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The objective of this retrospective study was to analyze the experience with intraoperative radiation therapy (IORT) at the present institution and to evaluate its contribution to the management of patients with recurrent gynecological cancer. Materials andRetrospectively this study reviewed data of patients with a gynecological malignancy considered for treatment with IORT at Freiburg University Medical Center between 2005 and 2012. For this purpose, an analysis of medical records, radiation oncology records, operation reports, and follow-up data was conducted.During the period of this study, 31 women with gynecological cancer underwent tumor resection in combination with IORT. The median age of the patients at the time of IORT was 62 years (range 38-85). Most patients had undergone surgery at the time of initial diagnosis (87%). More than one-third of the patients received prior radiation therapy. In addition to that, 52% of the patients had already received chemotherapy. The majority of patients suffered from the first relapse of their disease. The local recurrence was predominantly located at the pelvic side wall (32%) or in intra-abdominal lymph nodes (32%). In 12 patients the authors did not apply the planned IORT. Intraoperative complications were rare and IORT was tolerated without severe side-effects. Follow-up was 14 months (range 1-65), progression free survival (PFS) was five months (range 3-31).In carefully selected patients, IORT and cytoreductive surgery contributed to local control and disease palliation. The authors therefore consider IORT an important aspect of modern cancer treatment.

The German Medical Association (Bundesarztekammer) has launched a new organisational structure in the curriculum of medical qualification. Beside the field of obstetrics and gynecology this has led to three specialisation. The newly established specialisation is that of gynecological oncology. Therewith in the future the treatment and care for women with genital or breast cancer will be focused to those centers having the necessary qualification. In addition the German qualification is identical to that of the European Society of Gynecological Oncology (ESGO). So German fellows can obtain a national and international qualification at qualified centers.

An intramural pregnancy is rare, difficult to diagnose, and is associated with a high rate of uterus ruptures with high maternal morbidity and mortality. An intramural pregnancy ofthe 11 th pregnancy week occurred in a 33-year-old gravida II/para I who had undergone a previous cesarean section two years ago. The pregnancy was located in the ventral wall of the uterus. After 4 weeks of treatment with methotrexat in escalating doses the pregnancy was terminated without complications by sectio parva. Conclusion: A previous cesarean section can increase the risk for an intramural pregnancy at the ventral wall of the uterus. If treatment with methotrexate is not successful at the end of the first trimester, a sectio parva should be discussed in view of the high risk of uterine rupture.

Individual belief and knowledge about cancer were shown to influence coping and compliance of patients. Supposing that the Internet information both has impact on patients and reflects patients' information needs, breast cancer web sites in English and German language were evaluated to assess the information quality and were compared with each other to identify intercultural differences. Search engines returned 10 616 hits related to breast cancer. Of these, 4590 relevant hits were analysed. In all, 1888 web pages belonged to 132 English-language web sites and 2702 to 65 German-language web sites. Results showed that palliative therapy (4.5 vs 16.7%; P=0.004), alternative medicine (18.2 vs 46.2%; P

In order to decrease surgery-related morbidity, we evaluated the reliability of the evaluation of lymph node metastasis in patients with uterine corpus cancer by positron-emission tomography (PET) with 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG) before surgical staging.Patients with newly diagnosed uterine corpus cancer scheduled for surgical staging, including lymphadenectomy, underwent PET imaging within 30 days before surgery. PET results and postoperative histopathology were compared for each patient and each nodal site. Sensitivity, specificity, positive and negative predictive value (PPV/NPV) as well as accuracy of FDG-PET in predicting nodal disease was determined by joined meta-analysis of the present data and the data available in the literature.Of 21 patients examined, 13 patients were eligible to enter this pilot study. Only one patient had lymph node metastasis, which was preoperatively detected by FDG-PET scan. Additionally, another patient was considered to have lymph node metastasis according to increased focal FDG uptake; however, all lymph nodes were free of malignant disease upon final pathology. In contrast, all other patients without lymph node metastasis upon final pathology showed negative preoperative FDG-PET scans. The meta-analysis yielded a sensitivity, specificity, PPV, NPV and accuracy of 0.53, 0.91, 0.57, 0.90 and 0.84, respectively.In patients with uterine corpus cancer, FDG-PET had an insufficient positive predictive value in detecting lymph node metastases, indicating that this method cannot replace surgical staging. However, due to its high NPV, FDG-PET might be beneficial in selected patients who are poor candidates for surgical staging.

