Vulvar Paget's disease: review of the literature, considerations about histogenetic hypothesis and surgical approaches.

Paget's disease of the vulva is a rare neoplasm that occurs on the apocrine glands. It predominantly is an intraepithelial lesion, but has the potential for dermal invasion and on occasion has been associated with an underlying adenocarcinoma.

[Malignant phyllode tumor of the breast with features of intraductal carcinoma]. / Tumore filloide maligno della mammella con aspetti di carcinoma intraduttale.

Malignant phyllode tumor is a rare biphasic breast tumor consisting of a malignant mesenchymal component and an epithelial component that is usually benign. We report an unusual case of a malignant phyllode tumor of the breast with neoplastic features of both the epithelial and stromal components. The patient was a 39-year-old woman with family history for breast carcinoma. Grossly, the excised tumor was a 9 x 7 x 5.5 cm gray lobulated mass with infiltrative margins and necrotic-hemorrhagic areas. Histologically the tumor consisted mainly of neoplastic mesenchyme with non invasive comedo, cribriform and micropapillary features of the ducts. Three months after the excision of the neoplastic mass, the patient developed an infiltrating ductal carcinoma of the opposite breast. Hereditary and bilateral tumors are commonly associated with germline mutations. Tissue from both neoplasms however did not express either BRCA1 or BRCA2 mutations.

[Diagnostic and therapeutic problems in tubal adenocarcinoma. Report of a case]. / Problematiche diagnostiche e terapeutiche dell'adenocarcinoma tubarico. Caso clinico.

Primary adenocarcinoma of the Fallopian tube is one of the most rare tumours: its incidence varies from 0.5% to 1.1% of all gynecological neoplasias. In 1988 a total of 1,200 cases had been reported, the majority grouped in small series and/or individual case reports. The first case was reported by Renauld in 1847. The preoperative diagnosis has increased over the past forty years from 0.26% to 6.38%, and is still extremely low. The diagnosis of primary adenocarcinoma of the uterine tube is basically achieved by exclusion, and in fact the metastasization of the tubes by adjacent gynecological organs must be excluded. The trio of abdominal pain, leukorrhea, metrorrhagia is regarded by many authors as being pathognomonic of tubal adenocarcinoma. In about half of patients the interval between the onset of symptoms and histological diagnosis is 2-3 months, and in 30% less than one month. The authors report their experience of a case in a 62-year-old patient with typical symptoms of primary tubal adenocarcinoma.

[Heterologous mesodermal adenosarcoma of the endocervix. Description of a clinical case]. / Adenosarcoma mesodermico eterologo dell' endocervice. Descrizione di un caso clinico.

We describe a case of an endocervical heterologous mesodermal adenosarcoma, found in a 43 year old woman. Among mesodermal neoplasms, various histological types are distinguished: the carcinosarcoma, the embryonal rhabdomyosarcoma or botryoid sarcoma, and the adenosarcoma; the last is formed by a benign epithelial component and by a malignant stromal component, that may contain heterologous tissues, such as cartilage, skeletal muscle, etc. Adenosarcoma is a tumor of the uterine corpus and seems to be most common among menopausal women. A primitive adenosarcoma of the uterine cervix is very rare; in fact the overall percentage of the uterine cervical sarcoma is 0.2-0.4%. The patient, age 43 years, with regular menstrual bleeding came to an outpatient clinic referring a post coital metrorrhagia. After a control examination, a polyp from the uterine cervix was removed; the histopathologic diagnosis was: fibroangioadenomatous polyp of the isthmus with cartilaginous metaplastic areas. Two months later, the patient was referred to our clinic and another cervical polyp was removed. The histological diagnosis was adenosarcoma with chondrosarcomatous heterologous mesodermal component. Then the patient was operated and the postoperative histological examination confirmed the preoperative diagnosis. A literature review about the uterine adenosarcoma etiopathogenesis is reported, and a suitable diagnostic iter, is discussed.

