[PRIMARY VAGINAL NON-HODGKIN LYMPHOMA--A CASE REPORT AND REVIEW FROM THE LITERATURE].

Primary vaginal non-Hodgkin lymphoma is really uncommon disease. We describe a 71 year old woman with primary vaginal non-Hodgkin lymphoma to whom was made a standart chimiotherapy after diagnosis. Tumor recurrence was not detected for the last 2 years.

[Leiomyosarcoma of the vagina: a case report and review from the literature].

Leiomiosarcoma of the vagina is a very rare condition and that is why there is no standard treatment of this disease. We describe a 35 year old woman with vaginal leiomyosarcoma to whom was accomplished a complete surgical treatment and no postoperative radiation or chimiotherapy. Tumor recurrence was not detected for the last 6 months.

[Case of encapsulated solid papillary carcinoma with triple-negative and basal-like phenotype occurred in pregnant woman with review of the literature].

The term breast cancer in pregnant women is used when the disease has been diagnosed during pregnancy or within first 12 months after delivery. The frequency of this type of breast cancer is about 7% of all cases in reproductive period. We present a case of breast cancer that occurred in pregnant 35 year old woman. We performed histological and immunohistochemical tests of excised tumor formation. We did not find sufficient evidence of both carcinoma in situ and invasive ductal carcinoma. The lesion was consisted with encapsulated/intracystic carcinoma, solid papillary variant with a low degree of differentiation-G3. Young age of patient, receptor status of the tumor the characteristic morphology of hereditary cancer, the presence of inflammatory infiltrates intratumorally, absence of reaction to IHC protein product of the tumor suppressor gene BRCA1 in combination with a positive p53 IHC makes this case suitable for genetic testing of BRCA1/BRCA2 susceptibility genes. The case is interesting because of the rarity of the histological variant, the young age of the patient, the combination with BC and pregnancy and the triple-negative phenotype.

[Morphologically qnd immunohistochemically based screening criteria for selection of patients with possible mutation of BRCA1 gene in primary ovarian cancer].

UNLABELLED: SUMMARY AND AIM: Breast cancer (BC) and Ovarian cancer (OC) are some of the most common cancers affecting women. Environmental factors and genetic alterations are involved in the etiology of both cancers. The main susceptibility genes that predisposed to BC and OC are BRCA1 (BReast CAncer 1) and BRCA 2 (BReast CAncer 2). Those of BC and OC which are due to germline mutation in BRCA 1/2 are defined as hereditary. Because of the expensiveness of genetic testing for mutations in BRCA1 we aimed to select patients with ovarian cancer suitable for genetic testing, on the base of certain morphological and immunohistochemical criteria. MATERIAL AND METHODS: We have conducted a retrospective analysis of 29 cases with serous papillary OC, taken from the archives of the Department of Clinical Pathology, University Hospital "Dr. G. Stranski" Pleven. We performed morphological assessment and subsequent immunohistochemical study with antibodies against p53, anti BRCA1 and anti proliferative marker Ki-67. RESULTS: Nineteen (65.52%) of all 29 cases were found with loss of immunohistochemical expression of BRCA1 and we defined them as suitable for genetic testing of BRCA1 mutations. CONCLUSION: A set of morphological and immunohistochemical criteria allows screening of women that should be referred for genetic testing, as it is expensive, and the incidence of BRCA1 mutations in the general population is very low.

EPIDEMIOLOGICAL REGISTRY OF NEUROENDOCRINE TUMORS IN BULGARIA--A PILOT SURVEY.

