Multidisciplinary approach as the optimum for surgical treatment of retroperitoneal sarcomas in women.

INTRODUCTION: The study aimed at evaluating surgical treatment results of retroperitoneal sarcomas (RPS) in female patients in terms of urological and oncological-gynecological collaboration. MATERIALS AND METHODS: The authors performed a retrospective review of 17 women who underwent resection of a retroperitoneal tumor. The surgical results, complications, and both overall and disease-free survivals were evaluated. The assessment of a positive surgical margin and the size of the tumor were the second objective. The Kaplan-Meyer survival analysis was used for statistical evaluation. RESULTS: The median follow-up was 60 (26 - 128) months. The mean age was 55.4 (35 - 75) years. The mean size of tumors was 14.8 (6 - 45) cm. Local recurrences were recorded in three patients, while distal metastases were reported in one patient. Two patients died of distal metastases. The overall and cancer-specific survival was 87.5% and disease-free survival was 76.5%. CONCLUSIONS: Complete resection is the only effective treatment of retroperitoneal sarcomas. Presence of positive surgical margin is connected with a high risk of local recurrence regardless of an adjuvant chemo-and radiotherapy. The size of tumor had no impact on the survival or risk of local recurrence in the study group. The uro-gynecological collaboration was evaluated as well-suited in this part of oncological surgery.

Methylation in the p53 promoter in epithelial ovarian cancer

OBJECTIVE: Ovarian cancer is a leading cause of death from gynecologic tumors, however, the molecular and especially epigenetic events underlying this transformation are poorly understood. Promoter methylation status of tumor suppressor genes may be associated with transcriptional silencing and tumor progression. It has been shown that methylation of CpG dinucleotides located in the promoter region of p53 is associated with low expression levels of this gene. The aim of this study was to investigate promoter methylation of p53 gene in ovarian cancer by comparison with normal ovarian tissue. METHODS: To search for promoter methylation of p53 gene we used methylation-specific PCR (MSP) to compare the methylation status of 66 tissue samples of ovarian cancer with 37 control samples. RESULTS: In our study methylation specific PCR revealed p53 promoter methylation in 34 of 66 (51.5 %) of specimens with ovarian cancer. CONCLUSION: These results indicate that methylation in p53 promoter region may play an important role in carcinogenesis of ovarian cancer and could potentially be used in screening of ovarian cancer, and may have implications for future chemotherapy based on epigenetic changes (AU)

Methylation in the p53 promoter in epithelial ovarian cancer.

OBJECTIVE: Ovarian cancer is a leading cause of death from gynecologic tumors, however, the molecular and especially epigenetic events underlying this transformation are poorly understood. Promoter methylation status of tumor suppressor genes may be associated with transcriptional silencing and tumor progression. It has been shown that methylation of CpG dinucleotides located in the promoter region of p53 is associated with low expression levels of this gene. The aim of this study was to investigate promoter methylation of p53 gene in ovarian cancer by comparison with normal ovarian tissue. METHODS: To search for promoter methylation of p53 gene we used methylation-specific PCR (MSP) to compare the methylation status of 66 tissue samples of ovarian cancer with 37 control samples. RESULTS: In our study methylation specific PCR revealed p53 promoter methylation in 34 of 66 (51.5 %) of specimens with ovarian cancer. CONCLUSION: These results indicate that methylation in p53 promoter region may play an important role in carcinogenesis of ovarian cancer and could potentially be used in screening of ovarian cancer, and may have implications for future chemotherapy based on epigenetic changes.

[What is the prognostic importance of molecular genetic factors in endometrial carcinoma?]. / Jaký je prognostický význam molekulárne genetických faktoru u karcinomu endometria?

BACKGROUND: Evaluation of the importance of molecular genetic factors in endometrial carcinoma based on our review of available literature, and in the case of K- ras mutation based on our own data. The aim of the original part of our study was to compare the presence of K- ras mutation in early stages of endometroid carcinoma with normal endometrium and evaluate the role of the mutation in endometrial carcinogenesis. MATERIAL AND METHODS: Molecular bio-logical analysis was performed to detect K- ras mutation in samples of endometrial tissue obtained from women treated in the past at the Department of Obstetrics and Gynecology, University Hospital Hradec Kralove. The detection was made from DNA isolated from paraffin embedded sections using K- ras -StripAssay, ViennaLab Diagnostics GmbH. RESULTS: K- ras mutation was found in 7 out of 30 specimens of endometroid carcinoma in stage I (23%) and in 3 of 20 specimens of normal endometrium in the control group (15%). K- ras mutations were more frequent in IA stage and grade 1 of endometroid carcinoma. CONCLUSION: The importance of molecular genetic factors in endometrial carcinoma differs depending on the type of carcinoma. In more common type 1 endometroid cancer, published data are not as clear as in type 2 carcinoma, in which prevalence of alteration of p53 reaches 90%. Results of our study performed on local population of women support the theory about the possible role of K- ras mutation as an early event in the process of endometrial carcinogenesis in type 1 tumors.

Methylation analysis of tumour suppressor genes in ovarian cancer using MS-MLPA.

