CYP3A4 promoter variant is associated with prostate cancer risk in men with benign prostate hyperplasia.

Prostate cancer (PRCa) is one of the most common causes of cancer death in men and determinants of PRCa risk remain largely unidentified. Benign prostatic hyperplasia (BPH) is found in the majority of ageing men and has been linked with PRCa. CYP3A4 may influence PRCa through its role in testosterone metabolism. This nested case-control study assessed a CYP3A4 single nucleotide polymorphism as a risk factor for developing PRCa in patients with BPH. The CYP3A4 variant allele identified men with BPH who are at increased risk of progressing to PRCa (odds ratio 6.3, 95% CI 2.3-17.3), providing a potential tool to assist prediction strategies for this disease.

Ovarian conservation in a woman of reproductive age with müllerian adenosarcoma.

BACKGROUND: Total abdominal hysterectomy with bilateral salpingo-oophorectomy is generally considered optimal therapy for patients with uterine sarcomas. Local resection of the tumor or hysterectomy with ovarian conservation has been used in only a small number of patients. Recurrence risk in women undergoing ovarian-sparing surgery for müllerian adenosarcomas can be difficult to evaluate due to the paucity of literature in this area. We present a reproductive-age woman with a müllerian adenosarcoma and review the literature on conservative surgical management of this class of tumors. CASE: A 25-year-old nulligravida was diagnosed with a uterine adenosarcoma and the question of conservative surgical therapy arose. Following a literature review, discussion with the patient led to the decision for ovarian preservation at the time of hysterectomy. The pelvis and abdomen were grossly free of metastatic disease at laparotomy and all tumor was confined to the uterus on pathologic examination. She is free of disease 36 months postoperatively and is now considering in vitro fertilization using a surrogate. CONCLUSION: Ovarian conservation can probably be offered safely in carefully selected women of reproductive age with müllerian adenosarcomas.

Study of superficially invasive carcinoma of the cervix.

A detailed histologic study has been completed on 125 patients with squamous cell carcinoma of the cervix invading to a depth no greater than 5 mm. Depth of invasion was 3 mm or less in 73% and 3.1 to 5 mm in 27%. The median width was 4.8 mm (range 0.08 to 20 mm). Most of the lesions were multifocal (82%); the number of invasive foci correlated well with increasing width and depth of invasion. Lymphvascular space invasion was found in seven patients, none of whom had lymph node metastases, although in one a single focus of carcinoma was present in the parametrium. Therapy consisted of radical hysterectomy and pelvic lymphadenectomy in 55% of the women, including 43 patients with lesions invading less than 3 mm. There was tumor metastatic to lymph nodes in only one of 69 patients with dissected nodes (1.4%). The mean follow-up time was 5.0 years; there was one recurrence (cervical intraepithelial neoplasia only). This study and a survey of the recent literature imply that tumor pattern, width, and confluence can be ignored in lesions invading to 5 mm, and that the most important factor to consider in therapy planning is depth of invasion. The following guidelines are proposed. In lesions without lymphvascular space invasion, those invading the stroma to no more than 3 mm may be treated with a total abdominal or vaginal hysterectomy. In lesions invading between 3 and 5 mm, a total abdominal hysterectomy and a pelvic lymphadenectomy seem adequate therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Pelvic fibromatosis: an unusual gynecologic tumor.

Pelvic fibromatoses are only unusually encountered in gynecologic practice, but then consistently create a diagnostic and therapeutic challenge. The reported patient typifies the difficulties encountered in surgical excision. A discussion of theories of etiology and management options follows.

Lower extremity edema due to deep vein thrombosis in patients with recurrent cervix cancer.

Seven patients with recurrent cervix cancer and concurrent lower extremity edema and pain were studied with contrast venography. Five patients (83%) were proven to have deep venous thrombosis. Significant objective and subjective response to therapeutic intravenous heparinization was obtained in all patients with DVT. The low morbidity and high rate of efficacy of treating this problem should encourage the physician to investigate this problem, in order to offer palliation.