Clinical course and features of persistent polyclonal B-cell lymphocytosis with BCL-6 amplification during pregnancy.

BACKGROUND: Persistent polyclonal B-cell lymphocytosis is a rare nonmalignant disorder characterized by mild persistent lymphocyte proliferation with possible evolution to aggressive lymphoma. Its biology is not well known, but it is characterized by a specific immunophenotype with rearrangement of the BCL-2/IGH gene, whereas amplification of the BCL-6 gene has rarely been reported. Given the paucity of reports, it has been hypothesized that this disorder is associated with poor pregnancy outcomes. CASE REPORT: To our knowledge, only two successful pregnancies have been described in women with this condition. We report the third successful pregnancy in a patient with PPBL and the first with amplification of the BCL-6 gene. CONCLUSIONS: PPBL is still a poorly understood clinical condition with insufficient data to demonstrate an adverse effect on pregnancy. The role of BCL-6 dysregulation in the pathogenesis of PPBL and its prognostic significance are still unknown. Evolution into aggressive clonal lymphoproliferative disorders is possible and prolonged hematologic follow-up is warranted in patients with this rare clinical disorder.

Epidermoid cyst and primary trabecular carcinoid of the ovary: case report.

In the literature and in our experience epidermoid cysts and carcinoids of the ovary are rare benign pathologies which occur more frequently in younger women. They probably are a one-sided development of a teratoma, which arise from germ cells after the first meiotic division due to either a meiosis I or a meiosis II non dysjunction. Diagnosis is possible only with histological examination and immunohistochemistry which allow us to differentiate carcinoids from sex-cord tumors and ependymomas. Prognosis is very good because the rate of malignant transformation is 1.4%-2% and the rate of complications is 14%. Thus conservative surgical therapy associated with long-term follow-up is the treatment of choice.

Rectosigmoid endometriosis: diagnosis and surgical management.

The recurrence of endometriosis varies from 6% to 10% and, among the non-gynaecological sites, the bowel is involved in 12%-37%. Various symptoms, such as dysmenorrhea, dyspareunia, chronic pelvic pain, diarrhoea, constipation, cyclic rectal bleeding, colic-abdominal pain up to intestinal occlusion characterize this pathology. Surgery seems to be the best treatment especially for gastrointestinal symptoms; conservative surgery should be performed, particularly in young patients. Four cases of intestinal endometriosis were reevaluated.

Vaginal endometriosis. Two case reports and review of the literature on rare urogenital sites.

The authors present two rare cases of vaginal endometriosis. Moreover, the literature regarding other sites of low genital tract involvement is reviewed.

High risk pregnancy in a patient with angioma of the corpus callosum.

Literature data indicate that rupture of arterovenous malformations is 4 times more frequent in pregnant women. The Authors present a case of cerebral hemangioma of the third medium anterior of the corpus callosum diagnosed in a patient at the 28th gestational week by Magnetic Resonance scan. The patient underwent elective caesarean section under peripheral anesthesia (peridural and spinal block by Bupivacaine) and delivered a male infant 4560 gr, 52 cm. The postoperative course was uneventful. The arterovenous malformation constituted an important anesthesiologic risk factor but the Authors conclude that caesarean section can be safely performed with a very careful anesthesiological time schedule and a reliable haemodynamic monitoring.

Hysteroscopic follow-up in tamoxifen treatment for breast cancer.

In the postmenopausal women endocrinotherapy proves to be as useful as the cytotoxic treatment in breast cancer therapy, regarding the percentage and duration of response, both in prophylactic and palliative therapy, with the advantage of milder side-effects and a better quality of life. This study was carried out in order to evaluate the Tamoxifen weak estrogenic activity, which could appear during long-term therapies, determining endometrial morphological modifications. Twenty-one postmenopausal women suffering from breast cancer underwent hysteroscopy with target biopsy or curettage at the same time with mastectomy and afterwards during additional Tamoxifen treatment at 12 and 24 months. Our results confirm that this simple, outpatient endoscopic investigation should be provided as a routine in the follow-up of oncologic patients during hormonotherapy.

Risk factors for breast cancer. Case-control study results.

The great importance of knowing the risk factors for breast pathology in order to reveal the risk categories is well known. In many geographical areas breast cancer is the most common female neoplasm. Recent Italian statistics point out that every year 83 women out of 100,000 develop breast cancer and that its incidence is increasing. Every year in Italy 10,000 women die of breast cancer. In our retrospective study 146 women suffering from breast cancer, treated in our Institute from 1970 to 1993, were enrolled. We excluded 4 patients, surgically treated in another Institute and 35 who presented a second or a third gynaecological cancer. We considered age, menarche, parity and menopausal age in all patients in order to evaluate the association of these risk factors with breast cancer development. The average age when neoplasm was first diagnosed was 53.07 years (between 30-84 years), with a 9.4% incidence in patients under 35 years old. In 41.1% of the cases, menarche was present under 12 years and in only 14.1% after 14 years, therefore confirming the reduction of mammary cancer risk in women with late menarche. Twenty one point five per cent of the patients were nulliparous. In our case series no protective factor seemed to be related with 1 or 2 pregnancies (43.9%). The menopausal average age was 50.2, with an average fertile life period of 37.1 years. Our study also considered the location of the primary neoplasia (60.7% in the upper-outer quadrant), the tumor size (3.08 cm average diameter) and the histological type (81.3% ductal form).(ABSTRACT TRUNCATED AT 250 WORDS)

Systemic treatment of recurrent candidal vulvovaginitis by Itraconazole.

