A 15-year report of pathological and benign ovarian tumors in teenagers

The purpose of this retrospective study was to determine the frequency, clinical aspects and surgical management of ovarian masses in 52 adolescent patients, in whom surgery was deemed necessary, from 1991-2006. We considered age, symptoms, ultrasound investigations, CA 125 levels, family history, operative treatment, surgical complications tumor size, histopathological examinations, pregnancy rate and follow-up. Ovarian lesions in teenagers include a broad array of pathologic diagnoses that have variable and non-specific presenting symptoms. The most common presenting complaint was abdominal pain in 34 (65.4%). Forty-seven patients (90.4%) had benign lesions, two (3.8%) had borderline tumors and three patients had malignant lesions (5.8%). Most of the patients who wanted to conceive subsequently did so. For benign ovarian disorders the operation should be designed to optimize future fertility while in patients with malignancy, complete staging and resection of the lesion should be the first concern.

Laparoscopic treatment of ovarian dermoid cysts

Dermoid cysts are the most common germ cell tumors of the ovary in women of reproductive age. We report 67 cases of patients with dermoid cysts (mean age, 31.31 years) originating from the ovary treated from 1994 to 2006 at the Obstetrics and Gynecology Department of Aschaffenburg Hospital-Clinic in Germany. Most patients (60) underwent cyst removal. In two patients salpingo-oophorectomy was performed and in five partial oophorectomy was performed. Additional surgery ensuing laparotomy was never necessary. None of the patients had long-term postoperative complications. Two patients were at nine and 15 weeks of gestation and postoperatively were well following termination of pregnancy. In a group of 43 women, who desired pregnancy, 37 pregnancies resulted. The overall intrauterine pregnancy rate was 83.7%; one patient had an ectopic pregnancy (2.32%). To receive more information on this disease, treatment should be performed according to international protocols.

Irregular dental structures in a benign ovarian cystic teratoma (dermoid cyst): case report

Mature cystic teratomas, often referred to as dermoid cysts, are the most common germ cell tumors of the ovary in women of reproductive age. The gross pathologic appearance of a dermoid cysts is characteristic. Hair follicles, skin glands, muscle, and other tissues lie within the cyst wall. We present a case of a dermoid cyst ovarian tumor in a 24-your-old patient with a tooth lying on each wall. The mass was laparoscopically removed by ovarian cystectomy.

TV sonographic assessment in postmenopausal women with bleeding

The aim of this study was to evaluate retrospectively the usefulness of transvaginal sonography for the detection of endometrial disease in postmenopausal women with bleeding. This study involved 275 postmenopausal women aged 47-81 years (median 62). None of them were on hormone replacement therapy and all had had amenorrhea for more than one year. Concerning the age of the study patients, we confirm that endometrial cancer occurs at any age, but more commonly in ages above 58 years. Transvaginal sonography was performed in all women. About 89.2% of malignant diseases were discovered in the study women whose endometrial thickness was above 4 mm, but we also found endometrial cancer in 10.2% of the cases in women whose endometrial thickness was below 4 mm. In postmenopausal symptomatic women premalignant or malignant causes of bleeding can not be excluded with just transvaginal ultrasound.

Uterine sarcoma: a report of 57 cases over a 16-year period analysis

Uterine sarcomas comprese approximately 4-9% of all uterine malignant tumors with a poor prognosis. We report 57 cases of sarcoma originating in the uterus treated from 1990 to 2006 at the Department of Obstetrics and Gynecology of Democritus University of Thrace, Greece and the Department of Obstetrics and Gynecology of Aschaffenburg Hospital, Germany. The median age of occurrence was 49 years with the commonest symptom being abnormal uterine bleeding. Forty-nine patients underwent a total hysterectomy and bilateral salpingo-oophorectomy whereas 17 cases underwent radical lymphadenectomy. During the last followup (December 2006), six patients were alive and well with no evidence of disease, 23 patients had died of undercurrent disease, and 28 were alive with recurrence of disease. These rare cancers can be aggressive, and account for a greatly disproportionate number of deaths from uterine cancers. Treatment for this rare disease should be performed according to international protocols in order to have the most updated information.

