Diagnosis and management of an unilateral giant fibroadenoma of the breast in pregnancy.

BACKGROUND: Fibroadenomas represent the vast majority of breast pathologies in young women. 2-4% of the fibroadenomas exceed 5 cm in size or 500 g in weight and are called "giant fibroadenomas". Due to their excessive growth they are usually enucleated to clarify a malignant origin, to differentiate from phyllodes tumor and to prevent persisting deformities of the breast. CASE: We present a case of a 17-year-old female who was pregnant in the 24th week and suffered from a giant fibroadenoma in the right breast. Besides the massive swelling no other illnesses were found. The patient was clinically asymptomatic and had noticed the tumor just 8 weeks ago. On clinical examination we found a tumor of more than 10 cm in size which fulfilled the criteria of a benign process. A prior performed biopsy and an ultrasound investigation could not definitely differentiate the mass from phyllodes tumor. Because of the rapid growth and the progressive deformation of the breast a lumpectomy was indicated and performed without complications in consideration of the gestational stage. CONCLUSION: We present a rare case of giant fibroadenoma in pregnant young women. Because of the progressive structural damage of the breast immediate surgical enucleation was indicated. Safety of the fetus was provided by perioperative monitoring. The pre-operative differentiation from phyllodes tumor is still challenging.

PET-CT in recurrent ovarian cancer: impact on treatment planning.

BACKGROUND: Positron emission tomography-computed tomography (PET-CT) is currently not established in the management of recurrent ovarian cancer. Here, its value in diagnosis and therapy planning was evaluated. PATIENTS AND METHODS: Seventy patients received PET-CT for suspicion of recurrent ovarian cancer. PET-CT and surgery were reviewed to analyze the accuracy in the diagnosis of recurrence and prediction of full resectability. RESULTS: PET-CT showed disease relapse in 63 of 70 patients, with full sensitivity and specificity. Thirty cases were operated on. PET-CT indicated full resectability in 24, but in fact only incomplete resection was possible in three cases. Thus sensitivity and specificity for the identification of full resectability were 100% and 66%, respectively. Seven negative results in PET-CT were confirmed by a relapse-free follow-up of 1 year. CONCLUSION: PET-CT offers reliable detection of recurrent ovarian cancer. Although diagnostic accuracy in the prediction of full resectability is limited, surgical planning is improved by identifying sites of intraperitoneal involvement.

Effective relief of malignant ascites in patients with advanced ovarian cancer by a trifunctional anti-EpCAM x anti-CD3 antibody: a phase I/II study.

PURPOSE: Malignant ascites in ovarian carcinoma patients is associated with poor prognosis and reduced quality of life. The trifunctional antibody catumaxomab (anti-EpCAM x anti-CD3) enhances the antitumor activity by redirecting T cells and Fcgamma receptor I/III--positive accessory cells to the tumor. This multicenter phase I/II dose-escalating study investigated tolerability and efficacy of i.p. catumaxomab application in ovarian cancer patients with malignant ascites containing epithelial cell adhesion molecule (EpCAM)--positive tumor cells. EXPERIMENTAL DESIGN: Twenty-three women with recurrent ascites due to pretreated refractory ovarian cancer were treated with four to five i.p. infusions of catumaxomab in doses of 5 to 200 microg within 9 to 13 days. RESULTS: The maximum tolerated dose was defined at 10, 20, 50, 200, and 200 microg for the first through fifth doses. Side effects included transient fever (83%), nausea (61%), and vomiting (57%), mostly CTCAE (Common Terminology Criteria for Adverse Events) grade 1 or 2. A total of 39 grade 3 and 2 grade 4 treatment-related adverse events (AE), 9 of them after the highest dose level (200 microg), were observed in 16 patients. Most AEs were reversible without sequelae. Treatment with catumaxomab resulted in significant and sustained reduction of ascites flow rate. A total of 22/23 patients did not require paracentesis between the last infusion and the end of study at day 37. Tumor cell monitoring revealed a reduction of EpCAM-positive malignant cells in ascites by up to 5 log. CONCLUSION: I.p. immunotherapy with catumaxomab prevented the accumulation of ascites and efficiently eliminated tumor cells with an acceptable safety profile. This suggests that catumaxomab is a promising treatment option in ovarian cancer patients with malignant ascites.

