Sennur Ilvan

Oxidative stress in breast cancer.

The present study was undertaken to evaluate the place of oxidative stress on breast cancer. Lipid peroxidation as evidenced by malondialdehyde (MDA) and the status of the antioxidants superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) were estimated in tissues of 10 fibroadenoma and 40 breast cancer patients. Lipid peroxidation in breast cancer tissues was enhanced compared to nonmalignant tissues (p<0.001). Similarly, antioxidants SOD (p<0.001) and GPx (p=0.007) in tumor tissues significantly were increased. On the contrary, CAT activity was found significantly decreased (p<0.001). We found that oxidant/antioxidant status was independent from any prognostic factors concerning breast cancer. The results of our study have shown higher oxygen-free-radical production and decreased CAT activity support the oxidative stress hypothesis in breast carcinogenesis.

Inflammatory myofibroblastic tumor (inflammatory pseudotumor) of the breast

Inflammatory myofibroblastic tumor of the lung has often been reported but extrapulmonary cases are rare. Here we describe a case of inflammatory myofibroblastic tumor of the breast in a 60‐year‐old woman. This is only the eleventh case reported in the English language literature. The patient was free of disease 85 months after surgery.

Placental apoptosis and adhesion molecules expression in the placenta and the maternal placental bed of pregnancies complicated by fetal growth restriction with and without pre-eclampsia

Summary The aim of the study was to examine the expression of adhesion molecules VCAM-1 and ICAM-3 in placental tissue samples and placental bed (maternal decidual tissue) biopsies of pregnancies complicated by pre-eclampsia (PE) and fetal growth restriction (FGR), and to determine whether PE and FGR are associated with an increase in placental apoptosis. We studied placentas and placental bed samples of 49 third trimester pregnancies complicated by FGR (26 with associated PE, 23 without PE) and 25 normotensive healthy pregnant women. Placental apoptosis was assessed by the TUNEL method. Immunohistochemistry was used to assess expression of the VCAM-1 and ICAM-3. There was no significant difference in the staining intensity of VCAM-1 in placentas ( p = 0.472) and placental bed biopsies ( p = 0.754) of women delivering appropriate for gestational age and growth restricted fetuses (with and without associated PE). The amount of lymphocytes staining positively with ICAM-3 was significantly higher in both placental and placental bed biopsies of women delivering growth restricted fetuses compared with control pregnancies ( p < 0.001). Fetal growth restricted pregnancies with associated PE showed higher staining of ICAM-3 in placental compared with placental bed samples ( p = 0.049). In fetal growth restricted placentas, apoptotic nuclei were more abundant compared with control placentas ( p < 0.001). Increased expression of ICAM-3 on lymphocyte surface of both maternal and fetal side, suggests lymphocyte overactivation in PE and FGR. Increased placental apoptosis may play an important role in the pathogenesis or sequelae of PE.

Secretory carcinoma of the breast. Case report and review of the literature.

We report an elderly case of an indolent breast tumor in a 66-year-old woman. The patient presented with a locally advanced mass in the right breast that was present for 13 years, accompanied by bleeding and ulceration since the last 5 years. She had a modified radical mastectomy with axillary dissection. She was found to have secretory carcinoma with a tumor size of 8 × 4 × 4 cm in diameter. Two out of the 22 removed lymph nodes were involved. The secretory material stained positive with lactalbumin, as well as showed positivity with PAS. The patient received six cycles of adjuvant chemotherapy followed by chest wall irradiation. She is disease free with a follow-up period of 24 months. Preoperative chemotherapy should be primarily replaced by curative surgery in such indolent cancers, despite locally advanced disease.

Nodular Fasciitis of the Breast Previously Misdiagnosed as Breast Carcinoma.

Background: Nodular fasciitis of the breast is a rare be-nign pathology that can mimic breast cancer clinically, radiologically, and histopathologically. Case Report: An 18-year-old female patient had first visited a physician in a different center with the complaint of a lump in her left breast. Breast examination had revealed a palpable mass located in the left upper outer quadrant. Ultrasonography had demonstrated a hypo-echoic lesion. Excisional biopsy of the lump had been performed and histopathologic examination misdiagnosed this lump as a mesenchymal tumor. The patient was then referred to our clinic for further investigations. Pathologic revision was performed and the diagnosis of nodular fasciitis of the breast was established. Conclusion: Awareness of this rare clinical entity, nodular fasciitis, in the breast eliminates the misdiagnosis of breast cancer.

