LDH and LDH isoenzymes in ovarian dysgerminoma.

Lactic Dehydrogenase (LDH) serum levels were evaluated in three patients with ovarian dysgerminoma and LDH isoenzymes only in one of them. LDH serum levels were elevated at diagnosis and normal after therapy in all the patients; remained low in two patients in remission, increased in one at the moment of progression. LDH isoenzymes appeared to be of limited clinical use.

Immunophenotypic and genotypic characterization of B-cell chronic lymphocytic leukemia patients from northern Italy.

BACKGROUND AND METHODS: Immunoglobulin (Ig) gene expression and rearrangements provide information about cell lineage, clonality and differentiation of neoplastic lymphoid cells. We performed flow cytometry and Southern blot analysis in 25 patients with chronic lymphocytic leukemia (CLL) from the Po River delta region (Northern Italy), in order to correlate surface immunological phenotype and heavy and light chain gene rearrangements with clinical stages. RESULTS: In these 25 CLL cases, as in the larger group of 165, k-positive (k+) patients were more frequent than lambda-positive (lambda +) ones by a ratio of 59:41, with a predominance of lambda + in stage II (46:54) and of K+ in stage IV (77:23). However, the survival behavior of lambda + and k+ patients was not statistically different. Ig gene rearrangements were found in all patients in accordance with the immunophenotype. When Ig gene analysis was performed on two different occasions in 7 of the 8 who received chemotherapy, there was an increase in the percentage of the germline band. This variation was inversely related to changes in WBC count. In the treated subject who showed a reduction of both WBC count and the germline, there was rapid disease progression and short survival. CONCLUSIONS: Analysis of Ig gene rearrangements in our CLL patients demonstrated: i) the monoclonality of neoplastic cells; ii) no correlation between rearrangements and clinical stages, and iii) that this analysis may be a useful tool in evaluating biological behavior in selected CLL cases showing a discrepancy between hematological data and clinical response to therapy.

Risk factors in vulvar carcinoma recurrences.

18 patients with invasive vulvar carcinoma treated by radical vulvectomy and bilateral groin lymphadenectomy have been evaluated. An 18% of local and 22% of pelvic or distant recurrences occurred. The local recurrences had favorable prognosis, whereas the pelvic or distant recurrences a worse prognosis. The staging, the tumour size, the nodes involvement, the stromal infiltration and the lymphoplasmacytic infiltration, as prognostic factors, have been evaluated. All these factors, except the tumour size, influenced the pelvic or distant recurrences. The pelvic or distant recurrences were contemporaneously associated with mild phlogistic infiltration and depth of invasion > 5 mm.

[Cerebral lesions in patients with ovarian cancer]. / Lesioni cerebrali in pazienti con carcinoma ovarico.

The Authors report the appearance of Central Nervous System lesions in three patients previously treated for ovarian carcinoma. In one case (Stage 1) the histological sample found a glioblastoma, in the others (Stage 3) the lesion was the metastases after systemic diffusion of the primary carcinoma. CNS metastases are rare and more frequently occur in advanced ovarian carcinoma. In patients at Stage 1, CNS isolated lesions may be primary tumors.

[Dermoid cyst associated with planocellular carcinoma]. / Cisti dermoide con associato carcinoma a cellule piatte.

The case of an ovarian mature cystic teratoma with an associated squamous cell carcinoma is described. The patient, in advanced stage, died a few months after surgery, during the treatment by chemo and radiotherapy.

Combined use of progesterone challenge test and endometrium thickness evaluated by transvaginal ultrasonography in the preventive management of postmenopausal women.

Endometrial thickness was evaluated in apparently normal postmenopausal women by transvaginal ultrasonography and the results were compared with the response to the progesterone challenge test (PCT). A positive correlation between amount of withdrawal bleeding after PCT and endometrial thickness was found, also demonstrated by the significative correlation between bleeding length and endometrial thickness. Among women referring withdrawal bleeding, 100 and 22% of cases classified as overt flow and spotting, respectively, were characterized by pathologic histological findings. The combined use of these two procedures is suggested as an effective screening mean in the preventive endometrial management of apparently normal postmenopausal women to select candidates for diagnostic invasive procedures.

Surgical treatment of invasive carcinoma of the vulva. A reappraisal.

The Authors studied three groups of patients affected by invasive vulvar carcinoma. The first group (19 cases), treated by radical vulvectomy and bilateral inguinal lymphadenectomy, had a survival rate at 5 years of 89% in Stage I and 56% in Stage II. The second group (9 cases) which presented poor general health conditions, had a survival rate at 4 years of 33% and 14% in Stage I and in Stage II, respectively. The third group of patients (7 cases), who refused any type of treatment, died within 12 months. Nodal involvement influenced survival rate. In fact, regardless of the stage, a survival rate at 5 years of 92% and 26% was seen in patients with negative nodes and positive nodes, respectively. In conclusion, the study confirms that radical surgery is the therapy of choice in advanced carcinoma of the vulva. However, early diagnosis remains the most important agent in reducing the extension of the surgical treatment.

