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ABSTRACT: Despite the well-established role of hypoxia in cancer biology, the literature on its effects on endometrial cancer is scarce; it mainly refers to experimental settings rather than patient-derived results. Herein, an overview of the hypoxia inducible factor 1α (HIF-1α) biology, focusing on endometrial cancer, is presented. The molecular mechanisms possibly involved in endometrial cancer progression are presented, followed by a systematic approach to the current literature on immunohistochemistry evaluation of HIF-1α expression in endometrial carcinoma. Since no consensus has been made regarding HIF-1α evaluation, the evidence of possible involvement of HIF-1α in endometrial carcinoma prognosis is weak. After a consensus has been made, properly powered studies may be able to clarify whether HIF-1α can act as a prognosticator in endometrial carcinoma.
Histology and histopathology 10/2012; 27(10):1247-53. · 2.48 Impact Factor
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Journal of obstetrics and gynaecology: the journal of the Institute of Obstetrics and Gynaecology 07/2012; 32(5):484-5. · 0.43 Impact Factor
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ABSTRACT: Sentinel lymph node (SLN) biopsy is a well established option for assessing axillary lymph node status in breast cancer. Several techniques have been applied so far (superficial or deeper ones). Based on anatomical features of the lymphatic drainage in the breast, we assessed the feasibility of an intranipple approach for SLN mapping. Our data support the feasibility of SLN detection by our technique, with a high rate of SLN identification, which could be used in clinical practice as an alternative to the peri-areolar approach.
European journal of gynaecological oncology 01/2012; 33(3):304-5. · 0.47 Impact Factor
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ABSTRACT: Secondary lymphedema of the upper limb is a complication which can be found in patients who have undergone surgical breast cancer treatment with an axillary dissection. Lymphedema following breast cancer treatment remains a long-term disabling complication which cannot be treated in a decisive and radical manner. The objective of the treatment is to limit complications, to try to preserve the remaining lymphatic system and to develop new anastomosis. It consists of a specific decongestive physiotherapy, which may include a specific lymphatic drainage and skin mobilization, reducing bandages including Mobiderm (Thuasne), and sub-bandage muscular exercises. However variations in the therapy have been recorded by different teams. Our experience in treating lymphedema in Tunisia takes into consideration the epidemiological, climatic, cultural and socio-economic conditions of the country. The difference in our treatment compared to what is being advocated elsewhere essentially consists of the no muscular exercise while wearing a bandage. This is compensated for by daily domestic activities, by prolonging the first two phases of treatment (the intensive phase and the stabilization phase), and by the use of the hydro gel dressing Hydrosob (Hartmann) to prevent blisters induced by the pressure imposed by Mobiderm studs of the bandage on the skin, and also by the superimposition of two types of Mobiderm bandages (small and large blocks).
Clinical and experimental obstetrics & gynecology 01/2012; 39(4):483-8. · 0.43 Impact Factor
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ABSTRACT: Women with increased mammographic density (MD) have an increased risk of developing breast cancer. The purpose of our study is to evaluate an experimental method to quantify MD using a program (compatible with Windows XP, Vista and 7) which measures black areas as 0, white areas as 100 and grey scale areas with intermediate values between 0 and 100, depending on the "density" of the area. Digital screening mammograms were directly estimated with this method. Initial idea and steps of the program were based on a Mac utility used by our research team.
Journal of medicine and life 08/2011; 4(3):310-3.
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ABSTRACT: Cytology remains the mainstay for cervical screening. The need to achieve effective management, limit complications, and preserve reproductive function led to the popularity of local treatment. Although the cure rates for ablative and excisional methods are similar, the excisional method provides a more reliable histopathological diagnosis. Recent evidence revealed increased perinatal morbidity after treatment that appears to be related to the proportion of cervix removed. The human papillomavirus (HPV) DNA test appears to enhance the detection of disease in primary screening, in the triage of minor cytological abnormalities, and in follow-up. Further research on the clinical application of a scoring system is ongoing. The vaccines are now available and appear to be safe, well tolerated, and highly efficacious in HPV naive women. A synergy of vaccination and screening will be required. Treatment for early cervical cancer is increasingly shifting toward more fertility-sparing surgical techniques. Careful selection of patients is essential.
