Search

Background and Objective: Krüppel-like factors (KLFs) are transcription factors with the ability to mediate cross-talk with signaling pathways involved in cell proliferation control, apoptosis, migration, and differentiation. They also appear to influence steroid hormone signaling through transcriptional networks involving steroid hormone receptors and members of the nuclear receptor family of transcription factors. Our study aims to evaluate the potential prognostic role of KLF5, KLF9, and KLF11 in endometrial cancer, and their correlation with hormonal receptor status and cellular proliferation., Materials and Methods: Retrospective observational study on cases of endometrioid endometrial adenocarcinoma collected in the period January 2000-December 2011 at the University of Udine. Formalin-fixed, paraffin-embedded tissue samples were all submitted to tissue microarray immunohistochemical study. A survival analysis was performed., Results: One hundred forty seven patients were included in the study with a mean age at surgery of 65.6 years (±10.2). 80.3% of endometrial malignancies were classified as stage FIGO I (118/147). Radiation therapy and chemotherapy were administered in 62.3% (91/146) and 6.2% (9/145) of patients respectively. Five-year overall survival and disease-free survival resulted 85.4% (95% CI, 79.8-91.4%) and 79.4% (95% CI, 73.0-86.4%) respectively. A high Ki-67, cytoplasmatic KLF5 (HR 4.72, CI.95 1.61-13.89, p < 0.05), and nuclear KLF11 (HR 3.04, CI.95 0.99-9.36, p = 0.053) scores correlated with a shorter overall survival. In addition, a high nuclear KLF11 (HR 2.59, CI.95 1.13-5.95, p < 0.05) score correlated with a shorter disease-free survival., Conclusions: In patients affected by endometrioid endometrial carcinoma, higher staining levels of KLF5 and KLF11 correlated with a poorer prognosis. However, further studies are required in order to better clarify the role of KLFs in the natural history of endometrial cancer.

To evaluate the expression of markers correlated with cellular senescence and DNA damage (8-hydroxy-2'-deoxy-guanosine (8-OHdG), p53, p21, APE1/Ref-1 (APE1), interleukin (IL-6 and IL-8) in placentas from healthy and pathologic pregnancies. This retrospective study considered a placental tissue micro-array containing 92 controls from different gestational ages and 158 pathological cases including preeclampsia (PE), HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count), small for gestational age (SGA) fetuses, and intrauterine growth restriction (IUGR) occurring at different gestational ages. In this study, we demonstrated a significant influence of gestational age on the expression in the trophoblast of 8-OHdG, p53, p21, APE1, and IL-6. In placentas of cases affected by PE, HELLP, or IUGR, there was an increased expression of 8-OHdG, p53, APE1, and IL-6 compared to controls (only IL-8 was significantly decreased in cases). In both groups of pathology between 22- and 34-week gestation and after 34-week gestation, APE1 levels were higher in the trophoblast of women affected by hypertensive disorders of pregnancy than women carrying an IUGR fetus. The cytoplasmic expression of 8-OHdG was increased in placentas in IUGR cases compared to PE or HELLP pregnancies. In cases after 34-week gestation, p21 was higher in SGA and IUGR than in controls and late PE. Moreover, p53 was increased after 34-week gestation in IUGR pregnancies. Placentas from pathological pregnancies had an altered expression of 8-OHdG, p53, p21, APE1, IL-6, and IL-8. The alterations of intracellular pathways involving these elements may be the cause or the consequence of placental dysfunction, but in any case reflect an impaired placental function, possibly due to increased aging velocity in pathologic cases.

