Local immune response in endometrial carcinomas

Citations

from

the literature

/International

Journal

tantially higher for childless women (RR, 5.0; 95% CI, 1.7-14.4) than for women with children (RR, 1.3; 95% CL 0.5-3.5) (P < 0.06). Among miscarrying women, 72% of cases of major depressive disorder began within the first month after loss; only 20% of community cases started during the comparable period. Among miscarrying women with a history of major depressive disorder, 54% experienced a recurrence. However, RR did not vary significantly by history of prior reproductive loss or by maternal age, nor did risk vary by time of gestation or attitude toward the pregnancy. Conclusions: Physicians should monitor miscarrying women in the first weeks after reproductive loss, particularly women who are childless or who have a history of major depressive disorder. Where appropriate, supportive counseling or psychopharmacologic treatment should be considered.

ONCOLOGY Investigation

of 100 consecutive

negative

cone biopsies

Golbang P.; Scurry J.; De Jong S.; McKenzie RPyman J.; Davoren R.

D.; Planner

AUS

BR. J. OBSTET. GYNAECOL. 1997 104/l (100-104) Objectiue: To investigate the reasons for cone biopsies reported as not containing intraepithelial or invasive malignancy and thereby find ways to decrease their incidence. Design: One hundred cone biopsies reported as negative were identified out of a total of 436 consecutive cone biopsies. The patients’ cytology, colposcopy and histology reports and cytology and histology slides were reviewed. Further opinions in cases of doubt were obtained in cytology and histology. In cone biopsies still considered negative after reviews, deeper levels were cut, exhausting all paraffin blocks. Follow up cytology, colposcopy and histology were reviewed. Setting: Gynecological oncology unit in a university teaching hospital. Results: After re-evaluation the final diagnoses of cone biopsies initially reported as negative were positive (n = 21), unsatisfactory (n = 27) and true negative (n = 511, with one case excluded because of insufficient material for review. The positive cases were diagnosed on review (n = 11) or extra levels (n = 10). The unsatisfactory cases were all due to denudation. The 51 true negative cases were divided into those which never had histologic confirmation by punch biopsy or endocervical curettage (n = 47) and those with a previously confirmed histological abnormality (n = 4). Conclusions: The number of negative cone biopsies can be reduced by: (1) taking Pap smears after correction of atrophy and inflammation; (2) more scrupulous colposcopy aimed at reducing the number of unsatisfactory colposcopies or misinterpreted colposcopic findings; this thorough examination should include the vagina and vulva; (3) confirmation of smear and colpostopic findings by biopsy prior to cold-knife conization and performing a large loop excision of the transformation zone (LLETZ) for cases where there is a discrepancy between the smear abnormality and zone colposcopy/biopsy findings; (4) good quality cone biopsies using a technique that does not handle the mucosa and is performed after the mucosa has had

of Gynecology

& Obstehics

57 (1997) 233-243

231

time to regenerate following the colposcopic investigations; and (5) exhausting all blocks with multiple levels before reporting a cone biopsy as negative. Gestational tropboblastic Cbaring Cross experience

disease

with

liver

metastases:

the

Crawford R.A.F.; Newlands E.; Rustin G.J.S.; Holden L.; A’Hem R.; Bagshawe K.D. GBR

BR. J. OBSTET. GYNAECOL. 1997 104/l (105-109) Objective: To define management options for women presenting with gestational trophoblastic disease (GTD) which had already metastasized to the liver. Design: Retrospective analysis of case records between 1958 and 1994. Setting: A national referral center for trophoblastic disease. Results: The database containing 1676 treated patients was reviewed and 46 patients with hepatic metastases were identified (2.7%). The median age was 32 years (range 19-52 years). The antecedent pregnancy to the GTD was normal in 65% (30/46), and the time interval between the antecedent pregnancy and presentation was longer than 1 year in 50% (22/44). Lung metastases were present in 43 patients (93%) and brain deposits in 15 patients (33%). Forty-five patients (98%) were high risk by WHO criteria. The 5-year overall survival was 27%. The 5-year survival of the subgroup of patients having both hepatic and cerebral metastases was 10%. There was no significant survival difference between the different chemotherapy regimens used in the study period (pre-1979 CHAMOCA: methotrexate, actinomycin D, cyclophosphamide, doxorubicin, melphalan, hydroxyurea and vin&tine; 1979 onwards EMA/CO-EP: etoposide, methotrexate, adriamycin-D/cyclophosphamide, vincristine-etoposide and cis-platinum). Multivariate analysis revealed that a prognostic score > 12 was significant (Hazard ratio 5.4, 95% Cl, 0.7-41.9; P = 0.04) Conclusions: The outcome for women presenting with hepatic metastases from GTD is poor with an even worse prognosis if cerebral metastases are also present. Alternative therapeutic measures, such as high dose therapy or new drugs, should be explored in these women. Local

immune

response

Hachisuga T.; Fukuda Sugimori H.

in endometrial

carcinomas

K.; Nakamura

S.; Iwasaka T.;

JPN

BR. J. OBSTET. GYNAECOL. 1997 104/l (110-114) Objectiue: To determine whether Langerhans cells act as antigen-presenting cells in endometrial carcinomas and their related lesions. Samples: Frozen endometrial samples were obtained from 13 women with normal menstrual cycles, three post-menopausal women, 11 women with hyperplasia (four simple, four complex and three atypical) and 32 women with endometrial carcinomas. Main outcome measures: Langerhans cells (CDI), T lymphocytes (CD4 and CD81, B lymphocytes (CD22), natural killer (NK) cells (CD571 and HLA-DR were all quantitatively assessed in endometrial samples using immunohistochemical method. Results: The numbers of Langer-