Annals of the New York Academy of Sciences 09/2010; 1205:57-68. · 3.15 Impact Factor
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ABSTRACT: While women aged 50 and older are broadly considered to benefit from screening mammograms, the evidence of any similar advantages for younger women are still considered insufficient to form any substantial conclusions on the matter. The primary goal of this study was to examine whether or not the mortality rate of younger women is benefited by mammography, and if so, how can this beneficial effect be maximized.
The authors have taken into account all available randomized control trials (RCTs) and have conducted a meta-analysis based on those RCTs to study the effect of mammography on the mortality rate of women younger than age 50. Further interpretation on various aspects of the results has also led to separate meta-analyses, with the RCTs included grouped in accordance to the mean time interval between screening mammograms employed by each study. The findings and conclusions of the comparison were used to calculate the number of mammograms necessary to reduce the absolute death risk, depending on the time interval between screening mammograms.
The meta-analysis indicated a reduction in breast-cancer mortality in the intervention group, which reached statistical significance (relative risk (RR) 0.81 [95% CI 0.71-0.93] p < 0.01). Furthermore, when the RCTs included were grouped according to their mean time interval between mammograms, there was a definite increase of statistical significance in favor of those RCTs with shorter interval times (RR 0.76 [95% CI 0.64-0.89] p < 0.01).
The significant mortality rate reduction demonstrated by the meta-analytical results is a key indicator of the beneficial effect of mammography on the age group of women younger than 50. Additionally, the increase in the aforesaid significance when combining RCTs with short time intervals between mammograms, as opposed to those RCTs with longer intervals, suggests that the optimal use of mammographic screening lies with the former. This is better demonstrated when taking in account our approach to answering the practical question of "how many screening mammograms will take to save one life?" in correlation with the mean time interval involved.
Clinical and experimental obstetrics & gynecology 01/2010; 37(4):278-82. · 0.43 Impact Factor
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ABSTRACT: Breast density assessments performed by using the Breast Imaging Reporting and Data System (BI-RADS) have been completely qualitative and the American College of Radiology (ACR) fibroglandular density descriptors are mainly subjective. However, women with increased mammographic density (MD) have an increased risk of developing breast cancer. The purpose of our study was to evaluate an experimental method to quantify MD using a software utility which measures absolutely black areas as zero and absolutely white areas as 100. In grey scale areas, these values range between 0 and 100, depending on the "density" of the area. Digital screening mammograms were directly estimated with this method. We concluded that there is a significant correlation between ACR quartiles and this grey scale percentage method, although several improvements on the original idea are planned.
Clinical and experimental obstetrics & gynecology 01/2010; 37(1):24-5. · 0.43 Impact Factor
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ABSTRACT: Image analysis of tissue sections using RGB image profiling is a modern accepted technique.
A new method of RGB analysis, using the freeware ImageJ, is presented which can be applied to sections with either nuclear or cytoplasmic staining. The step-by-step process is presented and the method is tested using breast cancer specimens immunostained for CK-19 and estrogen receptors.
This image analysis easily discriminates CK-19 and estrogen receptor positivity in prepared breast cancer specimens. The method is easy to perform, without the need for previous image transformations.
Compared to previous methods, this method proved more accurate in estimating the actual colours that an observer recognizes as positive after immunostaining. Further studies are needed to evaluate whether this method is efficient enough to be applied in clinical practice.
Anticancer research 12/2009; 29(12):4995-8. · 1.73 Impact Factor
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ABSTRACT: As modern women delay childbearing, pregnancy-associated breast cancer (PABC) becomes a more frequent problem faced by oncologists, gynecologists, and obstetricians alike. However, no evidence exists concerning the management of this condition.
We summarized the current literature regarding epidemiology, pathology, diagnosis, treatment and prognosis of PABC. Data were collected by searching PubMed and Medline for the period from 1950 to 2007.
