Chemotherapy for gynecological malignancies--a contraindication during pregnancy?

Even though a malignant tumor during pregnancy is very rare it occurs in 0.02-0.1%. With the tendency in society to postpone childbirth to an older age, there will be more cancers diagnosed during pregnancy. The coincidence of malignant disease with pregnancy leads to an enormous emotional burden to the patient, the couple and the medical staff. Surgery for malignant tumors during pregnancy seems to be save. Radiotherapy on the other hand should be avoided. Chemotherapy is regarded to be save during the second and third trimester but it should not be applied during the first trimester because of its teratogenic effects. The most frequent malignant disorders during pregnancy are cervical cancer, breast cancer, melanoma and Hodgkin lymphoma. We discuss possible treatment options for breast cancer and gynecological tumors during pregnancy. Ovarian Cancer is a rare event during pregnancy. Because of frequent prenatal visits most of them are diagnosed at an early stage, with good prognosis. In case of advanced stage of ovarian cancer chemotherapy besides surgery is necessary. The former usually is preferred as monotherapy during pregnancy. To treat breast cancer during pregnancy a mastectomy with axillary lymphonodectomy is necessary to avoid radiotherapy. Indications for chemotherapy are the same as for not pregnant patients. Usually AC with and without 5-FU is used. For invasive cervical cancer surgery or radiotherapy +/- chemotherapy is indicated after induced abortion or cesarean section. Early termination of pregnancy is of no survival benefit to the mother in case of breast cancer and ovarian cancer. In these cases systemic therapy during pregnancy and delivery at 34 weeks is recommended.     

Congenital bilateral cryptorchidism in an infant conceived after maternal breast cancer treatment: A case report

BACKGROUNDThe incidence of breast cancer among women of reproductive age is increasing, as well as the desire for children at late childbearing age. Identifying factors that may be associated with fetal malformation and maternal and fetal prognosis has gained importance. We describe a 32-year-old woman with breast cancer who gave birth to a son with congenital bilateral cryptorchidism after treatment, with a literature review performed.CASE SUMMARYA 32-year-old woman with breast cancer who had been treated by surgery and radiotherapy experienced recurrence and underwent a second surgery, adjuvant chemotherapy, and targeted therapy. Her tumor cells were negative for estrogen receptor (ER) α, progesterone receptor (PR), and p53; positive for ERβ, human epidermal growth factor receptor-2 (HER2), epidermal growth factor receptor (EGFR), and Ki67. She had pathogenic BRCA gene mutations. She became pregnant within 2 years and delivered a boy with congenital bilateral cryptorchidism. The boy underwent bilateral orchidopexy. As of this writing, the woman and her son are both healthy.CONCLUSIONHER2 overexpression, positivity for EGFR, Ki67, and ER, and PR negativity are associated with a poor prognosis in breast cancer. While no link has been established statistically between treatment for breast cancer and cryptorchidism in a subsequent pregnancy, this case suggests the possibility that ERβ and gene mutations may be contributing factors.     

Prepregnancy exposure to cigarette smoking and subsequent risk of postmenopausal breast cancer

OBJECTIVE: To examine the association of cigarette smoking before first pregnancy with risk of postmenopausal breast cancer in a large population-based cohort. PATIENTS AND METHODS: The Iowa Women's Health Study is a prospective cohort study of 55- to 69-year-old women at baseline in 1986. In January 1986, a questionnaire was mailed to 99,826 postmenopausal women to Identify risk factors for cancer and other chronic diseases; 41,836 women responded (42.7% response rate). The primary analyses examined the associations among smoking, parity, age at first birth, and postmenopausal breast cancer. RESULTS: Of the 37,105 women in the cohort at risk, 7095 (19%) and 4186 (11%) initiated smoking before and after first pregnancy, respectively, and 2017 breast cancers were identified before December 31, 1999. Compared with parous women who never smoked, women who began smoking after their first full-term pregnancy were not at increased risk of postmenopausal breast cancer (multivariate-adjusted risk ratio, 1.03; 95% confidence interval, 0.88-1.21). However, women who began smoking before their first pregnancy had a slightly elevated risk of breast cancer (risk ratio, 1.21; 95% confidence Interval, 1.07-1.37). Results were not attenuated by adjustment for age at first pregnancy or number of live births. CONCLUSION: These data suggest that cigarette smoking is associated with a slightly greater risk of postmenopausal breast cancer for women who started smoking before their first full-term pregnancy.     

