[PROGNOSTIC MODELS IN MODERN MANAGEMENT OF VULVAR CANCER].

AIM: The aim of the research was to evaluate and analyse prognosis and prognostic factors in patients with squamous cell vulvar carcinoma after primary surgery with individual approach applied during the course of treatment. MATERIALS AND METHODS: In the period between January 2000 and July 2010, 113 patients with squamous cell carcinoma of the vulva were diagnosed and operated on at Gynecologic Oncology Clinic of Medical University, Pleven. All the patients were monitored at the same clinic. Individual approach was applied to each patient and whenever it was possible, more conservative operative techniques were applied. The probable clinicopathological characteristics influencing the overall survival and recurrence free survival were analyzed. Univariate statistical analysis and Cox regression analysis were made in order to evaluate the characteristics, which were statistically significant for overall survival and survival without recurrence. A multivariate logistic regression analysis (Forward Wald procedure) was applied to evaluate the combined influence of the significant factors. While performing the multivariate analysis, the synergic effect of the independent prognostic factors of both kinds of survivals was also evaluated. RESULTS: Approaching individually each patient, we applied the following operative techniques: 1. Deep total radical vulvectomy with separate incisions for lymph dissection (LD) or without dissection--68 (60.18 %) patients. 2. En-bloc vulvectomy with bilateral LD without vulva reconstruction--10 (8.85%) 3. Modified radical vulvactomy (hemivulvectomy, patial vulvactomy)--25 (22.02%). 4. wide-local excision--3 (2.65%). 5. Simple (total /partial) vulvectomy--5 (4.43%) patients. 6. En-bloc resection with reconstruction--2 (1.77%) After a thorough analysis of the overall survival and recurrence free survival, we made the conclusion that the relapse occurrence and clinical stage of FIGO were independent prognostic factors for overall survival and the independent prognostic factors for recurrence free survival were: metastatic inguinal nodes (unilateral or bilateral), tumor size (above or below 3 cm) and lymphovascular space invasion. On the basis of these results we created two prognostic models: 1. A prognostic model of overall survival 2. A prognostic model for survival without recurrence. CONCLUSIONS: Following the surgical staging of the disease, were able to gather and analyse important clinicopathological indexes, which gave us the opportunity to form prognostic groups for overall survival and recurrence-free survival.

[Primary malignant melanoma of the vagina and treatment options: a case report].

OBJECTIVE: To present and analyze the clinical characteristics, treatment, and treatment options for a patient with primary malignant melanoma of the vagina and review of literature. CLINICAL CASE: A 71-year-old patient with a history of vaginal bleeding caused by four tumor growths located in the vagina is presented. The size of each formation was about 2 cm. Three of them were located in the proximal two-thirds of the anterior wall of the vagina and one in the distal third. Excisional biopsy was performed of the lesion located near the entrance of the vagina. Histopathological examination revealed that it was a malignant melanoma of the vagina, which was confirmed immunohistochemically. After ruling out a tumor of an unknown primary site, the patient underwent radical hysterectomy type IV total vaginectomy and pelvic lymph node dissection. Hystological examination proved a clinically asymptomatic melanoma lesion of the uterine cervix. After surgery, the patient was given chemotherapy with Dacarbasine and monthly immunotherapy with BCG vaccine. The patient survived 21 months after surgery without developing a local relapse and died of distant metastases in the spine. CONCLUSION: Radical surgery for primary melanoma of the vagina is a secure way of achieving locoregional control of multifocal disease. The wide local excision can be used in unifocal lesions with security in achieving clean surgical margins.

[Surgical treatment of locally advanced vulvar cancer: report on two cases].

UNLABELLED: The aim of the study was to define the notion of locally advanced vulvar cancer (LAVC) and approaches to treatment by presenting clinical cases encountered by the authors. MATERIALS AND METHODS: The clinical cases described present different views on therapeutic approaches to cases with LAVC. Apart from cases of primary advanced vulvar cancer, there exist cases, in which primary treatment was applied. In such cases, however, involvement of adjacent structures was a result from recurrence of the disease. LAVC implies that the primary or recurrent tumour cannot be treated solely by radical removal of the vulva. Modem treatment of LAVC include ultraradical surgery, radiotherapy, chemoradiotherapy, or a combination of these methods. Studies have confirmed the hypothesis that megovoltage radiotherapy can yield a significant regression of LAVC that makes it possible to apply more sparing surgical resections and preserve the functions of adjacent organs, thus improving life quality. CONCLUSION: Surgical treatment of LAVC without preoperative chemoradiotherapy is recommendable only in cases of resectable tumours, possibly with non-metastatic and primarily resectable regional lymph nodes.

[Anatomic and topographic lymphatic metastasis and sentinel lymph node mapping in early stage of cervical cancer patients'].

