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Konigsberg R.,Applied Cancer Research Institution for Translational Research Vienna ACR ITR VIEnna | Konigsberg R.,Ludwig Boltzmann Research Institute | Pfeiler G.,Medical University of Vienna | Klement T.,Medical University of Vienna | And 6 more authors.
European Journal of Cancer | Year: 2012

Background: In an aging population an increasing number of breast cancers is diagnosed in elderly women. Tumor characteristics and patterns of metastasation have been extensively elucidated in younger triple negative breast cancer (TNBC) patients, but data regarding TNBC in elderly women are missing. The goal of this investigation was to compare clinical pathological characteristics of younger and elderly TNBC patients in order to assess their relevance for TNBC in an aging population. Methods: Data of TNBC patients diagnosed between 1998 and 2004 were retrospectively analyzed by computer based chart information. Baseline tumor characteristics, patient demographics and patterns of metastasation were compared between younger (<65 years) and elderly (≥65 years) TNBC patients. Results: Out of 254 TNBC patients 75.6% were <65 years and 24.4% were ≥65 years. Mean tumor size, tumor grade and number of positive lymph nodes did not differ significantly (p = 0.865, 0.115 and 0.442, respectively) between both age groups. Distant visceral metastases occurred significantly more often than bone metastases in both age groups (p < 0.001). Local recurrences, bone and secondary lymph node metastases were observed at significantly higher numbers in younger patients (p = 0.035, 0.025 and 0.041, respectively). Elderly TNBC patients received significantly less chemotherapy than younger patients (p < 0.001). Conclusions: TNBC of elderly patients is an aggressive breast cancer subtype claiming as much attention as TNBC in younger patients, thus warranting chemotherapeutic intervention irrespectively of age. © 2012 Elsevier Ltd. All rights reserved. Source

Brunner A.,Landesklinikum Thermenregion Moedling Vienna | Hinterholzer S.,Landesklinikum Thermenregion Moedling Vienna | Riss P.,Landesklinikum Thermenregion Moedling Vienna | Heinze G.,Medical University of Vienna | Brustmann H.,Landesklinikum Thermenregion Moedling
Gynecologic Oncology | Year: 2012

Objective: B7-H3, a member of the B7 family of immune regulatory ligands regulates T cell-mediated peripheral immune response. The purpose of this study was to correlate the expression of B7-H3 and number of lymphocytes in patients with endometrial cancer. Material and methods: A total of 107 patients with primary endometrial carcinoma (type I/endometrioid, n = 81; type II, n = 18) and endometrial hyperplasia (n = 8) were investigated. Expression of B7-H3 in endometrial hyperplasia, endometrial carcinoma, and the endothelium of tumor-associated vasculature was assessed using immunohistochemistry from paraffin-embedded tissue blocks. Detection of CD8-positive tumor-infiltrating lymphocytes (TIL) and CD8-positive tumor-associated lymphocytes (TAL) was correlated with the expression of B7-H3. Results: Patients with high grade tumors and patients with type II carcinomas expressed significantly more B7-H3 than low grade and endometrioid tumors (p = < 0.0001 and p = 0.0001, respectively). The expression of B7-H3 in the endothelium of identified vasculature in the tumor specimens showed similar results with strong relation to high grade tumors (p = 0.001) and type II carcinomas (p = 0.004). We found a significant correlation between B7-H3 expression on cancer cells and tumor T-cell infiltration (TIL) (p = 0.017). In a univariate survival analysis, overexpression of B7-H3 in tumor cells was associated with shortened overall survival (p = 0.005). Conclusions: B7-H3 is overexpressed on cancer cells and in the endothelium of tumor-associated vasculature in high grade tumors (G3) and type II carcinomas. B7-H3 expression on cancer cells is correlated with the number of T cells infiltrating the tumor. Endometrium tumor development and progression may be associated with downregulation of T-cell-mediated antitumor immunity through B7-H3. © 2011 Elsevier Inc. All rights reserved. Source

Brunner A.,Landesklinikum Thermenregion Moedling | Riss P.,Landesklinikum Thermenregion Moedling | Heinze G.,Medical University of Vienna | Brustmann H.,Landesklinikum Thermenregion Moedling Vienna
British Journal of Cancer | Year: 2012

Background: Phosphohistone-H3 (pHH3) is a promising reliable mitotic count biomarker. Our purpose was to study the relationship between the novel proliferation marker pHH3 and the established anti-apoptotic marker survivin and consider their prognostic relevance in endometrial cancer. Methods: A total of 106 patients with endometrial cancer (type I/endometrioid, n=81; type II carcinomas, n=18) and simple hyperplasia without atypia (n=7) were investigated. pHH3 and survivin expression were assessed using immunohistochemistry from paraffin-embedded tissue blocks. Results: A strong positive correlation was observed between pHH3 and survivin expression (P<0.0001). Patients with high-grade tumours and patients with type II carcinomas expressed significantly more pHH3 and survivin than low grade and endometrioid tumours (P<0.0001, P<0.0001, P<0.0001, and P<0.0001, respectively). In univariate survival analysis, overexpression of pHH3 and survivin were associated with increased recurrence and mortality (P<0.0001, P<0.0001, P<0.0001, and P<0.0001, respectively), in the multivariable Cox regression analyses both pHH3 and survivin could be identified as independent parameters for overall survival (P=0.004, and P=0.023, respectively). Conclusion: In endometrial cancer, pHH3 and survivin were strongly positive correlated and were both associated with type II and high-grade tumours. Increasing expression levels of pHH3 and survivin were associated with adverse prognostic factors. © 2012 Cancer Research UK All rights reserved. Source

