Unusual clinical tumor development in axilla.

This work describes clinical development of a sarcoma in the left axilla of a 36-year-old woman. The macroscopic picture changed from the initial inflammatory reddening to globular resistance of 2.5 cm, suggestive of an enlarged lymph node. Mammography did not reveal any associated breast disease. Colliquation found on the ultrasound images led to a biopsy, the result of which indicated only an inflammation, without any malignancy. Rapid growth of the axillar tumor to 10 cm in size within 8 weeks prompted surgery allowing proper diagnosis of a small mature-to-immature sarcoma. Special examinations performed by a histopathologist (at the Institute for Histopathology) could not establish the precise histogenesis, i.e. the tissue origin. Therefore it was necessary to remove any clinically obscuring tumor for the final proper histological diagnosis and adequate treatment of the patient.

[Invasive cervical cancer incidence in the span from the preventive check-up to the national screening programing in the Czech Republic]. / Invazivní karcinom cervixu od depistázních akcí k národnímu screeningu v Ceské republice.

OBJECTIVE: Former Czechoslovakia was the first European country in which the gynecological cytodiagnosticts was used for checking-up the cervix malignancy, in the years 1947-1957. The preventive measures in woman population together with building up the centres for gynekological oncological prevention result in the cervical cancer incidence lowering, as it is documented by national registry data. The cervical cancer incidence rate was 19.2/100 000 in the year 2008, that is the third endplace on the European scale. How to go positively forward? SETTING: 1st Faculty of medicine, Charles University Prague and General Teaching Hospital Prague. STUDY DESIGN: Analytical study od the incidence during the historical way up to now. Validity of the data should bring the strategy of solution. METHODS: The collected data od the cervical cancer incidence provided by national registry of the CR from the span 1960 to 2008 enabled to evaluate the effectivity od prevention measures used. RESULTS: The incidence rate od cervical cancer was 30/100 000 women before the prevention check-up started. the diagnosis was based cytology. The incidence of cervical cancer lowered to 22/100 000 in the year 1970. The establishment of the centres for oncological gynekological prevention ("COP") led up to the futher dropping up of cervical cancer incidence (20,7/100 000) the activity of the "COP" was based on the gynekologists having the II. degree certificate of the line, colposcopy skill, on cytolaboratory. The continuing education of cytotechnologists started in the year 1991 and it has influenced positively the cervical cancer incidence - its rate was below 20/100 000 -in the year 2008. the data analyses have shown, that the west regions of the CR (Karlovy Vary, Ustí nad Labem) have high incidence steadely respectively. The graph of incidence of age groups of women has 3 peaks: In the age 35-39, 55-59 and 75-80. The whole Moravia region reached the lowest cervical cancer incidence 15,2/100 000, which is lower then the world incidence standard. The Czech part of the republic has shown 20,7/100 000 in the average in the year 2008.

[Validity of the oncological cytodiagnostics and colposcopy examination versus biopsy in cervical carcinoma prevention]. / Validita onkologické cytodiagnostiky a kolposkopie versus biopsie v prevenci rakoviny cervixu.

