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Disseminated peritoneal leiomyomatosis (DPL) is a rare condition characterized by the presence of multiple histologically benign smooth muscle nodules on the surface subperitoneal tissue simulating macroscopic peritoneal carcinomatosis. This disease is rare, but in recent years, in connection with the widespread introduction of laparoscopic surgery, the reports of disseminated peritoneal leiomyomatosis occurring after laparoscopic morcellation, were frequent. The knowledge of DPL is necessary to develop methods of prevention, and individualized treatment depending on the pathogenesis and clinical manifestations in each patient.

We presented a case of 41-year-old patient underwent two laparoscopic Myomectomies and current laparotomy regarding suspection of necrotic leiomyoma. Intraoperative finding was suggestive of disseminated malignancy, but gefrir study showed benign smooth muscle tumors. The patient underwent total hysterectomy with right adnesectomy and total omentectomy. After histological and immunohistochemical study of the entire macroscopic material the final diagnosis was disseminated peritoneal leiomyomatosis. This disease is rare, but in recent years, in connection with the widespread introduction of laparoscopic surgery the reports of disseminated peritoneal leiomyomatosis occurring after laparoscopic morcellation, were frequent.

Aim: The aim of the research was to evaluate and analyse prognosis and prognostic factors in patients with squamous cell vulvar carcinoma after primary surgery with individual approach applied during the course of treatment., Materials and Methods: In the period between January 2000 and July 2010, 113 patients with squamous cell carcinoma of the vulva were diagnosed and operated on at Gynecologic Oncology Clinic of Medical University, Pleven. All the patients were monitored at the same clinic. Individual approach was applied to each patient and whenever it was possible, more conservative operative techniques were applied. The probable clinicopathological characteristics influencing the overall survival and recurrence free survival were analyzed. Univariate statistical analysis and Cox regression analysis were made in order to evaluate the characteristics, which were statistically significant for overall survival and survival without recurrence. A multivariate logistic regression analysis (Forward Wald procedure) was applied to evaluate the combined influence of the significant factors. While performing the multivariate analysis, the synergic effect of the independent prognostic factors of both kinds of survivals was also evaluated., Results: Approaching individually each patient, we applied the following operative techniques: 1. Deep total radical vulvectomy with separate incisions for lymph dissection (LD) or without dissection--68 (60.18 %) patients. 2. En-bloc vulvectomy with bilateral LD without vulva reconstruction--10 (8.85%) 3. Modified radical vulvactomy (hemivulvectomy, patial vulvactomy)--25 (22.02%). 4. wide-local excision--3 (2.65%). 5. Simple (total /partial) vulvectomy--5 (4.43%) patients. 6. En-bloc resection with reconstruction--2 (1.77%) After a thorough analysis of the overall survival and recurrence free survival, we made the conclusion that the relapse occurrence and clinical stage of FIGO were independent prognostic factors for overall survival and the independent prognostic factors for recurrence free survival were: metastatic inguinal nodes (unilateral or bilateral), tumor size (above or below 3 cm) and lymphovascular space invasion. On the basis of these results we created two prognostic models: 1. A prognostic model of overall survival 2. A prognostic model for survival without recurrence., Conclusions: Following the surgical staging of the disease, were able to gather and analyse important clinicopathological indexes, which gave us the opportunity to form prognostic groups for overall survival and recurrence-free survival.

Uterine smooth muscle tumors /USMT/ are the most common tumors of the female reproductive system. The main aim of the clinical histological classification and the grading of MGMT is to predict their progression. The diagnosis of USMT has of the following stages: the determination of the direction of differentiation of the tumor and the defining the morphological features (the mitotic index, the tumor necrosis and the cellular atypia). In each of them there are specific problems. This indicates, that the USMT are therapeutic and clinical challenge.

The establishment of the clinical behavior of uterine smooth muscle tumors /USMT/ is an essential stage of modern diagnostics. There are significant differences in the criteria determining the malignant potential of smooth muscle gynecological tumors. Generally USMT generating diagnostic problems are classified into: clinically benign tumors; clinically malignant tumors with benign morphological features; smooth muscle tumors of uncertain malignant potential (SMTUMP) and lesions whose smooth muscle differentiation is not obvious. The knowledge in this area is essential for an adequate therapeutic approach.

Objective: To present and analyze the clinical characteristics, treatment, and treatment options for a patient with primary malignant melanoma of the vagina and review of literature., Clinical Case: A 71-year-old patient with a history of vaginal bleeding caused by four tumor growths located in the vagina is presented. The size of each formation was about 2 cm. Three of them were located in the proximal two-thirds of the anterior wall of the vagina and one in the distal third. Excisional biopsy was performed of the lesion located near the entrance of the vagina. Histopathological examination revealed that it was a malignant melanoma of the vagina, which was confirmed immunohistochemically. After ruling out a tumor of an unknown primary site, the patient underwent radical hysterectomy type IV total vaginectomy and pelvic lymph node dissection. Hystological examination proved a clinically asymptomatic melanoma lesion of the uterine cervix. After surgery, the patient was given chemotherapy with Dacarbasine and monthly immunotherapy with BCG vaccine. The patient survived 21 months after surgery without developing a local relapse and died of distant metastases in the spine., Conclusion: Radical surgery for primary melanoma of the vagina is a secure way of achieving locoregional control of multifocal disease. The wide local excision can be used in unifocal lesions with security in achieving clean surgical margins.

