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Current Gynecologic Oncology. 12/2012; 12(4):270-285.
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Contemporary Oncology / Wspólczesna Onkologia 12/2012; 16(6):520-525. · 0.06 Impact Factor
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ABSTRACT: Germ cell tumors are the most frequent ovarian neoplasms among girls and young women under the age of 25. Female patients with gonadal dysgenesis are at higher risk of germ cell tumors. Two cases of women with pure gonadal dysgenesis were described. A hormonally active tumor secreting estrogens, caused the development of sexual features and genital tract bleeding what imitated premature puberty. It needs to be emphasized that the presence of sexual features does not exclude dysgenesis - a pathology that is connected with an increased risk of gonadal tumors--and that the ultrasound evaluation, during which the presence of follicles in gonads is evaluated, is essential.
Ginekologia polska 07/2012; 83(7):549-51. · 0.41 Impact Factor
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ABSTRACT: Adnexal torsion belongs to the group of urgent cases in gynecology Early diagnosis and management can prevent the loss of an ovary and the Fallopian tube. The case of the 14.5-year-old girl was described by the authors. The symptoms were moderate and caused diagnostics problems. During clinical assessment current literature knowledge, differentiation and treatment of the adnexa were taken into account.
Ginekologia polska 12/2011; 82(12):933-5. · 0.41 Impact Factor
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ABSTRACT: Resistant ovary syndrome (ROS) and premature ovarian failure (POF) represent two forms of hypergonadotropic hypogonadism. Principal symptoms include primary or secondary amenorrhea (before the age of 40 years), low levels of estradiol and elevated FSH (above 40IU/ml) in serum. The main difference is the presence of follicles in ROS which is tantamount to the possibility of pregnancy. We present the case of pregnancy in a 31-year-old patient who was initially diagnosed with POF, which was the basis of the final diagnosis of ROS.
Ginekologia polska 10/2011; 82(10):785-7. · 0.41 Impact Factor
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Hereditary Cancer in Clinical Practice 01/2008; 6(2):88-98. · 1.68 Impact Factor
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ABSTRACT: Leptin levels in serum depending on Body Mass Index (BMI) in patients with endometrial hyperplasia and cancer.
Concentrations of leptin, a hormone secreted by white adipose tissue, correlate strongly with body mass. Leptin interacts with several other hormones, modifies the activities of some enzymes and proinflammatory cytokines, participates in hematopoiesis, thermogenesis, and angiogenesis, and is involved in the control of carbohydrate and lipid metabolism. This study was undertaken to determine whether serum concentrations of leptin in obese patients with endometrial hyperplasia and cancer deviate from values in patients with normal endometrium.
We enrolled 86 obese postmenopausal women, including 40 with endometrial cancer and hyperplasia and 46 with normal endometrium. Depending on BMI, three subgroups were formed: I<30; II = 30-40; III > 40. Leptin concentrations were measured with immunoenzymatic test kits from IBL. Statistical comparison was done with the chi square (chi(2)) test and Statistica software package.
Mean serum concentration of leptin in endometrial cancer and hyperplasia was 16737.1 pg/ml as opposed to 9048.7 pg/ml in patients without endometrial pathology (p<0.0001). Significantly, higher concentrations of leptin were noted in every BMI subgroup of patients with endometrial pathology in comparison to controls (p<0.005).
Leptin appears to participate in proliferative processes of the endometrium. Obesity is an important risk factor in endometrial cancer.
European Journal of Obstetrics & Gynecology and Reproductive Biology 01/2008; 136(1):74-7. · 1.97 Impact Factor
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ABSTRACT: The female with Swyer syndrome requires close follow-up because of the high risk of neoplastic transformation in the dysgenetic gonads. The aim of this work was to present our experience with tumors in patients with Swyer syndrome.
We studied 8 females with Swyer syndrome. At the time of diagnosis, they were 13 to 18 years old. We performed an ultrasound examination of dysgenetic gonads, hormonal (follicle-stimulating hormone, luteinizing hormone, estradiol, and testosterone) and genetic (SRY, karyotype) tests, and histologic analysis of gonads (bilateral gonadectomy was performed in all patients).
