Microsatellite instability is correlated with lymph node-positive breast cancer.

We analyzed 81 cases of primary breast carcinoma and 7 cases of fibroadenoma for microsatellite instability at eight loci. Twenty-seven cases (33.3%) manifested aberrant microsatellite alleles: 7 (8.6%) at one locus and 20 (24.7%) at two or more loci [tumors with replication error-positive (RER+) phenotype]. No evidence of microsatellite instability was observed in fibroadenomas. We investigated correlations between RER+ phenotype and clinicopathological characteristics of the carcinomas. The RER+ phenotype was statistically associated with large tumor diameter; of 19 RER+ tumors with measured size, 16 were > 2 cm, compared to 28 of 58 tumors with no evidence of microsatellite instability or with shifts in allele sizes limited to one locus (P

[Diagnostic and therapeutic problems in tubal adenocarcinoma. Report of a case]. / Problematiche diagnostiche e terapeutiche dell'adenocarcinoma tubarico. Caso clinico.

Primary adenocarcinoma of the Fallopian tube is one of the most rare tumours: its incidence varies from 0.5% to 1.1% of all gynecological neoplasias. In 1988 a total of 1,200 cases had been reported, the majority grouped in small series and/or individual case reports. The first case was reported by Renauld in 1847. The preoperative diagnosis has increased over the past forty years from 0.26% to 6.38%, and is still extremely low. The diagnosis of primary adenocarcinoma of the uterine tube is basically achieved by exclusion, and in fact the metastasization of the tubes by adjacent gynecological organs must be excluded. The trio of abdominal pain, leukorrhea, metrorrhagia is regarded by many authors as being pathognomonic of tubal adenocarcinoma. In about half of patients the interval between the onset of symptoms and histological diagnosis is 2-3 months, and in 30% less than one month. The authors report their experience of a case in a 62-year-old patient with typical symptoms of primary tubal adenocarcinoma.

Microsatellite instability and pathological aspects of breast cancer.

Genomic instability plays a key role in hereditary nonpolyposis colorectal cancer and in a significant sub-set of non-hereditary colorectal tumors. Recent evidence suggests that microsatellite instability also occurs in various sub-sets of common, non-hereditary forms of extra-colorectal carcinoma. To investigate the role of microsatellite instability in breast cancer, and to correlate this type of alteration with clinico-pathological characteristics, including tumor proliferative activity, we analyzed the status of 8 different microsatellite loci in 28 cases of primary mammary carcinoma. For this purpose, microsatellite banding patterns were compared in paired breast-cancer/peripheral-blood DNA samples. Microsatellite instability was observed in 6/28 (21%) of the cases. Four of the 6 tumors had low proliferative activity, one had high proliferative activity, and in one case proliferative activity values were not available. All chromosomal loci investigated demonstrated microsatellite instability in one or more representative tumors of the series. Shifts in length larger than 2 bp were the most frequent change. Microsatellite instability significantly correlated with the lobular histotype, and with lymph-node involvement. A trend was also observed associating microsatellite instability and large tumor size.

[Hysteroscopy in septate uterus. Diagnostic and therapeutic features]. / L'isteroscopia nei setti uterini. Aspetti diagnostici e terapeutici.

Personal experience of diagnostic and operative hysteroscopy of septate uterus is reported. The diagnosis of septate uterus is an integrated diagnosis that makes use of hysterosalpingography, echography, hysteroscopy and laparoscopy. Of 545 hysteroscopies carried out between January and December 1993, 29 evidenced uterine septum, complete in 6 cases, incomplete in the remaining 23. Of the 29 patients, 7 underwent resection of the septum by the hysteroscopic route. No intra or postoperative complications worthy of note were observed. At follow-up after one month, the uterine cavity in 5 patients proved completely regular while in the remaining 2 one case of fundic fibrous synechia and one of small persistent fibrous bridge, of little importance within the context of the cavity, were observed. The purpose of the present paper is to demonstrate the twofold role of hysteroscopy with regard to the septate uterus; is that hysteroscopy is a diagnostic and a precise operative technique that is atraumatic, fast and of low cost.

