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To determine the efficacy of colposcopy plus ZedScan, which measures changes in tissue electrical impedance, for detecting intraepithelial high-grade lesions compared to colposcopy alone.

A 1 cm polypoid lesion was encountered on the posterior vaginal wall in a 56-year-old woman with no history of diethylstilbestrol exposure that on microscopic examination was a moderately differentiated adenocarcinoma of intestinal type. The tumor was cytokeratin 20 and carcinoembryonic antigen positive and negative for cytokeratin 7. Mucin histochemistry demonstrated the presence of o-acetylated sialomucin, a specific marker of large intestinal differentiation. The initial interpretation favored a metastasis from a colonic adenocarcinoma, but clinical investigations showed no evidence of a primary gastrointestinal lesion. The morphology, histochemical, and differential cytokeratin profile led to the lesion being reinterpreted as a primary intestinal-type adenocarcinoma of the vagina arising from a tubular adenoma. Although a very rare tumor, awareness of this lesion is important as it must be distinguished from metastatic adenocarcinomas from other sites.

This article aims to cover current concepts and controversies in the surgical management of ovarian cancer. While there have been significant advances in the surgical management of vulval, cervical and even endometrial cancer there have been few developments in the surgical management of ovarian cancer. This situation is likely to continue until we get a clearer understanding of the natural history of this disease and better therapeutic options become available. Copyright 2001 Harcourt Publishers Ltd

Two neighbouring centres, both located in an area where the prevalence of neural tube defects (NTDs) is low, were compared to determine if there was any advantage in their differing policies as regard the antenatal detection of NTDs. At both centres routine ultrasound examinations were performed at 16–18 weeks gestation but at Hospital A serum alpha-fetoprotein (AFP) was measured at 16 weeks gestation. The prevalence of NTDs was 1.3 per 1,000 births at Hospital A and 1.7 per 1,000 births at Hospital B. The detection of anencephaly at both hospitals was 100%, however, only 43% of spina bifidas were detected at Hospital A compared with 60% at Hospital B. These results, the loss of two fetuses following amniocentesis at Hospital A and the lower detection rate for NTDs at the hospital employing AFP measurement are discussed.

To determine if ovarian cancer patients would be suitable for MAGE-peptide vaccine-based immunotherapy, the frequency of expression of the MAGE-1-4 genes in ovarian tumours was assessed using reverse transcription polymerase chain reaction (RT-PCR) and product verification with digoxigenin-labelled oligonucleotide probes specific for each MAGE gene. In addition, the frequency of expression of more recently discovered tumour antigens (BAGE, GAGE -1, -2 and GAGE -3, -6) was established using RT-PCR and ethidium bromide staining. In this study 1/16 normal ovarian tissue specimens and 11/25 benign lesions expressed MAGE-1. In non-malignant tissue there was preferential expression of MAGE-1 in premenopausal women. A total of 15/27 malignant specimens expressed MAGE-1, including 10/14 serous cystadenocarcinomas. Expression of other tumour antigens was infrequent. The finding of MAGE-1 expression in both benign and malignant tissue questions previous assumptions regarding the role of MAGE genes in carcinogenesis. In addition, preferential MAGE-1 gene expression in non-malignant premenopausal tissue suggests that the MAGE genes may be involved in cellular proliferation as opposed to carcinogenesis or possibly that MAGE gene expression is under cyclical hormonal control. Finally, this study indicates that serous cystadenocarcinomas may be suitable tumours for MAGE-1 peptide immunotherapy.

Analyses of cancer cell lines and of anal cancers suggest an inverse correlation between infection with human papillomavirus (HPV) and somatic mutation of the p53 tumour-suppressor gene. We have investigated this association in primary cervical tumours. Tumour-tissue samples from 28 women with primary cancer of the cervix were analysed for presence of HPV sequences and for somatic mutations of the p53 gene. Southern blot analysis and the polymerase chain reaction (PCR) showed that 25 of the tumours contained H PV sequences; 20 were HPV16 positive and 5 HPV18 positive. 17 tumours subjected to restriction fragment length polymorphism analysis for the short arm of chromosome 17 showed no evidence of allelic deletion. Sequencing of the entire coding region of the p53 gene by asymmetric PCR detected heterozygous point mutations in only 3 H PV-negative tumours. By contrast, in 21 HPV-positive cancers the p53 sequence was wild-type throughout. Our data indicate that loss of wild-type p53 function is important in the pathology of cervical cancer and that in the absence of an HPV-encoded gene product that mediates loss of p53 function, somatic mutation of the gene is required. This pattern of p53 mutation may partly explain the apparently worse prognosis of HPV-negative cervical cancers. Lancet1992; 339:1070-73

Women with high-grade cervical smears may be offered a defer-and-treat (DT) option in which management depends on what is found on biopsies of colposcopically suspicious areas. Alternatively, the see-and-treat (ST) option entails large loop excision of the transformation zone if the colposcopist is certain that cervical intraepithelial neoplasia-2 (CIN2) or more advanced disease is present. This prospective study, based on mailed responses to a questionnaire by 272 women with high-grade CIN who were referred for colposcopy, was intended to explore the psychological impact of these two approaches and to test the authors’ hypothesis that women prefer ST to DT. The questionnaire, which assessed the women’s perceptions and emotional reactions following their first colposcopy visit, was sent to them 1 week afterward.

Electrical impedance may be measured using electrodes on the surface of the cervix and recording the potential that results when an electrical current is passed. Increased hydration of the cervix has been described throughout pregnancy and occurs most dramatically before labour. This study compared tissue impedance measurements of the pregnant and non‐pregnant cervix and found a statistically significant lower value (P< 0.001) in pregnancy. Further work may show that such measurements alter in relation to labour onset.