Preoperative irradiation therapy and radical hysterectomy: prognostic value of tumor regression after initial irradiation of squamous cell carcinoma of the cervix.

OBJECTIVE: To investigate the role of tumor persistence in patients submitted to irradiation therapy and radical hysterectomy. DESIGN: A retrospective analysis of prognostic factors. LOCATION: Hospital A.C. Camargo, São Paulo, Brazil, a private non-profitmaking foundation and tertiary referral centre. PATIENTS: A total of 629 cases of invasive squamous cell carcinoma of the cervix were studied. Criteria for inclusion in the study were: confirmed histological diagnosis of squamous cell carcinoma and no previous treatment (except for preoperative radiotherapy carried out at the Hospital A.C. Camargo itself). At the end of the follow-up period, 410 patients (65%) had no evidence of disease and 219 (34.8%) had died because of the tumor. INTERVENTION: The patients were submitted to radical surgery and radiation therapy, separately or in combination between 1953 and 1982. MAIN OUTCOMES MEASURES: Multivariate analysis of the different variables was performed according to the Cox regression method. RESULTS: The variables of prognostic value were, in decreasing order of importance: the decade of patient admission (p = 0.0001), the modality of therapy employed (p = 0.0005), the presence of residual tumor in the surgical specimens (p = 0.0055) and the clinical stage of the disease (p = 0.0575). CONCLUSION: Radiation therapy controlled a considerable number of local tumors and pelvic lymph nodes but not all of them in every patient. There is a specific group of patients for whom radical surgery is necessary to achieve control of the disease.

Complications of surgical treatment of cervical carcinoma.

A total of 302 patients with stage Ib and IIa cervical carcinoma were submitted to radical hysterectomy and lymphadenectomy during the period from 1980 to 1994. The morbidity rate was 37.5% and the mortality rate 0.6%. The most common intraoperative complications were injuries to the great pelvic vessels and the most frequent postoperative complications involved the urinary tract. The leading causes of morbidity were urinary infection (20.8%), bladder dysfunction (9.2%) and ureteral fistulas (2.9%). Although the rate of complications was high, morbidity has been decreasing over the last five years. Thus, radical hysterectomy continues to be one of the methods for the treatment of early cervical carcinoma that presents an acceptable 5-year survival rate.

Complications of surgical treatment of cervical carcinoma

A total of 302 patients with stage Ib and IIa cervical carcinoma were submitted to radical hysterectomy and lymphadenectomy during the period from 1980 to 1994. The morbidity rate was 37.5 per cent and the mortality rate 0.6 per cent. The most common intraoperative complications were injuries to the great pelvic vessels and the most frequent posto erative complications involved the urinary tract. The leading causes of morbidity were urinary infection (20.8 per cent), bladder dysfunction (9.2 per cent) and ureteral fistulas (2.9 per cent). Although the rate of complications w high, morbidity has been decreasing over the last five years. Thus, radical hysterectomy continues to be one of the methods for the treatment of early cervical carcinoma that presents an acceptable 5-year survival rate.

Peritumorous lymph-vascular invasion, grade of histologic differentiation, and myometrial infiltration as prognostic factors of endometrial carcinoma.

The authors evaluated 50 patients with endometrial carcinoma studying the prognostic parameters: histologic grade, myometrial invasion and lymph-vascular space invasion. The patients were divided into two groups: A--a good prognosis group (33 cases)--with no recurrences and/or metastasis occurring for five years; and B--a bad prognosis group (17 cases)--with recurrence and/or metastasis or death within five years. We concluded that lymph-vascular space invasion was more frequent in group B, and was a reliable parameter for bad prognosis. The lymph-vascular space invasion was always accompanied by myometrial invasion and patients whose myometrium had not been involved did not have lymph-vascular space invasion. In both groups, in well-differentiated tumors, there was no lymph-vascular space involvement. The well-differentiated tumors were statistically more frequent in the good prognosis group. Myometrial invasion was not statistically significant as a prognostic parameter.

[Primary carcinoma of the fallopian tube. A report of 3 clinical cases]. / Carcinoma primario de la trompa de falopio. Relato de tres casos clínicos.

Three cases of primary adenocarcinoma of the Fallopian tube have been treated at the Gynecology Department of Hospital A. C. Camargo, Fundación A. Prudente, São Paulo, between 1972-1987. The diagnosis was only possible at surgery. The poor prognosis was due to the advanced stage of the disease. In view of its rarity further studies are necessary for a better diagnostic and therapeutic approach.

Carcinoma of the vulva. Clinicopathologic factors involved in inguinal and pelvic lymph node metastasis.

Eighty-five women with vulvar squamous cell carcinoma were subjected to radical vulvectomy with bilateral inguinal and femoral node dissection or to radical vulvectomy with bilateral inguinofemoral and deep pelvic node dissection. The association between lymph node status (metastatic or not) and several parameters was analyzed: tumor location, size and clinical stage; tumor thickness, histologic grade and mitotic index; blood vessel, lymphatic and perineural infiltration; and lymphocytic and plasma cell infiltrates. There were no metastases to the pelvic lymph nodes without previous inguinal lymph node involvement. Unilateral vulvar carcinomas did not have contralateral metastatic nodes when there was no ipsilateral nodal involvement. Lymphatic vessel infiltration showed a statistically significant correlation with inguinal node metastases (P less than .05). No correlation was found between lymph node metastasis and tumor size, clitoral invasion, tumor thickness, histologic grade, blood vessel and perineural infiltration, lymphocytic and plasma cell infiltrates, and mitotic index.

Adenoid cystic carcinoma of Bartholin's gland: review of the literature and report of two cases.

Two patients with adenoid cystic carcinoma of Bartholin's gland and a review of the relevant literature are presented. With the inclusion of these two patients, there are now 24 cases reported. Both patients had large vulvar masses with a short clinical history, and several local tumor recurrences within the first 21/2 years after radical vulvectomy. The characteristic cribriform pattern and perineural involvement in addition to vascular invasion were present in the pathological material. No metastases were found in the inguino-femoral lymph nodes removed. Both patients are alive, without evidence of local recurrence but with lung metastases. A chemotherapeutic treatment scheme (adriamycin and cyclophosphamide) is underway but it is too early to evaluate its results.