UNLABELLED: Biopsy of the sentinel lymph nodes is a method by which using a specific marking. Can be detected and examined lymph nodes that are first in the way of lymph drainage and metastasis. In some cases they give us information for the metastatic status of the whole lymph region. They are named sentinel. The conception of the sentinel lymph nodes is one of the most important and interesting achievements of the clinical oncology for the last ten years. According to her it is possible by removing and examining of one or a few lymph nodes to predict if there is or no tumor invasion in the regional lymph basin. MATERIALS AND METHODS: In the prospective study for two years period are made in clinic of Oncogynecology, Oncologic center to University Hospital of Pleven. 129 cases with proved histological invasive cancer of the uterine cervix after making a clips--biopsy or separated curettage. We applied a preoperative method for detection of the sentinel lymph nodes by using a coloring agent to all the patients included and after that, they had a different kind of operative intervention on the uterine and the lymph nodes. AIM AND GOALS: Our aim was to show the locoregional metastasing and detection of the SLNB in patients with invasive cancer of the uterine cervix, by using a coloring agents Patent blau V (PV)--which passed through surgical intervention on the uterine and pelvic or paraaortic dissection. Our goal was to clear up the anatomic topographical lymph metastasing and coloring by levels and localization in invasive cancer of the uterine cervix--regionally in pelvic lymph nodes and in paraaortic area. CONCLUSION: Sentinel lymph biopsy has its place in the detection of the lymph metastasis in cancer of the uterine cervix, and their localization shows the ways of lymph metastasis and this kind of gynecological tumors and gives an opportunity for an individual way of surgical treatment in patients with early cancer of the uterine cervix.

[Case report of infected lymphocele].

The lymphorrhea is a problem that we face in the early postoperative period in patients undergoing lymph node dissection (LND) for treatment of cervical cancer (CC). The formation of lymphocele most often in the pelvis is as a consequence. The incidence of lymphocele different, ranging from 0.4% to 58.7%. It is diagnosed most common in random checks in the asymptomatic or by presence of complains in symptoms. Ultrasound is most commonly applied together with computed axial tomography. One of the methods for treatment of symptomatic lymphocele is percutaneous drainage under ultrasonic control. As a complication of this procedure are observed cases of infection of lymphocele.

[The role of cytological examination in diagnosis of precancer and cancer of the uterine cervix].

AIM AND GOALS: The aim of this study is to evaluate the efficiency of cytologic examination in the diagnosis of precancer and cancer lesions of the uterine cervix. MATERIALS AND METHODS: We made a retrospective study for the period 30.08.2007 to 30.12.2008 in clinic of Oncogynecology, Oncologic center to University Hospital of Pleven. We included 51 patients with inflammatory, dysplastic and microinvasive changes of uterine cervix. They all passed through a cytologic examination before the operation and followed by conization, 42 patients had PAP above III class and 9 had PAP up to II class--no correspondence is found in 17.64% between the PAP test and permanent histological results of the conization and 82.53% we found correspondence. CONCLUSION: Cytologic examination is a screening method for diagnosis of precancer and cancer lesion of the uterine cervix with proved efficiency, easy to perform and cheap, positive and negative predictive value is well.

[The role of colposcopy in diagnosis of pre-cancer and cancer of the uterine cervix].

AIM AND GOALS: Our aim in this article is to show the role of target biopsy in diagnosis of precancer and cancer diseases of uterine cervix. MATERIALS AND METHODS: We made a retrospective study for the period 30.08.2007 to 30.12.2008 in clinic of Oncogynecology, oncologic center to University Hospital of Pleven. We included 51 patients with inflammatory, dysplastic and microinvasive changes of uterine cervix. They all passed through a biopsy before the operation and followed by conization. There is a correspondence in 38 patients and in 13 patients no such correspondence is found between the histological results before the operation and permanent histological result of the conization. CONCLUSION: There is a big possibility in target biopsy not to get into a place of cervix with the most serious changes or there is no such in it because of the small volume of the material that is sent for examination. The positive results in diagnosis and treatment of precancer and cancer disease of uterine cervix require combination between PAP test colposcopy target biopsy and conisation.

[The role of target biopsy in diagnosis of precancer and cancer diseases of uterine cervix].

AIM AND GOALS: Our aim in this article is to show the role of target biopsy in diagnosis of precancer and cancer diseases of uterine cervix. MATERIALS AND METHODS: We made a retrospective study for the period 30.08.2007 to 30.12.2008 in clinic of Oncogynecology, oncologic center to University Hospital of Pleven. We included 51 patients with inflammatory, dysplastic and microinvasive changes of uterine cervix. They all passed through a biopsy before the operation and followed by conization. There is a correspondence in 38 patients and in 13 patients no such correspondence is found between the histological results before the operation and permanent histological result of the conization. CONCLUSION: There is a big possibility in target biopsy not to get into a place of cervix with the most serious changes or there is no such in it because of the small volume of the material that is sent for examination. The positive results in diagnosis and treatment of precancer and cancer disease of uterine cervix require combination between PAP test colposcopy target biopsy and conisation.

