Coincidence of giant uterine myomatosis and detection of two advanced malignancies in 77-year-old female patient.

OBJECTIVE: Our aim is to emphasize the importance of patient participation in screening programs available in the Czech Republic and in preventive gynaecological examinations. As an example, we present a case report of a 77-year-old female patient with the accumulation of serious gynaecological diseases (extreme uterine myomatosis, breast cancer) and non-Hodgkin´s B-lymphoma. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Faculty Hospital in Pilsen, Charles University Medical Faculty in Pilsen. CASE REPORT: Our case report of a 77-year-old patient is a rare case of the simultaneous detection of giant uterine myomatosis causing voluminous ventral hernia, invasive ductal breast cancer, and non-Hodgkin´s B-lymphoma. The patient was not gynecologically examined for last 20 years and did not undergo any screening examinations. In the postoperative period, the patient was diagnosed with invasive ductal breast cancer and follicular lymphoma. All the diseases were diagnosed in advanced stage. CONCLUSION: The occurrence of bulky fibroids is very rare in postmenopause. Long-term neglect of clinical symptoms and adverse health signals allows their gradual progression. Especially in older patients, other serious illnesses may complicate the situation.

[One-Step Nucleic Acid Amplification method - what is the future of sentinel lymph node management?] / Metoda One-Step Nucleic Acid Amplification - jaká je budoucnost zpracování sentinelových uzlin?

OBJECTIVE: The article summarizes current possibilities of usage of the One-Step Nucleic Acid Amplification method (OSNA) in the perioperative management of sentinel lymph nodes in oncologic surgery. The principle of this method is the detection of cytokeratin 19 (CK19) in the lymphatic tissue as a marker of the metastatic spread. DESIGN: Review article. SETTINGS: Department of Obstetrics and Gynaecology, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Prague; Department of Biology, Faculty of Medicine in Pilsen, Charles University, Prague; Department of Immunochemistry, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Prague; Sikl´s Department of Pathology, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Prague. METHODS: The review of the literature published until the end of April 2017 available on the PubMed database was performed. The official abbreviation OSNA and the full name of the method One-Step Nucleic Acid Amplification was used for search in this database. CONCLUSION: The usage of the OSNA method with the detection of CK 19 in the sentinel lymph nodes as a marker of metastatic spread to the lymphatic tissue currently represents an acceptable form of perioperative sentinel lymph node management in patients with breast and colorectal cancer. Until now published data are pointing towards possible successful application of this method in sentinel lymph node management in patients with some other malignancies, such as thyroid carcinoma, gastric cancer, uterus cancer and head and neck cancer. More data is needed to establish this method also in those neoplasms.

Significance of bizarre cells in cervical screening liquid-based cytology: A prospective study of 15 cases.

OBJECTIVE: The aim of this study was to assess the significance of bizarre cells (cells of squamous origin with a superficial squamous cell-type cytoplasm and characterised by multinucleation that produces bizarre nuclear shapes) in liquid-based cytology (LBC) Papanicoaou (pap) smears with clinical and histological follow-up correlation. METHODS: Fifteen patients, all with LBC samples containing bizarre cells, were identified in routine ThinPrep® LBC workload. HPV testing was performed in each case using residual LBC material. Cytological-histological correlations were reviewed. RESULTS: All 15 LBC samples contained bizarre cells and tested positive for high-risk HPV types. Ten of the 15 cases were identified as atypical squamous cells - cannot exclude an HSIL (ASC-H) with secondary diagnosis of low-grade squamous intraepithelial lesion (LSIL), while five cases were identified as high-grade squamous intraepithelial lesion (HSIL), and a subsequent biopsy was recommended. Additionally, 13/15 cases underwent cone biopsy or hysterectomy within 1-11 months, of which 10 showed histologically confirmed HSIL end-points. LSIL was present in three cases. Bizarre cells were identified in the HSIL epithelium of five cone biopsies. CONCLUSIONS: Identification of bizarre cells in LBC is straightforward and may facilitate diagnosis. The cytology of bizarre cells is associated with HSIL in cone biopsies. We recommend assigning LBC samples containing bizarre cells as ASC-H with secondary diagnosis of LSIL.

[Carcinosarcoma of the endometrium with melanocytic differentiation, case report]. / Karcinosarkom endometria s melanomovou diferenciací, kazuistika.

