Topo-optical investigations on the surface of bacterial cells during the phagocytosis of Klebsiella pneumoniae in mouse.

Polarisation optical methods provide the means to perform sub-microscopic investigations on structures containing spatially highly ordered molecules, for example the cell envelope of prokaryotic cells. Such structures can evoke birefringence, which can be enhanced or modified by different dyes or reagents, thus providing the possibility of a more specific investigation of the composition and structure of bacterial surface compounds. Klebsiella pneumoniae synthesises sterically different carbohydrate-rich structures, including those of the outermost capsular polysaccharide, the polysaccharide somatic antigen of the lipopolysaccharide molecule and the peptidoglycan layer of the cell wall. In the study reported here, the nature and intensity of topo-optical activity of these structures was analysed using the aldehyde-bisulphite-toluidine blue reaction, sialic acid topo-optical reactions and chlorpromazine-eosin charge transfer reactions. Furthermore, a mouse intraperitoneal model was used to analyse alterations in topo-optical characteristics of bacteria during phagocytosis. Both encapsulated and non-encapsulated bacterial cells changed their original pattern and orientation of birefringence after being phagocytosed.

Polarization optical analysis of the surface structures of various fungi.

Vicinal hydroxyl groups of the sugar compounds sialic acid and 9-O-acyl sialic acid can be visualised for polarization optical analysis on the surface of different fungi using several topo-optical reactions. We investigated the presence of these molecules in cultures of Cryptococcus neoformans (heterogeneous form), Saccharomyces cerevisiae, Candida albicans, Candida glabrata, Candida krusei and Candida tropicalis by topo-optical reactions. Additionally, we examined brain and stomach tissues of patients with infections by C. neoformans and C. albicans, respectively. The results suggest a highly fashioned orientation of the sugar chains on the fungal surface. Terminal sialic- and O-acyl sialic acid residues are permanently present and orientated in a highly specific way in the cell wall of fungi. Based on the polarization optical analysis after the ABT-r (anisotropic PAS-r), the linear oriented hydroxyl groups of the sugar molecules are localized either perpendicular or parallel to the surface coat, depending on the species. According to the orientation of the vicinal hydroxyl groups, the oligosaccharide chains are orientated vertically. The capsule of the heterogeneous form of C. neoformans presented an especially strong metachromatic reaction and anisotropy. It is especially remarkable that the sterical orientation of sugar chains, and the terminal sialic acid and 9-O-acyl sialic acid molecules, was opposite in the inner and outer layer of the capsule.

Expression of the pantumour Thomsen-Friedenreich antigen in the human placenta with the diagnosis of hydatidiform mole.

BACKGROUND: The Thomsen-Friedenreich (TF) antigen (or, more precisely, epitope, Galbeta1-3GalNAc) has long been known as a pancarcinoma antigen. Specific carrier proteins of the TF-antigen are the mucins, in particular Mucin 1. Here, we present our results of immunohistochemical identification of this carbohydrate antigen in human placenta. MATERIALS AND METHODS: Paraffin-embedded placental and decidual tissues from patients with the diagnosis hydatidiform mole were incubated with different monoclonal antibodies directed against TF-epitope (CD 176, IgM) and against Mucin 1 (CD 227, IgG). RESULTS: No expression of the TF-antigen or of Mucin 1 (Muc 1) was found in the decidual tissues, but the samples of chorionic tissues were TF- and Muc 1-antigen positive. As positive control, placental samples of the first trimester were investigated. CONCLUSION: A disorder of the extravillous trophoblast cells is present in hydatidiform mole.

Expression of the glycodelin A gene and the detection of its protein in tissues and serum of ovarian carcinoma patients.

BACKGROUND: Glycodelin A (GdA), also known as placental protein 14 (PP14), has been detected in endometrial, cervical and ovarian carcinoma cells. It is suspected to be a marker of human ovarian cancer tissues. MATERIALS AND METHODS: We investigated serum, tissue and cyst fluid samples of patients with an ovarian carcinoma in contrast to patients with benign and malignant diseases such as uterine myoma, endometriosis, cervical, uterine and breast cancer, and metastases of bladder and colon carcinoma. Used methods were enzyme-immunoassay, immunohistochemistry (IHC) and polymerase chain reaction (PCR). RESULTS: In 81% of the control group the GdA-expression was negative, which was confirmed by IHC and PCR. Of the ovarian carcinoma group only 52% showed correspondence between IHC and PCR. CONCLUSION: These results indicate that determination of GdA is not sensitive or specific enough for use as a tumour marker.

