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Purpose We compared response, survival and side effects of regiments with intravenous cyclophosphamide followed by intraperitoneal cisplatin versus intravenous cyclophosphamide followed by intraperitoneal carboplatin as second line treatment in one center retrospective study. Material and Methods Inclusion criteria were: relapse or recurrence of the disease after surgery and first line treatment; stage III histologicaly documented serous epithelial ovarian cancer after one or more prior regiments of chemotherapy. Recurrence were confirmed throughout restaging laparotomy or second look laparotomy. Patients from one of the groups received 90mg/m2 cisplatin on the first day and 750mg/m 2 cyclophosphamide intravenously, while the second group members AUC 6 carboplatin intraperitoneally and 750mg/m 2 cyclophosphamide intravenously. Four courses were administrated for each patient. Results Of the 49 patients in the cisplatin group the response rates were 21 (43%), 10 (20%) and 18 (37%) in the groups of pathologic complete response, pathologic partial response and progressive disease, respectively. The median survival from the initiation of intraperitoneal chemotherapy was 59 months. Of the 25 patients in the carboplatin group the response rates were 10 (40%), 4 (16%) and 11 (44%) respectively. The median survival -51 months. The differences between the groups were not statistically significant p>0.05 either in response or in toxicity. Conclusions The results of our research including relatively long survival from intraperotoneal chemotherapy initiation confirm that carboplatin treatment is as good as cisplatin in second line intraperitoneal chemotherapy for ovarian cancer.

Objective Regulatory T cells (Tregs), and the enzyme indoleamine 2,3-dioxygenase (IDO), have potential regulatory properties for immune escape in cancer. Inhibitors of IDO are available and could potentially be used in vulvar cancer if IDO was proved to drive progression of the disease. The aim of this study was to evaluate the expression of factor forkhead boxP3 (FOXP3), a marker of Tregs, and IDO in vulvar squamous cell carcinoma (vSCC), and to verify their prognostic significance. Methods 76 primary tumors and 35 lymph node metastases derived from 76 patients with full clinical history were analyzed. The intratumoral infiltration of Tregs and IDO expression within cancer were evaluated by immunohistochemistry. Results The number of Tregs in primary tumor and in corresponding lymph node metastasis was significantly correlated. Intensity of Treg infiltrates in the primary and metastatic sites was not correlated to IDO expression and had no influence on the overall patient survival. High IDO expression was associated with significantly worse overall survival among vSCC patients and was found to be an independent prognostic factor similarly to the tumor grade and patient's age. Conclusions The degree of intratumoral Treg infiltrates is an individual feature and remains stable throughout the course of the disease without impact on the patient's survival. IDO expression predicts shorter survival of vSCC patients. If immunologic tolerance of the tumor is promoted by the overexpression of IDO it will not influence the number of intratumoral Tregs. IDO expression seems to be an independent prognostic factor in patients with vSCC.

Loss of heterozygosity at BRCA1/2 loci in breast and ovarian tumors is a suggested risk factor for germline BRCA1/2 mutation status. We evaluated the presence of losses of selected microsatellite markers localized on chromosomes 17 and 13q in hereditary and sporadic ovarian tumors. 151 consecutive primary ovarian tumors (including 21 with BRCA1/2 mutations and 130 without the mutations) were screened for loss of heterozygosity at loci on chromosomes 17 and 13q. Losses of heterozygosity of at least one microsatellite marker localized on chromosomes 17 and 13q were revealed in 123 (81.5%) and 104 (68.9%) tumors, respectively. Losses of all informative markers on chromosomes 17 and 13 occurred in 30 (19.9%) and 31 (20.5%) tumors, respectively. There was no difference in the frequency of losses at BRCA1 intragenic markers (D17S855 and D17S1323) between BRCA1-positive and BRCA1-negative patients. The frequency of losses on chromosome 17 was higher in high-grade than in low-grade carcinomas. Loss of heterozygosity on chromosomes 17 and 13q is a frequent phenomenon in both hereditary and sporadic ovarian cancers. The frequency of losses at BRCA1 intragenic markers in the ovarian tumor tissue is not strongly related to the presence of BRCA1 germline mutations.

Objective Maspin is a member of the serine protease inhibitor superfamily. Experimental studies revealed that maspin suppresses tumor growth, angiogenesis, invasion and metastasis. We examined maspin expression in human ovarian tumors and relation between maspin expression and clinicopathological features as well as the role of maspin in predicting clinical outcome in patients with ovarian cancer. Methods Tissue samples consisted of 42 benign tumors, 10 borderline (LMP) tumors, 76 ovarian carcinomas, 8 Krukenberg tumors and 32 normal tissues. Immunoblot analysis was performed to evaluate the relative expression of maspin/β-actin. Results Relative maspin level was significantly higher in patients with LMP tumors (median 0.74) and early stages ovarian cancers (median 0.46) when compared with healthy tissues (median 0.03), those with benign (median 0.23) and metastatic tumors (median 0.22). Overexpression of maspin was found to correlate with the early stage of the disease ( p =0.001), non-serous subtype of ovarian cancer ( p =0.03) and positive response to chemotherapy ( p =0.02). A statistically significant longer PFS was seen in women with high as compared with low expression of maspin ( p =0.03). Conclusions Maspin is upregulated in borderline tumors and the early stages of ovarian carcinoma and then significantly downregulated with malignant transformation. High expression may paradoxically promote the invasion and metastasis of ovarian carcinomas. Our study revealed that maspin expression could play an important role in predicting the results of treatment of ovarian cancer patients.

Objective. To report the results of ovarian cancer treatment, where a regimen of intravenous cyclophosphamide followed by intraperitoneal cisplatin or carboplatin was administered as second line treatment. Design. Retrospective observational study on 198 women with stage I–IV histologically documented epithelial ovarian cancer after one or more prior regimens of chemotherapy. Setting. University tertiary referral clinic, Gdansk, Poland. Methods. The study group was recruited from among 593 ovarian cancer patients treated between January 1996 and December 2006. Conditions of inclusion for intraperitoneal treatment were: relapse or recurrence of disease after surgery followed by first line treatment. Recurrences were confirmed through re-staging laparotomy or second-look laparotomy. Patients received 90 mg/m2 cisplatin, or carboplatin AUC 6 intraperitoneally and cyclophosphamide 750 mg/m2 intravenously. Four or six courses were planned for each patient. Main outcome measures. Response to treatment defined a...

