Limitations of the evaluation of adnexal masses by its macroscopic aspects, cytology and biopsy.

To investigate the relevance of intraoperative macroscopic evaluation of adnexal masses a prospective study was conducted from June 1st, 1993 to May 31st, 1994, which included 57 premenopausal and 60 postmenopausal women, who underwent laparotomy because of a cystic adnexal mass. The surgeons were asked to classify the tumor intraoperatively as benign or malignant and to assign to histologic groups. In addition cytology of the cyst fluid and a biopsy from the cystic wall were evaluated. Comparison of these items with the results of permanent section diagnosis revealed the tendency of the surgeons to underestimate adnexal masses depending on patients' age and the complexity of the tumor, despite of the knowledge of preoperative ultrasonographic findings. Sufficient cytolologic examination was possible in only one third of aspirates and only 21% of the examined postmenopausal malignant neoplasms have correctly been diagnosed by cytology. Evaluation of the biopsy specimens demonstrates a marked percentage of false negatives with respect to benign tumors (30% of non-functional benign neoplasms in the premenopause were assessed as functional cysts) as well as malignant neoplasms (only 72% were diagnosed correctly in the postmenopause group). In conclusion intraoperative subjective assessment, cytology and representative biopsies do not necessarily concur with the definitive histological diagnosis.

Prognostic value of angiogenesis in mammary tumors.

Vessel density counting has been performed in a variety of tumors and used as predictive parameter for the tumor's malignant behavior (metastasis, five year survival). A number of studies have reported conflicting results on the predictive value of vessel density counts. We have quantitated the number of microvessels in routine pathology specimens of paraffin embedded mammary tumors and related these findings to the histopathological diagnosis. Average vessel density counts of vascular hot spots of malignant and benign mammary tumors were similar (34 +/- 15 vs. 31 +/- 10), though significantly higher as in the adjacent normal mammary tissue (12 +/- 5). Analysis of individual tumors, however, showed that significantly more malignant than benign tumors had vessel density counts beyond a defined cut-off value (50 microvessels/HPF). The results suggest that high counts may indeed serve as an independent prognostic parameter. In contrast, low counts may also be observed in malignant tumors and may, thus, not be used as negative prognostic factor.

Evaluation of ovarian tumors in postmenopausal women by transvaginal sonography.

OBJECTIVE: The aim of the present study was the evaluation of simple reproducible sonomorphological criteria for the preoperative evaluation of ovarian tumors in postmenopausal women by use of transvaginal sonography. STUDY DESIGN: Postmenopausal women (> or =1 year of secondary amenorrhea) with ovarian tumors (n=378; tumors > or =3 cm and <3 cm but with solid parts) were examined in a prospective study by transvaginal sonography prior to surgery between 1987 and 1993. The sonomorphological criteria were correlated with the histological findings of the tumors. RESULTS: Of all ovarian tumors in postmenopausal women, 6.3% were functional cysts (follicular or corpus luteum cysts). Almost all of them were detected within the first 5 years of postmenopause. The other ovarian tumors were diagnosed as retention cysts (17.5%), benign neoplasms (39.4%), and malignant tumors (36.8%). Simple ovarian cysts (monolocular, smooth inner wall) represented sonomorphologically the second most frequent type of ovarian tumors in postmenopausal women (35.7%). Of these tumors, 9.6% were diagnosed as malignant. CONCLUSIONS: Simple reproducible sonomorphological criteria proved to be a useful clinical parameter in the preoperative evaluation of ovarian tumors.

Increased serum levels of hyaluronic acid in pregnancies complicated by preeclampsia or hemolysis, elevated liver enzymes, and low platelets syndrome.

OBJECTIVE: Fifteen percent of patients who later have hemolysis, elevated liver enzymes, and low platelets syndrome develop initially have nonspecific symptoms. Early diagnosis could ensure adequate obstetric management; however, prognostic biochemical tests are lacking. We hypothesized that elevated hyaluronic acid serum levels might be an early indicator of hemolysis, elevated liver enzymes, and low platelets syndrome because it is known to be a sensitive marker of liver cell function. STUDY DESIGN: Hyaluronic acid in serum was measured in patients with normal pregnancies (n = 109) and in those patients with pregnancies complicated by preeclampsia (n = 14) or hemolysis, elevated liver enzymes, and low platelets syndrome (n = 11). RESULTS: A significant increase in hyaluronic acid serum concentrations was observed in patients with hemolysis, elevated liver enzymes, and low platelets syndrome or with preeclampsia (p < 0.05). The extent of hyaluronic acid serum levels in hemolysis, elevated liver enzymes, and low platelets syndrome correlated with the clinical severity of the individual course of disease as measured by intensive care unit time (r = 0.72; p < 0.02). CONCLUSIONS: Serum levels of hyaluronic acid in preeclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome are significantly elevated and might play an important diagnostic and prognostic role in patients with hemolysis, elevated liver enzymes, and low platelets syndrome.

Does an immunoscintigraphy with OC 125 affect the prognosis of ovarian cancer?

