Primary carcinoma of fallopian tube--a case study

Primary carcinoma of fallopian tube is a rare entity. We report an interesting case of primary carcinoma of fallopian tube with contralateral lymph node involvement. The clinicopathological findings and its management is presented.     

Retrospective audit of standards and quality in colposcopy services in a district hospital.

A retrospective audit to compare the performance of a colposcopy clinic with the standards set by National Health Service Cervical Screening Programme (NHSCSP) was carried out at Caerphilly District Miners Hospital, South Wales, United Kingdom. The study sample size consisted of 150 women who underwent colposcopy and diathermy large loop excision of the transformation zone (LLETZ) for abnormal cytology during January l995 to January 1998. The results showed deficiencies in the areas of communication for clinic appointments for women with high-grade cytology and in information given to general practitioners about test results. The services fell short of the standards in recording of colposcopy findings and grading of lesions. The rest of the parameters audited reached the NHSCSP standards. Recommendations to improve communication and to increase the objectivity of recording colposcopy findings were made. A more practical approach to set standards in areas of communication was suggested.     

Human Papillomavirus genotype testing combined with cytology as a ‘test of cure’ post treatment: The importance of a persistent viral infection

Background

Human Papillomavirus (HPV) testing has been evaluated as a test of cure in patients following treatment of high-grade cervical intraepithelial neoplasia (CIN2+). Studies show that women who are HPV and cytology negative post treatment can be safely returned to routine recall. The management strategy for HPV positive women requires confirmation.

Objective

To evaluate the clinical utility of the PapilloCheck^® genotyping assay for predicting disease recurrence in a test of cure setting.

Study design

Ninety-eight women (19–52 years) treated for CIN2+ by large loop excision of the transformation zone (LLETZ) were evaluated with samples taken before and 6 months after treatment for HPV testing. Cytology and histology were available from recruitment until 24 months post treatment.

Results

Recurrent disease was evident in 4% of patients with 2 cases low-grade and 2 cases of high-grade disease. In women with no disease recurrence, 40% (95% CI 30.42–51.05%) were high risk (HR) HPV negative post LLETZ. Both cases with high-grade disease had persistent HPV16 infection. Genotyping before and after treatment revealed 83% (95% CI 75.74–88.78%) of total viral infections were cleared and 17% (95% CI 11.22–24.26) viral infections persisted. Post treatment, combined cytology and HPV test results predicted CIN2+ with 100% sensitivity, 91.7% specificity, 100% NPV and 20% PPV and measuring viral persistence marginally increased specificity and PPV.

Conclusion

Post treatment, cytology combined with a single HR HPV test has high sensitivity and specificity for predicting disease recurrence. HPV genotyping before and after LLETZ identifies persistent viral infections and could help refine patient management.     

Napsin A and WT 1 are useful immunohistochemical markers for differentiating clear cell carcinoma ovary from high‐grade serous carcinoma

Clear cell carcinoma (CCC) of the ovary is an uncommon, but an aggressive epithelial ovarian cancer (EOC), which has overlapping histopathologic features with other ovarian tumours. Lately, Napsin A has been identified as its useful diagnostic immunohistochemical (IHC) marker. Fifty‐eight prospectively diagnosed ovarian CCCs, 53 high‐grade serous carcinomas (HGSCs), 16 endometrioid adenocarcinomas (EMACs), six mixed carcinomas, containing components of CCC and EMAC, seven metastatic mucinous adenocarcinomas and six ovarian yolk sac tumours (YSTs) were tested for Napsin A immunostaining. Fifty ovarian CCCs, 50 HGSCs, seven ovarian EMACs and five mixed carcinomas were tested for WT1 immunostaining. Napsin A was positively expressed in all 58 (100%) CCCs; was focally positive in 1 of 6 YSTs; in 1/16 EMACs and in six cases of mixed carcinomas, while it was negative in all 53 HGSCs and in seven metastatic mucinous adenocarcinomas. Other IHC markers expressed in cases of CCC ovary were CK7 (31/31) (100%), WT1 (0/50), p53 (20/26, ‘wild type’), ER (4/31, focal) (12.9%), PAX8 (14/14) (100%), glypican‐3 (4/10, focal) (44.4%), p16INK4 (5/5, focal) and CK20 (0/5). Various IHC markers expressed in HGSCs were WT1 (48/50) (96%), p53 (31/31, mostly ‘mutation type’), CK7 (9/9) (100%) ER (13/16, variable) (81.2%) and PAX8 (14/14) (100%). IHC markers expressed in EMACs were ER (15/16) (93.7%), CK7 (2/2) (100%) and WT1 (0/7). IHC markers expressed in mixed carcinomas were CK7 (2/2) (100%), WT1 (0/2), focal Napsin A (6/6) and focal ER (5/6). The sensitivity and specificity of Napsin A for the diagnosis of CCC ovary was 100% and 90.9%, respectively. The sensitivity and specificity of WT1 for diagnosis of HGSC ovary was found to be 96% and 100%, respectively. Napsin A and WT1 are highly sensitive and specific IHC markers for diagnosing ovarian CCCs and HGSCs, respectively, and in differentiating these tumours from their mimics. Napsin A is useful in identification of component of CCC in certain EMACs.     

Contribution of demographic, psychological and disease-related factors to quality of life in women with high-grade vulval intraepithelial neoplasia

Women with VIN experience significant psychological morbidity. Psychological factors and to some extent demographic factors were much stronger determinants of QoL in women with VIN compared to clinical factors. Multidisciplinary management of these women should therefore be considered in order to take into account the psychological co-morbidity. Accurate written information should be provided about the risk of developing invasive disease.Further research is needed to establish a VIN-specific instrument to measure quality of life, the benefit of multidisciplinary input and the true impact of VIN on partners.

Conflict of interest statement

The authors declare that they have no conflicts of interest to disclose.     

Omentopexy for reconstruction of the perineum following a radical vulvectomy: a case report

Colorectal surgeons have used omentum based on the left gastric epiploic vessels after any major operation in the pelvis(1). Omental flaps reach very well into the pelvis by the retrocolic route and have been used in the past for better and quicker healing of perineal defects following abdominoperineal resections(2,3). Omentum has excellent healing properties, which can be, used even as free flaps(4).