[Carcinoma of the cervical stump--multicenter study]. / Wystepowanie raka szyjki macicy po histerektomii nadszyjkowej--badanie wieloosrodkowe.

OBJECTIVES: Cervix-sparing hysterectomy due to benign conditions remains controversial, especially when the presumed risk of cervical cancer in the retained cervical stump is concerned. On the other hand, supracervical hysterectomy is associated with shorter operative time, decreased blood loss and decreased intraoperative complications. Moreover, beneficial effects of retaining the cervix on the pelvic statics and female psychosexual functioning have been suggested, although not yet proven. THE AIM: The aim of the study was to determine the frequency and types of cervical cancers in the retained cervical stump after supracervical hysterectomy performed due to benign diseases of the uterine corpus in four academic settings. MATERIAL AND METHODS: Retrospective review of medical records of 903 women who underwent treatment due to cervical carcinoma in four departments participating in the study: Centre 1- 2nd Department of Gynecology, Medical University Lublin (years: 2001- 2011); Centre 2- Department of Gynecology and Gynecologic Oncology, Military Institute of Medicine, Warsaw (years: 2002-2012); Centre 3- Katedra i Kliniki Poloznictwa, Chorób Kobiecych i Ginekologii Onkologicznej II Wydzialu Lekarskiego WUM, Warsaw (years: 2008-2013) and Centre 4- Department of Gynecologic Oncology, Poznan University of Medical Sciences, (years: 2000-2012). The occurrence rate of cervical stump carcinoma was reported in relation to patient age, time elapsed between supracervical hysterectomy and diagnosis stump cancer and histological type of cancer. RESULTS: Only 3 cases of cervical stump carcinoma (0.33%) were identified among the 903 investigated women. In all these cases, cervical stump cancers were diagnosed several years after supracervical hysterectomy. In one case the only treatment was radiotherapy in one case only trachelectomy was performed, whereas in one case surgery followed by radiotherapy was used. CONCLUSIONS: It should be remembered that subtotal hysterectomy carries a risk, albeit relatively low, of developing stump cancer. Therefore, patients should be informed that after such operation further cervical cancer screening is mandatory. Moreover subtotal hysterectomy should not be offered in populations at risk of developing cancer of the uterine cervix.

[Therapeutic and prognostic value of lymphadenectomy in gynecological oncology]. / Wartosc prognostyczno-terapeutyczna limfadenektomii w onkologii ginekologicznej.

Lymphadenectomy is an integral part of gynecological cancer surgery however there is still lack of standardization in the terminology used. In the current literature several types of surgical procedures for pelvic lymph nodes dissection are recognized. Complete pelvic lymphadenectomy is defined as the removal of all fatty lymphatic tissue from the predicted areas of high incidence of lymph nodes with possible metastatic involvement. Para-aortic lymphadenectomy is defined as the removal of all lymphatic tissue from the aortic region. The latter is divided into two levels: the lower--up to the inferior mesenteric artery and the upper--up to the left renal vein. Another classification divided pelvic and aortic lymphadenectomy into three classes. Class I is defined as the removal of the chosen lymph nodes, class II as the removal of lymph nodes located ventrally and laterally to the large retroperitoneal pelvic vessels, obturator nerves and laterally to the aorta and the inferior vena cava, whereas class III as the complete removal of lymphatic tissue surrounding the iliac vessels, obturator pits, dorsally to the obturator nerve and the presacral lymph tissue around the aorta and the inferior vena cava. In each gynecological cancer depending on the severity of the disease different procedures are applied concerning lymphadenectomy. In patients with advanced ovarian cancer systematic lymphadenectomy prolongs the survival rate. Omission of systematic lymphadenectomy can be considered only for patients with mucinous carcinoma G1 level. In the case of vulvar cancer removal of pelvic, iliac and obturator lymph nodes is inappropriate as it has not been proven to result in an increased survival rate. Inguinal lymphadenectomy in this cancer depends on the stage and location of the primary tumor--at an early stage vulvar cancer located laterally a superficial, unilateral inguinal lymphadenectomy can be performed, if the primary lesion is located centrally an inguinal lymphadenectomy should be performed on both sides. Deep inguinal lymphadenectomy should be performed only in cases where: primary tumor is located centrally in case of cancer in the early stages, in advanced stage and in patients with metastases in the superficial nodes. Sentinel lymph node biopsy is an alternative method that can be offered to patients with early-stage vulvar cancer located laterally. Lymphadenectomy in endometrial cancer is beneficial in stages I G3, II and III. In stages I G1 and G2 an increase in the survival time has not been shown. The cervical cancer stage IB-IIA removal of para-aortic lymph nodes (to the mesenteric artery) is indicated in patients with large tumors and suspected or known disease in the pelvic nodes. In patients in whom diagnostic imaging studies have not shown metastasis in para-aortic and pelvic lymph nodes or distant metastasis, para-aortic lymphadenectomy can be omitted. Further randomized studies are needed to elucidate the necessity and extent of lymphadenectomy in given gynecological cancers.

