Guillermo di Paola

A possible new trend in the management of the carcinoma of the cervix uteri

Thirty-three patients with locally advanced carcinoma of the cervix were treated with chemotherapy as first line treatment. Great emphasis was applied to document, in the most objective manner, the tumor size response. The first 8 patients received a conventional scheme composed of vincristine, bleomycin and cis-platinum (VBP) at 21-day intervals. The results were not as satisfactory as expected. In the other 25 patients a more aggressive VBP scheme was used, at 10-day intervals. Surprisingly satisfactory results and tolerance were observed. In many instances verified tumor reduction allowed surgical radical treatment in prechemotherapy inoperable cases.

Lymph node metastases in carcinoma of the cervix uteri: Response to neoadjuvant chemotherapy and its impact on survival

One hundred and sixty-nine patients with squamous cancer of the cervix uteri treated with three courses of neoadjuvant chemotherapy with the modified VBP scheme are presented. All were subjected to a Wertheim-Meigs operation with paraaortic lymph-adenectomy. The incidence of lymph node metastases is analyzed according to clinical stage, tumor volume, residual tumor in the surgical specimen, and clinical response to neoadjuvant chemotherapy. A significant decrease in the incidence of lymph node involvement was observed in good responders. Survival rates, after 2 years of follow-up, improved in those cases with small residual tumor, negative parametria, and negative nodes.

Results of a Phase II trial with neoadjuvant chemotherapy in carcinoma of the cervix uteri

Results of a Phase II trial with neoadjuvant chemotherapy in carcinoma of the cervix uteri (VBP modified scheme) show that 85.7% of patients given this therapy were NED in Stage IIb versus 54% of a nonrandomized control group given conventional therapy. In Stage IIIb the averages are 66.6% vs. 31% in the control group. Analysis of the ecographic data has shown that if a critical prechemotherapy volume (120 cm3) is exceeded, the prognosis is unfavorable, especially in cases treated with radiotherapy as second-line treatment.

Vulvar infection caused by human papilloma virus in children and adolescents without sexual contact

Abstract We studied the indirect transmission of human papilloma virus (HPV) to young children and adolescents who were proven, by in-depth sexual history and gynecological examination, never to have had sexual intercourse. Two groups were identified: group A, daughters and sisters (age less than 18 years) of 31 adults with HPV genital lesions (n = 40); group B, 10 virginal girls and adolescents with HPV vulvar lesions and the adult household members were studied for the HPV infection (n = 26). Evaluations included PAP smear, colposcopy, vaginoscopy, and vulvoscopy in the adult female; peneoscopy and biopsy in males; vulvoscopy and cytologic studies (labia minora, vaginal washing) in all minors. A biopsy was obtained from all lesions. Vulvoscopic findings consistent with HPV were found in 75% of the group A girls. In 83% of those, the biopsy was positive. In group 2, 90% were found to live in a household with at least one positive adult (previously undetected). One or more of the following practices were discovered in the majority of cases: occasional bed sharing, and joint use of towels, bathing suits, underwear, and tub bath. Postdefecation hygiene was carried out in the family bidet. This supports the hypothesis that HPV can be nonsexually transmitted.

Vulvar carcinoma in situ: A report of 28 cases

Abstract Twentyeight cases of vulvar CIS are reported. The interest of a group of specialists in this pathology notably improves early detection. Biopsy was the basic diagnostic method. The CIS vulvar patients are generally younger than those suffering invasive cancer. The association with other genital or extragenital neoplasias is analyzed. Seven cases were asymptomatic. Unifocal lesions were more frequent than multifocal lesions. Individualized treatment is considered.

Is subradical surgical treatment for carcinoma of the cervix uteri stage IB logical

Twenty-eight patients with squamous carcinoma of the cervix FIGO stage Ib were treated with three courses of neoadjuvant chemotherapy with a VBP modified scheme. Clinical responses showed that the percentage of complete and moderate responses exceeds 95% of the cases. Clinical response was also related to tumor bulk measurement by ultrasound scanning. Twenty-three of the patients were then subjected to the Wertheim-Meigs operation. Pathological findings of surgical specimens showed absence of residual lesion in 6 patients (26.1%) and carcinoma smaller than 0.5 cm in 5 patients (21.7%). Tumor response to neoadjuvant chemotherapy was excellent in NG3, MG3 tumors when lymphoplasmomonocytic infiltration was present. In accord with this result a new protocol was developed.

