A 35-yr-old patient suffering from secondary amenorrhea for two years before she was diagnosed. Secondary amenorrhea occurred after the first normal vaginal delivery, and it was initially associated ...with breastfeeding and a formerly diagnosed thyroid disease. Transvaginal ultrasound confirmed a tumorous mass of the right ovary. Blood hormone tests detected high serum inhibin B and Anti-Müllerian hormone levels and high androgen level with no signs of virilization. Surgical treatment was indicated for a definitive diagnosis of suspected sex cord-stromal tumor. Right-sided laparoscopic salpingo-oophorectomy was performed, and the histopathological analysis confirmed the diagnosis of granulosa cell tumor adult type. The oncological team recommended adjuvant chemotherapy after the operation, but the patient did not give an informed consent. One month after surgical treatment, spontaneous menstrual bleeding occurred with normalization of sex hormone levels and the menstrual cycle. Nine months after surgical treatment, the patient was examined again due to secondary amenorrhea. Ultrasound confirmed a vital intrauterine pregnancy. The pregnancy course was normal, and the patient had a full-term spontaneous vaginal delivery of her second child.
Restoration of fertility after a temporary loss due to hormone-secreting granulosa cell tumor is possible after sparing surgical treatment. The role of adjuvant chemotherapy is controversial, particularly in patients with stage I-II disease because of the rarity of this tumor and the absence of prospective randomized studies.
Vaginal carcinosarcomas (VCSs) are rare and clinically aggressive neoplasms. Primary vaginal malignancies are among the rarest malignant tumors, so clear management guidelines and optimal therapy, ...especially in the presence of significant pelvic organ prolapse, has not been determined. Here, we present a case of primary VCS closely associated with differentiated squamous intraepithelial neoplasia (DSIN), from which it appeared to have arisen in a postmenopausal patient with complete uterine prolapse. The unusual presentation of our case with DSIN in the adjacent vaginal epithelium with possible diagnostic pitfalls emphasizes the need for systemic presentation of these cases to help pathologists and clinicians know that such lesions can initially present in a patient with complete uterine prolapse. To our knowledge, this is the first case of vaginal DSIN described in the literature to date.
Problem
Differences in the expression of gp96 and its receptors were analysed in normal and pathological human pregnancy.
Material and Methods
Immunohistology and immunofluorescence of sections from ...decidual part of term placenta, first trimester normal decidua, missed abortion and blighted ovum decidua were performed together with reverse transcriptase–quantitative polymerase chain reaction and flow cytometry.
Results
In missed abortion, gp96 was intensively stained, when compared to normal early pregnancy. The intensity of CD91 and TLR4 was higher in the first trimester pregnancy and blighted ovum, when compared to missed abortion. Decidual part of the term placenta is invaded with gp96+, CD91+ and TLR4+ trophoblast. Progesterone‐induced blocking factor (PIBF) decreased the frequency of TLR4+ T lymphocytes, CD91+ T, natural killer (NK) and mature dendritic cells after an 18‐h culture. Decidual mononuclear cells (DMCs) treated with PIBF down‐regulated CD91, TLR4 and gp96 gene expression.
Conclusion
The presence of gp96, CD91 and TLR4 at the maternal–foetal interface provides a molecular basis for their interaction, particularly in the absence of PIBF.
Objective. Adult granulosa cell tumors (AGCTs) represent 2%–5% of all ovarian malignancies. The aim of this study was to analyze clinical and pathohistological parameters and their impact on ...recurrence, overall, and disease-free survival in FIGO stage I AGCT patients. Methods. The tumor specimens analyzed in this retrospective study were obtained from a total of 36 patients with diagnosis of ovarian AGCT surgically treated at the Department of Gynecology, Rijeka University Hospital Centre, between 1994 and 2012. Clinical, pathological, and follow-up data were collected. Results. The mean age at diagnosis was 54.5 years with a range of 24–84. The majority of the patients, 30 (83%), were in FIGO stage IA, 3 (8%) in stage IC1, 1 (3%) in stage IC2, and 2 (6%) in stage IC3. During follow-up period (median 117.5 months, range 26–276), recurrence occurred in 4 patients (12%) with 2 deaths of the disease recorded. In univariate analysis, the 5-year survival rates were significantly shorter in patients with FIGO substage IC (p=0.019), with positive LVSI (p=0.022), with presence of necrosis (p=0.040), and with hemorrhage (p=0.017). In univariate analysis, the 5-year disease-free survival rates were significantly shorter in patients treated with fertility surgery (p=0.004), with diffuse growth pattern (p=0.012), with moderate and severe nuclear atypia (p=0.032), and with presence of hemorrhage (p=0.022). FIGO substage IC proved to be independent predictor for recurrence (OR = 16.87, p=0.015, and OR = 23.49, p=0.023, resp.) and disease-free survival (p=0.0002; HR 20.84, p=0.02) at the uni- and multivariate analyses. Conclusions. FIGO substage IC is predictive of recurrence and disease-free survival in patients with early-stage AGCTs. LVSI, presence of necrosis and hemorrhage, diffuse growth pattern, and nuclear atypia in AGCTs seem to be associated with overall and disease-free survival, so these pathological features should be taken into consideration when managing patients with AGCT.