Riss P.,Landesklinikum Thermenregion Moedling | Hinterholzer S.,Landesklinikum Thermenregion Moedling
Maturitas | Year: 2010

Maintaining standards in surgery for female urinary incontinence: Operations for female stress urinary incontinence (SUI) are among the most common operations performed. In particular, recent advances in surgical technique and materials available for this type of surgery have made these operations more accessible, but even if an operation is characterized as "minimally invasive" surgeons must aim to maintain the highest possible standards in the interest of their patients. Standards in patient selection: Great care has to be taken to do a thorough workup of a patient about to undergo surgery. A detailed history and a good clinical evaluation including a clinical stress test is a prerequisite. It is highly recommended to do an urodynamic investigation prior to any surgery which affects bladder storage and micturition in order to confirm the presumptive diagnosis and to exclude patients who should not undergo surgery (e.g. with voiding disorders). Standards in surgery: Before taking a patient to theatre the surgeon must be clear in him or her mind about which operation to do. In other words preoperative selection of the appropriate type of operation is of the greatest importance. For this reason every surgeon has to be familiar with a certain range of incontinence procedures from which she can choose in a particular instance. There is no doubt that tension-free mid-urethral slings have become the procedures of choice in most cases of stress urinary incontinence. However, there will be cases where other procedures are called for such as traditional colposuspension or fascial slings. It is the responsibility of every surgeon not to use procedures which are outdated or not recommended. To maintain standards in incontinence surgery every surgeon has to familiarize him or herself with the procedure, to learn the procedure, to practice the procedure with the help of experienced peers, and finally to achieve the highest level of competence him or herself. So-called Industry sponsored "training centres" can be helpful but there are no shortcut to use all possible resources to learn and practice new surgery. Guidelines have become very important in evaluating new procedures and in categorizing the available evidence. They focus on specific recommendations which we can and should use in our daily practice. Again we still have the responsibility to follow the medical literature closely and to adapt our practice as new evidence becomes available-even before it is incorporated into guidelines. Standards in follow-up: Last but not least we have to follow standards when following up on our patients. As far as possible in the context of the health care system where we practice we should aim to see the patient we have operated on at least once 6-12 weeks after surgery. We must also make sure that the patient has access to care in case a problem develops later. And we ourselves must be familiar with the complications and consequences of surgery for stress urinary incontinence and must be able to manage a patient who is not completely satisfied after surgery. © 2009 Elsevier Ireland Ltd. All rights reserved. Source

Brustmann H.,Landesklinikum Thermenregion Moedling | Brunner A.,Landesklinikum Thermenregion Moedling
International Journal of Gynecological Pathology | Year: 2013

SOX2 is a transcription factor controlling pluripotency in both embryonic stem cells and adult tissue-specific stem cells. SOX2 has been reported as an important factor in squamous cell carcinomas (SCC) of different locations and is involved in tumorigenesis. We evaluated the expression of SOX2 in vulvar non-neoplastic and neoplastic epithelia to test whether it is related to neoplastic progression. SOX2 immunoexpression was evaluated in 101 formalin-fixed, paraffin-embedded archival vulvar epithelia consisting of normal squamous vulvar epithelia (n=25), lichen sclerosus (n=9), high-grade classic vulvar intraepithelial neoplasia (HG-VIN, n=16), differentiated vulvar intraepithelial neoplasia (d-VIN, n=18), and vulvar invasive keratinizing SCC (n=33). Immunoexpression of SOX2 was nuclear and increased stepwise from normal vulvar epithelia/lichen sclerosus to HG-VIN and d-VIN (P<0.0001), from HG-VIN and d-VIN to invasive SCC (P=0.0029), and followed the morphologic distribution of atypical squamous epithelial cells. Scores for normal vulvar epithelia versus lichen sclerosus and HG-VIN versus d-VIN, respectively, did not differ significantly. SOX2 expression increased from tumor Grade 1 to 3 (P=0.0124); there was no relation to recurrence and survival. This is the first study presenting SOX2 as overexpressed in vulvar intraepithelial and invasive squamous lesions. This overexpression apparently reflects an early event in the neoplastic transformation of vulvar squamous epithelia. However, SOX2 seems to play a role in histologic dedifferentiation to Grade 3 invasive SCC too, and may be relevant to vulvar carcinogenesis. © 2013 International Society of Gynecological Pathologists. Source

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