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Correlation between shrinkage of uterine leiomyoma treated with gnrh agonist and interstitial deletion of chromosome 7
THURSDAY,
SEPTEMBER
7
P4.09 GYN-ONCOLOGY P4.09.01 ANALYSIS OF 38 CASES OF CHORIOCARCINOMA B.K. N.R. Mondal, Cancer Welfare Home and Research Institute, Thakurpukur, Calcutta, India. Objective: A study epidemiology & treatment of choriocarcinoma. Study Methods: Retrospective. 38 cases were analyzed from 1992-98. Predominantly young women, Muslim, between the ages of 20-30 yrs, in their first or second pregnancy, mostly from a rural population, suffering from the condition. Diagnosis was made by clinical examination, histology report, serum B-HCG, U.S.G., Chest X-ray. 12138 cases the precedent event was hydatidiform mole. Result: 9 cases had hysterectomy in other peripheral hospital because of uncontrolled hemorrhage. All patients received chemotherapy -single or multiple drug. 4 cases were lost to follow-up. 34 cases were followed up for one year without any recurrence. 1 case had successful full term pregnancy 4 years after completion of treatment without any fetal abnormality. Conclusion: Chemotherapy should be the first line of treatment in choriocarcinoma. Most cases respond to methotraxate but in cases with high B-HCG in serum, metastsis & recurrence multiple drug has been useful. Pregnancy can be successfully undertaken 2-3 yrs. after completion of treatment. Hysterectomy is advised only in cases of uncontrolled hemorrhage due to uterine perforation by malignancy.
P4.09.02 ANALYTIC EPIDEMIOLOGY OF EPITHELIAL OVARIAN CANCER WITH A SPECIAL REFERENCE TO DEVELOPING COUNTRIES: AN EVIDENCE-BASED ANALYSIS M.M.F. Fathalla (l), R. Foy (2) (1) Dept. OBIGYN, Assiut University, Assiut, Egypt. (2) Clinical Effectiveness Network, Edinburgh, UK. Objective: The review aims to assess studies tackling descriptive and analytic epidemiology of epithelial ovarian cancer with a particular reference to the picture in developing countries. Study Method Original article of analytic epidemiology of ovarian cancer retrieved through Medline, hand searching and reference list checking was done as well. Results: The reported geographic difference in incidence cannot be accepted due to difference in data collection and quality. History of ovarian cancer in a 1”’degree relative is associated with a RR of 2.8-3.1. Each term pregnancy confers 14.16% risk reduction. Combined oral contraceptive use is protective (RR 0.46-0.55 for more than five years use). Association of depoprovera, HRT and infertility drugs with risk is uncertain. Perineal talc exposure and high-risk diet such as animal fat, lactose and coffee are associated with a RR of ~2. A history of tubal ligation or hysterectomy is associated with decreased risk. In the developing world, monitoring the risk factors shows that there is evidence toward an increasing adoption of a high-risk behavior. Conclusion: There is the need for better quality data on ovarian cancer in developing countries. Establishing cancer registries will help. With the evidence for a trend to adopt high-risk behavior for ovarian cancer, primary prevention hold the main hope, especially in developing countries. Achieving tertiary and secondary prevention is difficult and expensive. Primary prevention holds the main hope for developing countries. Better understanding of the risk factors can help in this direction.
