Leukemia in pregnancy: Diagnosis and therapeutic approach (Review).

The present study aimed to evaluate the epidemiological, diagnostic and therapeutic data of hematological malignancies in pregnancy. Leukemia in pregnancy is rare, and literature data are not extensive. Risk factors, epidemiology and pathogenesis of these diseases are not fully developed. Furthermore, there is a detailed report on the complications in pregnancy and the overall (per trimester) management of these diseases, specifically their treatment strategy. The possibility of achieving a future pregnancy in women with leukemia is described in the present study. The limited clinical research data currently available is mainly due to the inability to conduct randomized clinical trials for ethical reasons. Further research is needed, firstly due to the importance of these diseases for the pregnant woman and the fetus, and secondly, due to the continuous development of novel anticancer drugs that aim to improve the prognosis of these diseases.

The Impact of Adenomyosis on Pregnancy.

Adenomyosis is characterized by ectopic proliferation of endometrial tissue within the myometrium. Histologically, this condition is marked by the presence of islands of benign endometrial glands surrounded by stromal cells. The myometrium appears thinner, and cross-sectional analysis often reveals signs of recent or chronic hemorrhage. The ectopic endometrial tissue may respond to ovarian hormonal stimulation, exhibiting proliferative or secretory changes during the menstrual cycle, potentially leading to bleeding, uterine swelling, and pain. Adenomyosis can appear as either a diffuse or focal condition. It is crucial to understand that adenomyosis involves the infiltration of the endometrium into the myometrium, rather than its displacement. The surgical management of adenomyosis is contingent upon its anatomical extent. The high incidence of the disease and the myths that develop around it increase the need to study its characteristics and its association with pregnancy and potential obstetric complications. These complications often require quick decisions, appropriate diagnosis, and proper counseling. Therefore, knowing the possible risks associated with adenomyosis is key to decision making. Pregnancy has a positive effect on adenomyosis and its painful symptoms. This improvement is not only due to the inhibition of ovulation, which inhibits the bleeding of adenomyotic tissue, but also to the metabolic, hormonal, immunological, and angiogenic changes associated with pregnancy. Adenomyosis affects pregnancy through disturbances of the endocrine system and the body's immune response at both local and systemic levels. It leads to bleeding from the adenomyotic tissue, molecular and functional abnormalities of the ectopic endometrium, abnormal placentation, and destruction of the adenomyotic tissue due to changes in the hormonal environment that characterizes pregnancy. Some of the obstetric complications that occur in women with adenomyosis in pregnancy include miscarriage, preterm delivery, placenta previa, low birth weight for gestational age, obstetric hemorrhage, and the need for cesarean section. These complications are an understudied field and remain unknown to the majority of obstetricians. These pathological conditions pose challenges to both the typical progression of pregnancy and the smooth conduct of labor in affected women. Further multicenter studies are imperative to validate the most suitable method for concluding labor following surgical intervention for adenomyosis.

Breastfeeding and its Association with Breast Cancer: a Systematic Review of the Literature.

Objective:Breast cancer is a global public health issue. The disease can be diagnosed in both older and younger women, with the latter facing several dilemmas. Breastfeeding is of general concern to the scientific community as well as its connection with the prevention of breast cancer is being sought. The purpose of this review is to search for studies investigating the relationship between breast cancer and breastfeeding. Material and methods: The articles included in the present paper were searched in PubMed and Scopus databases according to PRISMA guidelines for systematic reviews. This systematic review sought primary studies investigating the relationship between breastfeeding and breast cancer and that were published in English between 2017-2022. Results:Seventeen articles that investigated the relationship of breast cancer with lactation duration, women's age, family history and lifestyle were included in the present review. Conclusion:It was found that, in most studies, breastfeeding could be evaluated as a protective factor of the disease. From all studied articles, the need for the design of additional studies investigating the relationship between breastfeeding and breast cancer emerges.

Association of Anti-Ro/SSA and Anti-La/SSB Autoantibodies With Pregnancy Outcome in the General Population.