Gonadal tumors were found in 6 patients (3 cases of gonadoblastoma, 1 dysgerminoma, and 2 gonadoblastoma with dysgerminoma). Hormonal activity of gonadoblastoma was noted in 3 patients, with 1 tumor producing androgens.
Our data suggest that patents with gonadal dysgenesis and 46,XY karyotype should be referred for bilateral gonadectomy because of the high risk of neoplastic transformation. Estrogen-producing gonadoblastoma may mask gonadal dysgenesis and delay the diagnosis of this pathology.
Journal of Pediatric Surgery 11/2007; 42(10):1721-4. · 1.45 Impact Factor
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ABSTRACT: This study was undertaken with regard to the gonadotropin theory of ovarian cancer advocated in the literature and was designed to disclose specific features of ovarian morphology in carriers of the BRCA1 gene mutation. We enrolled 171 patients and divided them into two groups: A (n=90)--operated for breast cancer (30 patients with and 60 without the BRCA1 mutation); B (n=81)--with the BRCA1 mutation qualified for preventive adnexectomy. According to the authors' classification described herein, some patients without the BRCA1 mutation retained "signs of estrogenization" in menopausal ovaries, revealing the role of estrogens as a factor promoting mammary carcinogenesis in these patients. A tendency to premature menopause was observed in BRCA1 mutation carriers of groups A and B as evidenced by the final menorrhea appearing at a younger age and almost total absence of "signs of estrogenization" in menopausal ovaries. It is concluded from these findings that earlier menopause in carriers of the BRCA1 mutation is associated with hypergonadotropic activity and may predispose to ovarian cancer at younger age.
Breast Cancer Research and Treatment 12/2006; 100(1):59-63. · 4.43 Impact Factor
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ABSTRACT: Constitutional delay of puberty (CDP), a rare condition among girls, manifests as retarded sexual maturity past the 13th year of life. The clinical and endocrinological aspects of this interesting problem appear to have escaped attention in the literature. The purpose of the present study was to compare body composition and concentrations of leptin, neuropeptide Y (NPY), beta-endorphin, growth hormone (GH), insulin growth factor-I (IGF-I) and insulin at menarche in CDP girls and girls with normal pubertal development (NP).
We enrolled 11 girls with CDP and 40 girls with NP. All participants were studied at or within 3 months of menarche. Age, height and weight were recorded. Body composition was established with a body composition analyzer. Radioimmunoassays were performed to measure concentrations of NPY, beta-endorphin, leptin, GH, IGF-I and insulin.
The mean age at menarche in the CDP and NP groups was 16.1 and 12.5 years, respectively (p = 0.0001). CDP girls at menarche were taller (1.64 vs. 1.57 m; p = 0.012). The difference between groups in body weight (57.5 vs. 50.4 kg; p = 0.1), body mass index (BMI), fat mass, fat percentage (BF%) and lean mass was not significant, and nor was the difference in leptin, GH and insulin levels. However, CDP girls demonstrated significantly higher NPY concentrations (199.4+/-105.1 vs. 56.9+/-26.3 pg/ml; p = 0.001). NPY correlated with BF% (r = 0.60) in this group. IGF-I concentrations were significantly lower in CDP girls (524.8+/-50.6 ng/ml) than in NP girls (744.5+/-56.1 ng/ml; p = 0.024).
Girls with CDP differed from NP girls only in age at menarche and height; they did not differ significantly with respect to BMI and body composition parameters. Higher concentrations of NPY in CDP girls may be responsible for CDP and reduced levels of IGF-I. Correlation of NPY with BF% suggests an involvement of this neuropeptide in the process of fat accumulation associated with CDP.