Summary The human papilloma virus (HPV) has been subject to intense discussion during the last decade, as evidence has accumulated to strongly suggest that viruses play an essential part in the genesis o f cervical neoplasms. The contamination rate o f the female population is reported to range between S and 80%, depending on the modality o f detection. Many indications almost reliably suggest the oncogenicity o f certain HPV-types. The highest progression rate was found in HP V 16 lesions, followed by HP V 18 lesions. In our material the incidence o f HP V 16118 and 31133 infections compared to 6111 was elevated in patients with cervical intraepithelial neoplasia (CIN) compared to women with non-CIN lesions. The exact histologic diagnosis o f CIN lesions is essential for a differentiated therapy. Our data indicate that mild and moderate CIN lesions are detected more frequently by Pap smear and colposcopically directed punch biopsy than by cervical smears alone. Histological diagnosis and HPV-typing by in-situ hybridisation offers the possibility to establish a differentiated therapy, e.g. by way o f close follow-up, local destruction or cone biopsy. Main attention should be directed at early detection o f dysplasia, at timely institution o f follow-up programs and a possibly conservative therapeutic management.

Overexpression of Aurora-A/STK15 kinase (hereafter AUKRA) is seen in a variety of epithelial cancers, such as gastrointestinal and gynaecological carcinomas. Its role as prognostic and/or predictive marker for adjuvant therapy of patients with advanced ovarian cancer is however still unclear. Therefore, the present study aimed at determining (1) the clinical value of AURKA expression (mRNA and protein) in 115 patients with ovarian carcinomas and (2) the basis of AURKA overexpression at the DNA level.Formalin-fixed and Paraffin-embedded tissue samples (ovarian carcinoma: n=115; non-neoplastic ovaries: n=28) were processed for microdissection and quantitative RT-PCR as well as for semi-quantitative immunohistochemistry (IHC) of tissue microarrays according to standardised protocols. Fluorescence in Situ Hybridisation (FISH) was performed in a sub-set of cases (n=37) to analyse AURKA DNA copy numbers.The results demonstrate significantly elevated AURKA expression at the mRNA and protein level in ovarian carcinomas as compared to non-neoplastic ovaries (p0.0001). AURKA protein overexpression was observed in 68/107 (63.5%) of cases. For patients with stage III ovarian carcinoma having been optimally debulked and receiving adjuvant Taxane-based chemotherapy, AURKA overexpression was significantly linked to prolonged overall survival (p = 0.02). Finally AURKA overexpression was associated with increased AURKA DNA copy numbers (p = 0.01).In summary, AURKA overexpression, which is regulated at the DNA level, is a novel predictive marker for a subgroup of patients with stage III ovarian carcinomas.

The German Medical Association (Bundesärztekammer) has launched a new organisational structure in the curriculum of medical qualification. Beside the field of obstetrics and gynecology this has led to three specialisation. The newly established specialisation is that of gynecological oncology. Therewith in the future the treatment and care for women with genital or breast cancer will be focused to those centers having the necessary qualification. In addition the German qualification is identical to that of the European Society of Gynecological Oncology (ESGO). So German fellows can obtain a national and international qualification at qualified centers.

