Adenoid cystic carcinoma: A case of rare breast cancer

Adenoid cystic carcinoma is a rare form of breast cancer accounting for 0.1%-1.0% of all mammary malignancies. It is characterized by an indolent clinical course and favorable prognosis, contrary to other breast cancers. Diagnostic mammogram and breast ultrasound play a pivotal role in the early detection and diagnosis of breast adenoid cystic carcinoma. Treatment may consist of lumpectomy and radiation therapy vs mastectomy alone. Even though rare, late disease recurrence and metastasis has been reported in the literature thus long-term surveillance is of utmost importance for these patients. We will review the literature and discuss the case of a 52-year-old female who presented with a palpable lump of the right breast, which was pathologically proven to be adenoid cystic carcinoma of the breast.     

Seasonal trend of acute pelvic inflammatory disease

Purpose

Many infections follow a seasonal trend. Aim of our study was to check whether acute pelvic inflammatory disease (PID) follows a seasonal progress.

Methods

In a retrospective study on 12,152 hospital records, 158 cases of acute pelvic inflammatory disease were identified. Periodogram analysis was applied to the date of pelvic inflammatory disease admission and to related environmental factors, such as temperature and photoperiod.

Results

Pelvic inflammatory disease follows a seasonal rhythm with mean to peak variation of 23 % and maximal values in September (±37.2 days). The rhythm, more evident in married women, is related to the rhythm of temperature advanced by 2 months and of photoperiod advanced by 3 months. Cases of pelvic inflammatory disease are more frequent than expected in unmarried (36 vs. 17.3/34,626, p = 0.015), particularly divorced women 30–40 years of age.

Conclusions

Our study evidences a seasonal trend and confirms unmarried, particularly divorced status, as important risk factor for acute pelvic inflammatory disease.     

Prospective measurement of blood pressure and heart rate over 24 h in women using combined oral contraceptives with estradiol

Objective

Combined oral contraceptives (COCs) containing ethinyl-estradiol are known to increase blood pressure (BP). We evaluated whether COCs containing estradiol (E2) influence 24-h ambulatory BP and heart rate (HR) in normotensive and normal-weight women.

Study design

Twenty-four-hour BP and HR were measured every 30 min with an ambulatory BP device in 18 normotensive healthy non-smoking women prior to (Days 3–6 of menstrual cycle) and after 6 months of use (Days 20–24 of cycle 6) of a COC containing either a quadriphasic combination of E2 valerate plus dienogest (n=11) or a monophasic association of micronized E2 plus nomegestrol acetate (n=7).

Results

Mean age and body mass index of the final sample were 32.50±7.49 years and 22.87±4.08, respectively. E2-based COCs induced no modification of 24-h systolic BP (+ 1.65±8.34 mmHg; p=.41), diastolic BP (+ 0.04±7.36 mmHg; p=.98), mean BP (+ 0.64±6.42 mmHg; p=.68) or HR (− 0.72±5.86 beats/min; p=.61). Differences were not observed even when daytime or nighttime values were separately considered. Though this was not a comparative study, we did not find differences between the effects of the two formulations (24-h mean BP; p=.699).

Conclusions

These data suggest a neutral effect of estradiol-based COCs on independent risk factors for cardiovascular diseases such as BP or HR.

Implications

BP and HR of normotensive women are not increased by E2-based COCs.     

Impact of laparoscopic cystectomy of endometriotic and non-endometriotic cysts on ovarian volume,antral follicle count (AFC) and ovarian doppler velocimetry

Objective: To evaluate the effect on ovarian reserve and blood flow of unilateral laparoscopic stripping of endometriotic versus non-endometriotic cysts.

Design: Prospective observational study.

Setting: Tertiary university gynecology unit.

Patients: During the study period, 71 subjects underwent the first laparoscopic surgery for removal of a monolateral benign ovarian cyst.

Interventions: Trans-vaginal ultrasound scans of the pelvis about six months after surgery.

Main outcome measures: Ovarian volume, Antral Follicle Count (AFC) and Resistance Index (RI) of ovarian artery of the operated and the contralateral ovary.

