[Health-Related Quality of Life in Patients with Non-Small Cell Lung Cancer before and after Surgery - a Comparison between Thoracotomy and Video-Assisted Thoracoscopic Surgery]. / Untersuchungen zum Verlauf der Lebensqualität vor und bis 2 Jahre nach anatomischer Resektion bei Patienten mit Lungenkarzinom ­ ein Vergleich zwischen anterolateraler Thorakotomie und videoassistierter Thorakoskopie.

BACKGROUND: Earlier studies have proven that in patients with non-small cell lung cancer video-assisted thoracoscopic surgery is functionally superior to thoracotomy in terms of perioperative and postoperative complications. The objective of this work was to determine whether there is a difference in health-related quality of life (HRQoL) of patients with non-small cell lung cancer - compared to the German normal population - before and after surgery. Moreover, HRQoL after thoracotomy was compared to HRQoL after video-assisted thoracoscopic surgery (VATS). MATERIAL AND METHODS: Based on retrospective data generated during a 7-year period (2010 - 2017), 327 patients with non-small cell lung cancer who underwent therapy were examined. Patients either underwent thoracotomy or video-assisted thoracoscopic surgery. 456 of short form 12 questionnaires were analysed. Via norm-based scoring, and physical and mental component summaries (PCS and MCS) were calculated before and 6, 12, and 24 months after treatment. Using t tests, potential differences in physical and mental component summaries were evaluated between patients and the German normal population as well as between patients after thoractomy and after VATS. RESULTS: Up to 24 months after surgery, the physical dimension of HRQoL is significantly reduced, while the mental component summary does not significantly differ from the German population. Moreover, thoracotomy and VATS gave equivalent values for health-related quality of life. CONCLUSION: With respect to health-related quality of life, thoracotomy and video-assisted thorascopic surgery are equivalent in the long term. But there was a trend to improvement with both summary scores that might indicate superiority of video-assisted thoracoscopic surgery.

Imaging Mass Spectrometry for Characterization of Atrial Fibrillation Subtypes.

PURPOSE: Atrial fibrillation (AF) is a cardiac arrhythmia characterized by a rapid and irregular heart rhythm. AF types, paroxysmal (PX), persistent (PE), and long-lasting persistent (LSP), require differences in clinical management. Unfortunately, a significant proportion of AF patients are clinically misclassified. Therefore, the aim of this study is to prove that MALDI-Imaging (IMS) is valuable as a diagnostic aid in AF subtypes' assessment. EXPERIMENTAL DESIGN: Patients are clinically classified according to the guidelines of the European Society of Cardiology. FFPE tissue specimens from PE, PX, and LSP subtypes are analyzed by MALDI-IMS and evaluated by multi-statistical testing. Proteins are subsequently identified using LC-MS/MS and findings are confirmed by immunohistochemistry and through the determination of potential fibrosis via histopathology. RESULT: Determined that characteristic peptide signatures and peptide values facilitate to distinguish between PE, PX, and LSP arterial fibrillation subtypes. In particular, peptide values from alpha 1 type I collagen (CO1A1) are identified that are significantly higher in LSP and PE tissues but not in PX myocardial AF tissue. These findings are confirmed by immunohistochemistry and through the determination of potential fibrosis via histopathology. CONCLUSION AND RELEVANCE: These results represent an improvement in AF risk stratification by using MALDI-IMS as a promising approach for AF tissue assessment.

Generation of coherent radiation in the vacuum ultraviolet using randomly quasi-phase-matched strontium tetraborate.

Tunable coherent radiation is generated in the vacuum ultraviolet down to 121 nm using random quasi-phase matching in strontium tetraborate, the shortest wavelength ever produced with a second-order nonlinear optical process in a solid-state material. Relevant properties of this radiation, the nonlinear process, and the nonlinear crystal are investigated.

Men and women differ in their diurnal expression of monocyte peroxisome proliferator-activated receptor-α in the fed but not in the fasted state.

