Incidental tubal endometrioid adenocarcinoma - case report.

The fallopian tubes represent a highly important structure for ovarian carcinogenesis. They provide the passage of eutopic endometrium from the uterus, as well as metastatic cells from the ovaries. A direct source of tumor cells for ovarian cancer was also recently confirmed in the fallopian tubes. The authors present a case report of an incidental tubal endometrioid carcinoma with the coexistence of adenomyosis.

[Laparoscopic treatment of borderline ovarian tumorsin fertile women]. / Laparoskopické resení borderline tumoru ovaria u zen ve fertilním veku.

OBJECTIVE: Evaluation of the benefits of laparoscopy and the fertility preserving approach in the borderline ovarian tumors. These tumors often occur in young women of childbearing age. The patient and the surgeon face a serious problem, especially for women who wish to maintain the possibility of pregnancy. Laparoscopy in these situations appear to be one of the preferred treatment methods. DESIGN: Retrospective study. SETTING: Third Faculty of Medicine, Charles University Prague, Gynecology and Obstetrics Department; P. J. Safarik University, L. Pasteur University Hospital, Kosice, Gynecology and Obstetrics Department; Hospital Ceské Budejovice. METHODS: Analysis of the data in 23 women who desired fertility and were operated laparoscopically for borderline ovarian tumors. We evaluated the extend of laparoscopic surgery, peri- and postoperative complications and final results of histopathological findings. RESULTS: Mean age of the patients was 30,4 years. All patients were completely staged during second laparoscopic operation. In 14 of 23 (60.9%) cases serous borderline tumor was identified, in 8 of 23 (34.8%) cases mucinous borderline tumor was identified and in one case Brenner tumor was diagnosed. Peritoneal implants were present in 5/14 (35.7%) of serous tumors and in 3/8 (25%) of mucinous tumors. Involvement of contralateral ovary is also calculated. CONCLUSION: Borderline ovarian tumors occur in women who wish to maintain the possibility of pregnancy. For these patients, we choose based on their desire, conservative surgery. This treatment can be done by laparoscopy. Intraoperative ruptures of the tumor are more likely during lapaparoscopic procedures compared with laparotomy. In contrast, laparoscopy provides, besides well-known advantages, better optical evaluation of the abdominal cavity, including the detection of superficial peritoneal implants. For the objective evaluation of the laparoscopic approach in patients with fertility desire, further prospective comparative study are needed.

Malignant changes in adenomyosis in patients with endometrioid adenocarcinoma.

OBJECTIVE: The aim of our retrospective study was to evaluate pathological changes in adenomyotic foci in hysterectomy specimens, and point out a possible mechanism of carcinogenesis in adenomyotic foci inside the myometrium. METHODS: Retrospective analysis of clinical data; 219 patients were operated at our departments from 2003-2008 with the diagnosis of early endometrial cancer. Standard staging operation was used in all cases and all hysterectomy specimens were afterwards routinely analyzed. RESULTS: Adenomyosis was found in 88 of a total of 219 hysterectomy specimens, while 205 of these 219 were affected by endometrioid adenocarcinoma, ten with clear cell carcinoma and four with papillary serous carcinoma. Within these subgroups adenomyosis was documented in 87 of 205 specimens with endometrioid adenocarcinoma (42.4%) and in one specimen of ten with clear cell carcinoma (2.2%), all found in the eutopic endometrium. All cases of malignant changes (n = 6) in adenomyosis were found exclusively with coexisting endometrioid adenocarcinoma: adenocarcinoma in adenomyosis was well or moderately differentiated in five cases, and poorly differentiated in just one case. Differentiation of the tumor in adenomyosis correlated with differentiation of the eutopic endometrial cancer in 50%. Hyperplastic changes like benign glandular hyperplasia, or atypical complex hyperplasia (ACH) were identified simultaneously in all cancer-positive adenomyotic foci. CONCLUSION: Malignant changes in adenomyosis were present in 6.8% of patients with endometrial cancer. All malignancy-positive cases of adenomyosis were associated with endometrioid adenocarcinoma of the eutopic endometrium. Interestingly, in all these cases, different stages of hyperplastic changes were also simultaneously identified. This observation suggests a similar pathway of carcinogenesis in adenomyosis as is known in estrogen-responsive endometrial cancer type I.

[Appendix protrusion from perforation of uterus--the rare complication during abortion]. / Protrúzia apendixu cez perforacný otvor v cervixe maternice ako zriedkavá komplikácia pri umelom prerusení gravidity.

AIM: Point to an extremly rare complication of a curettage during abortion and follow up surgical treatment of this complicated state. CASE: In the case of 32 years old woman, multipara, was perforated cervix uteri during the abortion curettage and fat tissue of mesentery was aspirated into canulla. Apendix vermiformis was aspirated into cannula with its protrusion through the neck of the womb during repeated revision. Surgeon made appendectomy lege artis after abdomen revision and looking after haemoperitoneum. Because of serious devastation of right fallopian tube, salpingektomy was performed. Perforation of cervix in the lenght of three cm was sutured. Extensive incomplete rupture continuing from perforation gap was sutured from ligamentum sacrouterinum I.dx to fundus uteri. Intact foetus of 5,5 week of gestation was leaved in toto because of the high risk of the womb wall disruption during repeatedly attempted abortion. CONCLUSION: In case of the suspection of the uterus injury a revision and interdisciplinary approach to the solution of complications is necessary.

In vitro antiproliferative and antiangiogenic effects of Flavin7.