Background: Autoimmune diseases encompass a diverse array of disorders that disturb the optimal functioning of the immune system, which is to eliminate the 'foreign or/and dangerous' to mistakenly target the body's own tissues. Objective: The aim of this research is to evaluate the most effective approach to managing autoimmune diseases within the framework of pregnancy. Methods: The exact causes and etiologies of these diseases are multifactorial and mostly still unclear. Ro/SSA autoantibodies and La/SSB, could be found in Sjögren's disease (SJ), systemic lupus (SLE) and other autoimmune disorders. Smoking, stress, UV exposure, vitamin D deficiency, and other genetic and environmental factors have been identified as risk factors for rheumatic diseases. Results: Over the years, an ever-increasing incidence of these diseases has been observed in the general population, with the female sex being at increased risk for their occurrence. This fact raises the question of what should be the management of these pathological entities during pregnancy. Taking into account the very significant impact on the quality of paitients'daily life and the seemingly augmented prevalence of autoimmune diseases, as well as their preference in the female population, the reasonable question arises as to what should be the optimal management of these diseases in the context of pregnancy. Conclusion: Given the limited data of the global medical community regarding the etiological factors and mechanisms that trigger the onset of rheumatic diseases, the management of pregnant women is a complex conundrum that health professionals are challenged to face and solve.

Our Experience with Hydrogel-Coated Trisacryl Microspheres in Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids and Adenomyosis: A Follow-Up of 11 Years.

Uterine artery embolization (UAE) for the treatment of symptomatic uterine fibroids and non-controllable adenomyosis symptoms is a relatively new procedure for organ-preserving therapy. These benign conditions can become symptomatic in about 30% of women between the ages of 35 and 50. The purpose of the UAE either for fibroids or adenomyosis is the elimination of blood loss, the reduction in pain, and bulky or rectal pressure symptoms. The purpose of this study is to present our experience in UAE with the use of hydrogel-coated tris acryl microspheres for the treatment of symptomatic uterine fibroids and adenomyosis.

A Retrospective Study of Various Iron Preparations Oral Administration in Pregnant Women with Iron Deficiency Anemia.

During pregnancy anemia is a common medical condition, with iron deficiency and megaloblastic anemia being the most common. The symptoms range from very mild to severe and if left without proper medical treatment, there can be serious consequences for both mother and fetus. The most frequent pregnancy problem is anemia. The term "Iron Deficiency Anemia" refers to erythropoiesis under conditions of absolute iron deficiency. This presupposes the depletion of iron stores in the body. Iron deficiency anemia or Sideropenic anemia is the most common form of anemia worldwide. Special attention must be given to nutrition during pregnancy. In the current retrospective study, it was evaluated the contribution of various iron preparations substitution during the pregnancy and puerperium.

Life Quality in Premenopausal Women after Embolization of Uterine Myomas.

Objectives: Fibroids cause significant morbidity and are the most common indication for hysterectomies worldwide, delimiting a major public health problem. Uterine artery embolization (UAE) is an alternative therapy to surgical treatment of symptomatic fibroids; it has satisfactory long-time results and is no longer considered investigational for the treatment of symptomatic fibroids. This study was undertaken to evaluate changes in fibroid specific symptom severity and health-related quality of life (HRQOL) after UAE and to optimize the assessment of safety and outcomes measures for participants who receive UAE to objective compare UAE and surgical alternatives for therapy of symptomatic fibroids. Study design: The analysis was based on questionnaires completed by 270 pre-menopausal females with a mean age of 42 years (range, 38-50 years) who underwent UAE for uterine leiomyomas and/or adenomyosis from November 2013 through December 2019. Only symptomatic women were selected whose symptoms were not improving with medication and who did not wish to have children. The primary outcome measure was a change in fibroid symptoms and HRQOL (health related quality of life) after UAE. Secondary outcomes included the decrease in uterine volume after UAE. Results: Questionnaires were completed by 270 women (100%) at a mean of 12.1 months from UAE. The median follow-up period was two years. Uterine fibroid embolization led to a shrinkage at three months for the 90% of the participants. A reduction of bleeding symptoms, pain and bulk-related symptoms was observed in 89.7%, 88.9%, and 89.5% of the patients, respectively. In the long term, there was no significant difference in parameters assessed compared with the midterm follow-up findings. A total of 6 patients (2.3%) underwent fractional curettage an average of 32.1 months after intervention due to necrotic changes in submucosal fibroids. All participants continued to be satisfied with the intervention, and 240 patients (88.9%) answered that they would recommend uterine fibroid embolization to other patients. Conclusions: Women who undergo UAE have a significant decrease in symptom severity and increase in HRQOL which is associated with high levels of satisfaction with the procedure (even when subsequent therapies are pursued).

Mastitis and Risk of Breast Cancer: a Case Control-Retrospective Study and Mini-Review.

