[Controversies on the staging of microinvasive cervix carcinoma]. / Controversie sulla stadiazione del carcinoma microinvasivo della cervice.

Controversies regarding the nosographical classification and staging of microinvasive cervical cancer are still the subject of debate largely based on two schools of thought: one privileges the morphovolumetric criterion, while the other, in an attempt to overcome one of the general aims of FIGO staging, pragmatically assigns a therapeutic orientation to it and proposes staging criteria that the opposing school finds arbitrary and not satisfactory for prognostic purposes. The key point that generates most of the dissension is the correctness of the biopsy procedures and the histological process used to examine material. The general rules for FIGO staging are rightly based on the limitation that clinical staging cannot be modified, even when subsequent histological or surgical findings show a different extension of the disease. But this is true of "clinical" carcinomas for which the diagnostic and staging criteria are still mainly clinical using procedures that have been classified by FIGO itself. However, in those cases where the diagnosis of staging is exclusively microscopic, as in IA, clear indications should be given regarding the procedures and failure to observe them should preclude staging.

[Tamoxifen and giant endometrial polyps]. / Tamoxifene e polipi endometriali giganti.

Tamoxifen is a synthetic non-steroid anti-estrogen that has been used effectively for several years in the adjuvant treatment of breast cancer. Although its therapeutic effect is due to its anti-estrogenic properties, the drug also shows modest type B estrogen-receptor agonist activity during the menopausal period in which estrogens are at a low level. Owing to the fall in estrogen levels in menopause, tamoxifen provokes an up-regulation of both estrogen and progesterone receptors at an endometrial tissue is a direct consequence of this. This proliferation, which is the result of an inappropriate response of the basal layer and the basis for the onset of hyperplasia and polyps in the tissue. At standard therapeutic dosages, tamoxifen in postmenopausal women is associated with the onset of alterations in the vaginal and endometrial epithelium. Cases of endometrial hyperplasia, endometrial polyps, adenomyosis, endometriosis and fibromyomas are described in the literature. Endometrial polyps represent the most common pathology associated with TAM in women with previous breast cancer in menopause. The estrogenic stimulus to polyps following TAM treatment may be considerable, resulting in their growth to sizeable proportions, causing metrorrhagia and suspected neoplastic pathology. Two cases of patients receiving adjuvant treatment with tamoxifen for previous breast cancer, who presented two giant endometrial polyps of uncommon dimension, are reported.

[Screening strategies for vulvar preneoplastic and neoplastic lesions]. / Strategie di screening delle lesioni preneoplastiche e neoplastiche della vulva.

BACKGROUND: Although they cover superficial areas, preneoplastic and neoplastic lesions of the vulva are often diagnosed late. The reasons for this delay is the low incidence of this invasive neoplasm, the advanced age of patients, the non-specific symptoms mainly taking the form of itch, burning, dyspareunia and blood loss, which are also compatible with a non-neoplastic infective pathology. The late diagnosis of carcinoma of the vulva may also be linked to the inadequate examination of the external genitals by doctors as a result of insufficient specific knowledge. Epidemiological data and the natural history of VIN lesions and carcinoma of the vulva argue that mass screening is not feasible, but an adequate programme of early diagnosis must be introduced. Early diagnosis is linked to three key elements: targeted anamnesis, clinical examination and the appropriate use of the various diagnostic procedures. Vulvoscopy represents the most reliable method, above all because it allows a biopsy to be taken of any suspected lesion. METHODS: From January 1992 to December 1998, a total of 1678 vulvoscopies were performed at the Institute of Clinical Obstetrics and Gynecology of the University of Catania in patients aged between 16 and 82 years old. Biopsies were taken of all suspected lesions. RESULTS: Sixty-nine cases of VIN (4.11%) were diagnosed: 28 VIN1, 24 VIN2 and 17 VIN3. Lesions were only symptomatic in 39.1% of cases. CONCLUSIONS: The association of vulvoscopy with biopsy of suspected lesions, even in the absence of vulvar symptoms, represents the most efficacious method for the diagnosis of intraepithelial lesions.

Angiogenesis as a prognostic factor in cervical carcinoma.

Angiogenesis and other prognostic factors have been studied among 32 recurrences and 28 deaths of 420 patients with cervical carcinoma operated in the 1st Department of Obstetrics & Gynecology of Catania University. Prognostic factors were studied in comparison with a group of patients still alive and NED was followed for more than 60 months independently of stage and node involvement. Angiogenesis, nuclear grading 3, and lymphovascular invasion were factors common to all patients with negative prognosis. It seems that in the presence of these negative prognostic factors, we should adopt a more aggressive attitude in both our surgical strategies and adjuvant therapies, particularly preferring chemotherapy where angiogenesis is more significant.

[Gynecologic oncology: a daily confrontation for the gynecologist]. / Oncologia ginecologica: confronto quotidiano per il ginecologo.

In the last decades a new discipline of "gynaecologic oncology" has spontaneously developed in the field of obstetrics and gynaecology. In this article the authors point out the necessity of an oncologic education for the gynecologist. The gynaecologist oncologist must have a solid cultural background in general and medical oncology, radio and immunotherapy. He also must have acquired surgical experience and clinical maturity. The authors underline the important role of the "general" gynecologist who must recognize risk cases, formulate a correct pre-surgical staging in order to plan a rational therapy and take part in the follow-up. His participation is important in the care of end-stage patients.