Comparative morphometric study on the depth of invasion in vulvar carcinoma.

Various studies assess the significance of depth of invasion as an important prognostic factor in squamous cell carcinoma of the vulva. However, methodologic problems exist with regard to the measurement points. While the deepest point of invasion can be measured accurately, the upper reference point is arbitrarily chosen. The goal of the present study was to identify the method of measurement and the threshold value, allowing the clearest prognostic differentiation between groups of patients with vulvar carcinoma. The study involved 124 patients treated between 1971 and 1980, who had received identical treatment (simple vulvectomy followed by local and inguinal irradiation) and identical histopathologic workup (large-scale sections). Beginning with the deepest point of tumor invasion, comparative measurement was carried out with three different points of reference: to the basement of the most superficial dermal papilla (method A), to the surface of the tumor (method B), and to the basement membrane of the deepest rete ridge (method C). The data were used to determine differences in specified end points. The results and conclusions are as follows: (1) The morphometrically determined degree of tumor invasion had prognostic significance. (2) Measurement of tumor thickness (method B) prognostically differentiates patient groups better than measurement of invasion from the most superficially lying epithelial papilla (method A), if classified into tumors up to and over 0.5 cm. (3) Patients with superficial invasive vulvar carcinomas up to 0.5 cm can be further prognostically differentiated into two groups, when measuring depth of invasion from the deepest rete ridge (method C), and classifying into tumors up to and over 0.3 cm.

Melanoma of the vulva.

This study evaluated the prognostic value of different morphologic tumor parameters in 13 cases of malignant melanoma. Tumor thickness correlated well with survival. The prognostic index--tumor thickness multiplied by the number of mitoses per square millimeter--was useful in predicting metastasis risk.

[Postoperative complications following gynecologic operations in elderly females with benign and malignant changes of the genitals]. / Postoperative Komplikationen nach gynäkologischen Operationen bei älteren Frauen mit benignen bzw. malignen Veränderungen des Genitale.

The retrospective study reported here, which covered 2116 patients operated on, indicates that postoperative complications are more likely to occur in women aged over 60 than in younger patients. There is also a connection between the patient's age and previous internal disease, the surgical approach, and the severity of the change requiring surgery. The connection between age and postoperative complications is principally explained by previous internal disease. Patients with malignant tumors are at greater risk than women with benign genital changes. Carcinoma cases apart, these patients are older and have suffered more from previous internal disease. While postoperative morbidity and mortality rates are higher among older patients, the percentage of complications occurring is so low that age does not represent a contraindication to gynecological surgery.

Infiltrating mononuclear cells in human breast carcinoma: predominance of T4+ monocytic cells in the tumor stroma.

Frozen sections of 52 breast carcinomas were examined for the presence and nature of a leukocytic infiltrate. The number of "common leukocyte (T200-) antigen"-bearing cells was remarkably high in the stromal compartment of the carcinomas, whereas the tumor foci themselves were usually infiltrated only sparsely. Approximately 80% of these T200+ stromal cells carried the myelomonocyte lineage-associated antigens M-M522 and 63D3 and exhibited "non-specific esterase" activity. More than 2/3 of the stromal monocytic cells expressed the T4 antigen as verified by monoclonal antibodies (MAbs) directed against different T4-associated epitopes. A T-cell analysis showed that T4+ cells clearly outweighed the total number of T cells as defined by anti-T3 and anti-TII antibodies. In addition, a correlation became apparent between the HLA-DR phenotype and the T lymphocyte content of tumor cell areas in the sense that densely infiltrated tumor areas were invariably HLA-DR+.

[Diagnostic conization in clinical cervix cancer]. / Zur Problematik der diagnostischen Konisation beim klinischen Zervixkarzinom.

Various methods of tissue sampling are used to verify histologically a clinical carcinoma of the cervix. The question arises whether or not diagnostic cone biopsy has any influence on the treatment and/or the clinical course of this disease. The clinical and histological data and the follow-up of 185 patients with squamous cell carcinoma of the cervix were statistically evaluated. We found no difference between patients with or without cone biopsy in respect of complications, frequency of metastases or recurrences, and survival. However, our deliberations permit the following statement: cone biopsy is an appropriate method to diagnose cervical intraepithelial neoplasia (CIN) or microcarcinoma of the cervix and may--under certain conditions--even be the adequate therapy. However, cone biopsy lacks any advantage over other diagnostic methods if it is employed merely for the purpose of histological verification of clinical carcinoma of the cervix.

[Selective removal of one twin with trisomy 21 by sectio parva in the 23rd week of pregnancy and later spontaneous birth of the healthy twin]. / Selektive Entfernung eines Zwillings mit Trisomie 21 durch Sectio parva in der 23. Schwangerschaftswoche und spätere Spontangeburt des gesunden zweiten Zwillings.