There are no randomized controlled trials regarding PABC management. Current evidence suggests that diagnosis may be carried out with limitations regarding staging; surgical treatment may be performed as for the non-pregnant women. Radiotherapy and endocrine therapy are contraindicated during pregnancy, while chemotherapy is allowed after the first trimester. Prognosis is considered poor. Subsequent pregnancy is allowed only 2 years after completing treatment.
Due to lack of prospective randomized controlled clinical studies, both ongoing studies and future evidence are expected to solve problems related to breast cancer management during pregnancy.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 09/2008; 34(8):837-43. · 2.56 Impact Factor
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ABSTRACT: The purpose was to compare the accuracy of multidetector CT (MDCT) on a 16-row CT scanner and magnetic resonance (MR) imaging in the characterization of ovarian masses. Preoperative CT examination of the abdomen and MR imaging of the pelvis was performed in 67 women, with clinically or sonographically detected adnexal masses. The CT examinations were performed on a 16-row CT scanner, and the protocol included scanning of the abdomen during the portal phase, using a detector collimation of 16 x 0.75 mm and a pitch of 1.2. We used a 1.5-T magnet unit to perform T1, T2 and fat-suppressed T1-weighted sequences, before and after intravenous administration of gadolinium chelate compounds. The accuracy of multidetector CT and MR imaging in the differentiation between benign and malignant ovarian masses was evaluated, using histopathologic results as the standard of reference. The sensitivity, specificity and accuracy of MDCT in the characterization of ovarian masses were 90.5%, 93.7% and 92.9%, respectively, and that of MR imaging 95.2%, 98.4% and 97.6%, respectively. Although MRI performed slightly better, this did not reach statistical significance. In conclusion, both MDCT on a 16-row CT scanner and MR imaging demonstrated satisfactory results in the characterization of ovarian masses.
European Radiology 06/2008; 18(5):1049-57. · 3.22 Impact Factor
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ABSTRACT: Embolization of the uterine artery represents a widely accepted invasive method for treatment of fibroids. It is indicated for women in perimenopause with symptomatic leiomyomas who do not require preservation of their fertility functions. The method should be used with caution excluding infectious diseases and malignancies. A experienced interventional radiologist is needed for the completion of the method. Complications are infrequent with rate reaching almost 5%. Few knowledge exists about pregnancy outcomes after uterine artery embolization. For this reason it should be used with caution in young women with symptomatic leiomyomas willing to conceive.
Akusherstvo i ginekologiia 01/2008; 47(1):38-42.
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ABSTRACT: The PDGF pathway is essential in tumor angiogenesis. Although the expression of the PDGF receptors has been excessively studied on breast cancer cells, few studies exist on PDGFR expression on the tumor endothelial cells. In the present study, it is investigated whether endothelial PDGF receptors' expression is altered in breast cancer. Endothelial PDGFRalpha and beta expression was initially studied under the influence of tumor conditioned medium derived from a breast cancer cell line. Following tissue culture experiments the endothelial expression of both receptors was studied on formalin-fixed paraffin-embedded tissue sections of normal breast and breast cancer specimens. The tissue culture experiment revealed a possible up-regulation of endothelial PDGFRbeta by breast cancer environment. Immunohistochemistry verified the result since 69.7% of the breast cancer sections were positive for PDGFRbeta compared to 43.3% of normal breast sections (p<0.05). No statistical difference was revealed by studying PDGFRalpha expression. In conclusion, our findings support the thesis of possible anti-PDGFRbeta anti-angiogenic therapy, in cases of endothelial PDGFRbeta-expressing breast cancer.