Objective: To investigate a possible association between mastitis and breast cancer risk in a cohort of Greek women. Material and methods:A series of 343 women who visited two breast clinics in Greece and delivered live neonates were studied in our case-control retrospective study. The case group comprised women with breast cancer and the control group women without breast cancer. All participants were subjected to a clinical examination with breast ultrasound and those aged over 40 years underwent digital bilateral mammography. Results:The χ2 (chi-square) test was the statistical tool used by us. We noted a statistically significant relationship between mastitis and risk for breast cancer (p=0.04). Moreover, the relative risk for breast cancer among patients with mastitis was RR: 2.069. Conclusion:Our study showed a relation between mastitis and breast cancer. Mastitis could be a potential risk factor. Further studies with larger number of patients are mandatory in order to confirm this possible relationship.

Feasibility Study of a Variant Procedure of Radical Breast Ductectomy (Dolichectomy) with a Perinipple Incision.

Papillomatosis and recurrent duct ectasia could be treated with terminal lactiferous ducts excision. In this study we describe a modified miniinvasive procedure of terminal lactiferous ducts excision with a perinipple approach to the lower or upper half of the nipple. This technique avoids the much more extensive periareolar incision and has excellent aesthetic results.

Breastfeeding and Breast Cancer Risk: Our Experience and Mini-review of the Literature.

Background: According to data from World Health Organization, breast cancer constitutes the second most common diagnosed malignancy after lung cancer and the second leading cause of death among women in 2020, worldwide. The protective role of breastfeeding in the emergence of breast malignancy has been mentioned in several studies, indicating the important part it can have in the effort of reducing breast cancer's incidence. Objective: To investigate a possible association between breastfeeding and breast cancer risk in Greek women. Methods: Totally, 391 women participated in our case-control retrospective study. In the case group included 238 women with breast cancer, while in control group 153 women without breast cancer who were enrolled in two breast clinics in Greece. All women were examined clinically and with breast ultrasound, while those older than 40 years old also with bilateral digital mammography. Results: The x2 (chi-square) test found a statistically significant reverse correlation between breast cancer and breastfeeding ⩾12 months (cumulative) (p = 0.001). It was observed that the percentages of patients who breastfed ⩾12 months were lower than those of healthy women. Conclusion: Breastfeeding and particularly the cumulative period of ⩾12 months is related to the maximum of the protection from breast cancer.

Neonatal Birth Weight of the Woman as a Risk Factor for Breast Cancer in her Life: a Case-Control Bicentric Study.

BACKGROUND: It is a global fact that the birth weight is increasing during the years around the world and for this reason it is very important to be examined as a potential risk factor for breast cancer. According to data from World Health Organization, breast cancer is the second most frequent malignancy across the world, after lung cancer, in Europe including Greece in incidence and mortality for women between the ages 0-85 years old. OBJECTIVE: The aim of this study was to investigate a possible association between neonatal birth weight of the women and breast cancer risk in Greek women. Although that many studies concluded that birth weight is positively related with breast cancer reinforcing the theory that breast cancer may originate in utero, some studies found no association. Moreover, the results from previous studies are inconsistent maybe due to several factors such as the study design and the number of cases. METHODS: This study was a case-control retrospective bicentric study. The case group included 238 women with breast cancer, while the control group included 153 women without breast cancer who consulted in two breast clinics in Greece. In all women, a clinical examination and breast ultrasound were achieved. Moreover, digital bilateral mammography was performed in patients older than 40 years. RESULTS: According to Fisher's exact analysis, there is a statistically significant relationship between the higher women's neonatal birth weight and the risk for breast cancer (p<0.001). More specifically in the group of women with breast cancer, 61% of them had more than 3500 grams birth weight, in contrast with 7.8 % in the control group. In our cohort, women who had birth weight more than 3500 grams are more likely to develop breast cancer in their life. CONCLUSION: Our study trend to show that the increased neonatal birth weight may influence future risk of breast cancer. However, further studies with larger number of participants are needed in order to clarify the role of birth weight as a complementary risk factor of breast cancer.

Risk Factors of Synchronous Breast and Thyroid Cancer: a Controlled Multicenter Study and Review of the Literature.

