2009, Vol 7, No 3
Histopathological diagnosis of endometrial hyperplasia. Part I
CURR. GYNECOL. ONCOL. 2009, 7 (3), p. 154-160
ABSTRACT

Bleeding from uterine cavity in peri- or postmenopausal women is usually the first symptom of endometrial hyperplasia. Endometrial cells are very sensitive to estrogen stimulation. Endo- or exogenous estrogen stimulation results in simple endometrial hyperplasia without atypia, hyperplasia with atypia (precancerous condition) to endometrial cancer. The key issue in histopathological diagnosis of endometrial hyperplasia is differentiation between hyperplasia and precancerous condition and frank cancer. Widely used WHO classification of endometrial hyperplasia not always enables selection of relatively homogenous groups of patients with a similar prognosis. Therefore, an alternative clinically useful classification has been developed, distinguishing between benign endometrial hyperplasia justifying hormonal therapy and endometrial intraepithelial neoplasia (EIN), which is a precancerous condition warranting both hormonal and surgical treatment. The product of suppressor gene PTEN is considered a biological marker of precancerous cellular clone. In some cases, to improve objectivism of interpretation of microscopic images, histopathological study may be supplemented by immunohistochemical assay of PTEN expression. From the clinical point of view, an important point is that subdivision of EIN has significant practical implications. It enables sorting out of groups of patients depending on prognosis and risk of development of cancer, and also helps to determine the best treatment modality. An indispensable prerequisite for a correct histopathological diagnosis of endometrial hyperplasia is a close cooperation between pathologists and gynecologists. Clinical data concerning the patient’s age, date of last menses and hormonal status have a significant influence on interpretation of microscopic image of endometrial biopsy.

Keywords: endometrial hyperplasia, endometrial precancerous condition, uterine bleeding, endometrial intraepithelial neoplasia (EIN), endometrial intraepithelial cancer (EIC)
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Analysis of selected clinical and histological factors predisposing to tumor recurrence after primary treatment of planoepithelial vulvar cancer
CURR. GYNECOL. ONCOL. 2009, 7 (3), p. 161-168
ABSTRACT

Aim of paper: Analysis of selected clinical and histological factors predisposing to local or regional-nodal recurrence in patients after primary treatment of planoepithelial vulvar cancer. Material and methods: Study population consisted of 34 women aged 37-93 years, operated on for planoepithelial vulvar cancer. Most patients underwent radical vulvectomy with bilateral inguinal lymphadenectomy. An indication for adjuvant radiotherapy was non-radical tumor excision or presence of metastases in inguinal lymph nodes. Results: Seven patients were excluded from study population. Recurrence occurred in 9 out of 27 patients (33.3%) aged 59-93 years . In 3 cases, recurrence developed at the place of inguinal lymph nodes, while in 6 – at the place of excised vulva. Out of 10 women (37%) with inguinal lymph node metastases, 5 patients (50%) developed a recurrence. Conclusions: Metastases to inguinal lymph nodes developed significantly more often in primary tumors exceeding 5 cm in diameter. Recurrence of vulvar cancer developed significantly more often in patients with late-stage disease process. Local recurrence of vulvar cancer developed significantly more often in patients with non-radical margin of excision, which in turn was more frequently seen in patients with tumors exceeding 3 cm in diameter.

Keywords: planoepithelial vulvar cancer, treatment, recurrence, clinical factor, histological factor
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SestaMIBI scintigraphy in diagnosis of ovarian cancer’s relapse
CURR. GYNECOL. ONCOL. 2009, 7 (3), p. 169-175
ABSTRACT

Ovarian cancer is the main cause of mortality among women suffering from malignant genital system cancer in Poland. Early detection of possible cancer recurrence after combined first-line therapy is necessary to launch adequate additional treatment with the best result for patient. Elevated concentration of CA-125 may precede clinical symptoms of reoccurrence even by a few months. A fusion of a functional study such as the positron emission tomography with a morphological study of computer tomography (PET-CT) allows for obtaining precise data about metabolic activity as well as anatomical evaluation of how advanced the cancer process is. Aim of the study: To compare the value of scintigraphy in which Tc-99m sestaMIBI is used and the value of PET-CT in early detection of cancer recurrence among women diagnosed with ovarian cancer. Material and methods: Fourteen patients diagnosed with ovarian cancer in clinical stages from IC to IIIC underwent scintigraphy (using Tc-99m sestaMIBI) of pelvis minor and abdomen as well as PET-CT of the whole body. Diagnostic value of the Tc-99m sestaMIBI scintigraphy and PET-CT was evaluated on the basis of sensitivity, specificity, and positive and negative predictive value of these tests. Results: Functional studies such as the Tc-99m sestaMIBI scintigraphy and the positron emission tomography linked with computer tomography, can be especially useful in a oncological gynecology in cases that cannot be equivocally decided using other available diagnostic methods. However, our results will require further investigation in which a greater number of patients in a study group should be used.

