Assessment of chemokine serum levels in epithelial ovarian cancer patients.

AIMS AND BACKGROUND: The study was undertaken to investigate CCL2/MCP-1, CCL3/ MIP-1α, CCL4/MIP-1ß, CCL5/RANTES and CXCL8/IL-8 women with epithelial ovarian cancer. METHODS AND STUDY DESIGN: Sixteen patients diagnosed with epithelial ovarian cancer and 18 healthy women with no evidence of malign neoplasia (control group) aged from 23 to 89 years (mean ± SEM, 58.7 ± 2.3) were included. The epithelial ovarian cancer patients underwent laparotomy and debulking surgery. Chemokines serum levels were measured by cytometric bead array. Statistical analysis was performed using Mann-Whitney and Kendall's tau. P <0.05 was considered statistically significant for all analyses. RESULTS: The tumor staging (FIGO) was classified into: I in 4 cases (25%), III in 5 cases (31.3%) and stage IV in 7 cases (43.8%). Sera chemokine dosages of CCL2/MCP-1 and CCL4/MIP-1ß were lower in epithelial ovarian cancer patients than in the control group (P = 0.021 and P = 0.030, respectively). No significant difference between groups was observed in the levels of CCL3/MIP-1α, CCL5/RANTES and CXCL8/IL-8. No association between the chemokines analyzed and tumor stage was found. The serum level of CCL4/MIP-1ß was correlated with CA-125. CONCLUSIONS: The study of serum levels of CCL2/MCP-1, CCL3/MIP-1α, CCL4/MIP-1ß, CCL5/RANTES and CXCL8/IL-8 chemokines in epithelial ovarian cancer patients identified a down-regulation in CCL2/MCP-1 and CCL4/MIP-1ß, which suggests that the two chemokines may play an important role in the pathophysiology of ovarian cancer.

Telomerase activity in the vaginal margins of radical hysterectomy in patients with carcinoma of the cervix: correlation with histology and human papillomavirus.

This study was undertaken to evaluate the telomerase activity both in the tumor and in the vaginal margins of radical hysterectomy in patients with squamous cell carcinoma (SCC) of the cervix. Thirty-three patients with SCC of the cervix (study group) and 13 patients with uterine myoma (control group) were prospectively studied. Tissue samples were taken from the tumor or cervix, anterior vaginal margin (AVM), and posterior vaginal margin (PVM). The specimens were analyzed by histopathology, by a telomerase PCR-TRAP-ELISA kit, and by polymerase chain reaction using human papillomavirus (HPV) DNA. The telomerase activity was significantly higher in the tumor than in the benign cervix (P < 0.001). There was no difference in telomerase activity in the AVM and PVM in patients with cervical carcinoma compared to the control group. Telomerase activity was associated with the presence of histologic malignancy in the PVM of patients submitted to radical hysterectomy (P= 0.03). This association was not observed with the presence of HPV in AVM or PVM in the study group. Telomerase activity is a marker of histologic malignancy in patients with SCC of the cervix. There was no association between the telomerase activity and the presence of HPV in vaginal margins of patients submitted to radical hysterectomy.

Sentinel node mapping in a pregnant woman with cervical cancer: a case report.

The possibility of reducing morbidity associated with surgical dissection while maintaining accurate tumor staging is one of the greatest advantages of the sentinel node approach in surgical oncology. The sentinel node mapping has already proven to be useful in melanoma, breast cancer, and vulvar cancer. We report the first case of sentinel node detection by technetium-labeled radiocolloid in a pregnant woman with cervical cancer. The histologic analysis of the operative specimen showed a poorly differentiated squamous carcinoma with metastasis in the sentinel node and a neoplasic embolus in a blood vessel of the placental bed. The lymphatic mapping and sentinel lymph node detection are feasible during pregnancy.

Association between CD31 expression and histopathologic features in stage IB squamous cell carcinoma of the cervix.

