Proliferative activity in primary ovarian carcinoid tumors.

The proliferative potential of six primary ovarian carcinoids with different clinical outcome and histogenetic origin was examined immunohistochemically. The results showed that two cases with extremely high level of proliferative activity were associated with metastatic spread. In the remaining tumors, the examined factor was found to be at low level comparable with excellent prognosis of typical carcinoids in other locations. The preliminary results showed a possibility of a prognosis prediction according to typing of the ovarian carcinoids into two categories, i.e., tumors of low and intermediate malignancy. Topoisomerase II-alpha and Ki-67 are suitable markers giving valuable information about this phenomenon.

Endometrial polyps. A clinical study of 245 cases.

OBJECTIVES: Endometrial polyps (EPs) are among the common cases of abnormal uterine bleeding. Hormonal factors may be involved in the pathogenesis as indicated by endometrial abnormalities in patients treated with tamoxifen. This study was designed to analyse the patient characteristics which may be associated with polyp occurrence and assess the diagnostic and therapeutic difficulties. Group of 245 patients was formed to 152 postmenopausal and 93 premenopausal women with EP diagnosed hysteroscopically and confirmed histologically. Evaluated factors were as follows: 1) patient characteristics: age, body mass, systemic hypertension, diabetes mellitus, nulliparity, late menopause, estrogen replacement therapy, and tamoxifen treatment; 2) clinical features of EPs, and 3) the number of curettage's (D & C) and hysteroscopies. RESULTS: Hypertension associated with obesity appears to be an important factor in combination which may play role in the pathogenesis of EPs like the late menopause which was noted in 30% of examined postmenopausal women. An association between EPs and tamoxifen was found in 8% patients with breast cancer. 2. Postmenopausal uterine bleeding and menstrual disorders were prominent clinical symptoms in 44% post- and in 82% of premenopausal women. The other 56% post- and 18% premenopausal patients were asymptomatic. 3. The multiple EPs were present in 26% of postmenopausal and in 15% premenopausal women. 4. Transvaginal ultrasonography supplemented by sonohysterography in cases with abnormal ultrasonographic findings should be the main diagnostic method. 5 Hysteroscopical polypectomy is regarded as the optimal therapy and the removal of the endometrial basalis in the EP origin area prevents persistence or recurrence of EP.

[Changes in the endometrium in treatment of breast carcinoma with tamoxifen]. / Zmeny endometria pri lécbe karcinomu prsu tamoxifenem.

A group of twenty postmenopausal breast cancer patients treated with tamoxifen was used for examination of the endometrial morphology, role of transvaginal sonography, and consequences of insufficient collaboration between gynaecologist and oncologist. One case of endometrial carcinoma, one case of abnormal hyperplasia, and ten endometrial polyps in asymptomatic patients support the need for routine transvaginal sonography as a screening method. Any uterine bleeding should be evaluated by hysteroscopy.

[Precanceroses and endometrial carcinoma]. / Prekancerózy a karcinom endometria.

Precanceroses and early screening of endometrial carcinomas are reviewed. Measures are evaluated on how to prevent this malignancy with administration of gestagens in hyperplastical endometrial changes in climacteric conditions and manifestations of endometrial estrogenization in postmenopause. On the basis of clinical, laboratory and histological investigations, the total of 31 female subjects with dysfunctional bleeding was given medroxyprogesterone acetate (Provera Upjohn tbl.) in 10 mg daily doses for up to 10-13 days cyclically prior to the onset of menopause. Under the mentioned treatment any of them experienced the rebleed, and no endometrial carcinoma had been diagnosed with control vacuum curettage within one year of observation. In a total of 196 women operated on to endometrial carcinoma, the occurrence of risk-factors for the development of mentioned tumour (obesity, late menopause, i.e. menopause after 50 years of age, sterility and dysfunctional bleeding backed with anovulation, long-term estrogen administration, feminizing ovarian tumours, liver diseases, glycide metabolic disorders and hypertension) was evaluated. The present work was aimed on the screening of asymptomatic group of women. Two important signs (obesity and late menopause) were invariably determined with the addition of any other risk factor. Mentioned women are supposed to undergo regular yearly histological investigation of endometrium. Of most benefit the vacuum curettage is believed by authors as a result of comparing the validation of cytological and histological methods in order of early evidence.

[The effect of hormone therapy on the lipid spectrum in postmenopausal women]. / Vliv hormonální terapie na lipidové spektrum u postmenopauzálních zen.

In a group of 92 postmenopausal women with climacteric and postcastration syndrome the relationship between different types of hormonal therapy and changes of indicators of the lipid metabolism was investigated. Before onset of treatment and after three weeks of treatment the authors assessed total cholesterol, beta-lipoproteins, triglycerides, HDL, LDL and plasma concentrations of oestrone and 17-beta-oestradiol. A significant rise of both oestrogens was recorded in a group treated with Presomen tablets and Folovirin inj. In the lipoprotein fractions only beta-lipoproteins rose significantly during administration of Mestranol tabl. and Provera tabl. The investigation is the beginning of a prospective study concerned with the possibility to influence one of the risk factors participating in the development of arteriosclerosis.

[Morphologic basis of hemorrhage during hormonal therapy in the climacteric syndrome]. / Morfologický podklad krvácení pri hormonální terapii klimakterického syndromu.

In a group of 133 postmenopausal women in the course of nine years the relationship between two types of hormonal treatment and one of the side-effects--metrorrhagia--was investigated. This symptom was found in 37 patients. The authors followed two aims. To evaluate the relationship between treatment of the climacteric syndrome and the morphological state of the uterine mucosa and to assess the optimal therapeutic pattern under local conditions. The insignificant frequency of proliferating endometrial changes supports some data in the literature which draw attention also to other causes of haemorrhage. With regard to therapeutic regimes, the authors consider continual administration of conjugated oestrogens--0.625 mg and medroxyprogesterone acetate 5 mg per day as suitable. They emphasize the necessity to follow up the patients in a special clinic with the opportunity to make hormonal examinations and to ensure interdisciplinary collaboration.

[Initial experience with centralized care of women with bleeding in the climacteric and postmenopausal period]. / První zkusenosti s centralizovanou pécí o zeny s krvácením v klimaktériu a postmenopauze.

In 31 women with haemorrhage during the climacteric and postmenopausal period the authors investigated as risk factors of endometrial carcinoma glandular cystic hyperplasia during the perimenopause and signs of oestrogenization of the endometrium in the postmenopausal period. Based on the results of anamnestic data, gynaecological, laboratory and histological examination treatment, incl. administration of gestagens, was outlined. None of the patients who had medroxyprogesterone acetate treatment had a relapse of dysfunctional bleeding or endometrial carcinoma during the one year follow up period. The authors present the results of control examinations after six months treatment. They give an outline of centralized care of risk groups of women in a centre for the pathology. This is a methodological paper, endometrial the basis for a subsequent investigation on the subjects.