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1.
Anticancer Res ; 43(1): 143-147, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36585183

RESUMO

BACKGROUND/AIM: The rate of local recurrence (LR) of phyllodes tumor (PT) varies from 4 to 18%. Several histological risk factors of LR of PT are known. The aim of this study was to estimate the LR rate of PT according to PT grade and to evaluate histological risk factors of PT LR in our retrospective cohort. PATIENTS AND METHODS: This was a two-center study, conducted from 1995 to 2019. All patients with PT diagnosed on surgical specimen were included. PT was diagnosed histologically according to the grade category defined by the 2012 World Health Organization classification as benign, borderline or malignant PT. Univariate analysis and then multivariate logistic regression analysis were performed to determine histological risk factors of LR of PT. RESULTS: A total of 224 patients with PT were included: 152 with benign, 49 with borderline and 23 with malignant PT. The median and standard deviation for the duration of follow-up was 136.60 ± 167.43 months, and 18 patients (8.04%) developed LR: 7 (4.61%), 7 and (14.29%) and 4 (17.39%) with benign, borderline and malignant PT, respectively. In univariate analysis, LR was statistically increased for histological size ≥45 mm (p=0.003), borderline/malignant TP (p=0.006) and dense stromal cellularity (p<0.001). In multivariate analysis, only histological size ≥45 mm and cellularity were statistically associated with LR (odds ratio=1.83, 95% confidence interval=1.06-9.83, p=0.04; and odds ratio=3.69, 95% confidence interval=1.11-12.28, p=0.03, respectively). CONCLUSION: Histological size ≥45 mm and dense stromal cellularity were demonstrated as histological risk factors of LR of PT. In our cohort, no association was found between LR and PT grade nor LR and surgical margins ≥10 mm.


Assuntos
Neoplasias da Mama , Tumor Filoide , Humanos , Feminino , Tumor Filoide/diagnóstico , Estudos Retrospectivos , Recidiva Local de Neoplasia/patologia , Fatores de Risco , Neoplasias da Mama/cirurgia , Neoplasias da Mama/complicações
2.
J Gynecol Obstet Hum Reprod ; 51(9): 102464, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36029956

RESUMO

BACKGROUND: Lymphadenectomy is part of cytoreductive surgery for patients with advanced epithelial ovarian cancer (AEOC) in case of abnormal lymph nodes before and during surgery. The aim of this study was to develop and validate a pre-operative radiological score to predict pelvic and/or para-aortic lymph node metastasis (LNM) in patients with AEOC undergoing cytoreductive surgery. METHODS: We conducted a multicentre retrospective study. The construction sample was composed of 53 patients operated within two referral centers. The validation sample was composed of 39 patients operated in a third referral center. The score was built with a logistic regression model with internal validation by bootstrap. RESULTS: Two variables were associated with the prediction of pelvic and/or para-aortic LNM at computerized tomography (CT) and/or positron emission tomography (PET/CT): "para-aortic lymph node involvement" (adjusted diagnostic odds ratio) (aDOR) = 8.77 95CI [1.42-54.09], p = 0.02) and "colon involvement" (aDOR = 7.97 95CI [1.28-49.58], p = 0.03). Bootstrap procedure showed that the model was stable. The 2-points LNM pre-operative radiological score was derived from these 2 radiological variables and a high-risk group was identified for a score ≥ 1: the probability of pelvic and/or para-aortic LNM was 76%, the specificity was 85.7% 95CI [67.3-96.0] and the positive likelihood ratio was 3.6 95CI [1.4-9.7]. In the validation sample, a score ≥ 1 had a specificity of 78.3% and a LR+ of 1.2. CONCLUSION: LNM pre-operative radiological score could help the surgeon's decision to perform pelvic and para-aortic lymphadenectomy in patients with AEOC undergoing cytoreductive surgery. TRIAL REGISTRATION: The research protocol was approved by the Ethics Committee for Research in Obstetrics and Gynecology (CEROG 2016-GYN 1003).


