[Treatment of pregnancy associated gynaecological malignancies].

Pregnancy, leading to new life, on one hand, and life threatening malignancies an the other hand, are per se diametric subjects. Symptoms of malignancies are ignored more frequently during pregnancy by patients and physicians, often resulting in delayed diagnosis. Diagnosis and treatment of gynaecological malignancies, however, are increasingly important for four reasons: the peak incidence of several malignancies occurs during the reproductive age; late pregnancies present more often in an age group with increased risk for cancer, intensified care for pregnant women leads to more thorough diagnosis, and, curative treatment of malignancies gives women the potential chance for becoming pregnant.

[Gynecological and obstetric aspects of general practice].

The general practitioner called upon to provide medical care to the older woman for diseases other than gynecological or obstetric illness, should not neglect to recommend gynecological cancer screening, which is of particular importance in this group. In many differential diagnoses, the general practitioner must also give consideration to gynecological-obstetric aspects. Thus, for example, when a patient presents with lower abdominal pain, gynecological pathology must always be taken into account.

Pregnancy-associated breast cancer -- special features in diagnosis and treatment.

For obvious psychological reasons it is difficult to associate pregnancy -- a life-giving period of our existence -- with life-threatening malignancies. Symptoms pointing to malignancy are often ignored by both patients and physicians, and this, together with the greater difficulty of diagnostic imaging, probably results in the proven delay in the detection of breast cancers during pregnancy. The diagnosis and treatment of breast cancer are becoming more and more important, as the fulfillment of the desire to have children is increasingly postponed until a later age associated with a higher risk of carcinoma, and improved cure rates of solid tumors no longer exclude subsequent pregnancies.

Anastrozole versus tamoxifen treatment in postmenopausal women with endocrine-responsive breast cancer and tamoxifen-induced endometrial pathology.

Purpose: To investigate the effect of switching from adjuvant tamoxifen to anastrozole (Arimidex) treatment in postmenopausal women with endocrine-responsive breast cancer and histologically proven tamoxifen-induced benign endometrial pathology.

Experimental Design: Two hundred twenty-six postmenopausal women who had received adjuvant tamoxifen 20 mg/d (> or =12 months, < or =48 months) and developed abnormal vaginal bleeding and/or an asymptomatic endometrial thickness >10 mm [measured by transvaginal ultrasound (TVUS)] were subjected to hysteroscopy and dilation and curettage (D&C). Thereafter, 171 patients were randomized in a phase III study to continue tamoxifen treatment (n = 88) or switch to anastrozole 1 mg/d (n = 83).

Prognostic relevance of disseminated tumor cells in the bone marrow and biological factors of 265 primary breast carcinomas.

Introduction: The prognostic significance of disseminated tumor cells in the bone marrow (DTC-BM) of breast cancer patients has been demonstrated in many studies. Yet, it is not clear which of the primary tumors' biological factors predict hematogenous dissemination. We therefore examined 'tissue micro arrays' (TMAs) of 265 primary breast carcinomas from patients with known bone marrow (BM) status for HER2, Topoisomerase IIalpha (Top IIa), Ki 67, and p53.

Complementary and alternative therapeutic approaches in patients with early breast cancer: a systematic review.

Complementary and alternative medicine (CAM) is becoming increasingly popular, particularly among patients with breast cancer. We have done a systematic review of studies published between 1995 and February 2005, identified through a comprehensive search. CAM encompasses a wide range of treatment modalities, including dietary and vitamin supplements, mind-body approaches, acupuncture, and herbal medicines.

Failure of Implanon contraception in a patient taking carbamazepin for epilepsia.

Until now, no pregnancies have been reported in association with the implantable hormonal contraceptive Implanon (Organon, Roseland, NJ, USA), resulting in a pearl index of 0. We present a 24-year-old patient who conceived despite the correct application of Implanon for one and a half year. The patient was concurrently taking carbamazepin for epilepsia.

A pooled analysis of bone marrow micrometastasis in breast cancer.

Background: We assessed the prognostic significance of the presence of micrometastasis in the bone marrow at the time of diagnosis of breast cancer by means of a pooled analysis.

Methods: We combined individual patient data from nine studies involving 4703 patients with stage I, II, or III breast cancer. We evaluated patient outcomes over a 10-year follow-up period (median, 5.

Detection of micrometastatic disease in bone marrow: is it ready for prime time?