The National registry of patients with neuroendocrine tumors (NET) in Bulgaria was established in 2013 as a joint initiative of the Bulgarian Surgical Society and the Institute for Rare Diseases. The register aims to explore the epidemiology of NET in Bulgaria, as well as the different diagnostic and treatment approaches for the disease throughout the country. This the first of its kind retrospective study of NET in the country is covering the period January 2012 - January 2013. A total of 127 patients with NET were identified. At the time of the survey the average age of patients with NET was 58.61 ± 15.59 years. The data show almost equal distribution between the genders with a slight predominance of women. The largest relative part of NET is those of NET located in the gastrointestinal tract (54.10 ± 4.51%), followed by those located in the pancreas (12.30 ± 2.97%) and in the lungs (10.66 ± 2.79%). In 72.44 ± 3.96% of the patients a immunohistochemical diagnosis was performed. The study confirmed the leading role of the surgery method of the NET management. In 65.83 ± 4.33% of the patients a radical removal of the tumor was conducted, while the relative part of the undertaken partial resection was 7.50 ± 2.40%. A statistically significant association between the type of surgical treatment and during the follow-up of patients was found. An update of the information in the register will allow a more precise determining of the distribution and management of NET in Bulgaria.

[Visceral metastases of triple negative breast cancers with contribution of cases and review of the literature].

Breast carcinoma is a heterogeneous disease. Clinical treatment of metastases from triple negative-Estrogen receptor-(ER(-), Progesterone receptor (PgR)(-), Human epidermal growth factor receptor 2(HER2)(-)) primary breast cancer and metachronous second cancer in visceral organs is different. In this article we report two cases of visceral metastases from two patients with Stage IV triple negative primary breast cancer. We presented morphology findings and immunophenotype of all lesions and we offered a practical recommendation for diagnosis of similar cases.

[Sentinel lymph node biopsy in endometrial cancer--our experience].

PURPOSE: The objective of the study was to determine the feasibility of a method described for the first time by Altgassen et al. of labeling sentinel lymph nodes in patients with endometrial cancer using blue dye. PATIENTS AND METHODS: 4 ml of blue dye was administreted in 12 patients with endometrial cancer subserosaly at eigth sites. After 10 min sentinel lymph nodes were harvested. RESULTS: Detection rate was 91.6%., In only one patient there was no detection of sentinel lymph node and in one patient the sentinel lymph node was marked only in one hemipelvis. CONCLUSIONS: This method for detection of sentinel lymph nodes in patients with endometrial cancer is promising, fast and easy to implement, but need to conduct additional studies to become part of the standard for the surgical treatment of endometrial cancer

[Evaluation of the expression of S100A1 protein in serous, mucinous and endometroid ovarian carcinoma].

According to literature approximately 60% from all ovarian malignances express epithelial phenotype. According to their histomorphological characteristics, epithelial ovarian tumors are divided into eight groups. In some particular cases, separate histological types are hard to distinguish one from another. Recent studies show the presence of beneficial effect of adjuvant radiotherapy on most of the early ovarian carcinomas (all, except serous carcinomas). In renal cell carcinomas SI00A 1 is used to distinguish between different subtypes of the malignancy. Forty cases of ovarian carcinomas were analyzed in a retrospective study. Immunohistochemical evaluation of the S100A1 protein expression was carried out on representative archival formalin -fixed -paraffin-embedded tissue materials. Positivity for S100A1 was observed in 31 (77.50%) of the studied cases. Twenty-seven out of thirty-two (84.38%) cases of serous ovarian carcinoma were found to express S100A1. S100A1 expression was observed in one out of the two mucinous and three out of the six endometroid ovarian carcinomas. Immunopositivity was nuclear, cytoplasmic or nuclear and cytoplasmic in serous carcinomas, nuclear in the one positive mucinous carcinoma and sytoplasmic in the three imunopositive endometroid ovarian carcinomas. The S100A1 immunohistochemical marker is not likely to be useful in clinical practice to distinguish between different histological subtypes of ovarian cancer. The large percentage of S100A1 positivity in serous ovarian carcinomas needs a better understanding.

[Investigation of S100A1 expression in normal ovarian tissues].