Synchronous Primary Cancers of the Endometrium and Ovary With the Same Histopathologic Type Versus Endometrial Cancer With Ovarian Metastasis: A Single Institution Review of 72 Cases.

Objective The purpose of this study was to evaluate the clinicopathological characteristics and survival outcomes of women with simultaneous endometrial and ovarian carcinomas having the same histopathologic type. Materials and Methods A review of medical records from 1997 to 2015 identified 72 patients with simultaneous carcinomas of the endometrium and ovary with the same histopathologic type. Patients with synchronous primary cancers of endometrium and ovary (SCEOs) were compared with patients with primary endometrial cancer with ovarian metastasis (ECOM). Clinical and pathological data were obtained from the patients’ medical records. Clinicopathological variables including categorical data were analyzed by &khgr;2 or Fisher exact test and continuous data by a Student t test. A Kaplan-Meier survival analysis was performed and compared by using the log-rank test. Results A univariate and multivariate analysis of 72 patients with SCEO with the same histopathologic type revealed that SCEO is an independent prognostic factor of 10-year overall survival. There were 31 patients in the SCEO group and 41 patients in the ECOM group. With a mean follow-up time of 68.2 months, the 10-year overall survival rates were 61.3% and 36.6% in SCEO and ECOM groups, respectively (P = 0.029). Age, menopausal status, stage of ovarian cancer, performing lymphadenectomy, grade of endometrial tumor, omental metastasis, and residual tumor were found to be significant risk factors for recurrence in the synchronous group. Conclusions The differentiation between SCEO and ECOM is of great clinical importance while our results showed a better prognosis for patients with SCEO compared with patients with ECOM. More aggressive therapeutic approaches may be considered for patients with SCEO who are older, postmenopausal, and/or have advanced grade of endometrial tumor, omental metastasis, and residual tumor. Lymphadenectomy should be performed in every patient with SCEO.

Reproducibility of endometrial intraepithelial neoplasia diagnosis is good, but influenced by the diagnostic style of pathologists

Endometrial intraepithelial neoplasia (EIN) applies specific diagnostic criteria to designate a monoclonal endometrial preinvasive glandular proliferation known from previous studies to confer a 45-fold increased risk for endometrial cancer. In this international study we estimate accuracy and precision of EIN diagnosis among 20 reviewing pathologists in different practice environments, and with differing levels of experience and training. Sixty-two endometrial biopsies diagnosed as benign, EIN, or adenocarcinoma by consensus of two expert subspecialty pathologists were used as a reference comparison to assess diagnostic accuracy of 20 reviewing pathologists. Interobserver reproducibility among the 20 reviewers provided a measure of diagnostic precision. Before evaluating cases, observers were self-trained by reviewing published textbook and/or online EIN diagnostic guidelines. Demographics of the reviewing pathologists, and their impressions regarding implementation of EIN terminology were recorded. Seventy-nine percent of the 20 reviewing pathologists’ diagnoses were exactly concordant with the expert consensus (accuracy). The interobserver weighted κ values of 3-class EIN scheme (benign, EIN, carcinoma) diagnoses between expert consensus and each of reviewing pathologists averaged 0.72 (reproducibility, or precision). Reviewing pathologists demonstrated one of three diagnostic styles, which varied in the repertoire of diagnoses commonly used, and their nonrandom response to potentially confounding diagnostic features such as endometrial polyp, altered differentiation, background hormonal effects, and technically poor preparations. EIN diagnostic strategies can be learned and implemented from standard teaching materials with a high degree of reproducibility, but is impacted by the personal diagnostic style of each pathologist in responding to potential diagnostic confounders.

Rare cutaneous metastasis in vulvar squamous cell carcinoma without any distant organ spread.