妊娠期乳腺癌临床特点及超声诊断

目的探讨妊娠期乳腺癌的临床、超声和病理学特征。方法回顾性分析7例妊娠期诊断为乳腺癌的患者的临床、超声和病理学特征。结果 1例患者在早孕期获得诊断,6例在中晚孕期诊断;对5例行术前超声检查,均表现为形态不规则、边界不清的低回声,其中4例血流丰富,术前均正确诊断为恶性病变;7例患者均接受患侧乳癌改良根治术,孕期未接受化疗及放疗;病理示病灶大小1.7～5.5cm;术后病理5例为浸润性导管癌,1例导管内癌,1例浸润性多形性癌;3例有患侧腋窝淋巴结转移。结论妊娠期乳腺癌恶性度高,预后差,超声有助于早期、正确诊断妊娠期乳腺癌。     

Primary twin ovarian pregnancy: case report and review of the literature

Primary twin ovarian pregnancy is extremely rare. We present one such case in a 25-year-old primigravida who complained of lower abdominal pain and mild vaginal bleeding at 8 weeks after her last menstrual period. Transvaginal sonography revealed an empty uterus and presence of a gestational sac containing 2 dead embryos in the right ovary. The patient underwent unilateral oophorectomy, and histologic studies confirmed a uniovular-diamniotic ovarian pregnancy. A brief review of the literature revealed that primary ovarian pregnancy may occur without any classical antecedent risk factors, and endovaginal sonography can be useful to establish early preoperative diagnosis of ectopic ovarian pregnancy.     

经腹部超声联合经阴道超声检查诊断妇产科急腹症

目的：探讨经腹部超声联合经阴道超声检查在妇产科急腹症诊断中的价值。方法：选择2013年1月～2016年6月经本院临床及病理确诊的妇产科急腹症患者110例为对象,所有患者均采用经腹部超声联合经阴道超声检查,比较超声检查诊断结果与临床病理诊断结果的符合率,并分析各类急腹症的超声影像表现。结果：经腹部超声联合经阴道超声检查诊断妇产科急腹症的符合率97.27%(107/110),与临床病理结果比较差异无统计学意义(P＞0.05);诊断异位妊娠的符合率96.77%(30/31),诊断宫内孕流产的符合率94.44%(17/18),诊断卵巢囊肿破裂的符合率93.33%(14/15),诊断急性盆腔炎、卵巢肿瘤蒂扭转、子宫内膜异位症、胎盘早剥的符合率均为100%(23/23、10/10、8/8、5/5),与临床病理结果比较差异无统计学意义(P＞0.05)。结论：经腹部超声联合经阴道超声检查在诊断妇产科急腹症中,与临床病理结果的符合率高,是一种可行的方案。     

Dichorionic quadruplet pregnancy comprising monozygotic triplets and singleton after intracytoplasmic sperm injection and transfer of two fresh embryos: a case report

Monozygotic triplet pregnancies are very rare in assisted reproductive technology, and the relationship between monozygotic multiple pregnancies and several assisted reproductive techniques, including blastocyst transfer, remains unclear. Here, the case of a 28-year-old female patient with dichorionic quadruplet pregnancy following intracytoplasmic sperm injection and transfer of two day-3 fresh embryos, without assisted hatching, is reported. At 7 weeks following embryo transfer, the dichorionic quadruplet pregnancy, comprising monozygotic monochorionic triamniotic (MCTA) triplets plus a singleton, was detected by a transabdominal ultrasound scan. After counselling, the patient underwent selective reduction of the MCTA triplet pregnancy at 7 weeks after embryo transfer. The remaining singleton pregnancy was uneventful, resulting in a live birth at 38⁺ weeks. As the predictors of monozygotic multiple gestations remain poorly characterized, clinicians and patients should give great consideration to the risks associated with monozygotic multiple pregnancies, even if the patient has not undergone blastocyst transfer.     

