Ovarian malignancies in adolescence.

Ovarian malignancies, although rare during adolescence, constitute the most common genital neoplasms in this age group. Germ cell tumors account for the majority of cases (61.5%), whereas 20% belong to the common epithelial group and 9.5% derive from sex cords and ovarian stroma. Dysgerminomas are the most frequent germ cell tumors. They are usually large and often secrete hormones and tumor markers that can be useful in monitoring the course of the disease. Diagnosis is often made in stage IA, and conservative surgery is the treatment of choice. In the epithelial neoplasm group, mucinous tumors are more common than usual (39.4% instead of 12%). The incidence of borderline tumors is also higher (30.3% versus 6-10%). Adnexectomy and, if needed, extirpation of peritoneal implants is considered adequate treatment. Sex cord-stromal tumors consist of epithelial (granulosa-Sertoli cells) and mesenchymal elements in a variety of combinations. Granulosa cell tumor is the most common subtype, presenting as the juvenile form in young females. It is of low malignant potential and is adequately treated with adnexectomy only.

"Butterfly" operation vs triple incision technique in vulvar cancer. a comparison of morbidity and clinical outcome.

Two groups (group A = 25 cases and group B = 34 cases) of vulvar cancer patients, treated with a modified "butterfly" operation (MBO = group A) and a triple incision (TI = group B) technique, were evaluated retrospectively. The aim was to compare the two operative methods, regarding perioperative morbidity and clinical outcome. The histopathologic and clinical characteristics of the patients were comparable, in the two groups. The hospitalization period was significantly shorter in group B (TI), both when primary (22 vs 34 days, p < 0.01) or secondary (41 vs 55 days, p < 0.05) healing occurred. Local recurrences were quite similar in number (A = 5/25, B = 6/34) and were successfully treated. No relapses in the remaining skin bridges were observed in group B. The overall survival was similar in the two groups (A = 64%, B = 63%). However, LN positive cases had a better (p < 0.05) survival when treated by MBO (48% vs 23%).

Pelvic lymphocysts after radical hysterectomy and lymphadenectomy.

Five cases (5.5%) of lymphocysts were diagnosed and treated, among 80 type III modified radical hysterectomies performed for cervical cancer St. Ia2-IIa, in the last 6 years. Identification was initially made by palpation and confirmed by CT or US, in 4/5 cases in the first 2 postoperative months. Pelvic pain, fever and pressure symptoms were the most common clinical findings. A conservative approach was successful in 4/5 cases. Spontaneous regression was observed in one, while needle aspiration under radiologic guidance with (1/3) or without (2/3) tube insertion was applied in the rest. Conservative treatment failed in the last case presenting with a 12 cm cyst. An intestinal fistula developed, necessitating partial resection of the ileus and marsipulization. The complicated course of this patient's disease may indicate that a more aggressive treatment is warranted for large persisting cysts located in the irradiated field.

Chromosome aberrations and expression of ras and myc oncogenes in leiomyomas and a leiomyosarcoma of the uterus.

Twenty eight leiomyomas and one leiomyosarcoma were cytogenetically analysed and also examined for ras and myc oncoprotein expression. Chromosome alterations were found in seven leiomyoma cases. In four of them 12q14-15 was involved. P21 product of H-ras and P62 product of c-myc genes were detected in paraffin embedded parallel tissue sections. A high expression of H-ras was apparent in most tumors. C-myc expression was weak or negative in most leiomyomas with normal karyotype while on the contrary in three out of seven cases with abnormal cytogenetic findings the gene product stained moderately positive. Considerable chromosome abnormalities and oncogene overexpression were also identified in the leiomyosarcoma.