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To assess the reliability of transvaginal ultrasonography and uterine needle biopsy, used singly or in combination, in the diagnosis of diffuse adenomyosis, a prospective study with pathological confirmation of the diagnosis was performed. A total of 102 premenopausal women scheduled for hysterectomy because of menorrhagia and/or pelvic pain underwent preoperative transvaginal ultrasonography. After removal of the uterus, a single full-thickness myometrial biopsy specimen was taken from along the median line in the upper third of the posterior uterine wall, using a 14-gauge Trucut needle. Adenomyosis was diagnosed by the sonographer by the presence of indistinctly demarcated heterogeneous myometrial areas with distorted echotexture, and by the pathologist when the distance between the lower border of the endometrium and the affected myometrial area was more than one-half of a low power field. The prevalence of adenomyosis was 28% (29/102 patients). The sensitivity and specificity of transvaginal ultrasonography were 82.7 and 67.1% respectively, compared with 44.8 and 95.9% for uterine needle biopsy. The positive predictive values of the two tests were 50.0 and 81.2% respectively, and the negative predictive values 90.7 and 81.4%, likelihood ratios of a positive test 2.5 and 10.9, likelihood ratios of a negative test 0.3 and 0.6, and k indexes of agreement 0.42 and 0.47. Combining the tests did not improve the overall diagnostic performance. Both transvaginal ultrasonography and uterine needle biopsy demonstrated suboptimal test characteristics. [ABSTRACT FROM PUBLISHER]

p16, a surrogate marker for human papillomavirus (HPV) infection, is uniformly present in HPV-related carcinomas. This study aims to further characterize p16 expression in trophoblastic lesions and squamous lesions of the upper female genital tract, as little data exists. p16 immunostaining was performed on sections from ichthyosis uteri (1), primary uterine corpus squamous cell carcinoma (UCSCC) (2), primary ovarian SCC (OSCC) (5; 2 associated with a dermoid cyst), endometrial endometrioid adenocarcinoma with extensive squamous differentiation (EC-SD) (5), ovarian endometrioid adenocarcinoma with extensive squamous differentiation (OC-SD) (4), placental site nodule (5), and placental site trophoblastic tumor (PSTT) (6). We evaluated the percentage of positive cytoplasmic and nuclear staining (focal ≤10%, multifocal=10% to 50%, and diffuse ≥50%) and staining intensity (weak, moderate, and strong). HPV-DNA analysis by polymerase chain reaction was performed on 5 OSCC. Ichthyosis uteri, all UCSCC and 1 OSCC (arising in a dermoid) were negative; the other dermoid-associated OSCC showed focal moderate staining, the remaining OSCC displayed strong (100%), diffuse (2), or multifocal (1) p16 positivity. Three of the 5 EC-SD cases showed strong diffuse staining of the squamous component. The glandular component focally showed strong p16 positivity (2), with variably intense focal staining in 3 cases. The squamous component of all OC-SD showed focal moderate staining, with variable staining of the glandular component. Overall, 3 EC-SD had 80% to 90% p16 positivity. Five of the 5 placental site nodules and 4 of the 6 PSTT showed focal weak staining, whereas 2 PSTT were p16 negative. HPV-DNA analysis was negative in 3 of the 5 OSCC, the other 2 cases being technical failures. p16 is expressed in OSCC and in the squamous and glandular components of EC-SD and OC-SD. As p16 is negative in UCSCC, it may help to identify the origin of SCC diffusely involving the corpus and cervix, and suggests different pathogeneses for SCC of the upper female genital tract, likely to be unrelated to HPV infection. In contrast to earlier data, we found weak and focal p16 expression in trophoblastic lesions. Thus, when considering the differential diagnosis of cervical SCC and trophoblastic lesions, only strong diffuse p16 staining should be considered helpful.

Lymph node positivity in invasive squamous cell vulvar cancer implies a severe decrease in survival rates. Pathological lymph node positivity covers a wide range of metastatization patterns. In the present investigation the nodal positivity of 53 patients affected by Stage III and IVA invasive vulvar squamous cell carcinoma has been carefully evaluated and correlated with survival. Number, size of the metastasis inside the node, intracapsular or extracapsular site of the metastasis, and immune response of the positive nodes were considered. Cancer-related survival has been obtained for the whole study group (53 cases), for the patients with monolateral node positivity (36 cases), and for the patients showing only one positive node (19 cases). The diameter and the site of the metastasis were significantly correlated with survival in all three groups studied. Patients showing an intracapsular positivity or a size of metastasis less than 5 mm had a 5-year cancer-related survival of almost 90%, while patients showing a metastasis larger than 15 mm or an extracapsular site had a 20% survival. The results demonstrate that patients affected by invasive squamous cell vulvar cancer with positive nodes can be divided into two groups with a significantly different survival according to the histopathological pattern of lymph node invasion.

Pregnancy has long been considered to have beneficial effects on endometriosis. We describe a patient who underwent emergency exploratory laparotomy at gestation week 35 for rupture of an ovarian endometrioma.

