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The aim of this study was to evaluate the possibility of identifying the sentinel lymph node and involvement of neoplastic cells in patients with endometrial carcinoma limited to the uterus, and also its correlation with the conditions of other pelvic and para-aortic lymph nodes. Forty patients with endometrial carcinoma, clinical staging I and II, were submitted to complete surgical staging through laparotomy, as recommended by FIGO in 1988. The sentinel node was investigated using patent blue dye in the myometrial subserosa. The sentinel node was excised and submitted to frozen section examination of specimen, stained with hematoxylin and eosin (H&E). Afterward, selective bilateral para-aortic and pelvic lymphadenectomy, total hysterectomy with bilateral salpingo-oophorectomy were performed. The lymph nodes excised were examined by means of paraffin-embedded slices stained with H&E and of imunohistochemistry with antikeratin antibody AE1/AE3. The sentinel lymph node was identified in 77.5% of patients (31/40), and 16.1% (5/31) presented neoplastic involvement in the node. In 25 cases of negative sentinel node, 96% (24/25) had no neoplastic involvement, and 4% (1/25) had other lymph node affected (false negative). In nine cases with no sentinel node identified, 55.5% (5/9) had lymph node involvement. The results of this study allow us to conclude that it is possible to identify the sentinel node using the methods described, and the pathologic examination significantly represents the same conditions of other pelvic and para-aortic lymph nodes.

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PURPOSE: This study aimed to evaluate the reproducibility of sentinel lymphadenectomy in breast cancer patients (T1N0M0 and T2N0M0) and its possibility of predicting the total axillary behavior. METHODS: A total of 25 patients were evaluated, all presenting palpable mammary nodes between 1.5 and 5 cm (T1 and T2), with clinically negative axillary lymph nodes (N0). After an incisional biopsy of the tumor and histopathological confirmation of invasive breast carcinoma, a study of the sentinel lymph node took place with a peritumoral injection of 4 ml of blue dye at 2.5%. After waiting for 15 to 20 minutes, a search for the blue stained lymphatic vase in the axillary fat was carried out, which would lead to the sentinel lymph node, stained or not. At that point, a mastectomy (20 patients) or a quadrantectomy (5 patients) was performed, both with axillary lymphadenectomy at grades 1, 2 and 3. The sentinel lymph nodes and the material from the axillary dissection were sent separately for an anatomicopathological test in paraffin. RESULTS: The lymph nodes were identified in 19 patients, which represented a 76% detection rate. There was a concordance between the sentinel lymphadenectomy and the standard axillary dissection in 68.4% of the patients. The false-positive and the false-negative rates observed were 10% and 55.5%, respectively. A higher detection rate was found in tumors larger than 2 cm and situated in external quadrants. CONCLUSIONS: Sentinel lymphadenectomy identified the sentinel lymph node in the majority of the patients in this study, although the high rate of false-negatives observed prevented an accurate staging.

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The authors investigate the differences between the angiogenesis that occurs in malignant and benign breast tumours (10 specimens of invasive ductal carcinoma and 10 specimens of fibroadenoma) as well as in the adjacent breast stroma of these women highlighting the microvessels by staining their endothelial cells for factor VIII immunohistochemically. The number of vessels counted in invasive ductal carcinoma was significantly higher than the number of vessels counted in fibroadenoma and in the adjacent breast stroma. There was no difference between the number of vessels counted in the fibroadenoma and its adjacent stroma. Even though the patients with invasive ductal carcinoma showed a adjacent stroma with a higher number of vessels, the difference was not significant when compared with the adjacent stroma obtained from patients with fibroadenoma.

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The authors demonstrate technique for obtaining endometrial fragments in 25 patients sent to Gynecological Cancer Preventive Service of the Arnaldo Vieira de Carvalho Cancer Institute, during the period of September 1991 through January 1992, presenting abnormal uterine hemorrhage. Technique consists in vacuum aspiration with the support of a No. 12 uretral sonde, provided with one lateral opening only. Correlation with curettage was positive in 88% of the patients; biopsy with sonde did not result in confirmation in three patients only. No complications at all were observed (infection, hemorrhage or uterus perforation). Authors understand that this method is in conformity with a correct diagnostic performance, being a low cost procedure, almost painless, easy to be done and furnishing sufficient material for the histo-pathologic diagnosis, in 88% of the cases studied.

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The biological behavior of breast cancer supports the impression that it is often a systemic disease which can recur many years after the treatment of the local lesion. Since 35% of patients without axillary nodal metastasis will have recurrence of the disease after mastectomy, prognostic indicators are necessary to identify the high-risk patients to allow a more rational adjuvant therapy. We studied the prognostic value of fatty tissue invasion, perineural involvement and lymphatic and venous peritumoral embolization in T2NOMO primary breast carcinomas. Fifty-three patients were studied after initial treatment (only Halsted mastectomy). They were divided into two groups: A (control), with 25 patients with 15 years of survival without clinical and laboratory evidence of metastasis, and group B, with 28 patients who developed metastasis after initial treatment. The results were analysed by the chi-square test (p < 0.05). The fatty tissue invasion was identified in 56.0% and 78.5% in the A and B groups respectively, while venous embolization was only detected in 8.0% of the group A tumors and in 10.7% of those in group B. Neither showed significant variation when analyzed according to the chi-square test. Lymphatic embolization and perineural involvement were found respectively in 36.0% and 40.0% in the group A tumors and in 67.8% and 71.4% of those in group B, exhibiting a significant statistical variation. When analysing the histopathological characteristics in the pre- and post-menopausal patients, the chi-square test disclosed that lymphatic embolization and perineural involvement had a significantly higher incidence only in premenopausal patients in group B.

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The authors show the clinical and histopathological difficulties for the diagnosis of a rare ovarian tumor in a 13 year old girl who had a bone disease called enchondromatosis, and the adequate treatment for this case. Laparotomy was performed with unilateral salpingo-oophorectomy of the left ovary after a detailed study to detect the origin of the pelvic mass, the patient, who had metrorrhagia and pains in the lower abdomen. Three years after surgery, the patient was once again seen in the outpatient clinic with regular catamenia, requesting some oral contraceptives because she had started sexual activity. The authors conclude that the lipid cell tumor of the ovary is difficult to classify and diagnose, and that it is normally benign, and that treatment for this type of tumor, specially in youngsters, in whom one should be concerned with maintaining menstrual and reproductive function, is the unilateral oophorectomy.

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After a short preface and demonstrations of the technique used to perform laparoscopies, the authors presented results of seven years (1980-1987) of the department of laparoscopy of the Gynecology Unit of the ICAVC in a total of 244 cases. From a review study of files, the authors concluded that laparoscopy is a very important propaedeutic method, specially in the oncology department, in the diagnosis of primary tumors and metastatic. They also concluded that the risk of complication is higher in patients with cancer.

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