Peroxisome proliferator-activated receptor-α (PPARα) plays a pivotal role in regulating metabolic response to fasting and is an inhibitor of inflammatory pathways in immune cells. It represents a therapeutic target for treatment of several diseases, mainly hyperlipidemia. To shed light on PPARα expression changes in response to fasting, young healthy male and female volunteers were fed or fasted for 24 hours. Monocytes were analyzed every 2 hours to compile both profiles of mRNA and protein expression of PPARα and its interactive partner, the circadian pacemaker brain and muscle aryl hydrocarbon receptor nuclear translocator like-1 (BMAL1). We found that women change their diurnal expression profiles of PPARα and BMAL1 when switching from the fed to the fasted state, whereas men do not. Interestingly, the PPARα and BMAL1 profiles of men and women in the fed state are different, whereas the profiles in the fasted state are virtually identical. The finding of diametrically opposite responses of male and female PPARα expression in the fed state might have practical implication in human medicine as PPARα activators like fibrates are used for the therapy of chronic lymphocytic leukemia, microvascular complications in diabetes, and kidney diseases.

Evaluation of the prognostic role of tumor cell podoplanin expression in locally advanced squamous cell carcinoma of the head and neck.

BACKGROUND AND PURPOSE: To investigate the potential prognostic role of tumor cell podoplanin expression in patients treated with resection followed by irradiation or chemoradiotherapy for locally advanced squamous cell carcinoma of the head and neck (SCCHN). MATERIALS AND METHODS: Podoplanin expression (≤10 % versus > 10 %) and 12 other factors were evaluated in 160 patients for their association with locoregional control (LRC), metastases-free (MFS) and overall survival (OS). Other factors were age, gender, Eastern Cooperative Oncology Group (ECOG) performance status, preradiotherapy (pre-RT) hemoglobin level, tumor site, histological grading, T category, N category, American Joint Committee on Cancer (AJCC) stage, human papillomavirus (HPV) status, extent of resection and concurrent chemotherapy. RESULTS: In multivariate analysis, ECOG performance status 0-1 (risk ratio, RR: 3.01; 95 % confidence interval, CI: 1.42-7.14; p = 0.003), pre-RT hemoglobin levels ≥ 7.45 mmol/l (12 g/dl; RR: 2.03; 95 % CI: 1.04-3.94; p = 0.038), oropharyngeal cancer (RR: 1.25; 95 % CI: 1.01-1.55; p = 0.038) and T category T1-2 (RR: 1.81; 95 % CI: 1.24-2.79; p = 0.002) were significantly associated with improved LRC. T category T1-2 (RR: 1.90; 95 % CI: 1.25-3.06; p = 0.002) and N category N0-2a (RR: 5.22; 95 % CI: 1.96-18.09; p < 0.001) were significantly associated with better MFS. Pre-RT hemoglobin levels ≥ 7.45 mmol/l (RR: 2.44; 95 % CI: 1.27-4.74; p = 0.007), T category T1-2 (RR: 1.97; 95 % CI: 1.36-3.04; p < 0.001) and N category N0-2a (RR: 2.87; 95 % CI: 1.37-6.61; p = 0.005) were significantly associated with improved OS. Podoplanin expression ≤ 10 % showed a trend towards improved OS on both univariate (p = 0.050) and multivariate analysis (RR: 1.86; 95 % CI: 0.96-3.59; p = 0.07). CONCLUSION: Treatment outcomes were significantly associated with performance status, pre-RT hemoglobin level, tumor site and tumor stage. Tumor cell expression of podoplanin ≤ 10 % showed a trend towards improved OS when compared to podoplanin expression of > 10 %.

Laryngeal chondrosarcoma with unusual dissemination to the humerus.

We report the case of an 81-year-old woman admitted to our clinic with a 16-month history of hoarseness due to unilateral vocal cord immobilization, slowly progressive dysphagia and an episode of painless swelling of the right arm. Radiological and histological workup revealed a medium-grade conventional chondrosarcoma of the cricoid cartilage with paratracheal spread and dissemination to the lung and the humeral bone. To our knowledge, this is the first humeral bone metastasis of laryngeal chondrosarcoma reported in the literature. The course of the presented case underlines the need for an early and detailed clinical and radiological workup of vocal cord immobilization.

Pathological complete remission in patients with oesophagogastric cancer receiving preoperative 5-fluorouracil, oxaliplatin and docetaxel.