Smooth muscle tumours of the uterine corpus: a clinicopathologic study with immunohistochemical aspects.

BACKGROUND: Based on a clinicopathologic study conducted at the University of Rostock, Germany, between 1/1997 and 6/2003, the histological records of 1761 patients who had been hysterectomized were evaluated. 1422 of these patients were suffering from smooth muscle tumours: 1389 were diagnosed as multiple leiomyomas, 26 as leiomyomas of uncertain malignant potential and 7 as leiomyosarcomas. PATIENTS AND METHODS: The data about the microscopic findings were obtained by use of both conventional histology (HE and Giemsa) and immunohistochemistry with markers for leiomyosarcomas (desmin, actin, sm-actin, myoglobin, vimentin, MIB1) and evaluated by statistical methods. Three case reports are also presented: 2 patients with leiomyosarcoma and 1 patient with an UMP tumour. RESULTS: The statistical evaluation included the frequencies of the different tumours subdivided into age groups, their localizations (with 23 distinctions), the associated microscopic findings (with 12 distinctions and most important combinations) and, finally, the number of tumours per patient and their (grouped) sizes. The case reports showed the presence of nuclear atypia, a heightened mitotic index and tumour cell necrosis. Immunohistochemical methods confirmed the histological diagnosis of a leiomyosarcoma. CONCLUSION: In accordance with earlier studies, more than 95% of the smooth muscle tumours were leiomyomas. Leiomyosarcomas were rare (<1% in our study). In 3 out of 7 cases, a leiomyosarcoma had its origin in a leiomyoma.

Primary melanoma of the female genital system: a report of 10 cases and review of the literature.

BACKGROUND: Primary melanoma of the female genital system are extremely rare (2-3%). PATIENTS AND METHODS: A retrospective review was undertaken of patients with primary melanoma of the female genital system treated from 1990-2003 at Rostock University Hospital, Germany. Different treatments (sentinel node biopsy, inguinofemoral lymphadenectomy, en bloc resection, adjuvant Interferon-alpha-therapy, adjuvant chemotherapy) are discussed. The complicated classification is reduced to a clinical path for daily use (UICC stage and invasion depth of Breslow, Clark's level and Chung's level). RESULTS: We report on 10 patients, aged 26 to 76 years, with primary melanoma of the female genital tract. Seven women developed a vulvar melanoma and one woman a malignant melanoma of the cutaneous inguinal region, while another 2 women had an unusual primary location of the malignant melanoma, the cervico-vaginal region (n=1) and the left ovary (n = 1). CONCLUSION: Initial surgical modality did not influence long-term survival, but affected disease-free survival significantly.

Vaginal metastasis of lung cancer: a case report.

BACKGROUND: Lung cancer is the second most common malignant tumor, with increasing incidence in the female population. The most frequent metastatic sites are the regional lymph nodes and surrounding areas as well as liver, adrenal gland, bones and brain. Metastases in the vagina of primary lung cancer have not been previously reported. CASE REPORT: Lung cancer was diagnosed in a 67-year-old, postmenopausal woman. Two years following partial lung resection (right apical lobe, R0-resection, CR), the patient complained of increasing problems with urination. A suspect tumor was identified with palpation and confirmed sonographically. Histological and immunohistochemical examinations of a vaginal excisional biopsy revealed metastatic adenocarcinoma, with the staining reactivity as primary lung neoplasm. Anterior exenteration was performed. CONCLUSION: Some cases of vaginal metastases from extragenital tumors have been previously reported. This is the first report of vaginal metastases from primary lung cancer. We suggest that adenocarcinoma especially tend to form metastases in the female genital tract. The present case emphasizes that, in women with unclear symptoms and findings in the small pelvis (e.g. urination problems, suspect vaginal tumor), the formation of such metastases should be taken into account.

Expression of the Thomsen-Friedenreich (TF) tumor antigen in human abort placentas.

