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The article presents a rare case of isolated massive pre-sacral metastasis in first stage cervical cancer. A 64 year old patient, which on occasion genital bleeding is made D&CI and histologically proven a "cancer of the cervix." Last period - 6 years ago. Clinically a patient diagnosed as IBI stage according to FIGO criteria. Surgery was radical hysterectomy (Class Ill) and pelvic and paraaortic lymph node dissection. HiStological result of the preparation is: vagina - clean resection lines, parameters - connective tissue and vessels, endometrium - atrophic changes, paraaortic lymph nodes - without metastases, cervix - infiltrative ulcerous adenosquamous carcinoma size vertically -4 cm. and -3.5 cm horizontally. Hitopathological diagnosis confirmed the clinical - pTlblNlMx.

A research about the incidence rate of extrauterine dissemination- lymph node metastases and positive peritoneal cytology in non-endometroid endometrial cancer (type 2) has been conducted and factors determining this dissemination-hystological subtype and depth of myometrial invasion have been evaluated, as well.

Risk factors for relapse in stage IB1 cervical cancer were analized and identified by the following statistical tests-Kaplan-Meier, Cox regression, Log-rank test, Breslow and Tarone-Ware tests. A quantitative analysis of significant factors for relapse in group submitted to surgery and adjuvant radiotherapy(group 1) and group submitted only to surgery (group 2), was done. These methods allow us to difine 3 different prognostic groups, requiring different therapeutic approaches.

Lymph node matastases (LNM) are the most important prognostic factor of the cervical cancer regardless the stage and other prognostic factors. Lymph node status is the basis for tailoring the management strategies. In negative for metastases lymph nodes adjuvant radiotherapy can be omitted, as well as the risk for complications. LNM can be detected by histopathologic examination after meticulous lymphadenectomy. Other methods for detection of LNM such as PET/CT, CT, MRI, frozen section, sentinel lymph node biopsy have low sensitivity.

Review was made of the literature about the long time used techniques Vaginal radical trachelectomy (VRT) and abdominal radical trachelectomy (ART) in respect of the following items--oncological results, obstetric outcomes, complications.

The authors'surgical experience on 14 patients with ovarian cancer recurrences in paraortic lymph nodes --infrarenal and suprarenal-celiac and triad, were presented. Complete cytoreduction was achivied in all recurrent patients (no visible tumor). The median time to recurrence was 16,5 months (from 10 to 36 months). The median operating time was 90 min (range from 30 to 120 min). The median blood loss was 200 ml (from 100 to 300 ml.). No intra- or postoperative complications were noted. The median postoperative period was 5 days (from 4 to 6 days).

The germ-cells tumors are the most common ovarian malignancy in young women between 15-25 years. Often advanced disease is present at the time of diagnosis. The management and treatment approaches of disgerminoma and immature teratoma, as most common germ-cells tumors (GST), are presented. Two clinical cases of advanced stages of GST with complete remision after conservative surgical treatment and chemotherapy have been reviewed.

The cervical cancer is one of the most common malignancies. Worldwide 500,000 women a year become ill from cervical cancer. The aim of the study was to establish the role of adjuvant radiotherapy in patients with IB1 cervical cancer in terms of disease free survival. Between 2002-2012, 132 patients diagnosed as IB1 stage according to FIGO criteria were enrolled in the study. Depending on the administered therapy the patients were divided into two groups--Group 1-93 patients were treated surgically and with adjuvant radiotherapy and Group 2--39 patients were treated surgically without adjuvant radiotherapy Surgery was radical hysterectomy class III and pelvic or paraaortic lymph node dissection(in cases of bulky paraaortic nodes), and adjuvant RT-telegamma therapy(TGT) in dose 52 Gy. The frequency of recurrence in a Group I (surgery and TGT) is 9.7%. Tree and five years disease free survival (DFS) is 88%. The frequency of recurrence in a Group 2 (surgery without TGT) is 25.6%. Tree and five years DFS respectively are 70% and 65%. In an analysis of oncological results establish that adjuvant TGT after surgery significantly increases DFS. On the other hand the addition of adjuvant TGT increases the patients morbidity Therefore should determine which are the risk factors for the occurrence of relapses and select group of patients who would benefit from adjuvant TGT and the risk of complications in them would be justified.

A survey to investigate the incidence rate and prognostic factors for positive peritoneal cytology in patients with endometrial cancer has been conducted.

Cervical cancer is the most common gynecologic malignancy during pregnancy. Laparoscopic pelvic lymphadenectomy and the nodal status are the main factors to tailor therapeutic approaches and to terminate or preserve the pregnancy. In node-negative pregnants neoadjuvant chemotherapy can be administered safely after 13 week of gestation in order to achive fetal maturity. In these cases, mostly in early stages, fertility- preserving techniques, such as vaginal simple or radical trachelectomy can be performed.