OBJECTIVE: The case report presents a case of 60-year old woman with a rare malignant mixed Müllerian tumor with melanomatous differentiation diagnosed from a histology after cervical polyp ablation and curettage. DESIGN: Case report. SETTING: Department of gynecology and obstetrics, University Hospital in Pilsen. CONCLUSION: Carcinosarcoma, previously malignant mixed Müllerian tumor, is a very rare aggressive endometrial carcinoma with low incidence, which typically occurs among older women and commonly affects the uterine body and cervix. Clinically, the carcinosarcoma is impossible to be distinguished from endometrial carcinoma or uterine sarcoma and the definitive diagnosis can only be made based on histological examination.

Incidence of uterine sarcomas in West Bohemia, at the Department of Gynaecology and Obstetrics, University Hospital in Pilsen, Czech Republic.

OBJECTIVE AND SETTING: A retrospective review of women of the West Bohemian population was performed at the Department of Gynaecology and Obstetrics, University Hospital in Pilsen, Czech Republic from 1/2005 - 1/2017. METHODS: The following data was analysed: patients age, histological type, tumour size, FIGO stage, body mass index, previous irradiation, Tamoxifen usage, and other possible risk factors. A total number of 20 uterine sarcoma patients were detected in the period from 1/2005 to 1/2015, and these cases were followed until 1/2017. RESULTS: The histological types identified were: leiomyosarcoma in 12 cases, endometrial stromal sarcoma in 7 cases and one case of high-grade undifferentiated uterine sarcoma. This only patient diagnosed with high-grade undifferentiated uterine sarcoma showed distant metastases 12 months after the surgical treat-ment and died one month later. The whole group of uterine sarcoma patients regardless histological subtype reached two years in 50% of cases, with the median disease-free interval 18 months and the median follow up of 38 months. The diagnosis of sarcoma was already known in 25% of cases from dilatation and curettage histology. There were suspicious sonographic findings suggestive of sarcoma in 10% of cases. Multiparity was associated with 48.2% of endometrial stromal sarcoma cases. The leading clinical symptom was postmenopausal bleeding in 55% of patients. CONCLUSION: We confirmed uterine sarcomas to be rare malignancies, even in the Czech population with high uterine malignancy incidence. Uterine cold knife morcellation during the vaginal part of laparoscopically assisted vaginal hysterectomy didnt worsen the prognosis of our patients.

[Agressive small cell carcinoma of the ovary, hypercalcemic type, surgery and oncological treatment: case report]. / Agresivní malobunecný karcinom ovaria hyperkalcemického typu, chirurgická a onkologická lécba: kazuistika.

Small cell carcinoma of the ovary (SCCOHT) is a rare tumor typically affecting young women. It is a highly malignant tumor accompanied with poor prognosis, early relapse and low survival rates. The most significant prognostic factor is stage of the disease. Due to above mentioned factors there are no guidelines for therapy of this rare tumor. We present a case of 22-years-old patient initially treated with antibiotics under diagnosis of pelvic inflammatory disease. Due to persistent mass at left adnexa, she was indicated for diagnostic laparoscopy, converted to laparotomy and left adnexectomy with frozen section revealing unspecified malignant tumor of left ovary. A conservative operation was performed and, after diagnosis of SCCOHT was established, the patient was indicated for adjuvant chemotherapy.

[Detection of cancer stem cells in ovarian cancer]. / Detekce nádorových kmenových bunek karcinomu ovaria.

OBJECTIVE: Detection of cancer stem cells (CSCs) in ovarian cancer, influence of CSCs on overall survival, disease free interval. Results in comparison with literature. DESIGN: Original study. SETTINGS: Department of Gynaecology and Obstetrics, Faculty Hospital Pilsen and Medical Faculty in Pilsen, Charles University, Sikls Institute of Pathology, Faculty Hospital Pilsen and Medical Faculty in Pilsen, Charles University. METHODS: 23 specimens of papillary-serous ovarian carcinoma and 4 specimens of endometroid ovarian carcinoma were included in the study. Specific antibodies to CD44 and CD133 antigens were used. Immunoreaction of both CD44 and CD133 was evaluated for the high power field. RESULTS: There was no significant correlation between CD44 expression and disease free interval and overall survival. CD133 expression was not evaluated due to an inadequate immunoreaction antibody - antigene. CONCLUSION: We did not find any statistically correlation between CD44 expression and overall survival and disease free interval in our series of patients with ovarian carcinoma. It seems to be better to use different antibody for CD133 detection.