The S100 protein family includes low-molecular weight (16-26 kDa) calcium-binding proteins. During the last decade data demonstrating the increased S100A 1 expression in several types of tumors was published. The authors of the basic studies, concerning the role of S100A1 expression in ovarian carcinomas emphasize the insignificant rate of S100A1 expression in normal ovarian tissues. So far the SI00A1 expression in ovarian tissues is based on tissue microarrays in limited number of cases. In order to be useful as biomarker for malignancy, S100A1 expression should be unequivocally negative or low in normal ovarian tissues. In order to ensure the application of S100A1 as biomarker for malignancy, a more detailed information on its' expression in normal ovarian structures is needed. This study aimed to evaluate the expression of S100A1 using immunohistochemical method in morphologically normal ovarian. Tissue samples from 40 ovaries were retrospectively studied. Immunohistochemical staining for S1001A1 was preformed in accordance to standard laboratory protocol. The immunopositivity was evaluated and interpreted in the context of the histomorphological findings in the analyzed ovarian tissues. Some benign (normal) ovarian tissue components were found to be S100A1 positive. Immunopositive in normal ovaries was found in: nerves and nerve endings, cells of rete ovarii, granulosa cells of follicular cysts, granulosa-lutein cells of corpus luteum, and corpus luteal cyst and in the granulosa cells in mature follicles. Immunopositivity in those cases was cytoplasmic, nuclear, or cytoplasmic/nuclear. Intensity of nuclear staining was found to vary from weak/moderate to high. Inclusion epithelial cysts were found to be negative for S100A1. The immunohistochemial staining for S100A1 in benign ovarian tissues may be useful for differentiating follicular from inclusion cysts (which have limited if any clinical importance). More importantly, the present study demonstrated expression of S100A1 in several normal tissue structures, which positivity would lead to very low levels of specificity of S100A1 if used as indicator for malignancy.

[Assessment of factors with possible influence over the duration of laparoscopic hysterectomy].

UNLABELLED: The duration of an operative intervention is directly related to the seriousness of the operative trauma. MATERIAL AND METHODS: A group of 14 factors with possible influence over operative time was investigated on the basis of the analysis of 635 laparoscopic hysterectomies accomplished over a six-year period (2004-2010) at the Oncogynecological Clinic at "Georgi Stranski" University Hospital for Active Treatment, and "St. Marina" Specialized Hospital for Active Treatment in Obstetrics and Gynecology, Pleven, Bulgaria. RESULTS: The factors which prolong the operative time statistically significant are uterine prolapse, as an: indication for operation, emergence of complications, hemotransfusion, enlarged uterus to the size of m. l. IV-V and increase in the body mass index by 1 kappag/m2, while previous conization and every following year of accomplishment of a laparoscopic hysterectomy significant shorten operative time. CONCLUSION: The fact that previous abdominal operations do not affect the duration of laparoscopic hysterectomy significant, indirectly supports the proposition that they are not a contraindication for the given operative procedure.

Distant metastasis after radical treatment of breast cancer: risk factors and their prognostic relevance in 378 consecutive patients.

PURPOSE: To evaluate the prognostic significance of 16 clinical, pathomorphological and immunohistochemical features for predicting distant metastasis (DM) and 5-year overall survival (OS) in breast cancer (BC) patients. PATIENTS AND METHODS: A retrospective study of 378 patients with invasive BC (T1-3N0-3M0), who were operated between 2000 and 2003 at our Institution, was carried out. Almost 80% had undergone modified radical mastectomy (MRM). Tumor size (T), axillary lymph nodes status (N), age, menstrual status, histological type, grade (G), lymphovascular invasion (LVI), in situ component, estrogen receptor (ER), progesterone receptor (PgR) content, HER-2, Ki-67, p53, bcl-2, cathepsin D and E-cadherin were evaluated. Mean follow- up time was 56 months (range 1-88). RESULTS: During the follow-up period 66 (17.4%) patients developed DM and 76 (20.1%) patients died. Univariate analysis showed that T (p=0.0001), N (p=0.0001), presence of comedo type in situ component (p=0.0001), LVI (p=0.016), Ki-67 (+) (p=0.007) and cathepsin D (+) (p=0.013) were independent prognostic indicators for increased risk for DM. After multivariate analysis only N (+) status (odds ratio/OR 8.8; 95% confidence interval/ CI 3.5- 21.77; p=0.0001) and presence of comedo type in situ component (OR 2.4; 95% CI 1.19-4.74; p=0.015) retained their significant association with DM development. The same 2 factors also influenced 5-year OS: N(+), OR 3.8; 95% CI: 1.36-10.56; p=0.011; and comedo type in situ component, OR 3.3; 95% CI: 1.61-6.56; p=0.001. CONCLUSION: N (+) status and presence of comedo type in situ component are the most reliable predictors of unfavorable events in BC patients. Our study is among the first ones to find a relationship between the presence of in situ component and risk for DM in patients after MRM. The results also show that comedo type intraductal component, no matter how extensive it is, bears high risk for DM equal to N1 axillary status and patients with presence of such intraductal component should be treated as N(+). The evaluation of optimal number of risk markers is substantial for making an individualized decision regarding adjuvant therapy, especially in N0 group.

