Ovarian ectopic pregnancy.

A twenty-eight-year-old female patient during the second pregnancy, about 6 hbd (according to the date of the last menstrual period) from the spontaneous cycle, was directed to the local hospital because of suspected ectopic pregnancy with the location of the fallopian tube on the left side. She had no symptoms and vital parameters were in normal range. It was revealed that three years ago ectopic pregnancy of the right uterine tubule ended with right fallopian tube removal.

[Bilateral tubal ectopic pregnancy in a spontaneous cycle--a case report]. / Ciaza ektopowa podwójna, umiejscowiona w jajowodach w cyklu naturalnym--opis przypadku.

Ectopic pregnancy occurs in 0.5-2% of all pregnancies. A double ectopic pregnancy is very rare and has the incidence of 1 in 725 ectopic pregnancies. We describe a case of a 30-year-old patient with double ectopic pregnancy located in tubas in spontaneous cycle--diagnosed and treated at the Gynecology and Obstetrics Hospital in Walbrzych. The patient had no risk factors for ectopic pregnancy. This case shows that even the diagnosis of an evident ectopic pregnancy cannot exclude the possibility of a double ectopic pregnancy.

[Aggressive angiomyxoma of the vulva presenting as a huge pedunculated tumor]. / Olbrzymi guz sromu--uszypulowany angiomyxoma profundum.

In 1983, Steeper and Rosai described aggressive angiomyxoma as a rare, slow growing, locally infiltrative, soft tissue tumor that occurs mainly in the genital, perineal and pelvic region, mostly in women. Usually this tumor is nonmetastasing. Recurrence is frequent in about 30%-72% cases. Angiomyxoma demonstrates estrogen and progesterone receptor positivity. Primary surgical resection is the treatment of choice. Hormonal therapy with tamoxifen, raloxifene, and gonadotropin-releasing hormone analogs (GnRH agonists) and vascular embolization are used as the treatment of recurrence and may help to make complete excision feasible in large tumors. We report a case of a 43-year-old woman with huge pedunculated aggressive angiomyxoma of the vulva treated with primary excision.

Decreased expression of p16 in ovarian cancers represents an unfavourable prognostic factor.

Decreased expression of p16 may result from hypermethylation of the promoter or from deletion of the gene. It can lead to intensified proliferation of neoplastic cells and to cytostatic drug resistance. The study was aimed at the examination of prognostic value of p16 expression in relation to Ki67 and caspase-3 in ovarian cancers using immunohistochemistry. The immunohistochemical studies were performed on 73 paraffin-embedded samples of ovarian cancers from 43 patients and samples from 6 healthy ovaries. We have used monoclonal antibodies against p16. ABC method and DAB were used for antigens visualisation. The intensity of the immunohistochemical reactions was appraised using the semi-quantitative IRS scale. In healthy ovaries we have shown strong reaction in the nuclei of surface epithelium. In the case of studied ovarian cancers, the reaction of a nuclear and cytoplasmic localization was obtained. The mean overall immunoreactivity score of nuclear p16 expression amounted to 5.30+/-3.44 SD in primary laparotomy material and 6.61+/-4.34 SD in secondary cytoreduction material. Statistical analysis demonstrated that lower p16 expression was typical of the younger patients and the patients who died. Kaplan-Meier's analysis proved that lower expression of p16 was characteristic of cases with shorter overall survival. In the present study we have demonstrated that lowered p16 expression represented an unfavourable prognostic index in ovarian cancer. Lowered p16 expression was also typical for chemotherapy-resistant ceases (cases of lower caspase-3 and higher Ki67 at secondary cytoreduction expression).

Stromal myofibroblasts in breast cancer: relations between their occurrence, tumor grade and expression of some tumour markers.

It is suggested that tumour stromal myofibroblasts exert an unfavourable effect on the biology of breast cancer. We are aware of only a single study which examined relationships between manifestation of myofibroblasts in the stroma of breast cancer and clinicopathological data of the patients. The present study was aimed at estimation of the effect exerted by myofibroblasts present in the tumour stroma on principal pathological parameters and on expression of Ki67, P53 and HER-2 proteins in the group of the most frequent breast cancers, the ductal cancers. In paraffin sections of 60 ductal breast cancers (20 cases in G1, 20 in G2 and 20 in G3), immunohistochemical reactions were performed to detect expression of smooth muscle actin (SMA) in order to visualize myofibroblasts, Ki67, P53 and HER-2. The studies demonstrated that the most numerous myofibroblasts were present in G3 cases and they were the least frequent in G1 cases (P = 0.02). Positive correlations were observed between the presence of myofibroblasts in tumour stroma and expression of Ki67 and HER-2 in breast cancer cells in the entire group (P < 0.001 and P = 0.001, respectively), in G2 cases (P = 0.003 and P = 0.03) and in G3 cases (P = 0.01 and P = 0.03). Considering that the higher grade, Ki67 and HER-2 are thought to represent unfavourable prognostic factors, the elevated content of myofibroblasts in tumour stroma is probably typical for cases with worse prognosis.