Purpose Most patients with advanced ovarian cancer develop recurrent disease. For those patients who recur at least 6 months after initial therapy, paclitaxel platinum has shown a modest survival advantage over platinum without paclitaxel; however, many patients develop clinically relevant neurotoxicity, frequently resulting in treatment discontinuation. Thus, an alternative regimen without significant neurotoxicity was evaluated by comparing gemcitabine plus carboplatin with single-agent carboplatin in platinum-sensitive recurrent ovarian cancer patients. Methods Patients with platinum-sensitive recurrent ovarian cancer were randomly assigned to receive either gemcitabine plus carboplatin or carboplatin alone, every 21 days. The primary objective was to compare progression-free survival (PFS). Results Three hundred fifty-six patients (178 gemcitabine plus carboplatin; 178 carboplatin) were randomly assigned. Patients received a median of six cycles in both arms. With a median follow-up of 17 months, median PFS was 8.6 months (95% CI, 7.9 to 9.7 months) for gemcitabine plus carboplatin and 5.8 months (95% CI, 5.2 to 7.1 months) for carboplatin. The hazard ration (HR) for PFS was 0.72 (95% CI, 0.58 to 0.90; P = .0031). Response rate was 47.2% (95% CI, 39.9% to 54.5%) for gemcitabine plus carboplatin and 30.9% (95% CI, 24.1% to 37.7%) for carboplatin (P = .0016). The HR for overall survival was 0.96 (95% CI, 0.75 to1.23; P = .7349). While myelosuppression was significantly more common in the combination, sequelae such as febrile neutropenia or infections were uncommon. No statistically significant differences in quality of life scores between arms were noted. Conclusion Gemcitabine plus carboplatin significantly improves PFS and response rate without worsening quality of life for patients with platinum-sensitive recurrent ovarian cancer.

BACKGROUND The clinical relevance of BRCA1/2 alterations in ovarian carcinoma patients is debatable. Our aim was to determine factors influencing the risk of recurrence and death in ovarian carcinoma patients with BRCA pathogenic and unclassified variant mutations. METHODS A consecutive series of 205 women with primary ovarian carcinoma were screened for mutations in BRCA1 and BRCA2 genes using a conformational sensitive gel electrophoresis and direct sequencing. Data regarding medical and familial history were collected using questionnaires. Clinical and pathologic data were extracted from medical records. RESULTS Unclassified variant mutations in BRCA1 or BRCA2 genes were found in 16 (8%) patients, and BRCA1 pathogenic mutations were found in 18 (9%) patients. No pathogenic mutation was found in BRCA2 gene. Multivariate analysis showed that BRCA1 pathogenic mutation was an independent predictor of reduced risk of relapse and death (Hazard ratios [HR] 0.52 [confidence interval {CI} 0.28–0.98] and 0.38 [CI 0.10–0.96], respectively). Unclassified variant mutation did not affect recurrence and survival (HR 0.84 [CI 0.43–1.66] and 0.94 [CI 0.48–1.82], respectively). Other factors associated with reduced risk of relapse and death were complete pathologic remission at second-look laparotomy and family history of breast and ovarian carcinoma, respectively. Recurrence and death outcomes among unclassified variant mutation carriers did not differ significantly from those in sporadic cases. CONCLUSIONS Patients with BRCA1 pathogenic mutation seem to have reduced risk of recurrence and death. These results should be interpreted with caution as they may be influenced by more intensive treatment, better response to cisplatin, and younger age of mutation carriers. Clinical relevance of BRCA1/2 unclassified variant mutations warrants further studies. Cancer 2005. © 2005 American Cancer Society.

The objective of this study was to determine the prevalence of BRCA1 and BRCA2 gene mutations in unselected ovarian cancer patients, and to analyse clinical and pathological features of ovarian cancer unclassified variant mutation carriers in comparison with BRCA1 pathogenic mutation carriers and sporadic cases. A consecutive sample of 205 women with primary ovarian cancer was screened for mutations in the BRCA1 and BRCA2 genes using a direct test for small deletions and insertions, conformational sensitive gel electrophoresis and direct sequencing. Data regarding medical and familial history were collected using questionnaires. Clinical and pathological data were extracted from medical records. Unclassified variants and polymorphic mutations accounted for 8% (n = 16) and 6% (n = 13) of all cases, respectively. BRCA1 pathogenic mutations were found in 18 (9%) patients. None were found in BRCA2. The mean age of onset for BRCA1-associated tumours was 43.1 years (standard deviation (SD: 7.3) whereas in the patients with an unclassified variant, polymorphism, or no detectable gene changes, the mean age of onset ranged from 49.5-56.4 years. The most significant predictors for pathogenic or unclassified variant changes in BRCA1 in ovarian cancer patients were a younger age of onset and a history of hyperthyroidism and infertility. Except for infertility and hyperthyroidism, unclassified variant-linked ovarian tumours share features with sporadic turnours rather than with BRCA1 pathogenic mutations. (C) 2004 Elsevier Ltd. All rights reserved.

This is a report of a case of gynecological hemorrhage after a posterior pelvic exenteration in patients with vulvar cancer treated by temporary pelvic packing at the Department of Gynecology of the Medical University in Gdańsk. The packing was successful and the sponges were removed after 24 h. Twenty-eight days after the operation, the patient was transferred to the Department of Radiotherapy for supplementary treatment. In patients with severe intraoperative hemorrhage, intra-abdominal packing has been successful as a mode of treatment.

First-line intravenous chemotherapy (CT) following debulking surgery is associated with prolonged survival, in particular in patients who achieve a pathological complete remission (pCR) at second-look surgery but in whom a high rate of relapses still occurs. Between 1988 and 1997, 153 patients in pCR following platinum-based intravenous CT were randomized between four courses of intraperitoneal cisplatin (P) (90 mg/m2 every 3 weeks) or observation. Overall survival (OS) was the primary endpoint, while progression-free survival (PFS) was a secondary endpoint. This intent-to-treat analysis includes 16 patients who were not eligible and 17 patients who had protocol violations. The two groups were well balanced in terms of age (median = 55 years), performance status (78% P.S. O), FIGO stage (96% stage III), histology (serous in 66%), grade (2 or 3 in 80%), and residuum before intravenous CT (>1 cm in 40%). Intraperitoneal CT was delivered mainly through intraperitoneal catheters (Port-a-Cath 61% and Tenckhoff 25%). Side effects of intraperitoneal cisplatin included vomiting [≥grade 2 (82%)], rise in serum creatinine [≥grade 2 (14%)], abdominal pain [grade 1–2 (38%)], and neurotoxicity [grade 2–3 (15%)].After a median follow-up of 8 years, 80 patients (52%) have progressed with no difference in the pattern of relapse between the two groups and 75 patients (49%) have died; the respective hazard ratios for PFS and OS with 95% CI are 0.89 (0.59–1.33) and 0.82 (0.52–1.29). These results are suggestive of a treatment benefit but do not support a change in clinical practice. Other randomized clinical trials of intraperitoneal CT are reviewed and briefly discussed.

