Vol. XXIX, n.2, 2008 ISSN: 0392-2936


european journal
of gynaecological oncology

an International Journal


Editors-in-Chief
A. Onnis
Montréal (CND)
P. Bösze
Budapest (Hungary)


Associate Editors
M. Marchetti
Montréal (CND)

Assistant Editor
J. Wilson
San Diego - CA (USA)
Editorial Board
Allen H.H., London, Ontario (Canada)
Anteby S.O., Jerusalem (Israel)
Audet-Lapointe P., Montreal (Canada)
Ayhan A., Ankara (Turkey)
Balat O., Graziantep (Turkey)
Barber H.K., New York, NY (USA)
Basta A., Krakow (Poland)
Bender H.C., Dusseldorf (Germany)
Benedetti Panici P.L., Rome (Italy)
Charkviani T., Tbilisi (Georgia)
De Oliveira C.F., Coimbra (Portugal)
Dexeus S. Jr., Barcelona (Spain)
Di Paola G.R.,Buenos Aires (Argentina)
Di Re F., Milan (Italy)
Di Saia P., Orange, CA (USA)
Fuller A.F. Jr., Boston, MA (USA)
Geisler H.E., Indianapolis, IN (USA)
Gerbaulet A., Villejuif (France)
Gorins A., Paris (France)
Heintz A.P.M., Utrecht (The Netherlands)
Ioannidou-Mouzaka L.,Athens (Greece)
Jordan J.A., Birmingham, England (UK)
Karseladze A.I., Moscow (Russia)
Klastersky J., Bruxelles (Belgium)
Kubista E., Vienna (Austria)
Kudelka A.P., Houston, TX (USA)
Maggino T., Padua (Italy)
Markowska J., Poznan (Poland)
Marth C., Innsbruck (Austria)
Massuger Leon F.A.G.,
Menczer J., Savyon (Israel)
Monsonego J., Paris (France)
Pinotti A., São Paulo (Brazil)
Piura B., Beer Sheva (Israel)
Piver S.M., Buffalo, NY (USA)
Rakar S., Ljubljana (Slovenia)
Raju K.S., London, England (UK)
Shepherd J.H., London, England (UK)
Stelmachów J., Warsaw (Poland)
Tjalma W., Antwerpen (Belgium)
Ungár L., Budapest (Hungary)
Vermorken J.B., Edegem (Belgium)
Vîrtej P., Bucharest (Romania)
Wang P.-H., Taipei (Taiwan)
Winter R., Graz (Austria)
Yokoyama Y., Hirosaki (Japan)

Publishing Organization (M. Morsani):
I.R.O.G. CANADA, Inc. - 4900 Côte St-Luc - Apt # 212 - Montréal, Qué. H3W 2H3 (Canada)
Tel. +514-4893242 - Fax +514-4854513 - E-mail: canlux@mgroup-online.com - www.irog.net

Editorial Office (M. Critelli):
Galleria Storione, 2/A - 35123 Padua (Italy) - Tel. (39) 049 8756900 - Fax (39) 049 8752018

 

EUROPEAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY (ISSN 0392-2936) publishes original peer reviewed works in the fields of female genital cancers and related subjects and also proceedings of gynecologic oncology society meetings all over the world. The Journal is covered by CURRENT CONTENTS, SCISEARCH, RESEARCH ALERT, INDEX MEDICUS, MEDLINE, EMBASE/ Excerpta Medica, CURRENT ADVANCES IN CANCER RESEARCH, BIOSIS.

 

European Journal of Gynaecological Oncology
www.irog.net


General Information

The EUROPEAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY (ISSN 0392-2936) publishes original peer reviewed work, preferably brief reports, in the fields of female genital cancers and related subjects – prevention, early detection, epidemiology, pathology, diagnosis, management – and also proceedings of Gynaecologic Oncology Society meetings all over the world.

The Journal is covered by CURRENT CONTENTS, SCISEARCH, RESEARCH ALERT, INDEX MEDICUS, MEDLINE,
EMBASE/ Excerpta Medica, CURRENT ADVANCES IN CANCER RESEARCH, BIOSIS.