Abstract Objective To evaluate the treatment and clinical outcome of patients with FIGO stage IA1 cervical squamous cell carcinoma (SCC). Methods Medical records, including 5-year follow-up, were ...reviewed for 276 patients with stage IA1 SCC. Results As definitive surgery, 152 (55.1%), 72 (26.1%), 40 (14.5%), and 12 (4.3%) patients underwent conization, hysterectomy, hysterectomy with pelvic lymphadenectomy (PL), and radical hysterectomy with PL, respectively. Among these groups, the 5-year recurrence-free rate was 94.1%, 98.6%, 95%, and 100%, respectively, and the survival rate was 98.7%, 98.6%, 100%, and 100%, respectively. Recurrent disease was identified among 12 (4.3%) patients, and was related to the depth of invasion ( P < 0.001). Eleven (4.0%) of 276 patients were found to have lymph vascular space invasion (LVSI). There were no positive lymph nodes among 52 patients who underwent PL, including those with LVSI. Conization was followed by hysterectomy in 49 patients. In these patients, residual intraepithelial neoplasia was found in 18 women, 3 of whom had no involved margins on previous conization. In the group of patients treated by conization, recurrence correlated with the status of the endocervical and lateral cone margin ( P < 0.001). Conclusion As a conservative approach, conization is an effective and reasonable treatment option for stage IA1 SCC, especially in actively reproductive women.
We studied 115 cases of EEC diagnosed on hysterectomy specimens. Double immunohistochemical staining (D2-40/CD31) was performed in all 115 cases to show LVI and BVI on the same slide. MELF pattern ...invasion was present in 24/115 (21%) cases. MELF-positive tumors had a higher frequency of LVI than MELF-negative tumors (58% and 23%, respectively); the frequency of BVI was twice as high in MELF-positive tumors in comparison to MELF-negative tumors (25% and 12%, respectively). These differences were significant (p ˂ 0.0001). All tumors with positive BVI also had a concomitant LVI. The presence of MELF invasion had no impact on overall survival, confirming previous studies. 5-year survival rates were almost equal in cases with negative LVSI and cases with positive isolated LVI (98% vs. 97%). However, in cases where BVI was also present, the 5-year survival rate was significantly lower, 63% (p ˂ 0.0001). Furthermore, BVI proved to be an independent prognostic factor for overall survival, disease-free survival, and recurrence in the multivariate analysis. In conclusion, MELF pattern invasion is a good predictor of lymphatic and blood vessel invasion but has no prognostic value. Our results suggest that BVI in EEC has greater clinical value than isolated LVI or myometrial invasion patterns, and the therapeutic approach should be guided by BVI presence. Therefore, we hope this study will promote the routine evaluation of BVI in the context of EEC diagnostic procedures.
The patients treated with conservative surgical therapy for cervical intraepithelial neoplasia (CIN) have an increased risk to develop invasive cervical carcinoma compared to the general population. ...Cervical cytology and HPV test are included in the protocols for the detection of treatment failure. The purpose of the study was to analyse cytology-histology correlation after conisation or Large Loop Excision of the Transformation Zone (LLETZ), resection margin status, compliance to the follow-up protocol and evaluation of cervical cytology and HPV testing in two year period after surgical treatment. We retrospectively reviewed 251 cases of conisation or LLETZ performed between January and December, 2006. Conventional cervical smears were analysed and abnormal cytology was defined as atypical squamous cells of undetermined significance or worse (ASCUS+). The digene Hybrid capture 2 test was used for detection of high-risk HPV types. Histology analysis demonstrated CIN1 + lesion in 234 cases (93.2%) with cytology-histology correlation in 97.9% of cases. A preoperative HPV test was made in 142 histologically confirmed CIN1 + lesions and 137 (96.5%) tested positive. The resection margins were involved in 48 (20.8%) cases. In 24 (10.3%) cases the margins were difficult to determine. Abnormal cytology was found in 33 (15.2%) cases of the 217 (86.5%) patients that attended the post-treatment visits. The post-treatment HPV test was performed on 159 women and it was positive in 25 (15.7%) cases. The complete follow-up control cytology, with at least three Pap smears in the subsequent two years or with second treatment, was registered in only 146 (58.2%) patients. 14/217 (6.5%) patients underwent second treatment with histologically confirmed treatment failure. In all patients with control smear, repeated cytology found HSIL. On six women, the control HPV test was performed. In five cases, it was positive and in one case with histological diagnoses of VAIN2, it was negative. Our study confirms the important role of cervical cytology in the diagnosis of cervical intraepithelial lesions and monitoring after treatment. In the future we will have to improve compliance to the follow-up protocols and use of the HPV test in the selection of women at risk of treatment failure.
