BACKGROUND:As modern women delay childbearing, pregnancy-associated breast cancer (PABC) becomes a more frequent problem faced by oncologists, gynecologists, and obstetricians alike. However, no evidence exists concerning the management of this condition. METHODS:We summarized the current literature regarding epidemiology, pathology, diagnosis, treatment and prognosis of PABC. Data were collected by searching PubMed and Medline for the period from 1950 to 2007. RESULTS:There are no randomized controlled trials regarding PABC management. Current evidence suggests that diagnosis may be carried out with limitations regarding staging; surgical treatment may be performed as for the non-pregnant women. Radiotherapy and endocrine therapy are contraindicated during pregnancy, while chemotherapy is allowed after the first trimester. Prognosis is considered poor. Subsequent pregnancy is allowed only 2 years after completing treatment. CONCLUSIONS:Due to lack of prospective randomized controlled clinical studies, both ongoing studies and future evidence are expected to solve problems related to breast cancer management during pregnancy.

BACKGROUND: Sepsis is extremely rare after invasive prenatal diagnosis. CASE: A patient, who had undergone amniocentesis at 15 weeks, cordocentesis at 20 weeks, and repeat cordocentesis 24 hours before presentation, was admitted at 21 weeks gestation with vaginal bleeding, rupture of membranes, and intrauterine demise. Although clinical and laboratory findings were unremarkable at presentation, she rapidly developed septic syndrome with disseminated intravascular coagulation and eventually multiple organ failure. The fetus was disintegrated and the uterus had to be removed. She was discharged from the intensive care unit after 34 days. Cultures of the uterine content grew Clostridium perfringens. Review of the literature revealed 10 more cases of sepsis after transabdominal prenatal diagnosis. CONCLUSION: Sepsis after prenatal diagnosis can be devastating, unless promptly diagnosed and treated.

Background and Objectives: Long-term administration of tamoxifen causes endometrial changes. The aim of this study was to evaluate the role of transvaginal sonography and vaginoscopic hysteroscopy in the screening of patients on tamoxifen. Methods: Seventy patients with breast cancer treated with tamoxifen 20 mg daily underwent transvaginal sonography and vaginoscopic hysteroscopy, a modified relatively painless approach, at the beginning of the treatment and at a follow-up visit approximately 9 months after its initiation. Results: At the follow-up visit, the mean uterine dimensions and mean endometrial thickness as measured by ultrasound were significantly larger, and pulsatility and resistance indices of the uterine arteries as measured by Doppler were significantly lower. Sonography revealed abnormal endometrial thickness in 73% (51 of 70) of the patients, and 83% (58 of 70) had hysteroscopical changes. Sonography missed 1 case of endometrial adenocarcinoma. Conclusions: Vaginoscopic hysteroscopy, an approach that causes reduced pain, can add significantly to the sensitivity of transvaginal sonography for the detection of endometrial changes in patients with breast cancer receiving tamoxifen. It is recommended for every patient prior to the initiation of treatment and at the follow-up visits.

International Journal of Gynecology & ObstetricsVolume 70, Issue S3 p. C59-C59 Free communication lower genital tract: Intraepithelial neoplasms The role of human papillomavirus testing in cervical screening E. Paraskevaidis, E. ParaskevaidisSearch for more papers by this authorG. Koliopoulos, G. KoliopoulosSearch for more papers by this authorM. Paschopoulos, M. PaschopoulosSearch for more papers by this authorE. Kontostolis, E. KontostolisSearch for more papers by this authorK. Zikopoulos, K. ZikopoulosSearch for more papers by this authorL. Pappa, L. PappaSearch for more papers by this authorM. Malamou-Mitsi, M. Malamou-MitsiSearch for more papers by this authorS.N. Kalantaridou, S.N. KalantaridouSearch for more papers by this authorI. Georgiou, I. GeorgiouSearch for more papers by this authorH.C. Kitchener, H.C. KitchenerSearch for more papers by this authorD.E. Lolis, D.E. LolisSearch for more papers by this author E. Paraskevaidis, E. ParaskevaidisSearch for more papers by this authorG. Koliopoulos, G. KoliopoulosSearch for more papers by this authorM. Paschopoulos, M. PaschopoulosSearch for more papers by this authorE. Kontostolis, E. KontostolisSearch for more papers by this authorK. Zikopoulos, K. ZikopoulosSearch for more papers by this authorL. Pappa, L. PappaSearch for more papers by this authorM. Malamou-Mitsi, M. Malamou-MitsiSearch for more papers by this authorS.N. Kalantaridou, S.N. KalantaridouSearch for more papers by this authorI. Georgiou, I. GeorgiouSearch for more papers by this authorH.C. Kitchener, H.C. KitchenerSearch for more papers by this authorD.E. Lolis, D.E. LolisSearch for more papers by this author First published: 10 December 2003 https://doi.org/10.1016/S0020-7292(00)80488-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS32000Pages C59-C59 RelatedInformation

Tamoxifen is a non-steroid antiestrogen widely used as adjuvant therapy in breast cancer. It has been associated with a variety of endometrial and/or myometrial changes. We propose a method for the diagnostic approach of these changes using vaginoscopic hysteroscopy.