[Gynecological aspects of allogenic stem cell transplantation--incidence, risk factors and preventive strategies--description of two clinical cases and literature review]. / Ginekologiczne problemy zwiazane z transplantacja szpiku--czestosc wystepowania, czynniki ryzyka i zalecenia lecznicze--opis dwóch przypadków i przeglad literatury.

Vaginal graft-versus-host disease (GVHD) is a rather common and underreported complication of allergenic stem cell transplantation. It occurs in approximately 25% of all women undergoing hematopoietic stem cell transplantation. In severe manifestation, GVHD might cause complete obliteration of the vagina which requires surgical intervention. In this paper we described 2 cases with complete obliteration of the vagina. We present a case report of 2 women (both 38 years old) diagnosed with complete vaginal obliteration after myeloablative chemotherapy and bone marrow transplant. Both patients were operated at the Second Department of Gynecology Lublin. During the operation we reconstructed the entire vaginal length using either sharp or blunt dissection until the cervix was visualized. Immediately after the reconstruction, we placed a phantom within the vaginal canal for 7 days in order to separate the vaginal wall and prevent the formation of new adhesions. Both patients received antibiotic prophylaxis for 5 days, as well as ointment with Cyclosporine twice a day since postoperative day 2, and 50 microg estrogen transdermal patch every 4 days. The patients were discharged from the hospital on postoperative day 7 and were recommended to use cyclosporine ointment twice a day and intra-vaginal tablets with Estrogen every 3 days. After 6 weeks a follow up revealed complete healing of the vaginal canal and both patients resumed uneventful sexual intercourses. A literature review of preventive strategies for vaginal GVHD was also presented.

[Intracrinology and dehydroepiandrosterone--a new perspective for the use of androgens in hormone replacement therapy in postmenopausal women]. / Intrakrynologia a dehydroepiandrosteron --nowe spojrzenie na terapeutyczne zastosowanie androgenów w terapii substytucyjnej u kobiet w okresie menopauzy.

During menopausal transition not only ovarian production of estrogens but also marked decrease of adrenal androgen production are observed Decreased secretion of adrenal DHEA and DHEA-S result in reduction of peripheral conversion of these steroids into active estrogens and androgens. Intracrinology describes the biosynthesis of active steroids in peripheral target tissues in which the action of theses steroids takes place, without release into the extracellular space or general circulation. DHEA administration to postmenopausal women significantly increases bone mineral density decreases insulin resistance and amount of fat tissue and exerts an estrogenic effect on vaginal cytology in the absence of endometrial stimulation. Moreover animal experiments proved that DHEA suppresses the growth of breast cancer which is yet another reason to consider this steroid as a part of hormone replacement therapy in women.

[Effect of topotecan as a second line treatment in small cell lung cancer patients. Preliminary report]. / Ocena wartosci topotekanu w drugiej linii leczenia drobnokomórkowego raka ptuca. Doniesienie wstepne.

INTRODUCTION: Small cell lung cancer (SCLC) is an aggressive malignancy with high propensity for early regional and distant metastases. Response rate to first-line chemotherapy is high but typically short-therm. All patients with extensive disease and majority with limited disease have recurrence of disease. The choice of second-line chemotherapy in case of progression depends on many factors, including type of first-line chemotherapy, response to treatment, progression-free survival and patients' performance status. No standard second-line treatment has been established until recently. Monotherapy with topotecan is widely used in second-line treatment especially in patients in poor performance status. MATERIAL AND METHODS: The aim of the study was to evaluate the results of monotherapy with topotecan. We also determined the predictive markers which could affect the therapeutic effect of topotecan. The examined group consisted of 42 patients with extensive stage of SCLC. Cox regression model was used to establish adverse factors, which were prognostic for overall survival of our patients divided into two groups according to administrated chemotherapy: 21 topotecan-treated and 21 standard chemotherapy-treated. Six variables that gave a maximum hazard ratio (HR) were used in the final model, e.g.: the age above 65 (HR = 2.35), anemia (HR = 1.83) and poor performance status (HR = 1.51). These variables scored the points according to their prognostic significance and HR. RESULTS: In Kaplan-Meier analysis, in the group of patients treated with topotecan, the higher survival probability was noted for patients scored below 10 points than for patients scored above 10 points. The prognostic scale was not useful for patients with other scheme of chemotherapy. Five partial responses (24%) in topotecan-treated patients were noted. CONCLUSIONS: Precise qualification of patients to topotecan monotherapy in second-line treatment may be effective to prolong survival and increase the percentage of SCLC patients with objective response.