To evaluate the diagnostic accuracy of three-dimensional (3D) ultrasound in comparison with conventional two-dimensional (2D) ultrasound in the characterization of breast lesions.The digitally stored 2D ultrasound images and the corresponding 3D scans of 100 breast lesions (57 malignant, 43 benign) that had been morphologically classified as solid tumors, were independently analyzed by six investigators. Ten 2D and 13 3D ultrasound characteristics were determined. Lesion characterization was classified on a four-point scale and a logistic regression model was used to analyze the data. A receiver-operating characteristics curve (ROC) analysis was performed to determine the diagnostic performance of 2D and 3D ultrasound, respectively.Ultrasound criteria showed major differences between 2D and 3D ultrasound. Logistic regression revealed the retraction phenomenon in the coronal plane of the 3D ultrasound scan to be a significant and independent factor for lesion characterization. The characteristics determined on the conventional planes of 3D ultrasound differed from those determined on the 2D ultrasound images. The diagnostic accuracy of 2D and 3D ultrasound in the ROC analysis was almost identical (area under the curve 0.846 and 0.851, respectively).Ultrasound features on 3D ultrasound differ significantly from those on 2D ultrasound. However, the diagnostic accuracy of both methods is almost identical. 3D ultrasound as an adjunct to conventional 2D ultrasound should be evaluated in larger trials to determine its clinical value in breast imaging.

In recurrent ovarian cancer the topoisomerase-1 inhibitor topotecan shows activity after prior treatment with platinum and taxanes. Overall response rates of up to 38% in combination with an acceptable toxicity profile have been reported. We performed a pilot study to evaluate the therapeutic efficacy and toxicity profile of a low-dose continuous infusion protocol of topotecan.Twelve patients with recurrent ovarian cancer and a measurable lesion received a continuous infusion of topotecan (0.4 mg/m2/d) over 14 days, repeated every 28 days. All patients had at least one prior platinum-containing regimen of chemotherapy (range 1-7). Responses were evaluated by ultrasound, computed tomography (CT) scans and/or magnetic resonance imaging (MRI).A total of 57 (median 5, range 1-12) topotecan treatment cycles were administered. The overall response rate was 2/12 (17%). Four patients had stable disease (33%), among them two patients with platinum-refractory tumors. The median time to progression was 26 (range 20-100) weeks. No grade 3 or 4 hematological toxicities were observed. However, one patient developed a grade 2 allergy leading to discontinuation of topotecan.Treatment of recurrent ovarian cancer with low-dose continuous infusion of topotecan over 14 days demonstrated response rates comparable to other dosing schedules with minimal toxicity in a preliminary series of 12 patients.

CA125 ist ein seit 1981 bekanntes, durch einen monoklonalen Antikorper definiertes Antigen der Mullergangdifferenzierung und wird von etwa 80% aller Patientinnen mit Ovarialkarzinom und weniger als 1% der gesunden Frauen exprimiert [1].CA125 wird in der Nachsorge von Patientinnen mit Ovarialkarzinom routinemasig eingesetzt. Verschiedene Definitionen eines CA125-Anstieges zur Diagnose eines Rezidives werden in der Praxis verwendet, beispielsweise eine Verdoppelung des Wertes innerhalb von 4 Wochen und/oder Absolutwerte uber 70—100 U/mL [2, 3]. Die Sensitivitat und Spezifitat der isolierten CA125-Erhohung zur Diagnose eines Ovarialkarzinomrezidivs werden in der Literatur mit 75—90% und 77—100% angegeben [4—6]. Sowohl Sensitivitat als auch Spezivitat von CA125 lassen sich durch eine Positronen-Emissionstomographie (PET) signifikant steigern [5, 6].

Chronic postoperative pouch-vaginal and vesicovaginal fistulas after hysterectomy and irradiation to treat advanced cervical cancer do not respond to conventional treatment because of the low vascularity in the irradiated area. We present the successful repair of these complications in a female patient, in whom several vaginal and abdominal approaches had been tried and had resulted not only in failure but also in tissue loss and fibrosis and persisting fistulas. First, a synchronous vaginoabdominal approach using a vertical myocutaneous distally based rectus abdominis myocutaneous flap was used successfully to close a pouch-vaginal fistula and simultaneously reconstruct the posterior vaginal wall. In a second approach, the persisting vesicovaginal fistula was closed by a right rectus abdominis myocutaneous flap while simultaneously reconstructing the anterior vaginal wall, closing the enterocutaneous stoma and performing an appendicovesicostomy as a continence channel for catheterization. Despite unfavorable local wound situations, including an enterocutaneous stoma through the rectus abdominis and various previous incision lines, the transfer of axially well-vascularized tissue can solve these problem wounds. Consecutive bilateral use of the rectus abdominis flap may be necessary to deal with extensive pelvic wounds. This technique should be considered as one repair modality in irradiated pelvic wounds with fistulas. Previous enterostomy is not a contraindication to the use of this flap.

