The impact of epithelial ovarian cancer diagnosis on women's life: a qualitative study.

PURPOSE OF INVESTIGATION: To describe the experience of ovarian cancer patients from symptoms complained before diagnosis until the impact of ovarian cancer diagnosis perceived by women. MATERIALS AND METHODS: The authors used the Psychological General Well being Index (PGWBI) and a semi-structured interview to measure the overall well being of 39 women diagnosed with ovarian cancer in the period 2005-2010 at a secondary care hospital in northern Italy. RESULTS: The PGWBI showed that the majority of the women reported general stress. On the semi-structured interview, 95% of women reported having symptoms and 69% reported a stressful event prior to diagnosis. More than 50% of women reported changes concerning life course. Almost all reported that their primary concerns had to do with the surgical scar, weight gain, and hair loss. CONCLUSIONS: Ovarian cancer diagnosis has a very stressful effect on the quality of life. Early assessment of psychological problems must be an integral part of the therapeutic pathway. Gynaecologists must provide clear and useful information regarding the disease itself as well as regarding correlated symptom relief.

[Localized lymph node lymphangiomyoma. Description of 2 cases]. / Linfangiomioma linfonodale localizzato. Descrizione di due casi.

Lymphangioleiomyomatosis is a rare disease characterized by an immature-appearing smooth muscle proliferation in the lung and along axial lymphatics. Rarely it is limited to lymph nodes, without extranodal disease. Two cases of localized nodal lymphangiomyoma in a 48 and 54 year-old women are presented: in both cases the lesion was limited to pelvic lymph nodes and it was an incidental finding during staging for tumours of the gynaecological tract.

[Adenomatoid tumor of the testicle. Description of a case]. / Il tumore adenomatoide del testicolo. Descrizione di un caso.

The authors report a case of adenomatoid tumour of the right testicle which was referred to their attention in a 40-year-old, asymptomatic male. During the course of the urological examination, a chance discovery was made of a fibrous area at the lower extremity of the testicle. The scan showed a small hyperechogenic, slightly dishomogenous and clearly delimited area with a diameter of 4 x 6 mm. Testicular markers were negative. During the course of surgical exploration, an extensive area of the suspect testicle was removed given that extemporary diagnosis revealed that the lesion was benign. The final diagnosis was adenomatoid tumour. Control scans performed over time exclude local recurrence, thus confirming the value of conservative surgery in this type of neoplasia.

[Metachronous intra-abdominal fibromatosis of the gastro-spleno-colonic ligament and the mesentery: histopathogenetic interpretation. Report of a case]. / Fibromatosi intra-addominale metacrona del legamento gastro-spleno-colico e del mesentere: interpretazione istopatogenetica. A proposito di un caso.

The paper reports a case of intra-abdominal fibromatosis with an initial localisation in the gastro-spleno-colic ligament followed by a metachronous localisation in the mesentery. Both localisations preceded the appearance of sigmoidorectal polyps and ovarian polycystosis. The authors discuss the biological problems related to the pathology and tend to interpret it as a dys-reactive disease of connective tissue in a genetically predisposed, subject.

[Perianal glands of Hermann and their pathology. Review of the literature. Apropos of a cyst case]. / Les glandes péri-anales de Herrmann et leur pathologie. Revue de la littérature. A propos d'un cas de kyste.

We present a case report of a cyst of Herrmann's glands. These glands have a vestigial origin and are present in more than 50% of the population. They are located in the posterior part of the anal duct. Their excretory duct, when it is permeable communicates with an anal krypt. They have their own microscopic, epithelial characteristics, and produce a mucoid secretion. They can cause acute (abscess) or chronic (fistula) infections of the peri-ano-rectal region. Cancer or cystic transformations are exceptional but typical. All these characteristics are so specific that Herrmann's glands cannot be longer denied as a distinct clinical entity.

