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Epithelial ovarian cancer remains the most lethal gynecologic malignancy in the Czech Republic. Due to the nonspecific symptoms of the disease, most cases are diagnosed only in advanced stages. The first line of treatment for ovarian cancer involves primary cytoreductive surgery, followed by combined adjuvant chemotherapy based on platinum and paclixatel, which generally achieves a good therapeutic response. However, in about two thirds of the patients, the disease relapses.Key words: ovarian cancer cytoreductive surgery.

Preinvasive lesions of the endometrium are histopathological and molecular alterations related to high-risk of uterine carcinoma development. Incidence has increasing tendency. Atypical endometrial hyperplasia is the preinvasive lesion of type I endometrial carcinoma, developing under a hyperestrogenic background. Carcinoma in situ of the endometrium is considered to be precursor lesion of type II endometrial carcinoma, first of all uterine serous carcinoma. Hysterectomy and bilateral oophorectomy is the main therapeutical modality in both preinvasive lesions of the endometrium. The hormonal therapy with progestogens is the possibility of fertility sparing approach in treatment of histological findings of atypical endometrial hyperplasia in young women. Even though preinvasive lesions of the endometrium are clearly defined, the possibilities of endometrial cancer screening are markedly limited.

Standardized gynecological oncological therapeutical guidelines are based on ordinary predictive factors, such as depth of stromal invasion, histopathological type of tumor, lymphovascular space invasion, lymph node metastases. Unfortunately, the power of these prognostic factors is not able to determine the safety of this procedure in the relation to disease recurrence in a group of patients who are indicated for conservative operations. This is the appropriate area for new, especially biomolecular prognostic factors (proteins: p63, TAp63, p16, p21, p27, COX-2, genes: hTERC, MYCC). Moreover, comprehensive evaluation of cervical cancer prognostic factors and assessment of new biomarkers of cancer can ease prediction of risk of spread outside primary localization and determine probability of disease recurrence. This information can help to individualize surgical, radiotherapeutic and chemotherapeutic treatment.

For preinvasive lesions of vulva, a common term VIN -  vulval intraepithelial neoplasia is used. VIN is a histological dia-gnosis based on abnormal squamous epithelial proliferation. There are two types of VIN apart from their association with human papillomavirus (HPV). Undifferentiated (usual) vulval intraepithelial neoplasia is commonly associated with carcinogenic genotypes of HVP, whereas differentiated vulval intraepithelial neoplasia is not associated with high-risk genotypes of HPV. The article presents an overview of VIN occurence and epidemiology, its classification system and dia-gnostics. In conclusion, VIN therapeutical possibilities are presented. It can be treated with surgical therapy (local excision, partial vulvectomy, vulvectomy, laser vaporization) or medical therapy (imiquimod).

Preinvasive lesions of the vagina are relatively rare, clearly defined afflictions, originating most of all in association with the highrisk human papillomavirus infection (HR HPV). The most frequent appearance is in coincidence with preinvasive lesions of uterine cervix and in vaginal cuff after hysterectomy. Preinvasive vaginal lesions are divided into squamous lesions (vaginal intraepithelial neoplasia) and nonsquamous lesions. Vaginal adenosis belongs to nonsquamous vaginal preinvasive lesions and is a precursor lesion of vaginal clear cell carcinoma. Surgical and nonsurgical techniques including laser destructive methods and local administration of 5- fluorouracile are used in the treatment of preinvasive lesions of vagina.

Preinvasive lesion of the uterine cervix can give rise to cervical cancer. High-risk human papillomaviruses with high oncogenic potential are considered to be the main etiopathological factors with interaction of other risk factors (recurrent inflammation of the cervix, injury of the cervix, immunosuppressive conditions, sexual promiscuity, etc.). Early dia-gnosis of these changes at regular gynecological examinations and adequate treatment can prevent of malignant transformation. Organized cervical screening and implementation of nationwide vaccination against human papillomavirus promises to reduce the incidence of cervical cancer.