The place and indications for lymph node dissection (pelvic and paraaortic) as a staging procedure in early ovarian cancer have been reviewed. The incidence rate of lymph node metastases after surgical staging in early ovarian cancer patients has been presented. The role of systematic and paraaortic lymphadenectomy in advanced stages of ovarian cancer has been presented,as well.

Aim: Our aim is to summarize our experience in screening for cervical cancer using liquid-based cytology system and the Bethesda system., Material and Methods: We did a clinical study of 92 patients, aimed to summarize the results of liquid-based cytology based on various criteria such as specificity, sensitivity, positive and false negative results. All patients had conventional Pap smear as well., Results: The better results stand out of the LBC, mainly due to the reduced number of unsatisfactory results and higher specificity and sensitivity for low-grade lesions--LSIL. There is better standardization of samples, because of the automation of the process. The method is much better quality and more economical., Conclusion: The results obtained by us confirm the diagnostic quality and efficiency of the method, so we offer routine use in Bulgaria, as it is in some developed countries.

One hundred thirty two patients with cervical cancer stage IB1 were evaluated for desease free (DFS) and overall survival (OS). All women were submitted to surgery-radical hysterectomy class III and pelvic and/or paraaortic lymph node dissection. Ninety three women were irradiated after surgery-telegamma therapy (TGT) 50-52 Gy. After median period of follow-up 44 months (from 1 to 114) OS and DFS were estimated using Kaplan-Meier method. Five-year OS and DFS were 83% and 82%, respectively.

The authors describe a rare case of bilateral tubal pregnancy after IVF. The patient is with secondary infertility. The preceding diagnostic laparoscopy excluded the presence of tubal factor. The results of the spermogram show average to severe form of Oligoasthenozoospermia. Short protocol with GnRH-antagonist was performed and two embryos were transferred on the third day. On the 36th day after the embryo transfer the patient was hospitalized with abdominal pain in the right hypogastric region, clinical and ultrasound indications for hemoperitoneum. Urgent laparotomy was performed followed by salpingectomy dextra due to hemoperitoneum caused by tubal abortion. The examination of the left adnexa reveals uruptured tubal pregnancy in the isthmic part of the tube and the decision for salpingectomy sinistra was taken. Histological examinations confirmed the diagnosis of ectopic pregnancy in both tubes. The frequency of some rare forms and localizations of ectopic as well as heterotopic pregnancies increase after ART.

Presented are the types of late postoperative complications and their frequencies combined radio-surgical and surgical treatment of 294 patients with invasive cervical cancer FIGO stages I and II.

Presented are the types of early postoperative complications and their frequency in radical hysterectomy and lymph node dissection (pelvic and paraaortic) as surgical treatment of 294 patients with invasive cervical cancer FIGO stages I and II.

Aim: The aim of this research work was to evaluate the distant results in patients with cervical adenocarcinoma stage T(1A1) treated conservatively only by conization., Material and Methods: 60 patients were) examined for 10 years period with cervical adenocarcinoma stage T(1A1) (stromal invasion to 3 mm in deapth and 7 mm horizontal spread)., Results: 50 patients were surgicaly treated by cold knife conization and 10 patients by LLETZ. In 40 patients a total hysterectomy was additionally performed. 20 patients (age range from 20 to 40 years) were treated only by conization because they desired to preserve fertility. In 12 patients an attempt was made for to get pregnant. In 7 patients there was a successful pregnancy., Conclusions: The conization of the uterine cervix as the only treatment in patients with cervical cancer T(1A1) adenocarcinoma is effective and safe therapy. It is very important when patients desire to save their reproductive functions. The individualization of this treatment method is not yet obligatory because of the small number of treated patients.

Authors track current trends in preterm labor diagnostics. The emphasis is laid on biochemical tests for examination of fibronectin (fFN) and insulin-like growth factor-binding protein (IGFBP-1) in cervical and vaginal secretions, as well as ultrasound assessment of cervical length.

A petro-prospective study on 132 women with early invasive cervical cancer was performed. According to Log-Rank test, Breslow and Tarone-Ware tests we analyzed the following factors: age, type of histology, tumor grading, tumor localization (exo-, endocervix), lymph node metastases, postoperative histologic findings, blood transfusion and Hb on the day of discharge. We found as an independent prognostic factors for overall survival: tumor localization, postoperative histologic findings and blood transfusion. Based on these factors two profnostic groups were created with favorable and unfavorable prognosis. The median survival for these two groups was 106 and 57 months, respectively.