In a 41-year old tertipara with twin pregnancy, foetal chromosome analysis showed a boy without abnormal findings, 46, XY, and a boy with free trisomy 21. Abortion of the abnormal twin was performed in the 23rd week of pregnancy via sectio parva. Despite preoperative onset of tocolysis and ultimately performed circular suture of the cervix, premature rupture of the membranes occurred in the 28th pregnancy week, followed by spontaneous birth of the second twin weighing 1010 g. Raising of the premature baby did not present any special problems.

What's new in prognosis of uterine cancer?

Prognosis represents an attempt of prediction of a future evolution, based on the critical judgement of a present status. A prognosis may have a qualitative as well as a quantitative character. The qualitative evaluation considers whether the course of a disease is modified, which means, whether it is influenced in a favourable or a disadvantageous way. In case of a quantitative statement, healing or absence of symptoms are taken as definitive criteria. It is our aim to analyse the prognostic significance of different criteria in patients with carcinoma of the uterus.

[Surgical treatment of cervix cancer. Treatment results and data on the postoperative course over a minimum of 5 years following uniform surgery and standardized histological examination of the histological material of 1092 patients at 4 university gynecology clinics]. / Die operative Behandlung des Zervixkarzinoms. Behandlungsergebnisse in Kenntnis des postoperativen Verlaufes über mindestens fünf Jahre nach einheitlicher Operation und standardisierter histologischer Untersuchung der Operationspräparate bei 1092 Patientinnen an vier Universitäts-Frauenkliniken.

Treatment results of 1092 patients with operated cervical carcinoma were evaluated and assessed on the basis of data supplied by four University Clinics of gynaecology. Surgical treatment and histological processing of all surgical specimens were uniform. Indication for postoperative radiation was determined differently at the individual clinics. The treatment results obtained can be compared with one another not on the basis of clinical stage assessment; the only criterion is the histologically proven extension of the tumour, ascertained via an examination of the surgically obtained specimen. With continuous tumour growth in accordance with stage Ib, the 5-year survival rate after surgery alone was 90.5%, after additional radiation 95.6%. In case of continuous tumour growth in accordance with stage II, the 5-year survival rate after operation alone was 79.5%, after operation and radiation 83.1%. The differences in the 5-year survival rates are statistically not significant. Taking into consideration a discontinuous metastatic tumour growth in the region of the parametric tissue, the 5-year survival rate after operation alone was 72.7%, after subsequent radiation 75%, in case of metastases in the region of the lymph nodes 77.8% and 60.5%, respectively. These differences in survival rates were not statistically verifiable. Furthermore, if individual tumour parameters were tested and statistical pairing was performed, it became evident that prognosis of patients with infaust tumour criteria could not be influenced by postoperative radiation.

[Morphological criteria in decreased patients who had undergone surgery for cervical cancer]. / Morphologische Tumorkriterien von verstorbenen Patientinnen mit operiertem Zervixkarzinom.

In 966 patients who had undergone surgery and who had been suffering from squamous cell carcinoma, tumour recurrence occurred in 16.8% of the cases. In almost 70% of these cases, recurrence was seen in the first two years following treatment. 15% of the patients died of the carcinoma. Compared with the patients who had stayed alive, post-mortem examination of the patients who had died of carcinoma revealed in 65.5% of the patients an immature squamous cell carcinoma, in 37.7% a dissociated tumour growth, in 21.7% penetration of the tumour into the lymph vessels, and in 62.1% penetration into the blood vessels. Macrometastases in the area of the regional lymphatic nodes were seen in 45.2%. In the surviving patients, the percentage of immature carcinomas was 47.4%, whereas dissociated tumour growth was seen in 18.7% and penetration into the lymph or blood vessels in 5.8 and 14.1% of the cases, respectively. Macrometastases in the area of the regional lymphatic nodes were seen in 11.8% of the cases. In woman patients with an early recurrence of tumour, or in women who had died of the carcinoma, mostly immature carcinomas, tumour penetration into vessels, and macrometastases in regional lymphatic nodes were observed.

[Comparison of mammography and automated sonography in 700 patients]. / Vergleich von Mammographie und automatisierter Sonographie an 700 Patienten.