The Thomsen-Friedenreich antigen (TF), or more precisely epitope, has been known as a pancarcinoma antigen. It consists of galactose-beta1-3-N-acetylgalactose. We have already described the expression of TF in the normal placenta. TF is expressed by the syncytium and by extravillous trophoblast cells. In this study, we investigated the expression of TF in the abort placenta. Frozen samples of human abort placentas (12 placentas), obtained from the first and second trimesters of pregnancy and, for comparison, samples of normal placentas (17 placentas) from the first, second and third trimesters of pregnancy, were used. Expression of TF was investigated by immunohistochemical methods. For identification of TF-positive cells in abort placentas, immunofluorescence methods were used. Evaluation of simple and double immunofluorescence was performed on a laser scanning microscope. Furthermore, we isolated trophoblast cells from first and third trimester placentas and evaluated cytokeratin 7 and Muc1 expression by immunofluorescence methods. We observed expression of TF antigen in the syncytiotrophoblasts layer of the placenta in all three trimesters of pregnancy in normal and abort placentas evaluated by immunohistochemical methods. There was no expression of TF antigen in the decidua of abort placentas. Immunofluorescence double staining of TF antigen and cytokeratin 7 showed reduced expression of both antigens in the abort decidua and co-expression of both antigens in the syncytiotrophoblast layer of normal and abort placentas. TF expression in the syncytiotrophoblast was reduced in abort placentas. In the isolated trophoblast cells, no TF expression was found, however, Muc1 expression was visualized. Expression of TF antigen was reduced in the first and second trimester abort decidua compared to the normal decidua during the same time of pregnancy. TF antigen was restricted to the syncytiotrophoblast and extravillous trophoblast cells in the decidua. Abort placentas expressed TF antigen on the syncytiotrophoblast layer, but with lower intensity compared to normal placentas. We found a significantly reduced co-expression of TF antigen and cytokeratin 7 in the decidua of abort placentas. These data suggested a reduction of extravillous trophoblast cells in the decidua of abort placentas. In addition, we found higher numbers of CD45-positive cells in the abort decidua compared to normal placentas.

Expression of inhibin/activin subunits, sialyl-lewis A (CA 19-9, sLea) and sialyl-Lewis X (sLex) carbohydrate antigens in a hydatidiform mole with persistent polymorphic trophoblastic hyperplasia.

UNLABELLED: The persistence of polymorphic trophoblastic hyperplasia in a hydatidiform mole is an extremely rare condition. Its early diagnosis is essential since such cases can transform into invasive tumours. MATERIALS AND METHODS: The paraffin-embedded biopsies were routinely stained with HE. Immunohistochemical staining reactions were performed with monoclonal antibodies against inhibin-alpha, inhibin-betaA and inhibin-betaB subunits. Additional immunohistochemical reaction was performed with, Sialyl-Lewis A and Sialyl-Lewis X and glycodelin. RESULTS: Large villi and hydatidiform villi with ranging syncyctio- and cytotrophoblasts were seen. Intervillous proliferating trophoblasts showed cell- and nuclear polymorphy with invasion of the myometrium wall. The immunohistochemistry exhibited strong positivity for inhibin-alpha, inhibin-betaA and inhibin-betaB subunits in trophoblastic tissue, while the decidua was negative. Sialyl-Lewis A and Sialyl-Lewis X showed no or minimal focal immunohistochemical reaction. CONCLUSION: A complete hydatidiform mole with hyperplasia and proliferation presents a high risk of developing a persistent (eventually metastatic) trophoblastic disorder and, in up to 15% of the cases, an invasive mole. In 2.5% of the cases it can transform into a choriocarcinoma. Since the inhibin/activin subunits reacted positively with trophoblastic tissue, they might be a useful diagnostic marker for hydatidiform mole with persistence of polymorphic trophoblastic hyperplasia.

Immunohistochemical expression of inhibin-alpha in human endometrium and the in vitro secretion of inhibin, estradiol and cortisol in cultured human endometrial glandular cells.