Assuntos
Neoplasias Ovarianas , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Humanos , Feminino , Metástase Linfática/diagnóstico por imagem , Carcinoma Epitelial do Ovário/diagnóstico por imagem , Carcinoma Epitelial do Ovário/cirurgia , Estudos Retrospectivos , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/cirurgia , Neoplasias Ovarianas/patologia
3.
J Gynecol Obstet Hum Reprod ; 50(1): 101993, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33217599

RESUMO

Breast cancer is the leading cause of cancer death in women, and most breast cancer related deaths are due to metastases. Uterine metastases from breast cancer are uncommon and rarely reported in the literature. We described the case of a 50 years-old-woman who developed a uterine metastasis, 6 years after the diagnosis of an invasive ductal breast carcinoma. Indeed, although the patient was asymptomatic, the monitoring imaging examinations, particularly the computed tomography (CT) and the positron emission tomography/computed tomography (PET/CT), showed a myometrial lesion. Non-conservative total hysterectomy was performed. The anatomo-pathological examination revealed a myometrial metastasis from an invasive ductal breast carcinoma. Seventeen months after surgery, the patient had no pelvic recurrence, but lungs and bones metastases progressed despite chemotherapy. In the lack of guidelines of uterine metastases from breast cancer's management, we reviewed the existing literature with the aim to provide a rational framework for clinical presentation, diagnostic approach, histological findings and treatment of this rare and heterogeneous pathology. Uterine metastases of breast cancer are frequently revealed with metrorrhagia. They occur preferentially in tumours with initial lobular carcinoma, initial lymph node involvement and positive hormonal receptors.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/secundário , Neoplasias Uterinas/secundário , Carcinoma Ductal de Mama/cirurgia , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Neoplasias Uterinas/cirurgia
4.
Anticancer Res ; 40(2): 1095-1100, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014959

RESUMO

BACKGROUND/AIM: Fibroepithelial lesions (FEL) of the breast include fibroadenomas and phyllodes tumors (PT). Their histologic characteristics on core needle biopsy can overlap, while their clinical management is different. The aim of this study was to develop and to validate a pre-operative score for the diagnosis of PT with surgical decision rules. PATIENTS AND METHODS: We developed a pre-operative score for the diagnosis of PT by performing logistic regression on 217 FEL of the Rene Huguenin Hospital. This score and the surgical decision rules were validated on 87 FEL of the Lariboisiere Hospital. RESULTS: Three variables were independently and significantly associated with PT: age ≥40 years, mammography's tumor size ≥3 cm and PT diagnosed by CNB. The pre-operative score was based on these three criteria with values ranging from 0 to 10. Surgical decision rules were created: the low-risk group of PT (score≤2) had a sensitivity of 92.6% and a LR- of 0.2, the high-risk group (score>7) had a specificity of 93.5% and a LR+ of 4.4. In the validation sample, surgical decision rules were applied. CONCLUSION: These surgical decision rules may prove useful in deciding which FEL needs surgical resection.


Assuntos
Neoplasias da Mama/diagnóstico , Mama/patologia , Fibroadenoma/diagnóstico , Neoplasias Fibroepiteliais/diagnóstico , Tumor Filoide/diagnóstico , Adulto , Biópsia com Agulha de Grande Calibre , Neoplasias da Mama/cirurgia , Tomada de Decisão Clínica , Diagnóstico Diferencial , Gerenciamento Clínico , Feminino , Fibroadenoma/cirurgia , Humanos , Mamografia , Pessoa de Meia-Idade , Neoplasias Fibroepiteliais/cirurgia , Tumor Filoide/cirurgia , Curva ROC , Estudos Retrospectivos , Adulto Jovem
5.
Ann Pathol ; 39(5): 357-363, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-30928254

RESUMO

We report the case of a 22-year-old patient with acute abdominopelvic pain. The diagnosis of hypercalcemic small cell carcinoma (SCCOHT)/ovarian rhabdoid tumor has been made. Small cell carcinoma of hypercalcemic type is a rare and aggressive tumor that occurs in young women. The diagnosis of this tumor and the management must be rapid in view of its aggressiveness. Through this observation, we specify the epidemiological, diagnostic, molecular aspects and discussions about its name.