700 patients underwent routinely x-ray mammography and breast ultrasound with an automated grey-scale breast scanner. The parenchymal pattern of the ultrasound B-scan was morphological identical to the x-ray film. The echogram gave further informations about the topographic localisation of pathologic lesions to the chest wall including the pectoral muscles. The sonogram was of no value in 10 percent due to diffuse reflection of the breast. In cystic disease the diagnostic accuracy of the ultrasound was with about 100 percent superior to that of x-ray mammography. On the contrary the accuracy of the x-ray mammography was higher than that of ultrasound in the diagnosis of benign or malignant solids. Benign adenoma smaller than 1 cm could not be definetively recognised as carcinoma of this size. The diagnostic accuracy of the sonogram was 70 percent by 40 histologically proved carcinomas. The only use of the automated scanner in the diagnostics of the breast seams to be not justified, even not as a screening method, especially because small tumors with good prognosis are not recognized, however, the ultrasound gives additional important informations in the differential diagnosis of benign and malignant lesions of the female breast.

[Hysterectomy for septicemia following caesarean section]. / Die Hysterektomie bei Sepsis nach Kaiserschnitt.

From 1971 to 1980 20 patients at the first department of women of the university of Munich required a puerperal hysterectomy because of septicemia following caesarean section. During the same time a total of 2,726 caesarean sections were performed. 14 of the 20 women requiring hysterectomy had the caesarean section in the first department for women. Six women were referred with septicemia following caesarean section in another hospital. The causative relationship between caesarean section and septicemia was reviewed leading to the indication for hysterectomy. The indications for the caesarean section, risk factors for increased puerperal infection, the postoperative course, the indication for hysterectomy, the findings at operation the findings in the operative specimen and the course following hysterectomy were reviewed. Risk factors promoting an ascending infection postpartum were the type of labor, frequent vaginal examinations, previous attempts at vaginal delivery, and internal fetal monitoring by a scalp electrode. The recognition of incipient septicemia include severe pain in the abdomen and a subjective feeling of severe illness in the patient. The white blood count is increased, the body temperature is high and beginning respiratory insufficiency points to the severity of the illness. In these cases a repeat laparotomy with hysterectomy to eliminate the focus of infection is the treatment of choice for the septicemia. 19 of the patients who required hysterectomy for septicemia following caesarean section were discharged home after a mean hospital stay of 36 days. One of the patients died 41 days following caesarean section and 20 days following hysterectomy because of septicemia resistant to treatment.

Prognostic criteria in patients with endometrial cancer.

Between 1970 and 1977 216 patients were operated on for adenocarcinoma of the endometrium at the I. Universitäts-Frauenklinik, Munich. The 5-year-survival rate for stage Ia was 79.7%, for stage Ib 86.4%, and for stage II 66.7%. Reliable prognostic criteria were tumor grading, lymphatic invasion, and myometrial tumor invasion. The 5-year-survival rate in patients with grade 1 carcinoma was 88.9% in patients with grade 3 carcinoma only 33.3% Patients with adenoacanthoma had a 5-year-survival rate of 73.3%, those with an adenosquamous carcinoma a 5-year-survival rate of 50%. Patients with no evidence of lymphatic invasion showed a 5-year-survival rate of 84.9%, those with proven invasion of lymphatic vessels a survival rate of 52.9%. In patients with tumor infiltrating one third of the myometrium the 5-year-survival rate was 90%. In patients with tumor infiltrating two thirds of the myometrium the 5-year-survival rate was 66.7%, and with infiltration of the full thickness of myometrium it was 33.3%.

[Non-radiologic measures for the diagnosis of ovarian carcinomas]. / Nichtradiologische Massnahmen zur Diagnostik des Ovarialkarzinoms.

The ovarian carcinoma is still a problematic carcinoma. There are no early symptoms and no early diagnostics. Those carcinomas which are detected in an initial stage are generally found by chance during an operation indicated otherwise. Gynecologic palpation is the most important among the non-radiologic diagnostic means. Every ovarian tumor with a size of more than 5 cm is suspicious to be a carcinoma and has to be further investigated. Age is the most important risk factor. After the age of 35, the incidence of the ovarian carcinoma increases continuously until the age of 70. A reliable confirmation of the diagnosis "ovarian carcinoma" is only possible by laparoscopy and/or laparotomy. Laparotomy should be planned in such a manner that therapeutic surgery can be immediately performed if the diagnosis is confirmed.

[The prognostic importance of the stage in patients operated for carcinoma of the endometrium (author's transl)]. / Prognostische Aussagekraft des Stadiums bei Patientin-nen mit operiertem Endometriumkarzinom.

The operative specimens of 216 patients who underwent operation for adenocarcinoma of the endometrium stage I and stage II were thoroughly examined. It was found that measuring the maximal depth of infiltration of the carcinoma in relation to the thickness of the uterine wall and other morphological criteria of the tumours such as tumour grading, and carcinomatous lymphangiosis have greater prognostic value than clinical staging and the length of the uterine cavity to the sound. In contradistinction to other observations we found that patients with a short length of the uterus had more often recurrences and distant metastases than patients with a long uterine length to the sound.