Benign multicystic peritoneal mesothelioma is a rare pathology that arises from the abdominal peritoneum. It has an affinity to develop on the surfaces of pelvic viscera. It predominantly occurs in ...women of reproductive age. The most used form of treatment is complete surgical removal. We report a case of a a 21-year-old female patient who presented with unclear diffuse abdominal pain. Transvaginal ultrasound and magnetic resonance imaging of the abdomen and pelvis revealed multiple functional cysts in the projection of the right and left ovary and free fluid in the pouch of Douglas. Laparoscopy was performed and multicystic tumor with thin, smooth walls, filled with clear serous content was found in lesser pelvis spreading to the left paracolic region and under the spleen. The multicystic mass was removed. Histologic examination revealed cystic formations filled with mucous content and formed from connective tissue outside and single row epithelium-mesothelium inside. Definitive diagnosis was benign multicystic mesothelioma of the abdominal peritoneum. The patient was well at one year follow-up. Key words: Benign multicystic peritoneal mesothelioma; Laparoscopy; Magnetic resonance imaging; Ultrasound
BACKGROUNDIchthyosis uteri is an extremely rare condition in which the entire or extensive parts of endometrial lining are replaced by stratified squamous epithelium. Malignant potential of this ...entity is unclear and its association with dysplastic changes and primary squamous cell carcinoma of the endometrium and endometrial adenocarcinoma has been reported. However, lack of data makes difficult to interpret the significance of neoplasms arising from this condition.PATIENTS AND METHODSWe report a case of ichthyosis uteri associated with squamous cell carcinoma of the endometrium in a 62-year-old female who presented with postmenopausal bleeding and thin endometrium on ultrasound.RESULTSEndometrial curettage was performed and revealed high grade squamous intraepithelial lesion. The patient underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy and bilateral pelvic lymph node dissection. Microscopic examination of sections revealed squamous cell cancer along with extensive replacement of the endometrial lining by stratified squamous epithelium, consistent with ichthyosis uteri.CONCLUSIONIf ichthyosis uteri is suspected we recommend hysterectomy in order to rule out possibility of coexisting carcinoma. Also, thin endometrium in women with postmenopausal bleeding does not reliably exclude endometrial cancer.
Summary
Background
The purpose of this study was to evaluate the relationships between interleukin 10 (
IL10
) (
rs1800896
) and interleukin 1B (
IL1B
) (
rs16944
) genetic polymorphisms and the risk ...for cervical cancer in a cohort of women from Croatia.
Methods
A case–control study of 81 patients with cervical cancer and 80 age-matched healthy controls was performed. We collected peripheral blood samples, extracted deoxiribonucleic acid (DNA), and analyzed two single-nucleotide polymorphisms (SNPs)
rs1800896
and
rs16944
using TaqMan assays (Fa. Thermo Fisher Scientific, Waltham, MA, USA) and real-time polymerase chain reaction (PCR). We investigated a possible association between two cytokine genetic polymorphisms and the occurrence of cervical cancer.
Results
Our results showed no significant difference in the frequency of
IL10
(
rs1800896
) and
IL1B
(
rs16944
) genotypes between the patients and the controls (χ2 test,
P
< 0.05).
Conclusion
In this study, no association was found between
IL10 rs1800896
and
IL1B rs16944
polymorphisms and cervical cancer development.
Summary
Prelabor rupture of the fetal membranes (premature rupture of membranes, PROM) before or at the limit of fetal viability is condition associated with significant and serious pediatric ...morbidity and mortality. It is a rare problem, with an estimated incidence between 0.1 and 0.7%. Management of this condition is one of the most challenging clinical situations in obstetrics. We report the case of a pregnant woman presenting at 16 weeks gestation with ruptured membranes. The course of pregnancy was further complicated by complete placenta previa. Expectant management was undertaken, with term delivery and successful outcome of pregnancy. Expectant management is a reasonable approach in properly selected patients. Better understanding of the mechanisms of spontaneous membrane resealing is needed in order to improve poor outcomes. More published data and evidence are necessary to standardize treatment options for this rare condition.
This study aimed to identify and quantify the clinical significance of the HE4 and ROMA index in patients with an adnexal tumour. We recruited 159 women and the HE4 and CA125 were measured with an ...electrochemiluminescence immunoassay in the sera. We used the Kolmogorov-Smirnov test, Mann-Whitney's test and logistic regression to interpret the data. In the premenopausal group (n = 57), the ROC analysis (with cut-off: 86.1 pmol/L for HE4; 40.7 U/L for CA125 and 21.9% for ROMA) demonstrated the superior prognostic potential of those markers when the higher cut-offs used are compared to producer
s
. The AUC for HE4/CA125/ROMA were 0.846/0.867/0.846, respectively. The HE4/ROMA showed 85.7% sensitivity and 94% specificity. In the postmenopausal group (n = 102), the ROC analysis cut-off values were: 99.8 pmol/L for HE4; 45.8 U/L for CA125 and 38.4% for ROMA. AUC for HE4/CA125/ROMA were 0.928/0.899/0.927, respectively. HE4 had an 86.1% sensitivity at 92.4% specificity, while ROMA showed an 88.9% sensitivity at a 90.9% specificity.