To investigate whether asymmetry exists in the left- and right-distribution of ovarian cystic lesions in women with endometriosis.We evaluated operative reports of women who underwent surgical treatment of endometrioma(n = 253) from January 1999 to December 2003. We included only those cases that had not been previously operated on (n = 234). Data of all operative findings consisted of a written report and a diagram, fulfilling the revised American Fertility Society Classification of endometriosis.Endometrioma was found in the left ovary in 113 women, in the right ovaryin 67, and bilaterally in 54. Left ovarian unilateral endometrioma was found more frequently (62.8%) than right endometrioma (p0.001, odds ratio (OR) 2.8, 95% confidence interval (CI) 1.9, 4.4). The frequencies of left and right ovarian endometrioma were compared with the expected 50% using Pearson's chi(2)-test. The results confirmed asymmetry(p = 0.001). We found 4 cases of ovarian cancer associated with left endometrioma without histological proof of transition.Our results confirm a left lateral predisposition of endometrioma. This predisposition may be caused by the presence of the sigmoid colon in the left side of the pelvis, which decreases peritoneal fluid movement. Our findings may support the transplantation theory of the origin for endometriosis.

Purpose Enzastaurin is an oral serine/threonine kinase inhibitor antitumor agent. Our phase II trial tested the efficacy and safety of enzastaurin added to a standard carboplatin/paclitaxel chemotherapy regimen in patients with newly diagnosed advanced ovarian cancer. Patients and Methods This was a randomized, placebo-controlled study in patients with International Federation of Gynecology and Obstetrics stage IIB to IV ovarian, fallopian tube, or peritoneal epithelial carcinoma. Patients were randomly assigned to six cycles of chemotherapy (paclitaxel/carboplatin ± enzastaurin [PCE/PC]) followed by maintenance therapy (enzastaurin/placebo). Primary end point was progression-free survival (PFS). Secondary measures included response rate, safety assessment, and translational research. Results A total of 142 patients were randomly assigned to PCE (n = 69) or PC (n = 73). Patients in the PCE group had a 3.7-month longer median PFS compared with patients in the PC group; this was not statistically significant (hazard ratio [HR], 0.80; 95% CI, 0.50 to 1.29; P = .37). Safety profiles of the treatment arms were comparable. Frequency of discontinuation because of adverse events was similar (PCE, 11.9%; PC, 9.7%). Multivariate analyses confirmed the importance of optimal debulking with regard to PFS (debulking optimal v suboptimal: HR, 0.51; 95% CI, 0.30 to 0.85; P = .009). HR for covariate stage (stage IIB to IIIB v IIIC to IV) was not statistically significant (0.75; 95% CI, 0.38 to 1.47; P = .40). Translational research of immunohistochemistry protein assays did not identify any markers significantly associated with treatment difference regarding PFS. Conclusion The PCE combination increased PFS, but it was not significantly superior to PC in this phase II study.

Background. To preserve fertility, hemi-pelvis irradiation was chosen for locoregional groin recurrence of vulvar cancer in an adolescent. Case. A case of squamous cell vulvar carcinoma in uncommonly young patient is presented. First surgical management (local excision of T1N0M0 tumor of the right labia minora) was performed at the age of 16.5 years. Further therapy included wide local resection of recurrent local lesion, two subsequent ipsilateral groin dissections of nodal metastases (with extranodal spread at the first instance), and ipsilateral pelvic lymphadenectomy. The patient was administered external beam irradiation of 45 Gy to the hemi-pelvis followed by 10.8 Gy boost to the right inguinal region. After 6.5 years from the completion of radiotherapy the patient is free of disease. She managed to conceive but the labor was premature and the infant died in its 7th week of life. Conclusion. In this case salvage hemi-pelvic irradiation for groin metastases of vulvar cancer has proved to be an effective treatment, allowing preservation of hormonal and obstetric functions. Partial post-irradiation damage of the uterus might have caused premature labor. Thus, special obstetric care is advisable in such situations.

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.

Background:The clinicopathological significance of the local spontaneous immune reaction in vulvar squamous cell carcinoma remains unclear. The purpose of this study was to clarify the role of the subtypes of tumor-infiltrating lymphocytes, both individually and synergistically.Methods:Seventy-six patients with verified histopathological data and complete clinical history were included into the study. We collected 76 paraffin-embedded samples of the primary tumor. The presence of CD4+and CD8+T cells was evaluated by immunohistochemistry and compared with commonly recognized prognostic factors. The primary end point analyzed was the overall survival.Results:CD4+and CD8+T cells were detected both within the nests of carcinoma and in the stroma, but only the infiltration within cancer cell nests was further analyzed. There was significant positive correlation (Spearman rho testR= 0.282,P= 0.014) between the number of intratumoral CD4+and CD8+T cells. No correlation was observed between the number of tumor-infiltrating CD4+and CD8+T cells and the patients' survival. Patients were classified into the following 4 groups (CD4+/CD8+, CD4−/CD8−, CD4+/CD8−, CD4−/CD8+), but none of them correlated with overall survival.Conclusions:These data support the statement that CD4+and CD8+T cells cooperate within cancer cell nests, but this spontaneous immune reaction is an individual feature not influencing the prognosis. Intratumoral CD4+T cells might control or reflect the immune responses against cancer cells, whereas CD8+T cells do not seem to work as sufficient effectors in tumor tissues.