Epigenetic changes are considered to be a frequent event during tumour development. Hypermethylation of promoter CpG islands represents an alternative mechanism for inactivation of tumour suppressor genes, DNA repair genes, cell cycle regulators and transcription factors. The aim of this study was to investigate promoter methylation of specific genes in ovarian cancer by comparison with normal ovarian tissue. To search for epigenetic events we used methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) to compare the methylation status of 69 tissue samples of ovarian cancer with 40 control samples. Using a 15% cut-off for methylation, we observed significantly higher methylation in genes MGMT, PAX5, CDH13, WT1, THBS1, GATA5 in the ovarian cancer group, while in the ESR1 gene we observed significantly higher methylation in the control group compared with the ovarian cancer group. These findings could potentially be used in screening of ovarian cancer and may have implications for future chemotherapy based on epigenetic changes.

Endometroid adenocarcinoma of the uterus, borderline tumor of the ovary and Brenner tumor of the contralateral ovary in a 63-year-old woman.

Synchronous primary cancers of the endometrium and ovary occur in approximately 10% of all women with ovarian cancer and 5% of all women with endometrial cancer. The pathogenesis of synchronous endometrial and ovarian cancer is unclear. Synchronous tumors tend to be low grade and early stage. The prognosis is much better with survival approaching ten years than if the disease was classified as a single organ disease with metastasis. We report a case of unusual co-existence of endometroid adenocarcinoma of the uterus, serous borderline tumor of the ovary and Brenner tumor of the contralateral ovary in a 63-year-old woman. The patient recieved a surgical treatment and postoperative irradiation.

[Prognostic factors of mesenchymal and mixed tumors of uterus]. / Prognostické faktory u mezenchymálních a smísených nádoru delozního tela.

OBJECTIVE: Analysis of clinical and histopathological prognostic factors with emphasis on carcinosarcomas, leiomyosarcomas and endometrial sarcomas of uterus. SUBJECT: Review. SETTING: Department of Obstetrics and Gynaecology, Medical Faculty Hradec Králové, Charles University, Prague; The Fingerland Department of Pathology, Medical Faculty Hradec Králové, Charles University, Prague; Department of Clinical Oncology, Medical Faculty Hradec Králové, Charles University, Prague; Department of Biological and Medical Sciences, Faculty of Pharmacy, Hradec Králové; Charles University, Prague. SUBJECT AND METHOD: Discussion about our experience and current evidence. CONCLUSION: Mesenchymal and mixed tumors of uterus are characterized by several prognostic factors as well. Except clinical prognostic variables, histopathological and molecular biological factors may play a role. The most important prognostic significance carry stage of disease, age and performance status of patient and sufficient therapy, especially surgery. In particular tumors some other prognostic factors are recognized. Except cases in really early stage of disease there is usually short interval between end of primary therapy and tumor recurrence. With the exception of endometrial stromal sarcoma, prognosis of these tumors remains very poor.

[Appendiceal mucocele in differential diagnosis of tumors in pelvic region]. / Mukokéla apendixu v diferenciální diagnóze tumoru malé pánve.

OBJECTIVE: To report two cases of appendiceal mucocele in patients with suspected gynecological pathology. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, Medical Faculty of Charles University and Faculty Hospital Hradec Králové. SUBJECT AND METHOD: We report two cases of appendiceal mucocele diagnosed and treated at our department. CONCLUSION: Appendiceal mucocele is a rare pathology, characterized by abnormal accumulation of mucous in appendix lumen. It is four times more common in females with a mean age of about 55 years. The pathogenesis could be neoplastic or non-neoplastic. Appendiceal mucocele with its anatomic location must be considered in terms of differential diagnosis of masses in pelvic region. Preoperative diagnosis is important, alerting the surgeon of an unintended rupture during surgery and avoiding the development of pseudomyxoma peritonei. US and CT were reported to be valuable.

[Sclerosing stromal tumor--a rare benign ovarian neoplasm]. / Sklerozující stromální tumor--vzácný gonadostromální nádor ovaria.

Sclerosing stromal tumor (SST) is a rare benign ovarian neoplasm of the sex cord-stromal category occurring predominantly in young women (usually younger than 30 years of age). Histologically, the tumor is characterized by cellular heterogenity, prominent vascularisation, and a pseudolobular appearance composed of cellular and hypocellular areas. We report a case of the ovarian SST in a 17-year-old girl. Clinical, microscopic, immunohistochemical, ultrastructural findings and differential diagnosis are disscussed.

[Angiomyxoma of the vulva--a case report]. / Angiomyxoma vulvae--kazuistika.

OBJECTIVE: The authors demonstrate the case of a rare vulvar angiomyxoma in a 57-year-old female. DESIGN: Case report. SETTINGS: Department of Obstetrics and Gynecology, Medical Faculty Charles Uni Prague and Faculty Hospital, Hradec Králové. SUBJECT AND METHOD: A rare case of pedunculated angiomyxoma involving the vulva of a 57-year-old female is reported. Complete excision of the tumor was performed. CONCLUSION: Angiomyxoma is a rare locally infiltrative neoplasm of the vulvovaginal region, perineum and pelvis. Notorious recurring after surgical resection is due to its infiltrative border that makes it difficult to attain a cleared margin at the time of resection.