Impact Statement
What is already known on this subject? The incidence of ovarian cancer has been increasing, despite the improvement of diagnostic, operative and therapeutic procedures. As a part of the multiparametric approach, the HE4 and ROMA index improve the diagnostic sensitivity and specificity of CA125 in the detection of ovarian cancer.
What the results of this study add? The evaluation of HE4 and ROMA efficacy in the preoperative stratification was made by logistic regression analysis. The better prognostic potential of ROMA index, in patients with present adnexal mass, was obtained using our higher cut-offs for the ROMA index (21.9% for premenopausal and 38.4% for postmenopausal) in comparison to the producer's (11.7% for premenopausal and 29.9% for postmenopausal). The HE4 and ROMA index had 14.29 +LR, 0.15 -LR, 67% PPV and 97.9% NPV in the premenopausal patients. In the postmenopausal group, the HE4 had 11.37 +LR, 0.15 -LR, 75.6% PPV and 92.4% NPV, the ROMA showed 9.78 +LR, 0.12 -LR, 91.2% PPV and 95.2% NPV.
What the implications are of these findings for clinical practice and/or further research? Application of a higher cut-off for HE4/CA125/ROMA index can significantly reduce the percentage of FP and FN in the preoperative stratification of ovarian cancer and justify speculations about this subject in the future.
Occurrence of bilateral pneumothorax, pneumomediastinum and subcutaneous
emphysema during gynecologic laparoscopic procedure is very rare. We report a case of a 23-year-old
woman who developed ...bilateral pneumothorax, pneumomediastinum and subcutaneous emphysema
during laparoscopic ovarian cystectomy. Carbon dioxide extravasations outside the peritoneal cavity
during laparoscopy may have fatal consequences. Careful monitoring, immediate diagnosis and proper
treatment are crucial for patient safety.
Ovarian hyperstimulation syndrome (OHSS) is a rare and potentially life-threatening complication of infertility treatment occurring during either the luteal phase or early pregnancy. An increasing ...number of thromboembolic complications associated with the increased use of assisted reproductive techniques have been reported in the literature. Identification of the risk factors is crucial for prevention of thromboembolic events in OHSS patients. Alterations in the hemostatic system cause hypercoagulability in women affected by severe OHSS. Coexistence of inherited hypercoagulable conditions increases the risk of thromboembolism. The role of clinical parameters that can help predict development of thrombosis is controversial. Patients with a personal or family history of thrombosis undergoing infertility treatment should be considered for thrombophilia screening, while routine examination of inherited thrombophilic mutations is not indicated in infertile patients. Antithrombotic primary prevention is not indicated in healthy women undergoing assisted reproductive procedures or in women with thrombophilia. Anticoagulant therapy is indicted if there is clinical evidence of thrombosis or laboratory evidence of hypercoagulability. In this review, the risks of hypercoagulability in the OHSS are discussed.
Mesonephric adenocarcinoma is a rare variant of cervical adenocarcinoma. We
present a case of mesonephric adenocarcinoma of endocervix with cervical and vaginal lobular mesonephric
hyperplasia in a ...57-year-old woman. Vaginal bleeding persisting for 12 months was the only
symptom. Histopathologic findings and characteristic immunophenotype are crucial for the diagnosis.
The tumor was composed of papillary formation with a central fi brovascular stroma, villoglandular and
densely compact tubular structures containing intraluminal eosinophilic secretion, and coated with
one or more rows of cylindrical atypical epithelial cells. There were 30 pathologic mitotic shapes found
per 10 HPF. The tumor invaded nearly full-thickness of cervical stroma with positive lymphovascular
space invasion and clear margins. The case demonstrated characteristic cytokeratin 7, vimentin and
epithelial membrane antigen positivity and high Ki-67 proliferation index (60%). Estrogen receptors,
progesterone receptors and carcinoembryonic antigen were negative. Intratubular lumen secretion was
periodic acid-Schiff positive with periodic acid-Schiff negative carcinoma cells. Diff erential diagnoses
include adenoma malignum, well-diff erentiated villoglandular adenocarcinoma, endometrioid adenocarcinoma,
serous adenocarcinoma, mesonephric adenocarcinoma with a sarcomatous component,
clear-cell carcinoma and mesonephric hyperplasia. Radical hysterectomy with bilateral salpingo-oophorectomy,
pelvic and para-aortic lymphadenectomy was performed. Three years after the surgery,
the patient remains well. There has not been any evidence of local or distant recurrence. There are no
specific recommendations for the treatment of this rare disease. It remains uncertain whether surgical
approach is sufficient or the treatment should include additional radio/chemotherapy.
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