The objective of this study was to find prognostic factors for the development of recurrences in patients who had undergone surgical treatment of vulvar cancer.The records of patients with primary vulvar cancer (n=104) treated at the Department of Gynaecological Oncology of the Medical University of Gdańsk between 1998 and 2001 were reviewed to identify those with squamous histology. Of the 93 thus identified 27 were excluded because of lack of standard treatment and 7 because of lack of radical surgery. A total number of 59 patients with squamous cell carcinoma were finally analyzed. For each record the age of the patient, size of the lesion, depth of invasion, margins of resection and lymph node status were analyzed. All patients were staged according to FIGO (1996). Recurrences were recorded by localization, whether local, groin or distant, and compared with a group of patients without any recurrences after radical surgery (n=59).Recurrence was recorded in 19 cases (28.8%). A local (vulvar/perineal) recurrence was diagnosed in 10 patients (10/59, 16.9%), while 5 (5/59, 8.5%) developed groin recurrence and 4 (4/59, 6.8%) had distant recurrences. Multifocality of the primary tumour is an independent risk factor for local recurrence (HR: 3.12; 95% CI: 0.84-11.6). A metastatic node was the only independent prognostic risk factor for groin or distant recurrence (HR: 3.16; 95% CI: 0.94-10.2).Close follow-up of patients treated for vulvar cancer is recommended to detect recurrences at an early and potentially curable stage. Deep inguinal-femoral lymphadenectomy could be replaced with superficial inguinal groin dissection.

"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.

To compare clinical characteristics of infertile and fertile patients with endometriosis.We evaluated medical records of women who underwent surgical treatment of endometriosis (n=284) between January 1999 and December 2003. Our study included only cases of histopathologically proven pelvic endometriosis (n=269). These patients were categorized into two groups named after infertile (n=45) and fertile cases (n=224). Clinical data were compared.Infertile patients are younger (t student. P=0.0000), have lower weight (Wilcoxon test P=0.0150), lower blood pressure--either systolic (Wilcoxon test P=0.0006) or diastolic (Wilcoxon test P=0.0007), separate noncystic endometriotic leasions occur frequently among these cases (Pearson chi-square P=0.000).Noncystic endometriotic implants are more strongly related to infertility than endometriomas. The relationship between blood pressure and infertility requires further investigation. endometriosis.

The HtrA family of serine proteases takes part in cellular stress response including heat shock, inflammation and cancer. Downregulation of human HtrA1 and HtrA3 genes has been reported in some cancers, including endometrial cancer (EC), suggesting a tumor-suppressor role for both genes. The mechanism of the HtrA function is not known, however, evidence exists showing that both HtrA1 and HtrA3 regulate biological processes by modulating TGF-beta signaling. In the presented study the expression of human HtrA1, HtrA2, HtrA3 and TGF-beta1 genes was examined in 124 endometrial tissue specimens including 88 cancers and 36 normal endometria. The expression of the tested genes was evaluated at mRNA and protein levels by semi-quantitative RT-PCR and western blotting methods, respectively. Our results showed significant decrease of HtrA1 and HtrA3 mRNA and protein levels in EC compared to normal tissues. The most dramatic decrease was found for HtrA3 at both mRNA and protein levels (3.2- and 5.6-fold, respectively). Moreover, the HtrA3 protein (short isoform) was not detected in 19% of the cancers, and its level decreased from the premenopausal to the postmenopausal group. The HtrA2 protein levels were significantly lower in EC tissues compared to normal tissues. We also found a significant increase of the TGF-beta1 protein level in EC as well as a significant negative correlation between HtrA1/2/3 and TGF-beta1 relative protein levels. Our results showing downregulation of HtrA1 and HtrA3 gene expression support previous studies suggesting a tumor suppressor role for these genes. Furthermore, our data suggest that HtrA2 may be involved in EC development as well as suggest the involvement of HtrA1, HtrA2 and HtrA3 in the inhibition of TGF-beta signaling in endometrial tissues.

Gestational hypertension is a recognized risk factor for the development of complications during pregnancy. The present study retrospectively assessed the respective values of blood pressure components derived from conventional and 24-h recordings (ABPM) as predictors of premature delivery in women with gestational hypertension based on office readings from 26th week of gestation onwards. Blood pressures were measured conventionally and over 24 h. Standard medical and obstetric history, and standard laboratory work-up were taken into account. The mean (+/- standard deviation, SD) age of 123 women was 29 +/- 6 years. Current pregnancy was, on average, the second. The conventional systolic (SBP)/diastolic (DBP) blood pressure averaged 140 +/- 19/92 +/- 14 mmHg, and pulse pressure (PP) and mean arterial pressure (MBP) averaged 48 +/- 10 and 108 +/- 15 mmHg. The corresponding values derived from ABPM were 135 +/- 16/90 +/- 11, 47 +/- 9 and 105 +/- 12 mmHg. The 24-h blood pressures had better prognostic value than the conventional blood pressures. The 24-h SBP predicted risk of premature delivery and was inversely related to the duration of pregnancy and birth weight. After the exclusion of 41 women with white-coat hypertension, the highest predictive value was associated with PP. PP wider by 1SD was associated with 66% higher risk of premature delivery, and was associated with shortening of pregnancy by 2 weeks and 400 g lower birth weight, even after adjustment for SBP. In conclusion, ABPM is superior to conventional blood pressure measurements in predicting adverse outcome of pregnancy. Twenty-four-hour PP, of all classic indices, seems to be most closely related to increase of that risk.

Background This Phase 3, randomized, open-label, multicenter study conducted at 44 sites in Europe evaluated the safety and efficacy of a continuous, daily regimen of levonorgestrel (LNG) 90 mcg/ethinyl estradiol (EE) 20 mcg compared with a 21-day, cyclic LNG 100 mcg/EE 20 mcg regimen. Study Design Three hundred twenty-three healthy women were randomized to continuous LNG 90 mcg/EE 20 mcg and 318 subjects to cyclic LNG 100 mcg/EE 20 mcg for 1 year (13 pill packs). Pearl index, adverse event (AE) incidence and bleeding profiles were assessed. Results No pregnancies occurred with the continuous oral contraceptive (OC) (Pearl index=0.00). As the study progressed, the percentage of women who achieved amenorrhea during each 28-day pill pack increased: 40% at pill pack 7, 53% at pill pack 13. The percentage of women with no bleeding [with or without spotting (defined as not requiring sanitary protection)] was 50%, 69% and 79% at pill packs 3, 7 and 13, respectively. The incidence of AEs was similar to that of the cyclic OC (except for metrorrhagia and vaginal bleeding in the first 6 months). Conclusions Continuous LNG 90 mcg/EE 20 mcg was shown to be a safe and effective OC in this direct comparison to a cyclic OC. Suppression of menses and the potential for no bleeding requiring sanitary protection may be provided by this continuous, low-dose OC.