DNA flow cytometric analysis of abortions. A simple method for detection of triploidy and tetraploidy in the trophoblastic cells.

By flow cytometric analysis of nuclear DNA content it is possible to demonstrate the cellular clones that have a quantity of DNA higher or lower in comparison with that of diploid nuclei. The possibility of measuring DNA ploidy by flow cytometry provides a simple way to asses triploidy and tetraploidy in placental tissue. In this investigation, are reported the results of the DNA analysis in a series of 540 consecutive spontaneous abortions or suction curettage material obtained after intrauterine death, which was detected by ultrasound examination. At microscopy 351 (65.0%) cases showed feature of normal placentas, 147 (27.2%) of hydropic abortus, 27 (5.0%) of partial hydatidiform mole and 15 (2.8%) of complete hydatidiform mole. DNA flow cytometric analysis showed triploidy in 38 cases (7.0%) and tetraploidy in 12 cases (2.2%). Comparing microscopic feature and ploidy, 12 normal placental specimens were triploid, 6 were tetraploid. Nine hydropic abortuses had a triploid DNA content, 5 a tetraploid DNA content. In the group of partial hydatidiform moles triploidy has been found in 14 cases, whereas tetraploidy in one case and diploidy in 12 cases. Twelve complete hydatidiform moles showed a diploid DNA content and 3 a triploid one. The incidence of poliploid pregnancies has been higher among young patients. In most cases the poliploid pregnancy was the first pregnancy of the patient. DNA flow cytometric analysis is a simple and useful mean to state etiology of many spontaneous abortion, even when histology is negative. This analysis must be associated with morphology in this field.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diaphragmatic pseudocyst of the pleuro-peritoneal membrane (pseudocyst of Bracket's membrane at the site of Bochdalek's orifice). Apropos of a case]. / Pseudo-kyste diaphragmatique de la membrane pleuropéritonéale (pseudo-kyste de la membrane de Brachet dans le siège de l'orifice de Bochdalek). A propos d'un cas.

After surgical exeresis of a large diaphragmatic cyst located at the Bochdalek orifice and with predominating endoabdominal extension, the pathological examination revealed it to be a pseudocyst involving the pleuroperitoneal Bracket membrane. This pseudocyst may have resulted from defective development of the primary lymphatic system of the pleuroperitoneal folds or of the pleuroperitoneal membrane. According to this hypothesis, myoblastic colonization of the membrane which gives the posterior part of the diaphragm would have been interrupted. The only clinical sign of this pseudocyst is a heavy painful feeling. Diagnosis is made on the basis of echography and tomodensitometry. Treatment to date is strictly surgical with very satisfactory outcome and no cases of mortality.

Early prenatal sonographic diagnosis of neuropathic arthrogryposis multiplex congenita with osseous heterotopia.

A prenatal diagnosis of arthrogryposis multiplex congenita (AMC) has been carried out on a 19-week-old fetus by means of echography. The ultrasonographic characteristics were unnatural position of the four limbs associated with articular anomalies together with absence of active fetal movements. A therapeutic interruption of pregnancy was performed and the diagnosis was confirmed. At autopsy, architectural disorder of the motor neurons of the anterior medullary horn revealed a neuropathic pathogenesis of the arthrogryposis. Moreover, at the lumbar level the spinal cord was progressively replaced by heterotopic bony tissue which caused a more severe deformity of the lower limbs compared with the upper. The aspects of anatomo-pathological, genetic, and differential diagnosis are discussed showing the precocity of the prenatal diagnosis and the peculiarity of the aetiology of our case.

Flow cytometric studies in spontaneous abortions. Applications in the medico-legal practice.

