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Malignant gynecologic tumors in pregnant patients are rare and a challenge to obstetricians, gynecologists, and neonatologists. Cervical cancer is the most common malignancy diagnosed during pregnancy, followed by ovarian malignancies. The treatment of cervical cancer during pregnancy depends on the stage of the disease, the age of the pregnancy, and the patient's preferences regarding the current pregnancy and future fertility. Dysgerminomas are the most frequent ovarian malignancies in pregnant women. Conservative surgery with preservation of the pregnancy is possible for patients with stage IA tumors. Cytotoxic chemotherapy in pregnant patients has been reported. Endometrial cancer associated with pregnancy is very rare but has been reported in endometrial biopsies performed for abnormal uterine bleeding postpartum and after abortion. Some of these cancers may predate the pregnancy. High levels of progesterone during pregnancy probably inhibit tumor growth. Conservative treatment of endometrial cancer is an option for selected patients who wish to preserve fertility.

Background: The female breast is a rare location of extranodal non-Hodgkin's lymphoma (primary breast lymphoma). Most lymphomas of the breast are unilateral, diffuse, large B-cell lesions. Case reports: We describe two women with primary non-Hodgkin B-cell lymphoma of the breast. Neither had a history of other malignancies. The first patient was 73 years old and had mammography and frozen-section histology findings interpreted as invasive carcinoma. Mastectomy and axillary lymph node dissection were performed. Histology of the paraffin-embedded specimens showed nodular breast involvement of PBL. Polychemotherapy (CHOP regimen) was administered and the patient is in complete remission. The second patient was 67 years old and presented with erythema and swelling of the breast. Inflammatory carcinoma was suspected. Mammography showed a large solid mass with microcalcifications. A large-core biopsy showed primary breast lymphoma. Four cycles of CHOP therapy induced a partial remission and the patient is now scheduled for radiation therapy. Conclusion: At imaging studies there are no findings pathognomonic of NH L of the breast. Gallium-67 scintigraphy may be useful. Frozen-section histology is unreliable for diagnosing lymphoma of the breast. The prognosis is associated with the stage of the disease and the age of the patient.

Background: Combinations of anthracyclines, taxanes and gemcitabine have shown high activity in breast cancer. This trial was designed to evaluate a modified combination regimen as primary chemotherapy. Non-pegylated liposomal doxorubicin (NPLD) was used instead of conventional doxorubicin to improve cardiac safety. Gemcitabine was given 72 h after NPLD and docetaxel as a prolonged infusion over 4 h in order to optimize synergistic effects and accumulation of active metabolites. Patients and methods: Forty-four patients with histologically confirmed stage II or III breast cancer were treated with NPLD (60 mg/m 2 ) and docetaxel (75 mg/m 2 ) on day 1 and gemcitabine as 4-h infusion (350 mg/m 2 ) on day 4. Treatment was repeated every 3 weeks for a maximum of six cycles. All patients received prophylactically recombinant granulocyte colony-stimulating factor. Patients with axillary lymph node involvement after primary chemotherapy received adjuvant treatment with cyclophosphamide, methotrexate and fluorouracil. Results: The clinical response rate was 80%, and complete remissions of the primary tumor occurred in 10 patients (25%). Breast conservation surgery was performed in 19 out of 20 patients (95%) with an initial tumor size of less than 3 cm and in 14 patients (70%) with a tumor size £3 cm. Seven patients had histologically confirmed complete responses accounting for a pCR rate of 17.5%. Expression of Ki-67 was the most important predictive parameter for response with high 38.9% breast pCR rate in patients with elevated Ki-67 expression. Although the predominant toxicity was myelosuppression with grade 3/4 neutropenia in 61% of patients few neutropenic complications resulted. Non-hematological toxicity was generally moderate with grade 3 or 4 toxicity in 10.0% of cycles. Most common non-hematologic toxicities were nausea, vomiting, alopecia, mucositis, asthenia and elevation of liver enzymes. Conclusion: The evaluated schedule provides a safe and highly effective combination treatment for patients with early breast cancer, which is suitable for phase III studies.

To assess the efficacy and safety of primary systemic treatment with doxorubicin and paclitaxel in patients with early breast cancer. Forty patients with newly diagnosed, histologically confirmed breast cancer (T2, N0–1, M0) received primary chemotherapy with doxorubicin (60 mg/m2) and paclitaxel (200 mg/m2) in 3-week intervals for up to four courses. A total of 151 cycles were administered. The clinical response rate as assessed by sonographic measurement was 70%, and complete remissions of the primary tumor occurred in two patients. Eight patients (20%) had histologically confirmed complete responses. Predominant toxicity was myelosuppression with grade 3/4 neutropenia in 70% of patients. Non-hematological toxicity was generally moderate. Grade 4 non-hematological toxicities were not observed and grade 3 toxicity was reported with alopecia (98%) and stomatitis (10%). The combination of doxorubicin and paclitaxel is safe and highly active in patients with early breast cancer. The evaluated schedule is suitable for phase III studies.

Thirty-two patients with histologically confirmed cervical carcinoma were preoperatively investigated using MRI; in addition, a CAT-scan was performed on 15 of these patients. The diagnostic results using both modalities were compared with the histological findings (after hysterectomy according to Wertheim-Meigs, including lymph node dissection in the pelvic and, in part, in para-aortal regions). Determination of tumour volume was possible with high accuracy using MRI. Accuracy in assessing the parametria was 86%, vagina 90%, bladder and rectum 97%. The shortcoming of MRI is still the detection of infiltrated lymph nodes. The accuracy of 69% achieved for lymph nodes is equal to results with computed tomography. The general accuracy for our patients in staging was 81% for MRI versus 47% for CT. MRI-based diagnosis enables us to determine a correct tumour staging preoperatively, and is therefore very helpful in planning an adequate therapy. If MRI were used more widely it would contribute to simplification and shortening of the preoperative diagnostic procedure in patients with cervical carcinoma.

The investigation of cervix carcinoma with magnetic resonance tomography (MRT) is still controversially discussed with regard to its diagnostic value as well as for planning radiation therapy. The purpose of this article is to present and discuss papers published between 1993 and 1997 in this field with respect to the technique used, the contrast media applied and its clinical value. A literature search using three different databases (Medline, Embase, Cancerlit) identified 39 publications, which were then analysed. Despite the partially suboptimal presentation of results in these papers MRT proved superior to other imaging modalities. Due to better demarcation of cervix carcinoma with MRT, it was possible to calculate tumor value as well as to correctly judge the infiltrative character. This allows for a more precise treatment and staging of the patient's prognosis. In the future, MRT might be useful in diagnosing recurrence at relatively early stage. Unfortunately lymphatic nodes can only be insufficiently verified using MRT.