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Referred analysis of an outpatient breast clinic performance women
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P1.03.11 SCINTIMAMMOGRAPHY (SMM) IN THE ASSESSMENT OF BREAST CANCER AND AXILLARY LYMPH NODE METASTASES.COMPARATIVE STUDY WITH Tc-99m-MIBI AND Tc-99m (V)DMSA. This study is part ofa CRP supported by IAEA V.Papantoniou’ >-> D.Lazari? J.Christodoulidouz, A.Stipsaneli’, A.Louvrou3, E.Papadaki’, G.Pampourasz, A.Keramopoulo?, S.Michala?, C.Zerva’ ‘Dpt. of Nuclear Medicine, ‘Dpt of Radiology, 3Dpt.of Obstetrics & Gynecology, <>Hospital, University of Athens, Athens Greece. Objectives: The purpose of this study was to evaluate and compare the diagnostic accuracy of both tracers in the detection of primary breast cancer and metastatic lymph node involvement and eventually minimize or clarify the cases of indeterminate mammographies (Mmx). Material and methods: 41 women (mean *SD 61*13y) referred for a suspicious breast lesion on physical examination and/or an abnormal Mmx underwent MIBI & (V)DMSA SMM at separate sessionslateral prone and anterior supine images were obtained after administration of 740-925 MBq of each tracer, at 10 & 60 min postinjection. In the field of view the ipsilateral axillary region was also included. SMM and Mmx were compared with biopsies. Results: Breast cancer of 5 different types was histologically confirmed in 26 patients: Tumor size ranged from 0,7-6cm (mean f SD: 2,02*0,94). Benign lesions were found in 15 patients with mean size 2,05*2,6 cm (range l-10,5 cm). Mmx was definitely positive in 21126 patients with breast cancer and indeterminate in 5126 (sensitivity 80,7%). In benign lesions Mmx was true negative in 5115 cases and indeterminate in 8115 (specificity:33,3%).MIBI and (V)DMSA SMM achieved to recognize 23126 breast cancer (sensitivity: 88,4%) and were true negative in 14115 (specificity:93,3%). Tumor/Background (T/B) ratio for breast cancer benign lesion and contralateral normal breast CNB) was: 1Tc-99m-MIBI 1Tc-99m (v)DMSA T/B 10 min 60 min 10 min 60 min Cancer 1,89*0,83 1,90*0,82 1,82*0,7 1,80*0,69 Benign lesions l,ll*O,ll 1,21*0,21 1,20*0,22 1,31*0,3 CNB 1,12*0,1 1,14*0,13 1,13*0,15 1,14*0,20 MIBI diagnosed correctly 12113 and (V)DMSA 11113 indeterminate Mmx. (V)DMSA detected moreover 9110 and MIBI 4110 ductal carcinomas in situ. (V)DSMA was also diffusely concentrated in benign lesions complicated with hepitheliosis. Metastatic lymph node involvement was successfully imaged in 16119 patients with metastatic disease (sensitivity: 84,2%), by both agents, while true negative scans were observed in 19122 (specificity: 86,3%) patients with benign or malignant tumors without lymph node metastases. Conclusion: MIBI as well as (V)DMSA showed an excellent ability in detecting breast cancer and its lymph node metastases. (V)DMSA had also the tendency to be localized diffusely and more intensely than MIBI, in benign or precancerous alterations which are at risk to develop malignancies and could provide a useful tool in their diagnosis and treatment. Finally, we believe that both tracers could offer an alternative in discriminating non-diagnostic Mmx.