Flavin7 (F7) is a nutritional supplement often taken by cancer patients in Central Europe during chemo- and radiation therapy. In this study, investigation of the antiproliferative and antiangiogenic activities of this supplement were performed. Flavin7 showed antiproliferative activity in Jurkat as well as in HeLa cells. It significantly reduced the growth of both cancer cell lines at the doses of 200 microg/ml to 20 microg/ml (p<0.001 and p<0.01, respectively). In F7-treated Jurkat cells we found a significant increase in the fraction of cells with sub-G(0)/G(1) DNA content, which is considered to be a marker of apoptotic cell death. Apoptosis was also confirmed by annexin V staining and DNA fragmentation. Furthermore, F7 at the doses of 100 microg/ml to 4 microg/ml inhibited endothelial cell migration and capillary tube formation what indicates its potential antiangiogenic properties. Flavin7 also inhibited the activity of matrix metalloproteinases (MMPs), preferentially MMP-9, at the doses of 100 microg/ml to 4 microg/ml. Our data suggest that F7 possesses marked antiproliferative and antiangiogenic properties in vitro. Further research is needed to elucidate also its in vivo activities.

[Prediction of intrauterine growth retardation using the integrated test markers]. / Predikcia intrauterinnej rastovej retardácie plodu pomocou markerov integrovaného testu.

OBJECTIVE: Author's objective was to ascertain the option for prediction of intrauterine growth retardation using the integrated test markers on the population of pregnant women in Kosice city. DESIGN: Retrospective, longitudinal, multicenter study. SETTING: 2nd Department of Obstetrics and Gynecology University of P. J. Safárik, Kosice, Slovak Republic. METHODS: The study group comprised 578 pregnant patients of 2nd Department of Obstetrics and Gynecology, in the period from 01.11.2001 until 31.01.2005 for integrated test consisting of (examination of the gestation age using CRL, concentration of PAPP-A, NT, AFP, uE3, hCG). Information on birth weight, gender, gestation age at the time of delivery, occurrence of preeclampsia and other pregnancy complications were found in 578 patients retrospectivelly. We have designed two outcome criteria: 1. intrauterine growth retardation <5th fetal weight percentile - IUGR 5 - and intrauterine growth retardation <10th percentile - IUGR 10. In order to make use of the summary information provided by the markers, we have used the method of logistic regression to identify statistically significant predictors of individual binary outcomes (IUGR 5 and IUGR 10). First we developed an equation based on all available predictors. Statistically insignificant predictors were gradually eliminated from the model (Stepwise regression) until the final model remained, for which a ROC curve was developed and values of sensitivity, specificity, positive and negative predictive values at 5% FP (false positivity) were calculated. RESULTS: The final model of IUGR 5, containing only statistically significant markers of integrated test achieved - at 5% FP level and 95% specificity level - a 34.8% sensitivity, 24.1% positive and 97.0% negative predictive value - in prediction of birth weight under 5th percentile with respect to gestation age and gender. The final model of IUGR 10, containing only statistically significant markers achieved - at 5% FP level and 95% specificity level - a 36.4% sensitivity, 32.1% positive and 95.8% negative predictive value - in prediction of birth weight under 10th percentile with respect to gestation age and gender. CONCLUSION: Our results, as well as the results of other studies, lead to the conclusion, that in spite of the multitude of biochemical markers and various options for their combination with ultrasound markers, so far it has been impossible to find a combination which would meet the following criteria: 1. high sensitivity and specificity at low false positive values and high positive and negative predictive value, 2. application as a screening method for prediction of intrauterine growth retardation and preeclampsia in unselected population of pregnant women.

[Prediction of preeclampsia using the integrated test markers]. / Predikcia preeklampsie pomocou markerov integrovaného testu.

OBJECTIVE: Author's objective was to ascertain the option for prediction of preeclampsia using the integrated test markers on the population of pregnant women in Kosice city. DESIGN: Retrospective, longitudinal, multicenter study. SETTING: 2nd Department of Obstetrics and Gynecology University of P. J. Safárik, Kosice, Slovak Republic. METHODS: The study group comprised 578 pregnant patients of 2nd Department of Obstetrics and Gynecology, the period from 01.11.2001 until 31.01.2005 for integrated test consisting of (CRL, NT, concentration of PAPP-A, uE3, hCG, AFP). Primary outcome was defined as incidence of preeclampsia during pregnancy. Data on incidence of preeclampsia was collected from birth journals and records in 578 patients retrospectivelly. In order to make use of the summary information provided by the markers we have used the method of logistic regression to identify statistically significant predictors of the binary outcome measure of preeclampsia. First we developed an equation based on all available predictors. Statistically insignificant predictors were gradually eliminated from the model (Stepwise regression) until the final model remained, for which a ROC curve was developed and values of sensitivity, specificity, positive and negative predictive values at 5% FP (false positivity) were calculated. RESULTS: The final model of preeclampsia, which is based only on statistically significant markers of integrated test achieved--at 5% FP and 95% specificity--36.4% sensitivity and 22.7% positive and 97,4 negative predictive value for prediction of preeclampsia in pregnant women. CONCLUSION: Our results, as well as the results of other studies, lead to the conclusion, that in spite of the multitude of biochemical markers and various options for their combination with ultrasound markers for prediction of preeclampsia, so far it has been impossible to find a combination which would meet the following criteria: (1) high sensitivity and specificity at low false positive values and high positive and negative predictive value, (2) application as a screening method for prediction of preeclampsia in unselected population of pregnant women.

[Fallopian tube torsion in appendicitis--case report]. / Torzia vajíckovodu pri apendicitíde--kazuistika.

The authors report a rare clinical case of coincidence appendicitis and Fallopian tube torsion. A 14-years-old girl is presented with acute pelvic pain, dysuria and diarrhoea. Acute appendicitis and right side Fallopian tube torsion were detected by laparotomy. Symptoms, differential diagnoses, etiology and diagnostic procedures are discussed.