In the medico-legal practice differential diagnosis between spontaneous and non-spontaneous abortion is important because causes of pregnancy wastage are often obscure and, moreover, spontaneous abortion is more common than accidental or voluntary. In all the cases in which the cause of abortion is not otherwise detectable and especially in cases of discovery of fetal adnexa, it is necessary to investigate genetic causes. Recently, DNA flow cytometric analysis has been applied in determining the genetic causes of spontaneous abortions. Among karyotypic abnormalities, flow cytometric analysis on paraffin embedded material can detect only polyploidies (triploidy and tetraploidy). Trisomies, monosomies and structural anomalies cannot be detected. In our study we tried to establish whether flow cytometry could be useful in determining the genetic cause of spontaneous abortions, in the lack of any other detectable cause. Histologic examination and flow cytometric analysis were performed on a series of 395 consecutive spontaneous abortions. Histologic examination allowed the detection of a molar pattern in about 9% of cases. DNA flow cytometric analysis showed diploidy in 346 (87.59%) cases, triploidy in 37 (9.36%) cases and tetraploidy in 12 (3.03%) cases. Combined microscopic and flow cytometric analysis revealed abnormalities in 17.5% of cases. A non-diploid pattern is more frequent in molar cases (P less than 0.001). Flow cytometry seems to be interesting in forensic pathology, as it allows the detection of some frequent genetic abnormalities in dead tissues and cells, when other techniques are no longer practicable.

[Pseudomyxoma of the peritoneum caused by rupture of a mucinous cystoma of the ovary. Description of a case]. / Pseudomixoma del peritoneo da rottura di cistoma mucinoso dell'ovaio. Descrizione di un caso.

A case of pseudomyxoma peritonei originating from spontaneous rupture of an ovaric mucinous cystoma is described: in this pathology we observe the spreading throughout the peritoneal cavity of free or encapsulated gelatinous masses arising from primitive lesion. The examined case presented a spreading of mucinous masses on contralateral ovary and omentum and a total laparo-hysterectomy, bilateral annessiectomy and omentectomy has been carried out. A year after surgery, on the base of a three months follow-up, no clinical or ultrasonic signs of local recurrence has been noticed. The pathogenesis of this pathology is discussed: the flogistic hypothesis considering such a spreading as a "foreign body" peritonitis and the neoplastic one, pointing out a metastatic process of mucus-secretive epithelia implantation as the etiopathogenetic moment of the injury, are actually the most accredited hypothesis by literature.

[Metachronous nodular leiomyosarcomatosis of peripheral vascular muscle cell in the systemic and regional circulation. A new nosological pattern?]. / Léiomyosarcomatose nodulaire métachrone de la myocellule vasculaire périphérique de la grande et de la petite circulation. Un nouveau cadre nosologique?

A patient with five different episodes of single or multiple leiomyosarcomatous nodules in 19 years is described. The nodules were subcutaneous, in the upper lobe of the right lung after 15 years, subcutaneous again after five years and one year later, in the left femoral diaphysis and in the 3rd and 5th abdominal vertebrae two years later. According to the authors, the five different lesions were primary because they were strictly limited to a single organ, they were identical from a histological point of view, no regional glands were affected, and there was no disseminated neoplasia. Finally, the authors emphasize the origin from peripheral vascular muscle cells because of the constant occurrence of peripheral vascular nodules and of signs of vascular muscle cell dysplasia near the neoplastic nodules. They believe to be faced with a new clinical picture which may be defined as: metachronous nodular leiomyosarcoma of peripheral vascular muscle cells in the systemic and lesser circulation.

Presence and synthesis of inhibin subunits in human decidua.