[Sentinel lymph dissection in cervical cancer--prognostic factors].

INTRODUCTION: The concept for the sentinel lymph nodes is one of the most significant and interesting achievements in clinical oncology in the last 10 years. It is possible according to it, by dissection and studing of one or a small number of lymph nodes, the status of the regional lymphatic network drainage to be foreseen. OBJECTIVE: To study the application of sentinel lymph nodes detection by applying Patent blue V marker in patients with invasive cervical cancer who had undergone radical hysterectomy and pelvic and/or paraaortic lymph detection. MATERIAL AND METHODS: In a prospective study in the period from January 2001- December 2003 the mapping technique for detection of the sentinel lymph nodes was utilized in 129 patients with cervical cancer. Preoperativly 2 ml. Patent blue V was injected into the cervix. Intraoperativly it was looked for blue coloured lymph flows going to the first (sentinel) lymph nodes in the pelvic lymphatic network drainage and the paraaortic area. All patients had a radical surgical intervention on the uterus and the lymph nodes but in a different degree. RESULTS AND DISCUSSIONS: The method was successful in 67 (51.94%) of the patients included in the study. The factors influencing the success of the method were recorded. CONCLUSIONS: The mapping method of detection of the sentinel lymph nodes could be utilized for patients with early stage of cervical cancer.

[Modified radical vulvectomy--a reasonable alternative in the treatment of T1-T2 squamous cell vulvar carcinoma].

AIM: To review our experience in the treatment of vulvar cancer by modified radical vulvectomy (MRV) in a selected group of patients. METHODS: In a retrospective analysis of a 5-year period, we studied 8 patients with vulvar cancer who underwent MRV, and diagnosed with early T1-T2 cancer. The primary tumor and groin lymph nodes were submitted to radical surgery, applying individual approach to each patient. RESULTS: In all patients, both operative and postoperative periods were uneventful and shorter as compared to patients in whom traditional approaches were used. Operative wounds healed by first intention. Until now, we have found only one local recurrence and the patient was successfully re-operated on. In all women treated by MRV we had a good cosmetic effect, as compared with patients who underwent radical vulvectomy, en-bloc resection or reconstructive surgery. CONCLUSIONS: MRV can be applied as a method of choice in selected patients with early vulvar cancer.

[Intraoperative lymphatic mapping and sentinel lymph node dissection in cervical uterine cancer].

Regional lymph node involvement is the most important prognostic indicator in patients with solid tumors. Conventional lymph node dissection has not been shown to affect survical and is often associated with considerable morbidity. Intraoperative lymphatic mapping and sentinel lymph node dissection were therefore designed as a minimally invesive alternative to routine elective lymph node dissection in patients with primary cutaneous melanoma. This study examined whether intraoperative lympatic mapping and sentinel lymph node dissection were accurate in staging patients with cervical cancer.

[A rare case of ovarian cancer in a patient treated for secondary sterility]. / Riaduk sluchai na kartsinom na iaichnika pri patsientka, lekuvana po povod na vtorichen sterilitet.

The authors described a rare case of ovarian cancer in a young woman who looked for gynecological help because of secondary sterility. There were found cysts of the both ovaries, which were conservative treated by insistence of the patient for three months. After unsuccessful gestagenic therapy there was performed a gynecological laparoscopy, which showed that on one of the ovaries there was an exophyte growths suspected for carcinoma tissue. It was offered an emergency operation, which was made only after 1,5 months because of personal causes of the patient. It was taken a sample that was with unconvincing data for ovarian cancer. The clinical experience and professionalism of the surgical team were put on the test. It was performed a radical operation with removal of the uterus, adnexa uteri, partial peritoneoectomy, total lymph dissection, appendectomy, total omentectomy. The patient was discharged from hospital in good condition and she is liable to postoperative chemotherapy.

[Vulvar reconstruction with myocutaneous flaps from musculus tensor fasciae latae after block-resection for vulvar cancer]. / Rekonstruktsiia na vulvata s kozhno-muskulni lamba ot musculus tensor fasciae latae sled blok-rezektsiia za vulvaren kartsinom.

Up-to date treatment of oncological diseases, in particular the vulvar cancer, leads to increasing of survival, in which to the foreground outlines not only the physical health but as well better social adaptation, sexual and adequate mental life of patients. Reconstructive surgery takes place in the oncological practice more and more. For vulvar reconstruction after operative treatment can be used cutaneous flaps and grafts, skin-fascial and myocutaneous flaps. The autors present their experience by describing in details the technique of vulvar reconstruction by myocutaneous flaps from m. tensor fasciae latae. It helps for eliminating the negative results of enlarged operative therapy.