238

Citation from the literature /International

Journal of Gynecology & Obstetrics 57 (1997) 233-243

ham, CD4 + , CD8 + and B cells were higher in the secretory phase than in the proliferative endometrium. The CD8 + cells appeared to be more plentiful than the CD4 + cells. When compared with the proliferative endometrium, the numbers of Langerhans cells were higher in hyperplasias and carcinomas. Most of Langerhans cells were HLA-DR + , showing a strong correlation with CD4 + cells in carcinomas. This suggests that MHC class II antigen restricted lymphocytes in carcinomas are activated by HLA-DR+ Langerhans cells. However, ep ithelial expression of HLA-DR in carcinomas did not show on association with high numbers of Langerhans and CD4 + cells. No correlation was observed between Langerhans cells and clinicopathologic features of carcinomas. In contrast, the number of NK cells significantly decreased in non-invasive carcinomas but increased in Grade 3 tumours. Condusion: Based on the above findings, Langerhans cells are considered to act as antigen-presenting cells in carcinomas, but it was not shown that they were activated by epithelial expression of HLA-DR in carcinomas. Induced

abortion

and the risk

of breast

cancer

Melbye M.; Wohlfahrt J.; Olsen J.H.; Frisch M.; Westergaard T.; Helweg-Larsen K.; Andersen PK. DNK NEW ENGL. J. MED. 1997 336/2 (81-85) Background: It has been hypothesized that an interrupted pregnancy might increase a woman’s risk of breast cancer because breast cells could proliferate without the later protective effect of differentiation. Methods: We established a population-based cohort with information on parity and vital status consisting of all Danish women born from April 1, 1935, through March 31, 1978. Through linkage with the National Registry of Induced Abortions, information on the number and dates of induced abortions among those women was combined with information on the gestational age of each aborted fetus. All new cases of breast cancer were identified through linkage with the Danish Cancer Registry. Results: In the cohort of 1.5 million women (28.5 million person-years), we identified 370 715 induced abortions among 280 965 women (2.7 million person-years) and 10 246 women with breast cancer. After adjustment for known risk factors, induced abortion was not associated with an increased risk of breast cancer (relative risk, 1.00; 95% confidence interval, 0.94-1.06). No increases in risk were found in subgroups defined according to age at abortion, parity, time since abortion, or age at diagnosis of breast cancer. The relative risk of breast cancer increased with increasing gestational age of the fetus at the time of the most recent induced abortion: < 7 weeks, 0.81 (95% confidence interval, 0.58-1.13); > 12 weeks, 1.38 (1.00-1.90) (reference category, 9-10 weeks). Conclusions: Induced abortions have no overall effect on the risk of breast cancer. Risk of endometrial cancer in relation combined with cyclic progestagen therapy women

to use of oestrogen in post-menopausal

Beresford S.A.A.; Weiss N.S.; Voigt L.F.; McKnight B.

USA

LANCET 1997 349/9050 (458-461) Background: Post-menopausal oestrogen therapy reduces the risk of osteoporosis and cardiovascular diseases but is associated with an increased risk of endometrial cancer. We have assessed the impact of a regimen of oestrogen with cyclic progestagen on risk of endometrial cancer for post-menopausal women. Metho& We did a population-based case-control study of women aged 45-74 years in western Washington State, USA. Cases were identified from a regional cancer registry as having histologically confirmed endometrial cancer during 1985-1991. 832 (72%) of 1154 eligible cases completed interviews. Controls were identified by random digit dialling, screened for intact uterus, frequency matched for age and county, and randomly assigned a reference date within 1985-1991. Interviews with 1114 (73%) of 1526 eligible controls were done. The women provided information about use of hormone replacement therapy, and reproductive and medical history before diagnosis date (cases) or reference date (controls). Results: Relative to women who had never used hormones (for > 6 months), women who had taken unopposed oestrogen had a four-fold increase (95% CI, 3.1-5.11 in risk of endometrial cancer. Women who used a combined therapy of oestrogen with cyclic progestagen leg, medroxyprogesterone acetate) had a relative risk of 1.4 (1.0-1.9). Among women with fewer than 10 days of added progestagen per month, the relative risk was 3.1 (1.7-5.7), whereas that for women with lo-21 days of added progestagen was 1.3 (0.8-2.2). The use of these combined regimens for 5 or more years was associated with risks of 3.7 (1.7-8.2) and 2.5 (1.1-5.51, respectively, relative to non-users of hormones. Conclusion: postmenopausal women who use combined therapy of oestrogen with cyclic progestagen on a long-term basis have an increased risk of endometrial cancer compared with those who are not on hormone replacement, even when progestagen is added for 10 or more days per month. This increase is much smaller than that associated with unopposed oestrogen, but needs to be confirmed.

FERTILITY

AND STERILITY

Vascular endothelial the clinical picture drome

growth factor plasma levels correlate to in severe ovarian hyperstimulatton syn-

Abramov Y.; Barak V.; Nisman B.; Schenker J.G. ISR FERTIL. STERIL. 1997 67/2 (261-2651 Objective: To assess the potential involvement of vascular endothelial growth factor in the hyperpermeability characterizing the ovarian hyperstimulation syndrome (OHSS). Design: A controlled clinical study that followed the kinetics of vascular endothelial growth factor in the plasma of patients with severe OHSS from the time of admission to the hospital and until clinical resolution. Setting Women hospitalized with severe OHSS in a tertiary medical center. Patients: Seven