Prenatal diagnosis of lipomyelomeningocele by ultrasound and magnetic resonance imaging (MRI).

OBJECTIVE: The authors report a case of a lipomyelomengocele with tethered cord, revealed on prenatal ultrasonography and confirmed by fetal magnetic resonance imaging (MRI). MATERIALS AND METHODS: A 32-year-old woman, gravida 1 para 1 underwent the routine second trimester prenatal ultrasound scan at 22(+5) weeks of gestation at the present hospital. RESULTS: The scan indicated an echoic semisolid subcutaneous mass covered by skin, posterior to the lumbosacral spinal canal of the fetus. Based on the findings indicating occult dysraphism, a fetal MRI examination was conducted, revealing that the mass was extending to the spinal cord, tethering the cauda equina. The diagnosis of lipomyelomeningocele was established. CONCLUSION: Lipomyelomeningocele is a form of closed neural tube defect with unclear predisposing factors. Its prevalence ranges between 0.3 and 0.6 per 10,000 live births. It leads to progressive conus tethering with associated neurological, urinary, and gastrointestinal deficits, demonstrating the importance of prenatal diagnosis.

Expression of E-cadherin in primary endometrial carcinomas: clinicopathological and immunohistochemical analysis of 30 cases.

INTRODUCTION: Decreased expression of E-cadherin has been associated with poorly differentiated endometrial carcinomas and poorer outcomes. AIM: The purpose of this study was to examine the distribution of E-cadherin immunohistochemical expression in specimens from primary endometrial carcinomas and its relation to classical clinicopathological prognostic factors. MATERIALS AND METHODS: Surgically-resected tissues of 30 patients with primary endometrial carcinomas were studied. Histological type and grade, depth of myometrial invasion, lymph-vascular space invasion, fallopian tube or ovarian invasion, and the presence of tumoral necrosis were evaluated. Immunohistochemical examination was performed on deparaffinized four-microm-thick sections. RESULTS: The mean age of patients was 65 years (+/- 11.41). The 63.54% of carcinomas were moderately/poorly differentiated. No statistical correlation was found between the score or intensity of E-cadherin immunohistochemical staining (strong or moderate positive expression) and the clinicopathological factors tested. CONCLUSIONS: The association of E-cadherin immunoreactivity with the standard clinicopathological factors seemed to be contradictory. The classical clinicopathological factors remain the most important prognostic parameters.

Peritonitis due to iatrogenic colpotomy after large loop excision of the transformation zone (LLETZ) in a patient with cervical intraepithelial neoplasia III: our experience of a rare case with review of the literature.

A case of peritonitis as an unusual complication of LLETZ (large loop excision of the transformation zone) for the treatment of CIN III associated with unrecognized iatrogenic posterior colpotomy is presented. After the procedure, the patient developed fever 38.3 degrees C and diffused severe pelvic pain. The contributing factors, prevention and management of this complication are discussed. Also, the complications of cold knife cervical conization and LLETZ procedure are reviewed.

Mild ovarian hyperstimulation syndrome coexisting with ectopic pregnancy after in vitro fertilization.

Ovarian hyperstimulation syndrome (OHSS) is an entity arising in women undergoing assisted reproductive techniques (ART). The simultaneous presence of two different clinical complications such as OHSS and ectopic pregnancy (EP) is not frequent. The diagnosis of an extrauterine pregnancy can be obscured by the stimulated ovaries and ascites, and actually be missed, especially in women with increased body mass index. We report a case of a woman who presented with mild OHSS after in vitro fertilization (IVF), (intracytoplasmatic sperm injection (ICSI) and embryo transfer). The ectopic pregnancy was ascertained soon after by transvaginal ultrasound (TVS) and right salpingectomy was performed.

Angiomyofibroblastoma of the vagina in a postmenopausal breast cancer patient treated with tamoxifen: clinicopathologic analysis of a case and review of the literature.

Angiomyofibroblastoma is a rare mesenchymal tumor. This study presents the clinical, histologic, and immunohistochemical features of an angiomyofibroblastoma of the vagina occurring in an 80-year-old breast cancer patient under prolonged treatment with tamoxifen. Histologically, the tumor was characterized by alternating hypercellular and hypocellular edematous zones and small- to medium-sized blood vessels, which were characteristically thin walled. The tumor cells were spindle shaped (mainly) or round shaped (occasionally) arranged in cords and nests. The stroma was edematous and contained inflammatory cells, especially lymphocytes and mast cells. Immunohistochemistry of the tumor cells revealed diffuse and intense immunoreactivity for vimentin and desmin. The staining for estrogen receptors and progesterone receptors was positive, with a percentage of 70% and 40%, respectively. In conclusion, the tumor was diagnosed as an angiomyofibroblastoma based on its typical histologic and immunohistochemical features. The expression of estrogen and progesterone receptors suggests that it might arise as a neoplastic proliferation of hormonally responsible mesenchymal cells. Tamoxifen may exert stimuli effects upon mesenchymal cells.

Aggressive angiomyxoma of the vulva: our experience of a rare case with review of the literature.