The visual diagnosis of endometrioma at laparotomy in 245 women operated on for ovarian cysts demonstrated a sensitivity of 97%, specificity of 95%, positive and negative predictive value of 98% and 94%, respectively, and overall accuracy of 96%. Because the visual detection of endometriomas is remarkably accurate, ovarian biopsy, although desirable in some cases, would seem dispensable for a correct laparoscopic diagnosis and staging of the disease.

We performed a follow-up hysteroscopy with multiple biopsies at different intervals after surgery in 19 women who underwent hysteroscopic septal incision. Seven days after operation the sectioned areas were very evident and not epithelialized (3 patients). At 14 days, the incised zone was depressed with scattered epithelialization (5 subjects). At 1 month, the sectioned surfaces were still depressed and uniformly covered by thin endometrium (5 cases). After 2 months the uterine cavity was almost normal with minimal tendency to central fundal adhesions (6 women). Thus, spontaneous healing processes after hysteroscopic metroplasty progressed regularly and completely and there is probably no reason to delay attempts at pregnancy for longer than two cycles after surgery.

From January 1, 1970 to December 31, 1979, 425 cases of endometrial carcinoma, FIGO stage I, were treated at the First Department of Obstetrics and Gynecology, University of Milan. Three different surgical approaches were used: total abdominal hysterectomy with bilateral salpingo-oophorectomy and selective pelvic lymphadenectomy was performed in 245 women, total abdominal hysterectomy and bilateral salpingo-oophorectomy without pelvic lymphadenectomy in 100, and vaginal hysterectomy with bilateral salpingo-oophorectomy in 80. Five-year survival was evaluated as a function of risk factors (histological grade, depth of myometrial invasion, metastatic nodes) in the three groups of patients, and we conclude that lymphadenectomy is useful for prognostic purposes but does not confer a therapeutic benefit.

We describe a case of primary alveolar soft part sarcoma presenting as a vaginal mass in a 27 year old woman and also review the literature on this type of tumor arising in the lower female genital tract. Histologically, most of the tumor exhibited poorly developed alveolar architecture, but anaplasia was absent. Although the mass was well circumscribed, a few tumor cells were seen focally within the peritumoral tissue. Treatment consisted of wide local excision followed by external radiation therapy. The patient is alive without evidence of disease 17 years after operation.

A review of a series of 245 ovarian teratomas disclosed 6 cases (2.4%) of immature teratoma. The tumors were FIGO stage IA(i) and histologic grade 1 (3 cases). With the exception of 2 specimens, all tumors were larger than 9 cm in the greatest diameter. All patients underwent conservative surgery alone and are alive without evidence of disease form 2.2 to 10.6 years (average 7.9 years). Our data support the view that conservative surgery is the treatment of choice for patients with stage IA(i), grade 1, immature teratoma, as well as for those with stage IA(i), grade 2 tumors, 9 cm or less in the greatest diameter.

One struma ovarii with agregates of epithelial nests indistinguishable from Brenner tumor was studied. The presence of a communication between the nests and the follicles and the association of Brenner, mucinous and respiratory epithelium in the lining of 1 cyst in the same tumor strongly support the germ theory of Brenner tumors associated with teratomatous elements.

A case of focal severe atypical hyperplasia-carcinoma in situ discovered during voluntary abortion is described. The patient did not undergo hysterectomy; after abortion, menses were regular and the endometrium was histologically normal at a control. Ten cases of endometrial epithelial neoplasia in pregnancy (9 cases) or in puerperium (1 case) found in the literature were reviewed. Although in some of them stromal invasion, which actually is the main prognostic indicator of endometrial neoplasia, was absent or not documented, all lesions were designated as adenocarcinoma. There is evidence that young women with a noninvasive neoplasm and desiring children or preservation of the uterus may be treated conservatively even if the lesion is detected in pregnancy or puerperium.

Psammoma bodies were found in less than 9% of 235 cases of endometrial carcinoma, considering both biopsies and surgical specimens. They may originate in papillary adenocarcinoma and do not indicate a slightly infiltrating or a well-differentiated tumor. The clinical profile of patients closely resembles that of women with endometrial carcinoma, but survival appears worse.

Seventy-two teeth from 10 ovarian mature teratomas and 12 unerupted and erupted teeth from subjects aged 8 to 21 years were examined at the scanning electron microscope to evaluate the morphologic and histogenetic differences. The ultrastructure of the teratomatous teeth was similar to that of the corresponding orthotopic tissues. Despite this similarity the morphology of the teratomatous teeth was much less well defined, attesting to the inductive effect of the contiguous tissues that are normally present in the oral cavity.

Endometrial reconstruction after hysteroscopic metroplasty of a septate uterus was studied by light microscopy and scanning electron microscopy when the uterus was removed 13 days after metroplasty for a histologic diagnosis of leiomyosarcoma. We observed a retraction of the margins of the incised septum, which could prevent the formation of intrauterine adhesions. Reepithelialization of the cut surface seemed to proceed both centripetally, by proliferation of the surrounding normal endometrium, and centrifugally from the bottom of the glands present at the base of the septum.

Three cases of clear cell carcinoma of the endometrium are here reported. Clear cell carcinoma is a rare and aggressive type of endometrial adenocarcinoma. Patients are older and are in the menopause much longer than are patients with typical endometrial carcinoma. This fact may reflect the presence of counterbalanced sex hormones in the process of carcinogenesis.