Laparoscopic treatment of 1522 adnexal masses: an 8-year experience.

Objective. To reevaluate the long-term effectiveness and safety of laparoscopy in benign ovarian pathology. Materials and Methods. 1522 women with benign adnexal cysts, laparoscopically treated in the 3rd Department of Ob/Gyn, General University hospital "Attikon" and "Lito" Maternity Hospital between July 1998 and December 2006, were included. Results. The diagnosis in 1222 (80,6%) cases was endometriosis of the ovary, 60 (4%) hydrosalpinx, 51 (3,3%) serous cystadenomas, 44 (2,9%) dermoid ovarian cyst, 38 (2,5%) borderline tumors, 35 (2,3%) unruptured follicles, and 33 (2,2%) paraovarian cysts. In 174 cases (11,5%) laparoscopy was converted to laparotomy due to technical difficulties or suspicion of cancer. In particular, laparotomy was performed in 119 (8%) women due to severe adhesions and 18 (1,2%) women due to bleeding that could not be controlled safely by laparoscopy. In 36 (2,4%) women frozen section during operation revealed malignancy and laparoscopy was converted to laparotomy. A few operative complications were recorded like post-op fever, small hematomas at the trocar entries. Conclusions. Laparoscopic surgery seems to offer significant advantages such as reduced hospital stay, less adverse effects, better quality of life, and superior vision especially on surgical treatment of cases like endometriosis.

Breast conserving surgery in multicentric breast cancer, preliminary data of our experience.

INTRODUCTION: It is widely supported that multicentric disease of the breast (MCDB) is a contraindication of breast conservative surgery (BCS). MATERIALS AND METHODS: This is a multicentric study (two breast cancer units from Greece, one from France) involving patients with at least two primary tumors in separate quadrants of the breast and no diffuse suspicious microcalcifications on mammography. Sixty-one patients were included in the study, but 49 were followed up to the end. Patients were randomly assigned in total mastectomy (TM) and BCS groups. End point of the study was disease-free survival rates three and five years after initial operation. RESULTS: Three years after BCS, local recurrence (LR) was observed in two patients (7%) and one after five years (total recurrence rate: 11%). A TM was performed in these patients, and in two there was no LR or distant metastasis (DM) five years after. The third patient was disease free two-years later. Three years after TM, eight patients (36.4%) had DM and 14 (63.6%) did not (p = 0.004). Five years after TM, eight patients (36.4%) had DM and 14 patients (63.6%) di not (p = 0.03). CONCLUSION: The results showed that conservative surgery was an alternative surgical option in multicentric breast cancer with good results regarding disease-free survival and recurrence.

Tomosynthesis improves breast cancer detection: our experience.

Breast tomosynthesis (BT) is a novel imaging technology in which an x-ray fan beam sweeps in an arc across the breast, producing tomographic images and it can reduce tissue overlap encountered in conventional two-dimensional (2D) and thus has the potential to improve detection of breast cancer and facilitate accurate differentiation of lesion types. The purpose of this article was to assess the positive predictive value (PPV) of breast cancer with BT versus full-field digital mammography (FFDM) and the assessment of detec- tion of both techniques in the present series.

Augmentation of cortical bone mineral density in women with polycystic ovary syndrome: a peripheral quantitative computed tomography (pQCT) study.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) may have increased cortical bone mineral density (BMD) and probably higher bone material quality as well as better resistance in the compression strength of the tibia, measured by peripheral quantitative computed tomography (pQCT), in comparison with that of age-matched healthy subjects. METHODS: Thirty women with PCOS, (15 lean and 15 obese) and 15 age-matched healthy controls were enrolled in this study. The clinical, biochemical and ultrasound characteristics of the two groups were evaluated. Using pQCT, the following parameters were measured: volumetric cortical density (CBD) and volumetric trabecular density (TBD) BMD, total bone cross-sectional area (ToA), cortical area (CoA), cortical thickness (CRT-THK-C) and finally the strength-strain index (SSI). RESULTS: The geometrical parameters (CoA, ToA, CRT-THK-C), the SSI as well as the TBD were increased in the PCOS women; however, these differences did not achieve statistical significance between lean PCOS women, obese PCOS women, and controls. Conversely, CBD was significantly higher in PCOS women compared with controls (P < 0.000) and furthermore in lean PCOS women compared with obese ones (P < 0.01040). CONCLUSIONS: The PCOS women of our study seem to have a higher quality of bone material in the distal tibia and probably a better resistance of bone in the compression strength without alterations in bone mass and geometry (especially the lean PCOS women), indicating that our oligomenorrheic and hyperandrogonemic PCOS women may be protected from the development of osteoporosis and fracture risk later in life.