Lipodermatosclerosis refers to a sclerosing panniculitis and dermopathy of the lower extremities sometimes seen in association with venous ulceration. Matrix metalloproteinases are implicated in the pathogenesis of venous leg ulcers and the in vitro activation of recombinant MMP-2 is controlled by the plasminogen activation system. To better understand the role of plasminogen activation in the pathogenesis of venous leg ulcers we investigated fibrinolytic factors and their inhibitors in tissue samples of lipodermatolsclerosis.The expression and the functional state of the urokinase-type plasminogen activator (uPA), the tissue-type plasminogen activator (tPA), the urokinase receptor (CD87), the plasminogen activator inhibitors-1 and -2 (PAI-1 and PAI-2) were assayed using reverse transcription polymerase chain reaction, Western blot, fibrin zymography and immunohistochemistry analyses in tissue samples of lipodermatosclerosis.Our results provide direct evidence of elevated expression of uPA (p0.01) and CD87 (p0.01) mRNA and protein level in lipodermatosclerosis in comparison with healthy skin. By immunohistochemistry, elevated expression of uPA and CD87 could be detected. Fibrin zymography showed significantly elevated endogenous uPA activity (p0.01) in liposclerotic lesions compared to healthy controls.Our findings indicate that elevated plasminogen activation in lipodermatosclerotic tissue may play a crucial role in the pathogenesis of venous leg ulceration.

Axillary lymph node metastases in breast cancer patients are one of the most important prognostic factors. Many previous studies have shown that in the detection of occult micrometastases immunohistochemical methods are superior when compared to routine hematoxylin-eosin staining. The aim of the study was to document the rate of missed occult micrometastases on routine hematoxylin-eosin staining in our department, in a retrospective study.One hundred and one tumors of patients with breast cancer were included in this study. Immunohistochemical staining was performed using Pan-Cytokeratin AE1/AE3 antibody. The number of nodes examined was 1301 (mean per patient: 12.9; range: one to 26).Of the 101 tumors studied, eleven had occult lymph node metastases detected by immunohistochemical methods. After repeated review by two independent pathologists, in two out of eleven patients lymph node metastases were confirmed even on hematoxylin-eosin staining. In nine out of eleven patients hematoxylin-eosin staining was not sufficient to detect occult micrometastases.Immunohistochemical methods enhance the detection rate of occult micrometastases in axillary lymph nodes of breast cancer patients and are recommended for routine diagnostic use in patients who have been diagnosed node-negative on routine hematoxylin-eosin staining.

A prospective study was conducted to determine whether patients with larger breasts show larger tumors.123 patients with primary breast cancer were evaluated (median follow-up 36 months). Breast size was determined as a reflection of cup size.Cup size correlated with tumor diameter at diagnosis (p = 0.0038). On average, cup sizes were larger in postmenopausal than in premenopausal women (p = 0.0011), however, postmenopausal women did not show larger tumors than premenopausal. There was a significant positive correlation between body mass index, body weight and breast size (p0.0001). The mode of tumor detection (self vs. not self) was independent of breast size. No correlation was found between breast size and the patient's height, duration of breast feeding, smoking behavior or amount of alcohol consumption, hormone replacement therapy or use of oral contraceptives, number of involved lymph nodes or DFS and OS.Patients with larger breasts showed larger tumors. The mode of tumor detection is independent of breast size.

