Melatonin and estrogen in breast cyst fluids.

Increased breast cancer risks have been reported among women with gross cystic breast disease (GCBD), although the mechanism for this increase remains unexplained. Relationships between GCBD characteristics, breast cancer risk factors, and the biochemical composition and growth properties of 142 breast cyst fluid (BCF) samples were studied among 93 women with GCBD. Concentrations of melatonin, estrogen (17-beta-estradiol), dehydroepiandrosterone-sulfate (DHEA-S), epidermal growth factor (EGF), transforming growth factor beta (TGF-B1 and TGF-B2), sodium (Na), and potassium (K) were quantified in BCF samples, and human breast cancer cells (MCF-7) were treated with BCF in vitro. Patients were grouped according to BCF Na:K ratios previously linked with increased breast cancer risks (Na:K 3, Type 2) and mixed cyst groups. Women with larger and more frequently occurring cysts had higher BCF estrogen and DHEA-S, and lower TGF-B1 levels. Women with Type 1 cysts had elevated BCF melatonin, estrogen, DHEA-S, and EGF, and lower concentrations of TGF-B2 compared to women with Type 2 cysts. BCF generally inhibited cell growth relative to serum-treated controls, consistent with previous studies. Melatonin and estrogen in BCF independently predicted growth inhibition and stimulation, respectively. Biological monitoring of BCF may help identify women with GCBD at greatest risk for breast cancer development.

Inadvertent vesicular placement of a vaginal contraceptive ring presenting as persistent cystitis.

BACKGROUND: The NuvaRing is a soft, flexible, ring-shaped vaginal contraceptive device that is placed by the user herself. Incorrect placement has not been described, because any intravaginal position allows appropriate hormonal delivery through the vaginal mucosa. CASE: A 22-year-old otherwise healthy woman presented with 2 months of urinary urgency, frequency, and pelvic pain, which were unresponsive to antibiotic therapy. Her symptoms began immediately after placement of a NuvaRing vaginal contraceptive device, which she was subsequently unable to locate. Thorough evaluation revealed the ring in the urinary bladder. CONCLUSION: Bladder or urethral foreign body should be considered in the evaluation of patients with chronic cystitis, especially if the patient uses vaginal medical devices. Intravesicular placement of a device may occur even without psychiatric or physical comorbidities.