AIMS AND SCOPE
The EUROPEAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY is dedicated to publishing editorial articles in the “Distin-guished Expert Series” and original research papers, case reports, letters to the Editor, book reviews and newsletters.

The Journal was founded in 1980 – the second gynaecologic oncology hyperspecialization journal in the world. Its aim is the dif-fusion of scientific, clinical and practical progress and knowledge in female neoplastic diseases in an interdisciplinary approach among gynaecologists, oncologists, radiotherapists, surgeons, chemotherapists, pathologists, epidemiologists and so on.

ANNOUNCEMENTS regarding meetings, postgraduate courses and symposia will be accepted 6 months before publication and will be published free of charge.
BOOK SAMPLES for review should be sent to the Editorial offices in Montréal or in Padova.
COPYRIGHT: the Journal has been registered with the Copyright Clearance Center, Inc. Reproductions are not allowed without the written consent of the Publisher. All photocopy fees should be paid to the Copyright Clearance Center, Inc., 21 Congress Street, Salem, MA 01970, USA stating the ISSN number, the volume and the first and last page numbers of each article copied.
ADVERTISING INFORMATION: advertising orders and inquiries may be sent to: I.R.O.G. CANADA Inc., Publisher, 4900 Côte St. Luc, Apt. 212, Montréal (Quebec) Canada H3W 2HS, Tél. 514.4893242-4893640 - Fax 514.4854513 - E-mail: canlux@mgroup-online.com - www.irog.net
RESPONSIBILITY: although every effort is made by the editorial staff and the printer to eliminate misleading or inaccurate infor-mation, the publisher accepts no responsibility for the consequences of faultful or incorrect information. The authors recognize that the editor and publisher have no responsibility and are indemnified against any liability or claim that may result from the publication of misleading or incorrect data.


SUBSCRIPTION INFORMATION
The Journal is published bimonthly (January, March, May, July, September and November); one volume per year. Subscriptions start from January and are automatically renewed if not cancelled by the end of September.

Subscriptions include six issues per year plus supplements, monographs and all official communications of Meetings, Courses, Symposia and all scientific activities of Gynaecologic Oncology Societies all over the world.

Subscriptions are entered with prepayment only. The annual subscription is $390 US for Institutions, $200 US for Individuals. For airmail add $30, for receipt add $10 US. Single copy prepaid cost $95 US.

Send subscription requests with cheque or credit card payment (Amex - Visa - Diner’s - Master Card) to I.R.O.G. CANADA Inc., 4900 Côte St. Luc, Apt. 212, Montréal, Québec H3W 2H3 Canada. Only US Funds are accepted. No bank transfers.

Claims for missing issues can be honoured up to six months. Changes of address: allow six weeks for all changes to become effec-tive. All communications should include both old and new addresses (with postal codes) – better if accompanied by a mailing label from a recent issue – and should be sent to the printer: La Garangola, Via E. Dalla Costa 6, 35129 Padova (Italy) or by Fax +39.049.7806580. Claims should be made within six months of publication date.

Duplicate copies will not be sent to replace those undelivered through failure to notify of change of address.

Single copies and back issue and volume information is available from the printer, La Garangola, Padova, Tel. +39.049.8075557, Fax +39.049.7806580. Certain back issues may only be available as photocopies of the originals.

All other business correspondence including orders for offprints and advertising space and any communication and requests should be addressed to I.R.O.G. CANADA Inc., 4900 Côte St. Luc, Apt. 212, MONTRÉAL, QUÉBEC H3W 2H3 (Canada), tel. (514) 4893242, fax (514) 4854513.

IN ALL LEGAL MATTERS THE COURT OF MONTREAL IS COMPETENT

 

European Journal of Gynaecological Oncology
www.irog.net


Instructions to Authors

SUBMISSION OF MANUSCRIPTS
Papers should be submitted to A. ONNIS Editor-in-Chief of the EUROPEAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY, 4900 Côte St. Luc, Apt. 212 MONTREAL, QUÉBEC H3W 2H3 (Canada) - Tel. +514-4893242 - Fax +514-4854513, or Galleria Sto-rione 2/A - 35123 PADOVA (Italy) - Fax +39-049-8752018.

