Villoglandular papillary adenocarcinoma of the cervix. Beware of a wolf in sheep's clothing.

Villoglandular papillary adenocarcinoma of the cervix is a well differentiated form of cervical adenocarcinoma with a favourable prognosis and a conservative procedure is suggested. We present three cases of villoglandular papillary adenocarcinoma of the cervix. Histological examination of a biopsy of each cervix showed well differentiated villoglandular papillary adenocarcinoma, stage Ib according to FIGO classification. In all cases the disease was limited to the cervix. Nevertheless, histopathological examination of the surgical specimen revealed an infiltrating component with squamous differentiation in one case, while in a second case histopathological examination revealed a moderately differentiated papillary adenocarcinoma with a superficially infiltrating growth-pattern besides the villoglandular papillary adenocarcinoma. Before conservative therapy is considered, careful evaluation of the presence of poor prognostic features must be made. One should consider whether conservative therapy is sufficient because of the predominance of concomitance of other carcinoma besides the villoglandular papillary adenocarcinoma.

Vulvar paraneoplastic amyloidosis with the appearance of a vulvar carcinoma.

Nodular cutaneous amyloidosis of the vulva is a rare phenomenon. We describe a patient with localized nodular lesions on the vulva that mimicked kissing ulcers such as are seen with vulvar carcinoma. These lesions were a result of multiple myeloma with subsequent primary systemic amyloidosis. The patient died of cardiac and renal decompensation 2 months after diagnosis.

Laser and cold-knife conisation for cervical intraepithelial neoplasia: a long-term follow-up.

The study was designed to compare the follow-up results after laser and cold-knife conisation. In both groups 28 patients were included matched for age and parity. All had histologically verified cervical intraepithelial neoplasia (CIN) 3. Laser conisation was performed using a CO2 laser attached to a handpiece. The same surgeon treated all patients. Follow-up consisted of cytology and colposcopy after 3, 12, 24, 36, 48 and 60 months.There were no intra- or postoperative complications. Recurrence or residual disease was found in 7% in both groups. In the laser group, in six patients the histological interpretation of extension of CIN in the excision margin was not reliable, compared to one case in the cold-knife group. The number of inconclusive colposcopy in the laser group is one out of 26 compared to the cold-knife group 17 out of 24 after 60 months.The major advantage of using a CO2 laser for conisation of the cervix in cases of CIN is the reliability of the colposcopic examination.

Bilateral ureteric obstruction following vaginal hysterectomy: oedema of the bladder can be a rare cause.

Known causes of bilateral ureteric obstruction following vaginal hysterectomy and vaginal wall repair are accidental bilateral ureteric ligation and kinking of the ureters. A case of bilateral ureteral obstruction due to bladder wall oedema is presented. A cause for this extreme oedematous reaction was not found. Post-renal obstruction does not necessarily result in dilatation of the ureters, therefore ultrasound cannot always be used to exclude a post-renal obstruction.

Primary diagnosis of gynecological tumors by ultrasonography and computed tomography.

In 33 patients with a pelvic mass or otherwise suspected to have gynecological malignancy, ultrasonography and computed tomography of the abdomen were performed. The results were compared afterward with the findings at operation. With both methods the nature of the tumor had been predicted correctly in the majority of cases. Localization and metastases were more frequently detected by computed tomography. Both tests appeared, in a way, to be complementary. There were no false-negative findings in both sonography and computed tomography. In three cases false-positive results were seen with both techniques.