Matrix metalloproteinases (MMPs) are a family of zinc-dependent metalloendopeptidases which participate in the degradation of collagen and other extracellular matrix macromolecules. Expression of gelatonic MMPs, such as MMP-2 has been linked to enhanced tumor invasion and metastasis in in vitro and in vivo model systems. It was the aim of this study to determine whether the expression of MMP-1, MMP-2, and TIMP-2 correlates with survival in patients with surgically treated endometrial cancer.A sample of 103 paraffin-embedded tumor specimens of surgical treated endometrial cancer was immunohistochemically investigated.MMP-1, MMP-2, and TIMP-2 were detected by immunohistochemistry in 95% (98/103), 87% (89/103), and 80% (82/103) of the tumour samples, respectively. Correlation coefficients for MMP-1/MMP-2, MMP-1/TIMP-2, MMP-2/TIMP-2 were 0.28 (p = 0.004), 0.05 (p = 0.6), and -0.03 (p = 0.73), respectively. In the univariate analysis, the expression of MMP-1 (log-rank test, p = ns), MMP-2 (log-rank test, p = ns), and TIMP-2 (log-rank test, p = ns) were not associated with overall survival.MMP-1, MMP-2, and TIMP-2, detected by immunohistochemistry are not helpful in predicting the prognosis of endometrial cancer patients.

Hormone receptor expression can be quantified by computerized image analysis in immunohistochemically stained specimens. When comparing semiquantitative scoring with computerized image analysis a review of the literature shows contradictory findings concerning the correlation of these two methods. Recent technical approaches have been developed with true-color computer-assisted image analysis facilitating new measurement designs. We performed a study with a new approach using the principle of semiquantitative assessment of hormone receptor content and measuring two different binary images (immunohistochemically stained nuclear area and total nuclear area).Eighty formalin-fixed, paraffin-embedded and immunohistochemically stained breast cancer specimens were assessed for estrogen receptor expression by true color computer-assisted image analysis and by conventional light microscopy scoring according to Remmele (immunoreactive score (IRS) = staining intensity (SI) x percentage of positive cells (PP)). The results of both methods were correlated.Mean optical density (MOD) and subjective scoring of SI as well as stained nuclear area vs. total nuclear area and subjective scoring of stained cells (PP) showed a high correlation (Spearman correlation coefficient: 0.95, p-value: 0.0001 and 0.64, p-value: 0.0001, respectively).On the basis of this new technical approach our results confirm the correlation of semiquantitative hormone receptor scoring and quantitative computer-assisted image analysis. We believe that by automating electronic analysis in the near future we will be able to establish reliable observer-independent evaluation of immunohistochemical variables ensuing comparability in multi-center trials and cost efficiency.

The increasing use of the laparoscopic surgery in the management of gynecologic diseases resulted in an increasing incidence of complications and the development of new complications. Postoperative complications are uncommon after laparoscopy. The most common complication is incisional herniation. A rare form of port-associated complications is omental evisceration. Since herniation through trocar incision sites might implicate severe complications, the use of safety techniques should be applied on a routine basis to reduce laparoscopy-associated morbidity.

Ovarian tumors of low malignant potential (borderline tumors) have a 5-year survival rate of 69-98%, illustrating that while the prognosis is better than in the typical epithelial carcinoma, a significant number of women still succumb to this disease. The aim of our study was to elucidate the role of numerical chromosomal aberrations in borderline tumors of the ovary in comparison with benign and malignant epithelial tumors in an effort to develop parameters to differentiate prospectively borderline lesions from benign and invasive tumors.Cytologic imprints of surgical specimens of 46 ovarian tumors of low-malignant potential, 17 invasive epithelial carcinomas of the ovary, and 18 benign epithelial tumors of the ovary were examined for numerical chromosomal aberrations (trisomy 7, trisomy 12, and trisomy 17) by fluorescence in situ hybridization (FISH).In benign tumors no evidence of trisomy 7 and 17 was present. Trisomy 12 was detected in six cases (33.3%). We did not find p53 protein overexpression in any case. Ki-67 stained positive in three cases (16.7%). In borderline tumors trisomy 12 was detected in 33 patients (71.7%). Numerical aberrations of chromosome 17 were absent in all cases. Fourteen patients (30.4%) showed trisomy 7. No immunohistochemical staining reaction for p53 protein was found. Staining of the proliferation marker Ki-67 was observed in two cases (4.3%). In malignant epithelial tumors of the ovary, trisomy 7, trisomy 12, and trisomy 17 were detected in 14 (82.3%), 11 (64.7%), and 5 (29.4%) cases, respectively. Four tumors (23.5%) showed immunohistochemically detected p53 protein overexpression. Thirteen tumors (76.5%) stained for Ki-67.Our results indicate that trisomy 7 argues against benign disease. Trisomy 17 was specific for invasive disease, while trisomy 12 is common in borderline tumors of the ovary.