[Assessment of the reliability of different methods in diagnosing endometrial cancer]. / Ocena wiarygodnosci metod diagnostycznych stosowanych w wykrywaniu raka endometrium.

OBJECTIVES: Endometrial cancer is the most common gynecologic malignancy. The purpose of the study was to compare the reliability of different methods for diagnosing endometrial cancer. DESIGN: A prospective study from January 1996 to September 1998. MATERIALS AND METHODS: 264 women at risk of endometrial cancer with clinical indications for hysteroscopy with curettage participated in the study. They underwent different diagnostic methods: endometrial cytology (121 cases), endometrial biopsy (150) or ultrasonography (200). The accuracy of these methods was related to the following results obtained from hysteroscopy with curettage. RESULTS: The results of the study suggest higher reliability of endometrial biopsy from cytology. The hysteroscopic diagnosis conforms with the histologic examination showed by the curettage. Endometrial cancer as the cause of post-menopausal bleeding can be excluded in cases with endometrial thickness of < or = 5 mm measured by vaginal ultrasonography. CONCLUSIONS: We concluded that the combination of hysteroscopy and endometrial biopsy may substitute for curettage and become the method of choice for the endometrium.

[Fine-needle biopsy of the breast in the material of Gynecology and Obstetrics Hospital in Walbrzych]. / Biopsja aspiracyjna cienkoiglowa sutka w materiale Specjalistycznego Szpitala Ginekologiczno-Polozniczego w Walbrzychu.

OBJECTIVES: Since the year of 2000 we have done more than 500 fine-needle aspiration biopsies in our hospital. DESIGN: The main cause was a breast lesion interpreted as suspicion of cancer in ultrasonography or mammography and its verification between benign tumor and a cancer. MATERIALS AND METHODS: 508 women with clinical findings of breast tumor were qualified for fine-needle biopsy procedure. RESULTS: The most common diagnosis was a benign cystic tumor found in 183 cases and the second one--fibro-cystic mastopathy (132 cases). Surgical operation of the breast was performed in 32 cases. In 17 we found breast cancer and in 14 the diagnosis was suspicion of breast cancer. CONCLUSIONS: Fine-needle biopsy is valuable for diagnosis of breast cancer and can be easily learned and used by the clinician. It's safe, cost-effective, and accurate technique, which has no counter-indications and causes little discomfort. Results are available in a short time so the decision about the necessity for excisional biopsy or mastectomy is made quickly.

[Occurrence of the cervix, corpus and ovarian carcinoma in the years 1984-2001 in women hospitalized in the Gynecological-Obstetric Hospital in Walbrzych]. / Wystepowanie nowotworów zlosliwych szyjki i trzonu macicy oraz jajnika w latach 1984-2001 w materiale Specjalistycznego Szpitala Ginekologiczno-Polozniczego w Walbrzychu.

OBJECTIVE: Retrospective analysis the cervix, corpus and ovarian carcinoma in the years 1984-2001. MATERIALS AND METHODS: 1104 women with cervix, corpus and ovarian carcinoma were investigated during the last 18 years. This time was divided conventionally into six-year periods. They include the occurrence, the age of the patients and clinical advanced degree by FIGO in the time of diagnosis of the disease. RESULTS AND CONCLUSIONS: Decrease of the quantity of women cured because of carcinoma of cervix. Considerable increase of quantity of women with carcinoma of corpus. Increase of the number of patients with carcinoma of ovarium.

[Delayed delivery of the second twin--a case report]. / Poród odroczony drugiego blizniaka--opis przypadku.

Delayed interval delivery of the second twin is not a conventional procedure in case of early delivery of the first one. The routine procedure is the provocation of the uterine activity and terminating pregnancy. Patient's willingness to have a desired child presents difficulties for obstetricians and necessitates unconventional steps. The described delivery of the second twin took place in the fifth week after the delivery of the first one. The patient was discharged on the 7th day after caesarean section and the new-born was discharged in good general condition on the 64th day when reaching body weight 3490 gram. Postponing the delivery of the second twin gave time for treatment with glucocorticoids and it prepared the fetus's lungs for extrauterine life. Therapeutically the most essential problem was the prevention of intrauterine infection. The described procedure posing a threat to both mother and foetus gives rise to understandable doubts. Possible risks should be thoroughly discussed with the patient as well as possible future child's problems.