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.

Cytogenetic analysis was performed after short-term tissue culture of a thecoma of the ovary. Trisomy of chromosome 12 was revealed as the sole chromosome abnormality. This is the first report of a chromosomal aberration in thecoma of the ovary.

Late recurrence of malignant tumours is very rare phenomenon. Seven cases of late recurrent malignancy (melanoma--2 cases, clear cell renal cancer, stomach sarcoma, breast cancer, basal cell carcinoma, ovarian cancer) after 20-32 (average 22.3) years from diagnosis and treatment were described. The histopathological examination results of primary and recurrent tumours were identical. Six patients died at the age from 40 to 89 (mean 66.8) years. The survival of patients after recurrence was from 4 to 11 (mean 7.3) months.

According to recommendations, the sentinel node (SN) procedure results causes of less radical treatment and reduction of morbidity.The aim of this study was to determine the feasibility of sentinel lymph node identification using radioisotopic lymphatic mapping with technetium-99m labelled nanocolloid and blue dye injection in patients with early-stage cervical cancer.100 patients with FIGO stage from IB1 to IIA primary carcinoma undergoing radical hysterectomy with pelvic lymphadenectomy have been investigated.84% of the patients have been diagnosed with at least one-sided SN and 66% of them with two-sided SN. The sentinel detection rates, depending on the stages, were as following: 181-96.6%, IB12-66.7%, IIA-62.5%. Successful identification of SN was less likely in patients with tumors2cm (54% of SN) compared with those with tumorsor = 2cm (96% of SN). The false negative rate for the SN procedure was 3% (3/100). In all false negative SNs the primary cervical tumor was above 2cm and there was an isthmus infiltration. SN detection had 86.4% sensitivity, 100% specificity, and 95.3% negative predictive value.Sentinel node mapping method for cervical cancer patients undergoing primary surgical therapy is a feasible option. The sentinel node detection rate is relatively high and depends on FIGO stage and the tumor size. The appliance of SN into cervical cancer procedures allows us to refrain from a surgery in favor of radiochemiotherapy, seems to be the right course of action in deciding treatment and may result in fewer postoperative complications rate.

Objectives Expression of human HtrA1, HtrA2, HtrA3 and TGF-β1 genes was examined in ovarian tissue specimens including 19 normal ovaries, 20 benign tumors, 7 borderline tumors, 44 cancers and 8 Krukenberg tumors. Design and methods mRNA and protein levels were evaluated by semi-quantitative RT-PCR and Western-blotting methods, respectively. Results A statistically significant decrease of HtrA1 and HtrA3 expression in ovarian tumors comparing to normal tissues was observed. A dramatic decrease of HtrA3 mRNA and protein levels in all tumor tissue groups, and a loss of HtrA3 protein in 30% malignant tumors were found. A significant decrease of HtrA1 mRNA, and of HtrA3 mRNA and protein in malignant tumors compared to benign tumors was revealed. HtrA2 expression in tumor tissues was slightly decreased. Expression of TGF-β1 in tumor tissues was not significantly different compared to control tissues. Conclusions Our results show downregulation of HtrA1 and HtrA3 genes' expression in different types of ovarian tumors and give additional evidence that these genes may function as tumor suppressors.

Background. We estimated the prevalence of BRCA1/2 germline mutations in consecutive ovarian cancers and correlated the mutation status with clinicopathological features. Methods. 151 consecutive primary ovarian cancer patients were screened for BRCA1/2 germline mutations. Results. We identified BRCA1/2 germline mutations in 21 (13.9%) patients. Seventeen (81%) of carriers have BRCA1 and four (19%) have BRCA2 mutation. BRCA1/2 carriers have a distinctly longer overall survival than sporadic cases (log-rank, p =0.014). Conclusions. The relatively high proportion of BRCA1/2 carriers among unselected ovarian cancer patients indicates the necessity of searching for recurrent BRCA mutations in each case of ovarian carcinoma. This routine screen should be widened to include denaturing high performance liquid chromatography (DHPLC) analysis of both exons 11 of BRCA1 and BRCA2 genes in women with positive family history.

The established of prognostics factors in ovarian cancer patients can be used to predict the outcome of the disease, and gives possibilities to identified the group of patients who must be treated more aggressive. Some authors believe that (SPF) is prognostic factor in ovarian cancer.Evaluation of prognostic significance of S phase fraction in ovarian cancer patients determined by flow cytometric (FC) analysis.Percent of S phase fraction by FC was investigated in group of 102 ovarian cancer patients from freshfrozen samples. FIGO: I--18 (17.65%), II--10 (9.8%), III--66 (64.7%), IV--8 (7.85%). Histopathologic grades (G): G1--u 30 (29.5%), (G2)--43 (42.16%), G3--26 (25.5%), Gx--2.94%). Serous tumours--66 (64.7%), endometrioid--5 (14.7%), undifferentiated--10 (9.8%), mucinous--7 (6.9%), clear cell tumours--4 (3.9%). The oldest patient was 82 and the youngest 24 mean 54 years. After primary citoreductive surgery patients was treated with intravenous chemotherapy 6 cycles. Tissue was fixed in liquid nitrogen (-195 degrees C), and after different period of time prepared according Vidlov method. SPF was measured with FACScan flow cytometr (FACS-Calibur Becton-Dickinson). In statistical analysis established confidential level was 95% (p0.05).We excluded 7 patients from the study. Average SPF in whole group--13.0637% (0.58-57.62), average SPF in aneuploidy group--13.536% standard deviation (SD)--10.71, in diploidy group--12.365%, SD 10.63. No differentiation between groups was found p = 0.66. We did not find, in whole group a ny influence of SPF on survival p = 0.992.S-phase fraction has no prognostic significance in ovarian cancer.

A case of actinomycosis presenting as tubo-ovarian abscess, misdiagnosed as ovarian malignancy in 54-year old woman with IUD is reported. Author presents the diagnostic problems due to uncommon location, no reliable clinical manifestation and nonspecific CT imaging findings, based on current literature. Knowledge of the characteristic features may help one consider the possibility of actinomycetic infection in the differential diagnosis, in patients with a previous history of predisposing factors and treat them appropriately.