[Non-neoplastic epithelial disorders of the vulva - lichen sclerosus]. / Nenádorové epiteliální zmeny vulvy - lichen sclerosus.

Lichen sclerosus (LS) belongs to frequent non-neoplastic epithelial disorders of the vulva. LS is a disease of unknown ethiology, affecting mainly postmenopausal women. LS has a typical macroscopic pattern, and it is characterized with an intensive pruritus and dyspareunia. Patients with LS have a risk of scarring of external genitalia and risk of developing squamous cell carcinoma of the vulva (4-5%). Treatment of LS is usually long-term, repeated, and it is based on local potent corticosteroids. Frequent reccurences require repeated therapy. A close follow-up in a 6-months intervals and biopsy of all atypical lesions is required. Surgical treatment is rarely indicated in the management of LS. Follow-up at the specialized center is recommended.

[Evaluation of p16 protein in the managementof cervical dysplasia]. / Význam stanovení proteinu p16 v managementu prekanceróz delozního hrdla.

OBJECTIVE: Protein p16 as an important cell-cycle inhibitor is a promising diagnostic and prognostic factor of cervical dysplasia. In our study we evaluate the impact of p16 protein evaluation on management of cervical dysplasia. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynecology, Medical Faculty Pilsen, Charles University Prague. METHODS: A retrospective study was performed on 122 consecutive patients with colposcopically-directed cervical biopsy (CDB) with following excisional procedure (LEEP or cold-knife conisation). P16 expression in the specimen from CDB was independently evaluated using immunohistochemistry in all patients. Relation among CDB histology, p16 expression, and final histology from excisional procedure was analysed. RESULTS: In our series, we identified 44 CIN 1 and 61 CIN 2/3 in CDB specimens. In the CIN 1 group, 15 cases (34.1%) were p16 negative and 29 (65.9%) cases were p16 positive. In CIN 1 p16 negative group, only 2 of 15 patients (13.3%) had CIN 2/3 in the final histology comparing to 19 of 29 patients (65.5%) in CIN 1 p16 positive group (statistically signifiant,p < 0,05; Wilcoxon test). In CIN 2/3 group, 60 (98.4%) specimen were p16 positive and 57 patients (93.4%) had also CIN 2/3 in the final histology. CONCLUSION: In our study of 122 patients with CDB we found that in group of CIN 1 patients, p16 evaluation had significant predictive value for final histology. In the group of patients with CIN 2/3, 98% specimens were p16 positive and therefore p16 evaluation had no prognostic impact on final histology. Prospective study is needed to confirm this data.

Blood acid-base and plasma electrolyte values in healthy ostriches: the effect of age and sex.

The effect of age and sex on blood acid-base and plasma electrolyte values was determined in venous blood samples from 45 clinically healthy ostriches (Struthio camelus) from 26 days to 6 years of age. Animals were divided by age into four groups and the group of adults was divided by sex into two subgroups. Blood samples were collected without sedation. There was a significant (P<0.05) age difference in blood values of base excess (BE), plasma HCO(3)(-), total CO(2) (TCO(2)), Na(+), K(+), Cl(-) and anion gap (AG). The highest plasma concentrations of Na(+), Cl(-) and value of AG were found in adult ostriches with a steady decrease to chicks. A significant (P<0.05) sex difference in adult animals with higher blood pH, lower blood values of pCO(2), BE, plasma concentrations of HCO(3)(-), TCO(2) and K(+) was found in females. We concluded that blood acid-base values and plasma electrolyte concentrations in ostriches are affected by age and sex.

[Neurological complications during gynecological pelvic surgery]. / Neurologické komplikace gynekologických pánevních operací.

OBJECTIVE: To summarize literary data dealing with neurological complications during gynecological pelvic surgery and present a case report. DESIGN: Literary review and a case report. SETTING: Department of Obstetrics and Gynecology, Medical Faculty Hospital Plzen. METHODS: Literary review of lesions of cerebrospinal nerves during gynecological pelvic surgery, case report. CONCLUSION: Neurological complications of pelvic surgery are usually discreet and their diagnosis is often delayed. A close cooperation with neurologists and anestesiologists is necessary.

CD44v6 as a prognostic factor in cervical carcinoma FIGO stage IB.