Background: Human papillomavirus (HPV) infection is a prerequisite of cervical cancer, the leading cause of cancer mortality in Ethiopian women today. Data on Ethiopian cervical HPV prevalence and genotype distribution are rare, but essential as pre-vaccine baseline data to monitor changes after initiating HPV vaccination. The objectives of this study were to assess the cervical HPV prevalence, genotype distribution and associated correlates among female hospital outpatients in rural Ethiopia., Methods: We examined a consecutive sample of 537 women 15-64 years of age in rural Ethiopia between November and December 2006. Screening for low risk (LR) and high-risk (HR) cervical HPV infection was performed and HR positive samples were genotyped with a GP5+/6 + - and SPF10-primer based system., Results: The age-standardized prevalence of HPV, HPV HR and HPV LR infection was 17.3% (95% CI 14.1-20.5), 15.8% (95% CI 12.7-18.9) and 3.9% (95% CI 2.3-5.6), respectively. Among HC2 HPV HR positive infections (n = 86), the most common genotype was HPV 16 (24.4%), followed by 52 (11.6%), 56 (10.5%) and 31 (10.5%). Non-married relationship and widowhood, increasing number of lifetime sexual partners, human immunodeficiency virus infection and non-traditional housing type, but not age, were significantly associated with HR HPV infection., Conclusions: These results on cervical HPV prevalence and genotype distribution may serve as baseline data in evaluating the impact of future HPV vaccination programmes in rural Ethiopia.

Background: Extramammary Paget disease (EMPD) is a very rare genital neoplasia associated with a high frequency of local recurrences. Surgical excision is the standard treatment, but results in mutilating procedures in patients with advanced or recurrent disease. Case reports have shown clinical responses to imiquimod in patients with EMPD, but this therapy has not been evaluated systematically., Objective: The aim of this study was to evaluate imiquimod as local treatment of first-time and recurrent EMPD., Methods: All cases of biopsy-proven EMPD of the vulva treated within the German Colposcopy Network or other institutions specializing in vulvar diseases in Germany were included in this retrospective analysis., Results: A total of 21 women with EMPD treated with imiquimod were identified: 11 (52.4%) achieved complete response, 6 (28.6%) achieved partial response, and there were no cases of progressive disease. The dose and duration of imiquimod differed between patients. The mean duration of treatment exceeded 16 weeks in women achieving complete response., Limitations: EMPD is rare and this retrospective study is limited by the small number of patients identified., Conclusion: When associated cancers and invasive growth are excluded, imiquimod appears to be a useful treatment option for recurrent EMPD and may avoid extensive mutilating surgical treatment., (Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Paget disease is a rare disorder of the skin of the vulva, comprising less than 1% of vulvar neoplasms. Surgical excision is considered the standard of care. While the invasive variant of Paget disease is rare, frequent local recurrences from non-invasive disease, which are inoperable, constitute a major clinical problem. In this article we report on a 71-year-old patient with recurrent disease treated successfully with imiquimod cream. Symptoms such as local itching subsided shortly after initiation of treatment. Four weeks later, first signs of resolution could be demonstrated colposcopically. Within 8 weeks, complete clinical remission was achieved. Thus, topical imiquimod is not only effective as treatment of vulvar intraepithelial neoplasia, but may also be used for selected patients with recurrent Paget disease as an alternative to repeat surgical interventions.

Introduction: Benign metastasising leiomyoma refers to a type of lesion characterised by leiomyomatous alterations without any indication of malignancy. It presents as either a singular nodule or multiple nodules of proliferating smooth muscle cells and is generally found in the lungs of women who have undergone a hysterectomy. The purpose of this case report is to contribute to the knowledge of this rare disease by presenting evidence and experience of a patient case. In particular, this report seeks to investigate the therapeutic approaches in order to understand whether a standard of care can be prescribed and whether the use of prophylaxis therapy with progesterone as a follow-up to surgery serves as a reasonable treatment in certain cases diagnosed as benign metastasising leiomyoma., Case Presentation: We present the case of a 52-year-old Caucasian woman who developed a pelvic relapse and a pulmonary localisation of benign metastasising leiomyoma following a hysterectomy for myomatous uterus., Conclusion: Our literature review revealed a single case of the use of chemoprophylaxis as treatment of a benign metastasising leiomyoma. The role of chemoprophylaxis in preventing future recurrences remains unclear. The use of progesterone as an adjuvant therapy for benign metastasising leiomyoma could simply be palliative, with associated psychological benefits, or it could be of therapeutic significance.