Editorial articles for publication in the “Distinguished Expert Series” should be submitted to P. Bösze, Editor-in-Chief of this section, Department of Gynecology, Saint Stephan Hospital, 1096 Budapest, Nagyvárad tér 1, Telephone (36-1) 275 2172, Fax (36-1)
275 2172, E-mail: bosze@axelero.hu

When a manuscript is submitted, an acknowledgement card is sent to the corresponding author within two or three weeks.

Submitted papers are reviewed by the Editor-in-Chief and his Peer Referees. Authors may be required to modify the manuscript according to the reviewers’ suggestions.

Manuscripts accepted for publication will be copyedited by the editorial staff for typographical and grammatical mistakes and to guarantee clarity and conciseness.

Publication time will be the shortest possible based on scientific and publishing needs. Manuscripts submitted for publi-cation cannot be returned.

Published papers will become property of the Journal and copyrighted under I.R.O.G. CANADA Inc.

After six months no grievances will be accepted regarding published articles.

All statements are the responsibility of the authors. Product dosages, indications and methods referred to in the papers reflect the author’s experience. No responsibility is assumed by the Editor-in-Chief or the Publisher for any damage from use of any products, operation methods or instructions contained in the published materials.

Trade names, trademarks, etc. are protected by the law and regulations. The Editor-in-Chief and the Publisher cannot accept any legal responsibility for any errors or omissions that may be made in press, particularly for information about drug dosage and appli-cation thereof contained in the Journal. Consult the prescribing information before administering any drug.

MANUSCRIPT REQUIREMENTS
The Journal follows the “Uniform requirements for manuscripts submitted to biomedical journals” published in the New England Journal of Medicine 1991, 324, 424-8 and in the British Medical Journal 1991, 302.

Three manuscripts, typed and double spaced should be submitted with an electronic disk, formatted in Word for Macintosh or Windows, version 6.0. Manuscripts without an electronic disk will not be accepted. A cover letter signed by all authors must state that all authors who have participated in the work take responsibility for the manuscript which has never been pub lished or submitted for publication elsewhere. Without a cover letter the publication will not be possible. Name, address and phone/fax numbers of the Corresponding Author, responsible for revision and approval of the proofs, should be indicated. Full-length articles should not exceed 8 printed pages including tables and references.

After the title page (full title and names of authors, institutions, eventual acknowledgement for financial support, running title of no more than 60 characters or spaces), original works should be arranged in the conventional order: Summary (purpose of investiga-tion, methods, results, conclusion - about 150 words), Key words, Content (a 20-word summary), Introduction, Materials and Methods, Results, Discussion, Conclusion, Acknowledgement (if any), References, Tables, Legends.

Authors should supply a complete address for reprint requests.

In the text only standard abbreviations can be used and must be avoided in the title. The full term for which an abbreviation stands should precede its first use in the summary and text unless it is a standard unit of measurement.

Authors must give their complete professional identifications and affiliations, including all academic titles and positions.

Letters to the editor should be brief (500 words or less) and offer objective, constructive and educational criticism of published material. The editor reserves the right to publish.

Figures: Two original copies (not negatives) of each figure are requested. Each figure should have a label on the back indicating its number, author’s name and top of the figure. Do not write on the back of the figures and do not mount them on cardboard. If sending colour pictures advise if they must be printed in colour or black and white (colour costs ten times more).

Legends should be typed on a separate page with Arabic numerals corresponding to the illustrations.

Tables should be titled, typed in double space on separate pages and numbered in Arabic numerals in the order of their first cita-tion
in the text. Do not use internal rules. Only standard, universally understood abbreviations should be used.

References should be numbered consecutively in the order in which they are first mentioned in the text. Identify references in the text, tables, and legends by Arabic numerals in parentheses.

Use the style of the examples below, which are based with slight modifications on the format used by the U.S. National Library of Medicine in Index Medicus. The titles of journals should be abbreviated according to the style used in Index Medicus.

References must be verified by the Author(s) against the original documents.