BACKGROUND: Inhibins are multipotent dimeric glycoproteins, composed of an alpha-subunit and one of two possible beta-subunits (betaA or betaB). Aims of this study were (a): the immunohistochemical characterisation of normal human endometrium for the inhibin-alpha subunit; (b) the assessment of the secretion and metabolism of inhibin, E2 and cortisol; (c) the evaluation of any relationship between these three substances in cell culture medium of isolated and cultivated normal human endometrial glandular cells. MATERIALS AND METHODS: Samples of human endometrium were obtained from 34 premenopausal patients. Nineteen endometrial specimen (proliferative [PP] n=8; early secretory [ES] n=7; late secretory phase [LS] n=4) were brought into cell culture. Fifteen endometrial specimen (PP n=5; ES n=5; LS n=5) were paraffin-fixed and used for the immunohistochemical analysis for inhibin-alpha. Stromal and epithelial cells were separated by collagenase digestions, filtrations, sedimentations and Ficoll-gradient centrifugation. E2 and cortisol were measured with radioimmunoassay (RIA) and inhibin with enzyme-immunoassay (EIA). Statistical analysis was performed with the non-parametric Mann-Whitney rank-sum test and linear regression analysis. RESULTS: Inhibin-alpha showed a weak (positive) expression during proliferative phase, which increased significantly as the menstrual cycle continued. In secretory glands the mean inhibin concentration was higher than that from proliferative samples. A significant correlation was observed between inhibin and E2 (p<0.001) as well as cortisol and inhibin (p<0.0001) in glands from proliferative phase. Between inhibin and E2 (p<0.05) as well as inhibin and cortisol (p<0.002) a significant correlation in early secretory glands was also noted. In late secretory phase inhibin and E2 (r2=0.78650; p<0.0001), inhibin and cortisol (r2=0.58326; p<0.001) and E2 and cortisol (r2=0.52880; p<0.001) showed a significant correlation. DISCUSSION: In conclusion, we found a cyclical expression of inhibin-alpha subunit in the endometrium demonstrated by immunohistochemical means. A higher in vitro secretion of inhibin from secretory glands was also observed. In addition, a significant correlation between inhibin with E2 and cortisol in PP and ES glands and a significant correlation between inhibin, E2 and cortisol in LS glands could also be demonstrated. We conclude that inhibin can be associated with E2 and cortisol metabolism, playing an important role in paracrine/autocrine mechanisms in the endometrium and possibly exerting its function through cortisol and E2. The cortisol concentration also correlates with E2, suggesting a link between these steroids in the endometrial function. The correlation of inhibin, E2 and cortisol suggest complex autocrine/ paracrine mechanisms in human endometrial glands, modulated and controlled by all these three substances.

Primary malignant melanoma of the cervix uteri: a case report of a rare tumor.

We present a case of malignant melanoma of the uterine cervix by focussing on the pathological and immunohistochemical studies that were done to confirm the diagnosis. A 67-year-old postmenopausal women suffering from vaginal bleeding was diagnosed with a polypous tumor at the uterine cervix. The histological diagnosis of a biopsy was pleomorphic malignant melanoma. Colpohysterectomy with bilateral adnexectomy, inguinal and pelvic lymphonodectomy was performed. The tumor was examined by histological and immunohistochemical methods. Multiple atypical cells (PAP V) were found in the cytological examination. The histological preparation showed partly atypical parvicellular, partly solid clear cellular tissue. The immunohistochemical staining reaction with pancytokeratin, LCA, estrogen- and progesterone- receptor was negative. A positive reaction was found on vimentin, S-100 and HMB-45. Thirty percent of the nuclei showed a positive reaction on the proliferation marker MIB1. The tumor was finally diagnosed as a primary pleomorphic malignant melanoma of the portio-vaginal border with satellite metastases into the vaginal wall and tumor thickness 2 mm. The value of immunohistochemical examination enabled us to make the diagnosis of a malignant melanoma of an unusual localisation at the cervix.

Diagnostic aspects of hydatidiform mole with persistence of polymorphic trophoblastic hyperplasia.

UNLABELLED: The persistence of polymorphic trophoblastic hyperplasia in a hydatidiform mole is an extremely rare condition. Its early recognition is essential since such cases can transform into invasive types of tumors. MATERIALS AND METHODS: The biopsies were routinely processed in paraffin, embedded and stained with HE. Immunohistochemical staining reactions were performed with the following monoclonal antibodies for hydatidiform mole: beta-hCG, HPL, MIB1, CK18, HER-2/neu, p53 and carbohydrate antibodies, Thomsen-Friedenreich antigen, Glycodelin A, Mucl and Mucl-cor. RESULTS: Large villi and hydatidiform villi with wide-ranged syncyctio- and cytotrophoblasts were seen. Intervillous proliferating trophoblasts showed cell- and nuclear polymorphy with a wall invasion of the myometrium. The immunohistochemistry exhibited strong positivity for the membrane-associated HER-2/neu and for the beta-hCG in syncytiotrophoblast and in multinuclear giant cells of intervillus trophoblasts. A weakly positive reaction with hPL was seen in most cells of the trophoblasts. The rest of the immunohistochemistry served as a diagnostic support. CONCLUSION: A complete hydatidiform mole with hyperplasia and proliferation of polymorphic trophoblasts presents a high risk of developing a persistent (eventually metastatic) trophoblastic disorder and, in up to 15% of the cases, an invasive mole. In 2.5% of the cases it can transform into a choriocarcinoma.

