Androblastoma of the ovary: clinical, diagnostic and histopathologic features.

Androblastomas of Sertoli-Leydig cell tumors of the ovaries are classified into the group of sex cord stromal tumors and represent an extremely rare form of tumor (0.2% of all ovarian tumors) in women. Their malignant potential is lower than that of epithelial ovarian cancer. They cause signs of virilization, although these are not obligatory. In many cases secondary amenorrhea is the only symptom of the disease. This leads to an intensive search for the source of the disorder. Frequently only the elevated production of androgens gives a preoperative clue to the tumor type. The recommendation to include the measurement of androgen levels in the routine diagnosis of secondary amenorrhea must therefore be endorsed. The tumors are usually sonographically identifiable; in differential diagnosis, hyperandrogenemia of other origins (e.g., Cushing's disease, adrenal hyperplasia, pituitary adenoma, other causes of ovarian and adrenal androgen hypersecretion, intersexuality, medically induced androgenization) have to be ruled out. In view of the good prognosis, the therapy of choice consists simply in adnexectomy of the affected side. With regular measurement of serum androgen levels an effective control of the course of the disorder is possible. A conclusive pathological diagnosis is difficult as heterologous tumors and mixed tumors exist and, furthermore, other tumor types are capable of imitating Sertoli-Leydig cell tumors.

Hormonal interactions in endometrial cancer.

Endometrial cancer (EC) is the most frequent malignant tumor of the female genital tract. Increasing evidence suggests that at least two different types of EC exist. Type I is associated with an endocrine milieu of estrogen predominance. These tumors are of endometrioid histology and develop from endometrial hyperplasia. They have a good prognosis and are sensitive to endocrine manipulation. Type II EC is not associated with a history of unopposed estrogens and develops from the atrophic endometrium of elderly women. They are of serous histology, have a poor prognosis, and do not react to endocrine manipulation. Both types of EC probably differ markedly with regard to the molecular mechanisms of malignant transformation. This article reviews reproductive and lifestyle factors modifying the risk of developing type I EC, including the use of hormonal contraceptives, hormone replacement therapy and tamoxifen. The roles of established and novel therapies for precancerous lesions and for invasive EC in the adjuvant and palliative settings are discussed.

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.

[Soluble adhesion molecules in patients with pre-eclampsia]. / Lösliche Adhäsionsmoleküle bei Patientinnen mit Präeklampsie.

Plasma concentrations of the circulating adhesion molecules ICAM-1 (CD54), VCAM-1 (CD106) were determined in 31 women with pre-eclampsia, 9 women with HELLP syndrome, and 13 women with transient pregnancy induced hypertension (PIH). Data were compared with a control group of 157 healthy pregnant women of the same gestational age. Furthermore, concentrations of circulating E-selectin (CD62E), P-selectin (CD62P), and PECAM-1 (CD31) were determined in a subpopulation of 17 women with pre-eclampsia. Plasma concentrations of circulating ICAM-1, VCAM-1, E-selectin, and PECAM-1 were significantly elevated in women with pre-eclampsia compared to healthy control pregnant women. Circulating ICAM-1 and VCAM-1 levels were also significantly elevated in the pre-eclampsia group compared to women with PIH. Concentrations of circulating P-selectin varied strongly in all experimental groups (SD > 70% of the mean), most likely reflecting various degrees of thrombocyte degranulation in the individual samples. Finally, longitudinal profiles of cICAM-1 and cVCAM-1 concentrations were determined in 123 healthy pregnant women between the 16th and the 42nd week of gestation. This analysis identified cICAM-1 and cVCAM-1 as tightly regulated plasma parameters that varied in a small concentration range. Concentrations of cICAM-1 and cVCAM-1 did not vary during pregnancy and the determined concentrations corresponded to the reported reference levels of nonpregnant individuals.

Monoclonal antibodies in solid tumours: approaches to therapy with emphasis on gynaecological cancer.

