Second lower genital tract squamous cell carcinoma following cervical cancer. A clinical study of 46 patients.

BACKGROUND: Patients after treatment for cervical cancer have increased risk of developing second squamous cell malignancy of the lower genital tract. MATERIAL AND METHODS: A retrospective study of 46 patients with second lower genital tract epidermoid cancers following previous treatment for invasive cervical carcinoma. RESULTS: Patient age at diagnosis of cervical cancer was 27 to 68 years (median 44 years) and at diagnosis of the second malignancy - 43 to 72 years (median 63 years). There were four cases (9%) of synchronous cancers. Time span between metachronous malignancies ranged from 66 to 406 months (median 206 months). In 32 cases (70%) second lesion was located in the vagina and in 14 (30%) - in the vulva. Out of 35 previously irradiated patients, in 24 (69%) second tumor was located within the high dose volume and in 11 (31%) - outside it. Treatment of second cancer consisted of surgery in 12 patients (26%), radiotherapy in 23 (50%), combined surgery and radiotherapy--in five (11%), chemotherapy in four (9%) and surgery plus chemotherapy - in one case. Median survival was 52 months and five-year survival from the diagnosis of second malignancy - 47.5%. No prognostic factors for survival were identified. CONCLUSION: Treatment outcome in patients with second lower genital tract carcinoma is unsatisfactory due to poor feasibility of another definite treatment after previous radical surgery and/or radiotherapy.

[Dramatic course of massive pulmonary embolism in a woman at 31st gestational week. Case report]. / Dramatyczny przebieg masywnej zatorowosci plucnej u kobiety w 31 tygodniu ciazy. Opis przypadku.

Pulmonary embolism during pregnancy is infrequent but serious complication. We report a case of 32-year old women at 31-st gestational week with massive pulmonary embolism. The management of the case and the review of current literature are presented. Our experience demonstrates the importance of interdisciplinary care.

[Heterotopic osteogenesis in postoperative care in ovarian cancer treatment]. / Heterotopowa osteogeneza w bliznie pooperacyjnej w przebiegu leczenia raka jajnika.

The case of calcification in postoperative scare in patient with ovarian cancer was described. The patient was operated because of ovarian cancer and had subsequently chemiotherapy. Afterwards the second look operation was performed which showed calcification (size 9.5 x 2 x 0.4 cm) in postoperative scare. The calcification wasn't a metastasis from the ovary. The etiology of calcification in unclear. The heterotopic osteogenesis in postoperative scars is quite rare. They usually appear as a result of calcification of connective tissue. Sometimes the relation between osteogenesis and neoplasmatic disease is supposed. Till now the reason of these kind of calcification is still unknown.

[Borderline ovarian tumors: clinical analysis of 114 cases]. / Nowotwory jajnika o granicznej zlosliwosci--analiza kliniczna 114 chorych.

OBJECTIVES: The aim of this study was to analyse the group of patients with borderline ovarian tumours. DESIGN: The analysis included 114 patients, operated for ovarian tumours of borderline malignancy in the Gynaecological Department of Medical University of Gdansk between 1978-1997. The study takes into account comparison of: age of patients, obstetrical past, clinical signs and symptoms, clinical stage (according to FIGO), type of surgery, tumour pathology, post surgical treatment. Furthermore, long-term follow up was assessed. RESULTS: Middle age in the group was 48 years, main symptoms: pain of lower part of abdomen (47%) and ascites (26%). 92% of tumours were recognised in stage I (FIGO). 44.7% of the tumours were histological serous, 36% were mucinous. All patients were treated by surgery and 12% received additional treatment. Mean follow up was 104 months (1-247). 9.6% of the patients died because of main disease, next ten persons for reasons not connected with the main disease. 5 year survival rate was 91.2%, 10-year 84.2%. CONCLUSIONS: 1. Borderline ovarian tumours are most frequently recognised in stage I. 2. Serous and mucinous borderline ovarian are dominant. 3. Type of surgery is dependent on age of patients, obstetrical past, clinical stage and tumour pathology. 4. Prognosis in borderline ovarian tumours is excellent.