The aim of this study was to determine the pathological complete remission (pCR) rate, and its relationship to clinical outcome, in patients with adenocarcinoma of the stomach or oesophagogastric junction receiving preoperative 5-fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) every 2 weeks. Data from these patients who received at least one cycle of preoperative FLOT followed by surgery were prospectively collected in three German centres. Outcome analyses were conducted and tumour samples were evaluated for pathological remission by a central pathologist. A total of 46 patients were included in this analysis. All patients had clinical T3- and/or N+-stages and 11 (23.9%) had distant metastases (M1). After a median of 4 (range 2-8) preoperative cycles, 8 of 46 patients (17.4%) achieved a pCR. The pCR rate was highest in tumours of intestinal type histology (30.8%) and in those located in the oesophagogastric junction (30.4%) and lowest in patients with diffuse/mixed type tumours (0%) or tumours located in the stomach (4.3%; p < 0.05 for both comparisons). Patients with pCR had 100% probability of overall and disease-free survival (DFS) during the observation period, which was significantly higher (p = 0.037 and p = 0.009, respectively) than the survival probability in patients without pCR. In conclusion, treatment intensification using FLOT was associated with significant pCR rates in patients with oesophagogastric cancer. The distribution of pCR appeared to be significantly different according to histological type and location of the tumours.

The prognostic impact of tumor cell expression of estrogen receptor-α, progesterone receptor, and androgen receptor in patients irradiated for nonsmall cell lung cancer.

BACKGROUND: The current study was performed to investigate the potential impact of tumor cell expression of estrogen receptor-α (ER-α), progesterone receptor (PR), and androgen receptor (AR) on the outcomes of patients who received radiotherapy (RT) for non-small cell lung cancer (NSCLC). METHODS: Tumor cell expression of ER-α, PR, and AR as well as 9 additional potential prognostic factors were retrospectively evaluated in 64 patients who underwent RT for AJCC stage II/III NSCLC. The endpoints investigated were locoregional control, metastases-free survival, and overall survival. The additional potential prognostic factors were age, gender, Karnofsky performance score, histology, T classification, N classification, surgery, smoking during RT, and hemoglobin levels during RT. Subgroup analyses were performed for women and men. RESULTS: On univariate analysis, locoregional control was not found to be associated with expression of PR or AR. ER-α expression demonstrated a strong trend toward worse locoregional control. On multivariate analysis, ER-α expression was found to be significantly associated with worse locoregional control (risk ratio [RR], 3.12; P = .035). On univariate analysis, metastases-free survival was not associated with expression of ER-α, PR, or AR. On univariate analysis, survival was found to be negatively associated with expression of ER-α (P = .003) but not with PR or AR expression. On multivariate analysis, ER-α expression maintained significance (RR, 2.73; P = .022). CONCLUSIONS: Tumor cell expression of ER-α was found to be a negative prognostic factor for treatment outcomes in both women and men. Expression of PR and AR was not associated with outcomes.

Primary metastasized extraskeletal Ewing sarcoma of the vulva: report of a case and review of the literature.

PURPOSE: Ewing's sarcoma (ES) and primitive neuroectodermal tumor (PNET) are closely related malignant neoplasms, usually affecting the skeletal system. Extraosseous ES/PNETs are uncommon, with occasional reports of tumors affecting the genitourinary tract. Only few cases of primary vulvar Ewing's sarcoma/PNET have previously been reported. METHODS: We present a patient with primary vulvar Ewing's sarcoma with pulmonary metastasis who presented at the Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Campus Luebeck. RESULTS: The present report is the third case of a primary vulvar Ewing's sarcoma and the first constellation with pulmonary metastasis at diagnosis in the current literature. We present the diagnostic and therapeutic management including surgery, chemotherapy and radiation. CONCLUSION: The treatment of the Ewing's sarcomas and PNETs requires a multidisciplinary systemic approach. Despite its rarity, the differential diagnosis of vulvar sarcoma must be considered in young women.

Fibroblast growth factor 2--a predictor of outcome for patients irradiated for stage II-III non-small-cell lung cancer.