P4.09.03 COMPARISON OF CONE MARGINS STATUS IN HIGH GRADE CIN TREATED BY SURGICAL CERVICAL AMPUTATION, COLD KNIFE CONIZATION AND LEEP AND THE ROLE OF FROZEN SECTION EXAMINATION IN PREDICTING INVOLVED MARGINS J.P. Carvalho, F.M. Carvalho, E.A.G. Pereyra, C.I. Parellada, P.L Schivartche, .I. Souen, Hospital das Clinicas, Universidade de SBo Paula, Brazil. Objectives: The aim of the study was to investigate the status of the cone margins in patients with high grade CIN treated by three different procedures: cervical amputation, cold knife conization and loop
109
electrosurgical excisional procedure (LEEP) and the role of frozen section examination in predicting the involved margins. Study Methods: One hundred and fifty four women with high grade CIN were included: 41 cervical amputation, 60 cold knife conization and 53 LEEP. The cone margins were evaluated. A subgroup of 25 women, older than 40 were submitted to conization, frozen section examination of the cone followed by hysterectomy. Results: The margins were positive in 8141 amputation, 28160 conization and 24153 LEEP. Age was the mean factor related to involved margins. Frozen section showed involved margins in 15125 women. All of them were confirmed by permanent sections. Residual disease was present in the uterus in 11115 women with cone involved margins. Conclusions: Margins involvement occurred in all groups but were higher in older women. Frozen section examination was accurate in the evaluation of margins status.
P4.09.04 CORRELATION BETWEEN SHRINKAGE OF UTERINE LEIOMYOMA TREATED WITH GNRH AGONIST AND ESTROGEN RECEmOR ALPHA GENE POLYMORPHISM A.Tsuiimura, N. Kawamura, K. Minakuchi, S. Ogita, Dept. OBIGYN, Osaka City University Medical School, Osaka, Japan. Objective: To determine the correlation between shrinkage of uterine leiomyoma treated with GnRH agonist and estrogen receptor (ER) alpha gene polymorphism of uterine leiomyoma tissue. Study Methods: 35 women with terine leiomyoma who were treated with GnRH agonist before surgery were studied. The volume of the largest myoma nodule was measured by MRI before and 3 months after the beginning of GnRH agonist treatment and the percent reduction in myoma volume was calculated. Genomix DNA was extracted from leiomyoma tissue and a part of the intron 1 ER alpha gene (1.3kbp) was amplified by PCR. The PCR products were then digested with a restriction endonuclease, Pvu-II or Xba-I. Genotypic polymorphism was defined as XX or PP (Absence of a restriction site on both alleles), xx or pp (presence of a restriction site on both alleles) and Xx or Pp (heterozygous). Results: The distribution of the Pvu-II and Xba-I RFLPs was as follows: five PP’s (14%), 15Pp’s (43%), 15 pp’s (43%), four Xx’s (ll%), eight Xx’s (23%) and 23 xx’s (66%). The mean percent reduction in volume of the largest myoma was 8*39% for PP, 4*66% for Pp; 41*21% for pp; 14*17% for Xx, 24*34% for Xx and 18*60% for xx. Uterine myoma with the pp genotype was thus significantly likely to shrink than the other Pvu-II genotypes (p=O.O36). There was no significant correlation between the shrinkage of uterine leiomyoma and Xba-I genotypes. Conclusion: This study showed that the extent of shrinkage of uterine leiomyoma treated with GnRH agonist was related to ER alpha gene polymorphism of uterine leiomyoma tissue.
P4.09.05 CORRELATION BETWEEN SHRINKAGE OF UTERINE LEIOMYOMA TREATED WITH GNRH AGONIST AND INTERSTITIAL DELETION OF CHROMOSOME 7 K. N. Kawamura, A. Tsujimura, S. Ogita, Dept. OBIGYN, Osaka City University Medical School, Osaka, Japan. Objectives: The purpose of this study was to investigate the correlation between shrinkage of uterine leiomyoma treated with GnRH agonist and interstitial deletion of chromosome 7q, which is one of the most common chromosomal changes associated with uterine leiomyoma. Study Methods: This study covered 31 women with uterine leiomyoma who were treated with GnRH agonist before surgery. The volume of the largest myoma nodule was measured by means of MRI before and 3 months after the beginning of GnRH agonist treatment, and the percentage of volume reduction was calculated. Genomic DNA was extracted from leiomyoma tissue and peripheral blood and amplified by PCR using florescently-tagged oligonucleotide primers of 12 microsatellite loci on chromosome 7. The PCR products were analyzed for loss of heterozygosity (LOH) by using an ABI 310 automated florescent DNA sequencer. Results: Of the 31 informative tumors, 5 (16%) showed LOH with deletion of common region D7S419. The mean percent reduction in volume of the largest myoma with LOH was 32*13% and without LOH was 18*58% (not significant). One tumor showed interstitial deletion of
110
both alleles and a reduction in volume of 19%. Another tumor showed an extra band and an increase in volume of 13%. Conclusions: This study with microsatellite LOH analysis revealed that 16% of uterine leiomyomas showed interstitial deletion of chromosome 7q. Although the existence of tumor suppressor genes in this region was suggested, there was no significant correlation between shrinkage of uterine leiomyoma treated with GnRH agonist and interstitial deletion of chromosome 7q.