Examples of correct forms of references are given below:

Articles in Journals: Authors’ surname and initials (if more than six names, give six followed by “et al.”), Title, Abbreviated Journal Title, Year of Publication, Volume, Issue and first page.

Books: Authors’ surname and initials, title of the book and title of chapter, in: Title, Editor(s), Place, Publisher, Year, Page.

Acknowledgments
will be limited to appropriate professionals who were contributors to the paper.

PROOFS revised by the editorial staff will be sent to the corresponding author and should be checked and returned within ten days. The corresponding author is responsible for detecting typesetting errors. After this deadline the proofs will be considered approved. Only essential corrections should be made; extensive changes will be charged to the authors.

BUSINESS MATTERS
The Journal has no commercial advertisements.

Authors will be expected to contribute to the printing expenses, tables, figures and postage. For every published article a copy of the Journal will be provided free of charge. Only payments in US dollars will be accepted. No bank transfers.

Reprints should be requested with the form enclosed with the acceptance letter. No free reprints will be supplied.



© By I.R.O.G. CANADA INC. - Publisher - Editorial office 4900 Côte St. Luc - Apt. 212 - Montréal Québec H3W 2H3 (Canada) - Tel. (514) 4893242-4893640 - Fax (514) 4854513 - Printed in Italy by “La Garangola” - Via E. Dalla Costa, 6 - 35129 Padua (Italy) - Responsible Director: Prof. Antonio Onnis M.D. - Authorization of Padua’s Court n. 633 - 28-6-1979
   
European Journal of Gynaecological Oncology - Vol. XXIX, n. 2, 2008
 
   
CONTENTS  
DISTINGUISHED EXPERT SERIES  
The 21st century role of Piver type II hysterectomy in FIGO Stage IA, IB cervical cancer: A personal perspective 109
M.S. Piver, J.Y. Lee - Buffalo, NY (USA)
A personal perspective on the use of the Piver type II hysterectomy based on FIGO classification of Stages IA1, IA2, IB1 and IB2 is presented
 
 
ORIGINAL ARTICLES  
Epidemiological, clinical and viral determinants of the increased prevalence of high-risk human papillomavirus (HPV) infections in elderly women 114
K. Syrjänen, S.M. Kulmala, I. Shabalova, N. Petrovichev, V. Kozachenko, T. Zakharova, J. Pajanidi, J. Podistov, G. Chemeris, L. Sozaeva, E. Lipova, I. Tsidaeva, O. Ivanchenko, A. Pshepurko, S. Zakharenko, R. Nerovjna, L. Kljukina, O. Erokhina, M. Branovskaja, M. Nikitina, V. Grunjberga, A. Grunjberg, A. Juschenko, R. Santopietro, M. Cintorino, P. Tosi, S. Syrjänen - Turku, FINLAND
In older women who fail to eradicate their HR-HPV infections, virus integration takes place leading to disease progression towards high-grade CIN and invasive carcinoma.
 
Comparison of conization and limited excision of the transformation zone (LETZ) in the treatment of squamous intraepithelial lesions (SIL) of the uterine cervix 123
E. González Bosquet, C. Esteva, C. Muñoz-Almagro, J.M. Lailla - Barcelona, SPAIN
LETZ may be an alternative to conization in the treatment of high-grade cervical SIL.
 
Estrogen receptor α and β expression in a case matched series of serous and endometrioid adenocarcinomas of the ovary 126
J.P. Geisler, E. Buller, K.J. Manahan - Iowa City, IA (USA)
The expression of estrogen receptors α and β in relation to stage and grade in serous and endometrioid adenocarcinoma is analyzed.
 
Uterine sarcoma: a report of 57 cases over a 16-year period analysis 129
P. Tsikouras, V. Liberis, G. Galazios, A. Savidis, A. Grapsa, X. Grapsas, A.T. Teichmann, G. Maroulis - Thrace, GREECE
Sarcoma of the uterus is a rare malignant neoplasm associated with a poor prognosis.
 
Magnetic resonance imaging in the preoperative staging of endometrial carcinoma 135
S. Cabrita, H. Rodrigues, R. Abreu, M. Martins, L. Teixeira, C. Marques, F. Mota, C. Freire de Oliveira - Coimbra, PORTUGAL
This study aimed to assess the value of MRI in the preoperative staging of endometrial carcinoma by comparing MRI images with pathological findings.
 
