Eugene H. Ruffolo

A comparative study of radical vulvectomy and modified radical vulvectomy for the treatment of invasive squamous cell carcinoma of the vulva

Forty-five patients who underwent a modified radical vulvectomy for invasive squamous cell carcinoma of the vulva were compared with forty-five patients who underwent radical vulvectomy for similar lesions. Vulvar wound infection and breakdown were infrequent in both groups. Anal incontinence developed postoperatively in five of the modified radical vulvectomy patients and in none of the radical vulvectomy patients. Urinary incontinence developed postoperatively in two of the modified radical vulvectomy patients and in seven of the radical vulvectomy patients. Possible reasons for these differences are discussed. One invasive local recurrence (2.2%) developed in the modified radical vulvectomy group and two (4.4%) local recurrences developed in the radical vulvectomy group. A modified radical vulvectomy appears to be efficacious for the vulvar phase of treatment of localized invasive squamous cell carcinoma of the vulva.

Ovarian pregnancy associated with intrauterine contraceptive devices

Four cases of ovarian pregnancy, occurring over a two-year period in the same hospital, are presented. Each case fulfills Spiegelbergs criteria. Each patient conceived with Cu-7 intrauterine contraceptive device (IUD) in situ. Review of the literature reveals an apparent increase in the frequency of ovarian pregnancy associated with IUDs. This aspect of the problem, as well as the management of this unusual type of ectopic pregnancy, is discussed. The data available do not justify a conclusion that ovarian pregnancies are caused by IUDs. Unless future studies demonstrate a cause-and-effect relationship, this may be merely an interesting coincidence. However, it seems that more than just coincidence is involved, even though the mechanism is unclear.

Basal cell carcinoma of the vulva with inguinal lymph node metastases

Basal cell carcinoma of the vulva is a rare neoplasm which is generally thought to be indolent, locally invasive, and nonmetastasizing. A case of basal cell carcinoma of the vulva with metastases to the ipsilateral inguinal lymph nodes is presented. This is the third well-documented case in the literature of vulvar basal cell carcinoma with inguinal lymph node metastases.

Endodermal sinus tumor: report of a case associated with pregnancy.

&NA; The case of a 15‐year‐old black primigravida with an 18week intrauterine gestation and concurrent endodermal sinus tumor is presented. Rationale for therapy is discussed.

Experience with the EndoPap device for the cytologic detection of uterine cancer and its precursors: a comparison of the EndoPap with fractional curettage or hysterectomy.

Cytologic assessment of the endometrium with the EndoPap sampler was compared with curettage or hysterectomy in 249 women with symptoms. The sensitivities for the detection of primary corpus cancer and hyperplasia were 0.90 (59/66) and 0.58 (18/31), respectively. All six cases of atypical endometrial hyperplasia were detected by the EndoPap device. Malignant EndoPap cytologic findings were present in 4 of 10 patients with a primary adnexal malignancy and normal endometrial histologic findings. Ninety-two percent of primary uterine cervical cancers were detected by EndoPap cytologic sampling. The specificity for the cytologic diagnosis of benign conditions was 0.93. EndoPap cytologic sampling has a reasonably high sensitivity for the detection of uterine cancers and preinvasive endometrial lesions with a high risk of progression to carcinoma. Further evaluation as to its usefulness in a screening program for uterine and adnexal cancers in postmenopausal women should be considered.

Adenocarcinoma of the endometrium and endometrioid carcinoma of the ovary associated with pregnancy

Nine well-accepted cases of endometrial carcinoma associated with pregnancy have been reported. A 10th patient is added and the cases are briefly summarized. At the time of her definitive surgery 6 weeks postpartum, our patient was also found to have a Stage I endometrioid ovarian carcinoma. Nine of the 10 cases have been well-differentiated adenocarcinoma or adenoacanthoma and the lesions have tended to be focal with minimal or no invasion. Given the small number of patients, conclusions regarding prognosis and treatment are difficult to make. However, in younger patients with noninvasive adenocarcinoma of the endometrium, the adnexa may be spared. Endometrioid adenocarcinoma of the ovary, discovered incidentally in our patient, is associated with a concomitant adenocarcinoma of the endometrium in 5-29% of cases, but the present case in which the lesions coexisted with pregnancy appears to be the first such report in the literature.

The value of needle biopsy in the diagnosis of gynecologic cancer

Abstract Needle biopsy was performed in 65 patients to establish the diagnosis of a gynecologic malignancy. In 50 patients, the method was used to aid either in the primary diagnosis or to rule out pelvic recurrence of a carcinoma of the cervix. An accurate diagnosis was made in 48 out of the 50 patients (96%), when often the Papanicolaou smears and surface punch biospies were negative. It is advised that when biopsying pelvic masses, this technique should be used for central and parametrial lesions, rather than those intimate with the lateral pelvic walls. Other sites, such as distal lymph nodes or liver metastases, are also suitable for biopsy by this method. It is concluded that the use of the Tru-cut biopsy needle with the modified technique described is a useful addition to the gynecologic oncologists armamentarium, especially for the detection of pelvic recurrent tumor.