Annika Riska

Adult-type ovarian granulosa cell tumors (AGCTs) have an unpredictable tendency to relapse. In a carefully validated patient cohort, we evaluated the prognostic factors related to AGCT recurrence. We identified all patients diagnosed with AGCT during 1956-2014 in Helsinki University Hospital, with a minimum follow-up of one year (n=240). After a histological review supplemented with FOXL2 (402C-G) mutation status analysis, we analyzed the clinical data for association with relapse. The final cohort included 164 (68%) molecularly defined AGCTs (MD-AGCTs). The majority of the women were postmenopausal (63%), and 92% of tumors were stage I. The median follow-up time was 15.5years. Fifty-two (32%) patients developed tumor recurrence, of whom 55% had successive recurrences. Multiple-site recurrences were common, and nearly half of the recurrences were asymptomatic. The median time to the first relapse was 7.4years, and 75% of relapses occurred within ten years after primary diagnosis. The median disease-free survival was 11.3years. Premenopausal status at initial diagnosis, FIGO stage Ic versus Ia, and tumor rupture associated with relapse. However, tumor rupture was the only independent predictive factor. Of the relapsed patients, 48% died of AGCT in a median time of 15.3years. Tumor rupture is the strongest predictive factor for recurrence, and these patients might benefit from a more aggressive initial treatment approach. AGCT requires active follow up for 10 to 15years after primary diagnosis, since recurrences may develop late, asymptomatically and in multiple anatomical locations.

Background: Abnormal prolongation of QRS duration is a common finding in patients with chronic heart failure, and is associated with an impaired prognosis. The optimum QRS duration for separating chronic heart failure patients with respect to prognosis has not ...

Primary fallopian tube carcinoma (PFTC) is a rare malignancy, but its incidence has been rising during the last decades and varies between 2.9/1,000,000 and 5.7/1,000,000. The epidemiology of PFTC has been sparsely studied. In Finland, the incidence rate has been rising during the last decades. The rise has been highest in the cities, in higher social classes, and in certain specific occupations. Parity gives protection against this disease, as does a previous sterilization procedure. Earlier thoughts of a previous salpingitis as a possible promoter of PFTC seem not to hold. Previous infections such as Chlamydia trachomatis infections or human papillomavirus infections cannot be regarded as risk factors. In this chapter, we clarify the possible epidemiological factors behind this disease.

The present study was undertaken to find a practical method for estimating the fetal shoulder width by ultrasound. Sixty pregnant women at term were included in the study. The distance between the lateral margin of the fetal cartilaginous caput humeri and the processus spinosus of the cervical vertebra C7 (humerospinous distance) was measured by ultrasound. The neonatal shoulder width was measured with a craniometer during the first postnatal day. Linear regression analysis was used to calculate the correlation between the humerospinous distance and the shoulder width, and a significant linear correlation (r = 0.612, p < 0.001) was shown. Although, in this small study, we could not show a relationship between humerospinous distance and dystocia, we feel a clinical study of humerospinous distance as a predictor of shoulder dystocia is indicated.

It was the aim of this study to evaluate the prognostic value of the pretreatment serum concentrations of the beta-subunit of human chorionic gonadotropin (hCGbeta), CA 125 and tumour-associated trypsin inhibitor (TATI) in primary fallopian tube carcinoma (PFTC). The pretreatment serum concentrations of hCGbeta, CA 125 and TATI were analyzed in serum samples from 60 women with a mean age of 61 years, treated for PFTC between 1985 and 2000. Of the 91 patients treated during this period, 31 were excluded because no serum sample was available. The patients were followed-up for recurrence and survival until February 14, 2003. The prognostic value of the serum markers were compared with those of stage, grade and histological type. The median survival time was 27 months and the overall 5-year survival rate 33%. Stage and size of the residual tumour (<1 vs. > or =1 cm) predicted both overall and disease-free survival (p < 0.050). Histology (serous vs. others) (p = 0.023) also influenced overall survival. Overall 5-year survival was 38% when serum hCGbeta was below 3.5 pmol/l, while it was 18% when the level was higher (p = 0.052). The corresponding disease-free 5-year survival was 38 and 20%, respectively (p = 0.014). Patients with CA 125 values above 1,017 kU/l had an overall 5-year survival of 39% as compared with 14% for those with lower values (p = 0.009), while the disease-free survival was 37 and 23%, respectively (p = 0.096). Serum TATI was not a prognostic marker. Serum concentrations of hCGbeta and CA 125 correlated significantly with stage (p = 0.049 and p = 0.050, respectively). In multivariate Cox proportional hazards regression analysis, only hCGbeta, stage and histology emerged as independent prognostic factors. Clearly elevated serum concentrations of hCGbeta and CA 125 predict survival in fallopian tube carcinoma, but in multivariate analyses, only hCGbeta is a prognostic factor independent of stage and histology.

This study examines whether depiction of users of antidepressants in advertisements for antidepressants in the 1995 issues of the major medical journal in each of Denmark, Finland, Norway, and Sweden differs from that in the American Journal of Psychiatry. The results show that the people shown in the Danish, Finnish, and Norwegian journals are predominantly women, whereas depiction of users in the American and Swedish advertising is predominantly of couples. The portrayals in the 1995 advertising are of antidepressants as female gendered; a feature that was not seen in advertising for psychotropic drugs in the Nordic countries in the 1980s.