Minimal residual disease (MRD), or isolated tumor cells (ITCs) in bone marrow, may be the source of potentially fatal overt distant metastases in solid tumors even years after primary treatment. MRD can be detected by immunohistochemical methods using antibodies directed against cytokeratins or cell-surface markers or molecular, polymerase chain reaction-based techniques. Among solid tumors, the clinical relevance of MRD has been most extensively studied in breast cancer patients.

Expression of glycodelin in human breast cancer: immunohistochemical analysis in mammary carcinoma in situ, invasive carcinomas and their lymph node metastases.

Objective: Glycodelin is a 28 kDa glycoprotein, previously known as placental protein 14 (PP 14). Glycodelin displays immunosuppressive and contraceptive properties. It also suppresses the cytolytic capacity of human natural killer (NK) cells in vitro and inhibits binding of sperm cells to the zona pellucida (the outer membrane of the oocyte).

Characterisation of disseminated tumor cells in the bone marrow of breast cancer patients by the Thomsen-Friedenreich tumor antigen.

The detection of disseminated tumor cells in the bone marrow (DTC-BM) of breast cancer patients has proved prognostic significance in all stages of the disease. Further characterisation of those cells could help to improve the biological understanding of metastases, develop targeted therapies and define surface markers for enrichment techniques. The Thomsen-Friedenreich (TF) antigen has been shown to be a tumor specific antigen in breast cancer.

Isolated tumor cells in the bone marrow (ITC-BM) of breast cancer patients before and after anthracyclin based therapy: influenced by the HER2- and Topoisomerase IIalpha-status of the primary tumor?

Purpose: The presence of isolated tumor cells in the bone marrow (ITC-BM) is an independent prognostic factor in all stages of breast cancer. Both the expression/amplification of human epithelial growth factor receptor 2 (HER2) and Topoisomerase IIalpha (TOP IIa), a key enzyme of DNA replication and main target of anthracyclins, in breast cancer tissue seem to have predictive value regarding the effectiveness of systemic therapies.

Methods: To investigate the correlation between these factors and their influence on clinical outcome, tumor tissue of 54 patients who were screened for ITC-BM before and after anthracyclin-based chemotherapy (abCTX) was examined for HER2 and TOP IIa by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH).

Current status of radiant whole-body hyperthermia at temperatures >41.5 degrees C and practical guidelines for the treatment of adults. The German 'Interdisciplinary Working Group on Hyperthermia'.

The term 'extreme' whole-body hyperthermia (WBH) describes the procedure of raising a patients' body-core temperature to 41.5-42.0 degrees C for 60 min.

Expression of glycodelin protein and mRNA in human ductal breast cancer carcinoma in situ, invasive ductal carcinomas, their lymph node and distant metastases, and ductal carcinomas with recurrence.

Glycodelin, previously known as PP14, has been localized in endometrial, ovarian and cervical carcinoma cells. Recently, glycodelin was demonstrated to be expressed in cancerous human breast tissue. In this study, paraffin-embedded slides of carcinoma in situ, invasive carcinomas without metastases, invasive carcinomas with corresponding lymph node metastases, invasive carcinomas with corresponding recurrence and invasive carcinomas with corresponding distant metastases were investigated for glycodelin protein and mRNA expression.

The persistence of isolated tumor cells in bone marrow from patients with breast carcinoma predicts an increased risk for recurrence.

Background: The prognostic significance of isolated tumor cells (ITCs) in bone marrow (BM) from patients with breast carcinoma at the time of their primary diagnosis recently was been confirmed by a large pooled analysis. If the persistence of ITCs after adjuvant therapy confers a similar risk for recurrence, then it would be an indication to consider secondary adjuvant therapy.

Methods: The authors analyzed BM aspirates from 228 patients during recurrence-free follow-up at a median interval +/- standard deviation (SD) of 21.

Obstetrical parameters influencing the duration of the second stage of labor.

Objective: To investigate the impact of parameters influencing the duration of the second stage of labor in vaginal deliveries.

Study Design: 1200 consecutive vaginal deliveries were analyzed. Descriptive statistics are reported for parity, duration of first and second stage of labor, maternal age, birth weight, position of the fetal head, epidural analgesia and oxytocin augmentation.

Is the histomorphological concept of the female pelvic floor and its changes due to age and vaginal delivery correct?