[A comparison of clinical and surgical-pathologic staging of advanced vulvar cancer]. / Porównanie wartosci rokowniczej klinicznej i patologiczno-chirurgicznej oceny stopnia zaawansowania raka sromu.

A surgico-pathological staging system introduced in 1988 by FIGO replaced previously used clinical classification of vulvar cancer extent. The aim of our study was to compare retrospectively the prognostic value of both of these staging systems (with the modification of surgical staging introduced in 1994) in the group of 123 vulvar cancer patients undergoing radical surgery including lymph node dissection in our institution. The comparison of both staging systems is presented in the table. Ninety patients (73%) have been assigned to the same stage in both systems, in 27 patients (22%) the use of surgical system resulted in upstaging, as compared to the clinical classification and 6 patients (5%) have been down-staged by the surgical system. In the analysis of prognostic value of both classifications the surgical staging system proved to have better discriminating power for prediction of survival in vulvar cancer patients.

[Analysis of intra- and postoperative complications and postoperative course in patients surgically treated for vulvar cancer]. / Analiza powiklan sród- i pooperacyjnych oraz przebiegu pooperacyjnego u chorych leczonych operacyjnie z powodu raka sromu.

Surgical complications were evaluated in 162 vulvar cancer patients. Assessed were: the frequency and type of postoperative complications, the incidence of perioperative blood transfusions, the course of postoperative wound healing, the length of postoperative hospital stay and reasons for perioperative mortality. An analysis of factors influence the risk of complications was conducted.

[Aggressive clinical behavior of ovarian tumor of low malignant potential: a case report]. / Nowotwór jajnika o granicznej zlosliwosci o bardzo agresywnym przebiegu klinicznym--opis przypadku.

We report a case of ovarian tumor of low malignant potential with very aggressive clinical behaviour reminded of invasive carcinoma and very advanced stage. The patient was dead in short term after radical operation although ovarian tumors of low malignant potential have excellent prognosis.

[Retrospective assessment of the feasibility of conservative surgery in the vulvar squamous cell carcinoma]. / Retrospektywna ocena mozliwosci zastosowania oszczedzajacych technik leczenia miejscowego u chorych na plaskonablonkowego raka sromu.

OBJECTIVES: Radical vulvar surgery is associated with significant morbidity. DESIGN: The aim of the study was to assess retrospectively the feasibility of less extensive surgery in vulvar cancer patients operated in our institution with radical intent. The feasibility of less extensive surgical procedures was investigated, based on the retrospective analysis of preoperative assessment of tumour location and extent in a group of 162 patients. RESULTS: In the next step, the pathology reports of actually performed extensive operations were carefully reviewed in a search of microscopic evidence of tumour outside the limits of proposed conservative procedures. Conservative surgery was regarded technically possible in 127 patients (85.8%). Macro- or microscopic multifocality was detected in 22 patients (14.9%), of whom in 15 cases conservative surgery was regarded possible on the basis of clinical assessment. However, only in 11 cases tumour was found outside the limits of planned excision, in 9 of those cases--due to multifocal lesions. CONCLUSIONS: Less extensive surgery is technically feasible in a vast majority of vulvar cancer patients, however the selection for conservative procedures based only on clinical assessment of tumour extent is not sensitive enough to assure radical treatment in all patients and better methods of preoperative evaluation, such as vulvoscopy or random vulvar biopsies need to be investigated before the decision on routine use of conservative surgery is made.

[Risk factors for groin lymph node involvement in patients with vulvar cancer]. / Czynniki kliniczno-patologiczne warunkujace ryzyko zajecia pachwinowych wezlów chlonnych u chorych na raka sromu.