Results: Among 71 cysts, 39.4% were endometriotic and 60.6% non-endometriotic benign cysts. All the procedures were performed by the same experienced surgeons with a standardized technique. No major complications were reported during surgery. The mean (±SD) age and BMI of women were 31.0?±?6.8 years and 24.2?±?3.3?kg/m², respectively. Mean diameter of the removed cysts was smaller for endometriotic than non-endometriotic cysts (4.35?±?1.77?cm versus 6.33?±?3.71?cm, p?=?0.046). In comparison to non-operated, volume of the operated ovary was significantly lower and with a reduced AFC, with no difference between endometriotic and non-endometriotic cysts (?2.41?±?2.35 versus ?2.00?±?2.23?cm³, p?=?0.496) (?3.45?±?3.07 versus ?2.43?±?1.95, p?=?0.11). Ovarian artery RI was higher in the operated ovary with no difference between endometriotic and non-endometriotic cysts (0.19?±?0.14 versus 0.14?±?0.10, p?=?0.455). The difference in ovarian volume (r?=?0.178), AFC (r?=?0.094) and RI (r?=?0.079) between operated and non-operated ovary was not dependent on the diameter of the removed cyst.

Conclusion: Ovarian surgery is associated with a decline of ovarian reserve, independently on the histological type and the diameter of the removed cyst.     

Management of vaginal atrophy: a real mess. Results from the AGATA study

Objectives: To investigate the management of vaginal atrophy (VA) in a population-based study.

Study design: A sub-study of a cross-sectional multicenter study on 913 postmenopausal women.

Main outcome measures: Management of VA was investigated on the 274 women referring having received a previous diagnosis of VA.

Results: Women had received, no therapy (9.8%), systemic hormones (9.2%), intra-vaginal estrogens (44.5%) or local non-hormonal (36.5%) therapy. There was heterogeneity of treatments. Local therapies were given in cycles, and used for a length of time ranging from 1 to 12?months. At the time of the investigation 59.5% of these women were not on treatment, either because following the physician’s indication (31.1%) or because spontaneously withdrawing from treatment (68.9%). Reasons for withdrawing from therapy were insufficient symptom relief (46.6%), messiness (24.3%), difficulty in application (7.8%) and vaginal discharge (1.9%). At the time of investigation only 2.9% of treated women did not suffer from VA.

Conclusions: This study underlines the presence of a great confusion about the therapy used for VA, along with patients’ dissatisfaction with actual treatments. The emerging evidence is that in real world VA remains untreated.     

Quantification of Women Who Could Benefit from Hormone Therapy after Endometrial Cancer Treatment: An Analysis of SEER Data

Our primary aim was to estimate the magnitude of stage I endometrial cancer (EC) survivors that could benefit from hormonal therapy (HT). Our secondary aims were to assess EC incidence in women below 50 and below 60 over the years, and analyze the overall survival and any influencing factors. We analyzed the endometrioid EC data from the Surveillance, Epidemiology, and End Results (SEER) program according to women’s age, tumor stage, and grade. We analyzed the proportions of EC survivors below 50 and below 60 years of age and stratified those age groups by race. For age distribution and survival analysis SEER, 18 registries’ research data (2000–2018) were analyzed. We analyzed the SEER 12 registries’ research data (1992–2019) for incidence time trends. Our investigation found a 14% and 40% cumulative prevalence of stage I EC that occurs in women below 50 or 60 years, respectively. EC’s prevalence has progressively risen in recent decades, but cancer-specific mortality remains low. The increasing number of women affected by EC in premenopause or early postmenopause face an 18 years-survival rate of 96.86% and 95.73%, respectively. A significant proportion of low-grade EC survivors can potentially benefit from HT treatment, and this requires awareness of other aspects of their health or quality of life, in addition to cancer treatments.     

Chronic pelvic pain improvement: impact on quality of life and mood

Abstract

Women with chronic pelvic pain (CPP) frequently suffer from mood disturbances and reduced quality of life. Whether pain improvement ameliorates mood and quality of life is still unclear, and it was investigated in an observational prospective study performed in a cohort of 117 of the outpatient services for endometriosis and chronic pelvic pain at a University Hospital. Depending on disease, women were treated either by surgery or by the administration of an estrogen–progestin or a progestin alone. Pain during menses, between menses and at intercourse was evaluated by a 100?mm visual analog (VAS) scale. Quality of life was evaluated by the SF-36 questionnaire, state of anxiety by the Y-1 form of the State-Trait Anxiety Inventory (STAI-Y1) and depression the Self Evaluating Depression Scale (SDS). Women were 34.2?±?8.1 years old. After a mean follow-up period of 10.0?±?9.1 months, and independently on treatment (43.6% surgery), pain during menses (?28.2?±?36.8; p<.0001), between menses (?11.3?±?37.1; p<.002) and at intercourse (?8.3?±?35.4; p<.02) decreased. SF-36 increased (3.3?±?16.2; p<.03), STAI slightly decreased (?1.9?±?8.6; p<.02), while depression did not change (?0.7?±?7.8; p=.36). Pain changes were not related to changes of SF-36 or mood scores. In women with CPP, prolonged pain amelioration, has little impact on mood, particularly on depression. The data support the need for a multidisciplinary approach to women with CPP.