P1.03.12 BREAST CANCER RISK OF GRAND MULTIPAROUS WOMEN M.Hinkula AKauppila, Dept.OB/GYN, University Hospital, Oulu, -> Finland E.Pukkala, P.KyyrGnen, Finnish Cancer Registry, Helsinki, Finland Objectives: The aim of this national cohort study was to assess the significance of parity, age at first birth, birth interval and age at diagnosis to the risk of breast cancer of grand multiparous (GM= at least five full-term pregnancies) women, by histological subtype and clinical presentation of malignancy. Study Methods: The Population Register of Finland with complete family information since 1974 included about 90, 000 GM women. This data was linked with that of Finnish Cancer Registry. During a followup of about 2 million person-years, 1,508 breast cancers were obtained. Standardized incidence ratios (SIR) were calculated by dividing the number of observed cases by the number of expected cancers. Poisson
87
regression modelling, that takes into account the effects of the other variables as confounding factors, was used in the relative risk (RR) calculations. Results: In the whole GM cohort, the risk of breast cancer was low (SIR=0.55,95% CI 0.52-0.58). Th e risk decreased significantly from 5paras (ref.) to 8-paras (RR adjusted for the other variables 0.68, 95% CI 0.52-0.90). The increase in the age at first birth from less than 20 years (ref.) to 30 years or more nearly doubled the risk (RR 1.83,95% CI 1.43-2.34). The increase in the birth interval had only a marginal independent effect on the RR. Parity was a significant risk determinant only in ductal cancer, pregnancy interval only in lobular cancer, while the age at first birth did so in both histological subtypes. Advanced breast cancer of premenopausal GM-women appeared to be relatively independent on the present reproductive variables. Conclusions: Parity, age at first birth and birth interval were significant and independent risk determinants in breast cancer of GM -women, especially on less advanced stages. Large number of full-term pregnancies and young age at first birth were powerful risk reducers, whereas short birth interval was relatively weak in this respect. Reproductive risk variables appeared to have divergent effects on different histological subtypes.
P1.03.13 BREAST PARENCHYMA THICKNESS ULTRASOUND MEASUREMENT (PSI: PARENCHYMAL BREAST INDEX) AND ITS CORRELATIONS WITH BBD (BENIGN BREAST DISEASE). M. Angiolucci, Dept. OBIGYN, University of Cagliari, Italy M.P. Gennamari, Dept. OBIGYN, University of Cagliari, Italy S. Dept. OBIGYN, University of Cagliari, Italy G.B. Melis, Dept. OBIGYN, University of Cagliari, Italy Objectives: To demonstrate if there is a relationship between parenchimal breast thickness and BBD. Study methods: We performed breast US (ultrasound) in 557 women. One group included US pattern of normality. Another group included women with diffuse, bilateral BBD, with no focal lesions (according to AND1 classification: see Hughes and Mansel, the Lancet 5112187). PBI was calculated measuring parenchymal breast thickness in 8 radial scans, disposing the probe along the bisectrix of the four breast quadrants (both right and left) and finally summing these 8 values. Data were analyzed by Student “t” test and analysis of variance for not coupled data. Values of ~~0.05 were considered significant. We also studied diagnostic value of some PBI’s values cut-off in assessing the presence of BBD. Finally, we evaluated within-operator and among operators variability in performing the examination. Results: There were significant PBI value differences in women with BBD in comparison with normal women. PBI was significantly higher in women with BBD than in women with normal US pattern. Among the different kinds of BBD, fibrous dysplasia was associated with PBI values lower than those we observed in other BBD (adenosis, cystic dysplasia, and so on). Conclusions: PBI is an interesting tool in monitoring the breast conditions in subjects with BBD. The possible use of PBI in patients submitted to hormonal therapy will be also discussed.