Erythropoietin (Epo) is a glycoprotein that stimulates proliferation and migration of human endothelial cells and promotes angiogenesis, which are crucial phenomena in cancer biology. The objective of this study was to investigate whether Epo is detectable in the ascitic fluid of patients with ovarian tumors. We investigated the presence of Epo in the ascitic fluid of 100 women undergoing laparotomy for an ovarian tumor. Epo concentration was quantitated with an immunochemiluminometric assay. Ten women had a benign tumor, 13 women had a borderline tumor, and 77 women had ovarian cancer. Epo was detected in all ascitic fluid samples, in similar amounts as in corresponding serum samples. Ascitic fluid Epo concentration did not differ between the 3 study groups (P = 0.081), but in multiple comparisons, ascitic fluid Epo was higher in the women with cancer than in the women with a benign tumor (P = 0.006). Ascitic fluid Epo concentration correlated positively with serum Epo (P < 0.0001) and the volume of ascites (P < 0.0001). In regression analyses, serum Epo, volume of ascites, blood hemoglobin, plasma CA125, tumor stage, tumor grade, and the presence of residual tumor after surgery had no significant independent effect on ascitic fluid Epo. Considerable amounts of Epo are present in the ascitic fluid of women with ovarian tumors. The origin of Epo in the ascitic fluid of women with ovarian tumors as well as the clinical relevance of our finding remain to be clarified.

Primary fallopian tube carcinoma (PFTC) is a rare malignancy and only sparse data exist on its possible association with postmenopausal hormone therapy (HT). We therefore studied this association in a nationwide cohort of Finnish HT users. All women> 50 years using systemic estradiol-only therapy (ET) (n=117,820 hysterectomized women) or estradiol-progestin therapy (EPT) (n=247,781 nonhysterectomized women) for ≥ 6 months during 1994-2008 were identified from the national medical reimbursement register. The incidence of PFTC in HT users was compared to that in the comparable background population (standardized incidence ratio, SIR, with 95% confidence interval, CI). A total of 160 cases of PFTC were encountered in users of ET (n=34) or EPT (n=126). The use of EPT ≥ 5 years was accompanied by an increased risk for PFTC (SIR 2.15; 95% CI 1.66-2.72). The SIR increased further to 3.36 (95% CI 2.02-5.24) when EPT use lasted ≥ 10 years. The EPT-related risk for PFTC was restricted to the sequential EPT and it was not seen for continuous EPT. Two leading progestins in EPT, norethisterone acetate and medroxyprogesterone acetate, associated with comparable risk elevations. ET use was not associated with the risk for PFTC. The long-term, sequential use of EPT associates with an increased risk for PFTC. In absolute terms, 4 additional cases of PFTC would be detected in 10-year follow-up of 10,000 women who have used EPT for at least 5 years.

While previous data link the use of postmenopausal hormone therapy to an increased risk for ovarian cancer, little is known about the impact of various progestins, modes or routes of administration of hormone therapy for this risk. In this nationwide study, we compared relations between different estradiol-progestin (EPT) formulations and epithelial ovarian cancer risk. All Finnish women over 50 years using EPT for at least 6 months (224 015 women with 602 ovarian cancers) during 1994-2006 were identified from the reimbursement register. The incidence of ovarian cancer in EPT users was compared to that in the age-matched background population by means of observed to expected ratio (standardized incidence ratio, SIR). Ovarian cancer risk was not elevated for EPT use of < 5 years but it was elevated for EPT use of ≥5 years (SIR 1.21, 95% confidence interval (CI) 1.06-1.37). Medroxyprogesterone acetate and norethisterone acetate as components of EPT were associated with similar risks for use for ≥ 5 years (SIR 1.26, 95% CI 0.94-1.64 and SIR 1.42, 95% CI 1.11-1.77, respectively). The risk did not differ between sequential or continuous EPT regimens or between oral or transdermal EPT formulations. The risk elevation for EPT use for ≥ 5 years was seen only for serous (SIR 1.56; 95% CI 1.33-1.80) and mixed cancers (SIR 1.54; 95% CI 1.22-1.91), whereas the risk for mucinous cancer was decreased (SIR 0.47; 95% CI 0.22-0.86). The elevated risk of non-mucinous ovarian cancer in users of EPT ≥ 5 years does not depend on progestin type, mode or route of administration of EPT.

Primary fallopian tube carcinoma (PFTC) is rare, constituting about 1% of female genital tract malignancies, and little is known about its etiological, protective, risk or prognostic factors. Earlier, such factors were thought to be similar to those seen in ovarian cancer. The incidence of PFTC has been rising during the last decades, especially in higher social classes and among women in certain occupations. Parity is a strong protective factor for PFTC, with a lower incidence associated with an increasing number of deliveries. Previous sterilisation seems to offer some protection. Earlier suggestions of previous genital infections as risk factors appear not to hold. Previous cancers are frequent among PFTC patients, especially breast cancer. Second primary cancers after PFTC are also frequent, especially non-lymphoid leukemia, colorectal, breast, bladder and lung cancer. Only 4% of primary fallopian carcinomas are correctly diagnosed before operation. Treatment consists of aggressive cytoreductive surgery and adjuvant chemotherapy with a platinum-taxane combination. A high preoperative serum hCGss is a strong prognostic factor for worse prognosis. The 5-year survival rates vary between 22 and 57%.