Objective: In this prospective study using the Munich II nomenclature for cervical cytology. Pap smear results obtained by the ThinPrep monolayer technique and those obtained by the conventional method were compared., Methods: Pap smears were obtained from 1,000 women using an Ayre spatula/endocervical brush combination. Following transfer of the cell sample onto a slide, the same collection devices were rinsed in a liquid medium and processed using ThinPrep-2000 processor (split-sample technique)., Results: Specimen inadequacies due to drying artefacts, cell overlap or low number of epithelial cells were rare with both methods without any significant differences. However, ThinPrep slides were significantly less often compromised by red or white blood cells or by cytolysis. In contrast, endocervical cells were missing in 11.6% of slides compared to only 2.3% in conventional Pap smears. ThinPrep yielded results of unknown significance (Pap III) significantly less often (4.2 vs 6.3%)., Conclusions: ThinPrep slides are less frequently compromised by blood components or cytolysis. Inconclusive results of Pap III are slightly less frequent when using ThinPrep. However, there is a significant percentage of slides lacking the endocervical component. Using a combination of spatula and cytobrush, this may not necessarily be due to non-representative cell sampling., (Copyright 2007 S. Karger AG, Basel.)

Background: It is widely accepted that vulvar carcinoma with a depth of invasion of less than one millimeter is sufficiently treated by vulvectomy or wide local excision without inguinal lymphadenectomy., Case Presentation: However, a patient with inguinal lymph node recurrence 21 months after radical vulvectomy for stage IA squamous cell carcinoma was observed., Conclusion: According to a review of the literature, there are five additional cases of metastasizing vulvar cancer with a depth of invasion of less than one millimeter. Therefore, the definition of microinvasive carcinoma of the vulva based on depth of invasion alone may not be as reliable as previously thought and does not rule out inguinal lymph node involvement or recurrence. Consequently, the necessity of inguinal node dissection for microinvasive carcinoma needs to be discussed on an individual basis taking into account the age of the patient as well as the potential morbidity of extended surgery.

Genetic investigation of BRCA1 and BRCA2 germline mutations is, nowadays, a diagnostic procedure with practical clinical applications. The role of this genes in DNA repair and stability and in cancer development is now well recognised. Most involved are breast and ovarian cancers, but, less frequently, other gynecological cancers like cervical, corpus uteri and Fallopian tubes cancers and also other non gynecological malignancies. We report the case of a 67-year-old patient with strong familiarity for breast cancer, with a BRCA2 germline mutation, who developed in 30 months 4 primary malignancies: in chronological order, breast cancer, chronic lymphatic leukemia, and synchronous ovarian and endocervical adenocarcinoma. A better knowledge of the biological and clinical behaviour of BRCA related cancers is of strategical importance in the management of patients with strong familiar neoplastic history or with genetic test positivity. An adequate counselling can help in the management of these cancers in the prevention and early diagnosis taking also into consideration the possibility of a prophylactic surgery.

Creation of a neovagina to treat vaginal atresia or aplasia in Mayer-Rokitansky-Kuester-Hauser syndrome must always be followed by long-term application of dilators to avoid shrinkage. However, rectoneovaginal fistulas are caused by chronic alteration and consecutive necrosis of the posterior neovaginal wall. We evaluated retrospectively the postoperative outcome of rectal wall and neovaginal reconstruction using a standardized surgical technique in an exclusive collection of women. Eight women with a mean age of 28 years (range 22-31 years) were treated for rectoneovaginal fistulas in our clinic. Preoperatively, proctoscopy, sphincter manometry, endoluminal rectal ultrasonography, and colonoscopy were performed; and regular postoperative follow-up by digital examination and rectoscopy were obligate. The standard surgical procedure via a perineal approach included fistulectomy and closure of the mucosa and rectal wall followed by a levatorplasty. All but one woman had a temporary colostomy. After 2 weeks the patients were allowed to wear vaginal dilators of a smaller size. Within the mean follow-up period of 20 months, reintervention was necessary twice because of late fistula relapse detected by proctoscopy, barium enema, and subjective symptoms. Morbidity was 25% (n = 2) due to secondary superficial wound healing or urinary tract infection. The average time of the hospital stay was 13 days (10-14 days). One patient complained of vaginal shrinkage and underwent local estrogen therapy with a good functional result 3 months later. Proper fistulectomy and surgical reconstruction with interpositioning of well perfused muscle layers achieved good functional outcome with an acceptable number of minor morbidities. Local estrogen treatment is helpful for avoiding scarification and decreasing the neovaginal size.