Diagnostic methods of early detection of endometrial hyperplasia and cancer.

Endometrial carcinoma is the most frequent genital neoplasia in women. Our own experience is based on a group of 3310 patients who were studied between 1985 and April 1994. In 2148 cases, equivalent to 56.4%, hysteroscopy was performed because of the presence of abnormal uterine bleeding (AUB). We found 672 endometrial hyperplasia (601 low risk-71 high risk) and 93 endometrial carcinoma. According to our experience we can assert that: hysteroscopy allows the measurement of the extension of the intracavitary neoplastic pathology and the definition of its topographic map; it is the only method that allows a target biopsy; it facilitates the evaluation of the extension of the neoplasia in the cervical canal, with the help of a deep biopsy into the cervical tissue (as proposed by La Sala) increasing its diagnostic accuracy.

Image cytometry for DNA analysis in endometrial carcinoma correlated with other prognostic parameters.

We evaluated by static cytometry DNA ploidy parameters in 30 stage I-IV endometrial carcinomas and correlated these data with standard clinical-pathological features and disease-free period. We observed a direct correlation between either non-diploid DNA content and deeper myometrial invasion (p<0.02) or D.I.greater than or equal to 1.2 and M2-M3 tumors (p<0.009). The Kaplan Meier survival curves illustrate a more rapid relapse of disease associated with non-diploidy, high 5cExR, high level of proliferation and D.I.greater than or equal to 1.2. while Cox regression model gave relative hazards for disease recurrence of 4, 6, 3.7 and 2.1 for non-diploidy, D.I.greater than or equal to 1.2, high 5cExR and high level of proliferation respectively. This prospective study confirmed the prognostic value of DNA Index, and its usefulness in clinical practice especially in stage I cases, otherwise characterised by favourable standard prognostic factors, is discussed.

[Breast pathology in adolescence. Diagnostic problems]. / La patologia mammaria nell'adolescenza. Problemi diagnostici.

Breast pathology, during adolescence, shows a typology like that in adults but with a completely different incidence. We observed 472 patients aged between 12 and 19 years in Senology Center of II Clinic of Obstetrics and Gynecology from 1984 to 1992. The most frequent pathologies diagnosed were: fibroadenomas (in the variety simple, phylloides, giant), cysts (simple and apocrine cysts); lower incidence for congenital anomalies, mastitis, mammary secretion caused by ductal hyperplasia or intraductal papilloma, lipoma. No incidence of cancer was detected. Echography was the principal diagnostic method for those patients who showed, at the clinical examination, a lump or palpable abnormalities. Mammography in this period does not affect the diagnoses and can be potentially harmful due to the exposure at X rays on such a sensible tissue.

Low-risk endometrial hyperplasia: hysteroscopy and histologic evaluation after treatment with LH-RH analogue.

Endometrial hyperplasia is an endometrial pathologic condition often found at perimenopausal age. Abnormal uterine bleeding (A.U.B.) is the most frequent symptom of endometrial hyperplasia. The combination of hysteroscopy and endometrial biopsy is the most suitable approach for the diagnosis of endometrial hyperplasia in symptomatic patients. We have studied endometrial modifications due to LHRH-analogue in 75 patients with AUB and with a hysteroscopic and histologic picture of low-risk endometrial hyperplasia. LHRH analogue is a valid treatment for all estrogen induced pathologies, because of its suppressive action on hypothalamic-hypophysary gonadotropins. The administration of LHRH for 4 months induced an improvement of the menstrual cycle within the first month of treatment in 53.3% of cases. At the end of treatment 100% of the patients were in amenorrhea. The hysteroscopic follow-up at 3 months showed an endometrial thinning with a tendency to hypoatrophy of the mucosa in 72% of cases. Three months after the end of treatment 20 patient had regular menstrual cycles and hysteroscopic and a histologic picture of normal endometrium. Only 30 patients had persistent amenorrhea with a consequent hysteroscopic and histologic picture of endometrial hypoatrophy. The use of LHRH analogue seems to have a great impact on the management of estrogen-dependent gynaecological benign diseases.

[Hysteroscopic evaluation of female infertility]. / Valutazione isteroscopica nell'infertilità femminile.