30岁以下妇科恶性肿瘤的临床分析

目的探讨30岁以下妇科恶性肿瘤的病例特征及合理的治疗措施。方法回顾性分析2000年1月至2009年12月间在我院住院诊治的30岁以下的妇科恶性肿瘤患者的临床资料,以及随访部分患者的月经生育情况等,进行统计分析总结。结果我院10年期间共收治妇科恶性肿瘤患者721例,30岁以下的患者56例,占7．77％,发生率排位分别为卵巢癌、恶性滋养细胞肿瘤、宫颈癌和子宫体恶性肿瘤。子宫体恶性肿瘤前5年收治数为0,后5年的收治数为3;宫颈癌收治比例从前5年的7．7％上升到后5年的23．3％,差异有统计学意义（P〈0．05）。30岁以下患者妇科恶性肿瘤的Ⅰ期诊断率分别为卵巢癌76．7％,宫体恶性肿瘤100％,恶性滋养细胞肿瘤35．7％,宫颈癌66．7％。14例卵巢癌患者行了保留生育功能的手术,12例恶性滋养细胞肿瘤只用化疗,1例宫颈原位癌患者行了宫颈锥切术。电话随访成功的10例卵巢恶性生殖细胞肿瘤患者,月经均基本正常,获得总妊娠数4例,其中3人各育1人;随访成功的9例恶性滋养细胞肿瘤患者中,月经均能恢复基本正常,共有2个妊娠,已出生一活胎;1例宫颈原位癌患者行了宫颈锥切术尚在随访1年中,无妊娠记录。结论30岁以下年轻女性的妇科恶性肿瘤发生率排位分别为卵巢癌、恶性滋养细胞肿瘤、宫颈癌和子宫体恶性肿瘤,而宫颈癌和子宫内膜癌的发病率有上升的趋势。各种保留生育功能或保留卵巢功能的治疗方法在不断地探讨总结中并形成规范。     

Ectopic production of prostate specific antigen by a breast tumor metastatic to the ovary

We have recently reported that about 30% of breast tumors produce prostate specific antigen (PSA). We examined here, 99 primary ovarian cancer tumors and found relatively low levels of PSA in only three tumors. One patient with metastatic ovarian cancer from a primary breast tumor, produced relatively high levels of PSA and responded well to antiestrogen treatment although she was steroid receptor-negative. Another patient with metastatic ovarian cancer from a primary breast tumor did not produce PSA and did not respond to treatment although she was steroid hormone receptor-positive. This data describe for the first time, ectopic PSA production by a breast tumor at the ovarian metastatic site and further support the view that PSA is a favourable prognostic indicator in breast cancer. © 1994 Wiley-Liss, Inc.     

Estrogens--a breast cancer risk?

Breast cancer is nowadays one of the most frequent cancers in female subjects. The highest risk factor is aging. Early age at first full-time pregnancy is in many studies associated with a reduced risk of breast cancer. Other risk factors are obesity, early menarche and late menopause. According to recent epidemiological studies and a reanalysis of all prospective studies longtime ERT and HRT are also associated with a slightly higher incidence of breast cancer. This higher incidence is, however, very limited and not associated with a higher mortality because only low grade, slowly progressing, receptor positive cancers are increased.     

Familial ovarian cancer

Ovarian cancer is the most lethal disease in gynecological malignancy. Approximately 5-10% of cases are thought to have a hereditary basis, and family history is the strongest risk factor for the development of the disease. Familial ovarian cancer occurs as a part of three clinically distinct syndromes, site specific ovarian cancer families, breast ovarian cancer families, and hereditary nonpolyposis colorectal cancer (Lynch syndrome II) families. The breast ovarian cancer susceptibility genes BRCA1 and BRCA2 are reported to account for around 50% of familial ovarian cancer families. In this paper, we describe the contribution of ovarian cancer susceptibility genes to familial ovarian cancer, and clinical features of ovarian cancer patients with germline mutations of BRCA1 and BRCA2.     