The aim of our study was to clarify whether CD44v6 evaluation can serve as a universally applicable prognostic factor in patients with FIGO stage IB cervical carcinoma. A retrospective study was performed on 178 FIGO stage IB (142 IB N0, 36 IB N1) radically operated cervical carcinoma patients. The expression of CD44v6 was investigated by immunohistochemistry (IHC). The prognostic significance of established prognostic factors and CD44v6 expression was analyzed by univariate and multivariate analyses. To test the reproducibility and to account for interobserver variability, all specimens were evaluated independently at two institutions. Two different IHC scoring systems, several cut-off levels for CD44v6 positivity and several statistical methods for IHC results evaluation were used. In a univariate analysis, the most significant prognostic factor for overall survival (OS) was lymph node status (p<0.001) followed by tumor volume, LVSI, GOG score (p<0.01) and a deep stromal invasion (p = 0.06). We found a strong correlation between CD44v6 expression and squamous cell carcinoma (SCC) (SCC vs. adenocarcinoma - p<0.001) and between CD44v6 expression and deep stromal invasion, LVSI and GOG score (p<0.05). The CD44v6 expression was not a statistically significant prognostic factor for OS in a univariate analysis (p=0.39 Vienna; p=0.54 Freiburg). In a multivariate analysis, the most significant prognostic factor for OS was lymph node status (p =0.002), followed by tumor diameter and LVSI (p<0.05). CD44v6 expression was not a statistically significant prognostic factor for OS or disease-free interval (DFI) independent of the scoring method used. In conclusion, we demonstrated that CD44v6 expression is associated with LVSI, deep stromal invasion and SCC, but has no prognostic influence on OS and DFI in a population of 178 women with FIGO stage IB cervical carcinoma.

[Prognostic factors of the cervical carcinoma]. / Prognostické faktory karcinomu delozního hrdla.

OBJECTIVE: Review of prognostic factors of the cervical carcinoma, new perspective methods. SETTING: Department of Obstetrics and Gynecology, Medical Faculty Hospital, Plzen. DESIGN: Review article. RESULTS: The most important prognostic factors of the early cervical carcinoma are the stage and regional lymph node status followed by the depth of stromal invasion, tumor volume, and lymphovascular invasion. Other factors are still only subjects of research. CONCLUSION: A detailed knowledge of particular prognostic factors of the cervical carcinoma is necessary for optimal treatment and flow-up strategy.

[Clinical relevance of tumor markers in epithelial ovarian cancer]. / Klinické vyuzití nádorových markeru u epitelových nádoru ovarií.

AIM OF STUDY: The authors present the view of possible usage of tumour markers in epithelial ovarian cancer, and they aim at their use in routine clinic practice. TYPE OF STUDY: Review article. SETTING: Oncology and Radio-Therapeutic Department, Faculty Hospital, Pilsen. SUBJECT AND METHODS OF THE STUDY: Summary of data published in Czech and foreign professional literature. CONCLUSION: In case of epithelium tumours of ovaries, CA 125 is the tumour marker of the first choice. For the reason of low sensitivity, it is not possible to use the tumor markers for screening and primary diagnostics. Regarding prognoses, high pre-operational levels of CA 125 are considered unfavourable. At the same time the study demonstrates that CA 125 levels monitoring in the course of chemotherapy appears to be one of the most significant indicators of chemotherapy effects and, therefore, also of prognoses. Regular CA 125 monitoring in the course of follow up can contribute to early detection of tumour disease relapses. The optimal time interval for monitoring seems to be three months for the period of the first two years, and then six-month interval. Other tumour markers used in routine clinic practice are mainly CA 19-9 and CA 72-4, particularly in case of mucinoid epithelium tumours. However, these markers are of subsidiary importance only.

[Role of p27Kip1 protein in the cell cycle and its appearance in lymphoid tissues, particularly non-Hodgkin's B-cell lymphomas. Review]. / Role proteinu p27Kip1 v bunecném cyklu a jeho výskyt v lymfoidních tkáních, zvláste v nehodgkinských B-lymfomech. Prehled problematiky.

