[Sarcomas of the vulva. Report of 2 cases]. / Sarcomas de la vulva. Informe de dos casos.

We report two cases of vulvar sarcomas that are our Institutional experience in 29 years. The first case was a teenager of 14 years-old with a low grade leiomyosarcoma surgically treated. Along a 22 years follow-up the disease has had four local recurrences of more than 5 cm each one: two after surgery and two after surgery plus chemotherapy and surgery plus radiotherapy respectively. She is alive disease evidence after two years from the last combined treatment. The second one, was a 26 years-old patient with a malignant schwannoma of 12 cm in diameter treated with combined radical surgery, radiotherapy, and chemotherapy. She is alive and without disease evidence 52 months after surgery. We emphasized that these tumors are very rare and the fact that the first patient is the youngest and with more years of follow up according the bibliography consulted. Treatment of vulvar sarcomas is radical local excision followed mainly by radiotherapy with infiltrating margins. The value of postoperative adjuvant chemotherapy is uncertain. According to the natural history and behavior of vulvar sarcomas, we conclude that the elective treatment of these tumors should be carry out in institutions of high level.

[Endometrial cancer. Clinico-surgical classification and treatment results (analysis of 134 patients)]. / Cáncer del endometrio. Clasificación clínico-quirúrgica y resultados del tratamiento (análisis de 134 pacientes).

The prognostic factors of Endometrial cancer at The General Hospital of Mexico, in accordance with the Surgical Pathologic Staging System of the International Federation of Gynecology and Obstetrics (FIGO, are reported here. One hundred and thirty four patients treated with conventional procedures, were evaluated for end results and in 127 cases, it was applied The Surgical-Pathologic Staging System of The International Federation of Gynecology and Obstetrics (FIGO). We had a follow-up without evidence of disease from 24 months to 10 years with a median of 30 months, in 58/105 adenocarcinomas (55.2%); 5/11 Adenoacanthomas (45.4%) and 4/14 Adenosquamous carcinomas, (28.5%). Same evolution was observed in 36/72 patients with age equal or less than 60 years, (50.0%) and 17/43 with age equal or more than 61 years, (39.5%. Using the current FIGO Staging System, the disease-free Survival was 51.9% (66/127 patients). This number includes 39/51, 76.4% for Stage I, (18/21 Ia, 90%; 13/15 Ib, 86.6% and 8/16 Ic, 50% P = 0.003); 17/23 cases: 73.9% for Stage II, (5/6 IIa, 83.3% and 12/17 IIb, 70.5%); 10/37 cases: 27.0% for Stage III, (5/14 IIIa 35.7%; 2/6IIIb, 33.3% and 3/17 IIc, 17.6%) and 1/17: 5.8% for Stage IV. P = 0.001. The current FIGO Staging System is a useful instrument for predicting natural evolution of endometrial carcinomas. In this series the survival was adversely affected by increasing Stage and age. A poor prognosis in pelvic tumors was related by a deep invasion of myometrial and by parametrial invasion.

[Current status of frequency and complications of pelvic exenterations for recurrent cervico-uterine cancer after radiation]. / Estado actual de frecuencia y complicaciones de exenteraciones pélvicas por cáncer cervico-uterino recurrente a radiación.

Frequency and morbimortality in pelvic exenterations for cervical cancer recurrent after radiation therapy at The Oncology Service, Hospital General de México, SSA., are presented here. Between 1990 to 1994, seventy six patients with this diagnosis, were subjected to surgical exploration with the next findings: forty seven cases, (61.5%) had unresectable tumors; 29, (38.1%) were treated by exenterative procedures: Anterior exenterations, 14, (48.2%); Total exenterations, 13 (44.8%) and Posterior exenteration, 2 (6.8%). Tumor beyond pelvis was the common cause of unresectability in 34 cases, (72.2%) and periaortic lymph node metastases were related with this finding in 29 patients, (61.7%). Thirteen patients with pelvic exenterations, (44.8%) developed postoperative complications between 1 day and seven months after surgery. In seven cases, (24.1%) these complications were considered as minor complications and in six (20.6%) as major complications: Dehiscence of ureteral anastomosis, two cases, (-6.8%); ureterovaginal fistula, two (6.8%); small bowel obstruction, one (3.4%) and Chronic renal failure, one (3.4%). There were no postoperative deaths related to radical surgery in this series. It is concluded that the rate of laparotomies for cervical cancer recurrent after radiation therapy, have decreased in our Service, as compared to previous analysis as well as the rate of postoperative deaths from pelvic exenterations.

[Pelvic exenteration for cancer of the uterine cervix (prognostic factors)]. / Exenteraciones pélvicas por ca. cervicouterino (Factores pronósticos).

The prognostic factors in 104 patients subjected to pelvic exenterations for cervical cancer recurrent after radiation therapy, at The Oncology Service Hospital General de Mexico, S.S., who survived the surgical procedures with a follow-up for three years or more, are presented here. Results were with statistical significance in the next cases: Patients with 35 years old or less, had a better prognosis when compared with the others: 15/22, 68.1%, vs. 36/82, 43.9%, P = 0.03; clinical reports of tumour localized in cervix, 17/22, 77.2%, vs. infiltration of lateral wall of the pelvis: 11/39, 28.2%, P = 0.008. Pyelographic findings of hydronephrosis or renal exclusion: 2/13, 15.3% vs. normal reports: 9/13, 69.2%, P = 0.01. Infiltration of urinary bladder and or rectal wall: 15/41, 36.5% vs. absence of these: 36/63, 57.1%, P = 0.03; tumour involving myometrium with or without ovarian metastases: 2/15, 13.0% vs. absence of these reports: 49/89, 55.5%, P = 0.03 and the absence of lymph metastatic nodes: 40/68, 58.8% vs. the presence of 3 or more positive lymph nodes: 4/15, 26.6%, P = 0.01. In this series we didn't find differences with statistical significance when compared, the modalities of schemes of radiotherapy, the variety of exenterative procedures and the period of time less or more than a year, between the radiotherapy and the surgery.