P4.09.06 CORRELATION OF DESCRIPTIVE SONOGRAPHIC CRlTERIA FOR ADNEXAL TUMORS AND OVARIAN MALIGNANCIES G. Ivanovic, D. Ivanovic, S. Kadija, V. Milenkovic, SV Petkovic, M. Radovic, IJ Mirkovic. Department of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Yugoslavia Objective: The aim of this study was to determine value of sonographic criteria in prediction of malignant potential of ovarian tumors. Study Methods: Our study included 112 patients after the surgical procedure on our clinic during two years with verified malignant ovarian tumor. We analyzed their sonographic findings as a part of routine preoperative treatment. Results: Among 112 patients 3 of them (3,36%) sonographicaly had unilocular tumor, 3 (3,36%) unilocular cystic To, 15 (16,8%) multilocular To, 69 (77,28%) multilocular solid To, 23 (64%) solid To. Results of our study showed that there is no absolutely specific ultrasound pattern which can show us whether the ovarian tumor is malignant or not, with one exception; malignant ovarian tumors more frequently have complex sonographic pattern. Conclusions: However as a conclusion we can say that despite inability to predict malignancy accurately echographic findings will frequently assist the ultrasonographer in making a correct diagnosis and can be of the crucial significance in decision making process about further therapeutic procedures.
P4.09.07 CYTOKERATIN 19 mRNA: A NEW MARKER FOR DETECTION OF METASTASES IN LYMPH NODES OF GYNECOLOGICAL CANCER PATIENTS M. Kanabu, T. Izutu, T. Kagabu, Dept. OBIGYN, Iwate Medical University, Morioka, Japan. Objectives: Lymph node metastasis is known as a significant predictor of prognosis in gynecological cancer patients. Recently, reverse transcriptase polymerase chain reaction (RT-PCR) has been applied to detecting micrometastasis. It is reported that cytokeratin 19 (CK-19) mRNA is not expressed in the peripheral blood cells and lymph nodes of the healthy subjects. Detection of DNA fragments of CK-19 in the lymph nodes suggests the existence of epithelial malignant tumor cells. We examined whether CK-19 expression can be used as a tumor marker for lymph nodes metastasis in gynecological cancer patients. Study Methods: We examined 7 gynecological cancer tumors, 3 types of gynecological cancer cell lines and 59 lymph nodes obtained from 16 gynecological cancer patients who underwent curative operation and were histologically diagnosed, using RT-PCR to amplify mRNAs for CK-19. Results: CK-19 mRNA was detected in 6 gynecological cancer tumors (85.7%). CK-19 mRNA was detected in all of gynecological cancer cell lines. CK-19 mRNA was detected in 2 cases of the histological metastasis (66.7%). And CK-19 mRNA was not detected in all of the histological no metastatic cases (13 cases). Conclusions: Our results indicate that CK-19 is a useful tumor marker for lymph nodes metastasis in gynecological cancer.