Vulvar cancer is the fourth most common gynaecologic cancer, representing 5% of malignancies of the female genital tract. It occurs most commonly in post-menopausal women with a mean age of 65. In recent years, an increase in incidence rates in young women has been observed. In the United States, about 4900 cases of vulvar cancer are diagnosed and 1000 patients die of vulvar cancer per year (Siegel et al. 2014). Two different pathways for vulvar carcinogenesis have been identified: HPV-dependent and induced by chronic inflammation. HPV is responsible for 60% for all cases. Of the vulvar cancers related to HPV about 55.5% are caused by two strains, HPV-16 or HPV-33 (Insinga et al. 2008). There are three ways that vulvar cancer spreads. First, direct extension to adjacent structures, such as vagina, urethra, clitoris, anüs. A second way of spread is by the lymphatic route. The third way of tumour spread is the haematogenous route associated with advanced disease. Cutaneous metastasis of vulvar cancer is very rare and only nine cases had been reported till 2010 (Wang et al. 2010).

Receptor Expression Discrepancy between Primary and Metastatic Breast Cancer Lesions

SummaryBackground: Recent studies have shown that the expression status of hormone receptors and human epidermal growth factor receptor 2 (HER2) in breast cancer may change during disease progression. The aim of this study was to determine and compare the estrogen receptor (ER), progesterone receptor (PR), and HER2 expression status in primary breast cancer and metastatic lesions. Methods: 58 patients with registered biopsy reports or available samples of the primary tumor and distant metastases were included in the final analysis. Biopsy samples were re-stained using immunohistochemical methods to determine receptor status (if not already recorded in previous reports) and re-examined by 2 independent pathologists. Results: Discordance rates for receptor expression status of the primary tumor and distant metastases for ER, PR, and HER2 were 17.4, 45.4, and 13.3%, respectively. No statistically significant difference in overall survival due to receptor expression discordance between the primary tumor and metastatic sites (p > 0.05) was found, although a tendency toward worse survival time was observed in patients with HER2 expression discrepancies. Conclusion: This study showed receptor discordance rates between primary and metastatic breast cancer sites for ER, PR, and HER2 of 17.8, 45.4, and 13.3%, respectively. Re-biopsy and IHC evaluation of metastatic sites for receptor status may change treatment decisions in patients with relapsed/progressed BC.

Ovarian metastasis from malignant thymoma

donors was reported in China [3]. Multistage randomized cluster sampling was used. Clusters for each of the two counties of Anhui were randomly selected from clusters used in a previous study [4]. In each cluster, 60 questionnaires were filled out anonymously by selected marriedwomenwhosehusbandsworked away fromhome, during faceto-face interviews conducted by femalemedical students. If the selected woman did not fully participate, she was replaced by another woman. Information on demographic characteristics and knowledge about condoms and condom use was obtained by the questionnaire. Data were analyzed using SPSS version 11(SPSS, Chicago, IL, USA). A total of 564 women participated in the survey. The demographic characteristics of the participants are given in Table 1. Thewomen had a low level of knowledge about condoms. The overall rate of correct answers given in response to questions about condoms was 45.9%. The proportions of women who knew that “using condoms can prevent STIs” and “using condoms can prevent HIV” were 57.3% and 56.2%, respectively. The proportions of respondents who knew that condoms have expiration dates and were unclear whether condoms could be reused were 47.0% and 41.0%, respectively. The proportion of women who knew that condoms are most effective against pregnancy when used consistently and correctly was 71.1%; 53.4% believed that condoms are effective if they are put on immediately before ejaculation during sexual intercourse. Of the 564 respondents, 92.7%were currently using a form of contraception, mainly female sterilization (69.6%) or an intrauterine device (27.7%). Other measures were oral contraceptives (0.8%), condoms (1.3%), and others (0.6%). Only 2.9% (95% CI,1.6–4.2) of the respondents using contraceptive measures reported that they had used condomswithinmarriage at least once in their life (ever used), and 97.1% reported that they had never used condoms. The present study found that many of the women did not know that condoms can prevent transmission of HIV or STIs and most had never used condoms within marriage. Potential reasons for not using condomsmight be that thewomenwere already using a contraceptive measure and did not think they need to protect themselves against STIs or HIV. This lack of knowledge and low level of use within marriage can put these women at high risk of infection. The present study underscores the need to promote condom use among married women whose husbands are migrant workers even if other contraceptive methods are being used, particularly in areas with high rates of HIV infection.