BACKGROUND: Breast cancer (BC) is one of the most common cancers diagnosed in women in the United States. Thyroid cancer (TC) is also one of the fastest increasing cancer types in the United States, with most cases being papillary thyroid carcinomas. OBJECTIVE: To identify possible risk factors for the synchronous or metachronous co-occurrence of breast and thyroid cancers. METHODS: We carried out a study, which consisted of data from four gynecological clinics: two in Greece (Athens, Alexandroupolis, Ioannina) and one in Germany, collected from June 2017 to June 2020. The patients were divided into two groups: the first group consisted of 58 patients with breast cancer and a personal history of thyroid cancer. The second group (control group) included 50 patients with the same characteristics as to age, parity, type of pregnancy, treatment for sterility, polycystic ovaries, regularity of the menstrual cycle, breast density, BMI, family history of cancer, blood group rhesus and histological results of breast cancer. The data we collected were analyzed using version 20 of the SPSS statistical package. The Chi-square test was used for statistical analysis and a p-value<0.005 was considered statistically significant. RESULTS: The only factors that seem to be related with the association of breast and thyroid cancer were: history of abortion and multiparity. CONCLUSION: In our study there is a higher chance of developing breast cancer after diagnosing thyroid cancer and vice versa. More than genetic mutations, a possible hormonal pathway of these two malignancies is possible. The hormonal change in women who had many children or abortions could be a risk factor to develop both cancers. More studies are necessary to confirm our findings.

Ductoscopy Coupled to Duct Lavage and Duct Brushing in Pathologic Nipple Discharge: Our Experience.

PURPOSE: to present our experience in the management of pathological nipple discharge using the procedure D.DL.DB: "ductoscopy" (D) coupled to "duct lavage" (DL) plus "duct brushing" (DB) for etiologic diagnosis. Also to compare the diagnosis obtained with D.DL.DB to the final histology. MATERIAL AND METHOD: Eighty-five patients with organic unilateral nipple discharge were enrolled in two Breast Units. 82 of 85 patients were investigated successfully with D.DL.DB. Results:: The final histological results were: papilloma 46.3%, duct ectasia 36.5%, breast cancer 8.5%, precancer lesions 4.9%, and mixed benign lesions 3.8%. Pyramidectomy and radical ductectomy were performed in 76 and 6 cases respectively. In 80% of the cases, DLDB cytology results were identical to the final histology. (Kappa=0;69 CI=[0.56 -0.82]. The sensitivity of D.DL.DB versus pathology, for cancer or precancer lesions was 81.8% (CI=0.59 -1) and the specificity was 97.1% (CI=0.93 -1). Using Koch scale, the concordance between the two methods D.DL.DB and surgery was high and the sensitivity was in the upper range regarding the literature (58% to 90%). CONCLUSION: Our experience confirms the high value of D.DL.DB in the management of organic nipple discharge.

Maternal and paternal age at birth and the risk of breast cancer in Greek women: a case-control study.

PURPOSE: To investigate the possible association between maternal and paternal age and breast cancer in Greek women. METHODS: This study enrolled 238 women with breast cancer and 153 healthy women as control group. All participants were examined clinically and with breast ultrasound and those older than 40 years, also with digital mammography. RESULTS: A statistically significant positive correlation was observed between the age of the father (x2=52.985, p<0.001) and the mother (x2=34.838, p=0.001). More specifically, in breast cancer patients, the majority of their mothers (45.4%) was over 30 years of age and their fathers' age (48.3%) was over 37 years of age. CONCLUSIONS: Our study found that as the age of the father and mother increases, the incidence of breast cancer increases in parallel. Further studies with larger number of patients are necessary in order to clarify the real role of parental age as a risk factor of breast cancer.

Significance of changes in inflammatory parameters following uterine artery embolization in pre-menopausal females.

The purpose of the present study was to describe the course of changes in laboratory inflammatory markers following bilateral uterine artery embolization (UAE) as a treatment for leiomyomas and adenomyosis. The body temperature was measured and blood samples were collected to determine white blood cell (WBC) count and C-reactive protein (CRP) levels in 270 patients on the day prior to UAE and for up to 4 days post-embolization. Aside from a single case with a non-inflammatory complication, none of the other cases had any complications. Post-UAE leukocytosis with a mean maximum value of 10.8±3.5x109/l (range, 5.9-18.6x109/l) was observed one-year post-intervention. The mean leukocyte numbers were indicated to be higher on day 3 post-UAE. The CRP level was also increased post-UAE, with a mean maximum value of 7.75±3.5 mg/dl. Maximum levels were reached in 8 patients on the 2nd and in 11 patients on the 3rd post-operative day. The maximum pain score was ~5.5 and reached its lowest level at the end of the 12th week post-intervention. The present study did not consider an association between the embolic material used or uterus size with the level of treatment success. No complications were observed post-UAE; however, a significant increase in the WBC count was observed within the first 3 days, indicating mild leukocytosis.

Blood groups type linked to breast cancer in a Greek cohort of women - a case control study.