In a retrospective study, a total of 120 ovarian cancer patients were paired in terms of staging, grading, patent age, and operative and cytostatic therapy. Half of the patients underwent radioimmunoscintigraphy for diagnostic purposes. From the point of view of possible adjuvant immunological therapy, we investigated to what extent patients with treated ovarian cancer benefit from the application of OC 125 in terms of survival time. In our study we have been able to show that at favorable stages (FIGO II) the patient benefitted more from a radioimmunoscintigraphy than at prognostically unfavorable stages (FIGO IV). Even within FIGO stage III we have been able to show, thanks to the large number of cases, that patients with an NED situation benefitted significantly more form radioimmunoscintigraphy in terms of survival than those with residual tumors. Throughout FIGO stage III, patients with radioimmunoscintigraphy showed significantly superior 5-year survival rates (p < 0.05) than those without radioimmunoscintigraphy. These data would appear to justify prospective studies to establish to what extent ovarian cancer patients benefit from an adjuvant application of OC 125 in terms of the 5-years survival rate and the relapse-free interval.

Preoperative evaluation of ovarian tumors in the premenopause by transvaginosonography.

OBJECTIVE: The aim of the study was to establish reproducible sonomorphologic criteria by use of transvaginosonography in the preoperative evaluation of ovarian tumors in the premenopause. STUDY DESIGN: In a prospective study from 1987 to 1993 we investigated 1072 ovarian tumors. All tumors > or = 3 cm were included in the study. To avoid unnecessary operations, all tumors we rescanned after 6 weeks. The sonomorphologic criteria were correlated with the histologic findings. RESULTS: A total of 4.3% of ovarian tumors in the premenopause were malignant. In the special group of sonographically simple ovarian cysts we found 0.8% malignancies. The incorporation of a control scan after 6 weeks in the management of ovarian cysts reduces the number of unnecessary operations on functional cysts. Only 5.5% of the functional tumors were operated on. The risk for malignancy in cystic-solid ovarian tumors is 17.0%, the highest of all sonomorphologic tumor types. CONCLUSIONS: The use of reproducible sonomorphologic criteria in combination with a control scan in premenopausal women with ovarian cysts proved to be efficient to reduce the number of unnecessary operations and to evaluate the risk for malignancy.

Prognostic value of transvaginal sonography in asymptomatic endometrial cancers.

In the period between 1985 and 1991, 83 postmenopausal women with endometrial cancer were examined by transvaginal sonography. None of them were on hormone replacement therapy and all had amenorrhea of more than 2 years. Twenty-two were asymptomatic and had an endometrial cancer detected by transvaginal sonography and 61 showed atypical bleeding as their only clinical symptom. Women with asymptomatic endometrial cancers detected by transvaginal sonography exhibited significantly less mean myometrial tumor infiltration and more well-differentiated tumors than those with atypical bleeding (4 mm and 45% compared with 10 mm and 18%, respectively). In 75% of the cases the estimation by transvaginal sonography of tumor stage completely agreed with the histological staging. These preliminary data show that asymptomatic endometrial cancers screened by transvaginal sonography are likely to have a better prognosis than symptomatic cancers. Furthermore, transvaginal sonography can be used as a reliable tool for tumor staging prior to surgery or radiotherapy.

Interleukin-8 synthesis and the onset of labor.

OBJECTIVE: To examine the role of cytokines in cervical dilation. METHODS: In 55 patients undergoing cesarean delivery, we took samples from the lower uterine segment, the decidua, and the membranes. We determined the concentrations of interleukin (IL)-2, IL-8, tumor necrosis factor-alpha, matrix metalloproteinase (MMP)-8, and MMP-9 in the different tissues. RESULTS: Depending on the state of labor, we observed a significant increase (P < .001) in IL-8 concentrations in the lower uterine segment. The leukocyte enzymes MMP-8 and MMP-9 were highly significantly correlated with the IL-8 concentrations. CONCLUSION: Interleukin-8 is critically involved in the process of parturition in humans. Interleukin-8 concentrations in the myometrium, decidua, and membranes correlated strongly with the observed MMP-8 and MMP-9 concentrations.

Biochemical events in cervical ripening dilatation during pregnancy and parturition.

In specimens taken from the posterior lip of the cervix uteri we determined the collagenase activity and the glycosaminoglycan concentration. In biopsies obtained from the lower uterine segment during cesarian section we measured cytokines (IL-8, IL-2, TNF alpha) and matrix metalloproteinases (MMP-8, MMP-9). We found that the release of collagenases is critically involved in the process of cervical dilatation. The glycosaminoglycan concentration increases during pregnancy and shows remarkable changes of the distribution patterns of the different glycosaminoglycans. The parturition is characterized by a dramatic loss of most of the glycosaminoglycans. Furthermore, the IL-8 shows a close correlation to the clinical feature of cervical ripening and is closely associated with the release of MMP-8 and MMP-9. Summarizing the process of cervical maturation and dilatation is a complex enzymatic controlled process with substantial remodelling of the cervical extracellular matrix. The cytokines IL-8 seems to play an essential role in triggering the process of cervical dilatation.

Endometrial cancer screening.

Endometrial cancer is the most common malignancy of the female genital tract. The prognosis of the endometrial carcinoma is strongly correlated with the myometrial infiltration depth. Therefore, it is of utmost clinical interest to detect the malignancies at the earliest stage or even as a precancer. All approaches, like cytologies and uterine smears, have failed to fulfil prerequisites for screening of endometrial cancer. Measurement of the endometrial thickness by transvaginosonography (TVS) can define a risk group for endometrial cancer in postmenopausal women. Further investigations have to clarify whether the combination of TVS and color Doppler can reduce the number of false-positive findings.