Whereas HER2 amplification is a well-known phenomenon in breast tumours, its frequency and clinical importance in ovarian cancer have not been established. The aim of the study was to compare the frequency of HER2 amplification in hereditary (BRCA-positive) and sporadic (BRCA-negative) ovarian tumours and to estimate the association of this gene alteration on clinical outcome in ovarian cancer patients. We analysed HER2 amplification in 53 ovarian tumours: 20 from mutation carriers (18 in BRCA1 and 2 in BRCA2 gene) and 33 from non-carriers. Fluorescence in situ hybridization for HER2 was performed on 'touch' slides from frozen tumour samples or formalin-fixed, paraffin-embedded tissue. Our results indicate that high amplification (HER2: centromere ratio>5) is an infrequent phenomenon in ovarian tumours (6/53 cases). It occurs in both hereditary (4/20) and sporadic (2/33) tumours and no difference in the frequency of HER2 amplification exists between these groups. There is no significant difference in the clinical outcome of patients with HER2 amplified and non-amplified tumours (p = 0.3). Our results suggest a different biological role of HER2 amplification in ovarian and breast cancer.

In our paper we described a rare case of heterotopic pregnancy after in vitro fertilization (IVF-ET). Heterotopic pregnancy (coexistence of intrauterine and ectopic pregnancy) appears in 1 per 30 thousand cases of natural pregnancies and in 1% of pregnancies after IVF. The pregnancy was obtained after ICSI and transfer of 2 embryos. The pregnancy was confirmed by HCG serum presence--13 days after ET. On day 39 after IVF procedure, the patient was admitted to the hospital because of abdominal pain. At admission, ultrasound examination confirmed an 8 week intrauterine pregnancy and enlarged polycystic ovaries. After 3-day-long observation, patient status worsened and laparoscopy procedure was performed. The ectopic pregnancy was confirmed during operation and the ovum was removed a long with fallopian tube. Ultrasound examination on the 6th day after operation confirmed single intrauterine viable fetus. in order to diagnose the possible complications, women undergoing IVF procedure should be carefully observed by IVF performing physicians.

The prognostic significance of DNA ploidy in ovarian cancer patients determined by flow cytometric analysis, in correlation with effectiveness of first line chemotherapy.DNA ploidy by FC was investigated in group of 102 ovarian cancer patients from fresh frozen samples (4 patients was excluded from the study).Positive answer for first line treatment we notified in 64(62,75%) cases, lack of answer 34 (37,25%) patients. Aneuploidy was more frequent in negative group 31(91,18%), diploid tumours occurred in 3(8.82%) cases. In positive group aneuploid tumours occurred in 29(45,31%) and diploid in 35(54,69%) patients (p0,001). Median survival in positive group--45 months, in negative group 12 months (p0,0001). In positive group median survival in patients with aneuploid tumours--31 months, in patients with diploid tumours median survival was not reached (p=0,0102). In negative group DNA ploidy has no impact on survival (p=0,1027)1. DNA ploidy determined by flow cytometry is prognostic factor in ovarian cancer patients who answered positively for first line treatment. 2. Aneuploid tumours appear much often then diploid in group of patient who did not answer for first line chemotherapy 3. Patients with diploid tumours have better prognosis. 4. Lack of positive answer for first line treatment is bad prognostic factor.

Young-age sexual activity, multiple sexual partners, number of pregnancies, smoking and human papilliomavirus (HPV) infections are factors commonly considered as promoters of cervical tumorogenesis. Cervical carcinoma patients' prognosis correlates significantly with staging (according to FIGO classification). In early stages lymph-node involvement is considered as the most important prognostic factor. Other factors are: initial volume of the lesion, lymphatic and blood vessels involvement, depth of cervical invasion. Also parametrium involvement seems to decrease the rate of 5-year survival. The aim of the research was to estimate correlation between HPV DNA lymph node presence and pathologic parameters of primary tumour in surgically treated cervical carcinoma patients. We analysed DNA isolated from lymph nodes sampled intra-operatively from 134 patients, surgically treated for cervical cancer with PCR. We confirmed the presence of HPV DNA sequences in lymph nodes in 81 (60.5%) cases. Lymph node presence of HPV DNA rate was significantly higher in: advanced tumours, cases with initial lesion volume exceeding 10 cm3, cases with uterus and vaginal involvement and with initial tumour invasion deeper than 10 mm.

The purpose of this study was to investigate the operative time, surgical complications and patient outcomes of the TOT surgery performed by an experienced surgeon compared to those performed by a senior resident under proper supervision by a senior surgeon.A prospective, open label, randomized study was conducted at the department of urogynecology of the Ministry of Health Ankara Etlik Maternity and Women's Health Teaching Research Hospital between June 2003-June 2004. The study included 60 women who had stress urinary incontinence. Patients were randomly allocated to either the TOT surgery performed by an experienced surgeon group (Group 1, n=30) or the TOT surgery performed by a senior resident under proper supervision by a senior surgeon group (Group 2, n=30). The operative time, intraoperative and postoperative complications, intraoperative blood loss and the effectivity of the TOT procedure were recorded by a senior surgeon who did not participate to the operation.The study was completed by 55 women. Baseline characteristics were comparable between the two groups. The mean operative time was significantly long in Group 2 compared with Group 1 (27 min [15-48]; 13 min [7-22], respectively). There was no difference between the Groups 1 and 2 in terms of the intraoperative and postoperative complications. No bladder injury was noted in Group 1. One bladder injury was observed in Group 2 and the bladder was repaired in the usual form by the assisting senior surgeon. Urinary retention was observed in two patients in Group 2 and the tapes were cut 7 days after the operation. Both of the patients have been dry since the intervention. The mean follow up period was 30 months. After the follow up period, there were no statistically significant differences in terms of cure, partial recovery and failure between two groups.There is no difference in the outcome when TOT is performed by residents under proper supervision.