P1.03.14 REFERRED ANALYSIS OF AN OUTPATIENT BREAST CLINIC PERFORMANCE WOMEN Jo& Tadeu Vicelli, L.C. Zeferino, M.S.C. Gurgel, J.E. Ferro. Unicamp, Oncologia Ginecolbgica, Rua Alexander Fleming, 101, BarPo Geraldo, Campinas, Brazil, 13083.970. Objectives: To evaluate the specificity and sensitivity of clinical examination of breast diagnosing the performance of outpatient breast clinic assisting 35-49 year women referred breast cancer control programmes performed in primary health community centers in Campinas, Brazil. Study Methods: This was a decriptive and diagnostic test validation study, that included seven hundred twelve (712) women referred the outpatient clinic due to clinical symptoms and/or abnormal breast clinical examination, according to physician evaluation. Mammography was available only in the outpatient clinic. Results: Six hundred and sixty one (661) symptomatic women and five eighty four (584) women with abnormal clinical examinations were
88
studied. Mass or thickening were the most frequent symptoms (65%). Four hundred and thirty six (436) surgical byopsies or cytologic procedures were performed. One hundred sixty four (164) carcinomas were diagnosed after the first consultation and four carcinomas during the follow-up. The positive preditive values of clinical examination and mammography were respectively, 82,3% and 82,4%. The sensitivity values of clinical examination were 80,3% and 83,3%. Stages I, II, III and IV were found in 13,9%, 60,8%, 15,1% and 10,2%. Conclusions: The breast cancer control programme for 35-49 year old women based on symptoms and clinical examination can be considered effective to promote early diagnosis without using mammography examination at primary health care level. For these women, mammography secondary level shows high Positive Preditive and Sensitivity values.
P1.03.15 MATCHED PAIR ANALYSIS OF SURVIVAL AFTER LOCAL RECURRENCE IN BREAST CANCER PATIENTS AFTER MASTECTOMY VS. BREAST CONSERVATION: A LONG-TERM FOLLOW-UP W. Th. Dimpfl, L. Stafflinger; D. Rjosk, F. Bergauer, W. Sigg, H. Sommer, Th. Genz. I. Universitaetsfrauenklinik, Klinikum Innenstadt, Munich, Germany Objectives: Local recurrence remains a major concern after primary treatment of breast cancer, with a major impact on subsequent survival. While most studies report a poorer survival in patients with a local recurrence after mastectomy than after breast conservation, it remains controversial, whether different risk profiles at time of primary diagnosis may account for this difference. Study Methods: Matched pair analysis of 134 patients with newly diagnosed locoregional recurrence of breast cancer without evidence of systemic disease. Patients were matched for equivalence in primary surgical treatment, tumor size, nodal status and age. The significance of various prognostic parameters at time of primary diagnosis and at time of recurrence were evaluated in respect to survival after recurrence by univariate and multivariate analyses (median follow-up 8.4 years). Results: Primary risk factors were comparable between both groups, but local recurrence occurred on an average of 9 months earlier in patients after mastectomy (P = .08). While univariate analysis demonstrated primary lymph node status (P = .OOOl) and disease free interval from primary treatment to local recurrence (P = .0002) to be the most significant prognostic factors for survival after local recurrence, primary surgical treatment was of marginal influence (P = .05). Multivariate analysis confirmed the potential significance of these prognostic factors, however demonstrated the combination of disease free interval and primary surgical treatment to be the most significant, independent risk factor for cancer related death (P = .OOOl). Conclusions: Local recurrence after mastectomy for primary breast cancer is followed by a marginally poorer outcome, which probably can be mainly attributed to a shorter disease free interval.
P1.04 CERVIX P1.04.01 EFFECT OF Gl CYCLINS EXPRESSON ON CLINICAL PROGNOSTIC PARAMETERS IN CERVICAL CANCER J.W. Y.T. Kim, E.K. Choi, E.M. Cho, Dept. OBIGYN, Yonsei Univeristy College of Medicine, Seoul, Korea Objectives: Alterations in the expression of genes that control the cell cycle may be of critical importance in tumorigenesis and malignant transformation. The major regulatory events leadin to cell proliferation occur in Gl phase of cell cycle, and the deregulated expression of Gl cyclins is related to oncogenesis. Cyclins Dl and E play important roles in the progression of cell through Gl phase of the cell cycle. Amplification and/or overexpression of the cyclin Dl gene and aberrant expression of cyclin E has been described in various forms of human cancer. However, the role of cyclins Dl and E in cervical cancer has been poorly defined. Study Methods: In this study, we examined the expression of cyclins DI and E by Northern blot technique and by the status of human papillomavirus (HPV) type 16 and 18 by polymerase chain reaction in
MONDAY,
SEPTEMBER
25 cases of cervical carcinoma to explore the relationship between cyclins Dl and E and cervical cancer. Results: We found cyclin Dl expression showed down-regulated expression in cervical cancer but cyclin E was increased in cancer group. Other clinicopathological prognostic factors were not correlated with cyclins Dl and E expression. Conclusions: Our results were consistent with the concept that the cyclin E overexpression may play an important role in neoplastic transformation of the cervix. However, further, study based on larger numbers of cases with correlation of cyclins Dl and E status and survival data will be needed to elucidate the use of cyclin expressions as prognostic factor.