THE AIM OF THE STUDY: The basic praebioptic methods detecting the precancerous lesions of the uterine cervix are oncologic cytology (PAP smears) and colposcopy. However in the Czech Republic the incidence of the invasive carcinomas during the last 10 years did not considerably decrease. Therefore the goal of our study is to estimate the validity of the prebioptic methods and compare the results of praebioptic methods (procedures) versus biopsy. TYPE OF THE STUDY: Analysis of the results of the oncologic cervical cytology comparing with the results of cervical biopsies performed during the years 2002-2003 were compared to those of the year 2009. THE SUBJECT AND METHODS OF THE STUDY: evaluation of the prebioptic methods (cytology, colposcopy) versus biopsy prior and during the start of the National Screening in the Czech Republic. SETTING: 1. Centre for Gynaecological Oncological prevention, 1st Faculty of Medicine, Charles University Prague, Department of Gynaecology and Obstetrics. 2. Institute of Physiology, Department of cybernetics, 1st Faculty of Medicine, Charles University, Prague. 3. Institute of Pathology, University of Ostrava. 4. Institue for Mother and Child Care, Prague. SUMMARY: We screened the documentation related to the treatment of 423 women with cervical lesions, examined at the Oncological prevention centre of the Obstetrical and Gynaecological Department of the 1st Faculty of Medicine Charles University Prague and the General Teaching Hospital in Prague 2. Results of the oncologic cytology, colposcopy and biopsy were compared. The comparison revealed differences related to the time of examinations. During the years 2002 and 2003 the agreement between cytologic diagnosis and biopsies in the group of HSIL was 40 %. In the year 2009 the agreement between HSIL and CIN was 68% the colposcopic diagnosis of precancerous lesions with those of bioptic specimens, during the years 2002 and 2003 was 90% while in the year 2009, during the National Screening, the agreement reached 98%.

[Ductal approaches in mammary diagnostics]. / Intraduktální prístupy v mamární diagnostice.

OBJECTIVE: Information about new possibilities of early diagnostics in mammary lesions. TYPE OF STUDY: Review. SETTING: Gynecology-Obstetrics Clinic, 1st Medical Faculty and General Teaching Hospital, Prague. SUBJECT AND METHODS: Most malignant tumors of the breast originate from ductal epithelium. A direct examination of the ductal system, could significantly improve diagnostics of breast cancer as well as its preinvasive stages (DCIS) and to influence mortality. The concept of ductal approaches includes several techniques and ductal lavage and duscoscopy. CONCLUSIONS: Ductal approaches represent an attractive area for minimal load upon the patients. Specificity and sensitivity of these methods have some limits, which will be subject to change in relation to understanding of carcinogenesis and in a close relation to the knowledge of biomarkers, genomics and proteomics. Ductoscopy appears to be the ideal method for the future due to possibilities of direct visualization of epithelium in combination with biopsy and ductal lavage. It other advantages include minimal invasiveness, minimal risk and the origin of possible complications for the patient.

[Contribution of neoadjuvant chemotherapy for operability of cancers of the uterine cervix]. / Prínos neoadjuvantní chemoterapie pro operabilitu zhoubných nádoru delozního hrdla.

OBJECTIVE: To compare per-operative and post-operative morbidity in patients undergoing radical surgery for carcinoma of the uterine cervix after administration of a neoadjuvant chemotherapy, and for primarily small cervical tumour. TYPE OF THE STUDY: A retrospective case-control study. SETTING: Department of Obstetrics and Gyneacology, 1st Faculty of Medicine, Charles University and General Teaching Hospital, Prague. METHODS: The study included 24 patients with squamous cell carcinoma of the uterine cervix who underwent radical hysterectomy including systematic pelvic lymphadenectomy after previous administration of neoadjuvant chemotherapy (NACT) during the period between 1/2004 and 6/2006. The control group of 24 patients was selected retrospectively from the population of women after radical surgery carried out in the same period, nevertheless, the controls underwent the surgery for primarily small carcinoma of the uterine cervix, stages IA2 or IB1. The tumour size consistent with the reduced tumour after NACT administration was the criterion for selection of the control group. The following parameters were monitored in both groups--duration of the surgery, blood loss objectivised by a difference in pre-operative and post-operative haemoglobin and haematocrit values, the need of blood transfusion, per-operative complications, early post-operative complications (up to 6 weeks after the surgery), duration of hospitalization and retaining the inserted epicystotostomy due to hypotonic bladder after discharge. RESULTS: A therapeutic response allowing the radical surgery was achieved in 92% patients after NACT. After NACT the original tumour volume was reduced by 70% on the average (58% - 100%). No significant differences between the group of patients treated with NACT and undergoing subsequent radical hysterectomy and the control group were reported in terms of duration of the surgery (165 min. vs. 160 min.), blood loss (the difference in pre-operative and post-operative haemoglobin values 18 g/l vs. 19 g/l, the difference in pre-operative and post-operative haematocrit values 0.056 vs. 0.064), administration of blood transfusion (25% vs. 21%) and duration of hospitalization (9.5 days vs. 9.6 days). A significant difference was reported only in the need to retain the inserted epi-cystostomy after discharge (67% vs. 47%). CONCLUSION: There were no significant differences in the evaluated parameters of per-operative and postoperative morbidity in patients after NACT and in control patients, except for the necessary duration of artificial urine derivation in patients after NACT due to the fact that their surgery was more radical in the parametria. Administration of NACT regimen involving ifosfamide/cisplatin (IP) improved surgical conditions in the bulky squamous cell carcinoma of the uterine cervix.