Aims: This study was performed to test the validity of different methods for determining the status of the erbB-2/HER-2 oncogene in breast cancer tissues for diagnostic use., Methods and Results: Forty formalin-fixed, paraffin-embedded breast carcinomas were investigated by fluorescence in situ and comparative genomic hybridization (FISH, CGH) as well as by immunohistochemistry (IHC) using Dako-HercepTest and CB11 antibody (Ventana). Additionally, competitive-differential polymerase chain reaction (cdPCR) was performed on frozen samples to estimate gene dosage alterations of erbB-2/HER-2. Amplification was detected in 12-23% and protein overexpression in 16-68% of the cases, depending on the methodology and/or the reagent used. Perfect concordance (100%) was found between the results of cdPCR and CB11-IHC, and a 97% concordance between FISH and CB11-IHC. The concordance between Dako-HercepTest and CB11-IHC was 78%: seven of eight 2+ carcinomas with the Dako-HercepTest were classified as nonamplified using FISH., Conclusions: Our results indicate that high-level expression as well as normal erbB-2/HER-2 status of breast carcinomas can be detected reliably both by IHC and gene dosage assessment in paraffin material for diagnostic use. However, borderline results, especially those with 2 + immunopositivity, should be interpreted with caution and increased emphasis should be given to other clinical and prognostic information available.

Objective: Mayer-Rokitansky-Küster-Hauser syndrome is a congenital malformation characterized by an absence of the vagina associated with a variable abnormality of the uterus and the urinary tract but functional ovaries. Surgical correction requires the creation of a neovaginal canal by the performance of a neovaginoplasty and an accurate long-term application of an artificial phallus phantom to avoid secondary shrinkage of the canal. Due to the chronic alteration of the posterior neovaginal wall, ulcers and consecutive fistulae may occur. We report the clinical course of a female who required surgical intervention for a rectoneovaginal fistula and developed a recurrence of the fistula due to one of the extremely rare squamous cell carcinomas of the neovaginal epithelium in order to show potential diagnostic and therapeutic features., Method: The systematic report of a case is presented., Result: Almost 13 years following the initial construction of a neovagina the patient developed a single-tract rectoneovaginal fistula. After surgical repair she represented with a recurrence due to a vast squamous cell carcinoma of the former operation site. Tumor en bloc resection was performed and currently (follow-up: 4 months) she has no signs of new tumor progression., Conclusion: Creation of a neovagina is the standard procedure for treating vaginal atresia or aplasia. Because of the long clinical course postoperatively, complications may occur. This report of a case of a malignant transformation in neovaginal epithelium shows the potential risk of malignancy and underlines the necessity of a close follow-up., (Copyright 2000 Academic Press.)

The detection of blood-borne cancer cells may help in clinical staging and further understanding of cancer metastasis. We developed a cytokeratin-based immunomagnetic method to isolate epithelium-derived cells from the circulating blood of patients. The number of cell clusters positive for cytokeratin/prostate-specific antigen (PSA) from the peripheral blood of prostate cancer patients and cytokeratin/p185c-erbB-2 from the peripheral blood of breast cancer patients has been related to stage of the disease. Breast cancer patients who presented cytokeratin/p185c-erbB-2-positive cell clusters showed a decrease in such cells under adriamycin adjuvant therapy with Further molecular characterization by a highly sensitive microsatellite multiplex-PCR enabled reproducible detection of microsatellite alterations. The impact of these individually targeted results may contribute to an individual diagnostic and therapeutic strategy.