Assuntos
Carcinoma de Células Pequenas/secundário , Neoplasias Primárias Múltiplas/patologia , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/secundário , Tumor Rabdoide/secundário , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/análise , Carcinoma de Células Pequenas/química , Carcinoma de Células Pequenas/epidemiologia , Carcinoma de Células Pequenas/genética , Terapia Combinada , DNA Helicases/genética , Diagnóstico Diferencial , Evolução Fatal , Feminino , Heterozigoto , Humanos , Hipercalcemia/etiologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Proteínas de Neoplasias/genética , Neoplasias Primárias Múltiplas/química , Neoplasias Primárias Múltiplas/epidemiologia , Neoplasias Primárias Múltiplas/genética , Proteínas Nucleares/genética , Neoplasias Ovarianas/química , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/genética , Síndromes Paraneoplásicas/etiologia , Neoplasias Peritoneais/cirurgia , Mutação Puntual , Tumor Rabdoide/química , Tumor Rabdoide/epidemiologia , Tumor Rabdoide/genética , Sarcoma de Ewing/diagnóstico , Fatores de Transcrição/genética , Adulto Jovem
7.
Abdom Radiol (NY) ; 42(6): 1762-1772, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28246921

RESUMO

Uterine myometrial tumors are predominantly benign conditions that affect one-third of women and represent the main indication for hysterectomy. Preoperative imaging is of utmost importance for characterization and for precise mapping of myometrial tumors to best guide therapeutic strategy. New minimally invasive therapeutic strategies including morcellation, myolysis, uterine artery embolization and image-guided radiofrequency or focused ultrasound ablation have been developed for the treatment of uterine leiomyoma. However, preoperative differentiation between atypical leiomyomas and leiomyosarcomas is critical on imaging as uterine sarcoma requires a specific surgical technique to prevent dissemination. A single, rapidly growing uterine tumor, associated with endometrial thickening and ascites, in post-menopausal women is suspicious of uterine endometrial stromal sarcoma and carcinosarcoma. Suggestive magnetic resonance imaging features have been described, but overlap in imaging appearance between uterine leiomyosarcomas and cellular leiomyomas makes it challenging to ascertain the diagnosis. This review aims to illustrate the imaging features of uterine sarcomas and potential mimickers to make the reader more familiar with this serious condition which needs special consideration.


Assuntos
Imageamento por Ressonância Magnética/métodos , Neoplasias Uterinas/diagnóstico por imagem , Carcinossarcoma/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Leiomiossarcoma/diagnóstico por imagem , Sarcoma do Estroma Endometrial/diagnóstico por imagem
8.
Arch Gynecol Obstet ; 291(6): 1229-36, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25416199

RESUMO

OBJECTIVES: Chronic intervillositis of unknown etiology (CIUE) is characterized by an intervillous infiltrate of mononuclear cells and a high recurrence rate of adverse obstetrical outcomes. The aim was to describe obstetrical history in patients with at least one event characterized by CIUE, and the possible impact of systematic investigation of an underlying autoimmune disease on the obstetrical outcome of subsequent pregnancies. METHODS: We retrospectively reviewed all pregnancies in patients having experienced at least one adverse obstetric outcome associated with chronic intervillositis of unknown etiology diagnosed by placental histological analysis between 2004 and 2011 in our university hospital. For each patient, data pertaining to obstetrical history, treatments during pregnancies, the results of systematic investigation of an underlying autoimmune disease, and treatments as well as obstetrical outcome in subsequent pregnancies, were collected. RESULTS: Twelve patients with 38 pregnancies were included [median age 30 (22; 40 years)]. Autoimmune disease or autoimmune antibodies (AID group) were found in 7/12 patients: primary antiphospholipid syndrome (APS) (n = 4), Sjögren's syndrome (n = 1), pernicious anemia (n = 1) and celiac disease (n = 1). When comparing pregnancies of patients with and without AID, there was no difference with regard to the type of obstetrical events or live-born babies, in spite of appropriate treatment. Corticosteroids (prednisone 10 mg/day) were used in only 2 cases with AID (Sjögren's syndrome and APS; n = 1 each), and these 2 pregnancies resulted in live-born babies. CONCLUSION: This study shows that the immunological assessment in patients with CIUE raises the possibility of a specific severity when AID or obstetrical APS is associated with CIUE, since conventional treatment did not improve obstetrical outcome in these patients as compared to those without autoimmune diseases. The benefit of immunosuppressant agents in this subset of patients needs further evaluation.


