Prevalence of abnormal Pap smears in a consecutive and previously unscreened population in Romania.

OBJECTIVE: To determine the prevalence of abnormal cervical smears in a previously unscreened and asymptomatic population in Romania and to compare the data with those from other countries in Europe. METHODS: In a retrospective study, data were reviewed from smears obtained from women in Romania who had been referred to the gynecologist between January 2006 and December 2011. The smears were collected through 3 regional opportunistic programs of cervical screening and were classified according to the Bethesda system. RESULTS: During the study period, 50536 smear tests were carried out. Of these, 100 smears (0.2%) were unsatisfactory and excluded from the study. Among the remaining 50436 smears, 2965 patients (5.9%) had abnormal epithelial changes. Most of the abnormal smears were represented by atypical squamous cells of undetermined significance (2.6% of all smears). The data confirmed that there is a high prevalence of high-grade intraepithelial squamous-type lesions (0.9% of all smears) in Romania, and of abnormal smears in women younger than 25years of age (14.0% of all abnormal smears). CONCLUSION: The data show that there is a high prevalence of epithelial abnormalities among cervical smears in Romania compared with other European countries that run a national screening program.

[Role of prognostic factors in evaluation of survival in breast cancer]. / Rolul factorilor de prognostic ai cancerului mamar in evaluarea supravietuirii.

UNLABELLED: The aim of our study is to evaluate the prognostic value of tumor size, regional lymph nodes and steroid-hormones receptors status, histological grade, and the presence of metastasis in other organs. MATERIAL AND METHODS: Our retro-prospective study analyzes a group of 266 patients diagnosed and treated for breast cancer in the IVth Obstetrics and Gynecology Clinic. RESULTS: 150 of the patients (56.7%) presented stage I disease, and only 39 (14.7%) stage IV. 151 (57%) of the patients had no regional lymph nodes metastasis and 252 (94.9%) were free of metastatic disease when they first presented for diagnosis. Almost 43% of all tumors were poorly differentiated. In the majority of cases, the tumors were positive for steroid receptors. The survival rate after 5 years was higher in the absence of lymph nodes metastasis (76%) and the presence of a low Nottingham prognostic index (78%). CONCLUSION: The identification and evaluation of prognostic factors is an essential step for treatment planning and limiting metastatic disease.

The evaluation of the sentinel lymph nodes status in breast carcinoma using microscopic, immunohistochemical and cytomorphometric methods in order to establish new stadializations and therapeutic schemes.

The state of axillary lymph nodes represents the most important prognostic parameter in patients with breast carcinoma. The biopsy and examination of sentinel lymph nodes, the former one containing metastases originating in mammary carcinoma, allows a better stadialization of the tumor but also the avoiding of the extirpation of the axilla, associated with a series of complications and high costs of hospitalization. In establishing the tumoral prognosis, not only the diameter but also the localization of the metastasis in the lymph nodes is utterly important. The evaluation of the metastases was carried out through the serial examination of the sentinel lymph node correlated to immunohistochemical examinations with AE1/AE3. Of the 570 patients with breast carcinoma evaluated in this research, 250 had macrometastases, 93 micrometastases, only 23 had isolated tumor cells, and in the case of 204 no metastases were found. The technique of computerized cytomorphometry allowed a better evaluation of the diameter and localization of the metastases in the lymph nodes than the examination through optical microscope. The tumoral prognosis in the case of patients with macrometastases is poorer than that of patients with micrometastases. The patients in whom only the presence of isolated tumoral cells was demonstrated have a similar prognosis with those who do not have metastases. As far as the localization of micrometastases in the sentinel lymph nodes is concerned, those with a subcapsular localization are associated with a poorer prognosis than those with an intraparenchymatous localization. As well as this, the subcapsular localization of micrometastases was also associated with the diameter of the primary tumor extending between 2-5 centimeters, a high microscopic grade, the presence of lymph vascular emboli and microscopic type of the primary tumor associated with poor prognosis. On the other hand, the presence of isolated tumoral cells was associated with tumors of a small diameter lacking the presence of lymph vascular emboli and with a low microscopic grade. All these data are essential in establishing the therapeutic management of the patients with breast carcinoma; consequently, we recommend their inclusion in future stadializations of this lesion and the evaluation of tumoral prognosis.

[Breast cancer in diabetic patients]. / Cancerul mamar la pacienta diabetica.

UNLABELLED: Many of the risk factors for postmenopausal breast cancer are related to excess estrogen exposure. Hyperinsulinemia associated with type 2 diabetes mellitus may promote breast cancer via increased peripheral production of estrogens and direct mitogenic effect of insulin itself. MATERIAL AND METHODS: Our retro-prospective study compares breast cancer characteristics between two study groups consisting of 53 diabetic and 391 non-diabetic patients diagnosed and treated for breast cancer. RESULTS: Almost 12% of the patients presenting breast cancer were diabetic and menopause occurred at 48.71 years for diabetic patients and at 49.87 years for the non-diabetic ones. Type 2 diabetes mellitus patients were treated by diet and oral agents, had greater body mass index (32.18 kg/m2), presented well differentiated (57% in G1) but greater (68% in T2) tumors and an increased incidence of lobular (13%) and mixed type (19%) carcinoma. CONCLUSIONS: Diet and physical exercises as methods for preventing type 2 diabetes mellitus together with screening strategies among diabetic patients could contribute to decreasing the incidence of breast cancer.