The documentation of operations in the field of gynecology and obstetrics is regulated by social laws in Germany. Only by optimal encoding of diagnoses and procedures an efficient cashing with the health insurance's can be achieved. This requires profound knowledge of the invoice modalities and usually support by computer systems. The Internet offers in this respect some assistance, which in the following is pointed out and evaluated critically.

The switch to the new millennium causes greater difficulties in computing concerning hard- and software. It is not foreseeable how much each computer will be hit by that. Due to the common use of computers in all parts of medicine the possible crash of data banks and networks across hospitals could afflict the regular care of patients in wards and outpatient clinics. The ability of each computer to go to the new millennium can be checked by simply performed tests or by highly specialized programmes as well. As many mistakes occur in co-operation of hardware and software, it is hard to fix the system. To continue the use of a data bank it is necessary to change the data bank's date format and all applications at the same time. Programmers and providers offer their advice via internet.

For decades scientific sessions and conferences were a proven way to spread and exchange scientific results worldwide--not only in the field of medicine. With growing availability and accessibility of information on the internet and WWW conferences are now not only listed and announced on a multitude of websites, but also are prepared ahead from simple registration to online discussions. By means of selected examples information is provided on how keeping oneself informed about former or planned conferences by using the internet.

The varying symptoms of rhesus incompatibility were recognized and described approximately sixty years ago. Jörg Schneider, then at the Freiburg University Hospital in Germany, had been the very first investigator to perform rhesus prophylaxis in pregnant women. The exact date of this achievement is August 9, 1963. One year later, Schneider could report on nine women, who-following delivery of a rhesus-positive child-did not develop rhesus antibodies during a subsequent pregnancy with a rhesus-positive fetus. Since the late sixties, rhesus prophylaxis has been an integral part of prenatal care in Germany. In the meantime, the role of ante-partum prophylaxis has also been established. Since the introduction of post-partum rhesus prophylaxis, fetal morbidity and mortality has been reduced by 90 percent.

Within the last two years Internet pages have become a highly interesting source of up-to-date information. The scientific value of those homepages for reproductive medicine differ in a wide range. The Internet still remains a very interesting source for up-to-date information covering the field of infertility treatment with a growing influence on patient decisions and with increasing economical impact.

The German gynecologist Friedrich Rumpf from Berlin performed the first radical hysterectomy in Europe. This pioneering achievement is even more remarkable as Rumpf was working in private practice without the support of one of the major Berlin university hospitals. Very few biographical data can be found. Fortunately, his views of gynecologic surgery are expressed in his publications. This aim of this article is to remind us of Rumpf's reflections on surgical technique which are still relevant today and to contribute to Rumpf's memory.

Extraperitoneal incision of the bladder is recommended for difficult gynecologic-oncologic operations. Cystostomy facilitates dissection of the bladder and helps to prevent injury of the distal ureter. Six cases are reported (2 cervical carcinomas, 2 ovarian carcinomas, 1 vaginal carcinoma, 1 sarcoma) to illustrate the indication and technique of cystostomy.

1895 was a crucial year in the course of the development of abdominal radical surgery for effective treatment of cervical cancer. In March of 1895, Ries presented the rationale of modern radical hysterectomy and was the first to call for systematic removal of pelvic lymph nodes. Independently, Clark in Baltimore, Rumpf in Berlin, and Latzko in Vienna performed the first radical hysterectomies. This article is dedicated to the memory of the contributions by these four pioneers of surgical gynecology presented in 1895.

