[Endometrial cancer: diagnostic validity of vaginal ultrasound screening].
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Gynaecological cancer screening was supplemented with examination of the vaginal microflora and pH in women suffering from vaginal discharge and/or colpitis. In alkaline samples Escherichia coli, Staphylococcus aureus and Candida albicans and, in cervical epithelial cells, herpes simplex virus antigen were of common occurrence, while in samples with acid reaction Trichomonas and, in cervical cells mainly from pregnant women, adenovirus antigen were often detected. Since vaginal pH may be informative of the pathogenic agent(s), its estimation by a rapid, simple and painless procedure, like litmus paper reaction, is recommended.
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Over a period of 5 years, among 108 ovarian carcinomas, malignant ovarian cells in the vaginal smears were found 8 times. No psammoma bodies were observed in any single case.
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The analysis of the data on 3225 irradiated patients with cervical cancer was performed to evaluate the probability of development of primary multiple tumors of the vagina. The actual risk of second tumor development within the mean period of survival of the treated patients (30 years) was 200 times higher than the expected risk of vaginal cancer in the general population. Local radiation injury and overdose proved the main factors of risk. Basic differences between these tumors, and primary vaginal malignancies and late metastases and relapses of cervical cancer are discussed. They were used as basis for the identification of a separate entity, namely radiation-induced cancer of the vagina. Patients irradiated for cervical cancer should be followed for their life-time.
The surgical pathology files at the University of Alabama Medical Center for 1958 through 1973 contain records of 157 cases of vaginal carcinoma. Of the 141 patients on whom complete records are available, 37 had primary and 104 secondary vaginal carcinoma. Only 3 of the primary vaginal malignancies were adenocarcinoma; the rest were epidermoid. The microscopic appearance of these carcinomas was frequently lateral spreading or papillary, but in a few instances the growth pattern was submucosal. Prognosis appeared to be related to the stage of the disease. Vaginal carcinomas associated with cervical cancer clustered either within 1 year or 5 years after the therapeutic treatment. In this paper, the relationship between primary vaginal cancer and cervical cancer is discussed.
With increasing lifespan and decreased incidence of uterine cervical cancer, the importance of the proper and early diagnosis of endometrial cancer has become a demand to gynecology. The objective of the present study is to evaluate the effectiveness of gynecologic diagnostic tools in detection of endometrial cancer in early stage. The patients (72) involved in the study, after giving their informed consent, were investigated by transvaginal ultrasound and subsequent vacuum endometrial sampling in office settings. Whenever the histology examination of endometrial vacuum sampling showed hyperplasia or carcinoma, it was reassured by sampling with dilatation and curettage. The analysis of sonography and histology results showed that in 4 cases (5.6%) endometrial hyperplasia and in two cases (2.8%) endometrial adenocarcinoma were present. Also analyzed were sensitivity, specificity, positive and negative predictive values for histology results and for sonographic findings. These results show that transvaginal ultrasound is a reliable method for screening for endometrial carcinoma. Moreover, in the case of pathologic endometrial change suspected by ultrasound, the combination of vacuum endometrial sampling with ultrasound examination can yield firm diagnosis in office settings, saving cost and time in early diagnosis of endometrial cancer.
OBJECTIVES: We wanted to examine reasons for the different incidence trends for cervical squamous cell carcinoma (SCC, declining) and adenocarcinoma (increasing). METHODS: The Swedish Family-Cancer Database on 9.6 million individuals was used to derive incidence trends between 1958 and 1996. Cervical cancers were compared to vaginal and vulvar cancers. RESULTS: A total of 15405 invasive cervical SCCs and 1920 adenocarcinomas were identified. The incidence of SCCs decreased and that of adenocarcinoma increased during the study period, with similar trends among the in situ forms. The incidence of in situ vaginal and vulvar SCC increase 22-fold, whereas, invasive SCC and adenocarcinoma remained unchanged. The age-incidence curves for adenocarcinoma resembled those for SCC before screening, suggesting similar clinical course. CONCLUSIONS: The data suggest that the increase in the incidence of adenocarcinoma is related to an increasing prevalence of human papilloma virus (HPV) infection in female genitals, perhaps in addition to other factors. The increase is not seen in SCC because of effective screening.
A 25-year-old parous woman was treated with radical hysterectomy for cancer of the cervix. Six months later she developed a vesico-vaginal fistula following coitus. The fistula was repaired and vaginal reconstruction performed. Sexual dysfunction and the need for vaginal reconstruction are discussed.
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