Gynecological Endocrinology 06/2006; 22(5):274-8. · 1.58 Impact Factor
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ABSTRACT: There is strong evidence that the initiation of adrenarche and gonadarche during puberty in girls depends on body mass in general and body fat in particular. The aim of this study was to analyze changes in body composition, i.e. body fat (BF), fat percentage (BF%), and lean tissue mass (LM) in girls during pre-menarcheal stages of development, including the earliest stage lacking clinical manifestations of changes in primary, secondary, and tertiary sexual characteristics. Puberty was assessed according to clinical and ultrasonographic staging of sex features developed by us. Concentrations of leptin and DHEA-S were compared and related to changes in body composition. SUBJECTS AND METHODS: The study was carried out on 65 healthy girls aged 8 years and older who were followed every 3 months over a 5-year period. Age, height, weight, and BMI were recorded. Body composition (BF, BF%, LM) was determined with an infrared method. Tertiary sexual features were staged according to Tanner. Vaginal secretion was assessed according to Peter et al. Transabdominal ultrasound of the uterus and ovaries was performed with the bladder unvoided. Groups were formed according to developmental stage: E0A = pre-estrogenization (no ultrasonographic or clinical evidence of estrogenization); E0B pre-estrogenization with 'luminosity' of mucus in cervical canal; E1 = onset of estrogenization; E = full estrogenization; M = menarche +/- 3 months. Concentrations of DHEA-S and leptin were determined by radioimmunoassay. RESULTS: BF in prepubertal girls averaged 16%. At menarche, BF was 23.9%. Body weight at menarche was 50.6 kg and the LM/BF ratio was 3.0. High leptin concentrations were found in E0B and M groups. Leptin concentrations were lowest during full estrogenization (E). Positive correlations of leptin with BF and LM were found in girls during developmental stages preceding menarche. Mean concentration of DHEA-S started at 1,091.6 microg/l during E0A stage, dropped significantly on passing to E0B (p <0.05), and increased by menarche. DHEA-S levels were found to correlate with BF, LM, and leptin in E0A, E0B, and E1 groups. Correlation coefficients were highest (DHEA-S/BF r = 0.61; DHEA-S/LM r = 0.54; DHEA-S/LEP r = 0.57) in the E0A group, i.e. about 5 months before the appearance of 'luminosity' of cervical mucus, considered to be the first ultrasonographic sign of puberty. Apparently, leptin stimulates somatic maturation during this stage of gonadarche which terminates with menarche. The action of DHEA-S is exerted during the early stages of female puberty.
Journal of pediatric endocrinology & metabolism: JPEM 10/2005; 18(10):975-83. · 0.88 Impact Factor
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ABSTRACT: Constitutional delay of puberty (CDP) is the absence of secondary sexual features in otherwise healthy girls past the 13th year of life. The aim of the present work was to follow the development of estrogen-dependent sexual features, determine the concentrations of gonadotropins, estradiol and sex hormone-binding globulin (SHBG) in girls with CDP at menarche and compare the findings with normal controls.
We enrolled 11 girls with CDP and 40 controls. Primary, secondary and tertiary sexual features were studied at menarche +/- 3 months. The size of the ovaries and uterus was measured using transabdominal ultrasound. Maturation of breasts and pubic hair was staged according to Tanner. Concentrations of gonadotropins (follicle-stimulating hormone (FSH), luteinizing hormone) and estradiol were measured with immunoenzymatic methods. For measurement of SHBG, a radioimmunoassay was applied.
Menarche in CDP girls usually appeared with Stage IV or V of breast development and Stage IV of pubic hair development according to Tanner. CDP girls demonstrated a significantly smaller volume of the uterine body at menarche compared with controls (p = 0.0004). Significantly lower levels of FSH (p = 0.0363) and estradiol (p = 0.0332), as well as a tendency towards lower levels of SHBG, were revealed in CDP girls at menarche.
In CDP girls, menarche is accompanied by more mature tertiary sexual features, apparently resulting from longer exposure of estrogen-dependent tissues to the action of bioactive endogenous estrogens. The smaller volume of the uterine body in CDP girls at menarche may be attributed to decreased concentrations of FSH and estradiol, as well as to the possibility of decreased insulin-like growth factor-1 and increased neuropeptide Y levels.