In order to evaluate the maximum tolerable dose of a combination chemotherapy consisting of cyclophosphamide, methotrexate, 5-fluorouracil, and folinate (CMFF), 30 female patients with histopathologically confirmed, previously untreated advanced breast cancer were entered into this pilot study. Chemotherapy consisted of fixed doses for methotrexate (40 mg/m2 i.v. on day 1), 5-fluorouracil (500 mg/m2 i.v. on day 2 to 4) and folinic acid (2 x 200 mg/m2 i.v., 0 + 2 h on day 2 to 4). The dose of cyclophosphamide was escalated stepwise, starting with 200 mg/m2 i.v. on day 2 to 4, to 240 mg/m2, 290 mg/m2, 360 mg/m2 and 400 mg/m2, respectively, for each subsequent five patients. Treatment was repeated every four weeks. A total of 92 treatment cycles was given. Myelosuppression was the dose-limiting toxicity: leukopenia WHO grade III or IV was observed after a total of 28 cycles and anemia of equal intensity after 1 cycle. No thrombocytopenia WHO grade III or IV was recorded. Myelotoxicity increased with higher doses of cyclophosphamide. Among non-hematologic toxicities, alopecia was reported in two-thirds of the patients. Nausea and vomiting was noted in 25% of treatment cycles, but in one cycle only WHO grade III was recorded. No other toxicities exceeding WHO grade II occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Between 1964 and 1991, vaginal hysterectomy was performed in 60 patients with clinical stage I endometrial carcinoma, who were not considered candidates for the conventional surgical approach. Of these patients, 66.7% were obese with a median weight of 235 pounds. Other risk factors included hypertension (63%), diabetes mellitus (34%), cardiac disease (28%) and pulmonary disease (12%). Operative mortality was 0%. The complication rate was 14%, with four patients requiring transfusions and four patients developing vaginal cuff cellulitis. Forty per cent of patients received adjuvant pre- or postoperative radiation therapy. Crude survival at 5 and 10 years was 91.1% and 87.1%, respectively. However, only one patient died from disease 6 years after primary treatment. Although we consider surgical staging as the standard of care for the treatment of endometrial cancer, vaginal hysterectomy has a definite place in the management of patients with good prognostic criteria who are at high operative risk for the standard surgical approach.

A case of granular cell tumor of the breast in a 59 year-old woman is presented. Clinical evaluation suggested carcinoma with infiltration of the skin. The granular cell tumor was diagnosed on frozen section and the lesion was treated by wide local excision including the overlying skin. Granular cell tumors of the breast, which are usually benign, may closely mimic breast carcinoma, both clinically and on frozen section. The possibility of granular cell tumor of the breast with its potential for a false-positive diagnosis on frozen section supports a two-step procedure for the treatment of breast cancer, especially in young women, to prevent inappropriate radical surgery.

The monoclonal antibody Ki-67 has been described in 1983 by Gerdes. Lymphocytes stimulated with PHA as well as a number of human tissues have been studied using the antibody. The results have shown, that the Ki-67 antigen is expressed by all cells in the active phases of the cell cycle not, however, by resting cells or the starting sequences of the cell cycle. Although the nature of the Ki-67 antigen ist not yet known, several studies have demonstrated that the Ki-67 growth fraction is a valuable parameter for characterization of malignant tumors. So far, the so-called "Ki-67 growth fraction" (Ki-67 GF) has been determined on non-Hodgkin-lymphomas and on malignant tumors of the bone, kidney and lung. The most extensive data are available on breast cancer. In the author's studies the APAAP-method (APAAP = "alkaline phosphatase-anti-alkaline phosphatase") is preferred as an immunohistochemical staining method. The median Ki-67 growth fraction of 261 breast carcinomas was 12.5% (range 1 to 65%), being five times higher than in benign breast tissue (n = 126). The Ki-67 GF of breast cancer was correlated to different parameters known to be related to prognosis. Thus, a correlation was found with the age of patients, tumor stage, histological grading and hormone receptor status. These results are similar to those obtained by autoradiography and flow cytometry. Of 141 patients the clinical outcome of disease is known (median follow-up 22 months): 25 patients have developed local recurrence of the chest wall. This group of patients showed no significant correlation to the Ki-67 growth fractions of the primary tumors. However, the Ki-67 GF was significantly higher in 20 patients with early systemic disease and in 19 patients who died from breast cancer. Based on these results a clinical trial on adjuvant chemotherapy of lymphnode-negative patients should be taken into consideration. Thus, the prognosis for early stage breast cancer might be improved.

