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A critical review of the surgical treatments performed during the years 1967 to 1989 in cases of squamous cell vulvar cancer at the 1st Department of Obstetrics and Gynecology of the University of Milan has been carried out. Two hundred and seventy cases of primary squamous cell vulvar carcinoma have been studied after a restaging according to recent FIGO recommendations. Depending on the type of surgical approach the early and late complications and the 5 year-cancer-related survival have been analyzed. The present investigation supports the importance of a complete and accurate surgical staging of vulvar carcinoma, particularly as far as it concerns the lymph nodes status. Thus, performing a node dissection in case of an invasive neoplasia is extremely important, not only for a precise staging but mainly for a prognosis formulation. In fact, 5 year cancer related survival dramatically falls from almost 90% to 25% in case of pelvic node metastasis.

Molar tissue expresses HLA antigens evidenced in the father. These antigens are present on the trophoblastic extravillous tissue, not on the syncytium and cytotrophoblast. These antigens show some characteristics of Qa murine antigens mapped in the HLA system linked to class I antigens. Antibodies anti HLA against the partner antigens and lymphocytotoxic antibodies have been evidenced in the serum of patients with vesicular mole. In vesicular mole the production of antibodies should be determined by the immunogenicity of cells that infiltrate the decidua, expressing paternal HLA antigens. It has been demonstrated that the recognition of "not self" antigens in the mother should stimulate a cellular immune response. We do not know why the tumor grows. Maybe the woman is not able to produce anti HLA antibodies although recognizes them as "not self", or the patients is not antigenically stimulated because there is immunocompatibility between the two partners. The literature shows that the development and progression of the disease are stimulated by histocompatibility, although this factors does not seem fundamental. If the two partners are histocompatible the tumor can be less immunogenic, so the mother shows a lower response and the growth of the tumor appears to be favoured.

Twenty-seven patients with carcinoma of the fallopian tube were treated at the First Obstet. Gynecol. Clinic, University of Milan. Nineteen of them had the primary surgical procedure in our center and accounted for 2% of tubal and ovarian carcinomas. The others had been operated elsewhere. Another primary genital cancer occurred in 7 of these women and a breast carcinoma was recorded in the history of other 2. At laparotomy, 11 tumors were Stage I, 9 Stage II, and 7 Stage III. Postoperative adjuvant therapy was not homogenous, however chemotherapy was given to about 59% of patients. Five years survival rate was 65% for Stage I, 34% for Stage II and 17% for Stage III. The discussion deals with early diagnosis, prognostic and/or therapeutic role of pelvic and/or aortic lymphadenectomy and effectiveness of adjuvant therapy.