The aim of this study was to analyze clinical data such as diagnosis, surgical treatment and follow-up of patients with Krukenberg tumor (KT). We also reviewed literature of the subject.We retrospectively analyzes medical data of 34 patients who were operated in Gynecology Clinic of Medical University of Gdansk in years 1999-2003. The definition of KT was that of Krukenberg's.The mean age of patients was 52, 23 of them were postmenopausal. Fourteen patients were diagnosed with malignant disease before surgery for ovarian tumor--11 were treated for breast cancer, 2 underwent resection of the stomach and one had rectosigmoidectomy. Before surgery a diagnosis for ovarian tumor such as ultrasonography, computer tomography and Ca125 were performed--in most cases sonography findings revealed mixed cystic and solid tumor of 320 cm in diameter; in 70% cases serum Ca125 was elevated with the highest result of 772 IU/ml. From among 20 patients who were suspected for primary ovarian cancer with no other malignant disease before surgery 9 had stomach cancer, 6 colon cancer, in 2 cases ovarian tumor was a metastasis from breast and in 1 from gall bladder; in 2 patients primary tumor was not found. The surgery performed in patients with KT was that of done for primary ovarian cancer. In 5 cased partial resection of colon was necessary. Surgical findings revealed ovarian tumor of 3-10 cm in diameter, solid and bilateral in most cases. The mean survival in our group was 4,7 months. The mean time between diagnosis of malignant disease and metastases to the ovary was 18 months. The best overall prognosis was for patients with breast cancer and the worst for cases with stomach cancer.There is a poor prognosis for patients with Krukenberg tumor. The diagnosis is late, in most cases during surgery for ovarian tumor. The most often site of primary malignancy was breast and stomach.

This is a report of two cases of haemorrhage after pelvic exenteration in patients with vulvar cancer and cervical cancer treated by temporary pelvic packing at the Department of Gynaecology of the Medical University in Gdańsk. The packing was successful and the sponges were removed after 24 and 48 hours. There were no major postoperative complications in both cases and one wound dehiscence. Both patients recovered after surgery. In cases with severe intraoperative haemorrhage, intraabdominal packing can be effective mode of treatment, especially in bleeding which originates from the sacral venous plexus.

Carcinoma of the Bartholin's gland is a rare lesion accounting for only 5% of all vulvar cancers. Initial diagnosis of Bartholin's gland cancer (BGC) and recurrence after primary radical surgery and adjuvant radiotherapy poses a challenge in the treatment of BGC. This case report presents a particularly aggressive course of BGC. Spontaneous rupture of the femoral artery in the postoperative period was observed. The length of the survival period from the moment of diagnosis amounted to less than 16 months. Aspects of initial diagnosis problem and treatment options in groin recurrence of vulvar carcinoma and vascular complications are discussed.

To analyze the major complications after exenteration of gynecological and rectal malignancies.Twenty-two patients with gynecological malignancy and 6 with rectal malignancy underwent pelvic exenteration (PE) between 1996 and 2005. PE was performed for primary malignancy in 71.4% of cases (vulvar cancer in 13, cancer rectal in 5, cervical cancer in 1 and Bartholin's gland cancer in 1 cases respectively and recurrent malignancy in 28.6% of cases (cervical cancer in 5, ovarian cancer in 1, uterine sarcoma in 1 and rectal cancer in 1 cases respectively). Posterior PE, total PE and anterior PE were most often performed.Major complications in the operative field involving the urinary tract infection or the wound dehiscence occurred in 12 patients (42.9%). Early complications included massive bleeding from the sacral plexus, adult respiratory distress syndrome (ARDS), thrombophlebitis, acute renal failure, urinary bladder dysfunction, ureter damage, re-operation and pulmonary embolus. Urinary incontinence was observed in 2 women as a late complication. In 1 patient a nephrostomy was performed in 1 patient due to extensive hydronephrosis and 1 patient had complications connected with the gastrointestinal tract. The mortality rate was 7%, of which inter-operative mortality accounted for 3.5%. Major complications often occurred in advanced primary vulvar cancer affecting those with recurrent malignancies.PE is more beneficial to patients with primary vulvar and rectal cancer than to those with recurrent cancer. Knowledge of the inherent complications and morbidity of PE is essential.

In vulvar cancer, in a large portion of patients with early stages of the disease, the inguinal lymphadenectomy not only does not influence the overall survival and recurrence rate but may increase the incidence of complications. Sentinel lymph node (SN) detection is a promising technique for detecting groin lymph nodes, which may in future lead to less extensive use of surgical treatment. The aim of the study was to evaluate the feasibility of the sentinel node detection technique in patients with vulvar cancer.Between the years 2003 and 2005, we performed intraoperative lymphatic mapping on 10 patients with planoepithelial vulvar cancer. In eight cases, vulvar lesion was localized centrally, around the clitoris. The extent of the surgery included radical vulvectomy with bilateral inguinal lymphadenectomy in nine cases and unilateral inguinal lymphadenectomy in one case. For the lymphatic mapping, we employed two detection methods: (99m)Tc-labelled radiocolloid (activity 35-70 MBq) and blue dye (3-5 ml). Both techniques were used in six cases (60%), blue dye only in three cases and radiocolloid only in one case.In each patient, we detected at least one sentinel lymph node. Sentinel nodes were localized in 14 of 19 operated groins (73.7%); a total of 25 SNs in all. The mean number of SNs for one groin was 1.78. Nodal metastases were found in four cases. In three cases, metastases were detected only in the SN. In one patient, two SNs with metastases were found in one groin and in the contralateral groin (without any SN) there was one unchanged node, which transpired to be metastatic. This can be explained by a complete overgrowth of neoplasm in the lymph node resulting in lymph flow stasis and disabling tracer uptake. In five cases, an SN was found only in one groin ó the first case is described above, in the second case the vulvar tumor was localized laterally, opposite to the groin without any SN. In the remaining three cases, we have used only one method of SN detection.Lymphatic mapping in vulvar cancer based on the combined detection technique is a highly accurate method after adequate training of the surgeons.