This study was undertaken to evaluate the association between the expression of CD31 in the tumor and the histopathologic findings in patients with carcinoma of the cervix. This study included prospectively 30 women, aged 46.6 +/- 10.7 years, with stage IB squamous cell carcinoma of the cervix submitted to radical hysterectomy from November 2001 to September 2002. Samples from the tumor were taken and immunohistochemically evaluated by a monoclonal antibody for CD31. Clinicopathologic characteristics such as stage, tumor size, grade of differentiation, lymphatic vascular space invasion (LVSI), parametrial involvement, and status of pelvic lymph nodes were also recorded. The clinical stage (FIGO) was IB1 in 22 patients (73.3%) and IB2 in 8 patients (26.7%). The expression of CD31 was significantly associated with tumor size and the presence of LVSI, but not with grade of differentiation and vaginal or parametrial involvement (P= 0.03, P= 0.032, P= 0.352, P= 0.208, and P= 0.242, respectively). On univariate analysis, the presence of pelvic lymph node metastasis was influenced by LVSI (P= 0.003) and CD31 expression (P= 0.032). However, on multivariate analysis, the presence of LVSI (P= 0.007) was the only independent predictor of pelvic lymph node metastasis. The CD31 expression in tumor is significantly associated with LVSI and tumor size in patients with early-stage squamous cell carcinoma of the cervix.

Inhibin B and ovarian function after total abdominal hysterectomy in women of reproductive age.

The aim of this prospective study was to assess ovarian function using clinical and endocrine parameters in women of reproductive age who underwent total abdominal hysterectomy. Sixty-one women, aged 40 mIU/ml, estradiol of < 20 pg/ml and inhibin B of < 5 ng/ml, compatible with ovarian failure. In the control group, all the parameters studied remained unchanged. These results suggest that total abdominal hysterectomy accelerates the decline in ovarian function in women of reproductive age.

Vulvar carcinoma in young patients and its relationship with genital warts.

We report the occurrence of aggressive vulvar carcinoma associated with condyloma acuminata in three patients under 33 years old. Discussion of the role of the human papilloma virus (HPV) in the development of vulvar cancer is also presented. Three patients with condyloma associated with aggressive vulvar squamous cell carcinoma, in situ (1 case) and invasive (2 cases), documented by biopsy and/or vulvectomy are presented. In situ hybridization (ISH) was used to characterize the subtypes of HPV. One patient with erythematous systemic lupus developed in situ carcinoma after 5 years. The other two cases also developed aggressive multicentric, invasive squamous cell carcinoma after 10 years of diagnosis of condyloma. In all cases HPV cytological abnormalities were seen throughout the pathological examination. HPV 16 and 18 were present in cells of invasive squamous cell carcinoma in cases 2 and 3. HPV 6 and 11 were detected only in the condyloma area in case 2. HPV 30 was seen only in the condyloma area in case 3. This report emphasizes the need for biopsies of all unusually persistent or treatment-resistant condylomas, particularly in young and/or immunosuppressed patients.

Criteria for the diagnosis of diffuse uterine myohypertrophy.

OBJECTIVES: Diffuse uterine myohypertrophy (DUMH) is a condition clinically diagnosed by the presence of uterine bleeding, homogeneous and diffuse uterine enlargement, and absence of any myoendometrial cause of bleeding. Since the morphologic criteria for the diagnosis of this entity are still controversial, this study aimed to investigate the clinical presentation and the morphologic findings of the cases of DUMH presenting at the University Hospital of Botucatu, São Paulo, Brazil. METHODS: We retrospectively studied 43 consecutive patients with DUMH submitted to hysterectomy (test group) and compared the findings with those obtained from 28 patients submitted to hysterectomy due to a prolapsed uterus (control group). There were no significant differences in age, weight or height between the two groups. RESULTS: The uterine weight of the DUMH group (mean +/- S.D. 157.4 +/- 46.4 g) was significantly heavier than that of the control group (99.5 +/- 35.4 g) and myometrial thickness was significantly greater in the DUMH group (2.5 +/- 0.5 cm) than in the control group (1.9 +/- 0.4 cm). No positive correlation was observed between increased uterine weight and parity, but there was a positive correlation between uterine weight and myometrial thickness. On the basis of the present study, we suggest that the diagnosis of DUMH be made clinically and in cases of uterine weight > or = 120 g and myometrial thickness > or = 2.0 cm. In addition, 10 cases of each group were analyzed by morphometry to evaluate interstitial fibrosis and myometrial hypertrophy. The data showed that the increase in uterine weight in DUMH is caused by enlargement of individual myometrial fibers rather than accumulation of interstitial collagen. CONCLUSION: Discriminant analysis to estimate the diagnostic significance of a number of clinical and pathologic variables (age, parity, uterine weight and morphometric parameters) was able to differentiate cases of DUMH from controls in 100% of the patients.