Unlabelled: The duration of an operative intervention is directly related to the seriousness of the operative trauma., Material and Methods: A group of 14 factors with possible influence over operative time was investigated on the basis of the analysis of 635 laparoscopic hysterectomies accomplished over a six-year period (2004-2010) at the Oncogynecological Clinic at "Georgi Stranski" University Hospital for Active Treatment, and "St. Marina" Specialized Hospital for Active Treatment in Obstetrics and Gynecology, Pleven, Bulgaria., Results: The factors which prolong the operative time statistically significant are uterine prolapse, as an: indication for operation, emergence of complications, hemotransfusion, enlarged uterus to the size of m. l. IV-V and increase in the body mass index by 1 kappag/m2, while previous conization and every following year of accomplishment of a laparoscopic hysterectomy significant shorten operative time., Conclusion: The fact that previous abdominal operations do not affect the duration of laparoscopic hysterectomy significant, indirectly supports the proposition that they are not a contraindication for the given operative procedure.

Unlabelled: The aim of the study was to define the notion of locally advanced vulvar cancer (LAVC) and approaches to treatment by presenting clinical cases encountered by the authors., Materials and Methods: The clinical cases described present different views on therapeutic approaches to cases with LAVC. Apart from cases of primary advanced vulvar cancer, there exist cases, in which primary treatment was applied. In such cases, however, involvement of adjacent structures was a result from recurrence of the disease. LAVC implies that the primary or recurrent tumour cannot be treated solely by radical removal of the vulva. Modem treatment of LAVC include ultraradical surgery, radiotherapy, chemoradiotherapy, or a combination of these methods. Studies have confirmed the hypothesis that megovoltage radiotherapy can yield a significant regression of LAVC that makes it possible to apply more sparing surgical resections and preserve the functions of adjacent organs, thus improving life quality., Conclusion: Surgical treatment of LAVC without preoperative chemoradiotherapy is recommendable only in cases of resectable tumours, possibly with non-metastatic and primarily resectable regional lymph nodes.

The authors review on a rare pregnancy accompanying disease--Melanoma malignum. After the definition are presented the epidemiology, etiology, pathogenesis, pathomorphology, clinical forms, diagnosis, differential diagnosis, treatment and prevention. Described are the effects of the pregnancy on this malignant disease and the impact of it during the pregnancy.

Unlabelled: The aim of present study is to investigate the immunohistochemical expression of tumor suppressor gene p16(INK4a) and proliferative marker Ki-67 in dysplastic vulvar lesions and nondysplastic ones., Materials and Methods: 30 female patients (mean age = 49.5 +/- 4.5) - Ca in situ (n = 2), VIN (n = 10), lichen sclerorosus (n = 8), squamous cell hyperplasia (n = 1), mixed vulvar dystrophy (n = 5), papilloma (n = 1), condyllomata accuminata (n = 3) are separated into two groups (first group of non-dysplastic- and second group of dysplastic lesions). The immunohistochemical method with monoclonal antibody for identification of p16(INK4a) and Ki-67 was applied., Results: P16(INK4a) is expressed in 1 patient (5.56%) in first group and in 8 patients (66.67%) in second group (chi2 = 84.93; p < 0.001). Ki-67 is positive in 4 patients (22.22%) in first group and in 12 of cases (100%) in second group (chi2 = 41.3; p < 0.001)., Conclusions: There is a significant statistical difference between immunohistochemical expression of p16(INK4a) and Ki-67 in HPV-associated dysplastic and non-dysplastic vulvar lesions.

Carcinosarcomas are rare malignant neoplasms that histologically contain both epithelial and mesenchymal components. In the female genital tract they occur mainly in uterus and rarely in cervix, ovaries and omentum. A rare case of ovarian carcinosarcoma is presented. Because of the presence of a solitary, massive metastasis in the uterine cervix, it created some serious diagnostic and therapeutic problems.

The aim of the present study is to show the advantages of the gynecologic laparoscopy for the diagnosis and treatment of the intact tubal pregnancy. For the fulfillment of this aim was made a prospective study for 5 years' period of the patients with diagnosis "Ectopic pregnancy", treated in Gynecological clinic of UMBAL-Pleven. The objects of observation were 33 women with diagnosis: "Intact ectopic pregnancy". Methotrexate was used by plan for 6 patients, in 7 patients was made laparotomy, and in 20 patients--gynecological laparoscopy. From the performed 20 gynecological laparoscopy, 16 women were recovered laparoscopically, in 14 of which was made partial salpingectomy, and in 2--milking. In one of the last two patients was injected Methotrexate in the bed of the gestational bag. In 4 women was necessary laparotomy, because of impossibility of performing of laparoscopic surgery. The authors emphasized the advantages of the gynecological laparoscopy for precise diagnosis and contemporary treatment of the intact ectopic pregnancy.

Two clinically identical cases of young, pregnant women, presented with exocervical polypoid masses are described. Because of beginning delivery in both cases, the diagnoses are made on frozen sections. In the first case histological examination reveals microglandular endocervical hyperplasia. A successful delivery by caesarian section and no more operations is performed. In the second case, an endocervical adenocarcinoma is diagnosed and after a successful delivery by caesarian section, a laparohysterectomy with bilateral adnexectomy and lymph node dissection is performed. Detailed histological examination of the endocervical neoplasm discloses a well differentiated papillary villoglandular adenocarcinoma, containing minor elements of more aggressive serous carcinoma, which may adversely affect the outcome. Three consequent recurrences are found in this patient for a period of 5 years and 3 months after the operation.