Three-hundred-seventy-one infertile patients underwent hysteroscopic evaluation. The test was performed in an outpatient setting without any form of anesthesia. A comparison has been made among this technique, the hysterosalpingography and ultrasounds: hysteroscopy showed to be more accurate in the evaluation of intracavitary pathology, because of its capability to obtain a direct view of the uterine cavity. We can evaluate hysteroscopically nature, dimension and localization of the lesions. However HSG remains the best technique for the study of tubal factors of infertility. We think that hysteroscopy should be used besides other diagnostic methods, in order to obtain a better evaluation of the infertile patients.

[Intraepithelial cervical lesions: colpo-microcolposcopic diagnosis]. / Lesioni intraepiteliali cervicali: diagnosi integrata colpo-microcolposcopica.

Integration of colposcopy and microcolposcopy allows to perform a complete study of eso- endo-cervix, for a diagnostic and topographic evaluation of cervical intraepithelial lesion. We have endoscopically studied 172 patients with histologically demonstrated CIN. In 218 cases (74.4%) the microcolposcopical evaluation corresponded to the histological diagnosis. These data confirm the methodological effectiveness of microcolposcopy and recommend it as helpful mean for cervical pathology investigation. However we believe that histological evaluation is necessary for a correct staging of the lesion. According to our experience indications for microcolposcopy are: 1) identification of endocervical lesion and squamo-columnar junction, when colposcopically not evident; 2) possibility of performing a "tailored" conization; 3) study of endocervix after conization.

Vulvar and penile HPV lesions: laser surgery and topic anaesthesia.

Treatment of genital warts (HPV lesions) by Laser-surgery was performed in 90 patients and 90 male partners under topical anaesthesia with 1-3 gr EMLA cream and in 45 patients and 45 males (control groups) under 1-2 ml 2% Carbocaine infiltration. EMLA cream was applied to warts 5-18 minutes (median = 7) before operation. Pain from application of anaesthetic and Laser surgery was significantly less (p < .001) in the groups treated by EMLA. Side effects were minimal in the EMLA groups. The results suggest that EMLA cream could be the anaesthetic of choice in Laser surgery of genital warts.

[Myomectomy via hysteroscopy. Indications, technics, results]. / Miomectomia per via isteroscopica. Indicazioni, tecnica, risultati.

Nowadays operative hysteroscopy represents the elective treatment of submucous and partially intramural fibroids. Seventy patients underwent hysteroscopic resection of fibroids, because of abnormal uterine bleeding in 58 (82.8%) cases, and infertility in 12 (17.2%) cases. The evaluation of the lesion was performed by diagnostic hysteroscopy and abdominal (57 patients) or transvaginal (13 patients) ultrasounds. In particular, for the evaluation of the intramural portion of the lesion, the hysteroscopic study of the angle between fibroid and myometrium was fundamental: the more acute the angle is the more intracavitary the myoma is. Forty-six (65.7%) out of 70 had a completely intracavitary fibroid; in 14 (20%) cases the intramural development was less than 1.5 cm and in the remaining 10 (14.3%) cases was more than 1.5 cm. Integration of hysteroscopy and ultrasounds for the assessment of myomas and the preoperative preparation by LH-RH analogues allow to perform an endoscopic resection of myomas which has up to, and sometimes over, 50% of their volume in the uterine wall.

[Diagnosis and therapy of low-risk endometrial hyperplasia. Experience with LH-RH-A]. / Diagnosi e trattamento delle iperplasie endometriali a basso rischio. Esperienza con LH-RH-A.

Endometrial hyperplasia is a endometrial condition often found in perimenopausal age. AUB is the most frequent symptom of endometrial hyperplasia. The combination of hysteroscopy and endometrial biopsy is the most suitable approach for the diagnosis of endometrial hyperplasia in symptomatic patients. The Authors have studied endometrial modifications due to LH-RH analogue, a depot formula, in 60 perimenopausal patients with AUB and with hysteroscopic and histologic picture of low-risk endometrial hyperplasia. They report the result of treatment efficacy (disappearance of symptoms and tendency to hypoatrophy of the mucosa). The use of LH-RH A seems to have a good result in the management of oestrogen-dependent gynaecological benign diseases.