Gynecological Endocrinology 06/2005; 20(5):270-3. · 1.58 Impact Factor
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ABSTRACT: The aim of this work was to determine gonadotropin (LH, FSH) levels in serum and cyst fluid in various type of ovarian epithelial neoplasms (benign, borderline, malignant) and to compare them with levels in benign cysts. Additionally we decided to estimate if there were some significant correlations between serum and ovarian cyst fluid in gonadotropin levels in all investigated groups.
The study group included 74 patients before (n=36) and after (n=38) menopause, divided into four groups depending on the histopathologic diagnosis. Serum and cyst fluid levels of LH and FSH were determined in all patients.
We found statistically significant differences concerning LH and FSH levels in serum and cyst fluid between malignant and borderline tumors, between malignant tumors and benign cystadenomas and between malignant tumors and non-neoplastic cysts. We also found statistically significant correlations between serum and cyst fluid as to FSH and LH levels in patients with borderline tumors. There were no statistically significant correlations between serum and cyst fluid as to FSH and LH levels in patients with malignant epithelial tumors (group 1) and in patients with benign cystadenomas (group 3).
High FSH and LH levels in cyst fluid of malignant epithelial tumors of the ovary are in line with the gonadotropin theory of tumor growth. Simultaneous determination of various types inhibin levels appears to be an interesting topic for our future research.
Archives of Gynecology and Obstetrics 12/2004; 270(3):151-6. · 1.28 Impact Factor
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Acta Obstetricia Et Gynecologica Scandinavica 06/2004; 83(5):501-3. · 1.77 Impact Factor
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Janusz Menkiszak,
Marek Brzosko,
Bohdan Górski,
Jacek Fliciński,
Anna Jakubowska,
Dariusz Zebiełowicz,
Jacek Gronwald,
Tomasz Huzarski,
Tomasz Byrski,
Leszek Teresiński,
Maria Chosia, Izabella Rzepka-Górska,
Jan Lubiński
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ABSTRACT: The study aimed to determine whether hereditary ovarian cancers that are not caused by BRCA1/BRCA2 constitutional mutations are associated with a predisposition to cystadenoma. The study consisted of two parts. Part one concerned the incidence of ovarian cystadenoma in females from families with hereditary ovarian cancer unassociated with BRCA1 mutations. The study group included 62 female patients from 29 families, without any previously diagnosed malignancy, with no proven constitutional mutation of the BRCA1 gene. The first control group was composed of 62 female patients from 53 families, without any previously diagnosed malignancy, with an identified constitutional mutation of the BRCA1 gene. The second control group comprised 124 female patients for whom the only reason for the examination was a prophylactic check-up. All studied women were subjected to intravaginal ultra- sonographic investigations. In 8 patients with benign and/or borderline ovarian cystadenoma, a complete sequencing of coding fragments of the BRCA2 gene from the peripheral blood DNA was performed. Part two of this study concerned the incidence and pattern of malignant tumors in the families of female patients with ovarian cystadenoma. The final study group included 117 patients who had 726 I0 relatives (359 females and 367 males). We concluded that cystadenoma is likely to be a characteristic feature of the subgroup of families with hereditary ovarian cancers unassociated with BRCA1/BRCA2 constitutional mutations.