Novi model patogeneze karcinoma jajnika Babarović, Emina; Krašević, Maja; Eminović, Senija
Medicina fluminensis,
09/2016, Volume:
52, Issue:
3
Journal Article
Peer reviewed
Open access
Karcinom jajnika je vodeći uzrok smrti među zloćudnim novotvorinama ženskog spolnog sustava. Usprkos pokušajima razvoja programa probira s ciljem ranog otkrivanja bolesti, kao i novim terapijskim ...pristupima, mortalitet nije značajno smanjen. Jedan od razloga ovog neuspjeha bio je slabo razumijevanje patogeneze karcinoma jajnika koji je smatran jedinstvenom bolešću. Nove spoznaje pokazuju da je karcinom jajnika vrlo heterogena bolest, koja se na temelju kliničkopatoloških karakteristika te molekularnih i genetičkih promjena može podijeliti u dvije skupine: tip 1 i tip 2 tumori. Ovaj novi model patogeneze karcinoma jajnika danas ima važan klinički i terapijski značaj
Cilj: Prikazati slučaj pacijentice s Raynaudovim fenomenom kao prvom manifestacijom seroznog karcinoma visokog gradusa te dijagnostički i terapijski postupak. Prikaz slučaja: Pacijentica stara 47 ...godina upućena je na Odjel za reumatologiju i kliničku imunologiju zbog pozitivnih antinuklearnih antitijela i Raynaudova fenomena. Kliničkim pregledom i laboratorijskom obradom isključena je sistemska bolest vezivnog tkiva. Ultrazvukom abdomena uočena je cistična tvorba u području zdjelice. Tumorski markeri CA-125, HE-4 bili su povišeni. PET/CT analizom (pozitronska emisijska tomografija / kompjutorizirana tomografija) uočeno je pojačano nakupljanje radiofarmaka u supra/retroklavikularnim limfnim čvorovima, zdjelično i paraaortalno. Citološka punkcija limfnog čvora na vratu upućivala je na metastatski slabodiferencirani adenokarcinom. Učinjena je laparoskopija desnog i lijevog jajnika, obostrana salpingektomija te zdjelična limfadenektomija. Patohistološka analiza potvrdila je da se radi o intraepitelnom seroznom karcinomu visokog gradusa jajovoda. Nakon dijagnostičke obrade provedeno je 6 ciklusa kemoterapije (Paklitaksel i Carboplatina). Na kontrolnom CT-u nije bilo znakova diseminacije osnovne bolesti. Pacijentica je trenutno dobrog općeg stanja i liječi se Olaparibom. Raynaudov fenomen je u značajnom poboljšanju. Zaključak: Serozni karcinom visokog gradusa može se prezentirati na atipičan način. Iznenadna pojava Raynaudova fenomena kod mlađih osoba treba pobuditi sumnju na moguću malignu bolest.
Aim: To present a case of a patient with Raynaud’s phenomenom as the first manifestation of a high grade serosus carcinoma. Case report: A 47-year-old female has been referred to the Department of Rheumatology and Clinical Immunology due to the positive antinuclear antibodies and Raynaud’s phenomena. Both clinical examination and laboratory treatment excluded systemic connective tissue disease. Abdominal ultrasound revealed cystic formation in the pelvis area. Tumor markers CA-125, HE-4 were elevated. PET / CT analysis (positron emission tomography/computed tomography) observed increased radiotracer uptake involving supra/retroclavicular lymph nodes, pelvic and paraortal. The cytology of the lymph node at the neck indicated a metastatic weak-bound adenocarcinoma. Left and right ovarian laparoscopy, double salpingectomy and pelvic lymphadenectomy were performed. The pathological analysis confirmed that it was intraepithelial serous high grade fallopian tube cancer. The patient went to 6 cycles of chemotherapy (Paclitaxel and Carboplatin). Follow up CT didn’t show any signs of dissemination of the underlying disease. The patient is currently in a good general condition and treated with Olaparib. Raynaud’s phenomenon is significantly improved. Conclusion: Serous high-grade cancer can be presented in an atipic manner. The sudden occurrence of Raynaud’s phenomena in younger people should raise doubts about possible malignancy.
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