Does the localisation of tumour at Stage I endometrial endometrioid adenocarcinoma have an impact on invasion of the tumour and individualisation of the surgical procedure? 141
S. Dilek, M. Dede, K. Gezginç, M.C. Yenen, Ü. Göktolga, H.C. Ulutin, M.S. Deveci, E. Erdemoglu, T. Aydogdu - Zekai Tahir Burak (ZTB) (TURKEY)
The impact on invasion of Stage I endometrioid adenocarcinoma in relation to localisation and surgical procedure is analysed.
 
Frequency of infectious agents for vaginitis in patients with a cytological diagnosis of atypical squamous cells of undetermined significance 114
N.R. Tirone, C.E.V. Souza, M.A. Michelin, E.F.C. Murta - Uberaba, MG (BRAZIL)
Diagnoses of ASCUS can be induced by the presence of infectious agents for vaginitis, mainly cocci and coccoids.
 
Knowledge about and attitudes to Pap smears, cervical cancer and human papillomavirus among women in Slovenia 148
M.U. Vrsˇcˇaj, A. Vakselj, V. Strzˇinar, S. Bebar, M. Baskovic, A.P. Fras, A. Djurisˇic´ - Ljubljana, SLOVENIA
In Slovenia relevant and accurate information on HPV infection, early detection of cervical cancer and preventive vaccination should be improved.
 
Evaluation of acute and late radiation morbidity in patients with gynaecologic malignancy using the RTOG criteria and Franco-Italian glossary 154
G. Yildirim, Z. Özsaran, D. Yalman, S. Kamer, A. Aras - Izmir, TURKEY
A prospective clinical study to evaluate the competence of two toxicity scoring systems in patients who undergo pelvic radiotherapy for gynaecologic cancers is reported.
 
Plasma lipid profile in gynecologic cancers 158
M.I. Qadir, S.A. Malik - Islamabad, PAKISTAN
The relationship between gynecological cancer and plasma lipids is studied.
 
SodiumPhosphate (NaP) versus polyethylene glycol-electrolyte lavage solution (PEG-ELS) tolerability: a prospective randomized study in patients with gynecological malignancy 162
F.B. Cebesoy, O. Balat, S. Pence - Gaziantep, TURKEY
Bowel cleansing before gynecological malignancy surgery with NaP was superior to polyethyleneglycol-electrolyte solutions in terms of patient tolerability, completing the regimen and cost effectiveness.
 
Can “chromohysteroscopy” help target endometrial biopsy in postmenopausal bleeding? 165
T. Küçük, S. Deveci - Ankara, TURKEY
Endometrial death during diagnostic hysteroscopy (chromohysteroscopy) can help target endometrial biopsy.
 
 
CASE REPORTS  
Fallopian tube cancer associated with paraneoplastic dermatomyositis - asymptomatic multivisceral exacerbated dermatomyositis mimicking recurrent widespread malignant disease: case report 168
J. Seeber, D. Reimer, E. Müller-Holzner, G. Spizzo, N. Sepp, P. Wiesbauer, C. Marth, A.G. Zeimet - Innsbruck, AUSTRIA
Asymptomatic exacerbated dermatomyositis involving the liver, spleen, lungs, adrenal glands and lymph nodes was mistakenly regarded as widespread recurrent fallopian tube cancer.
 
Neoadjuvant chemotherapy followed by extended-field concurrent chemoradiotherapy in squamous cell carcinoma of the cervix with positive paraaortic lymph nodes: two cases 171
M. Hirakawa,Y. Nagai, C. Yagi, T. Nashiro, M. Inamine,Y. Aoki - Okinawa, JAPAN
NAC followed by EF-CCRT is feasible and may improve the survival outcome of patients with cervical carcinoma with positive paraaortic lymph nodes.
 
Primary ovarian choriocarcinoma mimicking ectopic pregnancy managed with laparoscopy - case report 174
Y.X. Chen, J. Xu,W.G. Lv, X. Xie - Hangzhou, P.R. CHINA
Laparoscopy is invaluable in both the diagnosis and comprehensive staging procedure in early-stage primary ovarian choriocarcinoma.
 