Aggressive angiomyxoma is a rare, benign but locally aggressive mesenchymal neoplasm, which occurs almost exclusively during the reproductive years of women. A 28-year-old woman developed an aggressive angiomyxoma within the left labium minus of the vulva. The tumor was excised, but the lesion was expanded to the surgical margins. Microscopically, sections showed many walled vessels of various sizes, a loose myxoid and collagenous stroma and stellate and spindle-shaped neoplasmatic cells. Immunohistochemically, the neoplasmatic cells showed strong positivity for vimentin and desmin and moderate positivity for CD34 and estrogen receptors. In conclusion, aggressive angiomyxoma of the vulva should be distinguished from the benign and malignant myxoid tumors or tumor-like conditions of vulva. The pathologic and immunohistochemic characteristics, the difficulties in determining the surgical margins and the treatment of this tumor are discussed. Also, the international literature is reviewed.

Isolated torsion of the fallopian tube: a case report and review of the literature.

INTRODUCTION: Isolated torsion of the fallopian tube is a very rare condition. It occurs without ipsilateral ovarian involvement associated with pregnancy, haemosalpinx, hydrosalpinx, ovarian or paraovarian cysts and other adnexal alterations or even with an otherwise normal fallopian tube. We document a case of isolated torsion of the right fallopian tube associated with hydrosalpinx. CASE: The patient was a 39-year-old female, para 2, gravida 4, who was presented with acute pelvic pain, nausea and vomiting. Her medical history included an appendectomy and right hydrosalpinx diagnosed five months before admission by hysterosalpingography because of investigation for secondary infertility. The urinary pregnancy test was negative. Pelvic ultrasonography showed a dilated folded right tubular structure measuring 7.8 x 2.7 cm with thickened echogenic walls and mucosal folds protruding into the lumen; the ovaries and uterus were unremarkable. No free fluid in the cul-de-sac was noted. Preoperatively, a diagnosis of twisted right fallopian tube was suspected and an exploratory laparotomy confirmed the diagnosis of isolated torsion of the oviduct. The ipsilateral ovary appeared normal, but the fallopian tube was gangrenous and right salpingectomy was performed. The patient became pregnant three months after surgery. CONCLUSION: Isolated torsion of the fallopian tube should be considered in the differential diagnosis of patients with acute abdomen and previous medical history of hydrosalpinx.

Sclerosing stromal tumor of the ovary: a case report and review of the literature.

Sclerosing stromal ovarian tumor is an extremely rare neoplasm occurring predominantly in the second and third decades of life. It presents most often with non-specific symptoms. We describe a new case occurring in a young woman presenting with infertility and irregular menses. Ultrasound examination showed a left heterogenous ovarian mass without focal calcifications. Histological features included a pseudolobular pattern with focal areas of sclerosis, prominent vascularity and a two-cell population of spindled and polygonal cells. Immunohistochemical analysis for actin, vimentin, laminin, vascular epidermal growth factor (VEGF), oestrogen and progesterone receptors using formalin-fixed and paraffin-embedded materials showed predominant positivity for a-smooth muscle actin and consistent positivity for laminin and vimentin. The epidermal VEGF demonstrated rich tumor vascularity. Oestrogen and progesterone receptors were not expressed. suggesting hormonally independent development. Menstrual cycle disturbances, however, were corrected following extirpation of the tumor, indicating some endocrine involvement. In addition, the patient became pregnant ten months after the operation. The differential diagnosis is discussed.

Inhibition of puerperal lactation with 2-mercaptopropionyl-glycine.

OBJECTIVES: Thiols (sulfydryl compounds) have a prolactin-lowering effect in animals. The purpose of our study was to evaluate the effects of orally administered N-2-mercaptopropionyl-glycine (tiopronin) on suppression of lactation and plasma prolactin (PRL) levels in a group of women in the puerperium. METHODS: One hundred women aged 17-37 years were studied. We divided our population in four groups (25 patients in each group). In group I, no medication was administered but only conservative measures were taken (restriction of fluid intake, ice-bags applied on the breasts, tight breast binders). Subjects in group II received tiopronin (200 mg/day) for 14 days. In group III, tiopronin (500 mg/day) was administered for 14 days. Subjects in group IV, took bromocriptine (5 mg/day) for 14 days. Assessment of suppression of lactation was performed clinically and laboratory determinations were obtained before and after 1, 2, 3, 4, and 14 days of treatment. Furthermore, in seven healthy women plasma PRL responses to thyrotropin-releasing hormone (TRH) before and after one week of tiopronin therapy (500 mg/day) were studied. RESULTS: Statistically significant higher percentages of success of lactation suppression were obtained with tiopronin (84% and 88%) and bromocriptine (96%) compared to conservative treatment (60%). In the four groups a significant decrease of PRL was observed. However, in women who received tiopronin and bromocriptine, the levels of PRL after 14 days of therapy were lower compared to the conservative treatment group. Moreover, in the tiopronin groups and the bromocriptine group, lactation was stopped earlier. In the first group (conservative measures) the lactation was suppressed after 13.3+/-5.4 days of treatment. In the groups who received tiopronin (200 mg/day and 500 mg/ day) lactation was suppressed after 4.4+/-1.7 and 4.3+/-1.6 days of treatment. In the bromocriptine group the lactation was stopped after 1.2+/-0.4 days. Bromocriptine treatment was associated with more frequent side effects than the tiopronin. CONCLUSION: Administration of tiopronin in low to moderate doses is effective in suppression of puerperal lactation.