PURPOSE: The prognostic value of the tumor cell expression of the fibroblast growth factor 2 (FGF-2) in patients with non-small-cell lung cancer (NSCLC) is unclear. The present study investigated the effect of tumor cell expression of FGF-2 on the outcome of 60 patients irradiated for Stage II-III NSCLC. METHODS AND MATERIALS: The effect of FGF-2 expression and 13 additional factors on locoregional control (LRC), metastasis-free survival (MFS), and overall survival (OS) were retrospectively evaluated. These additional factors included age, gender, Karnofsky performance status, histologic type, histologic grade, T and N category, American Joint Committee on Cancer stage, surgery, chemotherapy, pack-years, smoking during radiotherapy, and hemoglobin during radiotherapy. Locoregional failure was identified by endoscopy or computed tomography. Univariate analyses were performed with the Kaplan-Meier method and the Wilcoxon test and multivariate analyses with the Cox proportional hazard model. RESULTS: On univariate analysis, improved LRC was associated with surgery (p = .017), greater hemoglobin levels (p = .036), and FGF-2 negativity (p <.001). On multivariate analysis of LRC, surgery (relative risk [RR], 2.44; p = .037), and FGF-2 expression (RR, 5.06; p <.001) maintained significance. On univariate analysis, improved MFS was associated with squamous cell carcinoma (p = .020), greater hemoglobin levels (p = .007), and FGF-2 negativity (p = .001). On multivariate analysis of MFS, the hemoglobin levels (RR, 2.65; p = .019) and FGF-2 expression (RR, 3.05; p = .004) were significant. On univariate analysis, improved OS was associated with a lower N category (p = .048), greater hemoglobin levels (p <.001), and FGF-2 negativity (p <.001). On multivariate analysis of OS, greater hemoglobin levels (RR, 4.62; p = .002) and FGF-2 expression (RR, 3.25; p = .002) maintained significance. CONCLUSIONS: Tumor cell expression of FGF-2 appeared to be an independent negative predictor of LRC, MFS, and OS.

Prognostic factors (including HPV status) for irradiation of locally advanced squamous cell carcinoma of the head and neck (SCCHN).

BACKGROUND AND PURPOSE: The prognosis of patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) is generally poor. However, prognostic factors can help optimize the care for the individual patient. This study investigated potential prognostic factors, including HPV status, for locoregional control (LRC), metastases-free survival (MFS), and survival (OS). PATIENTS AND METHODS: Twelve potential prognostic factors were investigated in 170 patients irradiated for stage III or IV SCCHN, including age (≤ 60 vs > 60 years), gender, ECOG performance score (0-1 vs 2), preradiotherapy hemoglobin level (< 12 vs ≥ 12 g/dl), tumor site (oropharynx, oral cavity, hypopharynx, or larynx), histological grade (G1-2 vs G3), T category (T1-T2 vs T3-T4), N category (N0-N1 vs N2-N3), AJCC stage (III vs IV), surgery (no vs yes), and chemotherapy (no vs yes). RESULTS: On multivariate analysis, positive HPV status (RR 2.34; p = 0.014), ECOG performance score 0-1 (RR 1.94; p = 0.017), preRT hemoglobin ≥ 12 g/dl (RR 1.88; p = 0.018), T category T1-T2 (RR 2.72; p < 0.001), and surgery (RR 2.29; p = 0.007) were significantly associated with improved LRC. PreRT hemoglobin ≥ 12 g/dl (RR 1.98; p = 0.040) and T category T1-T2 (RR 3.33; p < 0.001) were significantly associated with improved MFS. Positive HPV status (RR 2.19; p = 0.019), pre-RT hemoglobin ≥ 12 g/dl (RR 2.15; p = 0.002), T category T1-T2 (RR 2.31; p = 0.002), and AJCC stage III (RR 1.91; p = 0.034) were significantly associated with improved OS. CONCLUSION: Improved treatment outcomes were significantly associated with positive HPV status, better performance status, lower tumor stage, and pretreatment hemoglobin levels ≥ 12 g/dl. These factors should be considered in future trials.

Local calprotectin production in colorectal cancer and polyps--active neutrophil recruitment in carcinogenesis.