Aim: Our aim was to evaluate our experience in diagnosis and treatment of preeclampsia in the clinic of Pathological pregnancy--Varna Medical University. We compared our results with the results of prominent western clinics., Material and Methods: We evaluated 140 patients with preeclampsia for the period of 2010 to 2013. A special file was fulfilled. It included: age, parity, gestational age, value of arterial blood pressure, urea, creatinine, common protein in blood, duration of treatment, oedema, urine protein., Results: The mean age of the patients was 30 years. The urea and creatinine were normal. The mean hospital stay was 5,71 days. The blood protein was 61 g/l, only 4.17% of the patients were with protein lower than 58 g/l. In 87.5% of the patients the systolic blood pressure was between 135 and 160 mmHg, in 12.5% the systolic blood pressure was over 160mm Hg. In 58.34% there was a proteinuria. The mean gestational age was 33 gestational weeks. The delivery was performed in the most suitable for the preeclampsia gestational age., Conclusions: According to our research work the patients with preeclampsia have a very high risk for cardio-vessel diseases and again of preeclampsia in their future pregnancies from 30%-40%. High prenatal care can prevent most of the complications connected with this disease.

Objective: To establish the role of the lymph node dissection (LND) and the overall. Survival of patients with invasive cervical cancer depending on their lymph node status., Material and Methods: The follow-up period includes the date of registration until September 2011 or exitus letalis. (from 2 to 96 months, average 45 months)., Results: We presented the relationships between presense of lymph node metastases (LNM), number of LNM, localization of LNM, micro- and macro- LNM and the overall survival of patients staged IB1 -IIB., Conclusion: Patients with microscopic LNM reveal similar overall survival (81%) to patients without LNM (86%). In these patients LND demonstrates therapeutic effect.

Objective: To establish the prognostic significance of lymph node metastases (LNM) in terms of disease-free survival and incidence rate and localization of relapses., Material and Methods: 296 patients with invasive cervical cancer FIGO staged: IB1-110; IB2-98 and IIB-86 had been operated on between 2002-2011. Patients age ranges from 27 to 84 years, average 48 years. Follow-up period was estimated from the date of registration until September 2011 or until the occurrance of relapse. (2-96, average 45 months). 294 patients were submitted to pelvic lymphadenectomy and paraaortic lymphadenectomy was optional., Results: We presented the relationships between number of LNM, incidence rate of LNM, macro- and micro- LNM and incidence rate and localization of local and distant relapses., Conclusion: Lymph node macrometastases leads to significantly higher incidence rate of relapses outside true pelvis in comparison to lymph node micrometastases.

Objective: To establish the overall and disease-free survival (OS and DFS) in patients IB2 stage FIGO with primary surgical treatment or operated on after preoperative RT., Material and Methods: Between 2003-2011 98 patients (FIGO IB2 stage) were operated on. 83 patients were submitted to primary surgery (radical hysterectomy class III with pelvic lymph node dissection--group 1 and 11 were operated on after preoperative RT - 30 Gy - group 2. All operated patients were submitted to adjuvant RT - 52 Gy. Four patients were operated on after NCT (neoadjuvant chemotherapy). All patients were followed between 2 and 96 months--median period of 45 months., Results: The acturial OS and DFS for all patients were estimated as 73.5% and 75.6% respectively. The OS and DFS for group 1 were estimated as 73.5% and 74.7% respectively. The OS and DFS for group 2 were estimated as 72.8% and 82%, respectively., Conclusion: Stage IB2 cervical cancer is related to worse prognosis in comparison to IB1 FIGO stage, because of the higher incidence of distant metastases. Preoperative RT doesn't change the oncological outcomes. There is no statistical difference between group 1 and group 2 in terms of survival. Is important to perform paraaortic lymph node dissection and concurrent radiochemotherapy in these patients.

Objective: To establish the indices of surgical treatment (duration of operation--min, blood loss--ml, time to bowel and bladder function recovery--days) in treatment of invasive cervical cancer., Material and Methods: Between 11.2002-11.2011 296 patients with invasive cervical cancer were operated on by the author. 294 were valuable in terms of indices of surgical treatment. The age of patients ranges from 27 to 84 years, median--48 years. 110 women were in stage IB1 (FIGO), 86--in IIB, and 98--in IB2 stage. The surgery in 81% (238 cases) was radical hysterectomy class III (RH) and pelvic lymph node dissection (LND) in 2.7% (8 cases) RH and PLN and paraaortic lymph node dissection (PLD); LEP in 8.2% (24 cases) and RH with transposition of the ovaries and PLD in 5.1% (15 cases)., Results: The median duration of operations (only RH and LND) was 124 minutes, the median blood loss--480 ml. Blood transfusion was performed in 37% of cases. The median time for bladder and bowel function recovery was 22 and 3 days, respectively., Conclusion: Open surgery performed by experienced teams trained in good technical skills leads to blood loss and recovery of patients comparable with miniinvasive techniques.

