Lymphadenectomy in surgical stage I epithelial ovarian cancer.

OBJECTIVE: To identify the extent of lymphadenectomy performed in women presenting with epithelial ovarian cancer macroscopically confined to the ovary. Furthermore, the effect of lymphadenectomy on overall survival is evaluated. DESIGN: A prospective nationwide case-only study. SETTING: Denmark 2005-2011. SAMPLE: All women registered in the nationwide Danish Gynecologic Cancer Database from 1 January 2005 to 1 May 2011, presenting with a tumor macroscopically confined to the ovary without visible evidence of abdominal spread at the time of the initial exploration (surgical stage I). METHOD: Descriptive and survival analyses of data from Danish Gynecologic Cancer Database. MAIN OUTCOME MEASURES: The annual proportion of women with surgical stage I disease who received lymphadenectomy and the survival in the two groups. RESULTS: Of 2361 women with epithelial ovarian cancer, 627 were identified with surgical stage I. Lymphadenectomy was performed in 216 women (34%) of whom 13 (6%) had lymph node metastases. At 5-year follow up 85% remained alive in the lymphadenectomy group compared with 80% in the control group (p = 0.064). The lymphadenectomy fraction increased from 24% in 2005 to 55% in 2011. When univariate and multivariate analyses were conducted only an insignificant difference in the survival probability was found between lymphadenectomy and no lymphadenectomy in women presenting with tumor macroscopically confined to the ovary. CONCLUSION: Although increasing, the number of women with surgical stage I disease in Denmark who receive lymphadenectomy remains low, but this did not seem to make a difference to survival.

[Hydrops foetalis caused by a mediastinal teratoma]. / Hydrops foetalis forårsaget af et mediastinalt teratom.

Hydrops foetalis (HF) is defined as an accumulation of fluid in at least two compartments of the body, e.g. the subcutis, the pleural cavities, the pericardial cavity and the abdomen. In present time, non-immune causes, including tumours, predominate. We present a case of severe HF, caused by a mass which was clinically interpreted as a hernia of the diaphragm at gestational week 19 + 6. An abortion was granted and performed. Autopsy revealed an immature teratoma in the mediastinum compressing the heart and airway. The prognosis and treatment of mediastinal teratoma and HF is discussed.

[Syphilis as cause of foetal death]. / Syfilis som årsag til dødfødsel.

Syphilis is a well-known cause of foetal death. We describe a Danish case of foetal death in week 31 + 0 in an Iraqi-born woman. The foetus had ascites. Blood samples were positive for IgG and IgM, for syphilis, and immunohistochemical staining of the placenta showed Treponema pallidum in relation to the vessels of the umbilical cord. Congenital syphilis should be kept in mind even though it is rare in Denmark.

Spinal cord injury at birth: a hidden causative factor.

UNLABELLED: A case of perinatally acquired spinal cord injury (SCI) is presented. The foetus was vigorous until birth, the breech presented and delivery was performed by a non-traumatic Caesarean section. The infant displayed symptoms of severe SCI but diagnosis was delayed due to severe co-morbidity. Diagnostic considerations are briefly reviewed. Ventilatory support was withdrawn at the age of 20 days when the infant had still not exhibited any respiratory effort or spontaneous movements. Autopsy revealed a serious congenital malalignment of the upper cervical vertebrae and at the histological examination extensive reactive changes were observed in the same area. To our knowledge such findings have not been published previously. CONCLUSION: In cases of serious perinatally acquired SCI, claim of malpractice is often apparent. In this case a hidden congenital malformation of the cervical vertebrae was revealed, highlighting the need of careful postmortem examinations in such cases.

MAGE-A1, GAGE and NY-ESO-1 cancer/testis antigen expression during human gonadal development.

BACKGROUND: Cancer/testis antigens (CTAs) are expressed in several cancers and during normal adult male germ cell differentiation. Little is known about their role in fetal development of human germ cells. METHODS: We examined expression of the CTAs MAGE-A1, GAGE and NY-ESO-1 in fetal gonads by single and double immunohistochemical staining. RESULTS: We found that GAGE was expressed in the primordial germ cells of the gonadal primordium, whereas MAGE-A1 and NY-ESO-1 were first detected in germ cells of both testis and ovary after sexual differentiation was initiated. The number of positive germ cells and the staining intensity of all three CTAs peaked during the second trimester and gradually decreased towards birth in both male and female germ cells. In oocytes, MAGE-A1 expression terminated around birth, whereas NY-ESO-1 expression persisted through the neonatal stage and GAGE expression was maintained until adulthood. The population of GAGE-expressing male and female germ cells partially overlapped the population of OCT4-positive cells, whereas MAGE-A1 and NY-ESO-1 were clearly expressed only by OCT4-negative cells. CONCLUSIONS: Our results suggest that MAGE-A1 and NY-ESO-1 are associated with highly proliferating germ cells, whereas GAGE proteins have a more general function in germ cells unrelated to any specific developmental stage. The recognition of differential cellular expression of GAGE, MAGE-A1, NY-ESO-1 and OCT4 may help define biologically distinct germ cell subpopulations.

Age-related decrease in energy expenditure at rest parallels reductions in mass of internal organs.

This study explores to what extent the mass of internal organs may impact the age-related decrease in energy expenditure at rest (EErest). The relationship between direct measurements of EErest in elderly women and predicted EErest based on equations deriving from the metabolic activity in tissue from younger women were also elucidated. Body composition of elderly women was measured by an impedance method. EErest was measured by the Douglas bag method after an overnight fast. These data were compared with predicted values of EErest based on equations derived from studies in younger women. The mass of internal organs was obtained from autopsy material. Young women (mean age 31.7 years, range 14-60, n = 104) and elderly women of 65 years (n = 22), 75 years (n = 26), and 85 years (n = 31) participated in this study. Autopsy data were obtained from women (n = 238) from the same birth cohorts as the elderly women who died at ages 42-87 years. EErest showed a progressive age-related decline, which appeared to parallel a similar reduction in the mass of internal organs derived from autopsy material of women who died at the same ages. In contrast, FFM was identical in the group of 65 and 75-year-old women, but was lower in the 85-year-old women. Predicted and measured EErest revealed a strong correlation in elderly women. Modest reductions in the mass of internal organs with a high metabolic rate appear to contribute markedly to the decline in EErest observed in aging. Further, it is also possible to predict EErest from the body composition of elderly women using equations developed from younger women.