P1.04.02 EOSINOPHILIC STROMAL INFILTRATION IN CARCINOMA OF THE UTERINE CERVIX M.L. FenBndez-P&ez, .I. Lombardia, .I. Potenciano, M. Sanchez-Dehesa, .I. Porro, A. SBnchez-Dehesa, Gynecology Oncology Unit, Dept. OBIGYN, Hospital Virgen de la Salud, Toledo, Spain. Mortality from carcinoma of the uterine cervix used to be the highest with the ovarian carcinoma among all gynecological cancer, and the most effective way to reduce mortality seemed to be the screening for cervical cancer. A case of eosinophilic stromal infiltration in carcinoma of the uterine cervix in a 33.year-old woman is reported. The symptoms were: abnormal bleeding after sexual relations and abdominal pain. The exploration was normal except an irregular and bleeding lesion in posterior labia f 3 cm. After a positive cytology (squamous carcinoma), the colposcopy and the biopsy complemented the diagnosis of the uterine cervix carcinoma. The rest of the explorations were normal. The surgical treatment (radical hysterectomy) was made 15 days later; the histopathological study was: two cervix cancer lesions circunscribed of 4.5 and 14 mm, with eosinophilic stromal infiltration, locating in the uterine cervix. The rest of the histopathologic analyzing was normal (including the nodes). The FIG0 stage was I,. Three years later, the patient is out of illness. This class of cervical cancer with stromal eosinophilia has a positive correlation between the quantity of the stromal eosinophilia reaction and survival rate. These patients tend to have early stage disease and are younger than the patients lacking this intense eosinophilic infiltration. But, if the malignant disease is associated with peripheral eosinophilic, it is a marker of extensive disease and is associated with poor prognosis.
P1.04.03 SYNCHRONOUS CERVICAL CANCER M.A. Garcia-Large Seseiia, M. L. FernBndez-P&ez, .I. Lombardia, M.V. Peral, J. Porro, A. Sanchez-Dehesa, Gynecology Oncology Unit, Dept. OBIGYN, Hospital Virgen de la Salud, Toledo, Spain. Although it seems to increase in the incidence of adenocarcinoma of uterine cervix, the cervical adenocarcinoma concomitant with squamous cell neoplasm is not a common lesion. A case of synchronous malignant neoplasm of cervix in a 62.year-old woman is reported: a primary adenocarcinoma coexisting with squamous cell carcinoma in uterine cervix. The symptom was abnormal vaginal bleeding one year ago and the exploration was normal, except a small ulcerosus and bleeding polypous in the anterior cervical labia. The surgical treatment (radical hysterectomy) was complemented with radiotherapy (external radiation and brachytherapy). The histopathological study was: squamous cell carcinome (SCC) G,I, and an endometroid adenocarcinoma G,I,. One year and nine months later, the patient is well.
