Uterine tumour resembling an ovarian sex cord tumour.

Endometrial stromal sarcomas account for 0.25% of all uterine malignancies. These tumours were originally divided into low grade and high grade stromal sarcomas, but the recent World Health Organisation classification (2003) recognises low grade stromal sarcoma and undifferentiated endometrial sarcoma. Low grade sarcomas may exhibit other forms of differentiation, including smooth muscle and sex cord differentiation. In the latter form, the tumour contains epithelial-like or sex cord-like elements often with epithelioid appearance, arranged in nests, cords, trabeculae, solid, or tubular structures. If this element predominates, the tumour is considered to be a uterine tumour resembling ovarian sex cord tumour, and may cause diagnostic difficulties. This case report describes the histological and immunohistochemical features of a uterine stromal sarcoma showing exclusively a pattern reminiscent of ovarian sex cord tumour.

A prospective study of conization of the cervix in the management of cervical intraepithelial glandular neoplasia (CIGN)--a preliminary report.

OBJECTIVE: To assess the efficacy of cervical conization as primary management of cervical intraepithelial glandular neoplasia (CIGN). DESIGN: A multicentre prospective cohort study. SETTING: CRC Clinical Trials Unit, Birmingham. SUBJECTS: 84 women registered with the Unit between May 1986 and January 1989. After excluding 33 women, 51 who had been managed in accordance with the described protocol and had the presence of CIGN confirmed by central review of diagnostic histopathological material were included in the study. INTERVENTION/PROTOCOL: Women with CIGN diagnosed on a cervical cone specimen were managed in accordance with a specific protocol: (a) women with negative cone margins were managed conservatively and followed up with regular cervical cytological and colposcopic examinations; (b) women with involved cone margins were managed by hysterectomy. MAIN OUTCOME MEASURES: Presence or absence of CIGN at cone margins, results of cervical cytological examinations following conization, results of histopathological assessment of any surgical specimens taken after initial cone biopsy. RESULTS: Of the 51 women with confirmed CIGN, managed by conization, 14 (27%) were aged 30 or less and 15 (29%) were nulliparous. Thirty five women who had a cone biopsy showing margins free of CIGN have been managed by conization alone. After a median follow-up period of 12 months there is no apparent residual CIGN or invasive disease in this group. Thirteen women have had further surgical procedures (according to protocol) and two have had a hysterectomy for benign gynaecological disorders. Eight further procedures were carried out because the original cone biopsy had margins involved with CIGN, and only one of them was found to have residual CIGN. The other five procedures were carried out solely because of abnormal cytology, only one of them had a diagnosis of CIN 1. A total of 10 women had cytological abnormality following cone biopsy, one had CIGN, one had CIN 1 and a third had CIN 3. CONCLUSIONS: Our preliminary data suggests that when a diagnosis of CIGN is made upon a cone biopsy, further surgery is unnecessary in those women in whom the margins of the cone specimen are free of disease. Cytological and colposcopic follow up, including cytological sampling of the endocervical canal, is recommended for these women.

Invasive cervical cancer after laser vaporization for cervical intraepithelial neoplasia: a 10-year experience.

The treatment of cervical intraepithelial neoplasia by laser vaporization has been in progress at the Birmingham and Midland Hospital for Women since September 1977. In this interval, 3182 patients have been treated. Seven women have developed invasive cancer at intervals 4-34 months postlaser. The lesions diagnosed were stage Ia (3), Ib (1), IIb (1), IIIa (1), and IV (1). These case histories are presented. On retrospective assessment, there were contraindications to local destructive treatment in six of seven cases. This series emphasizes the need for thorough evaluation of patients before embarking on local destructive treatments and emphasizes the need for careful follow-up of treated patients.

Nucleolar organiser regions in adenocarcinoma in situ of the endocervix.

The AgNOR technique was used to analyse 11 cases of adenocarcinoma in situ of the endocervix and five examples of healthy cervices to assess whether areas of "increased nuclear activity" could be located adjacent to the malignant tissue. Areas of adenocarcinoma in situ had significantly more AgNOR staining dots than apparently normal bordering areas ("transitional areas") and areas of endocervical epithelium remote from adenocarcinoma in situ. There were no significant differences between AgNOR counts in transitional areas and areas remote from adenocarcinoma in situ, and between these areas and histologically normal cervices. These observations provide no support for the hypothesis that areas of glandular atypia of lesser severity or zones of "increased nuclear activity" exist adjacent to adenocarcinoma in situ.

A case of glandular intraepithelial neoplasia involving the cervix and vagina.

A case of high grade glandular intraepithelial neoplasia (GIN) of the vagina is described. This lesion developed 5 years after hysterectomy, which had been carried out because of histologically incomplete excision of cervical adenocarcinoma in situ, despite two conizations. The vaginal lesion was treated by local excision and subsequent radiotherapy to the vagina. The literature contains reference to only one case of vaginal adenocarcinoma in situ, which was successfully treated by local excision. The possible histogenesis of this lesion is discussed and recommendations made for follow-up of patients who have received treatment for high grade cervical or vaginal GIN.