To evaluate the effect of prophylactic cerclage on the course of pregnancy in women with prior conization.In a retrospective, observational study, the outcome of pregnancies in 69 women with (n = 30) and without (n = 39) cerclage who previously underwent conization was evaluated regarding hospitalization due to threatened preterm labor and delivery before 37 weeks of gestation.The occurrence of preterm delivery was 23.3% in the cerclage group and 20.5% in the control group (P = .78). Women with prophylactic cerclage were hospitalized significantly more often due to threatened premature labor: with cerclage, 66.7%; without cerclage, 33.3% (P = .006).Prophylactic cerclage should be used more sparingly in women with a history of conization because it does not prevent premature delivery and tends to induce preterm uterine contractions.

Our aim was to evaluate the prognostic value of CD44v3 overexpression in vulvar cancer patients. Twenty-five cases of squamous cell carcinoma of the vulva with International Federation of Gynecology and Obstetrics (FIGO) stages I to III were examined for overexpression of the CD44 isoform CD44v3. The correlation of CD44v3 overexpression with clinical stage, histologic grade and overall survival was investigated. Follow-up ranged from 36 to 120 months. Clinical stage and histologic grade did not correlate with CD44v3 overexpression. CD44v3 overexpression was associated with poorer overall survival (log rank: P0.03). Immunohistochemically detected CD44v3 overexpression is significantly correlated with a reduced overall survival rate for patients with vulvar carcinoma.

To evaluate the influence of delayed diagnosis on prognostic factors in endometrial cancer, we conducted a retrospective chart analysis based on the data of 116 postmenopausal patients with FIGO stage I-IV endometrial carcinoma. The interval from the first episode of post-menopausal vaginal bleeding to definitive, histological diagnosis (bleeding interval) was compared with tumor stage and various histomorphologic features in endometrial cancer. The mean bleeding interval was 12.7 +/- 17.8 weeks in 74 patients with FIGO stage IA, IB endometrial carcinoma and 35.2 +/- 69.3 weeks in 42 patients with stage IC-IV disease (t-test, p: 0.011). FIGO stage IA, IB disease was diagnosed in 23/26 (88%) patients with a bleeding interval4 weeks, and in 22/34 (64%) and 29/56 (51%) patients with bleeding intervals of 4-8 weeks and8 weeks, respectively (Chi-square 10.358, p=0.006). The correlation with histologic grade, lymph-node status, vessel invasion and histologic subtypes did not reach statistical significance. Our data confirm the clinical impression that postmenopausal vaginal bleeding is an early symptom in patients with endometrial cancer, and that advanced disease in the majority of cases might come from delayed diagnosis in women with poor compliance.

In the past, and still in some centres, patients with clinical stage I and II squamous cell vulvar cancer were treated by radical vulvectomy and bilateral inguinal-femoral lymphadenectomy. Modern management of vulvar cancer during the last 20 years has developed towards more conservative procedures in the therapy of early stage disease. At the Royal Hospital for Women, Sydney, women with invasive tumours20 mm (T1), are treated by a radical local excision. The lesion should be unifocal and the rest of the vulva healthy. A surgical margin of at least 10 mm should be obtained. If no focus with greater than 1 mm of stromal invasion is present, lymph node dissection may be omitted. Lateral lesions with a depth of invasion1 mm may undergo unilateral inguinal-femoral lymphadenectomy. Midline lesions and those involving the labia minora require bilateral groin dissection. In selected cases radical local excision of the primary lesion may also be performed in T2 lesions20 mm but should always be combined with a bilateral inguino-femoral lymphadenectomy. Adjuvant pelvic and groin irradiation should be given if at least one large node has undergone a tumorous change of if there are multiple nodes containing micrometastases. Careful patient selection is necessary to successfully achieve high cure rates, acceptable cosmetic results and psychosexual wellbeing.

Twenty-five cases of squamous cell carcinoma of the vulva were examined for p53 protein overexpression using immunohistochemistry. p 53 protein overexpression was associated with poorer overall survival.

