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The ENZIAN-Score is presented as a new instrument to classify the deep infiltrating endometriosis. Especially the retroperitoneal part of the severe endometriosis is focussed on. In analogy to an oncological staging four different stages are pronounced. The localisation and the expansion of the endometriosis nodule was indicated to different subgroups. The still used rAFS-score is of no clinical evidence, as we pointed out in a retrospective study of our patients with severe intestinal endometriosis.

Malignant tumors arising from endometriosis are rare. A frequency of about 1% has been reported with in 80% the ovary, and in 20% extragonadal sites being affected. The most common extragonadal manifestations are the rectosigmoid and the rectovaginal septum. For extragonadal malignant tumors arising from endometriosis, complete resection followed by post-operative radiotherapy, possibly plus adjuvant progestin therapy, is the treatment of choice. Endometriosis-associated ovarian carcinomas are likely to present with lower stage disease and predominantly lower grade tumors. While their treatment follows that of common ovarian cancer, a poorer response to chemotherapy must be considered. As unopposed estrogen replacement therapy has been identified as a risk factor for the development of endometriosis-associated cancer, it is not recommended for hormone replacement therapy in women with a history of endometriosis. Loss of heterozygosity and mutations of the PTEN tumor suppressor gene may be early events of tumorigenesis. Endometriosis and its malignant transformation, perhaps, may serve as a suitable model in this regard. According to recent studies, endometriosis is associated with an increased relative risk of non-Hodgkin lymphoma.

Non-invasive staging of cervical cancer according to FIGO is out-dated. In contrast to clinical staging exact histopathologic evaluation of tumor extension and tumor biology can be achieved via laparoscopic evaluation. Invasive endoscopic staging is advantageous and should be integrated into the diagnostic armamentarium of gynecologic oncologists and radiotherapists. Through magnification and blood-less surgery minute anatomical structures can be identified laparoscopically. Thus, fibers of autonomic nerves can be visualized and parasympathetic fibres can be preserved. Conservation of these neural structures leads to significant reduction of postoperative morbidity of bladder and rectum. The concept of the sentinel lymph node is also valid for the uterine cervix. Selected biopsy of the sentinel node and identification of single tumor cells leads potentially to higher oncologic safety and may reduce morbidity associated with radical lymphadenectomy. In early stage cervical cancer fertility may be preserved by radical trachelectomy which is combined with laparoscopic parametric and pelvic lymphadenectomy. Following radical trachelectomy a pregnancy rate of 40% is achieved, the recurrence rate following conventional radical hysterectomy is identical.

We performed a laparoscopic pelvic lymphadenectomy in three patients with vulvar cancer FIGO stage II or III and positive inguinal lymph nodes. Computertomographical and lymphographical findings of pelvic lymph nodes did not correlate with the histological findings in two patients: Surgical staging up-graded the clinical stage in one patient. No intra- or postoperative complications were encountered. Laparoscopic pelvic lymphadenectomy in inguinal metastasizing vulvar cancer is a valuable method with low peri- and postoperative morbidity.

Reviewing the historical development of radical vaginal surgery for the treatment of cervical cancer the different variations of this technique are defined. In 1880 the first modified radical hysterectomy for cervical cancer was performed by Pawlik. Radical vaginal hysterectomy is associated with the name of Schauta who further developed and categorized the technique. The most important modifications were done by Stoeckel and Peham/Amreich. Extraperitoneal dissection of pelvic lymph nodes was combined with radical vaginal hysterectomy by Stoeckel in 1928.

In recent years, ultrasound has become established as part of the diagnostic evaluation of breast tumours. Not replacing, but complementing mammography, ultrasonic investigations increasingly represent a sensitive means of early diagnosis. Thermography, on the other hand, has proved of relatively little value and doesn't play a significant role today. Lately, Colour Doppler sonography has been used for differentiating tumour-associated blood supply patterns--however, sensitivity and specificity were not as high as initially expected. Colour spectrum analysis of local findings in comparison to the remaining glandular tissue, however, seems to be a promising method in the differentiation of ultrasound findings of uncertain tumour status. A fibroadenoma shows no significantly different colour density as compared to surrounding tissue. In carcinoma, on the other hand, one regularly finds a hyperintensive zone with sharp margins. In 70 patients, who had breast tumours, we attempted the differentiation of benign and malignant findings with the help of colour spectrum analysis. Postoperatively, these results were validated by histology. With the exception of one mesenchymal tumour, the Doppler diagnosis was identical to the histopathological findings.

Aggregation und Serotonin-release were investigated depending on plasma magnesium levels. High magnesium levels inhibit the platelet function, which is stimulated in preeclamptic patients. Magnesium-infusions therefore might be of therapeutical use in SIH-patients by reducing the platelet function.