PURPOSE: To investigate the possible association between ABO blood types and breast cancer in Greek women. METHODS: 202 female patients with breast cancer and 139 healthy women as control group were examined clinically and with breast ultrasound and those older than 40 years, also with bilateral digital mammography. RESULTS: In the case-group, 26.7% had blood group O, 5.5% had blood group B, 61.9% had blood group A and 5.9% had blood group AB. In the control-group, 47.5% had blood group O, 13.7% had blood group B, 31.6% had blood group A and 7.2% had blood group AB. Usage of diagrams with the percentages of frequency, the average control, Pearson, Spearman, Student's t-tests analyzed with SPSS statistical software showed a significant correlation between breast cancer and blood group A (p<0.01). CONCLUSIONS: Although in the literature it is controversial whether ABO/Rh blood groups have association with breast cancer, the results of our study show a significant correlation between breast cancer and blood group A.

Management of malignant and borderline phyllodes tumors of the breast: our experience.

PURPOSE: Phyllodes breast tumors (PT) range from benign lesions to malignant ones that may give distant metastasis. Preoperative diagnosis is difficult, while the treatment of borderline and malignant disease remains controversial. METHODS: Eighteen patients in 3 clinics were included in the study. Lumpectomy with large margins was performed in 15 patients, while mastectomy was performed in 3 patients. Lymph node excision was carried out in 3 patients with malignant tumors. Radiation therapy (RT) was delivered after a second lumpectomy in cases of local recurrence. Chemotherapy was used only in 2 patients with aggressive recurrent tumors. RESULTS: Borderline behavior was reported in 4 patients. Lumpectomy was performed in these cases, with local recurrence in 2 of them. Malignant behavior was reported in 14 patients. Lumpectomy was performed in 10 patients and mastectomy in 3. Local recurrence was reported in 5 cases and in 2 patients recurrence after a 2nd operation was also reported. CONCLUSIONS: Borderline PT were treated conservatively and the prognosis was excellent, while malignant subtypes needed mastectomy in about 25% of the cases, The local recurrence rate was high, but the disease free survival (DFS) and the overall survival (OS) were also very high (94%).

Radioactive seed localization and wire guided localization in breast cancer: A systematic review and meta-analysis.

PURPOSE: Classically, wire-guided localization (WGL) is used for the localization of non palpable breast lesions. On the other hand, many studies report a newer technique called radioactive seed localization (RSL). The purpose of our study was a systematic review and meta analysis of the two techniques regarding the rate of positive margins and the quantity of excised tissue. METHODS: Our study searched publications up to March 24th 2018 in Medline, Embase and Cochrane Library regarding studies comparing the two techniques of localization of subclinical lesions with WGL or RSL using technetium 99m as radioactive agent. The primary target was the rate of positive margins and the second was the rate of second surgery for reexcision. Revman5.3 and STATE12.0 were used for the statistics. RESULTS: Five randomized controlled trials (RCTs) and 13 cohort studies comprising 3879 breast cancer patients were included. RSL was significantly superior than WGL both in better margin status (RR=0.72, 95% CI 0.56-0.92, p=0.01) and reduced reoperation rate (RR=0.68, 95% CI 0.52-0.88, p=0.004). Subgroup analysis of RCTs showed no different ability of both techniques in terms of free margin status (RR=0.85, 95% CI 0.55-1.31, p=0.46) and reoperation rate (RR=0.80, 95% CI 0.48-1.32, p=0.38). Further subgroup analysis excluding three studies with different ductal carcinoma in situ (DCIS) proportion exhibited same efficacy in margin negativity (RR=0.83, 95% CI 0.69-1.01, p=0.07) and further operation rate (RR=0.85, 95% CI 0.71-1.01, p=0.07).

A new risk malignancy index to predict ovarian cancer: a bicentric preliminary study.

PURPOSE: Ovarian cancer is the most common cause of gynecologic cancer death. Considering that diagnosis of ovarian cancer is done in advanced stage in most cases, the purpose of this study was to construct a "new risk malignancy index" (NRMI) to assess the risk of ovarian cancer in women with a pelvic mass. METHODS: The index includes the classical vaginal ultrasound and CA125 tumor marker along with risk and protective factors for ovarian malignancy. RESULTS: Compared to the original Risk Malignancy Index (RMI), NRMI found retrospectively a greater number of patients with ovarian cancer. CONCLUSIONS: NRMI seems to be a promising tool for the early and reliable detection of cases with ovarian malignancy in an effort to maximize surgical benefits.

Retraction: Human Papilloma Virus' Life Cycle and Carcinogenesis.

[This retracts the article , PMID: 28465751.].