Losses of heterozygosity in endometrial adenocarcinomas: positive correlations with histopathological parameters

We analyzed 37 samples of endometrial adenocarcinoma for loss of heterozygosity (LOH) by using a panel of 44 microsatellites located in 29 chromosomal regions. The aim of our study was to investigate the existence of a possible preferential involvement of some tumor suppressor genes in endometrial carcinogenesis. The analysis was performed on tumoral tissue and on a corresponding normal tissue by the use of polymerase chain reaction (PCR) and the comparison of the amplified alleles. We observed significative LOH (>20%) in the chromosomal regions of 2q14 (33.33%), 7q35 (24.00%), 10q22.1 (37. 50%), 11q13-q14 (44.12%), 15q26 (40.63%), 17p13 (25.71%), and 17q21. 3 (37.04%). We defined a 1-cM minimal common deletion in 11q13-q14 between D11S911 and D11S937 markers. A statistical analysis revealed a positive correlation between LOH of 11q13-q14 and clinicopathological data.

A new laparoscopic procedure for the correction of vaginal vault prolapse

PURPOSE

We verified the feasibility and results of a new laparoscopic technique for repairing vaginal vault prolapse.

MATERIALS AND METHODS

Laparoscopic repair of vaginal vault prolapse was done in 12 women 46 to 82 years old. Stage 1 consisted of culdoplasty similar to that of Moschowitz. Stage 2 included a transverse incision of the peritoneum covering the vaginal vault to expose the vaginal fascia. Two sutures were then fixed to the vaginal corners, passed through the subperitoneal connective tissue and attached to the fascia of the abdominal muscles with multiple stitches.

RESULTS

No intraoperative or postoperative complications occurred and anatomical repair was complete in all women. Followup ranged from 9 to 28 months. Sexual function was recovered in all cases.

CONCLUSIONS

If these results are confirmed in larger series with a longer followup, our laparoscopic approach would be considered a valid alternative to current surgical techniques.

Determinants of invasive vulvar cancer risk: an Italian case-control study

Risk factors for vulvar cancer have been evaluated in a case-control study conducted between 1987 and 1990 in northern Italy on 73 women with histologically confirmed invasive vulvar cancer and 572 control subjects in hospital for acute nongynecological, nonneoplastic non-hormone-related conditions. The risk of vulvar cancer was inversely related to education level: with reference to women reporting less than 7 years of schooling, the relative risk estimates were 0.6 and 0.4, respectively, in those reporting 7 to 11 and 12 or more years of schooling (chi 2(1) trend = 4.91 P = 0.03). No relationship emerged between number of births and spontaneous or induced abortions. Parous women reporting late first birth tended to be at lower risk (relative risk = 0.5, 95% confidence interval 0.3 to 1.1 for < 25 vs > or = 25 years at first birth), but there was no evidence of the risk to decrease with increasing age at first birth. The risk of vulvar cancer increased with body mass index, but the trend in risk was not significant after taking into account potential confounders in the multivariate analysis. No association emerged with indicators of sexual habits, menstrual history, and smoking. The risk of the disease was lower in women reporting Pap smears during their life and diminished with increasing number of cervical smears and decreasing recency of last Pap: compared to women reporting no Pap screening, it was 0.5 in those who reported one smear and 0.3 in those with two or more.

Prognostic value of pathological patterns of lymph node positivity in squamous cell carcinoma of the vulva stage III and IVA FIGO

Lymph node positivity in invasive squamous cell vulvar cancer implies a severe decrease in survival rates. Pathological lymph node positivity covers a wide range of metastatization patterns. In the present investigation the nodal positivity of 53 patients affected by Stage III and IVA invasive vulvar squamous cell carcinoma has been carefully evaluated and correlated with survival. Number, size of the metastasis inside the node, intracapsular or extracapsular site of the metastasis, and immune response of the positive nodes were considered. Cancer-related survival has been obtained for the whole study group (53 cases), for the patients with monolateral node positivity (36 cases), and for the patients showing only one positive node (19 cases). The diameter and the site of the metastasis were significantly correlated with survival in all three groups studied. Patients showing an intracapsular positivity or a size of metastasis less than 5 mm had a 5-year cancer-related survival of almost 90%, while patients showing a metastasis larger than 15 mm or an extracapsular site had a 20% survival. The results demonstrate that patients affected by invasive squamous cell vulvar cancer with positive nodes can be divided into two groups with a significantly different survival according to the histopathological pattern of lymph node invasion.

[Spinocellular carcinoma of the vulva. Critical review of the surgical case histories from 1967-1989]

A critical review of the surgical treatments performed during the years 1967 to 1989 in cases of squamous cell vulvar cancer at the 1st Department of Obstetrics and Gynecology of the University of Milan has been carried out. Two hundred and seventy cases of primary squamous cell vulvar carcinoma have been studied after a restaging according to recent FIGO recommendations. Depending on the type of surgical approach the early and late complications and the 5 year-cancer-related survival have been analyzed. The present investigation supports the importance of a complete and accurate surgical staging of vulvar carcinoma, particularly as far as it concerns the lymph nodes status. Thus, performing a node dissection in case of an invasive neoplasia is extremely important, not only for a precise staging but mainly for a prognosis formulation. In fact, 5 year cancer related survival dramatically falls from almost 90% to 25% in case of pelvic node metastasis.

