Cyclooxygenase-2 expression in cervical cancer.

BACKGROUND/AIM: Cyclooxygenase (COX) or prostaglandin H2 synthase is the first enzyme that catalyzes the first two steps in the biosynthesis of prostaglandins from arachidonic acid. The aim of the study was to determine the expression level of COX-2 in patients with cervical cancer and compare it with that in the control group with no cervical pathology. METHODS: The study included 76 patients divided into two groups: the control group--30 patients without histopathological changes and the group A--46 patients with cervical cancer, FIGO stage IB-IIA. Histopathological and immunohistochemical analyses were performed in these two groups of patients. RESULTS: In the control group, the expression of COX-2 was not confirmed compared to the group A of 26 (56.52%) patients. The expression of COX-2 showed a statistically significant difference in the presence oflymphocytic stromal infiltration (p = 0.0053). The expression of COX-2 was more pronounced in the stromal tissue without lymphocytic infiltration (80% vs. 20%). CONCLUSION: A higher expression of COX-2 in cervical carcinoma without stromal lymphocytic infiltration suggests a possible paradoxical effect of COX-2 in immunosuppression. Frequent COX-2 expression in the subgroup with poor prognostic histological parameters in the group A indicates the importance of COX-2 expression in the carcinogenesis of cervical cancer.

Comparsion the histopathological findings after cervical biopsy and excisional procedures.

INTRODUCTION: A definitive diagnosis of cervical intraepithelial neoplasia (CIN) is confirmed after histopathological (HP) examination of the tissue obtained through the biopsy. The aim of this study was to compare histopathological results obtained with punch biopsy and results obtained through one of the excisional techniques. MATERIAL AND METHODS: We analysed histology results of 130 patients referred to our institution with abnormal smear. Punch biopsy was performed after colposcopic examination in all patients before one of the excision methods. Excision methods performed were: large loop excision of transformation zone (LLETZ), radio-frequency knife conisation or cold knife conisation. Based on the histopathological examination of the punch biopsy specimen or excisional specimen diagnosis of CIN was established. RESULTS: CIN and invasive cancer were the most common diagnoses in the 31-40 age group at 45.4% (59/130). Discrepancies in the histological diagnosis between punch biopsy and excisional biopsy was identified in 58.5% (76/130) of the patients. In 6% of the of the cases the biopsy did not detect an invasive carcinoma. CONCLUSION: The most frequent discrepancies between punch biopsy and excisional biopsy were in the group of patients with a higher grade cervical dysplasia. Mild dysplastic changes diagnosed through punch biopsy, require a more conservative approach, as the majority of this group had negative specimens on the cone after excision, especially in the younger population. It is advisable that the patients above 30 years of age and a higher grade dysplasia in the biopsy specimen, should undergo one of the excisional techniques as a diagnostic/therapeutic method of treatment.

Radical abdominal trachelectomy in the 19th gestation week in patients with early invasive cervical carcinoma: case study and overview of literature.

Treating pregnant patients with a verified malignant disease represents a great clinical problem. Pregnancy-associated invasive cervical cancer is usually diagnosed at an early stage (approximately 70%). A 27-year-old patient was given the diagnosis of a pathohistologically verified cervical carcinoma, International Federation of Gynecology and Obstetrics stage IB1, in the 17th gestational week (GW). A radical abdominal trachelectomy was performed in the 19th GW. The patient was undergoing regular examinations at our institute of oncology while the Clinic of Gynecology and Obstetrics in Novi Sad, Serbia, monitored the pregnancy. In 36th GW, the patient had a cesarean section, with no visible traces of relapse, with good postoperative recovery and normal results in the newborn. The patient was discharged on the fifth postoperative day and advised to have her condition monitored at our institute of oncology. One year after radical trachelectomy, the patient is in the 15th GW of a new pregnancy with a normal Papanicolaou smear result.

[Neglected case of uterine leiomyoma--case report].

