Objective. The purpose of this work was to review current knowledge pertain
ing to angiogenesis in malignancies of the female genital tract.
Methods. We identified studies published in the English language regarding
angiogenesis in gynecologic malignancies, The studies were obtained from a
MEDLINE search from 1966 through June 1998; additional sources were identif
ied through cross-referencing.
Results. A growing body of evidence confirms the ability of vulvar and cerv
ical squamous cell carcinomas and endometrial and ovarian adenocarcinoma to
induce angiogenesis. In vulvar intraepithelial neoplasia a correlation bet
ween vascular endothelial growth factor (VEGF) expression, microvessel dens
ity (MVD), and progression of dysplasia has been demonstrated. In invasive
vulvar carcinoma, high VEGF expression and MVD portend poor prognosis. Curr
ently a debate exists regarding the ability of cervical squamous intraepith
elial neoplasia to induce angiogenesis. Most studies, however; indicate ang
iogenesis to he of prognostic value in patients with invasive squamous cell
carcinoma. The ability of complex endometrial hyperplasia to induce angiog
enesis has been demonstrated. A direct correlation between angiogenesis, hi
gher grade and depth of invasion in Stage I adenocarcinoma, and prognostic
value in Stage I and II and recurrent disease has been noted. In ovarian ep
ithelial adenocarcinoma, higher microvessel counts in the primary ovarian t
umor of omental metastases may serve as a prognostic indicator for survival
.
Conclusions. Similar to other malignant diseases, angiogenesis appears to p
lay an important role in disease progression and survival in patients with
gynecologic malignancies, Preliminary data indicate angiogenesis may serve
as a prognostic indicator in vulvar and cervical squamous cell carcinomas a
nd endometrial and ovarian adenocarcinomas, These findings may lead to futu
re application of therapeutic trials with antiangiogenic factors. (C) 1999
Academic Press.