Construction of a neovagina using the Grossman and mesh-graft techniques was done upon 20 patients with congenital absence of the vagina. Evaluation of cytologic specimens taken one to 13 years after the operation showed a remarkable resemblance to those from normal epithelium. In 18 of 20 patients, keratinization only pointed to the origin of the graft. No nuclear atypia or history of cytologic dysplasia was found. Thus, regular gynecologic and cytologic examinations, according to the principles applied to healthy women, are sufficient in patients who have undergone construction of a neovagina.

The following tumor markers were determined in body fluids associated with pregnancy: carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), neopterin, CA125, CA153 and CA199. CEA levels (cut-off 5.0 ng/ml) were not elevated during gestation, whereas TPA was above cut-off (85 U/l) in 98 out of 107 cases (range 40-408 U/l). TPA was significantly higher during the 3rd trimester of pregnancy than during the 1st and 2nd trimesters. 38.3% of CA125 measurements were slightly above the chosen cut-off of 35 U/ml, and the mean concentration was 33.5 +/- 16.2 U/ml. During delivery, 14 out of 21 values (67%) were elevated. Only 9.4% of CA153 values were elevated. CA199 and neopterin were also hardly ever above cut-off. In general, there was a wide scattering of individual values. With the exception of CA153 (neopterin not determined), high concentrations of CEA (maximum: 207 ng/ml), TPA (maximum: 1,565 U/ml), CA125 (maximum: 2,371 U/ml) and also CA199 (maximum: 1,533 U/ml) were found in amniotic fluid. The distribution in mixed cord blood was similar but with more moderate elevations and a lower incidence of levels above cut-off. Thus, none of these antigens is tumor specific. The term 'tumor-associated antigen' instead of 'tumor marker' is more appropriate. CEA, TPA, CA125 and CA199, but not CA153, are oncofetal antigens.(ABSTRACT TRUNCATED AT 250 WORDS)

Lymphoid subsets in the venous blood of 109 patients with various gynecologic malignancies were determined by monoclonal antibodies and compared with the results of 92 women without malignant disease. The patients were followed up for one year to study the influence of therapy on lymphoid cells. The results before treatment showed little difference between the two groups. In stage III and IV, total lymphocyte counts and OKT3+, OKT4+, OKT8+ and OKM1+ subsets were significantly lower compared with stage I and II. Radiation therapy caused a significant and long-lasting decrease of nearly all lymphoid cells. Patients who relapsed or died during the observation period had significantly diminished levels of OKT3- and OKT8-positive cells before treatment.

In 329 breast tissues (120 benign lesions and 209 invasive breast carcinomas) the growth fraction was determined using the monoclonal antibody Ki-67. The percentage of Ki-67 positive cells or the Ki-67 growth fraction was determined on histologic and cytologic specimens after immunoperoxidase staining. In benign breast lesions, the Ki-67 growth fraction never exceeded 11%, whereas in breast cancer 14.4 +/- 9.9% of cells were Ki-67 positive ranging from 1 to 48%. Breast carcinomas were classified according to the histologic grading system of Bloom and Richardson (G1-G3). Poorly differentiated carcinomas. (G3) had significantly higher Ki-67 growth fractions than well differentiated tumors (G1). Ki-67 was also correlated with axillary lymph node status. Growth fractions of N+ carcinomas were significantly higher than those of N0 tumors (16.4 +/- 10.4% versus 12.4 +/- 9.4%; p = 0.006). Thus, this new method yields similar results to those obtained by other researchers through the use of flow cytometry and thymidine labelling. As determination of Ki-67 growth fractions is an easy and rapid technique, it is ideal for routine clinical use. Ki-67 may be useful in prognosis and in the selection of patients for various treatment modalities such as adjuvant therapy. A wide-spread use of Ki-67 would be helpful to gain further experience.