[Cytologic examination of the axillary lavage fluid obtained during modified radical mastectomy]. / Citologia lavajului axilar practicat în cursul mastectomiei radicale.

The axillary dissection is part of the breast cancer surgical protocol. We have cytologically analyzed the axillary lavage fluid obtained during 67 modified radical mastectomy. Our results showed good correlation between the node status, histological grading and the cytological diagnosis of the axillary lavage fluid. As some other dissemination assessment techniques showed important prognostic value, the cytologic analysis of the axillary lavage fluid also seems to be a prognostic parameter.

[Assessment of prognostic factors in breast cancer]. / Evaluarea factorilor de prognostic in cancerul mamar.

Prognostic factors predict the long term outcome of treatment, recurrence rate and overall survival. Treatment decision is based on assessment of prognostic factors. They are classified as clinical (age, menopausal status, tumoral growth rate, inflammatory signs), histological (tumoral stage, pathological type, grading, tumoral necrosis, lymph nodes status, margins status) and biological factors (steroidal receptors pattern, ploidy etc). There are tumor markers currently evaluated, being considered conventional and new markers that are not usually evaluated. Patients with negative lymph node will show no recurrences after surgery and/or radiotherapy in 70% of the cases. Factors with specific prognostic value are used for deciding on the therapeutic strategy in negative axillary node cases.

[Breast conservative surgery]. / Tratamentul chirurgical conservator al cancerului mamar.

Breast conservative therapy is considered an adequate therapeutical method for early stage breast cancer. Breast conservative treatment consists of partial mastectomy, axillary dissection and radiotherapy. Patient selection is based on clinical, histological and individual factors. The frozen sections examination provides prompt differentiation between benign/malign lesions and precise assessment of the oncologic margins of the specimen. Preoperative marking of nonpalpable breast lesion with hook wire represents a progress for breast conservative treatment. Sentinel lymph node biopsy represents an alternative to axillary dissection, in order to reduce subsequent morbidity.

[Malignancy risk in some benign mammary lesions]. / Riscul malignizarii unor leziuni mamare benigne.

We analyzed retrospectively 821 patients operated on in our clinic for benign mammary lesions and for breast cancer. Histopathology identified in some cases associated benign and malign lesions. Atypical hyperplasia is considered significant risk factor for malignancy. Women in this category need close surveillance.

[Practical aspects in diagnosis and treatment of benign breast lesions]. / Elemente practice privind diagnosticul si tratamentul leziunilor mamare benigne.

We analyzed 444 patients operated on in our clinic. Triple test diagnosis is the modern trend. Surgical treatment is not justified in all cases. When needed, partial mastectomy is commonly used. Surgical principles must be respected for good cosmetic results. Histopathology only certifies the diagnostic.

[Reasons for conservative treatment in breast cancer]. / Argumentarea aplicarii tratamentului conservator în cancerul mamar.

We analyze 112 patients with breast conservative treatment operated in our clinic in the last 5 years. Breast preservation surgery represented 30.35% of all cases treated for breast cancer in this interval of time. In other 63 situations conservative treatment was attempted but finally given up due to justified motivations and decision for mastectomy was adopted as optimal. Rigorous selection of patients for conservative surgery was our care. Tumor size, excisional margins, nodal status were the main criteria. Correlation with breast volume, age, patient's opinion were also important. Preservation of breast in women interested and cosmetic results were the purposes of our attitude. Breast conserving therapy may be indicated only respecting the oncological principles and close surveillance of patients is obligatory.

[Malignant mixed mesodermal tumor: histo- and cytopathologic correlations]. / Tumora mixta mezodermica maligna. Corelatii cito-histopatologice.

To correlate the cytopathological and the histopathological findings in uterine mixed mesodermal malignant tumor (MMMT) we have examined the cervical smear, endometrial curettage and hysterectomy specimen of a patient diagnosed with uterine tumor. The smear was stained by Papanicolaou staining and the tissue processed by routine technique and stained H&E. The original cytological diagnosis was adenosquamous carcinoma. The histopathological diagnosis was MMMT of heterologous type. A review of the smear revealed features which may orientate the diagnosis: multinucleate cells, isolated cells with cyanophilic cytoplasm, hyperchromatic nuclei and prominent nucleoli, elongated cyanophilic cells of sarcomatous origin. We conclude that the cytopathological diagnosis of the MMMT in cervical smears is very difficult. This may be sustained by the evidence of more cell types and cellular features orientating to a sarcomatous origin. The most important differential diagnosis is adenosquamous carcinoma.

[Phyllodes tumor. The experience of the 4th Obstetrics-Gynecology Department]. / Tumora filoda. Experienta clinicii a IV-a obstetrica ginecologie.

The experience of the IVth Obstretrics Gynecology Department. Between the 1st of January 1994 and the 1st of November 2001 587 operations have been performed as treatment of breast tumors in the IVth Obstetrics and Gynecology Department. The phyllodes tumor has been diagnosed in 11 cases (1.8% of the benign breast masses). The genesis is unknown. Local trauma, pregnancy, lactation, high estrogenic levels have been suggested to have an influence upon the tumoral development. The most common aspect is a round, hard, unpainful breast mass. The diameter is variable (1 to 45 cm). The mammogram shows a well defined, high density, smooth contour opacity. A four degree classification has been described. Specific evolution features may involve local recurrences and metastasis. The surgical treatment is mandatory but radiotherapy, chemotherapy and endocrine treatment protocols have been brought up.