Risk of recurrences of borderline ovarian tumors is low (7-10%) but the cases with incidence of recurrence have worse prognosis. The time between primary operation and the first diagnosis of recurrence and treatment is different.The purpose of the current study was to evaluate frequency and the methods of treatment patients with recurrences of borderline ovarian tumors.The analyzing group consists of 129 patients with borderline tumors of the ovary (BTO) diagnosed and treated in Department of Gynecology between years 1978-2000.In our recurrences developed in 7% of patients. The recurrences in BTO were connected with stage of BTO, types of primary operations and residual disease. Recurrences developed in 5,9% patients with stage I and in 18,1% patients with stage II/III. Similarly recurrences developed in 5,8% patients with no residual disease and in 20% patient with residual disease. A higher relapse rate was observed in patients treated conservatively but recurrences was quickly recognized and efficaciously treated. 5 years survival of patients without recurrences was 91,7% and with recurrences was 72,9%.1. Risk of recurrences of BTO is low (7%) and depends on stage and residual disease. 2. Risk of recurrences is higher after primary conservative operation but long follow-up and regular gynecological examinations allows to early diagnosis and treatment of recurrences. 3. Prognosis of patients with recurrences of BTO is good. 5-years survival was 90,6% of group without and 72,9% of group with recurrences of BTO.

The pelvic exenteration is a method of treatment in cases of recurrence or locally advanced gynecological tumors without distance metastases. The total pelvic exenteration has been used as salvage therapy especially for advanced gynecological malignancy.The aim of study was to analyse the group of women who underwent pelvic exenteration.A series of 13 patients who underwent pelvic exenteration for advanced vulvar cancer at the Department of Gynecology, Medical University of Gdańsk Poland between 1996-2003 was retrospectively reviewed.The more often performed exenteration in patients with vulvar cancer was posterior pelvic exenteration in 11 cases, total pelvic exenteration in 2 cases. The mean age at diagnosis was 56 years. The estimated blood transfusion due to operation ranged from 300 ml to 3580 ml with a mean of 1200 ml. The operating time ranged from 4 hours to 7 hours 30 minutes with a mean of 6 hours and 5 minutes. Patients stayed in hospital from 14 to 54 days after operation with a mean 33 days. The overall complication rate after pelvic exenteration was 61.5% with 8 of the 13 patients. Three times it was infection, six times wound dehiscence, in 1 case it was: ARDS, thrombophlebitis, ureter damage. There was no late complication.Pelvic exenteration offers the last chance for some women with gynecological malignancy.

Authors described a serious, iatrogenic, vessel complications after hysterectomy for uterus sarcoma. After successful abdominal hysterectomy spontaneous rupture of right common iliac artery occurred causing massive exsanguination into intraperitoneal space. During secondary laparotomy procedure large, partial loss of arterial wall was recognized and provided with non-absorbable Prolene 4-0 suture. Subsequently, the injury was replaced by arterial artificial prosthesis gore-tec 8. Intraoperatively, ventricular fibrillation and cardiac arrest took place with subsequent acute respiratory and circulatory distress syndrome. Throughout next several days after reoperation patient was deep unconscious and hospitalized on Intensive Care Unit. She manifested symptoms of damaged extrapyramidal tracts. In spite of further unfavourable prognosis, after almost a month of respiratory therapy, she fully recovered without symptoms of brain damage and visual sequelae.

Radical hysterectomy has traditionally been the treatment of choice for early invasive cervical carcinoma. Validation of the sentinel lymph node concept in gynaecology has led to less radical surgery. If preservation of fertility is an issue, then radical trachelectomy is an accepted approach.A 29-year-old female presented with stage IB1 cervical cancer was treated by radical vaginal trachelectomy and pelvic lymphadenectomy as definitive treatment. Two obturator nodes visualised on lymphoscintigraphy and one parametrial not visualized on lymphoscintigraphy were "hot" and blue during surgery, and identified as sentinel nodes. All 18 nodes were non-metastatic.Preoperative lymphoscintigraphy is a useful tool in the preoperative localisation of sentinel lymph nodes, and should be undertaken in cases of early invasive cervical carcinoma where a radical trachelectomy is performed to preserve fertility.

The purpose of this study was to present twinning rates and to compare patients with multiple pregnancy delivered at Gynaecology and Obstetrics Department of Medical University of Gdansk in 1981-1990 and 1991-2000.A retrospective study of 523 twin births was performed. The analysis concerned: maternal age, place of living, education, parity, using of assisted reproductive techniques.The incidence of twin pregnancy was 1.0%. The percentage of twin deliveries in 1981-1990 was 0.84% and in 1991-2000: 1.28%. The number of twin pregnancies depending on maternal age in two periods was analysed. The statistically significant differences were observed in maternal age interval 21-25 years (32.4% in 1981-1990 versus 20.8% in 1991-2000, p=0.01) and in age interval20 years (3.5% in 1981-1990 versus 8.8% in 1991-2000, p=0.009). There were 3.2% patients with multiple pregnancy treated due to infertility in 1981-1990 and 7.4% in 1991-2000 (p=0.04).We observed the increase in twinning rates in our department. The mean age of patients with multiple pregnancy increased. We noticed the increase in number of iatrogenic multiple pregnancies.

The purpose of the research was to analyze the frequency and location of endometrial cancer recurrence in a group of women who underwent surgery due to neoplasm and frequency of relaparotomy because of the neoplasm recurrence.292 women underwent operation in Dept. of Gynecology at Medical University of Gdansk due to endometrial cancer in clinical stage IA-IV by FIGO 1988 in the years of 1981-1996. All materials were analyzed using Microsoft Excel 97. The information was gathered from the following sources: case histories Dept.of Gynecology and Dept. of Oncology and Radiotherapy Medical University of Gdansk, case histories from Dept.of Radiotherapy Marine Hospital in Gdynia-Redlowo and questionnaires sent to patients.The mentioned above group of 292 women underwent surgery. As far as 233 instances (79.8%) are concerned, only hysterectomy with bilateral oophorectomy was used, in 23 situations (7.9%)--also the lymph nodes biopsy was performed whereas in 10 cases (3.4%)--appendectomy and/or omentectomy. 24 women (8.2%) underwent Wertheim-Meigs operation and only 2 patients (0.7%)--with vaginal hysterectomy. 138 women were chosen to take part in the next stage of treatment. The regression of neoplasm illness was discovered among 13 patients (4.5%) with the apex of vagina being the most common place. The result comprised of 6 women--46.1% of all recurrences. All regressions happened 1-2 years after surgery. 5-year-survival for patients with regression was 23.1% which is 3 women. Relaparotomy due to neoplasm illness took part in 9 situations (3.1%). The danger of fatality grew up to 16 month after first surgical treatment; after this period of time the risk of dying went down.The recurrence of endometrial cancer can be observed among small group of patients (4.5%). When we concentrate the patients with regression of neoplasm disease, we can observe a high rate of fatality.