Assuntos
Síndrome Antifosfolipídica/complicações , Doenças Autoimunes/complicações , Doenças Placentárias/imunologia , Adulto , Síndrome Antifosfolipídica/epidemiologia , Autoanticorpos/imunologia , Doenças Autoimunes/epidemiologia , Vilosidades Coriônicas/imunologia , Doença Crônica , Feminino , Humanos , Doenças Placentárias/patologia , Prednisona/administração & dosagem , Gravidez , Complicações na Gravidez/imunologia , Estudos Retrospectivos , Adulto Jovem
9.
Autoimmunity ; 48(1): 40-5, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25028066

RESUMO

UNLABELLED: Introduction: In this prospective multicenter study, we aimed to describe (1) the outcome of pregnancy in the case of previous chronic histiocytic intervillositis (CHI), (2) the immunological findings and associated diseases, (3) the treatments, and (4) the factors associated with pregnancy loss. METHODS: We prospectively included all patients with a prior CHI with ongoing pregnancy between 2011 and 2013. RESULTS: Twenty-four women (age 34±5 years) were included in this study. An autoimmune disease was present in seven (29%) cases. Twenty-one prospective pregnancies were treated. The number of live births was more frequent comparatively to the previous obstetrical issues (16/24 versus 24/76; p=0.003). Most of the pregnancies were treated (88%), whereas only 13% of previous pregnancies were treated (p<0.05). No difference was found with respect to the pregnancy outcome in the different treatment regimens. In univariate analyses, a prior history of intrauterine death and intrauterine growth restriction and the presence of CHI in prospective placentas were associated with failure to have a live birth. DISCUSSION: In this multicenter study, we show the frequency of the associated autoimmune diseases in CHI, as well as the presence of autoantibodies without characterized autoimmune disease. The number of live births increased from 32% to 67% in the treated pregnancies. Despite the treatment intervention, the risk of preterm delivery remained at 30%. Last, we show that the recurrence rate of an adverse pregnancy outcome persisted at 30% despite treatment intervention. CONCLUSION: CHI is associated with high recurrence rate and the combined regimen seems to be necessary, in particular, in the presence of previous intrauterine death.


Assuntos
Aborto Habitual/imunologia , Doenças Autoimunes/complicações , Vilosidades Coriônicas/imunologia , Histiócitos/imunologia , Trabalho de Parto Prematuro/imunologia , Aborto Habitual/tratamento farmacológico , Aborto Habitual/patologia , Adulto , Aspirina/uso terapêutico , Autoanticorpos/sangue , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/patologia , Movimento Celular , Vilosidades Coriônicas/patologia , Feminino , Morte Fetal/prevenção & controle , Heparina de Baixo Peso Molecular/uso terapêutico , Histiócitos/patologia , Humanos , Hidroxicloroquina/uso terapêutico , Recém-Nascido , Nascido Vivo , Trabalho de Parto Prematuro/tratamento farmacológico , Trabalho de Parto Prematuro/patologia , Prednisona/uso terapêutico , Gravidez , Estudos Prospectivos , Recidiva
11.
Fertil Steril ; 94(7): 2909-12, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20605145

RESUMO

In this prospective comparative study, compared with fertile control subjects (n = 12), infertile patients with hydrosalpinx (n = 18) had lower E-cadherin and a trend toward decreased N-cadherin H-scores in the endometrium (3.6 ± 0.6 vs. 2.4 ± 0.8 and 0.57 ± 1.0 vs. 0.52 ± 0.5, respectively). In hydrosalpinx, epithelial N-cadherin expression was discontinuous and disappeared in atrophic patches.


Assuntos
Antígenos CD/metabolismo , Caderinas/metabolismo , Endométrio/metabolismo , Doenças das Tubas Uterinas/metabolismo , Receptores de Hialuronatos/metabolismo , Infertilidade Feminina/metabolismo , Atrofia/metabolismo , Biópsia , Estudos de Casos e Controles , Endométrio/patologia , Doenças das Tubas Uterinas/patologia , Tubas Uterinas/metabolismo , Tubas Uterinas/patologia , Feminino , Humanos , Infertilidade Feminina/patologia
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