RESUMEN
pT1G3 bladder tumors have a high tendency to recur and progress. We evaluated the prognostic values of the depth of submucosal invasion and immunostaining with survivin and p53 in 30 pT1G3 urothelial carcinomas at the first endoscopic resection. The depth of invasion was evaluated toward the muscularis mucosa and measured using a micrometer. Survivin and p53 immunostaining were performed using an automated immunostainer. Of the patients, 19 (63%) had tumor recurrence, 11 (37%) had tumor progression, 10 (33%) had metastatic spread, and 10 (33%) died of the disease. Infiltration of deep lamina propria (pT1b) and a micrometric measure of 1.5 mm or more were associated with an increased risk of tumor local and/or metastatic progression (P = .03 and P = .02, respectively). A combined high expression of survivin (Asunto(s)
Proteínas Asociadas a Microtúbulos/análisis
, Proteínas de Neoplasias/análisis
, Receptores de Ácido Retinoico/metabolismo
, Proteína p53 Supresora de Tumor/análisis
, Neoplasias de la Vejiga Urinaria/metabolismo
, Neoplasias de la Vejiga Urinaria/patología
, Biomarcadores de Tumor/análisis
, Progresión de la Enfermedad
, Humanos
, Inmunohistoquímica
, Proteínas Inhibidoras de la Apoptosis
, Pronóstico
, Estudios Retrospectivos
, Survivin
RESUMEN
OBJECTIVE: The purpose of this study was to evaluate transvaginal sonographic cervical length before and after cervical conization for squamous intraepithelial lesions. METHODS: Between November 2002 and October 2004, all women undergoing conization by either cold-knife conization or a loop electrosurgical excision procedure for squamous intraepithelial lesions were prospectively enrolled in this study. Cervical length was measured by transvaginal sonography (TVS) before and after conization. RESULTS: A total of 48 women were studied before and after a mean of 7 days after conization. Complete excision was achieved in 41 patients, and endocervical margins were involved in 7 patients. Mean TVS cervical length was significantly shorter after than before conization (mean +/- SD, 22.7 +/- 6.9 versus 26.7 +/- 8.1 mm; P < .001). The correlation coefficient between cone specimen length and postoperative length was r = 0.75 (P < .001). Mean TVS cervical lengths were 24.3 +/- 6.7 mm in the group of women who underwent a loop electrosurgical excision procedure and 20.7 +/- 9.4 mm in the group of women who underwent cold-knife conization (P = .13). CONCLUSIONS: Transvaginal sonographic measurement of cervical length after conization is well correlated with cone specimen length.
Asunto(s)
Cuello del Útero/diagnóstico por imagen , Cuello del Útero/cirugía , Conización , Criocirugía , Electrocirugia , Adulto , Cuello del Útero/patología , Femenino , Humanos , Persona de Mediana Edad , UltrasonografíaRESUMEN
OBJECTIVE: The purpose of this study was to evaluate a conservative cold-knife section technique for treatment of cervical intraepithelial neoplasia (CIN). This procedure can be adapted to patient age, preservation of childbearing potential and extent of dysplasia. DESIGN: Prospective study. SETTING: Gynecological Oncology Department in French Public Hospital. POPULATION: A total of 460 women treated for CIN between 1985 and 1999 were included. METHODS: A conservative cold-knife cervical section followed by blanket suture reconstruction was used in all cases. MAIN OUTCOME MEASURES: Immediate operative results, recurrence and reproductive function were assessed. RESULTS: The mean length of the cervical specimen was 11.4 mm (range, 4-22 mm). Mean specimen thickness was strongly correlated with age: 10.6 +/- 4.1 mm in women <40 years versus 12.1 in women >40 years; p < 0.001. Complete excision was achieved in 395 cases (85.8%). Post-operative bleeding was observed in 5 cases (1.1%). The mean duration of follow-up was 62 months (range, 12.3-156.5 months). Recurrences developed in 26 patients (6.6%) including CIN 1 in 9 cases, CIN 2 in 9 and CIN 3 in 8. No patient developed carcinoma. The actuarial risk of recurrence was 2.4% (+/- S.D., 0.9) at 24 months and 7.8% (+/-S.D., 1.9) at 60 months. A total of 52 pregnancies were observed in 39 patients. No case of de novo infertility was reported post-operatively. Amenorrhea was noted in 1 patient (0.1%) and dysmenorrhea in 1 patient (0.1%). CONCLUSIONS: This conservative cold-knife section technique is effective for treatment of CIN with low morbidity and little adverse effect on childbearing potential. Exposure of the squamocolumnar junction (SCJ) greatly facilitates follow-up.