P4.09.08 DIAGNOSIS OF THE INVASIVE CERVICAL CARCINOMA AFTER THE CONISATION Kesic V, Pantovic S, Petkovic S, Argirovic R, Milenkovic V, Mirkovic Lj, Radovic M., Department of Gynecology and Obstetrics, Clinical center of Serbia, Belgrade, Yugoslavia Objectives: Due to the fact that cervical biopsy don’t always recognize the most severe changes on the uterine cervix, it has been suggested that
THURSDAY,
SEPTEMBER
application of destructive methods in diagnosis of cervical intraepithelial neoplasia (GIN) may result in overlooking of invasive uterine carcinoma. Study Methods: In order to evaluate diagnostic reliability of target biopsy and consequently the incidence of cervical carcinoma in samples of the cervix obtained by conisation we examined the clinical histories of 239 patients operated because of CIN lesions: 17 for CIN-I, 48 for CIN-II and 174 for CIN-III. Results: Patohistological examination of the removed tissue evidenced: carcinoma in situ at 42 (15.57%) patients, microinvasive carcinoma in 34 (14.22%) and invasive cervical carcinoma in 8 (3.35%). One microinvasive carcinoma was detected in a patient operated for CIN-II, one invasive in a patient operated for CIN-I, while all other cases of carcinoma were detected in CIN-III patients. The results of our analysis support the principle of excising the abnormal transformation zone, if cytological or colposcopic criteria or biopsy indicate CIN. Conclusions: In spite of introduction of local destructive techniques for treatment of CIN, conisation of the uterine cervix remains irreplaceable since it is the most reliable method for identification of the presence or absence of invasive disease.
P4.09.09 DIAGNOSIS OF PLACENTAL INSUFFICIENCY BY A METHOD OF LASER CORRELATION SPECTROSCOPY (LCS) V. Nanornava, V. Marichereda, Dept. OBIGYN, Odessa Medical University, Odessa, Ukraine. Objectives: To determine the sensitivity of LCS in diagnosis of placental insufficiency at various terms of pregnancy. Study Methods: The LCS of serum, research of homeostasis by defining sub-fractional structure of serum in a range from 0 to 1000 nm by means of registration of modifications of spectral characteristics of a monochromatic coherent radiation as an outcome of light dispersion when passing through serum (plasma). For the qualitative and quantitative analysis of findings, “the semiotic classifier”, distinguishing 8 biological conditions has been used. Results: Fifty-seven pregnant women have been examined at the terms of gestation from 9 to 38 weeks - 30 of them had placental insufficiency and 27 had normal physiological pregnancy. Differentially significant indications have been revealed, defined by degree of placental insufficiency and pregnancy term. They concern an increase in the contribution of particles with a low hydrodynamic radius of 15nm in the women with placental insufficiency, absence of an increase (according to the term of pregnancy) of the contribution of middle molecular fraction and decrease of very large molecular fraction. The character of modifications of homeostasis in placental insufficiency using semiotic classifier is explained as autoimmune processes on the background of intoxication in the 1”’and 2”d trimesters of pregnancy, increase in catabolic activity in the 3’d trimester. Results: The LCS is capable of reliable diagnosis of the signs of placental insufficiency and to conduct monitoring of efficiency of administered therapy, that allows it to be suggested for a broad clinical apphcation in obstetrics.
P4.09.10 ENDOMETRIAL CHANGES ASSOCIATED WITH TAMOXIFEN ADJUVANT THERAPY OF POSTMENOPAUSAL WOMEN WITH BREAST CANCER : SONOGRAPHIC AND PATHOLOGIC CORRELATIONS M. El-Monaveri, A. Nadim, I. Abdel-Fattah, A. Abbass, Ain Shams University, Cairo, Egypt Objective: To assess the endometrial changes in postmenopausal women with breast cancer who received Tamoxifen as an adjuvant therapy and to determine the need to periodically check up these patients. Study Methods: A cross sectional study conducted on fifty postmenopausal women, operated upon for breast cancer, and were receiving tamoxifen as adjuvant therapy. All were subjected to transvaginal sonography and endometrial sampling using the Karmen Kit. Endometrial sampling was hysteroscopically guided in 18 cases and by dilatation and curettage in 3 cases. Results of ultrasound in terms of endometrial thickness and echo-patterns were correlated to histopathological findings.