Stefanidis, Konstantinos MD; Kontostolis, Stylianos MD; Pappa, Lambrini MD; Kontostolis, Emmanuel MD Author Information

Three cases of breast cancer during pregnancy and lactation which were referred to the Obstetrics and Gynecology Department of loannina University Hospital during the period 1990-1997 are presented. Diagnosis and management of these cases are discussed and a strength protocol is suggested to identify new cases of breast cancer during pregnancy and lactation.

The purpose of this study was to evaluate the effect of tamoxifen therapy on the endometrium by transvaginal color Doppler sonography and on lipid profile focusing on lipoprotein (a) [Lp(a)] levels. Seventy-five postmenopausal breast cancer patients were examined by transvaginal color Doppler sonography and serum Lp(a) levels. Lipid parameters were measured after overnight fasting. Forty of the patients were treated with tamoxifen (20-30 mg/day) for at least 1 year. The remaining 35 patients did not receive tamoxifen and were used as controls. Statistical analysis was performed using t-test and Mann-Whitney U-test (Systat version 5.0). The patients receiving tamoxifen had significantly thicker endometrium (7.9 +/- 3.6 mm) compared to the control group (4.5 +/- 1.8 mm) (p < or = 0.001). The mean pulsatility index and resistance index of the uterine arteries in the tamoxifen group were 2.063 +/- 0.49 and 0.83 +/- 0.07, respectively, and were significantly lower than those of the control group (2.69 +/- 0.16 and 0.88 +/- 0.02) (p < 0.001). In addition, tamoxifen decreased total cholesterol (p < 0.001) and low-density lipoprotein cholesterol (p <0.001) and apolipoprotein B (p < 0.05) significantly. Tamoxifen also increased high density lipoprotein cholesterol (p < 0.05) and apolipoprotein A-I (p < 0.05). These results indicate that tamoxifen stimulates the endometrium and acts as an anti-atherogenic agent in postmenopausal women.

Forty-one patients with operable breast cancer and >/=10 positive axillary lymph nodes were treated with 6 cycles of dose-dense adjuvant chemotherapy consisting of epirubicin (100 mg/m2) every 2 weeks with G-CSF support. A total of 240 cycles were administered, all of them at full dose and 19 (8%) with a delay. Thirty-eight (93%) patients completed the treatment according to the protocol. The relative dose intensity of epirubicin was 0.99. Grade 3 toxicities included anemia (3%), nausea and vomiting (5%) and alopecia (71%). After a median follow-up of 40 months, 16 (39%) patients were free of relapse. In conclusion, the present study has shown that the administration of dose-dense chemotherapy with epirubicin is feasible in the adjuvant setting with minimal toxicity.

This study evaluates the benefits and side-effects of two drugs (tamoxifen or danazol) used randomly in women with severe cyclical mastalgia. Ninety-three patients with severe cyclical mastalgia of more than 6 months duration were randomly selected for treatment with tamoxifen (32 women), danazol (32 women) or placebo (29 women) for six consecutive cycles. A standard protocol was used, which included pain relief as measured by linear analog, side-effects and cost. Statistical analysis was performed using the non-parametric Mann-Whitney U or Kruskall-Wallis tests and Student's t-test. As measured by linear analog scoring, pain relief was achieved in 23/32 (72%) of those receiving tamoxifen, 21/32 (65%) of those taking danazol (p < or = 0.001) and 11/29 (38%) of those taking placebo. Twelve months after the end of treatment, 17 (53%) women who received tamoxifen were still free of symptoms, as compared with 12 (37%) of the danazol-treated patients (p < 0.001) and none of the placebo-treated patients. These results suggest that tamoxifen is highly efficaceous and cost effective for the management of severe cyclical mastalgia.

A thirty four year old woman with recurrent catamenial pneumothorax is described. Pleural endometriosis was suspected and cytologic examination of fluid drained from the right pleural cavity showed glandular cell clusters of probable endometrial origin. The patient received a long-acting GnRH agonist (Triptorelin-Arvekap-Ipsen) 3.75 mg/month I.M. for nine months and remains asymptomatic with regular periods 12 months after discontinuing the treatment.