Fibronectin plasma levels in gynecological cancers.

PURPOSE: Fibronectin (FBN) is involved in the motility and migration of malignant cells. The purpose of this study was to investigate FBN plasma levels in gynecological cancers patients and in healthy women. METHODS: The study took place between 1998 and 2003. One hundred women with histologically diagnosed cancer of gynecological organs (cervix, ovary, endometrium, breast) formed the study group (group A), whereas the control group (group B) consisted of 100 healthy women. FBN plasma levels were measured with the radial immunodiffusion method. RESULTS: The average age of group A patients was 42.08 years (range 33-77), and of group B it was 41.1 years (range 32-65). Both groups were compared with the Student's-t test. The median plasma value of FBN in all gynecological malignancies was 258.4 mg/l (standard deviation/SD 163.9, p=0.0066, t-statistics: 2.768, (t95): 1.984, 95% CI: 225.4-290.9). The plasma levels were significantly elevated when compared to the control group (median=213 mg/l). The distribution of values showed a statistically important "tail" in high plasma levels (FBN >400 mg/l). Plasma levels of FBN were more increased in breast and cervical malignancies when compared to ovarian and endometrial cancers. CONCLUSION: FBN plasma levels were significantly increased in the total of group A patients, but not significantly increased in the endometrial and ovarian subgroup. Whether or not FBN could reliably be a marker for gynecological cancers should be confirmed in studies with larger number of patients.

Synopsis of new antiangiogenetic factors, mutation compensation agents, and monoclonal antibodies in target therapies of breast cancer.

Breast cancer is the most common type of cancer among females and the 5th most common cause of cancer death. About 5-10% of breast cancers occur due to gene mutations inherited from mother or father. The molecular basis of breast cancer has been extensively investigated, making gene therapy a potential new therapeutic alternative. Mutation compensation, molecular chemotherapy, proapoptotic gene therapy, antiangiogenic gene therapy, genetic immunopotentiation and genetic modulation of resistance/sensitivity are the main gene therapies used. The combination of gene therapy with chemotherapy or radiation is being investigated in ongoing trials. The purpose of this review was to make a synopsis of the currently existing target therapies in breast cancer.

Successful pregnancy after radiotherapy with 131I for differentiated thyroid cancer. A case report and review of the literature.

BACKGROUND: Radioactive iodine has been used effectively in the diagnosis and treatment of thyroid diseases. Since radiation is delivered to the whole body, including the ovaries, there is reasonable concern as to whether there is a possibility of mutagenic effect on germ cells. CASE REPORT: A 33-year-old woman with a differentiated papillary carcinoma. (T2N0M0), underwent radiotherapy three weeks after surgery and one year afterwards she became pregnant. At the 38th week of gestation she delivered vaginally a healthy female neonate weighing 3100 g. The child at the age of five years is healthy with no signs of malignancy or other disease. DISCUSSION: Washout of 131I of the whole body takes place in a few days. Nevertheless, most guidelines recommend avoiding pregnancy for four to six or even 12 months after RAI treatment or scanning. As reported in our case a normal uncomplicated pregnancy can follow an operative and complementary treatment of thyroid cancer.

Prevalence of severe pelvic inflammatory disease and endometriotic ovarian cysts: a 7-year retrospective study.

INTRODUCTION: The purpose of this study was to delineate the association between endometriosis and pelvic inflammatory disease (PID) and the prevalence of this coexistence. MATERIALS & METHODS: The records of all patients with endometriotic ovarian cysts treated at the 3rd Department of Obstetrics and Gynecology of the University of Athens and in "Lito" Maternity Hospital of Athens from 2000 through 2007 were reviewed. RESULTS: During this 7-year period 720 women underwent surgery due to endometriotic ovarian cysts. The average age was 40.9 years (range: 17-70). Median diameter of the cysts was 4.495 cm and 59% were located in the right ovary. PID was identified in 21 (2.9%) cases. The average age of these women was 31 years (range: 21-39). Half of the women presented with fever (10/21; 47.6%). Ultrasound examination was performed in all women, followed by laparoscopy. In 47.6% (10/21) the PID abscess was located in the right ovary and the rest (52.38%) in the left. The mean diameter of the endometriotic cysts in these women was 3.52 cm. Laparoscopy was the treatment of choice in all the women with the exception of five cases, where due to technical difficulties during laparoscopy, a laparotomy was performed. In all the cases with PID, abscesses were evacuated laparoscopically. No operative complications were observed. CONCLUSIONS: Endometriosis and PID are two conditions that can easily confuse the physician in setting the diagnosis, especially in the situation where they co-exist. In our study we report that the prevalence of PID in women with endometriosis is sufficiently higher than the prevalence in the general population.

