Adenoid basal carcinoma (ABC) is a rarely reported type of invasive cervical carcinoma with distinct clinical and pathological features. To make clinicians and pathologists more aware of this tumor and to investigate its pathogenesis, five new cases with human papillomavirus (HPV) DNA studies and a literature review of 30 cases were presented. The following tendencies of ABC were confirmed: occurrence in an older age group, absence of symptoms, abnormal Papanicolaou (Pap) smear, normal pelvic examination, endophytic growth pattern, associated cervical intra‐epithelial neoplasia, low nuclear grade, absence of vascular space invasion, absence of nodal metastases, low stage and good prognosis. In contrast to previous reports, ABC was not found to be rare in the older age group and a spate of cases occured following a Pap smear campaign directed at older women. Human papillomavirus DNA was found in three of five cases. One was typed as HPV 16 and the other two were HPV MM4 and HPV 58. Adenoid basal carcinoma should be considered when an asymptomatic postmenopausal woman has a high grade intra‐epithelial abnormality on Pap smear and colposcopy shows an endocervical canal lesion or no abnormality. It is important to recognize ABC because its good prognosis may allow less aggressive treatment than the usual forms of cervical cancer.

Objective To investigate the reasons for cone biopsies reported as not containing intraepithelial or invasive malignancy and thereby find ways to decrease their incidence.Design One hundred cone biopsies reported as negative were identified out of a total of 436 consecutive cone biopsies. The patients' cytology, colposcopy and histology reports and cytology and histology slides were reviewed. Further opinions in cases of doubt were obtained in cytology and histology. In cone biopsies still considered negative after reviews, deeper levels were cut, exhausting all paraffin blocks. Follow up cytology, colposcopy and histology were reviewed.Setting Gynaecological oncology unit in a university teaching hospital.Results After re-evaluation the final diagnoses of cone biopsies initially reported as negative were positive (n = 21), unsatisfactory (n = 27) and true negative (n = SI), with one case excluded because of insufficient material for review. The positive cases were diagnosed on review (n = 11) or extra levels (n = 10). The unsatisfactory cases were all due to denudation. The 5 1 true negative cases were divided into those which never had had histologic confirmation by punch biopsy or endocervical curettage (n = 47) and those with a previously confirmed histological abnormality (n = 4). Conclusions The number of negative cone biopsies can be reduced by: 1. taking Pap smears after correction of atrophy and inflammation; 2. more scrupulous colposcopy aimed at reducing the number of unsatisfactory colposcopies or misinterpreted colposcopic findings; this thorough examination should include the vagina and vulva; 3. confirmation of smear and colposcopic findings by biopsy prior to cold-knife conisation and performing a large loop excision of the transformation zone (LLETZ) for cases where there is a discrepancy between the smear abnormality and colposcopy/biopsy findings; 4. good quality cone biopsies using a technique that does not handle the mucosa and is performed after the mucosa has had time to regenerate following the colposcopic investigations; and 5. exhausting all blocks with multiple levels before reporting a cone biopsy as negative. INTRODUCTIONThe traditional management of preinvasive disease of the cervix begins with an abnormal smear detected on routine screening. The patient is referred to a colposcopist who attempts to grade, delineate and biopsy the abnormality. A colposcopic-directed biopsy confirms the smear and colposcopic diagnoses and, at a second visit, the abnormal transformation zone is destroyed. Where there is suspicion of invasion or adenocarcinoma in situ or an unsatisfactory colposcopy (defined as an inability to see the full transformation zone, the endocervical limits of a lesion or a discrepancy between the smear and colposcopic findings) a cone biopsy is performed. The cone biopsy usually provides a definitive diagnosis, with type, grade, extent of the lesion and state of the resection lines. Not infrequently, however, no lesion is found on histological examination of the cone biops...

Objective: To describe the management of and outcomes in patients with newly diagnosed ovarian cancer during 1993, 1994 and 1995 in Victoria. Design and setting: Retrospective cohort study conducted by surveying doctors involved in managing incident ovarian cancer cases identified from the population‐based Victorian Cancer Registry. The survey was conducted in 1997 and the cohort was followed up until the end of 1999 to obtain at least four years of follow‐up data on all patients. Patients: All women with invasive epithelial ovarian cancer diagnosed during 1993, 1994 and 1995. Main outcome measures: Reported management in terms of staging, treatment and survival. Results: Management details were obtained for 84.5% (562/665) of eligible patients. Median age at diagnosis was 66 years (range, 22–98 years). Surgery was the primary therapy in 77.2% of women (434/562). Only one in three women had adequate surgery, which was less likely to be performed by general gynaecologists and general surgeons than gynaecological oncologists (21.3% [35/164] v 13.3% [8/60] v 52% [105/202]). After surgery 78.6% of women (341/434) received chemotherapy, usually with platinum‐based regimens. The overall five‐year relative survival was 46% for women treated surgically; poor survival was related to increasing age, later tumour stage, presence of ascites, residual disease > 2 cm and poorer histological differentiation of the tumour. Conclusions: For optimal care a preoperative carcinoma antigen (CA)‐125 assay, chest x‐ray and pelvic ultrasound should be performed, and early referral to a multi‐disciplinary unit for definitive surgery is advised. Every effort should be made to adequately stage or debulk the tumour. Women with high‐risk early‐stage and advanced disease should be considered for platinum‐based chemotherapy.

Cervical cancer is the commonest malignancy which complicates pregnancy, but the management remains controversial. We reviewed our patients in an attempt to identify the best management options which resulted in long-term survival for the mother and a live baby. The total number of pregnancies managed between January, 1981 and March, 1995 was obtained from the hospital records, and patients with invasive cervical cancer diagnosed during pregnancy or within 12 months of delivery were identified. The case records were reviewed. Between January, 1981 and March, 1995 there were 22 cases of cervical cancer diagnosed either during pregnancy or within 12 months postpartum. This gave an incidence of cervical cancer associated with pregnancy of 1 in 3,817 pregnancies or 0.26 per 1,000 pregnancies. Eleven patients had microinvasive disease. Nine were treated by cone biopsy and 2 by radical hysterectomy. Nine patients had Stage 1B and 1 had Stage 2A disease and all were treated with radical hysterectomy. One patient had Stage 3B disease and was treated with radiotherapy and chemotherapy followed by simple hysterectomy. Fourteen patients delivered vaginally. Twenty of the 22 patients were delivered of live babies which survived. The patients have been followed from 1 month to 13 years with only 1 recurrence, and all 22 remain alive. We conclude that all pregnant women should have a Pap smear performed antenatally. Cone biopsy can be safely performed in pregnancy and may be adequate treatment for microinvasive squamous cell carcinomas. Treatment, including the timing of delivery, must be individualized, with the patient playing an important decision-making role.