Biological and pathological features in pregnancy-associated breast cancer: a matched case-control study.

BACKGROUND: The prognosis for breast cancer has been considered to be worsened by the coexistence of pregnancy. However, to date, significant controversy still exists regarding the pathological tumor features and prognosis of patients diagnosed with pregnancy-associated breast cancer (PABC). The aim of the present study was to analyze the different prognostic factors and outcome in PABC subset versus a non-PABC control group matched for age and year of diagnosis. MATERIALS AND METHODS: A total of 56 PABC cases were diagnosed from 1990 to 2008, for whom 73 non-PABC patients were identified. Pathological characteristics, immunohistochemical fea- tures, and differences in overall and disease-free survival were compared between both groups. RESULTS: Compared to non-PABC controls, PABC patients presented more advanced disease (31% vs 13%, p = 0.024) and greater lymph node involvement (53% vs 34%, p = 0.034). Pathological and tumor features tended to present poorer prognostic factors in the PABC subset. Survival was poorer in the PABC patients (five-year DFS 68% in PABC vs 86% in non-PABC, p = 0.12). However, analysing survival adjusted for stage and age, the authors did not find significant differences between both groups. CONCLUSIONS: PABC patients tended to be diagnosed in advanced breast disease and presented tumors with adverse pathological prognostic factors. While the authors found a poorer outcome in PABC group, no significant differences were observed with stage-matched analysis. The present results may suggest that the poorer prognosis observed within PABC women could not be due to pregnancy itself, but with a delay in diagnosis and tumor subtype pathological features.

Impact of Surgery on the Evolution of Uterine Sarcomas.

STUDY OBJECTIVE: To identify the characteristics of uterine sarcomas and assess the impact of morcellation on prognosis. DESIGN: Case-control study. (Canadian Task Force classification II-2). SETTING: Hospital Quiron-Dexeus, an academic hospital. PATIENTS: Patients with uterine sarcoma histologically diagnosed and treated in our center between 1987 and 2013. INTERVENTION: All descriptive data, including type of surgery and clinical and pathological data, were reviewed. Survival analysis was performed comparing patients with hysterectomy/myomectomy without any type of morcellation and patients with morcellation during surgery. MEASUREMENTS AND MAIN RESULTS: A total of 37 sarcomas were diagnosed during the study period. The most common symptom was metrorrhagia (50%). The indication for surgery was related to myoma growth in 40% of cases and to metrorrhagia in 37.1% of cases. Open surgery was performed in 23 patients (62.2%), and laparoscopy was performed in 9 (24.3%). Myomectomy was performed in 14 patients (37.8%), and 23 patients (62.1%) underwent hysterectomy as initial surgery. Morcellation for tumor extraction was done in 8 cases (21.6%). Survival analysis by surgical approach showed increased disease-free survival (DFS) in the laparotomy group compared with the laparoscopy group (median, 70.3 months vs 10.4 months; p = .018). Median DFS according to type of surgery was 6.3 months in morcellation cases, 11.9 months in vaginal fragmentation cases, and 149.9 months in nonmorcellated cases (p < .002). The median time to progression was shorter in morcellated cases (laparocopic and vaginal) compared with nonmorcellated cases (11.9 vs 14.9 months; p < .001). No statistically significant differences in prognosis were related to myomectomy versus hysterectomy; however, there were significants difference between morcellation and nonmorcellation cases. CONCLUSION: Taking into account the negative impact of morcellation in sarcomas, the use of this technique should be reconsidered in cases of myoma with atypical clinical presentation or symptomatology. Patients must be informed about the possibility of a nonidentified sarcoma and the possible impact on prognosis resulting from its morcellation.

Hormone receptor and HER2 status: The only predictive factors of response to neoadjuvant chemotherapy in breast cancer.

We report our experience in neoadjuvant breast cancer chemotherapy in a single centre between 2000 and 2011. We looked for predictive factors for response to neoadjuvant chemotherapy in the present study. A total of 110 consecutive breast cancer patients were treated with neoadjuvant chemotherapy in our centre. Pathological response was achieved in 24 HR+/HER2- (38.7%), 25 HER2+ (67.6%) and five triple-negative (45.5%) (p = 0.02) patients. No statistically significant differences were found in pathological tumour response according to T stage. The multivariate analysis revealed tumour subtype was the only associated factor for pathological response, with HER2 + tumours the best responders, OR 3.9 (1.5-9.9): 5-year DFS was 40% HER2+/no response; 78% HER2+/response; 65% HR+/HER2-/no response; 82% HR+/HER2-/response; 25% triple-negative/no response and 100% triple-negative/response. HR and HER2 status were the only prognostic factors for pathological response. pCR was correlated with survival in all tumour subtypes.

Role of lymphadenectomy in endometrioid endometrial cancer.