Analysis of factors influencing the ultrasonic fetal weight estimation.

OBJECTIVE: The aim of our study was the evaluation of sonographic fetal weight estimation taking into consideration 9 of the most important factors of influence on the precision of the estimation. METHODS: We analyzed 820 singleton pregnancies from 22 to 42 weeks of gestational age. We evaluated 9 different factors that potentially influence the precision of sonographic weight estimation (time interval between estimation and delivery, experts vs. less experienced investigator, fetal gender, gestational age, fetal weight, maternal BMI, amniotic fluid index, presentation of the fetus, location of the placenta). Finally, we compared the results of the fetal weight estimation of the fetuses with poor scanning conditions to those presenting good scanning conditions. RESULTS: Of the 9 evaluated factors that may influence accuracy of fetal weight estimation, only a short interval between sonographic weight estimation and delivery (0-7 vs. 8-14 days) had a statistically significant impact. CONCLUSION: Of all known factors of influence, only a time interval of more than 7 days between estimation and delivery had a negative impact on the estimation.

Long-term follow-up after ovarian borderline tumor: relapse and survival in a large patient cohort.

OBJECTIVES: To assess long-term survival and relapse rate of patients diagnosed with a borderline tumor of the ovary (BOT) with special focus on the influence of primary surgery. STUDY DESIGN: All women diagnosed and treated for BOT between 1983 and 2006 at our institution were included in this retrospective study. Clinical data including operative procedure, stage and histology at first diagnosis as well as follow-up data were analyzed with reference to survival times and relapse rates. RESULTS: Altogether 113 patients could be identified, including 19 women treated with fertility sparing surgery (19.2%). Mean follow-up time was 9.6+/-6.6 years. Relapse occurred during the follow-up period in 10 patients (10.1%) with a mean time to recurrence of 2.0+/-1.7 years. Patients with recurrent disease had a statistically significantly worse survival: 5- and 10-year survival rates were 90.0 and 80.0% compared with 98.9 and 94.4% for those without (p=0.0208), respectively. Relapse rate was 7.1% in early borderline patients (Ia: 4/56) and 14% (>Ia: 6/43) for all others (p=0.436). Patients with invasive implants had a statistically significantly higher relapse rate (p=0.0112). No significant difference in relapse rates or survival was observed between the histological subtypes. Five- and 10-year survival rates of women treated with fertility sparing surgery (n=19) were 100% and thus not worse than those of radically operated patients (5- and 10-year survival 95.1 and 90.1%). Relapse rates in both groups were comparable with 10.5 and 10.0% (p=0.723). The surgical procedure with lymphadenectomy vs. without had no influence on relapse or survival, neither did laparoscopy vs. laparotomy. CONCLUSION: Our findings confirm the good prognosis of BOT in general. Patients with invasive implants have higher relapse rates. Fertility sparing surgery in women at childbearing age can be an adequate treatment option in early stage disease.

Pregnancy in a patient with a displaced levonorgestrel-releasing intrauterine system: a case report.

We report the case of a 39-year-old woman who became pregnant despite a levonorgestrel-releasing intrauterine system (LNG-IUS), which was inserted 40 months before the pregnancy was detected. When a Caesarean section was performed, the LNG-IUS was found within the omentum majus. It has been reported, that displaced LNG-IUS can cause amenorrhea and high plasma levels of LNG in affected women, probably due to the higher resorptive capacity of the peritoneum, recommending a removal of the displaced LNG-IUS. Our case report demonstrates that a dislocated LNG-IUS does not necessary has the ability to suppress ovulation and therefore pregnancy. Therefore, every gynaecologist should be aware of a pregnancy despite a dislocated LNG-IUS.