20 women suffering from recurrent candidal vulvovaginitis were treated with Itraconazole, with a single oral dose of 200 mg/day administered after the main meal for three days. The diagnosis was obtained by microscope and culture tests, and check were made 7 and 30 days after completion of the treatment. The symptom score, assessed on the individual patients by means of the classic clinical parameters, showed a significant drop both at the first and second level checks. In our study, the culture tested negative in 75% of cases at the first check, and in 85% of cases at the second check. All patients completed the study without claiming any major side effects.

A rare case of IUD tubal migration. Case report.

The Authors describe a rare case of IUD tubal migration. The uterine device had been inserted twelve years before. A hysteroscopical removal of the IUD was tried unsuccessfully, because it was impossible to locate it either in the uterine cavity or at the fallopian tube orifice level. The patient underwent a minilaparotomy and the IUD was found out at the peritubal level. An ecographic control of all intrauterine devices insertions is recommended.

A voluminous paraovarian cyst. Case report.

Paraovarian cysts represent 9-10% of all annexial tumescences. The Authors present a case of voluminous paraovarian cyst in young woman referring abdominal heaviness and swelling for about eight months. During laparotomy a 35 cm cyst with liquid content was revealed. The cystic mass was extirpated preserving the woman's reproductive capacity.

Giant cell arteritis of fallopian tube.

One case of giant cells arteritis involving tubaric arteries in a postmenopausal woman is described. The patient was 59 years old and presented with asthenia, anemia, fever, weight loss, an abdominal palpable mass and elevated erythrocyte sedimentation rate. Exploratory laparotomy revealed a large ovarian cyst of 14 cm in diameter. Extensive giant cell arteritis, Horton's type, of the small-sizes arteries was found unexpectedly in the fallopian tube of the patient who had had a prior ovariectomy. Giant cell arteritis of the female genital tract is a rare finding in elderly women and may occur as an isolated finding or as part of generalised arteritis.

HPV genital infections and contraception.

Human Papilloma Virus genital infections are, especially during fertile age, a very common finding in performing PAP smear and colposcopy. The interest in these infections arises from their frequent association with dysplasia and their possible role in the etiology of carcinoma of the lower genital tract. The natural history of HPV infections is not very well known and foreseen. Epidemiological studies indicate that the progression, regression or stability of induced HPV lesions are correlated with cofactors which are considered risk factors in carcinoma of the lower genital tract. The aim of this study is to evaluate the influence of estroprogestinic contraception and other methods on the evolution of the HPV genital infections.

PIP: Human papilloma virus (HPV) genital infections are sexually transmitted and often found among young women. While not much is known about the natural history of these infections, they are known to be frequently associated with dysplasia and may have a role in the etiology of carcinoma of the lower genital tract. This paper, therefore, presents findings of an evaluation of the influence of estroprogestinic contraception and other methods on the evolution of HPV genital infections. 108 women aged 18-51 were diagnosed with HPV in the lower genital tract; 41 were using oral contraception with estroprogestinics and 67 were using other methods or none at all. The evaluation considered the evolution of lesions as related to the following potential influencing factors: patient's age, age at first sexual intercourse, number of pregnancies, lifetime number of partners, and smoking habits. Nothing could be concluded from this investigation, but it is suspected that estroprogestin use combined with smoking may increase the risk of HPV genital infections progressing to cervical cancer.

Cyst of the breast diagnostic-therapeutic approach.

We examined 148 cases of breast cysts and evaluated their association with breast cancer by means of a diagnostic and therapeutic protocol aimed at simplifying control of cystic disease of the breast.

Diagnostic breast screening: clinical significance during menopause.

Three-hundred and fifty nine out-patients with no signs of breast disease, who had been seen at the Gynecology and Obstetrics Clinic for problems related to their perimenopausal state, were also screened at the Breast Pathology Center to exclude the presence of hormone-sensitive neoplastic disease, in view of possible hormone therapy. The breast cancer incidence detected (1.7%), and the importance of thermography in evaluating the metabolic-functional aspects of the breast, confirm the utility of breast screening in all perimenopausal patients.

Diagnostic integrated program in breast pathology: clinical experiences.

1068 patients were examined using a unified diagnostic protocol. 618 patients at high risk were screened out, and underwent further instrumental and surgical investigation. 17 cases of breast cancer were detected, while the remaining patients were addressed to an appropriate, highly reliable and repeatable follow-up for breast care.

Manometric study on anal sphyncteres and intestinal MTT before and after extensive surgery on patients affected by cervical carcinoma. Clinical experiences.

The Authors report the preliminary results of a study performed on patients submitted to radical hysterectomy according to Wertheim-Meigs for cervical-carcinoma, in order to evidence possible changes of the intestinal functionality, by means of a manometric investigation of the anal sphyncteres and measurement of the intestinal transit times. The manometric survey showed that no essential parameter was uniformly altered whereas the transit time measurement proved in some cases the slowing-down of the intestinal progression at the level of the ascending and transverse colon, and a normal transit in the descending colon as well as in the rectum in all examined cases.