A case report of appendiceal adenocarcinoma without gastrointestinal evidence mimicking primary ovarian cancer

Metastatic tumours to the ovary comprise 10–25% of ovarian malignancies and may originate from various primary sites. Here, the case of a 49-year-old female patient who presented with periumbilical nodules and abdominal bloating is reported. She was found to have bilateral ovarian tumours with peritoneal carcinomatosis and ascites. Primary ovarian cancer was suspected while no contributory gastrointestinal lesion was detected by imaging studies and endoscopic examinations. Three cycles of neoadjuvant chemotherapy were administered, followed by interval debulking surgery. Appendiceal cancer was highly suspected based on analysis of a frozen section obtained during surgical debulking. Following the pathology investigation, the patient was finally diagnosed with primary appendiceal adenocarcinoma. She underwent chemotherapy comprising irinotecan and fluorouracil. Due to disease progression despite several chemotherapy regimens, the patient declined further treatment and was lost to follow-up 1 year after the debulking surgery. Metastatic tumours to the ovary may mimic primary ovarian cancers and often present with nonspecific manifestations. Therefore, meticulous exploration of the primary site is warranted if the diagnosis is clinically suspicious.     

Use of colour and spectral Doppler ultrasound examination in gynaecology

Objective: To review and sum up the published literature on gynecological Doppler ultrasound examination. Methods: Publications on gynecological Doppler ultrasound examination already known by the author, publications found in the bibliographic database Medline, and publications found in the reference lists of available studies were read, and relevant information was extracted and summarized. Results: Reference data representative of normal findings at transvaginal color and spectral Doppler ultrasound examination of the uterine and ovarian arteries have been established in healthy pre- and post-menopausal women and in normal early pregnancies. Blood flow velocities in the uterine and ovarian arteries change during the normal menstrual cycle and are very different in pre- and post-menopausal women. Lower blood flow velocities and higher pulsatility index (PI) values have been recorded in the ovarian arteries after the menopause. Uterine artery blood flow velocities increase and uterine artery PI values and resistance index (RI) values decrease with gestational age in the first trimester. There is not yet an established role of the gynecological Doppler ultrasound examination in clinical practice. It remains unclear whether the gynecological Doppler ultrasound examination contributes substantially to the clinical management of early pregnancy complications or infertility problems, to the differential diagnosis of pelvic masses or uterine pathology. Conclusions: Large prospective studies—preferably randomized controled trials—are needed to determine the clinical value of the gynecological Doppler ultrasound examination.     

