Clinical features and treatment of lactational mastitis: the experience from a binational study.

The characteristics of 38 patients with mastitis are listed in this study, including nationality, age, parity, history of mastitis, clinical and laboratory findings, and medical treatment. Differential diagnosis was mainly correlated to breast engorgement. Mastitis was primarily related to staphylococcus aureus and it was more common in primiparous patients.

Female genital mutilation in Greece.

The number of migrants and refugees with a female genital mutilation (FGM) living in Greece is rising. This study explores the characteristics and psychosexual issues of women with FGM who were examined in the 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Greece during the year 2009. The women were asked to fill out an anonymous questionnaire asking for demographic data, obstetric history, current complaints, and psychosexual problems. The results are presented and discussed, as FGM is a new reality for Greece. Healthcare providers have to familiarize themselves with issues related to FGM and improve their skills in transcultural care, so as to manage and support women with FGM adequately.

Endometrial stromal sarcoma in a 29-year-old patient. Case report and review of the literature.

OBJECTIVE: Endometrial stromal sarcomas are rare tumors accounting for about 0.2% of all genital tract malignancies. They are considered to occur more often in premenopausal women. Endometrial stromal sarcomas are hormone sensitive tumors. A state of hyper-estrogenemia could act as a growth stimulus. Given the rarity of these tumors there are limited reports in the literature referring to the clinical management and final outcome of these cases. CASE: The patient, a 29-year-old woman, had a surgical history of myomectomy in another hospital three months before her referal to our department. The histological examination of the removed myoma showed an endometrial stromal sarcoma. Total abdominal hysterectomy, with bilateral salpingo-oophorectomy, omentectomy and elective pelvic lymphadenectomy were then performed as a second radical surgical approach. CONCLUSION: Endometrial stromal sarcomas are uncommon and their differential diagnosis from typical submucosal uterine myomas or benign endometrial polyps could be difficult. The hysteroscopic features of uterine sarcomas are often similar to those of endometrial polyps or submucosal myomas. The histological examination of the specimen is necessary to exclude malignancy and establish the final diagnosis. Total abdominal hysterectomy, bilateral salpingo-oopherectomy with pelvic lymphadenectomy is the optimal treatment in cases of endometrial stromal sarcomas.

The impact of HPV diagnosis on women's sexual and mental health: preliminary findings.

PURPOSE OF INVESTIGATION: The objective of the present study was to demonstrate the impact of HPV diagnosis on sexual function and mental health of Greek women. METHODS: The study population included 51 patients who proceeded to the gynecological outpatient clinic of "Aretaieion" Hospital, Athens, during 2008-2009. The participants were asked to complete a questionnaire regarding demographic characteristics, knowledge on HPV, gynecological and sexual history, as well as questions regarding their mental and sexual health after the diagnosis. RESULTS: Mean age of the participants was 36 years and mean age of their first Pap smear test was 24.4 years. Mean age of HPV diagnosis was 34 years and mean number of sexual partners was four. Regarding mental health, the majority experienced anxiety after the HPV diagnosis as well as fear regarding their health in the future. Nearly half of the women experienced guilt and anger and some of them distress, shame, diminution of self-esteem and stigmatization. Diminution in the level of sexual interest and desire and decrease in sexual intercourse frequency were quite often reported. CONCLUSION: Except for the important physical impact of HPV infection, its diagnosis seems to trigger several negative feelings and reduce sexual desire.

Single umbilical artery: fetal and placental histopathological analysis of 24 cases.

AIM: 24 cases of single umbilical artery (SUA) are presented and the related histopathological findings of the fetuses and placentas examined. SUA is the most common congenital anomaly of the umbilical cord, resulting in the absence of one of the two umbilical arteries. It has an incidence of approximately 2.1% in autopsy material and there is evidence that is associated with anomalies of the fetus and placenta. MATERIAL-METHOD: The files were reviewed of 24 cases with SUA, out of 1,570 autopsies of fetuses and placentas performed in the Pathology Laboratory of Aretaieion Hospital, due to spontaneous or induced abortions after written parental consent. RESULTS: The incidence of SUA was 1.6%. Gestational age ranged between the 15th and 33rd week and mother's age ranged from 17-44 years. Three of 24 cases were twin pregnancies; 17/24 fetuses were male. In 21/24 cases complex congenital anomalies were observed and in five of 24 cases chromosomal anomalies were detected. In eight of 24 placentas extensive infarcts were observed; 7/24 dysmaturity, 5/24 severe chorioamnionitis, 3/24 extensive fibrin accumulation and 1/24 chorioangiosis. CONCLUSION: SUA is an umbilical congenital anomaly associated with severe fetal congenital anomalies and once detected with ultrasound techniques, further and more detailed control of the fetus is considered mandatory.

