J. E. Johnsson

Age and prognosis in stage Ib squamous cell carcinoma of the uterine cervix

Two materials consisting of patients with early invasive squamous cell carcinoma of the uterine cervix have been studied in regard to the influence of age and treatment technique on prognosis. In the first material, consisting of 254 Stage Ib patients treated only with radiation therapy, a poorer prognosis was found in the women under 35 years of age. The second material consisted of 274 Stage Ib patients who had been preoperatively irradiated and had undergone radical hysterectomy. The prognosis was (not significantly) better for those patients under 35 years of age in this group. The rate of central recurrence was higher among the younger patients who received only radiation therapy. Analysis of histologic grading and cell type according to J. W. Reagan and S. F. Yao (Int. J. Radiat. Oncol. Biol. Phys. 5, 1015-1020 (1979) ) revealed no explanation for the poorer prognosis among younger women treated solely with radiation therapy.

Bleomycin‐mitomycin C in advanced carcinoma of the cervix: A third look

Thirty‐three patients with advanced cervical cancer (31 squamous cancer, two adenosquamous cancer) previously untreated with cytotoxic drugs, were treated with bleomycin, 5 mg daily, for seven days and mitomycin C, 10 mg, on day 8. This regimen was repeated four times at two‐week intervals. All but one patient had previously been treated with radiotherapy; 36% of the patients had an objective response (five complete remission (CR), median duration 12 months; seven partial remission (PR), median duration six months). Severe myelosuppression occurred in nine patients. One drug‐related death due to thrombocytopenia occurred. Three patients developed pulmonary fibrosis and one of them died of respiratory failure. The bleomycin‐mitomycin C regimen has a definite but clearly limited effect in advanced cancer of the uterine cervix.

Prognosis of adenocarcinoma of the uterine cervix.

Abstract In a material of 42 patients with adenocarcinoma of the uterine cervix, Stages I and II, large tumor extension was recorded in 7 out of 8 patients in Stage IIA and in 5 out of 13 patients in Stage IB, all of whom had been given preoperative radiotherapy. Four patients out of 7 primarily given conization or hysterectomy for supposed preinvasive cancer had tumors growing deeply within the cervical stroma. The unexpected large tumor extension probably explains the less favorable prognosis for patients with cervical adenocarcinoma. The 2- and 5-year tumor death rates were approximately 21% and 1023, respectively. A combined radiotherapeutical and surgical approach is presented.

Radiation therapy and surgery in the treatment of regional lymph nodes in squamous cell carcinoma of the vulva

A series of 244 patients with vulvar squamous cell carcinomas was analyzed with regard to treatment of the regional lymph nodes. In 144 patients, groin dissection was performed, supplemented in 24 cases by pelvic lymphadenectomy. Preoperative irradiation was given and in cases with positive nodes postoperative irradiation as well. Patients in whom lymph node dissection was not performed received irradiation. Treatment failures in the regional lymph node regions were analyzed and the policy concerning treatment of the regional lymph nodes is discussed.

Basal cell carcinoma of the vulva

Abstract. A clinical and histopathologic study of material from a series of 21 patients with basal cell carcinoma treated from 1960 until 1979 are reviewed. In 3 patients ‘mixed’ tumor was recorded. The histopathologic diagnosis: baso‐squamous carcinoma and the behavior of this carcinoma are discussed. The mean age of the patients was 76 years. Presenting symptomatology consisted primarily of bleeding, burning or itching, and ulcerations. No case of pure basal cell carcinoma gave metastasis to the regional lymph nodes, in no case could the cause of death be attributed directly to this kind of lesion. A conservative approach consisting of wide local excision is suggested.

