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Diagnostic pracedures in cervical cancer
SELECTED AB8TRACTH
1628
;\rr,
J.
(Jb:,t. & (.)ynec,
December. 1054
Bordeaux chirurgical Jl ol. 4, October, 1953.
Laborit, H., Jaulmes, C., and Kiinlin, .T.: Intracardiac Surgery on tlw Exsanguinated Heart During Artificial Hibernation, p. 177. Masse, L., Tingaud, R., LaFargue, .T., and Magimel, .f.: Cellophane Envelopnwnt oE Abdominal Aortic Aneurysm, p. 182. *Magendie, .T., and Kolenc: *Masse, Dax, and Carles:
Diagnostic Procedures in Cervical Cancer, p. HJO.
Ovarian Leiomyoma, p. 196.
Magendie, J., and Kolenc: Diagnostic Pracedures in Cervical Cancer, p. lflO. This paper assays all of the methods of early diagnosis of cancer of the cervix where malignancy cannot be determined by bimanual or speculum examination. Such early forms are divided into two main groups, the true invading cancer with involvement of the underlying stroma, and the intraepithelial type of cancer or the so-called carcinoma in situ. Early symptoms for both groups are essentially the same. No cases were reported where pain was the dominant feature. 'l'he commonest complaint was that of small spontaneous flecking of blood and, second, of moderate-to-severe vaginal discharge, the former in 52 per cent of the cases of invasive carcinoma and in 39 per cent of the cases of carcinoma in situ. Diagnosis of all carcinoma of the cervix can actually be made solely on the basis of biopsy of the suspected lesion. Routine biopsy of all suspected lesions is impracticable, however, not only from the point of view of expended time and expense but also from the point of view of the patient's comfort. Various screening tests for evaluation of lesions of the cervix have been devised. These include the Schiller iodine test; colposcopy; curettage of the suspected lesion; and the study of the exfoliated cervical and vaginal cells. The author believes that the first of these, the Schiller test, should be included in every speculum examination. Although in his hands it is not always a reliable method, it can at least point the way for future examination and biopsy. Colposcopy, although highly recommended by the German authors, was felt to be accurate as a preliminary diagnostic meaRure only in the hands of those who were specially trained in the use of the instrument. The third method, or curettage of the endocervix or the edge of the suspected lesion, is simple and accurate. As a general rule, however, the authors have found that the most accurate screening test for carcinoma of the cervix is the study of the exfoliated cells. The procedure is speedy, and the actual examination of the smears can be done at leisure. In general, none of the screening tests outlined can be used as a true diagnostic test, but must he followed in all suspected cases by actual biopsy examination of the tissue. L. B. WINKELSTEIN, M.D.
Masse, Dax, and Carles: Ovarian Leiomyoma, p. 196. Leiomyoma of the ovary is a rare neoplastic growth. Since only 18 such cases have been reported previously in the literature, the authors felt that the case which they observed and operated upon should also be reported. The case history of a 65-year-old woman is presented. No gynecological symptoms were noted, the main complaints being abdominal pressure, increase in size of the abdomen, and general symptoms referable to the gastrointestinal and urinary tracts. Examination revealed a large, hard abdominal mass, the origin of which could not be determined. On operation a large tnmor mass, about the size of a baby's head, was noted. The mass had its origin in the right broad ligament and actually was interligamentous in position. Many intra-abdominal adhesions were present and connected the tumor not only with many intestinal loops but also with the other organs of the pelvis. No intra-abdominal fluid was present. The patient's postoperative course was uneventful. No radiation therapy was given. Pathological study demonstrated a typical reddish mass, characteristic of leiomyomas, in contradistinction to the blanched masses found with fibroma. On section typical muscle fibers were found. L. B. WINKELSTEIN, M.D.
1628
;\rr,
J.
(Jb:,t. & (.)ynec,
December. 1054
Bordeaux chirurgical Jl ol. 4, October, 1953.
Laborit, H., Jaulmes, C., and Kiinlin, .T.: Intracardiac Surgery on tlw Exsanguinated Heart During Artificial Hibernation, p. 177. Masse, L., Tingaud, R., LaFargue, .T., and Magimel, .f.: Cellophane Envelopnwnt oE Abdominal Aortic Aneurysm, p. 182. *Magendie, .T., and Kolenc: *Masse, Dax, and Carles:
Diagnostic Procedures in Cervical Cancer, p. HJO.
Ovarian Leiomyoma, p. 196.
Magendie, J., and Kolenc: Diagnostic Pracedures in Cervical Cancer, p. lflO. This paper assays all of the methods of early diagnosis of cancer of the cervix where malignancy cannot be determined by bimanual or speculum examination. Such early forms are divided into two main groups, the true invading cancer with involvement of the underlying stroma, and the intraepithelial type of cancer or the so-called carcinoma in situ. Early symptoms for both groups are essentially the same. No cases were reported where pain was the dominant feature. 'l'he commonest complaint was that of small spontaneous flecking of blood and, second, of moderate-to-severe vaginal discharge, the former in 52 per cent of the cases of invasive carcinoma and in 39 per cent of the cases of carcinoma in situ. Diagnosis of all carcinoma of the cervix can actually be made solely on the basis of biopsy of the suspected lesion. Routine biopsy of all suspected lesions is impracticable, however, not only from the point of view of expended time and expense but also from the point of view of the patient's comfort. Various screening tests for evaluation of lesions of the cervix have been devised. These include the Schiller iodine test; colposcopy; curettage of the suspected lesion; and the study of the exfoliated cervical and vaginal cells. The author believes that the first of these, the Schiller test, should be included in every speculum examination. Although in his hands it is not always a reliable method, it can at least point the way for future examination and biopsy. Colposcopy, although highly recommended by the German authors, was felt to be accurate as a preliminary diagnostic meaRure only in the hands of those who were specially trained in the use of the instrument. The third method, or curettage of the endocervix or the edge of the suspected lesion, is simple and accurate. As a general rule, however, the authors have found that the most accurate screening test for carcinoma of the cervix is the study of the exfoliated cells. The procedure is speedy, and the actual examination of the smears can be done at leisure. In general, none of the screening tests outlined can be used as a true diagnostic test, but must he followed in all suspected cases by actual biopsy examination of the tissue. L. B. WINKELSTEIN, M.D.
Masse, Dax, and Carles: Ovarian Leiomyoma, p. 196. Leiomyoma of the ovary is a rare neoplastic growth. Since only 18 such cases have been reported previously in the literature, the authors felt that the case which they observed and operated upon should also be reported. The case history of a 65-year-old woman is presented. No gynecological symptoms were noted, the main complaints being abdominal pressure, increase in size of the abdomen, and general symptoms referable to the gastrointestinal and urinary tracts. Examination revealed a large, hard abdominal mass, the origin of which could not be determined. On operation a large tnmor mass, about the size of a baby's head, was noted. The mass had its origin in the right broad ligament and actually was interligamentous in position. Many intra-abdominal adhesions were present and connected the tumor not only with many intestinal loops but also with the other organs of the pelvis. No intra-abdominal fluid was present. The patient's postoperative course was uneventful. No radiation therapy was given. Pathological study demonstrated a typical reddish mass, characteristic of leiomyomas, in contradistinction to the blanched masses found with fibroma. On section typical muscle fibers were found. L. B. WINKELSTEIN, M.D.