[Photodynamic diagnosis of vulvar precancerous conditions and invasive cancers using 5-aminolevulinic acid]. / Zastosowanie metody fotodynamicznej w diagnostyce zmian przednowotworowych i nowotworowych sromu.

BACKGROUND: Photodynamic therapy (PDT), in particular Photodynamic diagnosis (PDD) is a modern, non-invasive technique using photosensitizer like 5-aminolevulinic acid (5-ALA) in detection of the vulvar diseases. Photodynamic therapy gives the possibilities to differentiate inflammatory diseases from precancerous lesions and invasive vulvar cancer. OBJECTIVE: To assess accuracy of the PDD in detection, localisation and differentiation of precancerous diseases and invasive cancer of the vulva. MATERIAL AND METHODS: This study included 107 patients with vulvar disorders, 30 patients with VIN I, 31 patients with VIN II, and 46 patients with VIN III and vulvar carcinoma. All women underwent a standard gynaecologic examination. 5-ALA was topically applied to the vulva. After 180-360 minutes the vulvar skin was illuminated by a short--are xenon lamp at 380-440 nm and an output of 200 mW (D-Light; Karl storz). A filter to select the emitted wavelength range 630-670 nm was used in order to achieve differentiation's of the fluorescence--positive and negative areas. After the PDD, biopsies were taken from patients with multifocal VIN lesions. Macroscopic appearance, fluorescence pattern in scale of three degrees (zero, +, ++) and histology of the lesions were compared. RESULTS: The sensitivity, specificity, positive and negative predictive value for the detection of VIN I were 85.7%, 81.2%, 80.0%, 86.6% respectively, for VIN II there were 93.3%, 93.7%, 93.3% and 93.7%, and for VIN III and invasive vulvar cancer there were 96.3%, 94.7%, 96.3% and 94.7% respectively. The sensitivity, specificity, positive and negative predictive value for the detection of all VIN and invasive vulvar cancer common were 92.9%, 90.2%, 91.2%, 92.0 respectively. CONCLUSION: The Photodynamic therapy becomes a valuable, non-invasive diagnostic tool that lowers the amount of false negative diagnosis in cases of VIN and vulvar cancer.

[Malignant tumors of the female genital track in the elderly]. / Nowotwory zlosliwe narzadów plciowych u kobiet w okresie senium.

OBJECTIVE: In senium the increase in the incidence of most malignant neoplasms, as well as gynecological cancers is found. In this period of life the vast number of women do not apply for the preventive and follow-up examinations, which increases the number of malignant diseases diagnosed at advanced clinical stages. The coexisting another diseases often limits the possibility of the operative treatment in those cases. DESIGN: To assess the profile of malignant tumors of the genital tract and their treatment in women above 70 year old. MATERIAL AND METHODS: 61 women aged from 71 yrs. to 88 yrs. treated operatively between 1997-2001 due to gynecological cancers were included into the study. The structure and detectability of the neoplasms, as well as the type of performed surgical procedures were analysed. RESULTS: 30 endometrial cancers (49.2%), 16 ovarian cancers (26.2%), 14 vulvar cancers (22.9%) and 1 cervical cancer were diagnosed and surgically treated. The endometrial cancer stage I was detected in 18 cases, stage II in 4 cases and stage III in 8 cases. In each case the radical operation was done (total hysterectomy, lymphadenectomy and appendectomy). The ovarian cancer stage I was detected in 3 cases, stage II in 2 cases, stage III in 5 cases, and stage IV in 6 cases. Only in 5 cases out of this group the radical surgery was performed (total hysterectomy, omentectomy and appendectomy). The vulvar cancer stage I was detected in 2 cases, stage II in 11 cases, and FIGO stage III in 4 cases. In each of these women the vulva and bilateral inguinal lymph nodes were resected, and in 2 cases additionally at the same time the Miles operation was performed. The cervical cancer clinical stage I was detected, and the Wertheim operation was performed. CONCLUSIONS: The most often diagnosed malignant neoplasm in women above 70 yrs. was the endometrial cancer. The worst first-time diagnosis structure was observed in the ovarian cancer, what significantly decreased the ability of surgical treatment in this group.

