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Background: Prognostic factors such as surgery and pathology in vulvar squamous cell carcinoma are studied., Patients and Methods: 47 patients with vulva squamous cell carcinoma treated at the Gynecology Department of the University of Padua, have been retrospectively studied., Results: At the univariate relapse-free survival analysis, a significant association was found for histological grade, stage of disease and type of surgery. All patients presented vulvar squamous cell carcinoma: G(1) in 25 (53%), G(2) in 14 (30%), and G(3) in 8 (17%) patients. The distribution of stages was as following: stage 1 in 6 (13%), stage 2 in 20 (43%), stage 3 in 11 (23%), and stage 4 in 10 patients (21%). Radiotherapy was performed in 13 patients. Among the 47 patients evaluable: 26 (55.3%) developed local recurrence, 12 of these patients developed a second local relapse, 3 of these also had distant metastases (lung in 1 patient, lomboaortic and mediastinic lymph nodes in the other 2 patients). Stromal invasions were 9 mm in 30 patients with 27 relapses (univariated analysis p=0 0066). Five episodes (10,6%) of thrombosis were observed., Conclusion: After multivariate analysis, surgery, stage and stromal invasion over 9 mm (hazard ratio=3.1; 95% confidence interval: 1.3-7.7) proved to be the most dominant predictor for relapse-free survival. Histological grades 1 and 2 were predictive of better disease-free survival (p=0.0012).

The Authors studied 37 women affected by vulvar condylomatosis. Thirty-four presented features of florid or microflorid condylomatosis, three were affected by flat condylomatosis, Papillomavirus (HPV) infection of the cervico-vaginal tract was present in 25 women. No vulvar cellular atypia was found in the 37 cases with HPV lesions, while in 6 cases there were also cervical dysplasia (CIN 1-CIN 2). Nineteen out of 23 patients with disseminated revealed a vaginal flogosis mostly by yeats, detected by microbiological examinations. The evidence of disseminated florid or microflorid lesions associated with the virus infection, both located at the cervico-vaginal tract, support the ipothesis of virus types with higher virulence, a greater ubiquitary trophysm and a greater oncogenic risk, as supported also by other Authors.

The presence of second neoplasia in association with vulvar neoplasia is significant. We confirm the usefulness of including a screening procedure for vulvar neoplasia in the follow-up of patients with gynecological cancer, especially those with carcinoma of the portio. Patients with a first gynecological neoplasia who present vulvar viral infection, or dystrophies, or who have undergone radiotherapy or immunosuppressive treatment are considered at high risk.

187 patients with atrophic, hypertrophic and mixed vulvar dystrophy were treated with 2% testosterone propionate ointment from 18 months to 7 years. Symptoms, macroscopic, and histologic picture were evaluated before and during treatment. About 75% of the patients achieved good and excellent symptom relief. Treatment efficacy differentiates according to the type of dystrophy, and in relation to the lesion's extension and the duration of symptoms, which consist mostly of pruritus. Side effects from therapy were negligible.

An adequate and unified classification of vulvar pathology has been difficult and continues to be a problem hard to solve, due to the difficulties in including different clinical aspects in various pathological classes. The causes of this uncertainty, as rather a multiplicity of view points, may be ascribed in particular to the extreme polymorphic nature of vulvar pathology. Our classification, in attempting to overcome arbitrary and absolute distinctions in such a polymorphic and variable field, adopts an etiological and anatomo-histological criterium which distinguishes vulvar pathology in: primary disorders, secondary disorders. It is evidently important to know and distinguish possible vulvar infections, in order to be able to identify those disorders which assume an oncogenous risk, while trying to overcome the problems of differential diagnosis.

Plain films of the abdomen taken during pregnancy at term from 1971 to 1981 at the Radiology Service of the Obstetric and Gynecological Clinic of the University of Padua are summarized and analysed. The average frequency of X-ray investigation is 0.5%, ranging from 0.06% (in 1980) to 2.11% (in 1977), compared to Carmichael's data which range from 11 to 30%. Indications have remained fairly constant over the years, in view of the very low incidence of this examination. The most significant finding is the greater incidence of fetal malformation in recent years, and is explained by a more efficacious program of pregnancy screening. X-ray examination may be still employed in some cases to obtain superior information regarding the best definition of gestational age, some fetal malformation, and in rare cases, hemolytic disease.

Six patients with basal cell carcinoma of the vulva underwent differentiated surgical therapy, and their courses were evaluated. No apparent differences in survival time and absence of recurrences and metastases were observed inthe patients treated with radical vulvectomy (1 case), simple vulvectomy (3 cases) and local excision (2 cases). Conservative surgical therapy is therefore considered most indicated.

Since 1982 we have been associating the study of hormonal receptors with the histological examination of the vulvar lesions in an attempt to interpret the action mechanism of steroids on the vulva, to find possible correlations between histological pictures and receptorial order and to find a possible predictive "marker" toward therapeutic and prognostic ends. In our Laboratory assays for androgen, estrogen and progesterone receptors were performed with the Dextran-Charcoal technique in 41 patients with vulvar dystrophy; 20 of whom had atrophic dystrophy and 21 with hypertrophic dystrophy. Another 24 patients with vulvar carcinoma were studied; 23 with epidermoid carcinoma of various differentiation grades and only one case of Paget's Disease. None of the three receptors assayed could be considered a predictive or prognostic marker in the approach to neoplastic forms. The levels of the progesterone receptor appears increased in the case of dystrophies. This justifies the hypothesis of a hormonal involvement in the pathogenesis of the lesion, as has already been documented by the beneficial effects of therapy with topical steroids.