An extremely large, cauliflower-type, cutaneous metastasis of ovarian cancer associated with good prognosis.

We report an unusual case of a 37-year-old woman who presented in 1980 with a serous papillary cystadenocarcinoma of the ovary. The patient refused any treatment and the patient was lost to follow-up for 6 years. After this period of time she returned with an extremely large, cutaneous, cauliflower-type of metastasis located in the lower abdominal wall and measuring 20 x 20 cm. She received two courses of chemotherapy treatment consisting of intraperitoneal cisplatin (100 mg/m2) and intravenous epirubicin (50 mg/m2) every 3 weeks. After the second course of chemotherapy she received cobalt radiotherapy (5000 cGy). Subsequently, she received four more courses of chemotherapy with dramatic remission of the cutaneous metastasis. Shortly after chemotherapy, the patient underwent a laparotomy consisting of the resection of the abdominal wall including the cutaneous metastasis completed by total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. The patient is well after the surgery and without any evidence of residual disease after 6 years of follow up. This description illustrates a rare example of ovarian cancer with skin metastases and favorable outcome.

Consideraçöes sobre o câncer localmente avançado de mama (CLAM) acrescidas de identificaçäo dos receptores de estrogênios usando anticorpos monoclonais / Considerations of locally advanced cancer of the breast (LACB) increased of indentification of estrogen receptors by using monoclonal

Para investigar os resultados do tratamento do câncer localmente avançado de mama nós estudamos 49 pacientes, que foram submetidas à associaçäo de telecobaltoterapia convencional e quimioterapia dupla com ciclofosfamida e 5-fluoracil, combinadas com mastectomia radical nos casos operáveis. Obteve-se controle local do tumor em 86,7% dos casos. Näo houve recidivas logorregionais nas pacientes submetidas à cirurgia, índice que alcançou 21,7% nas inoperáveis que receberam só radioterapia e quimioterapia. O seguimento médio das pacientes falecidas foi de 29,5 meses e das sobreviventes, de 79,3 meses. O índice de respostas completas foi de 24,5%. O período médio livre de doença de 22,9 meses e índice global de sobrevida, entre três e cinco anos, de 32,7%. Os receptores de estrogênios foram identificados mediante método imuno-histoquímico (ER-ICA) usando anticorpo monoclonal antiestrogênio (RE, 22-SPy, Abbot). Näo houve diferenças de resultados entre as pacientes RE-positivas e RE-negativas, o que explica pelo adiantado estágio evolutivo dos tumores - no que tange aos índices de respostas completas, período livre de doença e sobrevida global. A presença de receptores de estrogênios correlacionou-se, significativamente, com alguns sinais histopatológicos das neoplasias: grau de diferenciaçäo, quantidade de elastose, ausência de infiltraçäo linfocitária e ausência de necrose

[Locally advanced cancer of the breast (LACB) and identification of estrogen receptors with monoclonal antibodies]. / Considerações sobre o câncer localmente avançado de mama (CLAM) acrescidas de identificação dos receptores de estrogênios usando anticorpos monoclonais.

The effects of therapy in locally advanced breast cancer submitted to combined conventional telecobalt therapy plus chemotherapy with cyclophosphamide and 5-fluorouracil were studied in 49 patients. Associated to radical mastectomy in operable cases. Local tumor control was achieved in 86.7%. There were no local recurrences in those submitted to surgery but they reached 21.7% in inoperable patients who received only radiation therapy and chemotherapy. The median follow-up time for dead patients was 29.5 months and for living patients 79.3 months. The index of complete responses was 24.5% and the median disease free interval was 22.9 months. The overall survival rate, between three and five years, was 32.7%. Estrogen receptors were identified by using immunohistochemical assay ER-ICA and monoclonal antibody H222-SP gamma, Abbott. There were no differences in the complete response index, disease free interval and survival rates, among ER-positive and ER-negative patients, explained by the far advanced stage of the disease. ER-positivity was significantly correlated with histological features of the tumors: cell differentiation, presence of elastosis, absence of lymphocytic infiltration and absence of tumor necrosis.

Abdominal colpopexy for complete prolapse of the vagina.

