274
Communications
in brief
one may expect to see more cases of tuba-ovarian abscesses due to saprophytic organisms. REFERENCES
El-Bagoury. S. M., and Fakhr. M. M.: J. Egypt. Pub. Health Assoc. 46: 114, 1971. 2. Corfman, P. A., and Sheldon. J, S.: AM. J. OBSTET. 1.
GYNECOL.
100: 448,
1968.
Microinvasive squamous-cell carcinoma of the vulva KIANOOSH EDWARD
N.
JAFARI, M.D. CARTNICK,
M.D
Department of Obstetrics and Cynecobg, Mercy Hospital. Rockville Center. New York, and Nassau County Medical Center, East Meadow, Neur York, and the Health Sciences Center, State University of New York at Stony Brook, New York
THERE ARE many articles on the treatment Of’ in SitU and invasive squamous-cell carcinoma of the vulva. Radical vulvectomy and bilateral inguinal lymphadenectomy with or without pelvic nodes dissection is generally accepted treatment for invasive carcinoma of the vulva. Many methods of treatment for in situ squamous-cell carcinoma of the vulva have been used. They range from topical application of 5-fluorouracil or local excision of the lesion to radical vulvectomy, but literature is lacking so far in reports on microinvasive carcinoma of the vulva. Whether this is due to the fact that microinvasive carcinoma of the vulva is a relatively rare finding or it is considered as a frank invasive carcinoma is not clear. Wharton and associates’ reported 25 cases of microinvasive squamous-cell carcinoma of the vulva (invasion of stroma to a depth of 5 mm. or less) treated at the University of Texas M. D. Anderson Hospital between 1944 and 1969. Ten patients in their series had lymphadenectomies. None of the nodes was positive. They believed that the result of their study justified further investigation regarding the treatment of the patients with microinvasive vulvar carcinoma by conservative surgery. We used to consider radical vulvectomy (without node dissection) as an adequate therapy for microinvasive squamous-cell carcinoma of the vulva until we found positive inguinal and pelvic nodes 19 months after vulvectomy in the following case. A SO-year-old, white woman. gravida 4, para 2, was admitted to Mercy Hospital in October, 197 1, with a history of itching of the vulva of 2 years’ duration. She had had a hysterectomy
2 years
prior
to her
present
Reprint requests: Dr. K. Jafari, Department and Gynecology, Cook County St.. Chicago, Illinois 60612.
Hospital,
admission
Nakao and his colleagues’ reported a patient with a well-differentiated microinvasive squamous-cell c’arcinema of the vulva (invasion of stroma to the depth of’ 3 mm.) treated by radical vulvectomy without node dissection in whom contralateral inguinal node metastasis was noted in 7 months and who died 12 months after vulvectomy. Since we have experienced the outcome of therap! in our patient, wc no longer consider vulvectomy 3s an adequate therapy for microinvasive carcinoma of the vulva. At the present time we treat such a lesion as a frank invasive carcinoma. REFERENCES
1. Wharton.
J.
‘I‘.. Gallager, S.. and Rutledge, F. K.: carcinoma of the vulva, AM. J, OBSTET. GYNECOL. 118: 159, 1974. 2. Nakao, C. Y.. Nolan, J. F., DiSaia, P. J., et al.: “Microinvasive” epidermoid carcinoma of the vulva with an unexpected natural history, AM. J. OBSTET. GYNECOL. 120: 1122, 1974. Microinvasive
Rectovaginal endometriosis: An isolated enigma CHARLES ROBERT
M. ISRAEL,
MARCH,
M.D
M.D.
Section of Reproductive B&o@, Dcpartnunt oj Obstetrics Gynecology, Women’s Ho&al, University of Southern California School of Medirine, Los Angeles, California ENDOMETRIOSIS,
been reported
for
of Obstetrics
1825 West Harrison
uterine prolapse. Physical examination revealed thickened white epithelium in several areas of the labia minora and majora. Multiple biopsies were performed and the result> were reported as “in situ squamous-cell carcinoma with earl) invasion.” The patient underwent radical vulvectomy (without node dissection). Pathologic examination of the surgical specimen revealed squamous-cell carcinoma with microinvasion, less than 1 mm. depth. In May, 1973, enlarged inguinal nodes were noted, which were biopsied and reported as due to metastatic squamouscell carcinoma. She underwent inguinal and pelvic node dissection. Because of positive obturator and iliac nodes. external radiation to the pelvis and inguinal area was started. Five months later, as persistent disease was evident, a course of chemotherapy consisting of Bleomycin. Cytoxan. and Oncovin was administered. In October, 1973, she returned to the hospital with hemorrhage from the femoral artery which was due to the tumor invasion. Ligation of the femoral artery and suhsequently amputation of the right leg was performed. She died within a month from pelvic recurrence.
sor, rics ern Los
and
a disease of uncertain origin, has with increasing frequency over the past
Reprint requests: Dr. Charles M. March, Assistant ProfesShction ol Reproductive Biology, Department of Obstetand Gynecology, Women’s Hospital/University of SouthCalifornia School of Medicine, 1240 North Mission Road, Angeles, California 90033.