OBJECTIVES: Morbidity of vulvar cancer surgery is predominantly related to groin lymph node dissection. DESIGN: The aim of the study was to determine factors influencing the probability of groin lymph node metastases and to select a subgroup of patients in whom the risk of nodal involvement is low and nodal dissection can be omitted. MATERIAL AND METHODS: A retrospective analysis was performed on the group of 123 patients who had undergone full inguino-femoral lymph node dissection as a part of their primary vulvar cancer treatment. RESULTS: The risk of involvement of groin nodes was related to the clinical assessment of the stage of disease according to 1970 FIGO classification (p < 0.001), depth of stromal invasion (p = 0.004), primary tumour diameter (p = 0.009) and to the presence of pain in the vulva (p = 0.028). In multivariate analysis the probability of groin node infiltration was related to the diameter of primary tumour (p = 0.008) and depth of stromal invasion (p = 0.013). CONCLUSION: The analysis allowed for division of vulvar cancer patients into subgroups of similar risk of lymph node involvement.

[Results of surgical treatment of vulvar cancer]. / Wstepna ocena wyników operacyjnego leczenia raka sromu.

OBJECTIVES: Vulvar cancer is a relatively rare genital malignancy. The mainstay of it's treatment is surgery. DESIGN: A retrospective study of vulvar cancer patients treated between 1967 and 1995 at Department of Gynaecology, Medical University of Gdansk. MATERIALS AND METHODS: The type and outcome of surgical treatment was studied in 162 consecutive patients. RESULTS: The surgery was limited to the vulva in 24% cases and in the reaming 76% of patients removed were also regional lymph nodes. Median survived of the whole group was 105 months and actuarial 5-year survival-60%. CONCLUSIONS: The results of treatment of vulvar cancer in presented series correspond well with the literature data.

[Pregnancy, labor and puerperium in patients after surgery for ovarian tumors of borderline malignancy]. / Ciaza, poród i pológ u chorych po leczeniu operacyjnym z powodu nowotworu jajnika o granicznej zlosliwosci.

OBJECTIVES: The aim of the study was to assess procreation in patients treated surgically for borderline tumours of the ovary. DESIGN: The analysis included 114 patients operated for ovarian tumours of borderline malignancy in the Gynaecological Department, Medical University of Gdansk between 1978-1997. Evaluated were: the incidence of pregnancy, age of patients, tumour pathology, type of surgery, the course of pregnancy, labour and puerperium. RESULTS: In the group of 37 stage Ia patients, who had undergone conservative surgical procedure, 7 patients conceived and 9 healthy children were born. All patients are free of disease. CONCLUSIONS: Conservative surgery for borderline ovarian tumours allows for retaining procreational potential and normal conception in young women.

[The use of biodegradable valtrac-bar rings for intestinal anastomosis in advanced ovarian cancer patients]. / Ocena przydatnosci biofragmentowanych pierscieni dociskowych typu Valtrac-Bar do zespolen jelitowych u chorych na zaawansowanego raka jajnika.

Intestinal anastomoses using Valtrac-Bar biofragmentable rings were performed in 9 advanced ovarian cancer patients presenting with symptoms of acute or subacute intestinal obstruction. Two ileo-transversal anastomoses, six sigmo-rectal and one ileo-ileal ones were performed. A part of sigmoid colon with tumour causing obstruction was resected in seven patients and in two patients a resection of an ileal loop was performed. In two patients a colostomy was necessary. The result of anastomosis with Valtrac-Bar was satisfactory in all patients: no cases of peritonitis, anastomosis leak or fistulae were observed. The treatment of intestinal obstruction allowed for a prolongation and improvement of quality of life of these patients and enabled further treatment with chemotherapy. We conclude that biofragmentable Valtrac-Bar ring is a safe and effective device enabling easy and fast intestinal anastomosis even in patients with inappropriate healing.

[The value of peritoneal cytology in the staging of ovarian cancer]. / Rola badan cytologicznych w ocenie stopnia zaawansowania u chorych na raka jajnika.

The results of peritoneal cytology obtained during primary surgery for stage I ovarian cancer and "second look" operations was assessed. Positive peritoneal smears were found in 10.7% of patients, while neoplastic cells were present in peritoneal fluid in 32.5% of cases. Of 144 patients undergoing "second look" surgery, positive cytology occurred in 55.5% of cases: in 26.4%--in peritoneal smears and in 29.1%--in peritoneal washings. Intraoperative peritoneal cytology was found to be a valuable diagnostic tool in early stage and minimal disease ovarian cancer.