Misoprostol and first trimester pregnancy termination

OBJECTIVE

To investigate the efficacy of vaginal administration of 800 microg misoprostol as a single dose without performing post expulsion systematic curettage in first trimester pregnancy termination.

METHOD

113 women, aged 16-44, who requested first trimester pregnancy termination, received 800 microg of vaginal misoprostol. All examined women were divided into two groups depending on gestation age. The first group included of 67 women with up to nine weeks and the second of 46 with up to 12 weeks of pregnancy.

RESULTS

Abortion occurred within 24 hours and was completed in 74.3% of the cases. The mean induction-abortion interval was 5.9 +/- 1.7 hours (median 5.5 hours). Side-effects were experienced by 24 women (21.2%). There was no significant difference between groups in the success rate, induction-abortion interval, number of previous deliveries and side-effects.

CONCLUSION

Misoprostol is an effective agent for first trimester medical termination.

The influence of serum HER-2 levels and HER-2 codon 655 polymorphism on breast cancer outcome

HER-2 (human epidermal growth factor receptor-2) proto-oncogene is a member of the EGFR family and plays an important role in the regulation of cell growth, differentiation and survival and is involved in the regulation of normal breast growth and development. Alterations of HER-2 have been associated with carcinogenesis and poor prognosis of breast cancer. The present case-control study was conducted to clarify the predictive and prognostic significance of serum HER-2 protein in breast cancer patients in relation to Ile655Val single nucleotide polymorphism (SNP) of this gene. Fifty-six consecutive patients with primary breast cancer and 45 healthy women were prospectively included and evaluated. Serum levels of HER-2 were significantly increased in breast cancer patients compared to healthy controls (p=0.035). The optimal cut-off point of 1.98 ng/ml, which was determined to classify breast cancer patients, yielded sensitivity of 54%, specificity of 73% and accuracy of 62%. Significantly elevated serum HER-2 levels were associated with lymphovascular invasion (p=0.022), poor differentiation (p=0.011), advanced clinical stages (p=0.001), lymph node metastasis (p=0.011), higher number of positive lymph nodes (p=0.007) and the immunohistochemical overexpression of HER-2 protein (p=0.016). Regarding to HER-2 Ile655Val SNP, Ile-Val and Val-Val genotypes exhibited highly significant serum HER-2 elevation compared to homozygous Ile-Ile (both p<0.001). In multivariate analysis advanced stages (p=0.003) and Val-containing genotypes (p=0.009) remained the two significant independent determinants of high HER-2 levels. Survival analysis demonstrated an independent prognostic significance of homozygous Val-Val genotype for reduced survival (p=0.045), but not of serum HER-2 (p=0.181). Our findings confirm that serum HER-2 could be used clinically as a useful tumor marker for the diagnosis and the progression of breast cancer. Furthermore, they provide clinical evidence that HER-2 Ile655Val SNP does affect serum HER-2 levels and it can be regarded as a predictive biomarker for breast cancer patients with poor prognosis.

Evaluation of predictive and prognostic significance of serum TGF-beta1 levels in breast cancer according to HER-2 codon 655 polymorphism

