Anastasiadis P

The angiogenic "vascular endothelial growth factor/flk-1(KDR) receptor" pathway in patients with endometrial carcinoma: prognostic and therapeutic implications.

Vascular endothelial growth factor (VEGF) is an important endothelial cell mitogen associated with increased angiogenesis and aggressive tumor behavior. Its stimulating effect on endothelial cells basically is dependent on the presence of specific VEGF receptors, such as the flk‐1(KDR) receptor. This study investigates the roles of VEGF and of a functionally intact angiogenic pathway, “VEGF/flk‐1(KDR),” in patients with endometrial carcinoma and their significance in prognosis and therapy.

Angiogenic co-operation of VEGF and stromal cell TP in endometrial carcinomas.

Vascular endothelial growth factor (VEGF) and thymidine phosphorylase (TP) are important angiogenic enzymes, inducing new blood vessel formation in many human malignancies. In this study, the immunohistochemical expression of the two molecules was analysed in a series of 121 endometrial carcinomas. VEGF was expressed exclusively in cancer cells, while TP expression was shown in cancer cells (TPcc) and in stromal cells (TPsc) of both fibroblastic and myometrial origin. In all cases, enzymatic detection was particularly evident at the invading tumour front. At this site, TPsc, but not VEGF, expression was associated with non‐endometrioid‐type carcinomas, high tumour grade, deep myometrial invasion, and advanced stage. VEGF, but not TP, expression was related to increased angiogenesis (p=0.01). Double stratification of the two factors, however, marked VEGF/TPsc co‐expression as the most potent angiogenic phenotype (p=0.008), suggesting a synergistic function. Survival analysis revealed that VEGF and TPsc, whether expressed alone or in combination, define poor prognosis. In multivariate analysis, however, stage of disease (p<0.0001, t‐ratio 4.4) and VEGF expression (p=0.01, t‐ratio 2.4) were the most important prognostic variables. Furthermore, VEGF expression emerged as the only independent prognostic variable in stage I endometrial carcinomas (p=0.04, t‐ratio 1.9). This was not shown for TP, probably because of its close association with histopathological parameters. In conclusion, VEGF is a major angiogenic factor in endometrial carcinomas and an independent prognostic factor in stage I endometrial disease. TP is not an effective contributor to the angiogenic process, but is associated with aggressive histological features. The two factors, when co‐expressed, play a co‐operative role in the induction of angiogenesis. Copyright

Patterns of episialin/MUC1 expression in endometrial carcinomas and prognostic relevance.

Patterns of episialin/MUC1 expression in endometrial carcinomas and prognostic relevance

Mast cell distribution and density in the normal uterus — metachromatic staining using lectins

This study investigates the number and the distribution of mast cells in the normal human uterus. Reliability of results was ensured by prompt tissue fixation and the use of biotin-labelled lectins in conjunction with the avidin-biotin peroxidase complex (ABC) method. This design revealed that mast cells are, indeed, normal constituents of the human uterus. They occur in large numbers in the myometrium, but are only scanty in the endometrium where they tend to be confined to the stratum basalis. The mean mast cell counts per high power field (MC/HPF), after staining with Canavalia ensiformis agglutinin (Con A), were 17.9MC/HPF in the inner half of the myometrium, and 8.3MC/HPF in the outer half of the myometrium; 2.7MC/HPF in the basalis, and 0.3MC/HPF in the functionalis (P<0.05). There are no apparent differences in the number of mast cells between the normal proliferative and secretory phase endometrium, however, endometrial mast cells are considerably reduced and, apparently, depleted of metachromatic granules during the immediate pre-menstrual phase of the menstrual cycle. It is presumed that this, almost exclusive, presence of mast cells in the basal layer of the endometrial matrix, combined with the discharge of their cytoplasmic granules towards the end of the cycle, may be related with the contracting process preceding menstruation. On the other hand, the relative paucity of mast cells in the functional layer may contribute to the immune tolerance of the gestational endometrium to the implantation of the blastocyst.

Two Episodes of Hemoperitoneum from Luteal Cysts Rupture in a Patient with Congenital Factor X Deficiency

The clinical manifestation of two episodes of hemoperitoneum from ruptured corpus luteum cysts, during the luteal phase of the cycle in a young patient with the rare congenital factor X deficiency, is reported for the first time in literature. The correct diagnosis of the underlying disorder, the gynecological management and the regular follow-up can minimize the risks of this potentially life-threatening hematological disorder.

Interpregnancy interval and the risk of preterm birth in Thrace, Greece

OBJECTIVE To examine the influence of short interpregnancy interval on the prevalence of preterm birth in two, ethically different, Greek populations. STUDY DESIGN We studied 652 urban Christian women and 578 rural, Romany, Muslim women who had had two consecutive, singleton pregnancies. We related the prevalence of preterm birth to the interpregnancy intervals (cut-off point, 6 months). Students t-test, x(2)-test and relative risk estimation were used. RESULTS Preterm birth and interpregnancy intervals less than 6 months occurred more often among Muslims than Christians. Among Muslims, an interval of <6 months was associated with greater prevalence of preterm birth (16% versus 7.3%, P=0.013, RR=2.4 and 95% C.I. 1.3-4.7). Christians did not demonstrate a similar relationship. CONCLUSIONS A short interpregnancy interval seems to be a risk factor for preterm birth in the population of rural, Romany, Muslim women.