A growing number of studies provided the evidence that human decidua is a pregnancy-related tissue capable of hormone production and metabolism. The aim of the present study was to evaluate the possible presence of inhibin subunits in human decidua. Tissue samples were collected in pregnant women during the first (8 weeks) and second trimester (18 weeks) of gestation and at term (40 weeks). Immunohistochemical data were obtained using affinity purified polyclonal antisera raised in rabbit against porcine alpha, beta A, or beta B subunits. Levels of the respective inhibin subunits were evaluated by Northern blot analysis using cDNA probes encoding sequences corresponding to each subunit. The present results indicated that human decidua contains and synthesizes inhibin alpha, beta A, and beta B subunits. The immunohistochemical data showed that decidual cells were stained with both inhibin alpha and beta B antisera, showing a similar localization. On the other hand, cells stained with inhibin beta A antisera were sparse and followed a distribution pattern different from that of cells stained with alpha or beta B antisera. The first inhibin alpha and beta B subunit mRNAs were both expressed in first trimester of pregnancy, and those mRNA levels showed a gestational related increase. The beta A subunit mRNA was expressed at very low levels at term and could not be detected earlier during pregnancy. The present data showed that human decidua actively produces inhibin subunits with a gestational-related profile. The results suggest that decidua may be a further source of inhibin-related proteins during pregnancy and emphasize the endocrine competence of human decidua.

[Epidemiological study of anencephaly in Italy and anatomo-pathological findings in cases observed by us]. / Studio epidemiologico dell'anencefalia in Italia e rilievi anatomopatologici sui casi di nostra osservazione.

Epidemiologic study of anencephaly in Italy and anatomo-pathological analysis of our series. Out of about 1,000,000 new-borns enrolled in the IPIMC Register (Italian Multicenter Study on Congenital Malformations) from 1978 to 1986, 205 were found with isolated anencephaly and 59 with anencephaly associated with other independent malformations, for a total of 284 cases. The study of preferentially associated malformations has pointed out that anencephaly is mainly associated with three kinds of malformations: cleft lip and/or palate, ambiguous genitalia, gastroschisis. Yet these combinations did not result to be the most common with spina bifida, thus proving the heterogeneity of these two neural canal defects. The total rate is 2.7 (/10,000), higher in the South (3.2) than in the North (2.3). The highest rate was reported in Sardinia (6.0). Moreover, a 58.1% trend reduction between 1978-80 and 1984-86 with seasonal peak in January (3.6%) was reported. The following major new-born and mother characteristics have been studied: sex (M/F = 0.76), twin pregnancies (6.4%), vitality (live births: 60, from them 40 died in the same day, 16 between day 1 and 7, 4 after day 7 since birth; still births: 47; born with unknown vitality: 10), mother age (no influence), consanguinity (4.4%), average weight (1,891 gr.), mean gestational age (246 days), intrauterine growth retardation (52.9%). The importance of a proper and careful examination during autopsy is stressed to identify and describe possible associated malformations. Immunohistochemical data (4 cases) on the cerebro-vascular area are reported, mainly to identify any neural buds and related structures (glia, neurofilaments, ganglia, nerves, ependyma, choroid plexus) as well as the connection between osteocartilaginous and epithelial and/or vascular rudiments.

[Down's syndrome caused by robertsonian translocation with cystic hygroma]. / S. Down da traslocazione robertsoniana con igroma cistico.

An echographic examination in a 33 year old woman at the 12th week of pregnancy revealed a foetus with a cystic hygroma of the neck. The amniocentesis was performed at the 14th week and the karyotype analysis showed a trisomy 21 with a translocation 21q21q.

The renin-aldosterone system and electrolyte balance during tocolytic therapy.

The effects of short and long-term tocolytic therapy, with salbutamol on renin activity, aldosterone levels, sodium and potassium concentration in urine, blood, and red blood cells in 44 pregnant women were studied. No significant changes were observed in renin activity and aldosterone levels between the 1st and 5th days of i.v. or p.o. therapy and in 24-h sodium urinary excretion. Serum potassium levels significantly decreased by the 2nd and 4th h from start of i.v. infusion of salbutamol, returning to preinfusion levels within 24-36 h, whereas no concomitant increase in red cell potassium levels was detected. Urinary potassium excretion showed significant decrease within 24 h from start of i.v. therapy, returning to control levels after 48 h. No change in sodium concentration in blood and red blood cells was observed.