Objective: To develop guideline for primary surgical treatment of endometrial carcinoma., Design: Review, consensus of expert group., Setting: Dept. of Gynaecology and Obstetrics, 3rd Medical Faculty of Charles University in Prague., Method: A retrospective review of published data, analysis of statistic data from Czech Republic, consensus among proposers and opponents., Results: The guideline recognizes endometrial carcinoma patients based on their risk and recommends type of surgical treatment for certain group. It emphasizes the importance of centralized oncogynaecological treatment. Surgical staging remains the basic principle for treatment of endometrial carcinoma patients. The aim of pre-operative diagnostics is to estimate the extent of the disease--"interim staging", that can be different from definitive histopathological staging. Based on risk factors patients are divided into low or high risk group. Standard procedure for low risk patients is hysterectomy and bilateral salpingoophorectomy. It is advisable to use peroperative biopsy in these patients that can shift the patient to high risk group. High risk patients are recommended for hysterectomy, bilateral salpingoophorectomy, and systematic aortopelvic lymphadenectomy. The guideline contains recommendation for young patients wishing to preserve their fertility, for cases of inadequate surgery and for follow-up., Conclusion: Guideline for treatment of endometrial carcinoma is recommendation for clinicians and other subjects who participate on the process of the diagnostics/treatment of endometrial carcinoma patients. All points of the guideline were discussed and voted about by all participants of expert group.

Backgrounds: Endometrial carcinoma is the most frequent gynecologic malignancy. The incidence is 30 : 100,000 with an increasing tendency. The main therapeutic modality remains radical surgery. The purpose of the study is to evaluate the feasibility of sentinel lymph node (SLN) detection in endometrial cancer using hysteroscopic administration of radiocolloid and the combination of preoperative lymphoscintigraphy with intraoperative gamma-detection probe examination., Patients and Methods: From May 2006 to January 2009, 99mTc-labelled nanocolloid (100 MBq) was administered preoperatively in 21 patients with endometrial cancer. On the day of surgery, radiocolloid together with blue dye was injected via 20-gauge needle under the endometrium using hysteroscopy. Lymphoscintigraphy was performed in all patients after 60 minutes. Therapeutic surgery followed the tracer administration 2 hours later in extensity of abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal wash, pelvic lymphadenectomy and in patients with positive high-risk prognostic factors of paraaortic lymphadenectomy. SLN was located by use of gamma-detecting probe intraoperatively., Results: At least one SLN was detected in 17 of 21 (81%) patients included in the study. The mean number of detected SLNs was 2 (range 1-5). 8 of 17 (47%) patients had radioactive nodes only in the paraaortic area. Synchronic appearance of SLNs in the pelvic and paraaortic areas was detected in 1 of 17 (6%) cases. Overall, in 4 of 9 (44%) cases of sentinel lymph node localization in the paraaortic area the SLNs were detected at the level above the inferior mesenteric artery. The metastatic involvement of 3 sentinel lymph nodes was detected in one patient (3 lymph nodes with micrometastases). All the remaining lymph nodes not labelled as SLNs were histologically negative in this case. The sensitivity and specificity for SLN metastases detection was 100%., Conclusion: SLN detection in endometrial cancer appears to be a promising method with the potential to reduce unnecessary surgery radicality and to clarify staging. The utilization of hysteroscopic application of radiocolloid respects the anatomical consequences and natural lymphatic drainage of the endometrium. The combination of pre-operative lymphoscintigraphy and intra-operative detection using a handheld gamma probe can be beneficial.

Aim of the Study: Aim of the study was to investigate connection between the level CA125, level of haemoglobin and emergence of recurrence and survival time for patients with ovarian cancer., Material and Methods: This concerns of retrospective study in which total 53 patients with histology confirmed ovarian cancer were included. These patients were diagnosed and subsequently treated in the GPK FN MU Brno during 2000-2002 period., Results: The level of CA125 in our study appeared to be statistically significant prognostic factor (beta = 0.44, p = 0.02) for survival. Signification of the plasma level of haemoglobin to be any prognostic factor was not proved in this study. Among other assessed factors influencing survival time of the patients was the number of gravidity to be important prognostic factor (beta = -0.96, p = 0.002). Survival time was shorter for patients with less number of pregnancies., Conclusion: Ovarian cancer is tumour with high mortality. That is why it is necessary to look for new markers, which would contribute to earlier diagnostic of this disease, and which could influence its prognosis.