Keywords: ovarian cancer, relapse, PET, sestaMIBI, follow-up
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Eff ectiveness of photodynamic therapy in the treatment of vulvar lesions
CURR. GYNECOL. ONCOL. 2009, 7 (3), p. 176-183
ABSTRACT

The essence of photodynamic therapy (PDT) is mutual interaction of light and chemical compounds excited by it. In order to obtain desired fluorescence, energy must be administered to tissues in the form of light, whose wavelength is concordant with light absorption spectrum of photosensitizer used. In the diagnosis and treatment of vulvar lesions, the photosensitizer of choice is 5-aminolevulinic acid (ALA), a precursor substance in the synthesis of protoporphyrin IX. Aim of paper: Assessment of effectiveness of PDT in the treatment of ailments associated with non-neoplastic vulvar diseases, depending on concentration of photosensitizer used (3% or 15%), comparison of therapeutic effectiveness and duration of remission. Material and methods: PDT was used in 89 patients complaining of severe ailments in the vulvar area, described by them as sensations of pain, stabbing, burning or itching. ALA in two concentrations was applied directly to the lesions. Patients in subgroup A received 15% ALA ointment on eucerin basis. Patients in subgroup B received 3% ALA gel with 2% DMSO. Red light generated by a xenon lamp (630±20 nm wavelength) was used for irradiation of lesions. Results: Follow-up time was 12 months. Mean recurrence-free survival in the subgroup A and B was 11.3 months and 10.6 months, respectively. Conclusions: PDT using topical 3% ALA + 2% DSMO is as effective as 15% ALA in the detection of vulvar lesions and in the relief of ailments associated with non-neoplastic vulvar diseases. Use of less concentrated ALA preparation did not result in any significant reduction of remission time.

Keywords: vulvar diseases, photodynamic therapy, PDT, aminolevulinic acid, ALA
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Management of precancerous states of the vulva: pathogenesis, diagnosis and treatment
CURR. GYNECOL. ONCOL. 2009, 7 (3), p. 184-191
ABSTRACT

Vulvar tumors make up for about 5% of all genital malignancies in the females and are a very heterogenous group in terms of histogenesis. This results in great variety of benign and malignant lesions developing within the vulvar area. From the clinical point of view, the most important entity is squamous cell carcinoma of the vulva (SCC), where the coefficient of incidence is estimated at 0.1-2.6 per 100 000, depending on population and location. Worldwide mean incidence is 1.2 per 100 000. Currently, two main forms of SCC are recognized, essentially different in terms of etiology, epidemiological profile, pathogenesis and morphological-clinical appearance: vulvar cancer associated with human papilloma virus (HPV) infection (SCC-HPV-linked) and vulvar cancer not linked with HPV infection (SCC-non-HPVlinked). In its natural course, SCC is preceded by precancerous conditions, defined as vulvar intraepithelial neoplasia (VIN). Histopathological features of VIN also depend on presence or lack of HPV infection. Routine diagnostic workup of VIN includes: clinical examination, colposcopic study (vulvoscopy), photodynamic diagnosis (PDD), cytologic study of cells collected from vulvar surface, histological study of biopsy specimens, other studies (aspiration/fine needle biopsy of lymph nodes), positron emission tomography (PET). Treatment of precancerous conditions may be conservative (Aldara, 5-FU) or surgical. The aim of this paper was to analyze current literature and systematization of information concerning vulvar malignancies, particularly SCC, with particular emphasis on its epidemiology and pathogenesis. Modern diagnostic and therapeutic modalities used in the management of precancerous conditions are presented.

Keywords: vulvar cancer, undifferentiated VIN, HPV, vulvar intraepithelial neoplasia, Aldara, Efudex
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Possible usage of the blood serum concentration measurements of sHLA-G and sRCAS1 in women treated surgically for vulvar cancer as an indicator of the status of the tumor microenvironment
CURR. GYNECOL. ONCOL. 2009, 7 (3), p. 192-198
ABSTRACT

Introduction: The suppression of the immune system constitutes a crucial event in the development of malignancy. Assessment of the blood serum concentration levels of sRCAS1 and sHLA-G may demonstrate the suppressive influence of cancer cells on the immune system as these proteins are involved in the evasion of immune system surveillance by cancer cells. Since, in some cases, surgery may restore proper immune system activity, we aimed to measure the blood serum concentration levels of both these proteins over the course of the applied therapy. Material and methods: We measured the sRCAS1 and sHLA-G blood serum concentration levels in a group of 19 patients treated surgically for vulvar carcinoma. We assessed the levels of these proteins by a series of measurements taken before and after the surgical intervention. The concentration levels of sRCAS1 and sHLA-G were established by means of ELISA kit. Results: In our study we observed that a statistically significant decrease in both sHLA-G and sRCAS1 blood serum concentration levels followed radical surgical intervention due to vulvar cancer. Conclusions: The detected levels of the blood serum concentration of these proteins may be a useful indicator of the status of the tumor microenvironment and may help to assess the degree of restoration of immune system activity following radical surgical vulvectomy.