Immunohistochemical expression of the tumour marker CA-125 in normal, hyperplastic and malignant endometrial tissue.

INTRODUCTION: The aim of this study was to determine the tissue distribution of CA-125 in normal, hyperplastic and malignant endometrium. MATERIALS AND METHODS: Endometrial tissue was obtained from women in proliferative (n = 5), early secretory (ES; n = 4) and late secretory (LS; n = 4) phase as well as glandular-cystic hyperplasia (n = 5), endometrial polyps (n = 5), endometrial polyps caused by tamoxifen use (n = 5), adenomatous hyperplasia (AH) grade I (n = 5), grade II (n = 4), grade III (n = 5) and endometroid adenocarcinoma (n = 5). The CA-125 expression was evaluated with the semiquantitative IRS-Score. RESULTS: CA-125 expression was observed in glandular and luminal epithelial cells, being significantly higher during LS than ES. The highest CA-125 reaction was observed in AH III in glandular and luminal cells, which was statistically higher compared to all groups (except glandular cells: proliferative and LS; luminal cells: AH I-II, glandular-cystic polyps). DISCUSSION: CA-125 was expressed in normal, hyperplastic and malignant endometrial tissue with a cyclical expression in premenopausal endometrial glandular cells. Adenocarcinoma expressed CA-125 with a lower intensity. The highest expression was observed in AH III in luminal and glandular cells, therefore CA-125 could be a marker of malignant cell transformation.

Immunohistochemical expression of steroid receptors and glycodelin A in isolated proliferative human endometrial glandular cells after stimulation with tamoxifen and phytoestrogens (genistein and daidzein).

INTRODUCTION: The aims of this study were an evaluation of the distribution patterns of steroid hormone receptors (ER, PR) and glycodelin A (GdA) expression of proliferative endometrial glandular cells after stimulation with tamoxifen (TAM) and phytoestrogens (PE) (genistein, daidzein). MATERIALS AND METHODS: Human endometrium was obtained from 4 premenopausal women. Glands were stimulated after isolation with single doses of TAM, genistein and daizein (0.1, 1 and 10 mumol/l) and characterised with ER, PR and GdA after 9 days of culture. RESULTS: ER showed a significant decline with the highest TAM and genistein concentration (p < 0.05), whereas PR increased significantly with TAM and genistein concentrations of 1 mumol/l and 10 mumol/l (p < 0.05). GdA did not show any significant expression under TAM and genistein stimulation. Stimulation with daidzein resulted in no statistically relevant alterations in ER, whereas the PR significantly increased with all three concentrations (p < 0.05) and GdA also showed a significant increase with 1 mumol/l (p < 0.05). DISCUSSION: TAM showed anti-estrogenic properties in premenopausal endometrium. PE showed a similar ER, PR expression pattern as TAM, so therefore PE (genistein and daidzein) could also act as antiestrogens. GdA marked a cell transformation from proliferative to secretory status or the antiestrogen effects of TAM and PE.

Simultaneous immunohistochemical detection of tumor cells in lymph nodes and bone marrow aspirates in breast cancer and its correlation with other prognostic factors.

