Could endometrial cytology be helpful in detecting endometrial malignancies?

This short communication assesses the concordance indexes between hysteroscopic biopsies and endometrial cytology for each endometrial pattern found in a sample of 37 women. Patients underwent endometrial cytology under sonographic guidance. The specimens were obtained with an endocervical brush and were fixed on slides (no liquid-based methods). After endometrial cytology, hysteroscopy with biopsy was performed. The best concordance index was found for endometrial malignancies, suggesting that endometrial cytology is able to detect cancers but not other endometrial diseases, as compared with endometrial hysteroscopic biopsies. Therefore, the overall concordance index suggests a fair concordance between histological and cytological findings. This leads us to conclude that usual endometrial cytology should not be recommended to screen endometrial diseases, but it may be used as an alternative diagnostic tool when hysteroscopic biopsies or other blinded procedures for endometrial sampling are unwanted, because it allows malignancies to be detected as well as hysteroscopic-guided biopsies.

Expression of basic fibroblast growth factor, its receptors and syndecans in bladder cancer.

Basic fibroblast growth factor (bFGF) is a heparin-binding cationic protein involved in a variety of pathological conditions including angiogenesis and solid tumour growth. The basic fibroblast growth factor receptor (FGFR) family comprises at least 4 high affinity tyrosine kinase receptors that require syndecans for their function. Mounting evidence indicates that syndecans, that bind both bFGF and their FGFRs, will act as stimulators, whereas syndecans that only bind bFGF will act as inhibitors of signaling by sequestering the growth factor. Recent findings have highlighted the importance of syndecans in urological cancers. The aim of this study is to investigate the expression of bFGF, its receptors (R1 and R2) and syndecans (1-4) in invasive urothelial carcinoma and normal-looking urothelium by Western blotting, RT-PCR, and immunohistochemistry analyses. Interestingly, bFGF, FGFR1 and FGFR2 protein levels statistically increased in bladder cancer tissues. mRNA of FGFR1 and syndecans (1-4), showed a statistically significant increase while an mRNA increase in the other molecules analysed was not significant. bFGF, its receptors and syndecan immunostaining were mainly present in the urothelium both in normal-looking tissues and urothelial neoplastic cells. In conclusion, our data report that the bFGF, FGFR and syndecan expressions are altered in bladder tumours.

[Laparoscopic treatment of ovarian cysts in women over 40]. / Trattamento laparoscopico delli cisti ovariche in donne al di sopra dei 40 anni.

BACKGROUND: Laparoscopy constitutes the main surgical method for treating benign ovarian pathology in women under 40 years of age. The discussion is about the possibility of extending this surgical method to patients over 40 in whom the risk of malignant ovarian pathology is either borderline or considerably higher. The objective of this study was to evaluate the feasibility of laparoscopic treatment for these patients, who have been submitted to adequate screening, comparing the results of echographic diagnosis, laparoscopy and histology. METHODS: This study includes 65 patients, all over 40 (average age 51 years, range 41-71 years): 34 were in menopause and 31 had a normal menstrual cycle. All were suffering from ovarian pathology. They were selected on the basis of a diagnostic protocol and then submitted to laparoscopic treatment and a follow-up check. RESULTS: The laparoscopic approach led to a clear improvement of the diagnosis compared to echography and dosage of the markers. The percentage of similarity between echographic and laparoscopic diagnosis was 84.6% while in the case of echographic diagnosis and histological examination this was 78%. The percentage of similarity between laparoscopic and histological diagnosis was 94%. Only one case of conversion to laparotomy occurred. CONCLUSIONS: Patients over 40 years of age can present a wide range of pathologies that can be treated by means of laparoscopy. Never the-less, also when confronted with an unclear diagnosis, which would otherwise require laparotomy, the laparoscopic approach significantly improves of the diagnosis without any ultimate worsening of the prognosis.

Prognostic relevance of altered Fas (CD95)-system in human breast cancer.

The Fas ligand (FasL) and its receptor Fas (APO-1 or CD95) are members, respectively, of the tumor necrosis factor family that, upon interaction with each other, play a key role in the initiation of one apoptotic pathway. Faulty regulation of the Fas system has been described in a variety of human tumors with different histogenetic origin. Here, we describe the expression and distribution of Fas receptor and ligand pair antigens in surgical samples collected from a cohort of 186 patients bearing breast neoplasms (45 benign and 141 malignant lesions). Immunoperoxidase staining of formalin-fixed tissues showed that 91.1% of benign lesions expressed Fas, which was present in only 56.7% of malignant tumors. On the other hand, FasL was found positive in 22.2% of benign neoplasms and up-regulated in in situ as well as invasive carcinomas (53.9%). Moreover, in malignant tumors, the expression of receptor and ligand antigens appeared to be inversely related. When these findings were correlated with pathological parameters of prognostic relevance, a significant association was observed between FasL and the presence of metastatic lymph nodes and larger tumor size while Fas expression correlated to node-negative status and smaller tumor size. Patients with Fas positive tumors exhibited longer disease-free survival than those with Fas-negative carcinoma while FasL did not influence patient outcome. These relationships indicate that benign and malignant mammary lesions are characterized by differential cellular expression of Fas and FasL and suggest that a neoplastic Fas negative/FasL positive phenotype may be linked to breast cancer progression.

[Postmenopausal endometrial tuberculosis. A clinical case]. / Tubercolosi endometriale post-menopausale. Caso clinico.

Post-menopausal tuberculosis of the female genital tract is an uncommon condition that has received relatively little attention in the literature. The case described by the authors is about a sixty year old woman whose condition was brought to attention by leukorrhea and abnormal bleeding associated with a smear test suggesting CIN 1. An endometrial aspiration biopsy revealed necrotic debris with focal granulomata and numerous acid-fast bacilli. Fungal stains were negative while mycobacterium tuberculosis was found. After three months of combination antimycobacterial treatment, she underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by six months of post-operative drug therapy.