Subdermal laterocranial mapping of sentinel lymph nodes in breast cancer as an alternative to the peritumoral mapping.

PURPOSE: Peritumoral injection of blue dye is standard method of sentinel lymph nodes (SLN) biopsy in breast cancer. Applying the marker to different locations will be of great benefit in cases in which the peritumoral mapping is difficult to implement. The aim of this study was to demonstrate that the subdermal laterocranial (SLC) mapping with a dye has similar diagnostic reliability to the peritumoral mapping and is applicable for clinical use. PATIENTS AND METHODS: 254 patients with operable breast cancer (cT

[Fibroblastic and myofibroblastic lesions of the breast--clinical and morphological aspects].

Fibroblastic and myofibroblastic lesions are challenging because they occur infrequently and there is significant clinical, radiologic and morphologic overlap between reactive and neoplastic lesions, as with non-fibrous lesions. In this article we describe and discuss four particular entities in some detail: fibromatosis of the breast, nodular fasciitis, pseudoangiomatous stromal hyperplasia of the breast and one case of mammary type myofibroblastoma.

[Morphologic changes in primary tumor due to neoadjuvant chemotherapy in breast cancer patients].

The use of chemotherapy as a form of primary treatment for breast cancer is increasing and, as a result, more resection specimens contain tumours which have been exposed to cytotoxic drugs. We have studied the effects of primary chemotherapy on the tumour morphology of breast carcinoma in a group of 77 patients. Characteristic morphological changes, related to the administration of cytotoxic agents, are seen in responded patients. The malignant cells become enlarged with vacuolated cytoplasm and vesicular nuclei containing prominent nuclei; occasionally the nuclei were angular and hyperchromatic. In most cases the stroma was found increased. These features are interpreted as degenerative in nature. It is important to be aware of these effects when studying breast carcinomas removed after chemotherapy.

[Granular cell tumor of the breast--review of the literature and research for a period of 5 years].

Granular cell tumor is relatively rare neoplasm, and always benign in its prognostic behavior. Location of this tumor in the breast presents serious problems for differential diagnosis, both from a clinical point of view and at gross pathologic examination, because of its resemblance to carcinoma. The histogenesis of these lesions has been widely debated in the past, but no universally accepted conclusions has been reached. Most granular cell tumors appear to be derived from Schwann cells of peripheral nerves, but many different lesions in the breast show granular cell changes. The authors describe four typical cases of breast granular cell tumors that occurred in patients of different ages, and discuss the most important problems concerning this lesion.

Clinical and surgical aspects of vulvar reconstruction with tensor fasciae latae flaps after en bloc radical vulvectomy.

PURPOSE: The aim of this study was to assess some clinico-surgical aspects of vulvar reconstruction with m. tensor fasciae latae flaps (TFL). PATIENTS AND METHODS: This retrospective study covers the period 1996-2002, and 51 patients with vulvar carcinoma were analyzed. Seven (13.7%) patients had undergone en bloc resection, followed by vulvar reconstruction with TFL., 28 (54.9%) radical vulvectomy with bilateral inguinofemoral lymph node dissection, and 12 (23.5%) patients simple vulvectomy. RESULTS: In 13 (25.5%) patients recurrences were found, that could not be statistically related to the type of surgical intervention (p=0.47). The overall 2-year survival was 82%. Factors contributing to prognosis included FIGO stage, the presence of recurrence and its type. Nine (17.6%) patients had died and the distribution by type of surgery in that group was as follows: en bloc resection with TFL reonstruction--14.3%, radical vulvectomy with lymph node dissection--17.9%, and simple vulvectomy--25%. The correlation was statistically nonsignificant (p=0.71). CONCLUSION: The comparison of the 3 surgical methods of treating primary vulvar carcinoma showed no influence on survival, mortality rate, and type and rate of recurrences. To obtain a reliable clinico-surgical assessment, a multicenter study is necessary.