The present study was conducted to clarify the predictive and prognostic significance of serum TGF-I(2)1 in breast cancer in relation to Ile655Val single nucleotide polymorphism (SNP) of human epidermal growth factor receptor-2 (HER-2). In a case-control study, 56 consecutive patients with primary breast cancer were prospectively included and evaluated. The control group consisted of 45 healthy women. Serum concentrations of TGF-I(2)1 were measured by quantitative sandwich enzyme immunoassay (ELISA). HER-2 SNP was genotyped using PCR-RFLP method. Serum levels of TGF-I(2)1 were significantly increased in breast cancer patients compared to healthy controls (p<0.001). For the evaluation of the diagnostic significance of serum TGF-I(2)1 the area under the receiver operating characteristic (ROC) curve (AUC) was 0.804, while the optimal cut-off point of 30.86 ng/ml was determined to classify breast cancer patients, which yielded sensitivity of 77%, specificity of 78% and accuracy of 77%. Significantly elevated serum TGF-I(2)1 levels were associated with advanced stages (p=0.023), positive lymph nodes (p=0.019) and postmenopausal status (p=0.031). A marginal trend towards higher TGF-I(2)1 levels was found among patients with Val-containing genotypes compared to homozygous Ile-Ile (p=0.094). In multivariate analysis lymph node metastases (p=0.009) remained the only significant independent determinant of high TGF-I(2)1 levels. With regard to prognostic significance for advanced stages (AUC, 0.704) and lymph node metastasis (AUC, 0.683), when the optimal cut-off value was set at 65.15 pg/ml, the sensitivity was 86% and 67%, the specificity was 60% and 62% and accuracy was 66% and 64%, respectively. Survival was shorter in patients with increased serum TGF-I(2)1 (36 months vs 46 months, p=0.022). Multivariate analysis demonstrated a marginal prognostic significance of serum TGF-I(2)1 for survival (p=0.072). The combination of high TGF-I(2)1 and Val-Val genotype predicts a worse prognosis than high serum TGF-I(2)1 alone. Our findings suggest that serum TGF-I(2)1 is involved in tumor malignancy and lymph node metastasis and could be used clinically as a useful tumor marker for evaluation, the extension and the outcome of the disease. They also provide clinical evidence for a significant association between HER-2 Ile655Val SNP and serum TGF-I(2)1, resulting to more aggressive phenotype of the tumor and poor prognosis.

Attitudes towards contraception in three different populations

OBJECTIVE

To investigate contraceptive behavior of women belonging to three different ethnic and/or socioeconomic populations as well as to evaluate the main sources of information concerning contraception in each population.

METHODS

150 Muslim women living in Germany (group A), 120 Muslim women living in Thrace, Greece (group B) and 140 Christian Orthodox women living in Thrace, Greece were enrolled in the study. Attitudes concerning contraceptive practices were assessed by means of a questionnaire. Demographic and socioeconomic characteristics of each group were compared with the method of contraception used. Statistical analysis was performed using one-way analysis of variance (ANOVA), followed by Turkey's test, chi-square test and multiple logistic regression analysis.

RESULTS

The contraceptive pill (41.7%), the condom (35.1%), periodic abstinence (24.4%) and interrupted coitus were the most common methods of contraception. The gynecologist (23.4%), the family consultant (12.0%) and the sexual partner (10.2%) were the most usual sources of information. The use of contraceptive pills was more frequent among Muslims from Germany and Christians from Greece (p < 0.001), while the use of condoms was more frequent among Christians from Greece (p = 0.019). The use of IUDs was more frequent among Muslims from Germany and Greece (p = 0.039).

CONCLUSIONS

Our study results reveal that there are behavioral differences between race/ethnic groups and minorities regarding contraceptive practices, probably due to different cultural, socioeconomic and educational factors.

A stromal myoid cell line provokes thymic T-cell immigration at the second and third gestational trimesters

Once lymphoid precursors enter the thymus form the blood stream, they come into contact with thymic stromal cells that guide their maturation into functionally competent T cells. Thymic myoid cells are one such cell type. They have been described as a regular constituent of the thymus of embryonic and young vertebrates and express muscle proteins including myosin, desmin, acetylcholine receptor (AChR), C-protein, MyoD, troponin T, rapsyn, and utrophin. It has been emphasized recently that the thymic myoid cells play an important role in the protection of thymocytes from apoptosis, and in the process of T-cell differentiation and maturation.

AIM

To provide a quantitative estimation of thymic myoid cells and T-cell population in different stages of development. A probable interaction between these two populations could explain an additional mechanism to the active T-cell migration from the thymus that is a direct contact to a specific myoid cell line.