Aims: To compare the histomorphology of pelvic floor specimens of 94 female cadavers, ten male cadavers, and 24 female symptomatic patients who underwent pelvic floor surgery, and to evaluate the association of age, parity, and sex to myogenic and/or neurogenic changes to the levator ani muscle (LAM).

Methods: The pelvic floor was biopsied at the pubococcygeus, the iliococcygeus and the coccygeus muscle. After staining, signs for myogenic/neurogenic changes to the muscle were evaluated (fibrosis, variation in fiber diameter, centralization of nuclei, small angulated fibers, and type grouping).

Unexpected metastatic lobular carcinoma of the breast with intraabdominal spread and subsequent port-site metastasis after diagnostic laparoscopy for exclusion of ovarian cancer.

Introduction: Although lobular carcinomas metastasize primarily to lymph nodes, bone, lung and liver, they can also spread to the gastrointestinal tract, peritoneum and gynecologic organs.

Case Report: We report a case of intraperitoneal carcinomatosis of a lobular breast carcinoma that metastasized primarily to the peritoneum, with a subsequent abdominal wall invasion at the trocar site following laparoscopic surgery for the exclusion of an ovarian carcinoma.

Discussion: Port-site metastases (PSM) have occurred after laparoscopic surgery for endometrial, fallopian tube, ovarian, and cervical cancers.

[A perioperative screening for metastatic disease is not indicated in patients with primary breast cancer and no clinical signs of tumor spread].

Objective: Is a perioperative metastatic screening programme indicated in patients presenting with primary operable breast cancer and no signs of distant metastases?

Patients And Methods: The impact of staging results (chest X-ray, bone scanning, liver ultrasound) for prognosis, treatment, quality of life and costs was retrospectively analysed in 1 076 patients with an operable breast cancer and no clinical signs of metastases.

Results: Staging examinations revealed 30 (2.8 %) distant metastases, 130 (12.

[Report from the 40th annual general meeting of the american society of clinical oncology].

This is a report about the annual ASCO 2004 with respect to clinical highlights of breast cancer, ovarian, endometrial and cervical cancer.

Comparative analysis between the HER2 status in primary breast cancer tissue and the detection of isolated tumor cells in the bone marrow.

The presence of isolated tumor cells in the bone marrow (ITC-BM) of breast cancer patients is an independent prognostic parameter, indicating hematogenous tumor cell dissemination. While the HER2 status of breast cancer tissue has predictive value for the efficacy of different therapies, its prognostic relevance is controversial. To investigate the relationship between HER2 and ITC-BM, we retrospectively analyzed tumor tissues of 327 patients who underwent bone marrow aspiration at primary diagnosis or during the disease-free interval.

[Juvenile gigantomastia. Case report and literature survey].

A juvenile gigantomastia with wet tender ulceration in a 13-year-old premenarchal girl (155 cm, 51 kg) developed in only 6 months. Treatment consisted of a bilateral reduction mammoplasty with free transplantation of the areolae and nipples and the removal of 4.2 kg of breast tissue.

Patients with recurrent breast cancer: does the primary axillary lymph node status predict more aggressive tumor progression?

Background: The extent of axillary lymph node involvement represents the foremost important prognostic parameter in primary breast cancer, and, thus, is one of the main determinants for subsequent systemic treatment. Nevertheless, the relevance of the initial axillary lymph node status on survival after disease recurrence is discussed controversially. Persisting prognostic impact after relapse would identify lymph node status as a marker for tumor biology, in contrast to a simply time-dependent phenomenon.

Evaluation of bone marrow in breast cancer patients: prediction of clinical outcome and response to therapy.

Blood-borne distant metastasis is the leading cause of cancer-related death in breast cancer. The onset of this fundamental process can now be assessed in cancer patients by using ultrasensitive immunocytochemical and molecular assays able to detect even single metastatic cells. To date, clinical studies with large study populations, validated immunoassays, and adequate follow-up time provide evidence for the independent prognostic value of the presence of disseminated tumor cells in the bone marrow.

Intra-mammary tumor location does not influence prognosis but influences the prevalence of axillary lymph-node metastases.

Background: The number of axillary lymph-node metastases is not only a function of disease progression in primary breast cancer, but is also influenced by the intra-mammary location of the tumor. Nevertheless, the prognostic role of the tumor site is discussed controversially. The objective of this study was to analyze the impact of primary-tumor location on axillary lymph-node involvement, relapse, and mortality risk by univariate and multivariate analysis, in patients both with and without systemic and loco-regional treatment.