Laparoscopic lymphadenectomy followed by NACT and RVT in pN0 patients with cervical cancer of more than 2 cm seems to be an oncologically safe procedure with promising fertility outcomes.

: Exocolposcopy with the VITOM is accurate and shows good correlation to histologic findings in high-grade disease of the lower genital tract. The potential advantages include patient and trainee involvement in examination, decision making, and documentation.

Recently antibodies against neuronal receptors have been identified as cause of a new type of encephalitis. The anti-N-methyl-D-aspartate receptor (anti-NMDA-R) encephalitis is the prototype of these disorders. Patients have a high incidence of teratomata. Removal of teratoma is considered the essential treatment of anti-NMDA-R encephalitis. Here, we aimed to investigate whether neurologically asymptomatic individuals suffering from ovarian teratomata may have positive anti-NMDA-R antibodies to be detected by an established assay. Over a time period of 15 months, all patients suffering from ovarian teratomata without neurological symptoms were included in this prospective study. Twenty consecutive patients were pair matched to patients with other benign ovarian disease and healthy controls. Preoperatively, patients had a gynaecological examination, transvaginal ultrasound, neurological examination and determination of anti-NMDA-R antibodies. None of the patients or controls presented with neurological symptoms. All tumours could be removed completely by laparoscopy. Anti-NMDA-R antibodies were absent in the group of patients with teratomata as well as in patients with benign ovarian tumours and healthy controls. Testing for anti-NMDA-R antibodies revealed negative findings in well-characterised patients with ovarian teratomata lacking neurological symptoms. Our data support the current clinical practice that a systematic screening for anti-NMDA-R antibodies in teratoma patients is not indicated.

Objective: The lymph node number as benchmark in oncologic operations depends on the patient’s anatomy, surgeon’s skill and pathologist’s accuracy. The influence of the pathologist is barely evaluated. Methods: A retrospective analysis of lymph node numbers after 700 laparoscopic lymphadenectomies in correlation to the examining pathologists was done. Three surgeons from the same department performed all operations at 2 campi, where 2 separate pathology institutions exist. Lymph node specimens were assigned randomly to any of the 62 involved pathologists. Results: The mean number of lymph nodes was equal for all surgeons. Lymph node specimens were analyzed in the pathology institute of campus I and II in 416 and 284 cases, respectively. The mean number of lymph nodes following pelvic and para-aortic lymphadenectomy was 36 at campus II and 30 at campus I (p < 0.0001). There was also a significant difference for pelvic (19.9 vs. 17.7; p < 0.0001) and para-aortic lymph node counts (16.2 vs. 14.1; p < 0.01) between both pathology institutes. At campus II, 22.6% of lymph node counts did not meet the oncologic standard for pelvic and 16.7% did not meet the standard for para-aortic lymph nodes. Moreover, at campus I, 35.5 and 20.8% of pathologists described less than the oncologic limit of pelvic and para-aortic lymph nodes, respectively. Conclusion: The number of removed lymph nodes is not an absolute parameter for surgical radicality. Interdisciplinary cooperation with pathologists is mandatory to meet oncologic standards.

There is a dire need for improved cervical cancer screening methods. New tests are in the pipeline, but their diagnostic capabilities may be limited without a way to assess specimen validity. Here we describe an enzyme-linked immunosorbent assay (ELISA) that captures specific intermediate filament proteins (cytokeratins) from potentially transformable target cells located within or originating from the cervical transformation zone as a means of cervical specimens. Seventy-five uterine cervical samples negative for human papillomavirus (HPV) were grouped based on microscopic analysis for the presence or absence of cervical transformation zone cells, and all samples were tested in both a newly developed recom Well Keratin 5/8/18 ELISA and a pan keratin control ELISA. Additionally, 15 samples from HPVpositive patients manifesting histopathologic lesions or squamous cell carcinoma were tested. Our results demonstrate the presence and detectability by ELISA of keratins 5, 8, and 18 in parabasal, squamous metaplastic, and endocervical cells, while simultaneously suggesting their absence in differentiated squamous cells. We also validate with ELISA the expression of these keratins in HPV-induced disease-state individuals. Our findings indicate recom Well Keratin 5/8/18 ELISA may be useful as a standardizing tool in cervical cancer screening, or alternatively as a quality indicator to denote specimen adequacy.