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Ultrasonic surgical aspiration is a useful technique for safe and accurate tissue removal. This study was conducted to evaluate its role in noninvasive vulvar disease. From December 1988 to March 1990, 27 patients underwent ultrasonic surgery; nine patients had vulvar intraepithelial neoplasia (VIN) and 18 had condylomata acuminata. All surgical procedures were done under general anesthesia, with two patients requiring hospitalization for perineal care and pain control after extensive vulvar surgery. Recurrent or persistent disease occurred in four patients with condylomata acuminata and in two with VIN, with a mean follow-up of 50 weeks. Reepithelialization was completed within 5 weeks and no patients developed vulvar scarring. Adequate samples for histopathologic review were obtained in 26 patients. Identical histologic grading occurred in all 13 patients who had preoperative vulvar biopsies and an adequate aspiration specimen. Ultrasonic surgery permits precise and rapid removal of epithelial lesions with rapid healing, minimal patient discomfort, excellent cosmetic results, and histopathologic documentation.

Use of exogenous estrogens has been associated with endometrial cancer in a number of case-control studies. This observed association could be biased as a result of frequent misclassification of estrogen-induced hyperplasia as endometrial cancer. To evaluate this possibility, pathology slides from 233 patients with a hospital diagnosis of endometrial cancer were reviewed independently by two pathologists. The hospital diagnosis was confirmed by both pathologists in 86% of the cases, indicating that the misclassification of hyperplasia as carcinoma is uncommon.

Knowledge of gland-like inclusions in pelvic lymph nodes has existed since 1897. The histogeneses proposed to explain such alterations have included congenital rests, endometriosis, metastatic neoplasia, and mesothelial metaplasia. The correct interpretation of the lymph node involvement is important in order to institute appropriate therapy. In the present study, there were 12 examples of benign mesothelial inclusions found in routine sections from pelvic lymph nodes removed in the treatment of 337 cases of gynecologic cancer. In an additional 4 cases, an intraabdominal neoplasm was present. The variations in the histologic patterns are described as is the clinical course of the disease.

The histopathology of the original and the persistent or recurrent epithelial ovarian cancer in 34 patients was simultaneously reviewed by two pathologists. The time between removal of the primary tumor and removal of the persistent or recurrent tumor ranged from four to 132 months (median, 13 months; mean, 25 months). The initial operation was followed by multiagent chemotherapy in 23 patients, single-agent chemotherapy in seven, radiation and chemotherapy in two, radiation in one, and no therapy in one patient. In four of the 34 primary tumors, a mixed tumor composition was initially identified. In comparing the initial histopathology with that of persistent or recurrent tumors, a change was identified in nine patients. In four patients, the tumor changed from a mixed to an undifferentiated histologic type; in four patients there was a change from a lower to a higher tumor grade, and two of these patients also had a change in tumor cell type from serous to undifferentiated. In the ninth patient, the tumor changed from a large cell undifferentiated to a small cell undifferentiated carcinoma. The observed changes could be the result of 1) modification of the tumor by cytotoxic therapy, 2) spontaneous dedifferentiation of the initial tumor, 3) tumor cell heterogeneity with preferential growth of one cell type over the others, or 4) the development of a second primary tumor.

A case is reported in which condylomata acuminata arose in a McIndoe neovagina. Histopathologic and virologic evidence are provided to support the characterization of these lesions as benign warty processes secondary to human papillomavirus-6. Factors influencing viral site specificity are discussed.

In view of the controversy regarding the appropriate frequency for cytologic screening, a 28-year-old woman who developed microinvasive carcinoma of the cervix less than one year after her fifth negative Papanicolaou smear is described. The lesion was found not high in the endocervical canal, but at the squamocolumnar junction well out on the portio of the cervix. This case documents that the risk of less frequent screening is not zero.

In a case-control study, we examined health care utilization histories to determine whether Papanicolaou tests provided by an obstetrician-gynecologist, as opposed to other providers, are more protective of cervical cancer. Women with cervical cancer were less likely than matched controls to have had regular Papanicolaou test screening, to have received a Papanicolaou test within the last five years, or to have obtained a Papanicolaou test from an obstetrician-gynecologist. After controlling for traditional risk factors, we found that receiving any Papanicolaou tests within the last five years from an obstetrician-gynecologist was more protective than receiving Papanicolaou tests from other providers, although the difference did not attain statistical significance. Among both cases and controls, younger women and women who had used prescription contraceptives were more likely to have had a recent Papanicolaou test by an obstetrician-gynecologist. The results support the importance of regular Papanicolaou test screening among older women and suggest that the obstetrician-gynecologist helps prevent cervical cancer by providing continuity of screening services.