Asunto(s)
Conización/instrumentación , Criocirugía/instrumentación , Displasia del Cuello del Útero/cirugía , Neoplasias del Cuello Uterino/cirugía , Adulto , Colposcopía/métodos , Conización/métodos , Criocirugía/métodos , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Estadificación de Neoplasias , Complicaciones Posoperatorias/diagnóstico , Probabilidad , Estudios Prospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Resultado del Tratamiento , Neoplasias del Cuello Uterino/patología , Displasia del Cuello del Útero/patologíaRESUMEN
Hypoxia-inducible factor-1alpha (HIF-1alpha) is a transcription factor that is involved in tumour growth and metastasis by regulating genes involved in response to hypoxia. HIF-1alpha protein overexpression has been shown in a variety of human cancers, but only 2 studies have documented the prognostic relevance of HIF-1alpha expression in breast cancer. The aim of our study was to determine accurately the impact of HIF-1alpha expression on prognosis in a large series (n = 745) of unselected patients with invasive breast cancer in terms of overall survival, local recurrence and distant metastasis risk. HIF-1alpha expression was investigated using immunohistochemical assays on frozen sections, and correlated with patients' outcome (median follow-up = 13.5 years). Univariate (Kaplan-Meier) analysis showed that high levels of HIF-1alpha expression (cutoff = 10%) significantly correlated with poor overall survival (p = 0.019). HIF-1alpha expression correlated with high metastasis risk among the whole group of patients (p = 0.008). Multivariate analysis (Cox model) showed that the HIF-1alpha predictive value was independent of other current prognostic indicators. Moreover among node negative ones, HIF-1alpha expression was also significantly predictive of metastasis risk (p = 0.03) and of relapse (p = 0.035). All the data suggest that HIF-1alpha is associated with a worse prognosis in patients with invasive breast carcinoma. Furthermore HIF-1alpha immunodetection may be considered as a potential indicator for selecting patients who could benefit from specific therapies interfering with HIF-1alpha pathway.
Asunto(s)
Neoplasias de la Mama/química , Proteínas de Unión al ADN/análisis , Proteínas Nucleares/análisis , Factores de Transcripción/análisis , Adulto , Anciano , Neoplasias de la Mama/patología , Femenino , Humanos , Factor 1 Inducible por Hipoxia , Subunidad alfa del Factor 1 Inducible por Hipoxia , Inmunohistoquímica , Persona de Mediana Edad , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia , Pronóstico , Estudios RetrospectivosRESUMEN
OBJECTIVES: To evaluate the frequency of testicular tumours in infertile men and to specify their clinical, ultrasound and histological characteristics. MATERIAL AND METHODS: Retrospective study of all partial or total orchidectomies performed between January 1995 and April 2004. During this period, 3,000 new patients consulted for assessment of infertility. The clinical, laboratory and ultrasound assessment was identical for each patient. RESULTS: Twenty-six testicular tumours were operated in 25 patients, i.e. 0.83% of the infertile men who consulted our department. Six tumours were clinically palpable (23%) and 20 (77%) were discovered on ultrasonography. The size of nodules ranged between 4 and 49 mm. Twenty-three radical orchidectomies and only 3 partial orchidectomies were performed, as 96% of testes presenting a nodule were hypotrophic. Histological examination demonstrated 15 Leydig cell tumours (58%), 8 seminomas (30%), mature teratoma,1 Sertoli cell tumour, and 1 burnt-out tumour. Nine (36%) patients had a history of cryptorchidism. Tumour markers were normal in 24 of the 25 patients (96%). All nodules were hypoechoic. All tumours were classified as pT1 N0 M0 and no recurrence has been observed to date. CONCLUSION: The incidence of testicular tumours in infertile men is much higher than in the general population. This incidence ranges between 0.35% and 0.83% according to various studies. A urological and andrological assessment should therefore be performed in all men presenting with infertility.