Faculty of Medicine

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Author: search.filters.author.Kubelka, KaterinaSubject: search.filters.subject.prognosis

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    Blood vessel invasion and inflammatory stromal reaction at the invasion front as additional significant prognostic factors in surgically treated patients with cervical carcinoma.
    (Springer, 2001-09)
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    Yashar, Genghis
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    Veljanoska, Slavica
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    Kubelka, Katerina
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    Prodanova, Irina
    Introduction: The objective of this study was to evaluate the prognostic significance of 23 clinical and histopathological variables in relation to disease-free (DFS) and overall survival (OS) in patients with early stage cervical carcinomas. Methods: A retrospective analysis of 237 patients with cervical carcinoma, undergoing radical hysterectomy and postoperative irradiation between 1988 and 1997 was conducted. The operative specimens were subjected to detailed and uniform histopathological work-up. The patients were staged according to the postoperative TNM classification of UICC (1997) guidelines. Mean follow-up time was 57 (18-124) months. Results: The 5 and 10-year OS rate was 80.8%, while DFS rates at 5 and 10 years were 76.8% and 75.5%, respectively. In multivariate analysis, blood vessel invasion, pelvic lymph node metastases, tumor diameter, inflammatory stromal reaction at the invasion front, and minimum thickness of uninvolved cervical stroma/parametrial extension, were independent and significant variables. The prognostic index, as an indicator of the patient's place in the prognostic spectrum, defined by the Cox regression model, was able to categorize the patients into three distinct risk groups. The 5-year DFS and OS rates of the low-, intermediate-, and high-risk groups were 97.5%, 86.3%, and 43.8%, vs. 98.8%, 84.5%, and 45.3%, respectively (P<0.0001). Conclusions: The prognostic index could be a sound basis for an appropriate planning of the following therapeutical strategy for the surgically treated patients with cervical carcinoma. The postoperative TNM classification should be modified, incorporating the blood vessel invasion and the inflammatory stromal reaction at the invasion front, as additional significant prognostic factors.
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    Immunohistochemical study of phyllodes tumor of the breast
    (Springer, 1999-09)
    Yashar, Genghis
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    Kubelka, Katerina
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    Zografski, George
    Phyllodes tumor ('PT) is a rare, fibroepithelial breast neoplasm with unpredictable prognostic and controversial therapeutic aspects. Aims: The aim of this retrospective study is to evaluate Ki-67 and CD34 antigen expression, as well as estrogen (ER) and progesterone receptor (PgR) status in stromal cells, as additional diagnostic criteria in assessing different types of PT. Methods: Routinely processed, formalin-fixed and paraffin-embedded surgical specimens from 47 cases of PT were stained by immunoperoxidase technique using Ki-67, CD34, ER and PgR monoclonal antibodies. On the basis of histopathological criteria proposed by Azzopardi, 6 malignant, 12 borderline and 29 benign PT have been evaluated. The mean size of the tumour was 9.4 cm (range 2.8-20 era). During the follow-up period (mean 50, range 2-127 months), recurrences were observed in 8 patients (17%). Results: The proliferating index determined by Ki-67 antigen expression was significantly different between histologically benign PT (19%), borderline PT (25%) and malignant PT (50%). There was a difference of the human progenitor cell CD34 antigen expression in malignant PT (50%), borderline PT (50%) and benign PT (30%). As expected, the stromal cells in various types of PT were mostly ER negative and PgR positive. Conclusions: Our preliminary results suggest that CD34 positivity and high proliferative index of Ki-67 antigen in stromal cells are more frequently associated with high grade PT. Therefore, the immunohistochemical features could provide better discrimination between different PT types. The prognostic implications of these observations should be evaluated in additional studies.
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    Paravaginal female adnexal tumor of probable Wolffian origin. A case report
    (Springer, 1999-09)
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    Yashar, Genghis
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    Kubelka, Katerina
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    Zografski, George
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    Stavrik, George
    Female adnexal tumor of probable Wolffian origin (FATWO) is a rare neoplasm originating from mesonephric remnants. Approximately 50 cases have been reported, predominantly arising in broad ligament, mesosalpinx, ovarian hilus, and periadnexal region. Aims: The aim of this report is to present the clinical and pathological features of a FATWO occurring in paravaginal area. So far, there have been only two cases reported to occur at this site. Case report: The patient is a 23-year old, nuliparous female, presented with a painless fixed paravaginal tumor. In August 1995, explorative laparatomy was performed. Encapsulated ovoid, tumor, located between urinary bladder and vagina, tightly fixed to vaginal wall connective tissue, was found. The uterus and both adnexa appeared unremarkable. The tumor was removed and biopsy sample from left ovary was taken. The patient had had an uneventful post-operative course and she remained well, without evidence of recurrence, 42 months after laparatomy. Results: The tumor was a solid ovoid mass with smooth surface, measuring 6.7 x 5 x 3.7 cm. On sectioning, the neoplastic tissue was solid, soft, butter yellow in colour; multiple cysts varying up to 3 cm in diameter and hemorrhagic foci were also present. Microscopically, it was well circumscribed and surrounded by fibrous capsule, composed of tumor cells arranged in different patterns: solid, closely packed tubules, and microcystic. The histochemical and immunohistochemical features of the tumor were identical to other cases of FATWO reported in the literature. Conclusions: Although the majority of these tumors are benign, a few cases have shown definite low malignant potential, with metastases and recurrences developing after at least 6 to 16 years following radical surgery. The presented case indicates that in spite of the unusual location, FATWO must be recognized, ensuring a careful and prolonged follow-up.