7
SEPTEMBER
7
P4.09 GYN-ONCOLOGY P4.09.01 ANALYSIS OF 38 CASES OF CHORIOCARCINOMA B.K. N.R. Mondal, Cancer Welfare Home and Research Institute, Thakurpukur, Calcutta, India. Objective: A study epidemiology & treatment of choriocarcinoma. Study Methods: Retrospective. 38 cases were analyzed from 1992-98. Predominantly young women, Muslim, between the ages of 20-30 yrs, in their first or second pregnancy, mostly from a rural population, suffering from the condition. Diagnosis was made by clinical examination, histology report, serum B-HCG, U.S.G., Chest X-ray. 12138 cases the precedent event was hydatidiform mole. Result: 9 cases had hysterectomy in other peripheral hospital because of uncontrolled hemorrhage. All patients received chemotherapy -single or multiple drug. 4 cases were lost to follow-up. 34 cases were followed up for one year without any recurrence. 1 case had successful full term pregnancy 4 years after completion of treatment without any fetal abnormality. Conclusion: Chemotherapy should be the first line of treatment in choriocarcinoma. Most cases respond to methotraxate but in cases with high B-HCG in serum, metastsis & recurrence multiple drug has been useful. Pregnancy can be successfully undertaken 2-3 yrs. after completion of treatment. Hysterectomy is advised only in cases of uncontrolled hemorrhage due to uterine perforation by malignancy.
P4.09.02 ANALYTIC EPIDEMIOLOGY OF EPITHELIAL OVARIAN CANCER WITH A SPECIAL REFERENCE TO DEVELOPING COUNTRIES: AN EVIDENCE-BASED ANALYSIS M.M.F. Fathalla (l), R. Foy (2) (1) Dept. OBIGYN, Assiut University, Assiut, Egypt. (2) Clinical Effectiveness Network, Edinburgh, UK. Objective: The review aims to assess studies tackling descriptive and analytic epidemiology of epithelial ovarian cancer with a particular reference to the picture in developing countries. Study Method Original article of analytic epidemiology of ovarian cancer retrieved through Medline, hand searching and reference list checking was done as well. Results: The reported geographic difference in incidence cannot be accepted due to difference in data collection and quality. History of ovarian cancer in a 1”’degree relative is associated with a RR of 2.8-3.1. Each term pregnancy confers 14.16% risk reduction. Combined oral contraceptive use is protective (RR 0.46-0.55 for more than five years use). Association of depoprovera, HRT and infertility drugs with risk is uncertain. Perineal talc exposure and high-risk diet such as animal fat, lactose and coffee are associated with a RR of ~2. A history of tubal ligation or hysterectomy is associated with decreased risk. In the developing world, monitoring the risk factors shows that there is evidence toward an increasing adoption of a high-risk behavior. Conclusion: There is the need for better quality data on ovarian cancer in developing countries. Establishing cancer registries will help. With the evidence for a trend to adopt high-risk behavior for ovarian cancer, primary prevention hold the main hope, especially in developing countries. Achieving tertiary and secondary prevention is difficult and expensive. Primary prevention holds the main hope for developing countries. Better understanding of the risk factors can help in this direction.