MATERIALS AND METHODS

Paraffin-embedded specimens from the thymus of forty five human embryos at the first, second and third trimester of gestation respectively, were investigated by conventional histology, and immunohistology for the presence in the stroma of the thymic medulla, of myosin in the myoid cells, and UCHL1 (pan T-cell) antigen in the medullary thymocytes.

RESULTS

Our results demonstrated a quantitative difference in the second and third trimester of development concerning the expression of myosin in the stromal myoid cells of the thymic medulla over the equivalent expression of the protein in the first trimester. Similar changes in the above periods were found concerning the population of medullary thymocytes expressing UCHL1 antigen.

CONCLUSIONS

Our results indicate that: (1) Thymic myoid cells play an important role in the thymic microenvironment as they are well conserved throughout species evolution. (2) The increased population of myoid cells in the medullary area during mid and late gestational age, in comparison with first trimester, probably reflects the increased demand of the growing fetus for mature T lymphocytes. Contractions of myoid cells mediated by their cytoplasmic structural proteins, including myosin which is well preserved during development, might aid the movement of thymocytes expressing UCHL1 antigen, across or out of the gland, suggesting a potential involvement of myoid cells in the thymic function. Further studies on larger series are needed to corroborate this.

Imbalance of mononuclear cell infiltrates in the placental tissue from foetuses after spontaneous abortion versus therapeutic termination from 8th to 12th weeks of gestational age

Placental macrophages (Hofbauer cells) are located close to trophoblastic cells and foetal capillaries, which make them perfect candidates for involvement in regulatory processes within the villous core. Their capacity of producing several cytokines and prostaglandin-synthesising enzymes, and expressing vascular endothelial growth factor, indicate a possible role in placental development and angiogenesis in order to support pregnancy. Common cells to Hofbauer macrophages sharing similar cell surface markers (HLA-A, -B, -C and leukocyte common antigen) have been reported in the stroma, decidua and amnion, indicating additional foetal protection. Yet this is not always the case. Most spontaneous abortions occur before 12 weeks' gestation, and most are due to chromosomal errors in the conceptus. Relatively few truly spontaneous abortions take place between 12 and 20 weeks' gestation. Thereafter, between 20 and 30 weeks, another type of premature spontaneous termination becomes prevalent, which is due to ascending infection. The numbers of cells expressing the various markers of the monocytemacrophage lineage change throughout pregnancy. In the present study, we investigated the immunohistochemical expression of mononuclear infiltrations in paraffin-embedded placentas, from foetuses after spontaneous abortion (8th, 10th and 12th weeks of gestational age), and those after therapeutic abortion at the same time, using a panel of monoclonal antibodies for the identification of leukocytes (CD45/LCA), B-lymphocytes (CD20/L-26), T lymphocytes (CD45RO/UCHL1), CD68 and CD14 cells. Immunologic factors in human reproductive failure are plausible mechanisms of infertility and spontaneous abortion. Approximately 25% of cases of premature ovarian failure appear to result from an autoimmune aetiology. Unfortunately, current therapeutic options for these women are limited to exogenous hormone or gamete substitution. Local inflammations at the sites of endometriosis implants are postulated to mediate the pain and reduced fecundability associated with this clinical syndrome. The recruitment of immune cells, particularly monocytes and T-cells, neovascularisation around foci of invading peritoneal lesions, and the possible development of antiendometrial autoantibodies support an immunologic basis of this disorder. To date, treatment of pain and infertility associated with endometriosis is primarily surgical, although immune-based adjuvants are theoretical possibilities for the future. Finally, although hypotheses supporting immunologic mechanisms of recurrent pregnancy loss have been popular over the past decade, most clinical investigations in this area do not provide compelling evidence for this position. Reputable specialists in reproductive medicine use experimental immunotherapies judiciously in selected cases of repetitive abortion. For example, the use of anticoagulation therapy can be beneficial in cases with documented antiphospholipid antibodies. At present, however, efficacious immunotherapy protocols for general application have not been established. Despite these caveats, continued strides in our understanding of human reproductive immunology should yield considerable future progress in this field. During the physiological changes that occur in the first and in the beginning of the second trimester of pregnancy, spiral arteries of the placental bed are converted into the uteroplacental arteries. The essence of this conversion consists of losing the muscular elements in the vessel walls, making them unable to respond to vasomotor influences. Cells that infiltrate the walls of spiral arteries and replace their normal elements are called migratory, non-villous or intermediate trophoblastic cells. Besides infiltrating and replacing the anatomic structures of spiral arteries, intermediate trophoblastic cells also penetrate into the lumina of these vessels forming endovascular plugs. These plugs are one of the reasons why early uteroplacental blood flow cannot be visualised, even with transvaginal ultrasound, during the first 12 weeks of gestation. In uncomplicated pregnancies, the endovascular trophoblast is bound to disappear by the end of the second trimester of pregnancy, but the literature on this topic is scarce. Here we describe the detection, isolation and characterisation of CD45RO-, L26- and CD68/CD14-positive cells from human early pregnancy deciduas. These cells were found in close vicinity to endometrial glands, with preference to the basal layer of the decidua. We conclude that (1) maternal cells, apparently CD45RO/UCHL1-positive cells, cross the maternofoetal barrier and participate in spontaneous (involuntary) abortions, and (2) a small proportion of maternal cells (approximately 30%), apparently CD68/CD14-positive cells, also cross the maternal-foetal barrier and cause growth delay and recurrent reproductive failure. Further investigation of involvement of the intercellular adhesion molecules 1 and 2, platelet endothelial cell adhesion molecule, vascular cell adhesion molecule and E-selectin in leukocyte accumulation will be needed to support the passage of maternal cells to the foetus. The results were statistically significant (P<0.0001, Student's t-test).