Behçet's disease is a chronic disorder of unclear pathogenesis defined by multiple genital and oral ulcers, as well as ophthalmic changes. The patient described in this case report presented clinically with recurrent genital discharge, recurrent mild genital pain and a cervical ulcer. The diagnosis of Bechet's disease was established by the presence of cervical ulceration, two minor aphthous lesions in the vestibulum oris and a positive pathergy test. Although rare, Behcet's disease should be considered in the differential diagnosis of genital ulceration of unknown etiology.

Leiomyomatosis peritonealis disseminata is a rare disease. Approximately 50 cases have been reported in the world literature so far. Origination from the Müllerian epithelium, which is distributed throughout the subperitoneal mesenchyme seems possible in histogenesis. By specific hormonal stimulation and individual predisposition proliferation takes place along the lines of myofibroblastic differentiation. The case of a 41 year-old woman is presented. The patient's history revealed hormonal therapy for dysmenorrhoea. An incidental finding during diagnostic laparotomy for suspicious endometriotic ovarian cysts, multiple grey-white, granular nodules were seen covering the peritoneal surface of the small pelvis, the intestines and omentum and the surface of the uterus and adnexal structures, as found with peritoneal carcinomatosis arising from the ovary. Microscopically, the nodules were composed of smooth muscle cells which did not show any a typical appearance or mitosis. Immunohistological investigation with Desmin antibodies confirmed the diagnosis. The benign tumours of leiomyomatosis peritonealis disseminata must be differentiated from peritoneal metastases of malignant tumours in order to avoid unnecessary aggressive treatment schedules. Nonetheless follow-up is desirable since malignant degeneration has occasionally been reported.

The extensive intraductal component (EIC) in infiltrating ductal carcinoma (IDC) was reported to be a predictor of local recurrence. We investigated the influence of this histopathological parameter on nodal status and overall survival. In 115 patients suffering from an IDC with tumor stage FIGO I and II, 35 were EIC positive. We did not find a correlation with the nodal status. The mean follow up was 73 (+/- 38) months. EIC showed no influence on overall survival. Based on our findings, the presence of EIC is not a criterion for therapeutic decisions in IDC.

Uterine papillary serous carcinoma (UPSC) is a histologic subtype of endometrial adenocarcinoma that is characterized by its papillary architecture, poor differentiation, and advanced stage at initial presentation. It behaves more aggressively than the more common endometrioid adenocarcinoma of the endometrium.The history, treatment and follow-up of 18 women with UPSC were evaluated.All women underwent total hysterectomy and bilateral salpingoophorectomy. Positive lymph nodes were found in 6 of 14 patients who underwent pelvic lymphadenectomy. Twelve of 18 women with UPSC had FIGO Stage III and IV tumors in contrast to 30 of 236 patients with endometrioid adenocarcinoma (P000.1). Subsequent treatment of these women was: radiotherapy, three women; chemotherapy, four, both radiotherapy and chemotherapy, eight. Chemotherapy consisted of cisplatin/carboplatin plus cyclophosphamide. None of the patients with Stage I or II UPSC died of tumor during a mean follow-up of 31.6 months (range, 12-68 months). Of the women with Stage III and IV disease, 4 of 12 are alive with no evidence of disease after a mean follow-up of 22.5 months (range, 8-45 months). Eight of 12 women who received chemotherapy are alive with no evidence of disease, 4 of whom had Stage III or IV disease. One of six women who did not receive chemotherapy is alive, three died of tumor, and two of intercurrent disease.These results would justify further study of the possible role of platinum-based chemotherapy in patients with uterine papillary serous carcinoma.

A case of intravenous leiomyomatosis of the uterus and 4 subperitoneal, pelvic leiomyomas without any connection to the uterus is demonstrated. The intravascular position of the tumors is proved by immunohistochemistry with positive reaction of antibodies against von Willebrand Factor. This rare growth pattern of benign leiomyoma of the uterus often shows extrauterine extension by intravascular growth within venous channels, sometimes causing cardiovascular complications. This tumor should not be confused with malignant neoplasia.