Evaluation of bone metabolic markers as indicators of osteopenia in climacteric women.

Lumbar bone mass (LBM) determination by quantitative computerized tomography in pre-, peri- and postmenopausal women was utilized to identify subjects at risk to develop osteoporosis. The results were related to determinations of bone metabolic markers (serum osteocalcin and urinary calcium excretion). Osteocalcin was the only metabolic marker which underwent significative changes. However, we found very poor correlations between LBM and metabolic markers and it is concluded that bone mass determination remains the method of choice to select women for preventive therapy.

Specificity of tumor markers (CEA, GICA, TPA, alpha-FP, FpA, gamma-GT) for the diagnosis of hepatic metastases from large bowel cancers.

In 98 patients affected by colorectal cancer (43 patients with colon cancer, 55 patients with rectosigmoid cancer) the specificity of some tumor markers (CEA, GICA, TPA, alpha-FP, FpA, gamma-GT) has been tested in evidencing the coexistence of liver metastases and the site of the primary tumor, i.e. the rectosigmoid region (rectum + 15 cm of the adjacent sigmoid colon) vs the rest of the colon. Liver metastases, present in 19 patients with colon cancer and in 24 with recto-sigmoid cancer, were previously ascertained by various instrumental investigations. Unlike previous studies which indicated CEA or alpha-FP as the most reliable markers to suggest the coexistence of liver metastases in such patients, the reported results allow the following sequence, in decreasing order of sensitivity, to be proposed: gamma-GT; FpA; CEA and GICA to a similar degree; TPA, which increases only when liver metastases from colon cancer are present; lastly, alpha-FP, which rises only in very few cases of massive hepatic involvement.

Reduction of erythrocyte magnesium concentration in heterozygote beta-thalassaemic subjects and in normal subjects submitted to physical stress.

Erythrocyte and serum magnesium (Mg) concentrations have been assayed in a group of sedentary heterozygote beta-thalassaemic subjects (beta-thal), in a group of non-thalassaemic well trained runners before and after a 25 km running race, and in a group of sedentary healthy controls. The mean erythrocyte Mg concentration (EMg) found in beta-thal (2.72 mEq/litre) and in runners, both before and after the race (2.58 mEq/litre before, 3.10 after), was significantly lower than the EMg values from the control group (3.69 mEq/litre). We propose various hypotheses to explain the reductions observed.

Specificity of carcinoembryonic antigen, gastrointestinal cancer-associated antigen, tissue polypeptide antigen, fibrinopeptide A and gamma-glutamyltransferase in the diagnosis and follow-up of gastric cancer.

The usefulness and specificity of the main tumor markers (carcinoembryonic antigen, CEA; gastrointestinal cancer-associated antigen, GICA; tissue polypeptide antigen, TPA; fibrinopeptide A, FpA; gamma-glutamyltransferase, gamma-GT) have been investigated in the diagnosis and follow-up of the circumscribed and disseminated gastric cancers (GCs). The comprehensive evaluation of all of these markers has given the most reliable results. For the diagnosis and follow-up of GCs, the present study has shown that the sensitivity and specificity of the above markers have the following decreasing order: FpA, TPA, GICA, CEA, gamma-GT. However gamma-GT has proved to be a reliable index of the presence of hepatic metastases.

Specificity of fibrinopeptide A (FpA) as a marker for gastrointestinal cancers before and after surgery.

In 70 patients affected by gastrointestinal malignancies the plasma fibrinopeptide A (FpA) levels were assessed both before and at various intervals after the operation. At the same time other more commonly used tests of coagulation were carried out. In all the patients plasma FpA levels were shown to be variously elevated, so that they could give useful clues to the diagnosis, treatment, prognosis and follow-up of the gastrointestinal malignancies. In all the patients the coagulation tests fell into the normal ranges. However in the patients affected by recto-sigmoid adenocarcinoma an increase of circulating fibrin degradation products (FDPs) was observed which paralleled the increase of plasma FpA. In conclusion, in gastrointestinal malignancies the increase of plasma FpA levels suggests the cancer-induced start of the coagulation cascade. The assay of this peptide proves to be a reliable marker for these diseases.

Hereditary hemorrhagic telangiectasy (HHT) and HLA.

Linkage between HHT and 10 genetic marker systems was investigated in a family with 7 affected members. The analysis supports the previously suggested linkage between HLA and HHT (theta = .17).