Contribution of laparoscopy in young women with abdominal pain

This study retrospectively evaluates the laparoscopic treatment of acute abdominal pain in 120 young girls aged 13 to 25 years from 1990 to 1995. Seventy-two (60%) of all operations were emergency procedures. Of these, 55 had functional ovarian cysts, eight patients were operated on for adnexal torsion and nine patients had other adnexal conditions. Ovarian cyst resection was performed in 46 patients and ovarian cyst coagulation in 17 patients. In the rest of the 48 patients (40%), 31 (26.67%) cases had pelvic inflammatory disease, three (2.5%) benign ovarian tumors, two (1.6%) ectopic pregnancies, one (0.8%) a paraovarian cyst and 11 (5%) endometriosis. Laparoscopy appeared to be a safe and effective surgical procedure.

Hypertensive disorders in pregnancy: risk factors and epidemiologic analysis

OBJECTIVE

To measure the incidence of preeclampsia-eclampsia and its perinatal mortality as they appear in the two major ethnic groups in Thrace: Christian Orthodox and Muslims.

STUDY DESIGN

Incidence and perinatal mortality of preeclampsia-eclampsia were studied retrospectively on all women managed in our clinic for hypertensive disorders in pregnancy who were delivered of a stillborn or healthy neonate between 1986 and 1999. We also compared the prevalence of certain risk factors of the disease as they appear in the above-mentioned distinct ethnic groups.

RESULTS

The total incidence of preeclampsia-eclampsia in Thrace was 2.3% and the total perinatal mortality 6.4%. Both variables presented higher values and severe preeclampsia-eclampsia had greater prevalence in the Muslim population. Most risk factors presented statistically significant differences between Christians and Muslims (chi2 test, p < 0.05).

CONCLUSIONS

There was an ethnic variation in most epidemiologic variables of hypertensive disorders in Thrace between Christians and Muslims.