Communications
in brief
one may expect to see more cases of tuba-ovarian abscesses due to saprophytic organisms. REFERENCES
El-Bagoury. S. M., and Fakhr. M. M.: J. Egypt. Pub. Health Assoc. 46: 114, 1971. 2. Corfman, P. A., and Sheldon. J, S.: AM. J. OBSTET. 1.
GYNECOL.
100: 448,
1968.
Microinvasive squamous-cell carcinoma of the vulva KIANOOSH EDWARD
N.
JAFARI, M.D. CARTNICK,
M.D
Department of Obstetrics and Cynecobg, Mercy Hospital. Rockville Center. New York, and Nassau County Medical Center, East Meadow, Neur York, and the Health Sciences Center, State University of New York at Stony Brook, New York
THERE ARE many articles on the treatment Of’ in SitU and invasive squamous-cell carcinoma of the vulva. Radical vulvectomy and bilateral inguinal lymphadenectomy with or without pelvic nodes dissection is generally accepted treatment for invasive carcinoma of the vulva. Many methods of treatment for in situ squamous-cell carcinoma of the vulva have been used. They range from topical application of 5-fluorouracil or local excision of the lesion to radical vulvectomy, but literature is lacking so far in reports on microinvasive carcinoma of the vulva. Whether this is due to the fact that microinvasive carcinoma of the vulva is a relatively rare finding or it is considered as a frank invasive carcinoma is not clear. Wharton and associates’ reported 25 cases of microinvasive squamous-cell carcinoma of the vulva (invasion of stroma to a depth of 5 mm. or less) treated at the University of Texas M. D. Anderson Hospital between 1944 and 1969. Ten patients in their series had lymphadenectomies. None of the nodes was positive. They believed that the result of their study justified further investigation regarding the treatment of the patients with microinvasive vulvar carcinoma by conservative surgery. We used to consider radical vulvectomy (without node dissection) as an adequate therapy for microinvasive squamous-cell carcinoma of the vulva until we found positive inguinal and pelvic nodes 19 months after vulvectomy in the following case. A SO-year-old, white woman. gravida 4, para 2, was admitted to Mercy Hospital in October, 197 1, with a history of itching of the vulva of 2 years’ duration. She had had a hysterectomy
2 years
prior
to her
present
Reprint requests: Dr. K. Jafari, Department and Gynecology, Cook County St.. Chicago, Illinois 60612.
Hospital,
admission
Nakao and his colleagues’ reported a patient with a well-differentiated microinvasive squamous-cell c’arcinema of the vulva (invasion of stroma to the depth of’ 3 mm.) treated by radical vulvectomy without node dissection in whom contralateral inguinal node metastasis was noted in 7 months and who died 12 months after vulvectomy. Since we have experienced the outcome of therap! in our patient, wc no longer consider vulvectomy 3s an adequate therapy for microinvasive carcinoma of the vulva. At the present time we treat such a lesion as a frank invasive carcinoma. REFERENCES
1. Wharton.
J.
‘I‘.. Gallager, S.. and Rutledge, F. K.: carcinoma of the vulva, AM. J, OBSTET. GYNECOL. 118: 159, 1974. 2. Nakao, C. Y.. Nolan, J. F., DiSaia, P. J., et al.: “Microinvasive” epidermoid carcinoma of the vulva with an unexpected natural history, AM. J. OBSTET. GYNECOL. 120: 1122, 1974. Microinvasive
Rectovaginal endometriosis: An isolated enigma CHARLES ROBERT
M. ISRAEL,
MARCH,
M.D
M.D.
Section of Reproductive B&o@, Dcpartnunt oj Obstetrics Gynecology, Women’s Ho&al, University of Southern California School of Medirine, Los Angeles, California ENDOMETRIOSIS,
been reported
for
of Obstetrics
1825 West Harrison
uterine prolapse. Physical examination revealed thickened white epithelium in several areas of the labia minora and majora. Multiple biopsies were performed and the result> were reported as “in situ squamous-cell carcinoma with earl) invasion.” The patient underwent radical vulvectomy (without node dissection). Pathologic examination of the surgical specimen revealed squamous-cell carcinoma with microinvasion, less than 1 mm. depth. In May, 1973, enlarged inguinal nodes were noted, which were biopsied and reported as due to metastatic squamouscell carcinoma. She underwent inguinal and pelvic node dissection. Because of positive obturator and iliac nodes. external radiation to the pelvis and inguinal area was started. Five months later, as persistent disease was evident, a course of chemotherapy consisting of Bleomycin. Cytoxan. and Oncovin was administered. In October, 1973, she returned to the hospital with hemorrhage from the femoral artery which was due to the tumor invasion. Ligation of the femoral artery and suhsequently amputation of the right leg was performed. She died within a month from pelvic recurrence.
sor, rics ern Los
and
a disease of uncertain origin, has with increasing frequency over the past
Reprint requests: Dr. Charles M. March, Assistant ProfesShction ol Reproductive Biology, Department of Obstetand Gynecology, Women’s Hospital/University of SouthCalifornia School of Medicine, 1240 North Mission Road, Angeles, California 90033.