[Ultrasonics in the diagnosis and staging of endometrial carcinoma]. / Contributo dell'ecotomografia alla diagnosi ed allo staging del carcinoma endometriale.

In the study of endometrial pathology actually ultrasounds have a few utility in precocious diagnosis, but can be useful during the staging phase (echo-histopathologic correlations, tumor biometry, myometrial invasion). Present study is relative to 134 patients affected by endometrial carcinoma (histologically proved) and preliminarily submitted to echotomography. The "false negative" results of ultrasounds were 16/134. Echographic observations, classified according to Niwa e coll. and Obata, were put in comparison with anatomo-histopathology. The evaluations of tumor dimensions and myometrial invasion were correct respectively in 59.2% of cases and in 64.1% of cases. During the staging phase of endometrial neoplasia echotomography can allow a better pre-surgical definition, mainly with a more detailed informations about tumor biometry (T) and myometrial invasion (M).

[Ultrasonics in the follow-up of cases of non-surgically treated endometrial carcinoma]. / L'ecotomografia nel follow-up dei casi di carcinoma endometriale non trattati chirurgicamente.

Authors present an experimental study to evaluate the possibilities of ultrasounds in the follow-up of endometrial carcinoma inoperable cases. 18 women affected by endometrial adenocarcinoma (I or II stage F.I.G.O.) not submitted to surgery (due to increased surgical risk or refusal of operation) and treated by radio-hormonotherapy were considered. In these inoperable cases, echotomographic follow-up (in association to the usual oncologic specific follow-up) permitted to evaluate uterine modifications directly "in vivo": both for tumor dimensions and for myometrial invasion. Without reference to the effectiveness of radio-hormonal therapy, from our experience the utility of ultrasounds in the selection of "non-responders" cases is evidenced ("non-responders" cases were then treated by chemotherapy).

[Post-menopausal metrorrhagia: endometrial ultrasonic aspects]. / Metrorragie post-menopausali: aspetti ecotomografici endometriali.

Main causes of uterine post-menopausal bleeding are estrogenic substitutive therapy, ipo/atrophy, hyperplasia, carcinoma of endometrium and sarcoma. To evaluate the real usefulness of echotomography in these conditions, 128 patients in post-menopause (end of menstrual cycles from over an year) with at least one uterine bleeding were considered. The patients were submitted to pelvic ultrasonography in order to study uterine and ovarian morphology and, in particular, to examine endometrial echopattern. Endometrial reliefs were classified into 4 groups of echopattern and put in comparison with histopathology. From this comparison a well defined role of echotomography in the study of post-menopausal bleeding is evidenced: in cases of "abnormal echopattern" the probability of endometrial pathology is elevated (83.3%), with a good "sensibility" but without a so good "specificity" of ultrasounds: therefore its "subsidiary" but "necessary" role in the diagnosis of climateric uterine bleeding is emphasized.

[Aspect of the cytological endometrial smear obtained from a removed IUD and its relationship to the clinical tolerance of the device]. / Aspetto dello striscio citologico endometriale ottenuto dallo IUCD rimosso e suoi rapporti con la tolleranza clinica del dispositivo.

PIP: The authors examined the cytological endometrial smears obtained from copper IUDs removed from a group of 232 patients, multiparas and nulliparas, among whom there were sufficiently represented groups of women who either tolerated the device quite well or who complained of pelvic cramping and bleeding. A remarkable correlation exists between the appearance of the endometrial cell population and clinical tolerance, with increased amounts of polimorphonucleates in patients with pelvic cramping and of endometrial epithelial cells in those with more or less marked bleeding. On the contrary, however, all the cell population in users who tolerated the device well were poorly represented and well-balanced among the various components, probably an expression of a favorable adaptation to the device. These data are interesting in that they justify the attitude of those who, seeing that the continuation of contraception is necessary, carry out the immediate substitution of the device as soon as the suggested period of use has passed without any interval after removal. (author's)^ieng