OBJECTIVE: To assess the risk factors associated with node involvement. STUDY DESIGN: In the period 1990-2008 a total of 265 endometrial cancers were treated in the Institut Universitari Dexeus. We analysed the rate of myometrial invasion, tumour grade, histological type and node involvement. RESULTS: Overall, 86% of tumours were endometrioid, 5.3% papillary serous, 4.9% mixed and 2.6% endometrial stroma sarcoma. Among those with endometrioid histology, lymphadenectomy was not performed (NL) in 85 cases (37.2%), whereas pelvic lymphadenectomy (PL) or pelvic and aortic lymphadenectomy (PAL) was carried out in 84 (36.84%) and 59 patients (25.87%), respectively. In NL patients the overall disease-free survival (DFS) rate at five years was 92.8%. In the PL group, node involvement was observed in 2.4% of cases and the five-year DFS rate was 92.3%. Among PAL patients, 18.6% showed node involvement (72.7% positive pelvic nodes and 63.6% aortic). Aortic involvement was present in 5.9% of cases when there was no pelvic disease, whereas in the presence of positive pelvic nodes the rate of aortic involvement was 50%. The DFS rate at five years was 93.6%. Referring to the risk factors, when infiltration was > 50% of the myometrium, lymph node involvement occurred in 37% of cases and G3 tumors in 45.5%. CONCLUSIONS: Node involvement is more commonly observed in cases with > 50% myometrial invasion and G3, accounting for 25% of cases that can be considered as at-risk patients. When node involvement is present it is equally distributed between the pelvic and aortic levels. As node involvement is a predictive factor for distant metastasis, the 25% of patients considered to be at risk should undergo pelvic and aortic lymphadenectomy

Hiperplasia intraductal atípica o carcinoma intraductal grado 1 vs. DIN1c / No disponible

Objetivo: La clasificación DIN incluye en el DIN1c la hiperplasiaintraductal atípica (HIA) y el carcinoma intraductal grado1 (CID1). El objetivo de este estudio es ver si esta agrupacióndiagnóstica, con las consecuencias terapéuticas que elloconlleva, implica o no un sobretratamiento de la HIA.Pacientes y métodos: Se ha revisado el tratamiento y laevolución de los casos de HIA y CID1 diagnosticados en nuestrocentro desde 1999 hasta 2008. Se han utilizado los mismoscriterios diagnósticos que utiliza la clasificación DIN paradiferenciar la HIA y el CID1.Resultados: De 117 casos, 49 fueron HIA y 68 CID1. Eltratamiento quirúrgico fue tumorectomía, independientementedel estado del margen, en 47 (96%) HIA y en 53 (78%) CID1consiguiendo siempre un margen libre. En 42 (62%) casos deCID1 el tratamiento se complementó con radioterapia. Uncaso de HIA y otro de CID1 recidivaron tras 24 y 39 mesesen forma de carcinoma ductal infiltrante.Conclusiones: La clasificación DIN simplifica el diagnóstico,no obstante agrupar alguna de estas lesiones puede conllevarsu sobretratamiento. En nuestra serie la simple extirpaciónde una HIA independientemente del estado del margen hasido curativa en la mayoría de casos(AU)

Objective: DIN classification includes into DIN1c the atypicalintraductal hyperplasia (AIH) and intraductal carcinomagrade 1 (IDC1). The aim of this study is to see if this grouping,with its therapeuthical consequences, implies an overtreatmentof AIH.Patients and methods: Treatment and follow-up of allthose cases diagnosed of AIH and IDC1 between 1999 and2008 at our centre have been revised. The diagnostic criteriato differentiate AIH and IDC1 were the same used in DIN classification.Results: Of the 117 studied cases, 49 were diagnosed asAIH and 68 as IDC1. Lumpectomy, independently of the statusof the margin was performed in 47 (96%) AIH, and 53(78%) IDC1 with adequate resection margin. In 42 (62%) casesof IDC1 adjuvant radiotherapy was given. One case of AIHand one case of IDC1 recurred as invasive ductal carcinoma,24 and 39 months later respectively.Conclusions: DIN classification simplifies the diagnosis butgrouping these lesions can result into an overtreatment. In ourserie the surgical excision of AIH independently of the statusof the margin was curative in the majority of the cases(AU)

Sperm recuperation and cervical insemination in retrograde ejaculation.

Seven infertile patients with retrograde ejaculation, in which spermatozoa could be recuperated from the postejaculation urine, were admitted to a sperm recuperation and cervical insemination program. A noninvasive method for sperm recuperation based on urine alcalinization and serial controls to time masturbation has been used. Insemination has been timed according to BBT charts and cervical mucus characteristics. Pregnancy has been obtained in the seven couples after one to eight treatment cycles.

Meiotic studies in a series of 1100 infertile and sterile males.

Meiotic studies have been carried out in a series of 1100 infertile and sterile males. Of these, 599 cases have been studied in testicular biopsy, and 501, in semen samples. This is the largest meiotic series published so far. The incidence of meiotic anomalies was 4.3%. The most frequent chromosome abnormality was desynapsis (3.7%). However, the number of cases with a meiotic arrest, usually due (73.9%) to synaptic anomalies in prophase I, was much higher (18.4%). An attempt is made to correlate the incidence of meiotic anomalies with the results of semen analysis. We discuss the prognosis of desynapsis, based on 41 cases studied, and reevaluate the results obtained in semen samples as compared with our previous results.