All 190 cases of gestational trophoblastic neoplasia diagnosed in the Baltimore metropolitan area from 1975-1982 were identified. Histologic slides were requested and reviewed independently by two pathologists who agreed upon uniform criteria for the diagnosis of hydatidiform (complete) mole, invasive mole, and choriocarcinoma. A representative sample of the slides was selected and resubmitted to one of the study pathologists for a second review. The inter- and intra-pathologist variability in the diagnosis of gestational trophoblastic neoplasia was calculated using the kappa statistic (K). Our findings indicated that the variability in the diagnosis of gestational trophoblastic neoplasia was low whereas that for the related tumor of incomplete mole was high.

A case of paraneoplastic cerebellar degeneration complicating ovarian cancer is presented. This rare disorder is characterized by vertigo, nystagmus, diplopia, and ataxia. Neurologic sequelae are progressive, ultimately culminating in complete incapacitation and death. Symptoms of paraneoplastic cerebellar degeneration precede the diagnosis of malignancy in the majority of cases. Marked elevation in the anti-Purkinje cell antibody titer together with immunofluorescent staining techniques suggest that an autoimmune mechanism plays a role in the etiology of this disorder.

Spontaneous preoperative rupture and/or perforation of an adjacent organ by a benign cystic teratoma is rare. Between 1952 and 1979 there were 4 documented cases at The Johns Hopkins Hospital. The incidence, etiology, and pathology of this complication are discussed.

In 100 consecutive cases in which grossly normal ovaries were removed at the time of pelvic surgery, 9% were found to contain crystalline foreign particles. An additional 9% contained cortical granulomas. In four of six cases, computer-assisted x-ray analysis of the crystalline foreign particles was successful and revealed magnesium and silicon.

Subsequent to the recognition of the intraperitoneal tumors of low malignant potential, clinicians have repeatedly faced the ambiguities inherent in a disease that seems aggressive on the basis of its wide distribution in the peritoneal cavity but benign on the basis of its histopathology and clinical course. Whereas the occasional case has been associated with extensive local reaction and ascites, except for a rare exception these tumors result in prolonged survival and in an absence of extraabdominal extension. The current review of 154 cases followed from 2 to 40 years, performed in an attempt to understand this perplexing disease, leads to the following conclusions: 1) Whereas frequently beginning on the ovary and showing a predilection for the pelvis, there are examples of widely disseminated peritoneal disease with minimal, if any, ovarian involvement; 2) the outcome without adjunctive therapy is excellent and thus such therapy is contraindicated in view of the death of only 2 of the 154 patients with disease, 1 of whom had had adjunctive intraperitoneal isotope therapy; and 3) this disease is best understood as a diffuse primary peritoneal tumor probably developing on the basis of irritating agents' reaching the abdominal cavity from the lower genital canal, a process similar to that proposed for the genesis of endometriosis. Such a low-grade primary in situ tumor that may involve the entire peritoneal cavity is compatible with prolonged survival.

Adenocarcinoma originating in a focus of mammary tissue in the vulva is an extremely rare occurrence. Only three such cases have been reported in the literature. Herein, the fourth example of a primary cancer developing in vulvar mammary tissue is described. Extension to regional lymph nodes is documented, as well as the presence of estrogen receptors in this tumor. Immunohistochemical evidence is rendered supporting an origin from mammary anlage.

A decidual reaction may occur in the pelvic lymph nodes during normal pregnancy. This reaction may be replaced by the same type of benign metaplastic reaction that gives rise to leiomyomatosis peritonealis disseminata. The occurrence of this apparent smooth muscle in the pelvic lymph nodes may result in an erroneous diagnosis of metastatic leiomyosarcoma, or of benign metastasizing leiomyoma.

The hemangiopericytoma is an uncommon stromovascular neoplasm that arises from the pericyte of Zimmerman. Since their original description in the female genital tract in 1954, the majority of these lesions have been of uterine origin. Presented is a clinicopathologic description of a hemangiopericytoma arising in the vagina and occupying the rectovaginal septum. Light and electron microscopic characterization is rendered. Current understanding of these lesions is reviewed and therapeutic options are discussed.