P4.09.03 COMPARISON OF CONE MARGINS STATUS IN HIGH GRADE CIN TREATED BY SURGICAL CERVICAL AMPUTATION, COLD KNIFE CONIZATION AND LEEP AND THE ROLE OF FROZEN SECTION EXAMINATION IN PREDICTING INVOLVED MARGINS J.P. Carvalho, F.M. Carvalho, E.A.G. Pereyra, C.I. Parellada, P.L Schivartche, .I. Souen, Hospital das Clinicas, Universidade de SBo Paula, Brazil. Objectives: The aim of the study was to investigate the status of the cone margins in patients with high grade CIN treated by three different procedures: cervical amputation, cold knife conization and loop
109
electrosurgical excisional procedure (LEEP) and the role of frozen section examination in predicting the involved margins. Study Methods: One hundred and fifty four women with high grade CIN were included: 41 cervical amputation, 60 cold knife conization and 53 LEEP. The cone margins were evaluated. A subgroup of 25 women, older than 40 were submitted to conization, frozen section examination of the cone followed by hysterectomy. Results: The margins were positive in 8141 amputation, 28160 conization and 24153 LEEP. Age was the mean factor related to involved margins. Frozen section showed involved margins in 15125 women. All of them were confirmed by permanent sections. Residual disease was present in the uterus in 11115 women with cone involved margins. Conclusions: Margins involvement occurred in all groups but were higher in older women. Frozen section examination was accurate in the evaluation of margins status.
P4.09.04 CORRELATION BETWEEN SHRINKAGE OF UTERINE LEIOMYOMA TREATED WITH GNRH AGONIST AND ESTROGEN RECEmOR ALPHA GENE POLYMORPHISM A.Tsuiimura, N. Kawamura, K. Minakuchi, S. Ogita, Dept. OBIGYN, Osaka City University Medical School, Osaka, Japan. Objective: To determine the correlation between shrinkage of uterine leiomyoma treated with GnRH agonist and estrogen receptor (ER) alpha gene polymorphism of uterine leiomyoma tissue. Study Methods: 35 women with terine leiomyoma who were treated with GnRH agonist before surgery were studied. The volume of the largest myoma nodule was measured by MRI before and 3 months after the beginning of GnRH agonist treatment and the percent reduction in myoma volume was calculated. Genomix DNA was extracted from leiomyoma tissue and a part of the intron 1 ER alpha gene (1.3kbp) was amplified by PCR. The PCR products were then digested with a restriction endonuclease, Pvu-II or Xba-I. Genotypic polymorphism was defined as XX or PP (Absence of a restriction site on both alleles), xx or pp (presence of a restriction site on both alleles) and Xx or Pp (heterozygous). Results: The distribution of the Pvu-II and Xba-I RFLPs was as follows: five PP’s (14%), 15Pp’s (43%), 15 pp’s (43%), four Xx’s (ll%), eight Xx’s (23%) and 23 xx’s (66%). The mean percent reduction in volume of the largest myoma was 8*39% for PP, 4*66% for Pp; 41*21% for pp; 14*17% for Xx, 24*34% for Xx and 18*60% for xx. Uterine myoma with the pp genotype was thus significantly likely to shrink than the other Pvu-II genotypes (p=O.O36). There was no significant correlation between the shrinkage of uterine leiomyoma and Xba-I genotypes. Conclusion: This study showed that the extent of shrinkage of uterine leiomyoma treated with GnRH agonist was related to ER alpha gene polymorphism of uterine leiomyoma tissue.
P4.09.05 CORRELATION BETWEEN SHRINKAGE OF UTERINE LEIOMYOMA TREATED WITH GNRH AGONIST AND INTERSTITIAL DELETION OF CHROMOSOME 7 K. N. Kawamura, A. Tsujimura, S. Ogita, Dept. OBIGYN, Osaka City University Medical School, Osaka, Japan. Objectives: The purpose of this study was to investigate the correlation between shrinkage of uterine leiomyoma treated with GnRH agonist and interstitial deletion of chromosome 7q, which is one of the most common chromosomal changes associated with uterine leiomyoma. Study Methods: This study covered 31 women with uterine leiomyoma who were treated with GnRH agonist before surgery. The volume of the largest myoma nodule was measured by means of MRI before and 3 months after the beginning of GnRH agonist treatment, and the percentage of volume reduction was calculated. Genomic DNA was extracted from leiomyoma tissue and peripheral blood and amplified by PCR using florescently-tagged oligonucleotide primers of 12 microsatellite loci on chromosome 7. The PCR products were analyzed for loss of heterozygosity (LOH) by using an ABI 310 automated florescent DNA sequencer. Results: Of the 31 informative tumors, 5 (16%) showed LOH with deletion of common region D7S419. The mean percent reduction in volume of the largest myoma with LOH was 32*13% and without LOH was 18*58% (not significant). One tumor showed interstitial deletion of
110
both alleles and a reduction in volume of 19%. Another tumor showed an extra band and an increase in volume of 13%. Conclusions: This study with microsatellite LOH analysis revealed that 16% of uterine leiomyomas showed interstitial deletion of chromosome 7q. Although the existence of tumor suppressor genes in this region was suggested, there was no significant correlation between shrinkage of uterine leiomyoma treated with GnRH agonist and interstitial deletion of chromosome 7q.