[Evaluation of level of expression of p16 (INK4a) in endocervical lesions of uterine cervix].

UNLABELLED: The incidence of malignant and premalignant endocervical glandular lesions is increasing. Several research groups have recently used the protein p16 (INK4a) as a possible diagnostic biomarker of cervical cancer. The objects of study were to evaluate whether the specificity of p16 (INK4a) expression in is sufficient for distinguishing normal, dysplastic and neoplastic endocervical epithelium. MATERIALS AND METHODS: Paraffin-embedded samples of diagnostic biopsies and surgical materials were used. Control group included biopsy samples from 10 patients with normal findings. We examined 20 samples with different pathologic endocervical lesions. Monoclonal antibody against p16 was used (DAKO). RESULTS: In control samples we did not find any p16 (INK4a)-positive cells. Overexpression of p16 (INK4a) was detected in samples of cervical dysplasia and invasive carcinomas. CONCLUSIONS: Overexpression of the protein p16 (INK4a) is typical for dysplastic and neoplastic epithelium of cervix uteri. p16 (INK4a) may be regarded as a supplementary test for routine diagnostics of cervical lesions.

[Sclerosing stromal ovarial tumor--a case report and review].

Sclerosing stromal tumor (SST) is a rare benign ovarian neoplasm of stromal origin with less than 100 cases reported in the literature. Unlike the other stromal tumors, the comas and fibromas, which tend to occur in the fifth and sixth decades, sclerosing stromal tumors predominantly affect females in the second and third decades. Several unique histologic features including pseudolobulation, sclerosis and prominent vascularity of the tumor are clearly reflected at ultrasonography. We present a case of SST of the ovary in a 26-year-old female, and describe the ultrasound findings with pathologic correlation.

[Immunohistochemical analysis of epidermal growth factor receptors expression in malignant ovarian tumors].

OBJECTIVE: To study the frequency of EGFR expression in patients having malignant and benign ovarian tumors and to analyze its relation to some clinico-pathological factors. MATERIAL AND METHODS: In a prospective study 71 patients with malignant and 19 with benign ovarian tumors were included for the period 1999-2004. We utilized immunohistochemical analysis with monoclonal mouse antihuman EGFR antibody and EGFR pharm Dx kit (DAKO). RESULTS: The frequency of EGFR expression for the malignant ovarian tumours was 62.9% compared to 36.8% for the benign ones (p = 0.042). The patients with peritoneal washing positive for tumour cells and those with progressing cancer express EGFR significantly more frequently, 77% and 75%, respectively (p = 0.05). CONCLUSION: Malignant ovarian tumours have significantly greater frequency of EGFR expression compared to benign ovarian tumours.

[Primary peritoneal carcinoma: a report of two cases and a review of the literature].

Primary serous peritoneal carcinoma (PSPC) is rare tumor histologically identical to epithelial ovarian carcinoma (EOC); it is differentiated from EOC based on the extent of gross ovarian involvement and microscopic invasion of the cortex. When this tumor involves the extraovarian peritoneum significantly and the ovarian surface minimally or not at all, it is generally considered to be of peritoneal origin. We report macroscopical and histopathological findings of 2 cases of PPC, which were diagnosed, in our Department. Total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy were performed in 2 patients. PPC is a rare tumor currently managed in the same way as ovarian cancer. Primary debulking surgery and chemotherapy represent the cornerstones of treatment. Considering the limited number of patients with PPC, no definitive conclusion can be drawn concerning the prognostic factors for survival.