Monoclonal antibodies have progressed from the laboratory to the clinic. Although recognised in diagnosis there are still problems as far as their therapeutic use is concerned. This review looks at the history, principles of active specific immunotherapy, clinical experience with monoclonal antibodies in therapy of solid tumours, in particular the development of new bispecific monoclonal antibodies, and trials in ovarian, breast and colorectal cancer. Immunoconjugates, linked with radionuclides and cytotoxic drugs, indicate future developments. Conditions for successful therapy, especially with adjuvants in patients with small tumour residues, are also described.

[Acute fatty liver of pregnancy (AFLP) as a rare and severecomplication and differential diagnostic problem in the last trimester]. / Die akute Schwangerschaftsfettleber (AFLP) als seltene und schwere Komplikation sowie differentialdiagnostisches Problem im letzten Trimenon.

In context of hepatic failures in pregnancy HELLP-Syndrome is defining more and more the reflections of differential diagnosis. Therefore, the inclusion of very rare complications like the AFLP with an estimated incidence of 1:13,000 becomes difficult. Since 1940 250 cases are documented in the literature. Clinical features, approaches of therapy and pathophysiological ideas of the AFLP are also proofed as her role in the spectrum of liver-involved diseases of pregnancy.

[Neurinoma in the area of an episiotomy scar. A case report]. / Neurom im Bereich einer Episiotomienarbe. Eine Fallbeschreibung.

Neuromas are caused by lesions of intact nerves. They are defective regenerates and are characterised by benign neoplastic proliferation. Little is known about the presence of neuromas in episiotomy scars or at the vulva. The authors describe the course of a neuroma in an episiotomy scar on the basis of a case report by the Department of Gynaecology of the University of Göttingen. Only few case reports have been published. Preoperative diagnosis is based on suspicion; imaging methods fail to yield relevant information in the majority of cases. The number of undiscovered cases of neuromas after trauma of the perineum/of the vulva, the size of which is often just 1 or a couple of millimetres, may be higher than assumed; quite often a possible organic cause is excluded from the very beginning by assuming the cause was psychosomatic. If diagnosis proves difficult, simple resection of the tissue containing the focal point of the pain is the therapy of choice after detailed patient history exploration and gynaecological examination.

[Reaction of umbilical cord arteries to PGF2 alpha and glycerol trinitrate during the first days post partum]. / Reaktion der Nabelschnurarterien auf PGF2 alpha und Glyzerol-trinitrat innerhalb des ersten Tages post partum.

OBJECTIVE: Are there changes in the reactivity of umbilical cord arteries within the first day after parturition? METHODS: Groups of rings made from umbilical cord arteries were investigated by a force transducer for their reactions to PGF2 alpha and glycerol trinitrate after 1, 6, 12 and 24 hours after parturition. RESULTS: PGF2 alpha induces vasoconstriction, glycerol trinitrate vasodilatation of the umbilical cord arteries. The quantity of these reactions remains the same at each of the investigation times. But the standard deviation decreases 12 and 24 hours after parturition. CONCLUSIONS: There is an increase of the reproducibility of these investigations in the second half of the first day after parturition. The higher standard deviation in the first 6 hours after parturition may be caused by endogenous autacoids.

Concentration of cefixime in bile, gallbladder wall and serum after preoperative administration in patients undergoing cholecystectomy.

Cefixime is a new oral cephalosporin antibiotic with improved activity against Gram-negative pathogens comparable to the parenteral third generation cephalosporins, high beta-lactamase stability and a long elimination half-life of about 3 h. 15 patients undergoing cholecystectomy received 2 x 200 mg/day cefixime for two days before surgery. The last application was administered 13-17 h preoperatively. Intraoperatively, the mean biliary level of cefexime was 199.3 micrograms/ml (8.8 micrograms/ml-1163.8 micrograms/ml). The mean level in gallbladder wall was 25.02 micrograms/g (0.68 micrograms/g-61.20 micrograms/g). Serum samples were taken simultaneously. Despite relevant concentrations in bile and gallbladder wall, no cefixime could be detected in the serum samples of two patients. The other 13 patients, however, showed relevant serum levels between 0.28 micrograms/ml and 2.98 micrograms/ml (mean 1.01 micrograms/ml). Side effects as well as an influence on laboratory parameters were not seen. After administration of cefixime in bile and gallbladder tissue high antibiotic levels were achieved, even 13-17 hours after the last application.