[The place of sonography in the diagnosis of recurrence of malignant gynaecological tumours (author's transl)]

The scope of sonography in the diagnosis of tumour recurrence is discussed on the basis of 134 patients with suspected recurrence of malignancy. In 67 cases recurrence was verified by means of ultrasonic diagnosis. In 63 cases the tentative diagnosis proved to be negative. In the remaining 4 cases the examination result was equivocal. The ultrasonic results were compared with physical examination, I.V.P., scintigraphy, histological examination of specimens of second-look operations and curettages, and autopsy material. It is pointed out that small tumours posterior to the urinary bladder can be overlooked because of the enhancement caused by the impedance mismatch between the fluid-filled bladder and the solid structures posterior to it. In cases of local and lymphonodal recurrent tumour the examination is extended to the upper abdomen to detect possible hydronephrotic changes. Two different echographic patterns can be observed after primary irradiation of cervical and endometrial cancer. The enlarged uterus with inhomogeneous structures is more likely to be a recurrent tumour. A more "cystic" appearance of the enlarged organ would suggest a mucometra caused by cervical occlusion. In recurrent ovarian tumours ascites is detectable which sometimes even disturbs the examination owing to the extreme curvature of the abdominal wall hindering a sufficient coupling of the probe. Ultrasound is applied with good results in irradiation planning and for the monitoring of therapeutic results.

Morphology of the spleen in women who died of metastatic genital tract cancer

The histology of the white pulp of the spleen was assessed in 56 women who died of metastatic genital tract cancer and in 56 age-matched women who died of a myocardial infarction or a stroke. Special attention was paid to the areas associated with T cells and B cells. The T-cell and B-cell areas were profoundly depleted in patients with carcinoma. This suggests that women who die of genital tract cancer have impaired humoral and cell-mediated immunity.

Progressive histobiologic alterations in the development of vulvar cancer

Identification of the patient at risk for the development of cancer and the precursory histopathologic changes has led to improvement in 5-year survivals among patients with cancer of the cervix and endometrium. In conrast, there has been controversy as to these factors in discussions of vulvar neoplasia. This report of five cases of patients who developed invasive cancer after treatment for in situ disease attempts to define some of the at-risk factors, including the specific area at which three of the five malignancies subsequently developed.

Fine-needle aspiration cytology in gynecologic oncology. I. Diagnostic accuracy

A prospective study was undertaken to determine the diagnostic accuracy of fine-needle aspiration (FNA) cytology in gynecology. A total of 77 aspirations were performed on 74 patients. In 34 instances the purpose was to rule out or confirm a diagnosis of primary disease, and in 43 cases the procedure was used for suspected metastatic disease or disease recurrent after surgery, radiation therapy, and/or chemotherapy. Excellent correlation was noted between the cytologic and subsequent histopathologic diagnoses of 58 aspirations from patients who also underwent surgical biopsy. Two specimens were false negatives as the result of sampling errors. The applicability of FNA cytology in the field of gynecolotic oncology is discussed.