[Glandular premalignant lesions of the uterine cervix]. / Adenoprekancerózy delozního hrdla.

OBJECTIVE: Review of diagnostical and therapeutical methods in glandular premalignant lesions of the uterine cervix. DESIGN: Review article. SETTING: Department of Obstetrics and Gyneacology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. RESULTS: The incidence of invasive adenocarcinomas of the uterine cervix is increasing. Incidence ratio between adenocarcinomas and spinocellular carcinomas is approximately 1:5; however ratio of premalignant lesions reaches only about 1:80. Glandular premalignant disease is usually found in the specimen taken for squamous disease. The coincidence of both types of premalignant lesions, so called "mixed lesion", is revealed in about 46-72%. PAP-smear of AGC-NOS/-NEO or adenocarcinoma in situ (AIS) in combination with typical colposcopic appearance raise a suspicion of glandular lesion. Direct biopsy must be always performed to get definite diagnosis. Optimum biopsy technique requires cylindrical excision. A woman can be carefully followed if desires pregnancy and specimen margins are negative. Hysterectomy is indicated if reproductive plans are completed. CONCLUSION: Diagnosis of glandular premalignat lesion of the uterine cervix is more complicated in comparison to spinocellular one, however it is getting more significant due to increasing incidence. Colposcopy and cytology are less reliable. Any suspicion on glandular premalignat leasion requires more active approach and radical procedure (hysterectomy) if possible.

[Radical parametrectomy in women with invasive cervix cancer after previous simple hysterectomy]. / Radikální parametrektomie u zen s invazivním karcinomem delozního hrdla po piredchozí prosté hysterektomii.

OBJECTIVE: Evaluate technique, indications and limits of surgical procedure in the treatment of cervical cancer diagnosed from uterus specimen from simple hysterectomy. DESIGN: Retrospective observational study, review of literature. SETTINGS: Department of Obstetrics and Gynecology, 1st Medical Faculty and General Faculty Hospital, Charles University, Prague, Czech Republic. METHODS: Women following radical parametrectomy with upper vaginectomy and pelvic lymphadenectomy were enrolled to the study. In all patients unexpected invasive cervical cancer was found from the uterus specimen after simple hysterectomy. RESULTS: Together 10 patients were enrolled to the study. CIN was the indication for primary hysterectomy in all but two patients. There were two operative complications, cystostomy in both cases, treated properly during surgery. In the specimen from radical procedure residual tumor in parametria was found in 2 cases, and metastasis to pelvic nodes in 4 cases. There was no postoperative complication. Adjuvant radiotherapy was recommended in 4 patients due to positive lymph nodes, in one case due to residual tumor in parametria, and in one case for both reasons. CONCLUSIONS: Radical parametrectomy with upper vaginectomy and pelvic lymphadenectomy should be considered as an alternative solution in patients following simple hysterectomy with unexpected finding of invasive cervical cancer. Morbidity of the procedure is higher in comparison to standard radical hysterectomy, however majority of complications are easy to repair. The most significant criteria for patient's selection for surgical approach is a depth of invasion to cervical stroma. In our group radical procedure obviated the need for radiotherapy in half of the patients.