SEPTEMBER
4
P1.03.11 SCINTIMAMMOGRAPHY (SMM) IN THE ASSESSMENT OF BREAST CANCER AND AXILLARY LYMPH NODE METASTASES.COMPARATIVE STUDY WITH Tc-99m-MIBI AND Tc-99m (V)DMSA. This study is part ofa CRP supported by IAEA V.Papantoniou’ >-> D.Lazari? J.Christodoulidouz, A.Stipsaneli’, A.Louvrou3, E.Papadaki’, G.Pampourasz, A.Keramopoulo?, S.Michala?, C.Zerva’ ‘Dpt. of Nuclear Medicine, ‘Dpt of Radiology, 3Dpt.of Obstetrics & Gynecology, <
P1.03.12 BREAST CANCER RISK OF GRAND MULTIPAROUS WOMEN M.Hinkula AKauppila, Dept.OB/GYN, University Hospital, Oulu, -> Finland E.Pukkala, P.KyyrGnen, Finnish Cancer Registry, Helsinki, Finland Objectives: The aim of this national cohort study was to assess the significance of parity, age at first birth, birth interval and age at diagnosis to the risk of breast cancer of grand multiparous (GM= at least five full-term pregnancies) women, by histological subtype and clinical presentation of malignancy. Study Methods: The Population Register of Finland with complete family information since 1974 included about 90, 000 GM women. This data was linked with that of Finnish Cancer Registry. During a followup of about 2 million person-years, 1,508 breast cancers were obtained. Standardized incidence ratios (SIR) were calculated by dividing the number of observed cases by the number of expected cancers. Poisson
87
regression modelling, that takes into account the effects of the other variables as confounding factors, was used in the relative risk (RR) calculations. Results: In the whole GM cohort, the risk of breast cancer was low (SIR=0.55,95% CI 0.52-0.58). Th e risk decreased significantly from 5paras (ref.) to 8-paras (RR adjusted for the other variables 0.68, 95% CI 0.52-0.90). The increase in the age at first birth from less than 20 years (ref.) to 30 years or more nearly doubled the risk (RR 1.83,95% CI 1.43-2.34). The increase in the birth interval had only a marginal independent effect on the RR. Parity was a significant risk determinant only in ductal cancer, pregnancy interval only in lobular cancer, while the age at first birth did so in both histological subtypes. Advanced breast cancer of premenopausal GM-women appeared to be relatively independent on the present reproductive variables. Conclusions: Parity, age at first birth and birth interval were significant and independent risk determinants in breast cancer of GM -women, especially on less advanced stages. Large number of full-term pregnancies and young age at first birth were powerful risk reducers, whereas short birth interval was relatively weak in this respect. Reproductive risk variables appeared to have divergent effects on different histological subtypes.
P1.03.13 BREAST PARENCHYMA THICKNESS ULTRASOUND MEASUREMENT (PSI: PARENCHYMAL BREAST INDEX) AND ITS CORRELATIONS WITH BBD (BENIGN BREAST DISEASE). M. Angiolucci, Dept. OBIGYN, University of Cagliari, Italy M.P. Gennamari, Dept. OBIGYN, University of Cagliari, Italy S. Dept. OBIGYN, University of Cagliari, Italy G.B. Melis, Dept. OBIGYN, University of Cagliari, Italy Objectives: To demonstrate if there is a relationship between parenchimal breast thickness and BBD. Study methods: We performed breast US (ultrasound) in 557 women. One group included US pattern of normality. Another group included women with diffuse, bilateral BBD, with no focal lesions (according to AND1 classification: see Hughes and Mansel, the Lancet 5112187). PBI was calculated measuring parenchymal breast thickness in 8 radial scans, disposing the probe along the bisectrix of the four breast quadrants (both right and left) and finally summing these 8 values. Data were analyzed by Student “t” test and analysis of variance for not coupled data. Values of ~~0.05 were considered significant. We also studied diagnostic value of some PBI’s values cut-off in assessing the presence of BBD. Finally, we evaluated within-operator and among operators variability in performing the examination. Results: There were significant PBI value differences in women with BBD in comparison with normal women. PBI was significantly higher in women with BBD than in women with normal US pattern. Among the different kinds of BBD, fibrous dysplasia was associated with PBI values lower than those we observed in other BBD (adenosis, cystic dysplasia, and so on). Conclusions: PBI is an interesting tool in monitoring the breast conditions in subjects with BBD. The possible use of PBI in patients submitted to hormonal therapy will be also discussed.