TV sonographic assessment in postmenopausal asymptomatic women

The aim of this study was to evaluate retrospectively the usefulness of transvaginal sonography for the detection of endometrial disease in postmenopausal women without symptoms. The study involved 750 postmenopausal women aged 52-65 (mean 58.5). None of them were on hormone replacement therapy and all had had amenorrhea for more than two years. Transvaginal sonography was performed in 750 women. An endometrium of < 5 mm and non-measurable (627 women) was not investigated further. The 627 cases of this group were reassessed one year later. In the remaining 123 postmenopausal women with suspicious endometrium > 5 mm, 19 endometrial polyps (7.13%), one cervical polyp with extension in the cavity (0.8%), 90 endometrial atrophies (73.17%), ten atrophic endometritis (8.13%), two simple hyperplasias (1.62%), and one hyperplasia with atypia (0.8%) were found. Transvaginal sonography is an efficient and acceptable noninvasive method for the early detection of endometrial pathology in postmenopausal asymptomatic women.

Transvaginal sonographic assessment of the cervix and preterm labor

OBJECTIVE

The purpose of the study was to assess the accuracy of cervical measurements by transvaginal ultrasonography during the 1st and 2nd trimester in the prediction of preterm labor.

STUDY DESIGN

Five hundred high-risk pregnant women in preterm labor were studied retrospectively.

RESULTS

A significantly higher percentage rate of preterm delivery was found in women with abnormal cervical length compared to those with normal cervical length (54.6% [118 of 216 women] vs 16.5% [47 of 284 women], p < 0.001). Also in women with abnormal dilatation of the internal cervical os the percentage was significantly higher compared to those with normal findings (78.7% [133 of 216 women] vs. 9.7% [32 of 284 women], p < 0.001). For women with cervical funneling the incidence of preterm delivery was significantly higher compared to the rest of the women (94.3% [33 of 35] vs 28.4% [132 of 465], p = 0.015).

CONCLUSION

Our data confirm that sonographic assessment between the 9th and 12th week is the best cut-off period for predicting preterm labor.

Allelic imbalance of HER-2 codon 655 polymorphism among different religious/ethnic populations of northern Greece and its association with the development and the malignant phenotype of breast cancer

Alterations of c-erbB-2 (neu or HER-2) proto-oncogene have been associated with carcinogenesis and poor prognosis of breast cancer. A single nucleotide polymorphism (SNP) at codon 655 resulting in a G to A transition (Ile655Val) in the transmembrane domain-coding region of this gene has been associated with an increased risk of breast cancer. This study aims to determine the prevalence of the HER-2 genotype and its association with breast cancer in the Greek Christian and Greek Muslim population of Thrace, Greece. In this case-control study, we genotyped 56 patients (43 Christians and 13 Muslims) with primary breast cancer and 45 healthy women (32 Christians and 13 Muslims) for the Ile655Val polymorphism, with the PCR-RFLP method. The Val allele and the Val-containing genotypes were significantly more frequent in Muslims than in Christians (p=0.020 and p=0.008, respectively). Among the Greek Christian population, a 5-fold and a 3.1-fold increase in risk of breast cancer was associated with the Val-Val genotype and the Ile-Val or Val-Val genotypes (95% CI, 1.3-18.4; p=0.017 and aOR, 3.1; 95% CI, 1.2-8.3; p=0.025; respectively) compared to homozygous Ile-Ile. No significant association was found in the Muslim population. Among the entire cohort, the Val allele confers a modest increase in breast cancer risk (OR, 2.6; 95% CI, 0.9-7.6; p=0.076, for Val-Val and OR, 2.2; 95% CI, 0.9-5.2; p=0.079 for Ile-Val or Val-Val). This effect was even more pronounced in younger women. Among breast cancer patients, invasive carcinomas, low differentiation tumors, advanced stages, positive lymph nodes, high number of lymph nodes and HER-2 overexpression were more frequent in patients with allele Val than those with allele Ile. Our study proposes the allelic imbalance of Ile655Val polymorphism between Greek Christian and Greek Muslim populations of Thrace contributes to the inconsistent association between this SNP and breast cancer risk across these two different ethnic groups. The association of the HER-2 genotype with clinicopathologic characteristics and HER-2 expression may indicate its possible implication on the more aggressive phenotype.