Unusual histologic finding in tissue obtained from voluntary pregnancy termination: a case report 177
G. Giordano, T. D’Adda, C. Grassani - Parma, ITALY
This report demonstrates that pathological study of tissue obtained from voluntary pregnancy termination provides new information regarding a woman’s gynecological health.
 
Metastatic breast carcinoma initially presenting as acute cholecystitis: a case report and review of the literature 179
A. Manouras, E.E. Lagoudianakis, M. Genetzakis, N. Pararas, A. Papadima, P.B. Kekis - Athens, GREECE
A rare case of a solitary breast cancer metastasis to the gallbladder found after laparoscopic cholecystectomy for acute cholecystitis is reported.
 
Virchow’s node as a first manifestation of ovarian serous carcinoma: case report 182
F.B. Cebesoy, O. Balat, A. Aydin - Gaziantep, TURKEY
Ovarian carcinoma could present not only with ascites and an adnexal mass but with an extrapelvic lymph node such as Virchow’s node.
 
Vaginal paraganglioma presenting as a gynecologic mass: case report 184
J.G. Shen,Y.X. Chen, D.Y. Xu,Y.F. Feng, Z.H. Tong - Hangzhou, P.R. CHINA
The possibility that a tumor is a paraganglioma should be considered before surgical removal of vaginal solid tumors.
 
Two cases of immature teratoma with positive reproductive outcomes 186
S. Milicevic, R. Argirovic´, N. Radunovic´, Z. Vilendecˇic´, D. Plec´asˇ, M. Pervulov, L. Mirkovic´, M. Berisavac, V. Boskovic´ - Belgrade, SERBIA
Two cases of immature teratoma with a positive reproductive outcome are presented. Surgery alone is curative in most cases.
 
Pathological complete response after primary chemotherapy in a mother and daughter with hereditary breast carcinoma: two case reports 188
B. Melichar, P. Fridrichová, Sˇ. Lukesˇ ová, J. Mergancová, H. Urminská, A. Rysˇ ka, L. Foretová - Brno, CZECH REPUBLIC
Pathological complete response after primary chemotherapy was observed in both a mother and daughter carrier of the BRCA1 mutation.
 
Uterine leiomyosarcoma metastasis to the breast 191
H.H. Hsiao,Y.C. Liu, M.F. Hou, S.F. Lin- Kaohsiung, TAIWAN
Uterine leiomyosarcoma is a rare female neoplasm. A case of a 62-year-old female with uterine leiomyosarcoma metastasis to the breast is presented.
 
A sacomatous-type peritoneal malign mixed mullerian tumor implant in association with ovarian adenocarcinoma: a case report 193
M. Dede, K. Gezginç, I·. Alanbay, U. Fidan, M. Yenen - Ankara, TURKEY
A case of a malignant mixed mullerian tumor implanted in the peritoneum associated with ovarian adenocarcinoma is described.
 
Secondary involvement of breast with non-Hodgkin’s lymphoma in a patient with HIV infection - case report 196
V. Georgountzos, L. Ioannidou-Mouzaka, T. Soldatos, D. Apessou, A. Karatasiou, M. Tsouroulas, G. Kontogeorgos - Athens, GREECE
A rare case of secondary lymphoma of the breast in a female AIDS patient who presented with a unilateral breast mass.
 
Tamoxifen and giant endometrial polyp 198
E. Erdemoglu, M. Güney, B. Keskin, T. Mungan - Isparta, TURKEY
The case of a woman with a giant endometrial polyp of uncommon dimension who was receiving adjuvant tamoxifen for breast cancer is presented.
 
BRIEF COMMUNICATION  
A breast cancer patient with pelvic and gastric malignancy after adjuvant tamoxifen treatment for breast cancer 200
M. Dede, K. Gezginç, M. Ulubay, I ·. Alanbay, S¸. Güran, M. Yenen - Ankara, TURKEY
A case of woman with three different tumors which developed after tamoxifen treatment for breast cancer is described.