P4.09.06 CORRELATION OF DESCRIPTIVE SONOGRAPHIC CRlTERIA FOR ADNEXAL TUMORS AND OVARIAN MALIGNANCIES G. Ivanovic, D. Ivanovic, S. Kadija, V. Milenkovic, SV Petkovic, M. Radovic, IJ Mirkovic. Department of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Yugoslavia Objective: The aim of this study was to determine value of sonographic criteria in prediction of malignant potential of ovarian tumors. Study Methods: Our study included 112 patients after the surgical procedure on our clinic during two years with verified malignant ovarian tumor. We analyzed their sonographic findings as a part of routine preoperative treatment. Results: Among 112 patients 3 of them (3,36%) sonographicaly had unilocular tumor, 3 (3,36%) unilocular cystic To, 15 (16,8%) multilocular To, 69 (77,28%) multilocular solid To, 23 (64%) solid To. Results of our study showed that there is no absolutely specific ultrasound pattern which can show us whether the ovarian tumor is malignant or not, with one exception; malignant ovarian tumors more frequently have complex sonographic pattern. Conclusions: However as a conclusion we can say that despite inability to predict malignancy accurately echographic findings will frequently assist the ultrasonographer in making a correct diagnosis and can be of the crucial significance in decision making process about further therapeutic procedures.
P4.09.07 CYTOKERATIN 19 mRNA: A NEW MARKER FOR DETECTION OF METASTASES IN LYMPH NODES OF GYNECOLOGICAL CANCER PATIENTS M. Kanabu, T. Izutu, T. Kagabu, Dept. OBIGYN, Iwate Medical University, Morioka, Japan. Objectives: Lymph node metastasis is known as a significant predictor of prognosis in gynecological cancer patients. Recently, reverse transcriptase polymerase chain reaction (RT-PCR) has been applied to detecting micrometastasis. It is reported that cytokeratin 19 (CK-19) mRNA is not expressed in the peripheral blood cells and lymph nodes of the healthy subjects. Detection of DNA fragments of CK-19 in the lymph nodes suggests the existence of epithelial malignant tumor cells. We examined whether CK-19 expression can be used as a tumor marker for lymph nodes metastasis in gynecological cancer patients. Study Methods: We examined 7 gynecological cancer tumors, 3 types of gynecological cancer cell lines and 59 lymph nodes obtained from 16 gynecological cancer patients who underwent curative operation and were histologically diagnosed, using RT-PCR to amplify mRNAs for CK-19. Results: CK-19 mRNA was detected in 6 gynecological cancer tumors (85.7%). CK-19 mRNA was detected in all of gynecological cancer cell lines. CK-19 mRNA was detected in 2 cases of the histological metastasis (66.7%). And CK-19 mRNA was not detected in all of the histological no metastatic cases (13 cases). Conclusions: Our results indicate that CK-19 is a useful tumor marker for lymph nodes metastasis in gynecological cancer.