AIM: The aim of this study is to examine the expression level and localization of calprotectin in cancer tissue, tumor-adjacent mucosa, and polyps in colonic biopsies. Calprotection expression was correlated with neutrophil infiltration, markers of bacteremia, and systemic inflammation. MATERIALS AND METHODS: Patients with colorectal cancer (n = 28) and adenoma (n = 38) were compared with healthy controls (n = 33). Calprotectin expression levels were measured by ELISA, and its localization was visualized by immunohistochemistry and correlated with the degree of neutrophil infiltration (visualized by Esterase staining). The expression of tumor necrosis factor (TNF)-alpha, procalcitonin, endotoxemia, carcinoembryonic antigen (CEA), and C-reactive protein was also investigated. RESULTS: Mucosal calprotectin was expressed in significantly higher concentrations in carcinoma (94.2 ± 31.2 ng/mg total protein) and adenoma (122.8 ± 60.3 ng/mg total protein) in comparison with mucosal biopsies from healthy controls (20.4 ± 5.4 ng/mg total protein), tumor-adjacent mucosa from patients with colorectal carcinoma (21.6 ± 5.1 ng/mg total protein), and adenoma (45 ± 14.6 ng/mg total protein, all p < 0.05). Immunohistochemistry showed calprotectin reactivity mainly in granulocytes and macrophages with only singular reactive epithelial cells. Positive staining (quantified by the number of positive cells per square millimeter) was markedly increased in carcinoma tissue (85 ± 21.5) and in adenoma (67.5 ± 20) as compared with tumor-adjacent epithelia (18.8 ± 4.3, p = 0.0007, p = 0.003, respectively), and there was a highly significant correlation, r = 0.89, p = 0.001) between calprotectin staining and neutrophil infiltration. No significant differences were found in the systemic levels of TNF-alpha, procalcitonin, and endotoxemia, whereas CEA and C-reactive protein levels were significantly higher in the cancer group (p < 0.05). CONCLUSION: Our results support the evidence that increased calprotectin expression is an early step in the neoplastic transformation during colorectal carcinogenesis. Moreover, its expression is closely related to an inflammatory response and points out a possible biological link between inflammation and neoplastic transformation in colorectal cancer.

Prognostic impact of erythropoietin expression and erythropoietin receptor expression on locoregional control and survival of patients irradiated for stage II/III non-small-cell lung cancer.

PURPOSE: Prognostic factors can guide the physician in selecting the optimal treatment for an individual patient. This study investigates the prognostic value of erythropoietin (EPO) and EPO receptor (EPO-R) expression of tumor cells for locoregional control and survival in non-small-cell lung cancer (NSCLC) patients. METHODS AND MATERIALS: Fourteen factors were investigated in 62 patients irradiated for stage II/III NSCLC, as follows: age, gender, Karnofsky performance score (KPS), histology, grading, TNM/American Joint Committee on Cancer (AJCC) stage, surgery, chemotherapy, pack years (average number of packages of cigarettes smoked per day multiplied by the number of years smoked), smoking during radiotherapy, hemoglobin levels during radiotherapy, EPO expression, and EPO-R expression. Additionally, patients with tumors expressing both EPO and EPO-R were compared to those expressing either EPO or EPO-R and to those expressing neither EPO nor EPO-R. RESULTS: On univariate analysis, improved locoregional control was associated with AJCC stage II cancer (p < 0.048), surgery (p < 0.042), no smoking during radiotherapy (p = 0.024), and no EPO expression (p = 0.001). A trend was observed for a KPS of >70 (p = 0.08), an N stage of 0 to 1 (p = 0.07), and no EPO-R expression (p = 0.10). On multivariate analysis, AJCC stage II and no EPO expression remained significant. No smoking during radiotherapy was almost significant. On univariate analysis, improved survival was associated with N stage 0 to 1 (p = 0.009), surgery (p = 0.039), hemoglobin levels of ≥12 g/d (p = 0.016), and no EPO expression (p = 0.001). On multivariate analysis, N stage 0 to 1 and no EPO expression maintained significance. Hemoglobin levels of ≥12 g/d were almost significant. On subgroup analyses, patients with tumors expressing both EPO and EPO-R had worse outcomes than those expressing either EPO or EPO-R and those expressing neither EPO nor RPO-R. CONCLUSIONS: EPO expression of tumor cells was an independent prognostic factor for locoregional control and survival in patients irradiated for NSCLC. EPO-R expression showed a trend. Patients with tumors expressing both EPO and EPO-R have an unfavorable prognosis.

Radiolabeled cetuximab plus whole-brain irradiation (WBI) for the treatment of brain metastases from non-small cell lung cancer (NSCLC).