[Clinical aspects of breast cancer in the aged woman]. / Aspetti clinici del carcinoma mammario nella donna anziana.

In Italy breast cancer mortality is constantly increasing in women over 70 years of age. The retrospective analysis of the cases observed at the "Senology Center" of the II Institute of Obstetrics and Gynecology (University "La Sapienza" of Rome) shows when compared to the group of women under age of 40 a higher number of advanced cases. This delayed diagnosis needs a most radical treatment and adjuvant therapies (i.e. chemotherapy) that cannot often be carried out because of general problems. Therefore, elderly women should be sensibilized to undergo periodical and regular sanitary inspection.

[The breast in adolescence. Physiopathological and clinical considerations]. / La mammella nell'adolescenza. Considerazioni fisiopatologiche e cliniche.

Mammary pathology, during adolescence, is an uncommon event and generally not very serious. During this growth period the different tissue mammary components are influenced by metabolic and hormonal stimulus in a proliferative and differentiative sense. In this growth period an efficient clinical approach is really necessary and it must not be only confined to senologic control, but inserted in the traditional semeiotics of a teenage patient, associated with a practice of self-palpation from the conclusive phases of the mammary development.

An overview of adolescents breast disorders.

Our investigation has confirmed the low incidence of mammarian pathology in adolescents and the near absence of malignant neoplastic pathology. Programs of breast control in this age can be valid only by aiming at health education prevention and correction of eventual risk factors. The group of adolescents studied by us has allowed us to define the most frequent pathology as the functional one, that is, mastodinia, and among the organic cases single or multiple fibroadenomas are the most frequent lesions. An exact diagnostic profile is necessary in order to reassure the patient in cases of absence of pathology, or to schedule a follow-up or to program an eventual surgical and/or medical treatment.

[Recurrent vaginitis]. / Le vaginiti recidivanti.

Vaginitis is one of the most frequent infections of the female genital system and, in the United States, represents the main reason for gynecological consultation. Candida albicans, Trichomonas vaginalis and Gardnerella vaginalis are responsible for 90% of cases of vaginal phlogosis. It has been calculated that a percentage varying between 5% and 40% of the female population will suffer, at least once in their lifetime, from an episode of vaginal candidosis. The re-appearance of symptoms after suspension of the antimycotic therapy still represents an unsolved and obscure problem from the etiopathogenetic point of view. The incidence of recurrences in women suffering from various forms of vaginal candidosis, according to the Authors, is between 5% and 25%. Considering the uncertainties existing regarding the clinical and etiopathogenetic definition of recurrent vaginitis we carried out a perspective study, at the General Out-patient Department of the II Obstetrical and Gynecological Clinic of "La Sapienza" Rome University in collaboration with the Bacteriological Laboratory of the III Medical Clinic of "La Sapienza" Rome University, on a group of 60 women suffering from recurrent vaginitis. We included in the study in the period 1 October 1987 - 30 September 1988 60 women reporting to the General Out-Patient Department of the II Obstetrical and Gynecological Clinic of the "La Sapienza" Rome University. These patients complained about the appearance of a leukorrhea or a leukoxanthorrhea in combination with at least one of the following symptoms: burning sensation; itch; dyspareunia; dysuria; recurring cystitis. All the women reported in their case histories having suffered from at least three episodes of recurrent vaginal candidosis in the previous twelve months. Diagnosis had been established on the basis of fresh microscopic examination with determination of the vaginal pH on the occasion of the first episode only; whereas clinical examination only was undertaken on the occasion of the subsequent ones. In 30% of patients (or 18 cases) the diagnosis of the subsequent episodes was "telephonic". In all cases, at each episode, a local therapy with antimycotic drugs had been prescribed. Following the introduction of a sterile speculum sterile swabs were used to remove 2 samples of the fluid present at the level of the posterior vaginal fornix. The first swab was placed in a test-tube containing 2 ml of prereduced transport broth (brain-heart infusion broth oxoid) for the successive aerobe and anaerobe cultures.(ABSTRACT TRUNCATED AT 400 WORDS)