Immunohistochemical expression of VEGF-A and its ligands in non-neoplastic lesions of the breast sampling-assisted by dynamic angiothermography.

The aim of this study was to investigate the expression of angiogenic markers, vascular endothelial growth factor A (VEGF-A) ligand and its receptors, VEGFR-1 and -2, in a series of biopsy-proven non-neoplastic lesions of the breast detected by dynamic angiothermography. We have also studied the vascular density demonstrated by CD31 immunoreactivity, in order to assess the potential of the imaging method to recognize lesions with an enhanced vascular network of clinical importance in routine breast examination. The lesions were classified as non-proliferative, proliferative without atypia and proliferative with atypia. VEGF was diffusely expressed in the epithelial cells of proliferative lesions in almost all cases. Similarly, VEGFR-1 and -2 also exhibited epithelial positive reactions in the majority of cases. VEGF-A and its receptors were also present in blood vessels. CD31 showed an increase in vascular proliferation at the periphery of proliferative epithelial lesions, but not in non-proliferative lesions. Our results, showing marked expression of VEGF by the epithelial proliferative lesions and neoangiogenesis at their periphery, confirm that these lesions can be detected by dynamic angiothermography.

Cytoreductive surgery (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of diffuse peritoneal carcinomatosis from ovarian cancer.

BACKGROUND: Because of scarce data from larger series and nonhomogeneous selection criteria, further information is needed on peritonectomy with hyperthermic intraperitoneal chemotherapy (HIPEC) in managing patients with ovarian peritoneal carcinomatosis. METHODS: In an open, prospective, single-center nonrandomized phase 2 study conducted from November 2000 to April 2007, 47 patients with primary advanced or recurrent ovarian cancer and diffuse peritoneal carcinomatosis were enrolled; 22 underwent primary and 25 secondary cytoreduction plus immediate HIPEC followed by systemic chemotherapy. RESULTS: The overall mean Sugarbaker peritoneal cancer index was 14.9 (range, 6-28). A mean of 6 surgical procedures were required per patient (range, 4-10). In 87.3% of the patients debulking achieved optimal cytoreduction (Sugarbaker completeness of cytoreduction [CC] score 0-1), whereas in 12.7% it left macroscopic residual disease (CC-2 or CC-3). Major complications developed in 21.3% of the patients and the in-hospital mortality rate was 4.2%. The mean overall survival was 30.4 months, median survival was 24 months, and mean disease-free survival was 27.4 months. Five-year survival was 16.7%. Univariate (log-rank test and analysis of variance) and multivariate analyses (Cox proportional-hazard model) identified the CC score as the main factor capable of independently influencing survival. CONCLUSIONS: Peritonectomy procedures combined with HIPEC offer promising long-term survival in patients with diffuse peritoneal ovarian carcinomatosis. They achieve high adequate primary and secondary surgical cytoreduction rates with acceptable morbidity and mortality.