Recurrent Vulvar Malignancies in an 11 -Year Prospectively Followed Vulvar Distrophy: A Gynecologist's Permanent Concern

This case reports on a vulvar lichen sclerosus, followed during 11 years, with poor response to many different local and general treatments. After 6 years of control the patient developed a mild atypia. Two years later, an invasive carcinoma was diagnosed and radically treated. Six months later, a local recurrence was excised. During the last year of control new biopsies of the neovulva showed, at different times, carcinoma in situ and severe atypia.

Association of human papillomavirus infection and vulvar intraepithelial neoplasia: A morphological and immunohistochemical study of 30 cases

Thirty cases of vulvar intraepithelial neoplasia (VIN) were analyzed in order to determine the frequency of association with human papillomavirus (HPV) infection, and the relationship between this association and patients age, extent of vulvar lesions, and coexistence with cervicovaginal neoplasia. The presence of condyloma or moderate to marked koilocytosis, now considered as morphological evidence of HPV infection, was observed in 66.6% of our cases. A search for HPV antigens, using the peroxidase-antiperoxidase (PAP) method, was performed in 13 selected cases, and positive staining was detected in 3 of them. The presence of HPV infection correlates with a mean age of 48.8 years, 50% of multicentricity of VIN and coexistence with cervical neoplasia in 30% of the cases, as opposed to a mean age of 55.5 years, 10% of multicentricity of VIN and absence of cervical neoplasia in patients without HPV infection. The demonstration of multiple foci of early stromal invasion in a 43-year-old woman, with multicentric VIN lesions associated with HPV infection, indicates that, even in the presence of such clinicopathological features, the risk of developing stromal invasion should be considered. Considerations are made in relation with the presence of HPV antigen in morphological normal epithelium adjacent to the lesion. Therapeutic implications were also investigated.

Laparoscopically Assisted Schauta Operation: Learning Experience at the Gynecologic Oncology Unit, Buenos Aires University Hospital

OBJECTIVES The aim of this study was to show the learning experience of the employment of laparoscopic lymphadenectomy followed by a Schauta operation to treat patients with cervical carcinoma at a university hospital and to evaluate the feasibility, complications, hospital stay, delay in return to work, and overall survival of this procedure. METHODS Between June 1, 1993, and December 30, 1997, 56 patients were selected. Surgical treatment began with a pelvic laparoscopic lymphadenectomy followed by a Schauta operation. Patients were staged according to FIGO criteria (Ia2, 10 cases; Ib1, 33 patients; Ib2, 8 cases; IIa, 3 cases; and IIb, 2 patients). Patients had a follow-up of 47 months. Overall survival was calculated with Kaplan-Meier tables. RESULTS The procedure was not completed in 9 pts, in 5 cases among the first 20 pts that were entered on the trial due to technical problems and in 4 due to extracervical spread of disease (2 with gross laparoscopically unresectable lymph node metastases, 1 with parametrial infiltration, and 1 with rectovaginal septum involvement). In the 47 pts in which the procedure could be completed, the laparoscopic approach was done in 102 min and the vaginal part in 165 min. There were 4 complications: 1 ureteral injury, 1 abscess of the ischiorectal fossa, 1 hematoma of the Schuchardt incision, and 1 case of leg edema. The mean number of resected nodes was 17. Among the 47 cases in which the surgical procedure was completed, overall survival was 100% for Stage Ia, 88% for Ib1, and 85% for Ib2 after a mean follow-up of 4 years. Four pts have relapsed and died; 3 were stage Ib1 and the other was stage Ib2. They had pelvic recurrences. CONCLUSIONS This surgery is secure and has an excellent outcome, so it can be considered a valid approach for the treatment of patients with cervical carcinoma, but in our hands, 20 cases were needed to obtain the minimum skill needed to perform it.

Epithelial ovarian cancer: Do all metastases present similar chemosensitivity?

Three cases of advanced epithelial ovarian carcinoma Stage III-IV which could not be submitted to classical surgical and oncological treatment (BSO-TH) are presented. After a year of chemotherapy a complete remission was observed. Myometrial and myocervical micrometastases were found in a specimen from the hysterectomy, carried out during second-look, that was negative. These micrometastases, when they are present, apparently show a different chemosensitivity, as compared with other metastasis localization. The causes of this phenomenon are analyzed.