P1.03.14 REFERRED ANALYSIS OF AN OUTPATIENT BREAST CLINIC PERFORMANCE WOMEN Jo& Tadeu Vicelli, L.C. Zeferino, M.S.C. Gurgel, J.E. Ferro. Unicamp, Oncologia Ginecolbgica, Rua Alexander Fleming, 101, BarPo Geraldo, Campinas, Brazil, 13083.970. Objectives: To evaluate the specificity and sensitivity of clinical examination of breast diagnosing the performance of outpatient breast clinic assisting 35-49 year women referred breast cancer control programmes performed in primary health community centers in Campinas, Brazil. Study Methods: This was a decriptive and diagnostic test validation study, that included seven hundred twelve (712) women referred the outpatient clinic due to clinical symptoms and/or abnormal breast clinical examination, according to physician evaluation. Mammography was available only in the outpatient clinic. Results: Six hundred and sixty one (661) symptomatic women and five eighty four (584) women with abnormal clinical examinations were
88
studied. Mass or thickening were the most frequent symptoms (65%). Four hundred and thirty six (436) surgical byopsies or cytologic procedures were performed. One hundred sixty four (164) carcinomas were diagnosed after the first consultation and four carcinomas during the follow-up. The positive preditive values of clinical examination and mammography were respectively, 82,3% and 82,4%. The sensitivity values of clinical examination were 80,3% and 83,3%. Stages I, II, III and IV were found in 13,9%, 60,8%, 15,1% and 10,2%. Conclusions: The breast cancer control programme for 35-49 year old women based on symptoms and clinical examination can be considered effective to promote early diagnosis without using mammography examination at primary health care level. For these women, mammography secondary level shows high Positive Preditive and Sensitivity values.
P1.03.15 MATCHED PAIR ANALYSIS OF SURVIVAL AFTER LOCAL RECURRENCE IN BREAST CANCER PATIENTS AFTER MASTECTOMY VS. BREAST CONSERVATION: A LONG-TERM FOLLOW-UP W. Th. Dimpfl, L. Stafflinger; D. Rjosk, F. Bergauer, W. Sigg, H. Sommer, Th. Genz. I. Universitaetsfrauenklinik, Klinikum Innenstadt, Munich, Germany Objectives: Local recurrence remains a major concern after primary treatment of breast cancer, with a major impact on subsequent survival. While most studies report a poorer survival in patients with a local recurrence after mastectomy than after breast conservation, it remains controversial, whether different risk profiles at time of primary diagnosis may account for this difference. Study Methods: Matched pair analysis of 134 patients with newly diagnosed locoregional recurrence of breast cancer without evidence of systemic disease. Patients were matched for equivalence in primary surgical treatment, tumor size, nodal status and age. The significance of various prognostic parameters at time of primary diagnosis and at time of recurrence were evaluated in respect to survival after recurrence by univariate and multivariate analyses (median follow-up 8.4 years). Results: Primary risk factors were comparable between both groups, but local recurrence occurred on an average of 9 months earlier in patients after mastectomy (P = .08). While univariate analysis demonstrated primary lymph node status (P = .OOOl) and disease free interval from primary treatment to local recurrence (P = .0002) to be the most significant prognostic factors for survival after local recurrence, primary surgical treatment was of marginal influence (P = .05). Multivariate analysis confirmed the potential significance of these prognostic factors, however demonstrated the combination of disease free interval and primary surgical treatment to be the most significant, independent risk factor for cancer related death (P = .OOOl). Conclusions: Local recurrence after mastectomy for primary breast cancer is followed by a marginally poorer outcome, which probably can be mainly attributed to a shorter disease free interval.