Aim: The aim of this study was to find out if the incidence of cholecystectomy is more frequent in patiens with endometrial carcinoma and if the incidence of the anamnestic information concerning cholecystectomy in patiens with endometrial carcinoma influences the course and the result of the treatment of the said tumorous disease., Type of Study: Retrospective study., Methods: 470 females with endometrial carcinoma were entered into the study, the group was divided into the patients who have had cholecystectomy and those who have not had it. There was a control group of 370 females. All the said patients were diagnosed and subsequently treated at the Department of Gynecology and Obstetrics Masaryk University affiliated Hospital, Brno between January 2004 and December 2006., Results: We have not proved any statistically significant difference concerning the origin of the endometrial carcinoma after a performed cholecystectomy. There was no difference in grading as well as the stage according to the FIGO standards. Nonetheless, we can say that the patients with endometrial carcinoma and cholecystectomy have significantly higher BMI., Conclusion: The relation between cholecystectomy and the endometrial carcinoma can be influenced by various factors. However, we can assume that the pathological processes of cholelithiasis are pathophysiologically connected with the development of changes, which fall within the category of hormonal risk factors for the development of endometrial carcinoma.

Objective: The verification of the predicive part of the vaginal ultrasonography in diagnostics of cancer of endometrium with the help of comparison of vaginal sonography finding (through the mediation EMI--endometrium/myometrium index) with relevant histological results., Design: Clinical prospective study., Setting: Department of Gynaecology and Obstetrics, Faculty of Medicine, Masaryk University and Faculty Hospital, Brno., Methods: In this work we included 200 patients--on one hand the patients with the symptoms (pre- and perimenopauzal irregular bleeding and postmenopauzal bleeding), on the other hand the patients without symptoms, but with the suspicious ultrasonography find (suspicious or positive EMI). Each of the patients included in this study underwent the ultrasonography examination witch determined EMI and then the endometrial biopsy or the diagnostic hysteroscopy with sampling the material. The determined value EMI was compared with the histological result., Results: On the basis of the results of this work we found out the possibility utilization of the vaginal ultrasonography as the prebioptic method in diagnostics cancer of endometrium through the mediation of determined EMI. The sensitivity of the method, however, is lowered by the next diseases of uterus (especially uterine myoma) that cause wrong negativity of EMI with connection with increased thickness of uterus in the region body of uterus., Conclusion: We can expect a high sensitivity of EMI in patients with diseases of endometrium, if there is by ultrasonography examination verified uterus with smooth border without uterine myoma. This examination acquires a special significance as the pre-bioptic and along with the preventive method the timely catch first of all in patients without symptoms, but with one or more risk factors for rise to cancer of endometrium.

Objective: Elaboration of guideline for primary and secondary treatment of ovarian cancer., Design: Review, consensus between proposers and opponents., Method: A retrospective review of published data, analysis of Czech statistics and consensus between proposers and opponents., Results: We underline importance of comprehensive approach in therapy of ovarian cancer. We notice importance of expert ultrasound and CA 125 level in diagnostic algorithm. Extension of surgery depends on result of frozen section. All departments which want to perform surgery for ovarian resistance must have possibility to do peroperative histopathology. We can perform conservative fertility sparing surgery in patient with wishing of pregnancy and low stage disease. The effort of maximal debulking with radical surgery including lymphadenectomy is the standard procedure. When we diagnose ovarian cancer during laparoscopy, we have to convert on laparotomy procedure. We define the role of the neoadjuvant chemotherapy followed by surgery after 3-4 cycles of chemotherapy. We define adequate surgery treatment, indication for adjuvant chemotherapy and indication for second line therapy., Conclusion: Guideline for the treatment of epithelial ovarian cancer should become directions for clinicians and others, who participate in the process of treatment of the ovarian cancer. The guidelines include all parts of the process from diagnosis, treatment to follow up. All topics of the guidelines arose from a voting of the proposers and opponents.

Objective: The detection of p16 in oncocytology and in the surgical pathology of the uterine cervix., Setting: Department of Pathology and Department of Gynaecology and Obstetrics, University Hospital Brno., Methods: An imunocytochemical and immunohistochemical analysis of formalin-fixed, paraffin embedded samples of the uterine cervix (included knips biopsies) and liquid based smears was performed. The bioptic database included 7 cases of CIN II-III, 5 cases of reactive epithelial changes and 3 cases of atrophic epithelium. 36 liquid based smears, 25 cases of CIN III and 11 cases of uterine cervix without a dysplastic lesion., Results: Nuclear and cytoplasmatic p16 positivity was found in 22 cases of CIN III in liquid based smears. Diffuse and intensive p16 expression was in 5 cases of knips biopsies CIN III., Conclusion: The detection of p16 seems to be a valuable tool in surgical pathology of the uterine cervix: possible evaluation of the surgical margins, differential diagnosis regarding reactive atypia, and it is also prospective in oncocytologic diagnosis regarding differential diagnosis of the ASCUS, or can be used in monitoring of the uterine cervix dysplasia.