PURPOSE: We studied the prognostic and predictive value of immunohistochemically detected occult tumor cells (OTCs) in lymph nodes and bone marrow aspirates obtained from node-negative breast cancer patients. All were classified as distant metastases-free using conventional staging methods. PATIENTS AND METHODS: A total of 484 patients with pT1-2N0M0 breast cancer and 70 with pT1-2N1M0 breast cancer and a single affected lymph node participated in our trial. Ipsilateral axillary lymph nodes and intraoperatively aspirated bone marrow were examined. All samples were examined for OTCs using monoclonal antibodies to cytokeratins 8, 18, 19. Immunohistological findings were correlated with other prognostic factors. The mean follow-up was 54 +/- 24 months. RESULTS: OTCs were detected in 180 (37.2%) of 484 pT1-2N0M0 patients: in the bone marrow of 126 patients (26.0%), in the lymph nodes of 31 patients (6.4%), and in bone marrow and lymph nodes of 23 (4.8%) patients. Of the 70 patients with pT1-2N1MO breast cancer and a single involved lymph node, OTCs were identified in the bone marrow of 26 (37.1%). The ability to detect tumor cells increased with the following tumor features: larger size, poor differentiation, and higher proliferation. Tumors of patients with OTCs more frequently demonstrated lymph node invasion, blood vessel invasion, higher urokinase-type plasminogen activator levels, and increased PAI-1 concentrations. Patients with detected OTCs showed reduced disease-free survival (DFS) and overall survival (OAS) rates that were comparable to those observed in patients who had one positive lymph node. Multivariate analysis of prognostic factors revealed that OTCs, histological grading, and tumor size are significant predictors of DFS; OTCs and grading of OAS. CONCLUSION: OTCs detected by simultaneous immunohistochemical analysis of axillary lymph nodes and bone marrow demonstrate independent metastatic pathways. Although OTCs were significantly more frequent in patients with other unfavorable prognostic factors, they were confirmed as an independent prognostic factor for pT1-2N0M0, R0 breast cancer patients.

Analysis of aqueous humour proteins of eyes with and without pseudoexfoliation syndrome.

UNLABELLED: Pseudoexfoliation syndrome (PEX) has been suggested to represent a blood-aqueous barrier impairment leading to a higher protein content in aqueous humour of eyes with PEX. However, the nature of a prospective PEX protein has not yet been described. We set out to reevaluate protein content and examine protein composition for prospective PEX protein candidates in aqueous humour of eyes with PEX syndrome. Aqueous humour of 52 patients with PEX and 38 without PEX signs was sampled during cataract or glaucoma surgery. Total aqueous protein concentration in the samples was analysed in 43 PEX specimens and 32 non-PEX specimens according to Bradford. Aqueous protein composition of all samples was determined by sodium dodecylsulphate polyacrylamide gel electrophoresis (SDS PAGE) and silver staining. Screening for amyloids was performed in nine PEX samples and six non-PEX samples by Congo Red staining and polarised light microscopy. Aqueous protein concentration was not significantly increased in PEX eyes in comparison with non-PEX eyes. Furthermore, we could not detect any characteristic difference in protein band sizes of the two groups after SDS PAGE. However, we were able to show the presence of amyloid exclusively in aqueous humour of PEX patients. CONCLUSION: our results do not confirm a generally higher protein concentration in pseudoexfoliation syndrome eyes. This does not necessarily contradict a blood-aqueous barrier impairment but illustrates the variance in protein concentration between and within the two groups. No characteristic protein band allocatable to pseudoexfoliation syndrome proteins could be detected in any of the samples. However, our findings support the theory that the pseudoexfoliation syndrome is associated with an amyloid of a serum protein.

[Detection of atypical site of "sentinel lymph nodes" by lymph drainage scintigraphy in patients with breast carcinoma]. / Nachweis atypisch lokalisierter "Wächterlymphknoten" durch Lymphabstromszintigraphie bei Patientinnen mit Mammakarzinom.

OBJECTIVE: Sentinel lymph node (SLN) localization in breast cancer allows biopsy of directly tumor drained lymph nodes. The objective was to study the association of tumor and SLN localization. PATIENTS AND METHODS: SLN was identified in 39 (81%) of 48 patients with histologically proven breast cancer, clinically and sonographically unsuspected axillary lymph nodes after peritumoral application of 40-50 Mbq 99mTc-Nanocolloid. Patients age, tumor size and localization, histology and localization of the SLN as well as removed axillary lymph nodes were analyzed. RESULTS: Axillary lymph node metastases were found in 11 (28%) of 39 patients. Involvement of the SLN was confirmed by intraoperative frozen sections (n = 9) and paraffin embedded histology (n = 1). One (9%) patient with a positive node revealed a false-negative SLN. In 24 patients with a tumor in the lateral hemisphere of the breast the SLN were identified in the ipsilateral axilla. In 6 (40%) of 15 patients with a central or medial localized tumor the SLN was observed infraclavicular (n = 3), parasternal (n = 2) or in the contralateral axilla (n = 1). In the latter one the SLN of the contralateral axilla showed metastases, whereas the simultaneous SLN and all removed lymph nodes of the ipsilateral axilla were not involved. More than one SLN were found in 12 (31%) of the 39 cases. CONCLUSION: A correlation between tumor localization and localization of the SLN is suggested, but the lymph drainage seems more variable in cases of medial tumor size. Using blue dye for map of extraaxillary SLN seems inappropriate. Currently the diagnostic and therapeutic impact of the detection of extraaxillary SLN is still unclear.

Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: a prospective long-term study using transvaginal ultrasound.

PURPOSE: To study the value of transvaginal ultrasound (TVS) in endometrial screening of postmenopausal breast cancer patients treated with tamoxifen. PATIENTS AND METHODS: In 247 tamoxifen-treated (20 to 30 mg/d for >/= 2 years) women and 98 controls, the endometrium was prospectively followed-up by means of TVS every 6 months for up to 5 years. Patients with homogeneous endometrium of more than 10-mm thickness were then scanned repeatedly every 3 months. RESULTS: The mean endometrial thickness was 3.5 +/- 1.1 mm before treatment and increased to a maximum of 9. 2 +/- 5.1 mm after 3 years of tamoxifen application (P: <.0001), which was significantly (P: <.0001) thicker compared with controls. Fifty-two asymptomatic patients with thickened or morphologically suspect endometrium underwent hysteroscopy and dilatation and curettage (D&C), resulting in four uterine perforations. Histopathologically, atrophy was found in 38 patients (73.1%), polyps in nine, hyperplasia in four, and endometrial cancer in one case. In 20 screened patients who reported vaginal bleeding, five atrophies (25%), five polyps, four hyperplasias, and two endometrial cancers were found. Before hysteroscopy and D&C were performed, 36 (69.2%) of 52 asymptomatic and four (20%) of 20 symptomatic patients were scanned by repeated TVS over 2 to 30 months. Invasive diagnostic procedures were significantly (P: <.05) more frequent in younger and obese patients. In the controls, one asymptomatic polyp and one symptomatic hyperplasia were found. CONCLUSION: In tamoxifen-treated patients, TVS offered a high false-positive rate, even with a cutoff value of 10 mm for endometrial thickness and repeated TVS scans. Increased iatrogenic morbidity and only one asymptomatic endometrial carcinoma do not warrant endometrial screening by TVS in tamoxifen-treated patients.

[Skin sparing mastectomy with autologous immediate reconstruction: oncological risks and aesthetic results]. / Hautsparende (skin sparing) Mastektomie mit autologer Sofortrekonstruktion: Onkologische Sicherheit und ästhetische Ergebnisse.

OBJECTIVE: Is the oncological safety of skin sparing mastectomy (SSM) with immediate autologous reconstruction and improved aesthetic results comparable to postoperative findings in patients treated with modified radical mastectomy (MRM)? MATERIAL AND METHODS: Sixty patients with T1-2 breast carcinomas and contraindications for breast conserving therapy were treated by SSM and compared to 81 patients of the same age groups and MRM with regard to oncological and aesthetic data. In 33 (55%) patients the nipple areola complex (NAC) could be spared. For autologous tissue TRAM- and Latissimus dorsi-flaps were used. The mean follow-up was 40 (range 20-71) months. RESULTS: The observed local recurrence rates were not significantly different (p = 0.443) after SSM (n = 3; 5.0%) or MRM (n = 5; 6.2%). Distant metastases and death were seen in 26.7% and 15.0% (SSM), respectively, and in 25.9% and 13.5% (MRM), respectively. Body mass index, operation time and postoperative haemoglobin concentration differed between both groups significantly (p < 0.001) but not the rate of complications (p = 0.232). Aesthetic results of SSM were judged as excellent or good in 90.0% of patients and in 83.4% of surgeons. Nine patients (11.1%) underwent a secondary breast reconstruction after MRM. Furthermore, 12 (14.8%) patients with MRM would prefer a SSM with immediate reconstruction in a similar situation. CONCLUSION: Skin-sparing mastectomy improves aesthetic results to a high degree without increasing of local or distant recurrence rates. Skin-sparing mastectomy should be offered to selected patients with breast cancer as an alternative to modified radical mastectomy.