Intra-epithelial carcinoma of the cervix uteri. Our experience with treatment, the role of conization

The authors re-emphasize that the sure diagnosis of carcinoma of the cervix depends on histology; having considered a series of 15,000 smears in an article on cytological screening for carcinoma of the cervix. They show that the main prop of this histological examination should definitely be conisation. They furthermore prepare an inventory of the different possible methods of treatment of intra-epithelial carcinoma, stating for each method the advantages and disadvantages of the method. Their attitude to treatment is conservative, and they believe that conisation in every case is sufficient when complete removal of the in situ lesion is carried out whatever the age of the patient is. They state the limits of this method and define clearly the contra-indications for such a scheme of treatment, which can only be carried out routinely with the absolutely necessary cooperation of a cytology laboratory and faultless histology.     

Loop conization of cervix uteri in gynecological practice

Loop electrosurgical excision procedures (LEEP) in Danish office gynaecology was introduced in April 1992. This paper gives a retrospective survey of 1388 LEEP performed on 1347 patients out of an estimated number of 1483 LEEP on a nationwide basis in private gynaecological practice until the end of March 1996. At the end of the study period 46% of full-time-practices performed the operation. Indications were almost exclusively CIN. The complication rate was 10.5% in this introductory period, mainly as relatively modest postoperative bleeding. Almost all patients were preoperatively assessed by cervical biopsies and/or endocervical curettage, and information on preoperative colposcopy was obtained in 96.2% of the procedures. Unsuspected invasion was found in 2.3%. Cure-rate/LEEP was 92.5% at four-month follow-up and 89.4% at 16-month follow-up. We conclude that the method, even in the introductory period of an office setting, has acceptable complication and cure rates. Postoperative follow-up, however, is mandatory.     

Cryosurgical treatment of dysplasia and carcinoma in situ of the cervix uteri

Fifty-nine patients (age range 18-40 years, mean 28 years) with dysplasia or carcinoma in situ of the cervix uteri were treated with cryosurgery. Healing occurred in 54 patients (91.6%) after one treatment ("double-freeze" technic) and in 2 patients after refreezing. No early or late complications occurred during a follow-up period of 7-37 months. Five of the patients with carcinoma in situ were followed immunologically with determinations of serum TPA (tissue polypeptide antigen), which can be employed as a parameter of malignancy. In all instances, the initially elevated TPA normalized after cryosurgical treatment. Cryosurgery is a simple, painless and safe treatment method in ectocervically localized carcinoma in situ and dysplasia that is particularly suited for out-patient use.     

Adenoid basal carcinoma of the cervix uteri: a case report

We report a rare case of adenoid basal carcinoma of the uterine cervix, unexpectedly found in a uterus resected for the treatment of cervical intraepithelial neoplasia (CIN) 3. The patient was a 47-year-old Japanese female. She received a total abdominal hysterectomy under a diagnosis of CIN 3 of the cervix. Grossly, there were no significant findings in the surgical specimens. Microscopically, in seven of the 12 blocks of the cervix examined, scattered small nests of uniform small cells, which extended 4 mm below the epithelial surface, with dark nuclei and scant cytoplasm were observed. Peripheral palisading as well as the formation of gland-like or acinar structures were noted. The latter were positive for mucicarmine. Stromal reaction was not obvious. There were also foci of squamous differentiation in some portions of the small nests. Occasional mitoses as well as large atypical cells were also seen in this area. Immunohistochemically, the foci of squamous differentiation were positive for carcinoembryonic antigen. The epithelial surface in other portions showed CIN 3 with crypt extension. Distinction between adenoid basal carcinoma of the cervix and other diseases, such as adenoid cystic carcinoma and squamous cell carcinoma with basaloid features, is important for clinical management because the clinical behavior of adenoid basal carcinoma is less malignant.     

Our experience with the use of a Bulgarian cyanoacrylate tissue adhesive in obstetrical and gynecologic surgical practice

The effect of somatostatin was tested on gastrin release induced by electrical vagal stimulation in anaesthetized cats. The antral release of gastrin was determined in the gastric venous outflow by simultaneous recording of gastrin concentration and blood flow. Repeated vagal stimulation at the same frequency and duration caused release of similar amounts of gastrin within the same cat. Infusion of somatostatin, at a rate of 0.5 microng/kg/min, reduced the vagally induced gastrin release to about 40%. Similarly, basal gastrin output was depressed to about 40% of the control values.     