Endometrial carcinoma and ovarian sex cord tumor with annular tubules in a patient with history of Peutz-Jeghers syndrome and multiple malignancies.

BACKGROUND: Peutz-Jeghers syndrome is a rare syndrome which is inherited in a dominant manner. It is characterized by hamartomatous polyps of the gastrointestinal tract, hyperpigmented macules of the oral mucosa and an increased risk of developing neoplasms in the gastrointestinal tract, pancreas, breast and genital system. Women with Peutz-Jeughers syndrome often develop an ovarian sex cord tumor and cervical adenocarcinoma of minimal deviation adenoma malignum type. A case of a 58-year-old patient with Peutz-Jeghers syndrome and history of multiple malignancies (thyroid, breast and colon cancer) who presented with metrorrhagia is reported. The dilatation and curettage revealed endometrial adenocarcinoma. The patient underwent total abdominal hysterectomy with bilateral oophorectomy. The histologic examination showed an endometrioid endometrial adenocarcinoma that developed in atypical endometrial hyperplasia. The histologic examination of the right ovary revealed a sex cord tumor with annular tubules, measuring 3 cm. Sex cord tumors with annular tubules in patients with Peutz-Jeghers syndrome are usually small, bilateral tumors of the ovaries which have common characteristics with granulosa cell tumor and Sertoli cell tumor. Hyperestrogenism is a rather common finding with development of estrogen-dependent lesions.

Rare case of an ovarian monodermal teratoma with functional stroma and extensive ovarian decidualization in a 74-year-old woman.

We present the clinicopathological findings of a rare case of a monodermal teratoma of the right ovary with functional ovarian stroma and extensive decidualization in a 74-year-old woman. The patient presented with vaginal bleeding. Ultrasound scan revealed a pelvic mass measuring 9.5 cm in the lower right abdomen. A right oophorectomy was performed. The tumor was cystic and multilocular filled with colloid material. Histological examination revealed follicles of thyroid type, and stromal clusters of fusiform or polygonal cells were found in the stroma. An extensive decidual reaction was observed. Morphological and immunohistochemical examination of the tumor revealed cystic struma ovarii with functional ovarian stroma and ectopic decidua. Total abdominal hysterectomy with oophorectomy was performed. A benign endometrial polyp, proliferative endometrium, two fibroids, and an ovarian cyst were observed.

Advantages of radio frequency (RF) cone biopsy compared to large loop excision of the transformation zone (LLETZ) in patients with high-grade squamous intraepithelial lesions: a retrospective study.

OBJECTIVE: The aim of this study was to compare radio wave cone biopsy to the LLETZ method in patients with high-grade squamous intraepithelial lesions. METHOD-RESULTS: This was a retrospective study of 186 patients diagnosed with HGSIL who underwent cone biopsy either with the LLETZ method (82/186) or with the radio wave method (104/186) in the 2nd Obstetrics and Gynecology Department, University of Athens, Aretaieion Hospital, Athens, Greece during the period January 1999 to December 2008. The mean age of the patients was 31 years (range 23 to 53 years). The volume of cone ranged from 1.2 x 2 cm up to 3 x 3.6 cm in both techniques. Histopathological analysis revealed focal or extensive high-grade squamous intraepithelial neoplasia extending into the underlying endocervical glands in 128/186 patients. Concomittent low-grade squamous intraepithelial lesions were observed in 160/186 patients and coilocytic atypia was observed in 172/186 patients. The endocervical margins were free of disease in 172/186 cases. In seven cases the neoplastic lesions were at least 0.1 cm from the margin and in seven cases they extended to the margin. In all cases a degree of tissue coagulative change was observed, but not extensive to the point of obscuring the diagnosis. CONCLUSION: 4.0 MHz radio wave surgery is an excellent alternative in the treatment of HGSIL. Clear surgical margins due to decreased heat and tissue damage, controlled hemostasis, faster healing, and patient and doctor satisfaction are notable advantages.

Cervical adenocarcinoma with clear cell morphology. report of six cases and literature review.

Clear cell cervical adenocarcinoma (CCA) is a rather rare malignancy of the genital tract. We report six cases of CCA, diagnosed in our laboratory during a 15-year period: five patients with sporadic primary CCA and one young patient with CCA and a history of in utero exposure to DES. The possible DES exposure, clinicopathological findings as well as the differential diagnosis and the the prognosis of such patients are presented in a mini-review of the literature.

HPV-related verrucous carcinoma of the vulva. A case report and literature review.

Verrucous carcinoma of the vulva is a rare type of squamous cell neoplasm with distinct morphology, pathogenesis and special therapeutic management. A case of a 72-year-old patient who developed verrucus carcinoma of the vulva is reported. Data regarding the diagnosis, management and treatment of this neoplasm are presented, and a review of the literature is performed.