A comparative study of abdominal colpopexy using rectus fascia and sacral fixation for the treatment of prolapsed vagina following hysterectomy was performed. The abdominal approach yields better results than the vaginal route. Fixation of the vaginal vault using a Dacron prosthesis is more rational and was the method of choice, resulting in a complete cure in 10 of 11 patients. The Brady technique failed in 25% of cases.

Cytochemical evaluation of gamma-glutamyl-transpeptidase activity in cervical smears.

The cervicovaginal smears of 43 patients attending an outpatient service for early cancer detection were cytochemically studied for the presence of gamma-glutamyl-transpeptidase (GGT) in epithelial cells. This was done in order to evaluate such an enzyme phenotype as a marker for cancer development. The results showed that 70% of the 38 patients with a cytologic diagnosis of "inflammatory" or preneoplastic/neoplastic conditions had GGT-positive cells in their smears. None of the five cytologically normal cases showed any epithelial cells with GGT activity. Although most of the GGT-positive cells were metaplastic, some morphologically normal, dysplastic or neoplastic cells also expressed the enzyme. The data suggest that cytochemically detectable transpeptidase activity appears whenever alterations of the normal epithelial microenvironment occurs, but is not necessarily linked to the carcinogenic process. Therefore, cytochemically GGT-positive cells should not be used as an indicator of neoplastic transformation of the cervical epithelium.

An unusual case of malignant cystosarcoma phyllodes of the breast.

A unusually large tumor of the left breast diagnosed as a cystosarcoma phyllodes with multiple malignant sarcomatous changes of the stroma, consisting of liposarcoma, myxoid fibrosarcoma, anaplastic, and giant cell sarcoma is described. The weight of 6200 g (13.5 lb) seems to be the largest so far presented in the literature reviewed by the authors.

[Transvaginal tubal ligation]. / Laqueadura tubaria pela via transvaginal.

PIP: Vaginal tubal ligation is a simple procedure, offers minor surgical risks, and has few contraindications. The authors consider it the surgical contraceptive of choice in selected cases. From July 1975 to March 1983 the authors performed 155 tubal ligations by the vaginal route after posterior colpotomy. For each patient opinions were sought from at least 3 physicians, who advised regarding the medical or psychological need for sterilization. The median age was 35 years, with ages ranging from 23 to 48. Median parity was 5.3, with 57 patients having 6 or more children. All were from low socioeconomic backgrounds. 140 tubal sterilizations were done by the Pomeroy method, in 14 by the Pomeroy method on 1 side and fimbriectomy on the other, and in 1 patient a bilateral fimbriectomy was performed. In 3 patients the tubal ligation was completed by abdominal route because of difficulty of vision during colpotomy. All patients recovered well postoperatively, with minimal pain. All received antibiotic therapy with penicillin for 5 days following surgery. Average duration of surgery was 42 minutes. There were no occurrences of lesions, hemorrhages, abcesses, or infection of incisions. With an average follow-up of 41.2 months, the incidence of problems was 0.65%. Contraindications against using the vaginal route include a history of pelvic inflammatory disease, anterior gynecological surgery, alterations in the mobility or size of the uterus, and presence of adnexal tumors. Colpotomy presents several advantages: it is well accepted by the patient because there is no abdominal scar, it is an efficient method that does not require special apparatus such as optical or mechanical equipment, it is associated with minimal morbidity, and there are few complications. Additionally, surgery is of short duration, postoperative pain minimal, and it is economical because hospitalization time is short, with rapid convalescence. Disadvantages observed were: it is not applicable to all patients and requires major surgical training to perform; it requires an extended period of postoperative sexual abstinence, usually 4 weeks. This procedure cannot be used during the immediate postpartum period, with a recommended interval of 6 weeks. Tubal sterilization using posterior colpotomy, in view of the advantages and results obtained, is recommended for selected cases.^ieng

Laqueadura tubaria pela via transvaginal. / Tubal ligation by transvaginal route

A laqueadura tubaria pela via transvaginal e de tecnica simples, oferece menores riscos cirurgicos, tem poucas contra-indicacoes e os resultados obtidos em 155 casos permitem concluir tratar-se de metodo de alta seguranca. Os autores consideram tal metodo contraceptivo cirurgico de escolha em casos selecionados