420 clinical and serological examinations prior to surgery and during follow-up were performed in 30 patients suffering from ovarian cancer. The population consisted of three FIGO stage Ia, nine stage Ic, four stage II and fourteen stage III cases. Serous carcinoma of the ovary, mucinous carcinoma and other kinds of ovarian cancer were found in 16, 9 and 5 cases, respectively. The serum levels of the tumor markers tissue polypeptide specific antigen (TPS), cancer associated serum antigen (CASA) and carbohydrate antigen 125 (CA 125) were determined. Cut-off values of 97 U/l, 4 U/ml and 35mU/ml for TPS, CASA and CA 125, respectively, were selected according to the 95% of serum concentrations measured in healthy controls. Sensitivity, specificity, PPV and NPV of CA 125 were 75%/96%/69%/92%, respectively. Sensitivity, specificity, PPV and NPV of TPS were 67%/84%/59%/90%, respectively. CASA showed a sensitivity of 58%, specificity of 96% and a PPV and NPV of 73%/94%, respectively. The combination of TPS and CA125 increased the sensitivity to 81%, reaching a specificity of 82% and a PPV and NPV of 58/96%, respectively. The combination of CASA and CA125 showed a sensitivity, specificity, PPV and NPV of 88/85/65/96%, respectively. Twelve patients developed recurrence of disease after response to primary treatment. TPS, CASA and CA 125 detected recurrent disease in six, two and four cases, respectively. For TPS mean lead time was 4.6 months (range 2-18 months), for CASA 1.7 months (range 1-6 months), and for CA 125 3.5 months (range 1-24 months. As a matter of fact TPS never showed lead time effects in patients without elevated pretherapeutic levels. A combination of all makers showed a mean lead time of 6.72 months. Detection of recurrent disease by CA 125 is improved when CA 125 is used in combination with TPS, especially in those patients with pretherapeutically elevated TPS serum levels.

In 83 specimen of amniotic fluid both a dynamic measurement of the surface tension by the Wilhelmy-balance and a determination of the lecithin-sphingomyelin-ratio were performed in 1987-1992 in order to predict a respiratory-distress-syndrome (RDS) of the newborn. 7 cases showed divergent results of both methods. In comparison with the measurement of surface tension by the Wilhelmy-balance, determination of the lecithin/sphingomyelin-ratio showed more false positive results (4:1). Both methods provided false negative results in two cases each. In two cases both methods showed false positive results, with RDS occurring in spite of predicted lung maturity. In our high risk-collective 5 of 83 newborns developed a severe RDS. All of them were delivered by caesarean section. A secondary deficiency of surfactant as a result of fetal hypoxia or acidosis as well as a possible influence of the way of delivery might be responsible for the development of RDS. The Wilhelmy-balance, which can be used as a bed-side-method, provides similar results in the prediction of fetal lung maturity compared to the L/S-ratio.

Aberrant expression of specific isoforms of the cell adhesion molecule CD44 has been detected in various malignant human tumors. We wanted to verify whether the expression of these splice variants was associated with a higher incidence of metastasis and poor prognosis.We studied the expression of CD44 splice variants v5, v6 and v7-8 by immunohistochemistry in human cervical cancer. 105 surgically treated patients with cervical cancer of stages IB-IIB were included in the study.Tumors expressing exon v6 had significantly more often metastasized to the pelvic nodes (p = 0.04), and patients suffering from tumors expressing CD44v6 showed poorer overall survival. Even in cases with negative pelvic lymph nodes, we found a significantly poorer prognosis when tumors expressed CD44v6.Among the investigated CD44 splice variants, expression of exons v6 and v7-8 is the most promising prognostic marker in cervical cancer. They can possibly identify patients with an increased risk earlier than morphologic prognostic parameters.

Gynecologic oncology is centralized in Australia. In centers like the Royal Hospital for Women in Sydney, more than 300 patients/year with gynecologic malignancies are operated on. The establishment of gynecologic oncology as a special field is illustrated. In addition, the 3-year training program of gynecologic oncologists is reviewed. The international trend towards specialization is emphasized, and the advantages of centralization and additional training are pointed out. An adaptation of the Australian model for Austrian circumstances is proposed.