Intraepithelial lesions of the cervix uteri and human papillomaviruses: comparative study of histological data and in situ hybridization. Apropos of a series of 77 cervical biopsies

Seventy seven biopsy samples of cervical mucosa were tested for the presence of human papillomavirus (HPV) by immunohistochemistry and in situ hybridization. From the 38 samples identified as condyloma or cervical intraepithelial neoplasia (CIN), 31 were positive after in situ hybridization and 14 after immunochemical analysis. HPV 6 was found exclusively in condyloma acuminata (2 samples) whereas the HPV 16 probe essentially hybridized with high grade intraepithelial lesions (CIN II, CIN III). Low grade intraepithelial lesions (flat condyloma, CIN I) demonstrated a larger diversity of HPV types (HPV 16, 18, 31, 33). A close correlation was demonstrated between the histologic features of lesions and their HPV 6 or HPV 31 content but not for other HPV types. HPV 31 containing lesions showed a peculiar architecture with numerous, elongated papillae resulting in a spiked appearance.     

Urinary complications of the resectable cancers of the cervix uteri (author's transl)

The authors studied the urinary complications following 721 operations performed between 1960 and 1974 for cervix uterin carcinoma. The surgical method was the one used at the Fondation Curie according to the protocol of treatment. They have noted that: --first, the surgical act as primary treatment (672 cases) was innocuous, as this series showed only 0,6% of the severe complications; in contrast, when the surgery is performed for a recurrence after a total dose irradiation, the severe complications raised to 8%; --secondly, the uretero-hydronephroses following this type of surgery are relatively frequent on the systematic urograms, but most of them are quite asymptomatic and without later sequelae only 0,3% of them required a surgical treatment. The authors analyse the factors influencing the ureteral stenoses, especially the extent of lymphadenectomy and the associated external irradiation. They studied too the ureteral stenoses due to a local recurrence.     

i(5p) and del(6q) are nonrandom abnormalities in carcinoma cervix uteri. Cytogenetics of two newly developed cell lines

BACKGROUND: It is impossible to treat all varicose veins employing the same method. Cryosurgery offers a new modality for the detraction of the long and short saphenous vein deletion. OBJECTIVE: To describe the technique, its indications, potential complications, and cosmetic results. METHODS: We followed 800 patients over 6 years. The study allows evaluation of the results of and the best indications for this method. With a follow up of five years, we have analyzed: 1) the immediate complications, and 2) middle-term results. RESULTS: The results of cryosurgery of varicose veins were generally comparable to those obtained using classical surgery (stripping). CONCLUSION: Cryosurgery of varicose veins is a fast and safe method for selected varicose disorders, exhibiting good cosmetic results.     

Villoglandular adenocarcinoma of the cervix uteri. A case report and analysis of the literature

The authors described a case of villoglandular adenocarcinoma of the uterine cervix treated with radical hysterectomy (Piver type 2) and pelvic lymphadenectomy. The cytohistologic and clinical aspects of this rare neoplasia are debated also considering the literature data where, until 1996, 41 cases of villoglandular adenocarcinoma of the uterine cervix were reported (10 cases at Stage 0 and 31 cases at Stage IB), all with favorable prognosis.     

Cytologic study of ascites and the endometrium in ovarian carcinoma. Clinical significance

OBJECTIVE: To ascertain the usefulness of endometrial cytology with ovarian cancers when examining extension of the disease and to analyze significant factors associated with migration of ovarian cancer cells into the uterine cavity. STUDY DESIGN: Cytologic results on ascites and the endometrium were analyzed in 87 patients with primary ovarian cancer in the absence of metastasis to the endometrium or cervicovagina. RESULTS: Positive results for cytology were found in 62/87 of ascites cases (71.3%) and in 20/87 endometrium cases (23.0%). The 15 cases (15/62 or 24.2%) positive for ascitic and endometrial cytology, divided clinically into stage III (6 cases) and stage IV (9 cases), were classified histologically as serous, 7 cases; mucinous, 2 cases; clear cell, 4 cases; endometrioid, 1 case; and unclassified, 1 case. Half the clear cell carcinomas (4/8 or 50.0%) were positive in the ascites and endometrium. The ascitic volume at surgery exceeded 500 mL in 9/15 cases (60.0%). CONCLUSION: Papillae with basement membrane material in the cores may be structurally associated with migration of ovarian cancer cells into the uterine cavity, especially in clear cell carcinomas. Cytologic positivity of the endometrium and ascites significantly correlated with ascitic volume.     

A phase II trial of CPT-11 in recurrent squamous carcinoma of the cervix: a gynecologic oncology group study

The purpose of this paper is to present an outline of student's practice of interviewing simulated patients at behavioral science in dentistry. This practice was initiated as part of a newly introduced behavioral science course at our school of dentistry, to enable students to acquire communication skills, comprehensive understanding, and a proper attitude vis-à-vis patients. Students as well as instructors involved in the practice evaluated it as highly relevant for clinical education. It is concluded that the development of such practices in dental education is a prerequisite for training students to dentists oriented toward patient-centered dental practice.