BACKGROUND AND PURPOSE: The addition of systemic drugs to whole-brain irradiation has not improved the survival of patients with multiple brain metastases, most likely because the agents did not readily cross the blood-brain barrier (BBB). Radiolabeling of cetuximab was performed to investigate whether this antibody crosses the BBB. CASE REPORT: A patient with multiple brain lesions from non-small cell lung cancer was investigated. The largest metastasis (40 x 33 x 27 mm) was selected the reference lesion. On day 1, 200 mg/m(2) cetuximab (0.25% hot and 99.75% cold antibody) were given. On day 3, 200 mg/m(2) cetuximab (cold antibody) were given. Weekly doses of 250 mg/m(2) cetuximab were administered for 3 months. RESULTS: The reference lesion showed enhancement of radiolabeled cetuximab ((123)I-Erbi) on scintigraphy; (123)I-Erbi crossed the BBB and accumulated in the lesion. The reference lesion measured 31 x 22 x 21 mm at 4 months. Enhancement of contrast medium was less pronounced. CONCLUSION: This is the first demonstration of cetuximab crossing the BBB and accumulating in brain metastasis.

Prognostic impact of VEGF and VEGF receptor 1 (FLT1) expression in patients irradiated for stage II/III non-small cell lung cancer (NSCLC).

BACKGROUND AND PURPOSE: The prognostic value of the tumor expression of vascular endothelial growth factor (VEGF) and VEGF receptor 1 (FLT1) is still unclear. This study investigated the impact of tumor expression of VEGF and FLT1 on outcomes in 61 patients irradiated for stage II/III non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: The impact of tumor VEGF and FLT expression and twelve additional potential prognostic factors on locoregional control (LC), metastases-free survival (MFS), and overall survival (OS) were retrospectively evaluated. These factors included age, gender, performance status, histology, histological grade, T-category, N-category, surgery, chemotherapy, pack-years, smoking during radiotherapy, and hemoglobin levels during radiotherapy. RESULTS: On univariate analysis, improved LC was associated with lower T-category (p = 0.046), lower N-category (p = 0.047), and not smoking during radiotherapy (p = 0.012). VEGF (p = 0.26) and FLT1 expression (p = 0.70) had no significant impact. On multivariate analysis, lower N-category (p = 0.037) maintained significance; not smoking during radiotherapy was almost significant (p = 0.052). On univariate analysis, improved MFS was associated with lower T-category (p = 0.034) and lower N-category (p = 0.027), and almost with hemoglobin >or= 12 g/dl during radiotherapy (p = 0.053). VEGF (p = 0.80) and FLT1 expression (p = 0.61) had no significant impact. On multivariate analysis, lower N-category (p = 0.040) maintained significance. On univariate analysis, improved OS was associated with lower T-category (p = 0.028), lower N-category (p = 0.003), not smoking during radiotherapy (p = 0.047), and hemoglobin levels >or= 12 g/dl during radiotherapy (p = 0.019). VEGF (p = 0.59) and FLT1 expression (p = 0.85) had no significant impact. On multivariate analysis, lower N-category (p = 0.011) maintained significance. CONCLUSION: Tumor expression of VEGF and FLT1 appear to have no significant impact on LC, MFS, or OS in patients irradiated for NSCLC.

Radiofrequency ablation in breast tissue: experimental study for evaluation of radiofrequency effects in the bovine udder and review of the literature.

PURPOSE: To investigate the radiofrequency (RF) effects on the nonlactating and lactating ex vivo bovine udder as a model for normal breast tissue. MATERIALS AND METHODS: RF ablation in three lactating and three nonlactating ex vivo bovine udders (ie, six udders) was performed. The opening of the electrodes was 3 cm. The temperature was applied in 10 degrees C increasing steps between 60 degrees C and 100 degrees C and each temperature was maintained for 15 minutes. The experiment was repeated three times for each temperature step in the lactating and nonlactating udder. Resected specimens were assessed histologically. The maximum diameter of the ablation zone and maximum width of the transition zone with respect to the temperature applied were measured. RESULTS: In the nonlactating tissue, there was a correlation of the temperature and diameter of tissue damage. There was a narrow transition zone of 0.10 cm in all cases except at 100 degrees C, when it was 0.17 cm. In the lactating udder, no correlation was seen. The transition zone was not well visualized at temperatures less than 80 degrees C, ranging in overall size between 0.15 cm and 0.20 cm. CONCLUSIONS: The results of the study, with clear demarcation of the ablation zones and transition zones in the normal breast tissue, support the potential of breast thermal ablation as a viable treatment for further study. Lactating tissue does not seem ideal for thermal ablation. The discrepancy of the extent of ablation and the length of the electrodes is an important finding in this study. Further in vivo studies in normal glandular tissue and tumor are necessary.