[Complications of axillary dissection in breast carcinoma ]. / Komplikace disekce axily pro karcinom prsu.

OBJECTIVE: The objective of the work was to evaluate the incidence and type of postoperative complications after radical exenteration of the axilla in conjunction with an implemented surgical operation. DESIGN: Retrospective clinical study. SETTING: Gynaecological and Obstetric Clinic, First Medical Faculty Charles University and General Faculty Hospital Prague, Apolinárská 18, Prague. METHOD: The authors made a retrospective analysis of postoperative complications in 116 selected patients, who underwent partial breast surgery or ablation of the breast with dissection of the axilla at the Gynaecological and Obstetric Clinic, First Medical Faculty Charles University and General Faculty Hospital in Prague in 1994-2000 on account of breast cancer stage I and II according to FIGO. The group comprised patients where radiotherapy or chemotherapy of the axilla was not used. The patients were at least 12 months after operation without signs of locoregional relapse of the disease and in the dissected axillary tissue at least 10 lymph nodes were found. The operations were implemented by nine different surgeons. Early (infection, seroma, haematoma) as well as late (oedema, paraesthesia, stiffness, pain, weakness of the upper extremity) complications were also evaluated. The authors compared the incidence of complaints in relation to age, the number of dissected nodes and extent of the breast surgery. The statistical significance of the phenomena was evaluated by Fisher's exact test. RESULTS: At least one complication was recorded in 65% of the patients. In early complications (haematoma, infection, seroma) neither the correlation with the patient's age nor with the number of removed nodes was significant. There was a statistically significant relationship (P < 0.05) between the incidence of infection and the extent of the breast surgery which probably was associated with the wound area. As to late complications (oedema, paraesthesia, stiffness, pain and weakness of the upper extremity) a significant relationship was found with lower painfulness in patients above 55 years (P < 0.05) and lower sensation of weakness and paraesthesias in patients with partial breast operations (P < 0.05). The more frequent complaints of younger patients were probably due to their greater everyday physical activity as compared with older women. The higher number of subjective complications in patients after ablation of the breast is explained not only by the size of the wound area but also by psychosocial reasons. CONCLUSION: Dissection of the axilla is part of standard surgical treatment of breast cancer. The surgical operation without radio- or chemotherapy is associated in 65% cases with long-term morbidity of the patients. With regard to the shift of diagnosis of breast cancer to earlier stages it is important to seek a less invasive staging method which will reduce the patient's morbidity. The sentinel node biopsy method seems perspective.

[Granulosa cell tumor--clinical group and literature review]. / Nádor z bunek granulózy--klinický soubor a literární prehled.

OBJECTIVE: To present a review of literature and to analyse a clinical retrospective series of patients with granulosa cell tumor. DESIGN: Retrospective study and review. SETTING: Department of Obstetrics and Gynaecology, First Faculty of Medicine, Prague, Czech Republic. METHODS: Retrospective analysis of age, stage, surgery, radiotherapy and chemotherapy, survival curve, number of recurrences and time to recurrence. Literature and information database (Medline 1997-1999) review. RESULTS: In a group of 43 patients the median of age was 53.5 years. 83.7% of cases were in a stage I. There were two duplicate tumors in a series. Conservative surgery was performed in 9/43 cases, 5 of them were reoperated on. The most frequent chemotherapy regimens were platinum-cyclophoshamide and BEP (bleomycin, etoposide, platinum). The 5-year overall survival was 86% and specific survival 90.7%. There were 3/43 recurrences, median time to recurrence was 22 months. CONCLUSION: A good prognosis of a patient with granulosa cell tumor requires a precise histopathologic examination, an adequate surgery and a comprehensive clinical analysis of a case to evaluate an indication of adjuvant therapy. Concentration of patients in oncogynaecological centres is advisable. A careful follow-up because of a risk of late recurrences is necessary.