血清人附睾蛋白4对妇女盆腔疾病的诊断价值

目的探讨血清人附睾蛋白4(HE4)对妇女盆腔疾病诊断的临床价值。方法分别采用酶联免疫吸附试验(ELISA)、免疫化学发光法测定43名健康妇女(正常对照组)和133例妇女盆腔疾病(包括卵巢癌7例、子宫恶性肿瘤40例、卵巢良性病变34例、子宫良性病变52例)患者血清HE4和糖类抗原125(CA125)水平。患者根据术后包块切片病理报告分组。以正常对照组x珋±2s作为正常参考范围,计算血清HE4和CA125水平对妇女盆腔恶性疾病的灵敏度和特异性等诊断性能。结果 HE4的正常参考范围上限为55.86 pmoL/L、CA125为35 kU/L。卵巢良性病变组、子宫良性病变组及正常对照组血清HE4及CA125水平差异无统计学意义(P>0.05);卵巢癌组患者HE4及CA125水平明显高于正常参考范围上限,且高于子宫恶性肿瘤、卵巢良性病变、子宫良性病变及正常对照组(P<0.01);子宫恶性肿瘤组血清HE4水平也高于正常参考范围上限,亦高于卵巢良性病变、子宫良性病变及正常对照组(P<0.05);但血清CA125水平4组间差异无统计学意义(P>0.05)。卵巢癌组和子宫恶性肿瘤组HE4与CA125呈正相关[相关系数(r)分别为0.467、0.380,P<0.05],其他3组之间无明显相关性。HE4和CA125在卵巢癌、子宫恶性肿瘤、卵巢良性性病变、子宫良性病变及正常对照组中的阳性率分别为100.00%、71.43%,37.50%、30.00%,14.70%、11.76%,19.23%、32.69%,2.32%、2.32%;HE4及CA125对卵巢癌的灵敏度分别为100.00%、71.43%,特异性为82.35%、85.29%,阳性预测值53.85%、50.00%,阴性预测值为100.00%9、3.50%;卵巢癌组HE4的受试者工作特征(ROC)曲线下面积(AUC)明显大于CA125(P<0.01)。将卵巢癌组和子宫恶性肿瘤组合并为盆腔恶性肿瘤组,血清HE4、CA125、HE4+CA125对其诊断的灵敏度分别为46.80%、36.17%、54.41%,特异性为82.60%、75.58%、47.22%,阳性预测值为59.50%、44.74%4、9.33%,阴性预测值为74.00%、68.42%、52.31%。结论血清HE4水平除了可以作为卵巢癌与部份子宫恶性肿瘤的辅助诊断标志物外,还应注意部份妇女盆腔良性疾病患者血清HE4水平也可增高。     

2005～2012年武汉市妇科癌症患病趋势及危险因素分析

目的：探讨2005～2012年武汉市妇科癌症患病趋势并对其危险因素进行分析，为临床妇科癌症的防治提供指导。方法收集武汉市2005～2012年育龄妇女妇科普查资料，并对其中妇科癌症患者患病情况及其危险因素进行汇总，分析统计武汉市妇科癌症的患病率。结果武汉市育龄妇女中妇科癌症发病率前3位分别为宫颈癌、乳腺癌、卵巢癌，且从2009年开始呈上升趋势，与2009年以前相比，差异有统计学意义（ P＜0．05）。对妇科癌症患者临床资料进行危险因素分析，年龄、学历、普查频率、妇科癌症病史、农村户口与妇科癌症发病率关系密切。结论武汉市育龄妇女妇科癌症近年呈上升趋势，临床应针对性地对育龄妇女进行生殖健康知识宣教，以降低高危妇科癌症患者的发病率及病死率。     

Application of neoadjuvant chemotherapy combined with anlotinib in occult breast cancer: A case report and review of literature

BACKGROUNDOccult breast cancer (OBC) is a special type of breast cancer presenting as axillary lymph node metastasis with undetectable primary lesions in the breast. Due to its low incidence and unique clinical manifestations, there is a lack of consensus on the diagnosis and treatment of OBC. We report a case of OBC treated with neoadjuvant chemotherapy combined with anlotinib. The treatment was well tolerated, and the patient achieved a pathologic complete response.CASE SUMMARYA 53-year-old woman presented with a lump in her right axillary area with no primary lesions in the breast. Pathological biopsy confirmed right axillary metastatic carcinoma. Immunohistochemical staining results were positive for progesterone receptor, cytokeratin 7, specific breast markers GATA3 and gross cystic disease fluid protein-15. Tumor cells were negative for estrogen receptor, human epidermal growth factor receptor-2, cytokeratin 5/6, cytokeratin 20, and villin. The patient was diagnosed with OBC, and she underwent neoadjuvant chemotherapy combined with anlotinib. Mastectomy plus axillary lymph node dissection was performed. The patient achieved pathologic complete response with no residual invasive tumor cells in the breast or axillary lymph nodes. Postoperatively, she received adjuvant radiotherapy and endocrine therapy.CONCLUSIONNeoadjuvant chemotherapy and anlotinib had good efficacy and safety in the treatment of OBC and may be a new therapeutic option.     

