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Objective: In 2009, International Federation of Gynecology and Obstetrics (FIGO) modified staging of vulvar cancer-the prognostic significance of the new classification relative to the prior system as well as to the commonly recognized prognostic factors has not been assessed. The aim of this study was to test prognostic ability of 2009 staging in a cohort of uniformly treated and staged cases with long-term follow-up., Methods: Pathologic characteristics were obtained by blind review of the original tissue samples. 76 patients who qualified for surgery on the basis of the same criteria, with full clinical history, were included in the study. The histological analyses were performed on 76 and 35 paraffin-embedded tissue samples from primary tumors and lymph nodes, respectively. Survival analyses included the Kaplan-Meier method, log-rank test and Cox proportional hazards model., Results: Univariate analysis has demonstrated that age (p = 0.0170), lymph node metastasis (p = 0.0393), tumor grade (p = 0.0086) and FIGO1994 stage (p = 0.001) were the significant prognostic factors for overall survival. Multivariate analysis has demonstrated that growing age (HR 2.25, 95 % CI 0.79-3.71, p = 0.0321), tumor grade (G1 vs. G2 and G3) (HR 1-3.11, 95 % CI 1.6-4.62, p = 0.0057) and FIGO1994 stage (HR 1.78, 95 % CI 0.55-3.01, p = 0.0061) are independent prognostic factors with respect to overall survival., Conclusions: The results indicate the prognostic advantage of the 1994 FIGO staging as it has become an independent prognostic factor in contrast to the new FIGO system. This should be tested in future larger cohort studies. Differentiation grade turned out to be a very valuable independent prognostic factor and should be incorporated as a routine component of the histopathologic reports in vulvar cancer.

The vascular endothelial growth factor (VEGF) family and VEGF receptors (VEGFR) play an essential role in angiogenesis and lymphangiogenesis. The aim of this study was to clarify the prognostic significance of VEGFR expression in ovarian carcinoma. Levels of VEGFR-2 and VEGFR-3 tissue expression in human ovarian tumours were assayed by immunoblotting and the correlations between analysed factors and clinicopathological features were examined. Tissue samples consisted of 42 benign and 10 borderline (low malignant potential - LMP) tumours, 76 ovarian carcinomas, 8 Krukenberg tumours and 32 normal ovarian tissues. The highest relative level of VEGFR-2 was detected in cases with at the early stages of cancer development. The highest level of VEGFR-3 was detected advanced cancer stages and those with Krukenberg tumours. Overexpression of VEGFR-3 was found to correlate with the debulking status (p = 0.02) and positive response to chemotherapy (p = 0.04). A statistically significant longer progression free survival (PFS) was observed in women with a low than with a high expression of VEGFR-3 (p = 0.01). Increased levels of VEGFR-2 expression at the early stages of ovarian cancer may indicate the significance of neoangiogenesis at these stages. Overexpression of VEGFR-3 reflects the aggressiveness of ovarian carcinoma spread and has a predictive value for identifying high-risk patients with poor prognosis.

The aim of this study was to selectively profile the activation status of mammalian target of rapamycin (mTOR)-associated oncogenes and tumor suppressor genes (TSGs) in ovarian cancer specimens, healthy ovaries and benign ovarian tumors, including endometrial cysts. We used a novel type of microfluidic gene array to examine the expression of 15 human tumor suppressors and oncogenes in ovarian cancer specimens of 53 patients, benign ovarian cysts of 29 women (endometrial and simple) and 11 healthy ovaries of individuals in whom the material was obtained during total hysterectomies performed because of fibroid changes. The array was custom-designed to include the following genes: NF1, RHEB, mTOR1, AKT-1, PTEN, TSC1, TSC2, KRAS, RPS6KB1, 4EBP1, TP53, EIF4E, STK11, PIK3CA and BECN1. Confirmatory immunohistochemical detection was performed for a group of selected proteins. Particularly significant differences were observed as to the expression of PTEN (p < 0.0001), TP53 (p = 0.0003), PIK3CA (p = 0.0003) and BECN1 (p = 0.0014) which were shown to be downregulated in cancer patients when compared to healthy ovaries and benign ovarian cysts (endometrial and simple). These markers did not show association with grade or stage of the tumor. Immunohistochemistry showed that PTEN, TP53, PIK3CA and BECN1 proteins are expressed in ovarian cancer. Our results indicate that there are significant differences in the expression of some of the mTOR-related tumor suppressors and oncogenes which could be associated with the pathogenesis of ovarian cancer.

"Hand-foot" syndrome is a well-documented, dermatologic reaction after several chemotherapeutic agents with wild spectrum of symptoms. To the best of our knowledge, palmar-plantar erythrodysesthesia syndrome--presented as irreversible cytotoxic side effect induced by gemcitabine alone--has not been reported so far. We present a case of a patient with a history of peripheral sensory neuropathy who developed a painless finger necrosis caused by gemcitabine used in the second-line therapy for progressive ovary cancer.

A rare case of a 22-year old patient with obstetric urethrovaginal fistula, resulting in urinary incontinence, has been reported in the following report The emphasis is put on a number of medical and social consequences related to the formation of the fistula. Authors have presented the diagnostic difficulties. The aim of the report is to draw attention to the probable complications following prolonged labour and the necessity of appropriate treatment.