Primary peritoneal carcinoma in a young woman with suspected endometriosis.

OBJECTIVE: To describe the treatment of a 23-year-old patient with primary peritoneal carcinoma and preservation of her fertility. DESIGN: Case report. SETTING: University of Schleswig-Holstein, Campus Lübeck, Department of Gynecology and Obstetrics. PATIENT(S): A 23-year-old patient with primary peritoneal carcinoma. INTERVENTION(S): The patient was given treatment by first preserving her fertility with oocyte vitrification and cryoconservation of ovarian biopsy samples. Surgery was performed with radical resection of the peritoneal lesion, ovarian biopsies, omentectomy, and pelvic and para-aortic lymph node sampling before starting chemotherapy with carboplatin and paclitaxel (Taxol). Hysterectomy and bilateral salpingo-oophorectomy were not performed. MAIN OUTCOME MEASURE(S): Treatment of peritoneal carcinoma and number of vitrified oocytes. RESULT(S): Twenty-five oocytes of the patients were vitrified before chemotherapy was performed. CONCLUSION(S): Primary peritoneal carcinoma is a rare disease that laparoscopically resembles peritoneal endometriosis and histologically is very similar to primary epithelial ovarian cancer. The advised therapy is based on ovarian cancer treatment; however, it is unclear whether the radical operation improves prognosis. In this case, a 23-year-old patient underwent treatment preserving her fertility with oocyte vitrification and cryoconservation of ovarian biopsy samples before surgery and chemotherapy were performed.

Relative expression of 1,25-dihydroxyvitamin D3 receptor, vitamin D 1 alpha-hydroxylase, vitamin D 24-hydroxylase, and vitamin D 25-hydroxylase in endometriosis and gynecologic cancers.

The authors demonstrate expression of the vitamin D receptor (VDR) and its hydroxylases in the endometrium and ovaries of women with and without endometriosis and endometrial or ovarian cancer. Immunohistochemistry showed strong staining of the VDR in endometriosis and endometrial cancer, with the most intense staining in epithelial cells. The VDR mRNA was significantly increased in patients with endometrial and ovarian cancer compared to the control group. There was a significantly higher 1 alpha-hydroxylase expression in the endometrium of patients with endometriosis compared to healthy controls. The observed differences in VDR and 1 alpha -hydroxylase mRNA levels were maintained at the protein level. The authors found no differences in 25-OH vitamin D levels between the serum of patients with endometriosis (25.7 +/- 2.1 ng/mL, n = 46) and healthy controls (22.6 +/- 2.0 ng/mL, n = 33, P = .31). They hypothesize that vitamin D might influence the local activity of immune cells and cytokines thought to play important pathogenic roles in the development and maintenance of endometriosis.

Lethal outcome in xanthogranulomatous endometritis.

Xanthogranulomatous inflammation is rare, mainly involving the kidneys, while primary xanthogranulomatous endometritis (XE) is a very unusual finding, histologically characterized by partial or complete replacement of the mucosa by granulation tissue with an abundance of foamy histiocytes, siderophages and multinucleated giant cells. We present the case of a 69-year-old woman with a short history of abdominal pain and a palpable mass in the pouch of Douglas. Dilatation of the cervix drained a pyometra. Histological examination of the curettage rendered the diagnosis of XE. Microbiological studies revealed enterococcus spp. and Peptostreptococcus magnus. Despite antibiotic treatment the patient died of heart failure due to systemic inflammation. Autopsy confirmed the diagnosis of XE with transmural extension into the peritoneal cavity. Such a lethal course of XE is extraordinary. Proposed causes of XE include obstruction, infection and hemorrhage. Demonstration of enterococcus spp. and P. magnus supports the probable significance of bacteria in the development of XE. Because this condition may mimic malignant disease macroscopically and histologically, knowledge of XE is of major importance for both pathologists and gynecologists.

Primary extranodal NK/T cell lymphoma ("nasal type") of the endometrium: report of an unusual case diagnosed at autopsy.

Primary natural killer (NK)/T cell lymphoma of the female genital tract is extremely rare. We here report the case of a "nasal type" NK/T cell lymphoma arising in the uterus. The diagnosis was established only at autopsy.