[Malignant non-epithelial neoplasms of the uterine body--clinical analysis]. / Zlosliwe, nienablonkowe nowotwory trzonu macicy--analiza kliniczna.

Twenty six cases of primary uterine sarcomas treated between 1980-1990 are analyzed. There were 16 cases (62%) of endometrial stromal sarcoma, 8 cases (31%) of leiomyosarcoma and 2 cases (7%) of botryoid rhabdomyosarcoma. Symptoms of uterine sarcoma are presented. In 19 patients (73%) pathological diagnosis was obtained by endometrial curettage before surgery. Stage of disease was classified according to intraoperative scale of Lewis. Median survival for the whole group treated surgically, by radiotherapy and chemotherapy was 22.2 months. Five patients (19%) in whom the disease was limited to the endometrium survived more than 5 years. Recurrences of the neoplasm and their treatment by secondary cytoreductive surgery are described.

Alveolar rhabdomyosarcoma of the uterine cervix.

Alveolar rhabdomyosarcoma is an uncommon tumor occurring mostly in extremities of children and adolescents. This type of tumor located in the uterine cervix has not been reported previously. A case of pure alveolar rhabdomyosarcoma arising from the uterine cervix in a 45-year-old patient and having a very aggressive clinical course is described. The patient presented with rapidly progressive cervical tumor, which was originally diagnosed as mesonephroid adenocarcinoma. She was treated with a radical two-stage surgical procedure and postoperative external beam and intracavitary irradiation. Despite treatment, she developed metastatic disease and died 3 months after the surgery. The aggressive course of the disease at this location was consistent with that of the majority of alveolar rhabdomyosarcoma cases of other sites reported in literature. No standard effective treatment is known for this tumor in adult patients.

[A case of a foreign body--surgical linen left in the abdominal cavity 25 years earlier]. / Przypadek ciala obcego--chust chirurgicznych w jamie brzusznej pozostawionych przed 25 laty.

A case of 2 surgical linen measuring 12 x 7 cm left after surgery for prolapsed recti performed 25 years earlier is presented. Symptoms suggesting ovarian cancer and details of operation performed to remove the foreign body are described.

[Use of intraperitoneal chemotherapy in patients with clinical stage I ovarian neoplasms]. / Zastosowanie chemioterapii dootrzewnowej u chorych na raka jajnika w I degree zaawansowania klinicznego.

Results of treatment with intraperitoneal cisplatin chemotherapy via Tenckhoff catheter of 14 high-risk stage I ovarian cancer patients are presented. Seven patients had malignant ascites and in 6 a spillage of the tumor occurred before or during surgery. All patients achieved pathological complete remission after IP chemotherapy. During a median follow up of 38.5 months (range: 15-58) one recurrence was noted 16 months after treatment.

[Small cell tumor of the uterine neck]. / Drobnokomórkowy rak szyjki macicy.

Small cell cervical cancer is a rare, but important for its distinct biological properties and clinical behaviour, neoplasm. It is both morphologically, and clinically aggressive, in many aspects resembling small cell lung cancer. This paper discusses the present knowledge about biology and treatment of this rare malignancy.

[Invasive vulvar carcinoma in a sixteen year old patient]. / Inwazyjny rak sromu u szesnastoletniej chorej.

A case of vulvar carcinoma diagnosed in 16 year old patient is described. Presented are steps in diagnosis and multi-stage conservative surgical treatment aimed at cure without unnecessary mutilation of the young woman.

[Alveolar rhabdomyosarcoma of the uterine cervix]. / Miesak Prazkowanokomórkowy pecherzykowy szyjki macicy.

A rare case of cervical alveolar rhabdomyosarcoma in a 45-year old female is presented. The removal of the tumour was performed in two stage-procedure, due to its large dimensions: first the bulk of the tumour was removed per vaginam, proceeding afterwards to a radical hysterectomy. Metastases were detected in pelvic lymph nodes. The patient was given postoperative radiotherapy, but a dissemination of the tumour was found at the termination of the treatment and the patent died 3.5 months after surgery.