Prevalence of acute hemoperitoneum in patients with endometriotic ovarian cysts: a 7-year retrospective study.

INTRODUCTION: Endometriosis is a quite common condition in women of reproductive age. The purpose of this study is to delineate the association between hemoperitoneum and endometriosis. MATERIALS & METHODS: The records of all patients with endometriotic ovarian cysts treated at the 3rd Department of Obstetrics and Gynecology of the University of Athens and at "Lito" Maternity Hospital of Athens from 2000 through 2007 were reviewed. RESULTS: During this 7-year period 720 women underwent surgery due to endometriotic ovarian cysts. The average age was 40.9 years (range: 17-70). The median diameter of the cysts was 4.49 cm and 59% were located in the right ovary. Hemoperitoneum was identified in 16 (2.22%) of them. The average age of these women was 28.5 years (range: 22-44). Ten (62.5%) of these women presented with acute and strong abdominal pain and moderate signs of cardiovascular shock. The rest presented with abdominal pain and distension worsening at the onset of menses, nausea and/or vomiting and hemorrhagic fluid in the pelvis. Ultrasound examination was performed in all women and afterwards they underwent laparoscopy to identify the source of bleeding. In all cases a ruptured endometriotic cyst was found. In 68.8% (11/16) the ruptured cyst was located in the left ovary and the rest (31.2%) in the right. A thorough examination did not reveal any other sources of bleeding. No operative complications were observed. DISCUSSION: The simultaneous occurrence of ascites and endometriosis is rare. A physician, though, must always take into consideration endometriosis in the differential diagnosis of ascites and acute abdominal pain or pelvic mass.

[Incidence of synchronous primary neoplasms of the female reproductive tract in women with ovarian endometriosis: a retrospective analysis of 811 cases].

PURPOSE: Although endometriosis is a benign disorder recent studies suggest endometriosis could be viewed as a neoplastic process. Objective of this study is to explore the epidemiology of synchronous neoplasms (SPN) in women with severe endometriosis. PATIENTS & METHODS: The prevalence of SPN in cases with endometriotic ovarian cysts that underwent surgery at "Lito" Maternity hospital of Athens and at Anticancer Institute of Sophia was investigated. The review period was 2000 through 2009. The medical records and pathology were reviewed to confirm the diagnosis and stage of tumors. RESULTS: 5 women with synchronous cancers of the genital tract were identified. All of our patients had a grade-I endometrioid carcinoma of the uterus (Ia in 3, Ib in 2). Myometrium was invaded less than 1/3 in 4 cases and less than 1/2 in one. Similarly, 4 out of 5 ovarian cancers were endometrioid, while one was serum cystadenosarcoma. All of the ovarian malignancies were grade I (Ib in 3 and Ia in 2). Median diameter of the ovarian neoplasias was 4.3 cm, in contradiction to 4.5 cm that was the median diameter of all endometrioid cysts. When only the larger ovarian malignant cyst in each patient was accounted, then median diameter was calculated as 5.8 cm. CONCLUSIONS: Women with synchronous primary cancers of the endometrium and ovary have distinct clinical characteristics including younger age, premenopausal status, and nulliparity. This suggests that a hormonal "field effect" may account for the development of these simultaneous endometrioid cancers, supporting the theory of estrogen receptors.

Gastric outlet obstruction caused by a giant gastroduodenal artery aneurysm: a case report.

Gastric outlet (GO) obstruction in an adult is usually caused by intrinsic gastric or duodenal lesions or pancreatic tumours. This study describes a case of a 77-year-old man who developed GO obstruction due to extrinsic compression from a large gastroduodenal artery aneurysm under rupture. This cause of GO obstruction has never previously been reported in the literature.