then analyzed in 22 patients, 50% were local recurrences, and the remaining distant metastases. Of these only one patient was cured and is still free of disease 5 years after recurrence. The criteria used to select patients for vaginal surgery are also indicated.

Cefoxitin single dose prophylaxis and/or T tube suction drainage for vaginal and abdominal hysterectomy (Prospective randomized trial on 155 patients).

Pelvic infections represent the most feared complications associated with vaginal and abdominal hysterectomy. In the present paper we show result of a prospective randomized clinical trial carried out to study different morbidities (F.M. febrile morbidity, U.T.I. urinary tract infections, P.C. pelvic cellulitis, P.A. pelvic abscess, W.I. wound infection) in a sample of 155 patients undergoing vaginal or abdominal hysterectomy for non malignant disease, divided into three groups. group C, treated with 2 g cefoxitin i.v. in the preoperative period; group C+T, the same treatment with the addition of T tube suction drainage; group T, with only the T tube suction drainage. A statistical analysis of the sample showed the homogeneity of each group, while the study of the morbidities showed a statistical significant difference for W.I. between the groups treated with antibiotic and the T group (p less than .001). For all the other morbidities, no statistically significant differences were found between the groups, demonstrating that all three methods are considerably efficient in reducing postoperative morbidity in hysterectomy.

Breast metastasis of ovarian cancer during cis-platinum therapy. A case report and review of the literature.

Metastases of the breast are extremely rare. Organs with a high incidence of primary tumors are believed to be more highly resistant to secondary tumors. This paper reports on a case of right breast metastasis in a woman being treated for ovarian cancer with cis-Platinum therapy. Review of the literature and illustration of the nine cases so far reported.