Argon laser versus microscissors for hysteroscopic incision of uterine septa

We performed hysteroscopic metroplasty in 21 women with repeated abortion and subseptate uterus. The patients were randomly allocated to septal incision with the argon laser (group I, 10 subjects) or microscissors (group II, 11 subjects) to compare these instruments in terms of surgical feasibility and anatomic results. The mean operating time was 57% longer in group I than in group II (p = 0.001), the intra- and postoperative morbidity of the whole series was negligible, and the anatomic results at abdominal ultrasonography and hysteroscopy performed 2 months postoperatively were similar in the two groups. This study confirms that microscissors are the simplest, fastest, most effective, and least expensive instrument to correct a septate uterus. The complete agreement of the findings at follow-up hysteroscopy and ultrasonography suggest the use of the latter as the method of choice to check the surgical results.

[Prognosis factors in epithelial tumors of the ovary]

87 patients treated for epithelial ovarian carcinoma between 1975 and 1986 were evaluated intensively. In all cases the original operation was followed by surgical reassessment to evaluate the result of adjuvant therapy and to study the cases without apparent disease. The actuarial survival rate after 3 years, by Kaplan-Meier calculation, demonstrated 73.5% survival in patients with negative second-look versus 32% in presence of positive reassessment (P less than 0.01). Surgical reexploration and histologic study were negative in 34 cases (39%). Original stage, histotype, histological grading, peritoneal washing and age of patients were considered for prognostic evaluation of the tumor. The absence of residual tumor (RT) at first surgery resulted in complete response after adjuvant therapy in 70.8% of women, versus 25.8% with RT greater than 2 cm (P less than 0.01). Negative second-look appears the most important prognostic factor for the evaluation of epithelial ovarian cancer (P less than 0.001).

Risk factors for vulvar lichen sclerosus

To assess risk factors for vulvar lichen sclerosus data were collected in a case-control study of 75 cases and 225 age-matched control subjects. Questions concerned personal characteristics and habits, gynecologic and obstetric data, general indicators of sexual habits, and selected dietary habits. The risk of vulvar lichen sclerosus was greater in parous women than nulliparous women, but there was little tendency for the risk to increase with number of births; the finding was not significant when only married women were considered. There was no material difference between cases and control subjects in relation to major indicators of sexual habits (age at first intercourse and number of sexual partners). A smaller proportion of cases was married, but no difference was observed in the distribution of cases and controls with reference to education, smoking habits, body mass index, and previous history of diabetes. There was no association between retinoids and risk of vulvar lichen sclerosus, but intake of carotenoids was inversely and strongly associated with vulvar lichen sclerosus. This apparent protection did not materially change after adjustment for socioeconomic status and other potential confounding factors.

[Primary carcinoma of the fallopian tube: cases from 1971 to 1985 (27 patients). Current therapeutic approaches]

Twenty-seven patients with carcinoma of the fallopian tube were treated at the First Obstet. Gynecol. Clinic, University of Milan. Nineteen of them had the primary surgical procedure in our center and accounted for 2% of tubal and ovarian carcinomas. The others had been operated elsewhere. Another primary genital cancer occurred in 7 of these women and a breast carcinoma was recorded in the history of other 2. At laparotomy, 11 tumors were Stage I, 9 Stage II, and 7 Stage III. Postoperative adjuvant therapy was not homogenous, however chemotherapy was given to about 59% of patients. Five years survival rate was 65% for Stage I, 34% for Stage II and 17% for Stage III. The discussion deals with early diagnosis, prognostic and/or therapeutic role of pelvic and/or aortic lymphadenectomy and effectiveness of adjuvant therapy.

Antigens of the HLA system in women with vulvar lichen sclerosus. Association with HLA-B21

The cause of vulvar lichen sclerosus (VLS) is unknown. An autoimmune origin has been suggested. The HLA system is responsible for the synthesis of major histocompatibility antigens and is considered a genetic marker of the risk of or resistance to some diseases. Recently, the association between some antigens of the HLA system and diseases of proven autoimmune origin has been reported. A possible association between antigens of the HLA system and VLS has been investigated by others, with contradictory results. Here we report the results of HLA typing in 68 women with histologically proven VLS. The following antigens were tested: A1, A2, A3, A9-11, A28, A29, A32, B5, B7, B8, B12-B18, B21, B22, B27, B35, B40, Cw1-4, Dr1-5 and Dr7. The results were compared with the frequency of HLA antigens in about 2,000 controls. Patients affected by VLS showed an increased frequency of HLA-B21 (22.06% vs. 9.56%, P less than .001), HLA-Dr5 (55.38% vs. 40.92%, P less than .025) and HLA-Dr7 (38.46% vs. 25.19%, P less than .025). After correction for the number of antigens tested (44) the difference in HLA-B21 frequency was significant at the P less than .05 level. This finding gives further support to the suggestion that an immune system disorder is involved in the origin of VLS.

Connective tissue regeneration after laser-CO2 therapy

The ultrastructural pattern of fibroblasts involved in the healing process of laser-treated tissues has been investigated. This study has been performed on the uterine cervix, the epithelial abnormalities of which are frequently treated by laser. Observations carried out immediately and two and seven days after treatment, have demonstrated that: fibroblasts show an active and almost uniform pattern; myofibroblasts are not present; and macrophages are limited in number. This healing process is interpreted as a proliferative pattern of the connective tissue which differs from that of some benign tumors and of healing wounds.