Keywords: vulvar cancer, sRCAS1, radical vulvectomy, sHLA-G, tumor microenvironment
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Analysis of serum bFGF concentration in women with malignant and benign ovarian tumors
CURR. GYNECOL. ONCOL. 2009, 7 (3), p. 199-205
ABSTRACT

Aim of paper: The purpose of this paper was to assess serum bFGF level on women with malignant and benign ovarian cancer. Material and methods: The study encompassed 62 patients treated at the Department of Surgical Gynaecology of the Medical University in Poznań since 2006 thru 2009. The patients were subdivided into two groups: those harboring ovarian cancer (group 1; n=17) and those affected with a benign tumor (group 2; n=45). Serum bFGF level was assessed in both groups in relation to several features of the disease. Results: Median serum bFGF level in group 1 was 40.10 pg/ml (95% CI: 29.17-113.89), while in group 2 – 20.60 pg/ml (95% CI: 16.33-36.59). The difference was close to statistical significance (p=0.068). Prognostic value of bFGF in ovarian cancer in terms of sensitivity and specificity was 47% and 93%, respectively. Its positive predictive value (PPV) was 73%, negative predictive value (NPV) – 82%, and AU-ROC (area under curve) – 0.647. Analysis of AU-ROC for bFGF and CA-125 revealed superior predictive value of the latter in ovarian cancer (p=0.011). Median serum bFGF level in women with ovarian cancer at FIGO stage III and IV was 99.60 pg/ml (95% CI: 37.59-185.04) and was significantly higher than at FIGO stage I and II (16.29 pg/ml; 95% CI: 4.57-37.78; p=0,025). In clear-cell- and non-differentiated cancers, higher serum bFGF level was noticed (p=0.0037). No correlations have been noticed between bFGF and histological malignancy grade (p=0.56) or tumor size (group 1: p=0.56; group 2: p=0.87). Conclusions: In women affected with ovarian cancer, serum bFGF level is higher than in those harboring benign tumors and the difference is close to statistical significance. In women with ovarian cancer, serum bFGF level is significantly higher in those at more advanced clinical stage of the disease. BFGF may be a valuable adjunct in preoperative diagnostic work-up of ovarian tumors.

Keywords: bFGF, CA-125, ovarian cancer, ovarian tumor, diagnosis
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Vaginal hysterectomy as a method of treatment of endometrial cancer
CURR. GYNECOL. ONCOL. 2009, 7 (3), p. 206-216
ABSTRACT

The aim of this paper is to assess transvaginal hysterectomy as a technique of surgical treatment of selected group of patients (n=28) with endometrial cancer, treated at the Department of Gynecology and Oncological Gynecology of Medical University in Gdańsk since 1983 thru 2008. Material and methods: Analysis encompassed the following clinical parameters: patients’ age, number of deliveries, coexisting internal medical diseases, past surgical procedures, body weight and BMI index, histological grade and clinical stage of endometrial cancer, depth of myometrial infiltration and invasion of uterine cervix by the tumor, intra- and postoperative complications. Due to retrospective character of the study, FIGO 1988 classification of endometrial cancer based on surgical-pathomorphological criteria was used throughout the text. Results: The youngest patient was 42, the oldest – 82. Twenty seven women (96.4%) were at postmenopausal age and only one (3.6%) – at premenopausal age. Most patients have had 2 or 3 deliveries. In the study population, the lowest body weight was 72 kg, the highest – 230 kg. Obese and pathologically obese patients predominated, whereby 60.5% of the patients weighted over 100 kg. In this group, 26 patients (92.9%) had a serious internal medical comorbidity and only 2 patients (7.1%) did not report any coexisting disease. In the group of patients operated on by transvaginal approach, the predominating histological type was adenocarcinoma. Over one-half of the patients had low-stage cancer, limited to endometrium only or not exceeding one-half of myometrial layer. In this group, coexisting superficial invasion of uterine cervix was seen in 3 cases and coexisting cervical cancer in 1 case. Conclusion: Selected group of patients with endometrial cancer presented in this paper proves the feasibility of treating this type of malignancy by transvaginal route.

Keywords: endometrial cancer, obesity, vaginal hysterectomy, transvaginal approach, treatment of endometrial cancer
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