Objective: To establish the overall and disease-free survival and the role of surgery as well as in cervical cancer stage IIB (FIGO) patients submitted to combined radiotherapy and surgery., Material and Methods: Between 2003-2011 86 patients with cervical cancer stage IIB had been operated on. Five patients were operated on after neoajuvant chemotherapy. Thirty one women (group 3) had primary pelvic surgery (radical hysterectomy class III and lymphonodulectomy) and adjuvant RT until 52 Gy and 50 women were operated on after preoperative RT (30 Gy) and were submitted to adjuvant RT until 52 Gy (group 4)., Results: After median follow of 45 months the acturial overall and disease-free survival (OS and DFS) were estimated as 75.6% and 77.9% respectively for all patients staged IIB (FIGO). In group 3 the incidence of local relapses and distant metastases was 9.7% and 12.9%, respectively and in group 4--local and distant recurrences were 6% and 14%, respectively. The acturial OS and DFS for group 3 were 80.6% and 77.5%, respectively and for group 4--76% and 80% (NS)., Conclusion: Combinated treatment (RT and pelvic surgery) produce reliable local control of the disease (cervical cancer IIB stage) but is ineffective for metastases outside the small pelvis which is the cause of worse survival of patients with cervical cancer stage IIB (FIGO). Preoperative RT (group 4) doesn't change the OS and DFS significantly. The main indication for surgery in patients with cervical cancer stage IIB is the surgical staging (pelvic and paraaortic lymph node dissection) which enables the appropriate individual treatment planning.

Objective: To establish overall and disease-free survival (OS and DFS) for patients with FIGO IB1 stage cervical cancer for median period of follow-up of 41 months., Material and Methods: Between 11.2002-11.2011 110 women with histologically confirmed cervical cancer IB1 stage were operated on by the author. Surgery was radical hysterectomy class III (Piver) and pelvic lymphonodulectomy (ovariectomy was optionally). 76 patients were submitted to adjuvant RT (TGT- 52 - 54 Gy). The period of follow-up ranges from 2 to 104 monts, median 41 monts., Results: The acturial OS and DFS in patients with cervical cancer IB1 stage were estimated as 90% and 90.9%, respectively. Eleven patients had died for the period of follow-up and in 10 occurred local or distant recurrences. The time to develop recurrences was estimated as 16.81 months. Four patients developed local recurrences and six--distant metastases., Conclusion: Surgical and combined therapy of cervical cancer patients IB1 stage leads to high rate OS and DFS--90% and 90.9%, respectively. The incidence rate of distant metastases (5.5%)--in six patients in this stage makes pelvic lymph node dissection crucial and the presence of LM in gluteal and presacral lymph nodes requires paraaortic lymph node dissection.

Objective: To study the feasibility of the nerve-sparing radical hysterectomy (NSRHT) stage by stage in cervical cancer and its impact on the blood loss, the duration of RH as well as on bladder dysfunction in irradiated and non-irradiated patients., Material (patients): Between XI.2002 and IX.2011 294 consecutive patients with invasive cervical cancer (IB1, IB2, IIB) were operated on. The performed surgery was radical hysterectomy class III and pelvic lymphadenectomy 77 patients were submitted to NSRH (26.19%)--56 patients--non-irradiated (gr. 1) and 21--after preoperative radiotherapy (gr.2) CONCLUSIONS: NSRH is feasible technique in stages IB1, I82, IIB before or after radiotherapy. NSRH doesn't compromise the radically of the RH. Preoperative radiotherapy doesn't change the benefits of NSRH. The latter is associated with minimal blood loss during RH (280 ml vs 600, p < 0.005), fast recovery to spontaneous voiding (16th day vs 24, p < 0.005) and is little more time--consumpting procedure (75 min. vs 60 min., NS).

The role of the lymphadenectomy (staging, prognostic, curative) as a part of surgical treatment of endometrial cancer type I is a subject of controversial discussions among oncogynecologists. In the present study has been presented the experience in the surgical management of endometrial cancer type I in one single institution. The incidence rate of lymph node metastases (LM) and the relationship between grading, stage, depth of myometrial invasion and LM have been revealed. The analysis of the results drew the conclusion that stage, grading and depth of myometrial invasion increase the risk of LM in women with endometrial cancer type I.