P4.09.08 DIAGNOSIS OF THE INVASIVE CERVICAL CARCINOMA AFTER THE CONISATION Kesic V, Pantovic S, Petkovic S, Argirovic R, Milenkovic V, Mirkovic Lj, Radovic M., Department of Gynecology and Obstetrics, Clinical center of Serbia, Belgrade, Yugoslavia Objectives: Due to the fact that cervical biopsy don’t always recognize the most severe changes on the uterine cervix, it has been suggested that
THURSDAY,
SEPTEMBER
application of destructive methods in diagnosis of cervical intraepithelial neoplasia (GIN) may result in overlooking of invasive uterine carcinoma. Study Methods: In order to evaluate diagnostic reliability of target biopsy and consequently the incidence of cervical carcinoma in samples of the cervix obtained by conisation we examined the clinical histories of 239 patients operated because of CIN lesions: 17 for CIN-I, 48 for CIN-II and 174 for CIN-III. Results: Patohistological examination of the removed tissue evidenced: carcinoma in situ at 42 (15.57%) patients, microinvasive carcinoma in 34 (14.22%) and invasive cervical carcinoma in 8 (3.35%). One microinvasive carcinoma was detected in a patient operated for CIN-II, one invasive in a patient operated for CIN-I, while all other cases of carcinoma were detected in CIN-III patients. The results of our analysis support the principle of excising the abnormal transformation zone, if cytological or colposcopic criteria or biopsy indicate CIN. Conclusions: In spite of introduction of local destructive techniques for treatment of CIN, conisation of the uterine cervix remains irreplaceable since it is the most reliable method for identification of the presence or absence of invasive disease.
P4.09.09 DIAGNOSIS OF PLACENTAL INSUFFICIENCY BY A METHOD OF LASER CORRELATION SPECTROSCOPY (LCS) V. Nanornava, V. Marichereda, Dept. OBIGYN, Odessa Medical University, Odessa, Ukraine. Objectives: To determine the sensitivity of LCS in diagnosis of placental insufficiency at various terms of pregnancy. Study Methods: The LCS of serum, research of homeostasis by defining sub-fractional structure of serum in a range from 0 to 1000 nm by means of registration of modifications of spectral characteristics of a monochromatic coherent radiation as an outcome of light dispersion when passing through serum (plasma). For the qualitative and quantitative analysis of findings, “the semiotic classifier”, distinguishing 8 biological conditions has been used. Results: Fifty-seven pregnant women have been examined at the terms of gestation from 9 to 38 weeks - 30 of them had placental insufficiency and 27 had normal physiological pregnancy. Differentially significant indications have been revealed, defined by degree of placental insufficiency and pregnancy term. They concern an increase in the contribution of particles with a low hydrodynamic radius of 15nm in the women with placental insufficiency, absence of an increase (according to the term of pregnancy) of the contribution of middle molecular fraction and decrease of very large molecular fraction. The character of modifications of homeostasis in placental insufficiency using semiotic classifier is explained as autoimmune processes on the background of intoxication in the 1”’and 2”d trimesters of pregnancy, increase in catabolic activity in the 3’d trimester. Results: The LCS is capable of reliable diagnosis of the signs of placental insufficiency and to conduct monitoring of efficiency of administered therapy, that allows it to be suggested for a broad clinical apphcation in obstetrics.
P4.09.10 ENDOMETRIAL CHANGES ASSOCIATED WITH TAMOXIFEN ADJUVANT THERAPY OF POSTMENOPAUSAL WOMEN WITH BREAST CANCER : SONOGRAPHIC AND PATHOLOGIC CORRELATIONS M. El-Monaveri, A. Nadim, I. Abdel-Fattah, A. Abbass, Ain Shams University, Cairo, Egypt Objective: To assess the endometrial changes in postmenopausal women with breast cancer who received Tamoxifen as an adjuvant therapy and to determine the need to periodically check up these patients. Study Methods: A cross sectional study conducted on fifty postmenopausal women, operated upon for breast cancer, and were receiving tamoxifen as adjuvant therapy. All were subjected to transvaginal sonography and endometrial sampling using the Karmen Kit. Endometrial sampling was hysteroscopically guided in 18 cases and by dilatation and curettage in 3 cases. Results of ultrasound in terms of endometrial thickness and echo-patterns were correlated to histopathological findings.
7