Cell cycle progression is governed by cyclin dependent kinases (CDK) that are activated by cyclin binding and inhibited by CDK inhibitors. Protein p27Kip1 functions as a CDK inhibitor, which controls the progression from G1 to S phase. Further, p27Kip1 may have a positive regulative influence. In nonneoplastic tissues and in the majority of tumors investigated so far, the immunohistochemical positivity of p27Kip1 showed an inversely proportional relationship to the proliferation index. Among B-cell non-Hodgkin lymphomas, the exceptions to this rule are represented by mantle cell lymphoma, hairy cell leukemia, and the immunoblastic Epstein-Barr virus latent membrane antigen positive diffuse large B-cell lymphoma in AIDS patients. The loss of p27Kip1 expression is a negative prognostic factor in numerous tumors, including the majority of B-cell lymphomas.

[Endometrial ablation and resection techniques]. / Techniky ablace a resekce endometria.

OBJECTIVE: To summarize all currently used and experimental, hysteroscopic and non-hysteroscopic methods of endometrial ablation and resection, their indications, operation techniques, and treatment results. DESIGN: Literary review. SETTING: Department of Obstetrics and Gynecology, Medical Faculty and Faculty Hospital, Charles university, Capkovo námestí 1, Plzen, Czech Republic. METHODS: Analysis of the literature (textbooks, medical journals, database Medline, Current Contents, Embase, PubMed). RESULTS AND CONCLUSION: Endometrial ablation and resection play an important role in the treatment of dysfunctional uterine bleeding. Hysteroscopic methods visualize the uterine cavity and enable to treat lesions in it at the same time. Non-hysteroscopic methods are less invasive for the patient and comfortable for the surgeon. Both groups of methods have similar treatment results.

Blood acid-base and serum electrolyte values in red deer (Cervus elaphus).

Acid-base, serum electrolyte, plasma protein, and packed cell volume (PCV) values were determined in venous blood samples from 30 red deer (Cervus elaphus) of both sexes showing no clinical signs of disease. The animals were 5 months of age and kept on pasture in the Valley of Mexico, at an altitude of 2450 m. Blood samples were collected without sedation. Mean blood values were: pH 7.411 +/- 0.041, pCO2 37.7 +/- 4.4 mmHg, base excess 0.7 +/- 3.2 mmol/L, actual bicarbonate 24.3 +/- 3.1 mmol/L, total CO2 25.3 +/- 3.2 mmol/L and anion gap 23.5 +/- 5.5 mmol/L. Mean serum electrolyte levels were: Na+ 142.3 +/- 2.5 mmol/L, Cl- 100.5 +/- 2.3 mmol/L, and K+ 7.03 +/- 1.03 mmol/L. Plasma protein and PCV values were 60.0 +/- 6.6 g/L and 0.47 +/- 0.05 L/L, respectively. Blood values determined in this study can be considered reference data for health control and disease diagnosis.

[Hysteroscopic polypectomy versus fractionated curettage in the treatment of corporal polyps--recurrence of corporal polyps]. / Hysteroskopická polypektomie versus frakcionovaná kyretáz v lécbe korporálního polypu--recidivy korporálních polypu.

OBJECTIVE: The evaluation of hysteroscopy contribution in the treatment of endometrial polyp. The evaluation of the risk of endometrial polyp recurrence. DESIGN: Prospective clinical study. SETTING: Department of Obstetrics and Gynecology of Medical faculty and Faculty Hospital, Pilsen. METHODS: Two groups of patients were followed. Group I had 81 patients (30 premenopausal and 51 postmenopausal) that underwent hysteroscopical polypectomy followed by diagnostic hysteroscopy in 6-12 months. Group II consisted of 100 patients (36 premenopausal and 64 postmenopausal) that underwent fractional curretage with histological diagnosis of endometrial polyp. These patients were checked by diagnostic hysteroscopy in up to 12 months. Presence of endometrial polyp during diagnostic hysteroscopy and a relation of its recurrence or persistence to a type of preceding procedure, risk factors and histological findings during the first procedure were evaluated. RESULTS: 11 (13.5%) cases of an endometrial polyp were recorded in hysteroscopical controls in group I. 46 (46%) cases of an endometrial polyp were recorded in group II. Recurrence of the endometrial polyp was revealed only in one case of atrophic endometrium and in no case of atrophic endometrial polyp. CONCLUSION: Hysteroscopical polypectomy showed considerably better results in the treatment of endometrial polyp comparing to fractional curretage. The recurrence risk of endometrial polyp is expected in a case of presence of an abnormal proliferative activity or hyperplasia both in the endometrial polyp and the surrounding endometrium.