Journal of applied genetics 02/2004; 45(2):255-63. · 1.66 Impact Factor
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ABSTRACT: The timing of pubertal changes depends on the concerted function of the hypothalamic - pituitary - ovarian and other endocrine systems. The somatotropin system and insulin play important roles during the growth and maturation of girls. Our clinical observations have enabled us to determine and implement criteria that split the pre-menarcheal period into three phases with distinct features associated with rising levels of estrogens (pre-estrogenization, onset of estrogenization and full estrogenization). The aim of this work was to determine levels of growth hormone, insulin - like growth factor 1 (IGF-1), sex hormone binding globulins (SHBG), insulin, and estradiol in relation to somatic features in girls during subsequent phases of estrogenization. This prospective study was done in 45 healthy girls. Every three months, we recorded weight, height, BMI, maturation of tertiary sex features, estrogen-related changes in hymen, sonographic dimensions of ovaries and uterus and serum levels of growth hormone, IGF-1, SHBG, insulin, and estradiol. Onset of estrogenization was accompanied by reduction of body mass and slowing down of growth associated with declining levels of growth hormone. These changes were followed by weight gain, pubertal acceleration of growth, rising levels of growth hormone, IGF-1, insulin, and estradiol, and falling levels of SHBG.
Archives of Gynecology and Obstetrics 11/2003; 268(4):293-6. · 1.28 Impact Factor
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Janusz Menkiszak,
Jacek Gronwald,
Bohdan Górski,
Anna Jakubowska,
Tomasz Huzarski,
Tomasz Byrski,
Małgorzata Foszczyńska-Kłoda,
Olga Haus,
Hanna Janiszewska,
Magdalena Perkowska, [......],
Katarzyna Lamperska,
Elwira Strózyk,
Dariusz Godlewski,
Małgorzata Stawicka,
Bernard Waśko,
Marek Bebenek,
Andrzej Rozmiarek, Izabella Rzepka-Górska,
Steven A Narod,
Jan Lubiński
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ABSTRACT: There is increasing evidence that hereditary factors play a greater role in ovarian cancer than in any of the other common cancers of adulthood. This is attributable, to a large extent, to a high frequency of mutations in the BRCA1 or BRCA2 genes. In Poland, 3 common founder mutations in BRCA1 account for the majority of families with identified BRCA mutations. Our study was conducted in order to estimate the prevalence of any of 3 founder BRCA1 mutations (5382insC, C61G and 4153delA) in 364 unselected women with ovarian cancer, and among 177 women with ovarian cancer and a family history of breast or ovarian cancer. A mutation was identified in 49 out of 364 unselected women with ovarian cancer (13.5%) and in 58 of 177 women with familial ovarian cancer (32.8%). The majority of women with ovarian cancer and a BRCA1 mutation have no family history of breast or ovarian cancer. The high frequency of BRCA1 mutations in Polish women with ovarian cancer supports the recommendation that all Polish women with ovarian cancer should be offered testing for genetic susceptibility, and that counseling services be made available to them and to their relatives. It is important that mutation surveys be conducted in other countries prior to the introduction of national genetic screening programs.
International Journal of Cancer 11/2003; 106(6):942-5. · 5.44 Impact Factor
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ABSTRACT: Germ cell tumours are the most common ovarian tumours in childhood and adolescence. This diverse group of tumours derives from germ cells.
The aim of this work is presentation of germ cell tumours in the material from our clinic with characteristic clinical features, the scope of operation and effects of many years of observation.
We treated 109 girls with germ cell tumours of the ovary: 13 had malignant tumours: there were 7 patients with dysgerminomas, 2 with endodermal sinus tumour of the ovary, 3 with immature teratomas, 1 with carcinoma embryonale. Gonadoblastomas was diagnosed 4 patients and mature teratomas in 92 patients.
11 patient had gonadal dysgenesia with abnormal karyotype. These girls had no follicle apparatus in gonads and had elevated levels of gonadotropins. Gonadoblastoma is almost always found in patients with gonadal dysgenesis. Gonadoblastoma often produces estradiol or testosterone. There can be problems with diagnosis of the syndrome, because developmental features imitate the onset of normal puberty. Most patients with dysgerminoma have stage I of disease and surgery is sufficient. It must be suggested that patients of stage I who wish to preserve childbearing function may be treated with unilateral salpingoophorectomy and adjuvant chemotherapy. Monitoring of the treatment is connected with measurement of biochemical markers. Some of these markers are useful for monitoring of response to therapy. When levels of markers are low second look laparoscopic operation should be performed. Cytological smears and biopsy specimens from the remaining ovary, peritoneum and subdiaphragmatic area should be obtained laparoscopically.