Giant Condyloma Acuminatum with Focal Malignant Degeneration

Buschke, in 1896, (3) described two cases of giant condy~oma acuminatum occurring on the penile shaft. In 1925 a similar tumor of the penile shaft was described by the same author and Loewenstein (4). The tumor was described as a generally slow growing, locally invasive, verrucose tumor which commonly involves the male external genitalia, oral cavity and, rarely, the female genitalia. Condyloma acuminatum is generally considered to be a benign epithelial hyperplasia, although some authors have incriminated it as a premalignant lesion (6, 9). Condyloma acuminatum is auto-inoculable and transmissible and has been shown to be caused by a filterable virus, which is apparently identical with or related to the virus that causes the common wart, verruca vulgaris (8). Dawson et QI. suggested the possibility of malignant change in a case of giant condyloma acuminatum ( 5 ) . This is strongly supported by well-known experiments with virus-induced tumors in rabbits (10, 16). Ackerman (1) was the first to use the term verrucous carcinoma. The lesions he found were located in the mouth and pharynx. Kraus & Perez-Mesa (12) reported the first case involving the female genitalia. Vulvo-vaginal lesions are rather rare, however. Partridge et d. (14) have reviewed the literature and 36 cases of verrucous carcinoma have so far been reported. We report here another case of giant condyloma acuminatum, in the vulvar region with malignant degeneration and discuss aspects of treatment. ed small tumors in the vulvar region but was afraid to mention them to anyone. Physical examination revealed a grotesque tumor in the vulva and the left peri-anal region. The vulvar tumor mass consisted of two separate parts measuring 6 x 8 x 9 cm and 6 x 10 x 13 cm respectively. The anal tumor was 3 x 5 x 6 cm (Fig 1). The urethra and the vagina were unaffected. Macroscopally there was no suspi-

Radical vulvectomy with warm-knife and open-wound techniques in vulvar malignancies

Radical vulvectomy using warm-knife and open-wound techniques was performed as the first step in a two-phase surgical approach in 274 patients with malignant vulvar tumors. Crude 5-year survival was registered in 133/223 (60%) patients. The complication rate was low and the hospitalization period was short (mean 16 days).

Stage I squamous cell carcinoma of the vulva

Eighty-six patients with invasive squamous cell carcinoma of the vulva stage I were followed for 2 to 20 years after surgical treatment varying from local excision to radical vulvectomy with inguinal lymph node dissection. The results are presented and the prognosis discussed in relation to the radicality of the surgical intervention, the degree of tumour differentiation, the morphologic properties of tumour cell population, and the tumour host relationship. The most important prognostic factor seemed to be the radicality of the surgical intervention. To reduce patient morbidity in radical surgery while still achieving a comparable survival rate an operative approach with less than radical vulvectomy, inguinal dissections or pelvic lymphadenectomy, or both, is proposed for selected patients.

RECURRENCES AND METASTASES IN CARCINOMA OF THE UTERINE BODY CORRELATED TO THE SIZE AND LOCALIZATION OF THE PRIMARY TUMOR

Abstract. Hysterography was used for judging the size and location of the primary tumor in 475 patients with stage I carcinoma of the uterine body. No increased frequency of recurrence and metastases was noted in patients where the tumor involved the uterine cervix. Large tumors, however, were accompanied by an increased frequency of recurrences, metastases in the pelvic nodes and remote metastases.

Carcinoma of the ovary in stage III. Effects of postoperative chemotherapy, radiation therapy and repeat laparotomy

A prospective randomized trial was carried out in 153 patients with stage III malignant epithelial tumours for comparing the effects of irradiation or combination of chemotherapy and irradiation on prognosis and operability. No significant differences between these two treatment modalities were found. Of the patients primarily considered inoperable were 41 per cent operated upon after preoperative treatment. Minimum residual disease (0 to less than or equal to 2 cm) occurred in 38 per cent of the primarily operated and in 31 per cent of those operated upon after preoperative treatment. Preoperative irradiation in primarily inoperable patients enabled more effective surgical measures at relaparotomy. The size of the residual tumour after surgery and the tumor grade influenced the survival.