INTRODUCTION: Uterine leimyomas are the most common gynaecologacal tumors and represent 30% of all benign gynecological tumors. The vast majority of leiomyomas are asymptomatic and do not need to be treated. Pelvic pain and abnormal uterine bleeding should be considered as the most important reasons for surgical treatment of uterine fibroids. CASE REPORT: A female patient, age 69, was treated at the Institute of Oncology in Sremska Kamenica because of a huge abdominal tumor. Major symptoms were increased body temperature, abnormal uterine bleeding and extensive abdominal enlargement. After the clinical, laboratory and imaging evaluation, the offered hysterectomy was performed. The evacuated tumor was 18 kg heavy and 40 cm in length. The pathohystological diagnosis was leiomyoma per magnum. The patient was released after 11 days of hospitalization without any postoperative complications and in good general condition. DISCUSSION: Uterine fibroids can be managed medically and surgically. Hysterectomy should be performed in every case with dominant symptoms like abnormal uterine bleeding, tumor growth and increasing abdominal pain (when other causes are excluded) in postmenopausal women. This particular case is an example of low general and health culture of the reported patient and maybe caused by fear from medical and surgical treatment. Sometimes, making a diagnosis of the nature of pelvic tumor is very hard, but by respecting diagnostic procedure an adequate treatment of those patients can be ensured.

[The influence of aging on pathologic and immunobiologic parameters of invasive ductal breast carcinoma].

BACKGROUND/AIM: Most human cancers, including breast one, increase in frequency with aging. The aim of this study was to explore the hypothesis that aging also alters breast cancer biology. METHODS: The study included 120 women with primary invasive ductal carcinoma of the breast. We correlated the patients age and diagnosis with the commonly used clinical, pathological factors and newer tumor biomarkers. Immunohistochemical staining was conducted for p53, c-erbB-2, Ki-67, estrogen (ER), progesterone (PR) receptors, and angiogenesis. RESULTS: In our study, the patients with axillary lymph node metastases and negative steroid hormone receptors (ER and PR) were significantly younger than the patients with nodal involvement and positive hormone receptors. There was also a significant association between the patients age, diagnosis and angiogenesis. No association was found between the patients age and tumour size, histological grade, p53, c-erbB-2, and Ki-67. CONCLUSION: The results of our study supported only partially the hypothesis that the breast cancer biology is significantly affected by a patient's age.

[Psychophysiologic disturbances in early postmenopause in women after physiological and surgical menopause].

BACKGROUND/AIM: The most common secondary manifestations of menopause are clinical manifestations of estrogen deficiency. They could be early and late. The aim of this study was to compare manifestations of somatic disturbances in early postmenopause in women after physiological and surgical menopause. METHODS: This prospective study included 60 women, age 41-55 years, divided into two groups: physiological (30 of them) and surgically induced menopause. For every subject a special evidence list, consisting of the disease history questions, physical and gynecology examination as well as dates about physiological variables (arterial tension, height, weight, and body-mass index) and laboratory examination was formed. The values of arteriol blood pressure, body height, body mass, body mass index (BMI), and lipid status were determined and gynecological examinations were performed in each patient. RESULTS: The most frequent symptoms in both groups were vasomotor ones. Headache was the more intensive sign in the group after induced menopause. Extrasistolyc heart excursion was a common symptom in both study groups. Arterial tension, regardless of the type of menopause, was in the physiological range. The frequent organic signs of menopause, more intensive in the group after induced menopause, were genitourinary and skin atrophy. An analysis of the BMI showed that the women in both groups were obese (BMI > 25). The lipids analysis confirmed the predomination of hyperlipoproteinemia type IIa in the group with physiologic menopause and type IIb after induced menopause. CONCLUSION: The dominant signs of menopausal syndrome were vasomotor and bone-joint symptoms, more frequent in the group after induced menopause. There were no statistically significant differences between the study groups according to the genitourinary atrophy and other signs of aging. Menopausal hormonal changes, regardless of the way of menopause developing, increase the risk for hyperlipoproteinemia. The frequency of somatic signs in early post menopause is typically higher after induced menopause. More intensive follow-up in patients after surgical removing of the ovaria is necessary in order to improve the quality of life in these patients.

[Ovarian epithelial carcinoma--a malignant disease sparing no age group]. / Epitelijalni karcinom jajnika--maligna bolest koja ne pita za dob.