The sift ultrasonographic investigations can be helpful in the early diagnosis of germ cell tumours of the ovary in girls. Absence of follicle apparatus in the gonads requires determination of levels of gonadotropins and karyotype. Fertility sparing operative treatment is preferred when karyotype is normal.
Ginekologia polska 10/2003; 74(9):840-6. · 0.41 Impact Factor
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ABSTRACT: Ovarian granulosa cell tumor is uncommon malignancies. By virtue of histopathological examination we distinguish two subtype of GCT: adult type granulosa cell tumor typically in older women and juvenile granulosa cell tumor recognized primarily in children and young adults. GCTs behave unpredictably. Depending on histological type patients suffer recurrences in different time after treatment, even many years from diagnosis.
The aim of our study is clinical analysis of patients with AGCT and JGCT, especially the problem of choice of treatment, time to occurring recurrences and new possibility in long term follow up.
We analyzed 22 patients treated in Department of Gynecological Surgery and Oncology of Adults and Adolescent Pomeranian Academy of Medicine and then observed in our outpatient clinic.
Among analyzed 22 patients 18 had adult type of granulosa cell tumor, mean age of these women was 47 years (32-72). Juvenile type of granulosa cell tumor were recognized in 4 patients and they were from 4 to 7 years old. All young girls were underwent sparing surgery, one of them was treated with radiotherapy. In histopathological examination of 4 years old girl atypia and a lot of mitosis was observed and she was treated with chemotherapy. Unfortunately after 18 months from diagnosis she died due to very dynamic recurrence. Remained 3 girls live without evidence of disease and the longest time of follow up is 36 years. 16 women with AGCT were underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy, 2 were performed conservative surgery because they wish to preserve their fertility. 16 patients were treated with radiotherapy as an adjuvant treatment, two additionally with GnRH analogues. Recurrences in patients with AGCT were recognized in 5 cases. Mean time to recurrence from diagnosis were 11.7 years. In two patients it happened after 21 and 22 years. Despite of aggressive chemotherapy four of these patients died during one year. Remained 13 women with adult granulosa cell tumours live without evidence of disease and the longest time of observation is 9 years. In histopathological examination of all patients who died were describe cellular atypia and high mitotic rates. During long time follow up our patients were performed second-look laparoscopies, tested of estradiol levels and 5 of them also inhibin B levels which always correlated with actual condition.
Granulosa cell tumor is ovarian neoplasm of different behaviour. Patients with this diagnosis should be monitoring for many years. Inhibin is valuable examination in long term follow up.
Ginekologia polska 10/2003; 74(9):689-94. · 0.41 Impact Factor
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ABSTRACT: The purpose of this study was to determinate the frequency, clinical aspects and management of epithelial parovarian neoplasms among patients hospitalised in our department.
This work has a retrospective character. The research material composed of patients treated in our clinic in the years 1992-2001 because of adnexal mass. In clinical analysis of 13 cases with epithelial parovarian neoplasms we took account of age, symptoms, ultrasound investigations, CA 125 levels, family history, operative treatment, histopathological examinations and follow up.
Among 1110 patients operated for of adnexal mass 19.21% constituted parovarian cysts, and 2.6% (13 cases) of them were epithelial neoplasms (11 benign cystadenomas and 2 borderline malignancy neoplasms in FIGO I). The mean age of patient was 42.1. The clinical presentation was lower abdominal pain. CA 125 had the normal range in all patients. In ultrasound investigation parovarian cysts was suspected only in 2 cases when both normal ovaries were apparent. All patients were operated and extension of surgical procedures depended firs of all on age. Two patients with borderline tumors were operated in 1998 and have lived ever since without signs of disease.
Parovarian cysts are not always benign and broad ligament region may be the point of issue for neoplasms of different histopathological types.
Ginekologia polska 12/2002; 73(11):1078-83. · 0.41 Impact Factor