Oncology Reports 05/2007; 17(5):1115-9. · 1.84 Impact Factor
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ABSTRACT: Pathologic nipple discharge presents a diagnostic dilemma as no one diagnostic test has proven clearly superior to any other in the differentiation of benign versus malignant conditions. This is a clinical study of 80 patients with unilateral suspicious nipple discharge whose complete investigation included histological evaluation. A transnipple approach was used to identify, get to and excise the breast tissue suspicious of having caused the pathological discharge, with a pyramide-shaped tissue dissection (pyramidectomy). Specimens satisfactory for histological evaluation were obtained in all cases. Breast cancer was detected in six cases, papillomatosis in four, papillomas in 30, fibrocystic changes in five, ductal ectasia in 31 and non specific findings in four cases. There were no intraoperative complications and functional and healing-esthetic recovery was very good in all cases. It is concluded that transnipple pyramidectomy is a useful technique for a reliable diagnosis of pathologic nipple discharge.
European journal of gynaecological oncology 02/2007; 28(4):307-9. · 0.47 Impact Factor
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ABSTRACT: The purpose of this prospective study was to investigate the efficacy of preoperative administration of recombinant human erythropoietin in patients with gynecological cancer.
The study included 38 women with gynecological cancer who were divided randomly in two groups. Study group A included 20 women with gynecological cancer who received recombinant human erythropoietin (rHuEPO) plus iron supplementation for ten days before surgery and five days postoperatively. Group B (controls) included 18 patients who received only iron supplementation for the same time period. Blood samples were obtained on days -10, -3, 0, +3, +5, +10.
The mean hemoglobin level was significantly higher in group A than in group B on the day of the operation and remained significantly higher postoperatively while an inverse relationship was observed for mean ferritin values in the two groups.
Preoperative administration of rHuEPO in patients with gynecological cancer seems to be effective in the blood management of these patients.
Clinical and experimental obstetrics & gynecology 02/2005; 32(2):129-31. · 0.43 Impact Factor
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ABSTRACT: Although leiomyomas usually remain asymptomatic during pregnancy, they may complicate its course. In this study, pregnancy outcome observed when myomectomy was performed during pregnancy in carefully selected patients is presented.
A prospective cohort study of 13 women who underwent myomectomy during pregnancy between January 1994 and December 2001. Surgical management of leiomyoma was required on the basis of characteristics of the myoma and symptoms.
Among a total of 15,579 women registered at the authors' prenatal clinic, 622 consecutive pregnant women had sonographically identified myoma; hence, the incidence was 3.9% (95% CI 3.6-4.3%). The vast majority of these women was asymptomatic during pregnancy or managed conservatively (97.4%; 95% CI 96-98%). Among 622 pregnant patients with leiomyoma, 13 presented with complications during pregnancy that required surgical intervention (2.1%; 95% CI 0.9-3.2%), due to increase in lesion size causing discomfort and/or severe abdominal pain not responding to conservative management with analgesic and non-steroidal anti-inflammatory drug medication. In 92% of these cases, successful myomectomy was performed and the pregnancy progressed to term without further complications.
These data provide reassurance for pregnant women with uterine myoma. Surgical management of uterine leiomyoma during pregnancy may be successfully performed in carefully selected patients.
Human Reproduction 09/2003; 18(8):1699-702. · 4.47 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the efficacy of preoperative recombinant human erythropoietin (rHuEPO) treatment in a group of mildly anemic women.
This randomized controlled study included 50 healthy, mildly anemic women who underwent total hysterectomy for leiomyomas. The study group (Group A) included 23 women who received rHuEPO 600 U/kg once weekly for three weeks, plus iron supplementation. The control group (Group B) included 27 women who received only iron supplementation. Blood samples were obtained on days -14, -7, 0, +3, +7 and +14.
An increase in preoperative mean hemoglobin concentration was noted in both groups; however, the increase was significantly higher in Group A throughout the study period. Mean reticulocyte count was also significantly higher in this group, whereas mean ferritin level was significantly lower. No postoperative transfusion was needed in Group A, whereas five women were transfused in Group B.
Rapid and persistent improvement of hematologic parameters makes the use of rHuEPO for preoperative treatment of mildly anemic women with benign uterine pathology a very interesting approach.
Clinical and experimental obstetrics & gynecology 02/2003; 30(4):235-8. · 0.43 Impact Factor
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ABSTRACT: To investigate whether central diathermy ball cauterization after loop excision affects satisfactory colposcopy at follow-up.