[Vaginal leiomyoma]. / Miesniak gladkokomórkowy pochwy.

Vaginal leiomyoma is a very rare condition. The earliest reference made to such a tumor is attributed to Denys De Leyden in 1773, and the first review of the literature concerning such tumors was published in 1882. It is estimated approximately 300 leiomyomas of the vagina have been reported in the world literature. The case of a 39-year-old female with large vaginal leiomyoma illustrates the diagnostic difficulties in such cases. In leiomyoma of the vagina surgical treatment is recommended.

[Clinical analysis of 105 cases of vulvar cancer]. / Analiza kliniczna 105 przypadków raka sromu.

OBJECTIVES: Vulvar cancer has a low frequency (4-5%) compared to other genital cancers. It should be considered as a skin tumor and its detection is possible in an early stage. However, because of patients' and doctors' delay, one in three vulvar cancers is not treated before an advanced stage. DESIGN: To estimate clinical and histopathological features of vulvar cancer. MATERIAL AND METHOD: We analysed 105 women with a primary malignant vulvar disease treated operatively in our Dept. in the years 1991-2002. In the group there were 82 invasive tumours (80 squamous and 2 solid) and 23 intraepithelial cancers. RESULTS: The mean age in the group of intraepithelial cancer was 53.2 +/- 13.2 years, and in the group of invasive disease 65.0 +/- 11.7 years. The most common symptoms were ache (40.0%) and pruritus of the vulva (35.2%). 33.3% women were asymptomatic. Most of cancers were localised on the large pudendal lip (71.4%). Inguinal node dissections performed on invasive cancer patients showed negative nodes in 57 cases and positive in 25 cases. Sensitivity, specificity, positive and negative predictive value for clinical detection of metastatic cancer in the inguinal nodes were 60%, 82.4%, 60%, 82.4% respectively. The distribution by stage included Stage 0--21.9%; Stage I--19.0%; Stage II--31.4%; Stage III--11.5%; and Stage IV--19.0%. The commonest surgical procedure was a simple vulvectomy with a bilateral inguinal lymphadenectomy. CONCLUSIONS: Vulvar squamous cell carcinoma predominantly affects older women. It benefits from early detection, and their morbidity is decreased by early treatment. It is necessary to educate patients to improve the detection of vulvar cancer.

[The results of screening program for cervical cancer in Lodz]. / Wyniki badania przesiewowego dla wczesnego wykrywania raka szyjki macicy u kobiet w regionie lódzkim.

OBJECTIVES: Despite effective screening methods, most often tumor of the urogenital tract is still cancer of the uterine cervix. Proven in many countries the value of widespread screening of the precancerous lesions and cervical cancer justifies carrying out such prophylactic tests in Poland. DESIGN: Assessment of results of screening as a method of early detection of cancer of the uterine cervix among inhabitants of Lódz area. MATERIAL AND METHODS: Study was done between 1.07.2000 and 31.12.2000 among 5,000 women aged from 30 to 59 years, inhabitants of Lódz area. Smears were evaluated in five-grade Papanicolaou scale and according to TBS system. In cases of detection of erosion of the uterine cervix or abnormal results of cytological test (> or = III degree) biopsies were taken to make pathological diagnosis. RESULTS: 459 smears were qualified to group I according to Papanicolaou (9.18%), 4435 smears to group II (88.7%), 38 smears to II/III (0.76%), 65 smears to group III (1.3%), 2 smears to IV (0.04%) and 1 smear to V (0.02%). Due to histopathological verification of the cytological results 53 low grade cervical dysplasia (1.06%) were diagnosed, 8 dysplasia of medium grade (0.16%), 7 high grade dysplasia (0.14%), 3 pre-invasive cancers (0.06%) and 3 invasive cancers (0.06%). CONCLUSIONS: Population of inhabitants of Lódz area aged 30 to 59 years old is characterised by a high frequency of incidence of pre-cancerous conditions and invasive cervical cancer. Number of detected pathologies of the uterine cervix proves purposefulness of this project.