卵巢癌合并卵巢脓肿一例

卵巢癌是常见的妇科恶性肿瘤,其早期病变因症状及体征不明显且起病隐匿,故缺乏有效的筛查手段。卵巢癌合并卵巢脓肿或者卵巢脓肿恶变为卵巢癌在临床上发病率极低,确诊需要依赖临床实验室、病理及免疫组织化学等相关检查,治疗以手术为主,辅以化学治疗联合或不联合靶向治疗,临床疗效欠佳。该文结合病历资料及相关文献进行回顾性分析,对1例卵巢腺癌合并卵巢脓肿的临床特点及其诊治方法进行总结报道,以期引起临床医师的重视,提高对这类疾病的认识,为该类疾病的诊断和治疗提供支持。     

Influence of physiologic hormonal modification and of hormonal treatment in a patient with a history of migraine with aura

We present the case of 48-year-old woman suffering from migraine with aura (MA) since menarche. During her life the patient frequently presented catamenial MA attacks with an increasing frequency during pregnancy in particular in the second and third trimesters, and then during breast-feeding. Treatment with oral contraceptive (OC) for endometriosis and later with cyclophosphamide, methotrexate, fluorouracil (CMF) for breast cancer produced a higher number of attacks. Instead, she referred an improvement with gonadotropin releasing hormone agonist (GnRH-a) for the treatment of endometriosis and then with tamoxifen as hormonal therapy after mastectomy and chemotherapy for breast cancer. We highlight the importance of physiological hormonal modification and hormonal therapies on the course of MA.     

重复癌并发慢性粒细胞白血病1例并文献复习

目的：报告1例乳腺癌、胚胎性横纹肌肉瘤并发慢性粒细胞白血病(CML)的少见病例。方法：病理切片用单克隆抗体进行免疫组化染色分析：骨髓细胞短期培养后按常规方法制备染色体，用R显带技术进行细胞遗传学分析；采用RT-PCR法检测CML细胞bcr／abl融合基因。结果：该病例为乳腺癌、胚胎性横纹肌肉瘤双重癌后并发的Ph^ ／bcr-abl^ CML。结论：原发肿瘤、放化疗及机体免疫监视系统损害，是导致继发性Ph^ ／bcr-abl^ CM的主要因素。     

Papillary thyroid carcinoma (PTC) in Lynch syndrome: Report of two cases and discussion on Lynch syndrome behaviour and genetics

We present here two cases of papillary thyroid carcinoma (PTC) in patients affected by Lynch syndrome (LS). The first case is a 47-year-old woman with typical hereditary non-polyposis colorectal cancer (HNPCC) syndrome, reported with endometrial and ovarian carcinoma at age 43, and colon cancer at age 45. The patient underwent total thyroidectomy and central node dissection in 2007, at 47 years old, with a histological diagnosis of PTC (T1aN1a). Molecular genetics showed a germ-line mutation of the MLH1 gene, 1858 G>T(E620X), with substitution of glycine with a stop codon at position 620. This mutation has pathogenetic significance and was considered responsible for the various tumours of the HNPCC spectrum. In particular, in the same kindred, spanning 5 generations, there were 5 members with colorectal cancer, 4 with endometrial cancer, 3 with gastric and 2 with breast cancer. The second case is a 34-year-old man with typical HNPCC syndrome with colonic resection for colon cancer at age 21. The patient underwent total thyroidectomy with central and lateral node dissection in 2010, at age 34, with a histological diagnosis of PTC with nodal metastases (pT4N1b). Molecular genetic analysis showed a germ-line mutation of the MSH2 gene (thymine insertion at position 907). This mutation had pathogenetic significance and was considered responsible for HNPCC development. Two similar cases have been reported: a 39-year-old woman, and a 44-year-old woman, affected by HNPCC syndrome, with anaplastic thyroid carcinoma and undifferentiated thyroid carcinoma, respectively. We reviewed the Lynch syndrome literature on the history, genetics and expanding tumour spectrum of this condition.