The slow levonorgestrel-releasing intrauterine system (LNG-IUS) 20 mcg/day: a literature review.

The aim of the study is to present the mechanisms of action, indications, complications, contraindications and the necessary tests before the insertion of a levonorgestrel-releasing intrauterine system (Mirena). After a literature search in Pubmed, a narrative review in the field is presented.

Vulvar cancer: prognostic significance of the clinicopathological characteristics.

Vulvar cancer is a relatively uncommon neoplasm of the female reproductive system. The aim of this retrospective study was the analysis of the pathologic and clinical characteristics of vulvar cancer and their prognostic significance. During the period January 1996 to December 2005, 82 patients were treated for a vulvar malignancy. The management was surgical.

Granular cell tumor of the female genital system. Clinical and pathologic characteristics of five cases and literature review.

The clinical and pathological characteristics of a rare granular cell tumor that developed in the vulva (4 cases) and the breast (1 case) offive women aged 35-52 years are reported. The differential diagnosis from skin carcinomas, melanoma and various soft tissue tumors is emphasized.

Primary mixed epithelial and germ cell tumors of the ovary. Two case reports and literature review.

Two cases of mixed germ cell and epithelial primary ovarian tumors which developed in women 47 and 57 years of age are reported. In both cases, large teratomas measuring 20 and 21 cm were observed in combination with carcinoids and malignant mucinous neoplasms. A possible common oncogenic mechanism is discussed and a literature review is presented.

Unwanted pregnancy and induced abortion among young women 16-22 years old in Greece: a retrospective study of the risk factors.

UNLABELLED: Unwanted pregnancies and the subsequent induced abortions are common problems of our youths in modern Greece. The aim of this study was to recognize the risk factors of the problem in an effort to find the best possible solution out of this social dead end. MATERIALS AND METHOD: We interviewed 1,320 young female individuals and analyzed their answers using statistical analysis. RESULTS: Several useful conclusions were reached concerning the forces that are involved in unwanted pregnancy/induced abortions. DISCUSSION: We have tried to underline the strategy to combat the problem. CONCLUSION: Sexual education and the proper use of contraception remain the essential tools in this effort.

A rare case of congenital pulmonary lymphangiectasia, hydrothorax and ascites in a male embryo aborted at 20 weeks of gestation.

A case of a male embryo aborted at the 20th week of gestation with extensive ascites, hydrothorax, pulmonary lymphangiectasia and pulmonary hypoplasia is presented together with the pathological findings, the etiology, differential diagnosis, course and therapy of this pathologic entity. Also a short review of the literature is discussed.

Retroperitoneal ancient schwannoma presenting as an ovarian tumor in a patient with uterine cancer. A case report.

Ancient schwannomas are rare tumors of neural origin. We present a case of a retroperitoneal ancient schwannoma by discussing the main symptoms, ultrasound and CT findings, treatment, and histopathological characteristics.

Ectopic pelvic spleen. Presentation of two cases.

We present two cases of nulliparous women with ectopic pelvic spleens who were hospitalized in our department during the last decade. The clinical and laboratory characteristics and the management of such a rare entity are discussed.

Clinical parameters linked with malignancy in endometrial polyps.

AIM: To investigate the association of different clinical parameters with the histological diagnosis and the prevalence of premalignant and malignant endometrial polyps. METHOD: The study included 516 cases from January 2002 to December 2006. Possible risk factors such as age, menopause status, abnormal bleeding, obesity, hypertension, diabetes mellitus, hormone therapy, use of tamoxifen and size of polyp were investigated in relation to their association with the malignant potential of endometrial polyps. RESULTS: All cases of endometrial polyps underwent hysteroscopic resection; 96.9% of the cases were benign, 1.2% premalignant and 1.9% malignant. Premalignant and malignant endometrial polyps were significantly associated with advanced age (>60 years), menopause, obesity and diabetes. The malignant polyps were analyzed to eight endometrioid, one serous and one clear cell carcinoma. CONCLUSION: The prevalence of premalignant and malignant endometrial polyps is very low. Advanced age, menopause, obesity and diabetes increase the risk of endometrial polyp malignancy.

Vascular tumors: rare neoplasms of the female genital tract.

BACKGROUND: Vascular tumors of the genital tract are rare entities. METHOD-RESULTS: We conducted a retrospective study of such tumors during the period January 1993 up to December 2007. During this period we identified thirteen patients with vascular tumors of the female genital tract. Their age ranged from 28 up to 76 years. More specifically, we identified one patient with angiomyxoma, five patients with angiokeratoma, one patient with vascular malformation, two with cervical hemangioma, two with hemangioma of the uterus and two with ovarian hemangioma. CONCLUSION: Our 15-year-old experience on the field is presented through description and images of such tumors.