INTRODUCTION: Ovarian epithelial carcinoma is one of the most common gynecologic malignancies and the fifth most frequent cause of cancer death in women. Ovarian cancer affects women 65 years of age and older more frequently than younger women. MATERIAL AND METHODS: Four young patients with ovarian epithelial carcinoma were treated at the Institute of Oncology in Sremska Kamenica, Serbia and Montenegro, in the period 1981-2000. The median age at diagnosis was 17.3 years. Final histopathological findings revealed cystadenocarcinoma, either mucinous or serous. The stage of the disease was established using International Federation of Gynecology-Obstetrics (FIGO) Calssification. Spread of the disease dictated the extent of operation and post-operative chemotherapy. Patients were strictly followed-up at the Institute. RESULTS: The first two patients underwent unilateral adnexectomy as initial treatment. Final histopathological examination revealed an epithelial ovarian carcinoma, stage IIIa and IIb. Total hysterectomy with unilateral adnexectomy and total omentectomy were performed in both patients as second treatment with chemotherapy, according to the Cisplatin/Carboplatin and Cyclophos-phamide (CP) protocol following surgery. Another two patients underwent total hysterectomy with bilateral adnexectomy and total omentectomy as initial treatment with chemotherapy, CP protocol, following surgery. Both patients had stage IIc. Despite treatment, in two patients with stage IIIa and IIc, metastases were diagnosed. In 2 patients survival was over five years. One patient lived less than 3 years, and one less than 4 years. DISCUSSION: Ovarian carcinomas are difficult to diagnose at early stage. Histologic confirmation of the diagnosis, surgical staging, and aggressive surgical debulking, when possible, are all part of the initial evaluation and treatment. In most cases, surgery is followed by chemotherapy. The risk increases from 15.7 to 54 per 100,000 in the age group 40-79 years. Our study included 4 patients, medium age 17.3, with epithelial ovarian carcinoma which warns us to think twice when we get an adolescent patient with an adnexal mass. CONCLUSION: Advancing age, the major risk factor for development of ovarian carcinoma is, of course, unalterable. We investigated 4 patients medium age 17.3 years, with epithelial ovarian carcinoma. Pelvic masses found in women of reproductive age, must also be evaluated preoperatively to determine the probability of malignancy.

[Olfactory perception in women with physiologically altered hormonal status (during pregnancy and menopause]. / Osecaj mirisa kod zena u fizioloski izmenjenim hormonalnim stanjima (u trudnoci i postmenopauzi).

INTRODUCTION: Olfaction is considered to be the ability to: perceive, conduct and recognize scents and odors. With its numerous connections to the limbic system and reticular formation, the olfactory system affects regulation of numerous vegetative functions, visceral functions and sexual behavior. Since estrogen and progesterone protect the olfactory function, changes in their levels in particular physiological states in women (in pregnancy and posmenopause) exert an influence on the ability to feel and recognize smells. It has its role in creating emotions and adjustment of visceral and vegetative response to particular emotional states. Also, it represents the connection between higher cortical functions and the endocrine system. MATERIAL AND METHODS: Our investigation was performed at the Ear, Nose and Throat Clinic in Novi Sad. The research included 80 healthy women classified into 4 groups; 20 women aged between 20 and 30; 20 women in the first trimester of pregnancy aged between 20 and 30; 20 premenopausal women aged between 41 and 50; and 20 women at least 3 years in postmenopause, aged between 41 and 50. For our research we used an olfactometer and the Fortunato-Niccolini method. RESULTS AND DISCUSSION: In pregnancy the thresholds of perception (TP) and identification (TI) of examined substances were slightly lower in comparison to nonpregnant women of the same ages, but without any statistical significance (p > 0.05). In climacteric-postmenopausal women there was a significant decrease of olfactory ability in comparison to nonmenopausal women of the same ages (p < 0.01). CONCLUSION: All changes of the olfactory function in pregnancy are explained by mental changes of pregnant women as well as their hormonal status. Significant decrease of olfactory ability in postemnopause is explained by decline in sexual hormone levels.