Sarcomas and the conservative management of uterine fibroids: a cause for concern?

The introduction of conservative management options has further increased the choices available to clinicians treating women with symptomatic uterine fibroids. However, in the absence of a tissue diagnosis, the possibility of mismanaging an underlying uterine sarcoma is still present, placing these patients at potential risk of a delayed diagnosis of this serious pathology. Evidence suggests that 1 in 250-400 women presenting with what are thought to be symptomatic fibroids, will in fact have an underlying sarcoma, making this an important clinical issue. This paper therefore reviews the methods currently available for the assessment of women in whom conservative management of symptomatic fibroids is contemplated.

Difficulties using the Franco-Italian Glossary in assessing toxicity of cervical cancer treatment.

Shakespeare TP, Ferrier AJ, Holecek MJ, Jagavkar RS, Stevens MJ. Difficulties using the Franco-Italian Glossary in assessing toxicity of cervical cancer treatment. Int J Gynecol Cancer 1998; 8: 51-55 We assessed the toxicities of patients treated for cervical cancer using the revised Franco-Italian Glossary (FIG). A total of 69 separate complications were appraised in 47 patients; however, only 43.5% of these side-effects could be accurately graded. In all, 56.5% of toxicities could not be scored for a variety of reasons: (1) the FIG does not account for all possible complications of cervical cancer treatment; (2) some important toxicities are regarded as too minor to be graded; (3) subjective assessment of some side-effects did not allow consensus to be reached when assigning a grade; (4) we could not accurately score toxicities using the FIG in a retrospective manner. Previous studies utilizing the FIG retrospectively have noted few problems with its use, with no indication of the number of toxicities unable to be graded. In view of the inability to grade the majority of complications in the present study in an accurate manner, we conclude that the revised FIG requires detailed data that are best collected prospectively and that several minor modifications of the glossary should be considered. Results of studies using the glossary retrospectively should be viewed with caution.

Angiomyofibroblastoma of the vulva.

Angiomyofibroblastoma is a rare, myxoid tumor of the vulva. To date only 12 cases have been reported in the world literature. Patients are usually premenopausal and present with a vulval mass initially diagnosed as a Bartholin's cyst. The lesions are well circumscribed and range from 0.5 to 12 cm in size. Microscopically the tumors are characterized by high cellularity, numerous blood vessels, and plump stromal cells. Treatment is by surgical excision. There are currently no published reports of local recurrence or metastatic disease. Angiomyofibroblastoma should be differentiated from other neoplasms of the vulva where radical surgical treatment is indicated. A Case Report of angiomyofibroblastoma of the periclitoral region diagnosed in a postmenopausal woman is presented.

An experience of laparoscopic and transvesical oocyte retrieval in an in vitro fertilization program.

Successful pregnancies have been achieved after in vitro fertilization of oocytes obtained by an ultrasound-guided transvesical approach, as well as with the traditional laparoscope. With the use of the same laboratory facilities, success rates for each retrieval method were evaluated in an established in vitro fertilization program. There was a significantly increased cancellation rate and a decrease in oocyte/follicle rate in the transvesical group, but there was a greater fertilization rate with possible improved embryo quality. Although the transfer rates were similar, the pregnancy rate appeared lower in the transvesical group. A valid comparison of these data is not possible because the two groups are dissimilar for factors known to influence oocyte development and recovery. Different criteria were applied to patient selection and treatment, and operation expertise differed between the two groups.