Cytologic diagnosis of axillary lymph node metastasis in breast cancer.

OBJECTIVE To compare imprint cytology with histology as a method for rapid intraoperative diagnosis of axillary lymph node metastasis in breast cancer. STUDY DESIGN We evaluated imprint cytology, comparing it with histopathology. A sample of 635 axillary lymph nodes was studied by imprint cytology using both Giemsa stain and hematoxylin-eosin. The results were compared with each other and with those of histopathologic examination. RESULTS The Giemsa stain method, as compared to histopathology, had 94% accuracy, 97% sensitivity, 90% specificity and 94% positive prognostic value. The hematoxylin-eosin stain method was less accurate than the Giemsa stain method as compared to histopathology (accuracy 91%, sensitivity 96%, specificity 83% and positive prognostic value 92%). CONCLUSION These data confirm the value of imprint cytology as a rapid, reliable method of intraoperative assessment of axillary lymph node metastasis in breast cancer. It results in better staging of the disease. It can be used intraoperatively, as an alternative to frozen section, if a pathology laboratory is not available, to exclude stage I patients from further treatment.

Trends in epidemiology of preinvasive and invasive vulvar neoplasias

Abstract Objective: To describe the trends in incidence of preinvasive and invasive vulvar neoplasias in the rural area of Trace, as well as to check the hypothesis that patients found with these two distinct entities represent populations with different epidemiologic characteristics. Patients and Methods: We performed a retrospective study on 34 patients found with invasive vulvar cancer and vulvar intraepithelial neoplasia (VIN) (12 and 22 respectively), who referred to our department from 1986– 1998. Epidemiologic characteristics of the patients were abstracted from medical charts. To evaluate our results we used the direct standardization method (1995 Eur. Population) and χ2 test. Results: The age-adjusted incidence rates for VIN1–2, in situ cancer (CIS)-VIN3 and invasive vulvar cancer were 0.9\100,000, 1.6\100,000 and 1.8\100,000 respectively, while for the whole VIN lesions 2.5\100,000. There were statistically significant differences in most epidemiologic characteristics between the two study groups, one with invasive cancer patients and one with patients found with preinvasive vulvar neoplasia. Conclusions: The overall age-adjusted incidence rate for vulvar neoplasia in Thrace is comparable to the one reported in literature. Our study results confirm that patients with invasive and preinvasive vulvar neoplasia represent populations with different epidemiologic characteristics.

Incidence and Detection of Contralateral Breast Cancer

Abstract: In this study we estimated the efficacy of contralateral breast biopsy as a subsidiary method of early detection of bilateral breast cancer. We performed blind biopsies in the upper outer quadrant of the opposite breast in 195 patients undergoing surgical treatment for primary breast cancer. The histologic examination of the biopsy specimens showed 12 malignant lesions, which accounts for an incidence of 6.1%. In detail, we had two infiltrating ductal cancers, two infiltrating lobular cancers, three ductal in situ cancers, and five lobular in situ cancers. The overall incidence of invasive disease was 2.05%. We concluded that contralateral breast biopsy should be reconsidered as a method for enhancing early detection of contralateral breast cancer in high‐risk groups, especially when it meets the emotional needs of patients. Permission given, it is included in the main surgical treatment of patients, avoiding the cost and complications of anesthesia, and it is cosmetically acceptable, without being an emotional burden for the woman.

Differentiation in contraceptive behavior of the female population in Thrace, Greece

Objective To investigate the factors influencing the contraceptive practice of the female population in the rural area of Thrace, Greece. Methods We conducted a retrospective sociopsychological study on representatives of the two major religious subgroups in Thrace: 127 Orthodox Christians and 120 Muslims. The women were reasonably representative in terms of age, education, marital status and professional life. Interviews covered sexual history and contraceptive use in detail. Results We observed a significant preference of Christians for condoms, and of Muslims for coitus interruptus. The use of the male condom was significantly higher in younger, compared to older, Christians (p < 0.001). Muslim women aged 30–39 years showed a significant preference for coitus interruptus and intrauterine devices, as compared with Christians. Highly educated women of both subgroups did not present statistically significant differences concerning contraception. It was found that, the more intense the sexual activity, the more common the use of the condom for Christians and the more popular the choice of interrupted intercourse for Muslims. Muslims with a permanent sexual relationship preferred interrupted intercourse, while all Muslims with multiple sexual partners used the male condom. Conclusions There is an urgent need to promote information concerning the variety of modern contraceptive options in order to improve the prevalence of contraceptive use and reproductive health in the region of Thrace.