P1.04 CERVIX P1.04.01 EFFECT OF Gl CYCLINS EXPRESSON ON CLINICAL PROGNOSTIC PARAMETERS IN CERVICAL CANCER J.W. Y.T. Kim, E.K. Choi, E.M. Cho, Dept. OBIGYN, Yonsei Univeristy College of Medicine, Seoul, Korea Objectives: Alterations in the expression of genes that control the cell cycle may be of critical importance in tumorigenesis and malignant transformation. The major regulatory events leadin to cell proliferation occur in Gl phase of cell cycle, and the deregulated expression of Gl cyclins is related to oncogenesis. Cyclins Dl and E play important roles in the progression of cell through Gl phase of the cell cycle. Amplification and/or overexpression of the cyclin Dl gene and aberrant expression of cyclin E has been described in various forms of human cancer. However, the role of cyclins Dl and E in cervical cancer has been poorly defined. Study Methods: In this study, we examined the expression of cyclins DI and E by Northern blot technique and by the status of human papillomavirus (HPV) type 16 and 18 by polymerase chain reaction in
MONDAY,
SEPTEMBER
25 cases of cervical carcinoma to explore the relationship between cyclins Dl and E and cervical cancer. Results: We found cyclin Dl expression showed down-regulated expression in cervical cancer but cyclin E was increased in cancer group. Other clinicopathological prognostic factors were not correlated with cyclins Dl and E expression. Conclusions: Our results were consistent with the concept that the cyclin E overexpression may play an important role in neoplastic transformation of the cervix. However, further, study based on larger numbers of cases with correlation of cyclins Dl and E status and survival data will be needed to elucidate the use of cyclin expressions as prognostic factor.
P1.04.02 EOSINOPHILIC STROMAL INFILTRATION IN CARCINOMA OF THE UTERINE CERVIX M.L. FenBndez-P&ez, .I. Lombardia, .I. Potenciano, M. Sanchez-Dehesa, .I. Porro, A. SBnchez-Dehesa, Gynecology Oncology Unit, Dept. OBIGYN, Hospital Virgen de la Salud, Toledo, Spain. Mortality from carcinoma of the uterine cervix used to be the highest with the ovarian carcinoma among all gynecological cancer, and the most effective way to reduce mortality seemed to be the screening for cervical cancer. A case of eosinophilic stromal infiltration in carcinoma of the uterine cervix in a 33.year-old woman is reported. The symptoms were: abnormal bleeding after sexual relations and abdominal pain. The exploration was normal except an irregular and bleeding lesion in posterior labia f 3 cm. After a positive cytology (squamous carcinoma), the colposcopy and the biopsy complemented the diagnosis of the uterine cervix carcinoma. The rest of the explorations were normal. The surgical treatment (radical hysterectomy) was made 15 days later; the histopathological study was: two cervix cancer lesions circunscribed of 4.5 and 14 mm, with eosinophilic stromal infiltration, locating in the uterine cervix. The rest of the histopathologic analyzing was normal (including the nodes). The FIG0 stage was I,. Three years later, the patient is out of illness. This class of cervical cancer with stromal eosinophilia has a positive correlation between the quantity of the stromal eosinophilia reaction and survival rate. These patients tend to have early stage disease and are younger than the patients lacking this intense eosinophilic infiltration. But, if the malignant disease is associated with peripheral eosinophilic, it is a marker of extensive disease and is associated with poor prognosis.
P1.04.03 SYNCHRONOUS CERVICAL CANCER M.A. Garcia-Large Seseiia, M. L. FernBndez-P&ez, .I. Lombardia, M.V. Peral, J. Porro, A. Sanchez-Dehesa, Gynecology Oncology Unit, Dept. OBIGYN, Hospital Virgen de la Salud, Toledo, Spain. Although it seems to increase in the incidence of adenocarcinoma of uterine cervix, the cervical adenocarcinoma concomitant with squamous cell neoplasm is not a common lesion. A case of synchronous malignant neoplasm of cervix in a 62.year-old woman is reported: a primary adenocarcinoma coexisting with squamous cell carcinoma in uterine cervix. The symptom was abnormal vaginal bleeding one year ago and the exploration was normal, except a small ulcerosus and bleeding polypous in the anterior cervical labia. The surgical treatment (radical hysterectomy) was complemented with radiotherapy (external radiation and brachytherapy). The histopathological study was: squamous cell carcinome (SCC) G,I, and an endometroid adenocarcinoma G,I,. One year and nine months later, the patient is well.