One hundred one consecutive women with the squamocolumnar junction visible at the ectocervix scheduled for loop excision were assigned alternately into two groups. In group A, diathermy ball cauterization was applied to the entire crater following excision. In group B, cauterization was avoided in a 2-3-mm zone around the new os. The women were re-examined 4 months postoperatively by colposcopy and microcolpohysteroscopy with specific intention to identify the location of the squamocolumnar junction. The examiners performing colposcopy and microcolpohysteroscopy were not aware of each other's interpretation, or of the method of cauterization used.
Follow-up colposcopy was satisfactory in 12 women in group A (24%) and 47 women in group B (92.2%) (P <.001). Forty-three women (86%) in group A and ten in group B (19.6%) had the squamocolumnar junction partly or fully located within the cervical canal (P <.001). Microcolpohysteroscopy located the squamocolumnar junction at a mean depth of 4.5 +/- 2.4 mm (+/- standard deviation [SD]) in the women in group A and 1 +/- 0.9 mm in group B (P <.001). Microcolpohysteroscopy could not be performed in 13 women in group A (26%) and one woman in group B (2%) (P <.001).
Diathermy ball cauterization at the new cervical os after loop excision results in a shift of the squamocolumnar junction toward the endocervical canal, and predisposes to cervical stenosis, thereby decreasing satisfactory colposcopy rates.
Obstetrics and Gynecology 05/2001; 97(4):617-20. · 4.73 Impact Factor
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ABSTRACT: To explore the association of the estrogen receptor two-allele (point) polymorphism and multiallele (microsatellite) polymorphism with endometriosis.
Case-control study.
Genetics and Endoscopy Unit, Department of Obstetrics and Gynecology, Ioannina University HOSPITAL, Ioannina, Greece.
Fifty-seven women with surgically and histologically diagnosed endometriosis of stages I-IV.
Diagnostic laparoscopy.
Frequency and distribution of the estrogen receptor gene polymorphisms.
There was a statistically significant difference between the patients and the controls in the frequency of the two-allele Pvu II polymorphism (0.72 vs. 0.49) and in the median repeats of the (TA)n multiallele polymorphism (15 vs. 20 repeats). In both groups, linkage was found between the fewer (TA)n repeats (range, 12-19) and the positive Pvu II polymorphism.
The variability of the estrogen receptor gene likely contributes to the pathogenesis of endometriosis.
Fertility and Sterility 08/1999; 72(1):164-6. · 3.56 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the effect of tamoxifen therapy on the endometrium by transvaginal color Doppler sonography and on lipid profile focusing on lipoprotein (a) [Lp(a)] levels. Seventy-five postmenopausal breast cancer patients were examined by transvaginal color Doppler sonography and serum Lp(a) levels. Lipid parameters were measured after overnight fasting. Forty of the patients were treated with tamoxifen (20-30 mg/day) for at least 1 year. The remaining 35 patients did not receive tamoxifen and were used as controls. Statistical analysis was performed using t-test and Mann-Whitney U-test (Systat version 5.0). The patients receiving tamoxifen had significantly thicker endometrium (7.9 +/- 3.6 mm) compared to the control group (4.5 +/- 1.8 mm) (p < or = 0.001). The mean pulsatility index and resistance index of the uterine arteries in the tamoxifen group were 2.063 +/- 0.49 and 0.83 +/- 0.07, respectively, and were significantly lower than those of the control group (2.69 +/- 0.16 and 0.88 +/- 0.02) (p < 0.001). In addition, tamoxifen decreased total cholesterol (p < 0.001) and low-density lipoprotein cholesterol (p <0.001) and apolipoprotein B (p < 0.05) significantly. Tamoxifen also increased high density lipoprotein cholesterol (p < 0.05) and apolipoprotein A-I (p < 0.05). These results indicate that tamoxifen stimulates the endometrium and acts as an anti-atherogenic agent in postmenopausal women.
Gynecological Endocrinology 06/1998; 12(3):185-9. · 1.58 Impact Factor
