Primary non-Hodgkin,s lymphoma of the uterine cervix.

Primary malignant lymphoma of the cervix is a rare disease. Because the number of reports of this cancer is limited, there is no consensus on its management, prognosis or the efficacy of various treatments. Primary malignant lymphoma of the cervix stage Ib was diagnosed in a 25-year-old woman. The patient was treated with 6 courses of CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone). Clinical and pathological responses were complete. This case supports current thinking in that, in selected young patients with primary malignant lymphoma of the cervix who desire to preserve fertility and ovarian functions, combination chemotherapy regimens such as CHOP are the treatment of choice.

Endometrial cancer in Thai women aged 45 years or younger.

The aim of this retrospective study was to clarify the clinopathologic profile of endometrial cancers in women aged 45 years or younger. All patients with histopathologically confirmed endometrial cancer treated at Songklanagarind Hospital from 1996-2005 were included. Of the 51 identified, 40 (78.4%) were in stage I, 7 (13.7%) in stage II, and 4 (7.8%) in stage III. The age range was 25-45 years (median 41) with a body mass index ranging from 17.6-44.2 (median 27.2). Eighty one percent reported abnormal vaginal bleeding, and twenty four percent polycystic ovaries. Prevalences of diabetes mellitus, hypertension and thyroid disease were 17.7%, 15.7%, and 3.9%, respectively. Seven cases (13.7%) had synchronous ovarian cancer with endometriod adenocarcinoma as the most common histopathological form. Forty patients had well differentiated, 8 moderately differentiated and 2 poorly differentiated tumors. The 5-year disease-free survival (and 95% CI) and 5-year overall survival rates were 88.0% (75.1-94.4%) and 87.5% (74.1-94.2%), respectively. Univariate analysis revealed that patients who had a history of hypertension or lymph node metastasis had a poor prognosis. We conclude that the majority of women aged 45 years or younger with endometrial cancer were obese and the tumors were most commonly in an early stage and were well differentiated.

Association between prognostic factors and disease-free survival of cervical cancer stage IB1 patients undergoing radical hysterectomy.

This study was designed to identify prognostic factors of patients with cervical cancer stage IB1 undergoing radical hysterectomy. The medical records and specimens of two hundred and five patients with cervical cancer stage IB1 undergoing radical hysterectomy at Songklanagarind Hospital from July 1995 to June 2005 were reviewed. Patients' age, tumor size, histologic type, tumor grade, depth of invasion, degree of stromal invasion, lymph-vascular space invasion (LVSI), surgical margin status, pelvic node status, and adjuvant treatment were assessed for correlation with disease-free survival (DFS). The mean age of these patients was 44.2 years and the median follow up was 56 months. Twenty five patients (12.2%) developed recurrent disease. The overall 5-year DFS was 86%. In univariate analysis, depth of invasion, degree of stromal invasion, LVSI, and pelvic node status were significant prognostic factors. In multivariate analysis, degree of stromal invasion remained the only independent prognostic factor. In conclusion, degree of stromal invasion was the main independent predictor of prognosis in surgical cases of cervical cancer stage IB1.

Lack of effect of perioperative blood transfusion during radical hysterectomy with lymph node dissection on the prognosis of cervical cancer stage Ib.

The aim of this retrospective study was to analyze the effects of perioperative blood transfusion during radical hysterectomy with lymph node dissection on the prognosis of cervical cancer stage Ib. A total of 295 patients who had undergone surgery from 1987-2002 were included. Forty seven patients underwent conization before definite surgery, and 2 patients were subsequently lost to follow up. Among the remaining 246 patients, 97 received allogenic blood transfusion, 38 received autologous blood transfusion, and 111 received no transfusion. The clinicopathologic finding of these three groups were reviewed and analyzed. There was no significant difference among three groups in age, chief complaints, duration of symptoms, size of lesion, histopathology, grade, margin or parametrium involvement, node status or postoperative adjuvant treatment. The most prominent presenting symptoms were abnormal vaginal discharge, abnormal vaginal bleeding, and postcoital bleeding. Although the 5-year disease-free survival (DFS) (and 95% CI) for autologous blood transfused group was 90.9% (74.4-97.0%), falling to 88.1% (77.8-93.8%) in untransfused blood group and 81.7% (71.3-88.6%) in allogenic transfused blood group, there were no significant differences among three groups (P = 0.699). In multivariate analyses, only age (P = 0.046), size of lesion (P = 0.024) and histology (P = 0.046) were statistically significantly associated with DFS, whereas transfusion status was not. In conclusion, there is no evidence that perioperative blood transfusion affects DFS of patients undergoing radical hysterectomy and pelvic lymphadenectomy. Only age, size of lesion and histology were statistically significantly associated with DFS.

Gynecologic tumors during childhood and adolescence.

The majority of genital tumors are similar in almost all of the cell types but the frequency is different between children, adolescents, and female adults. The primary site of tumor is similar to the adults, however, the potential of malignant occurrence is higher among children and adolescents. The outline of this article covers clinical manifestation, differential diagnosis, investigation, and management in the particular disease/condition. The challenges of gynecology in children and adolescents are the complexity of physical and mental health, so the approach needs delicate skill and reasoning. Because they are not in full adulthood but in the transitional stage, the multidisciplinary and meticulous approach and management is a substantial issue. Balance and flexibility are the main key of this medical care. Extreme surgical intervention leading to over treatment or ignorance and carelessness leading to under quality of care are challenges facing the doctor.

Clinico-pathological profile of vulva cancer in southern Thailand: analysis of 66 cases.

OBJECTIVE: To evaluate the clinico-pathologic findings and treatment outcome of women with vulva cancer in Southern Thailand. MATERIAL AND METHOD: The authors retrospectively reviewed the medical records of 66 women who had been treated with surgery from June 1984 to October 2003 at the Department of Obstetrics and Gynecology, Prince of Songkla University. RESULTS: The patients' age ranged from 30 to 87 years, mean 58.2 years. Two most common presentations were vulva mass (89.4%) and pruritus (57.6%). Duration of symptoms at presentation ranged form 1 month to 5 years. Most cases were squamous cell carcinoma (82.0%). The distribution by FIGO surgical stage I, II, III and IV was 9.1%, 47.0%, 34.8% and 9.1%, respectively. The most common complication was wound infection (45.5%), followed by wound dehiscence, lymphosis and leg edema (each 15.2%). The 5-year survival (and 95% CI) for stages I, II, III and IV was 100%, 96% (76-99%), 94% (63-99%) and 60 (13-88%), respectively. The 5-year survival for node-positive cases was 82% (54-94%) versus 100% for node-negative cases (p = 0.0003). Stage was a significant predictor of survival (p = 0.0142) and disease-free survival (p = 0.0112). CONCLUSION: Stage and nodal involvement are predictors of survival, and stage is a predictor of disease-free survival.