Exaggerated placental site/placental site trophoblastic tumor: an underestimated risk factor for emergency peripartum hysterectomy.

OBJECTIVE: To assess the indications and possible underlying causes of emergency peripartum hysterectomy (EPH) at the present hos- pital during the 2001-2011 period. MATERIALS AND METHODS: A revision of the charts and pathology reports corresponding to 42,728 parturients. RESULTS: During the study period, 25 peripartum hysterectomies were performed (0.61/1.000), of which 23 were EPHs (0.54/1.000) and two were planned cesarean hysterectomies. The indication for EPH was acute postpartum hemorrhage in 22 of 23 instances (95.7%). Roughly two-thirds of the operated uteri (16/25, 64%) showed placental site anomalies, half corresponding to different degrees of placental accretism and half to anomalies derived from the implantation site intermediate trophoblast. In five cases (31%), the anomaly was an exaggerated placental site and three cases corresponded to placental site trophoblastic tumors. Of the 16 cases showing placental site anomalies, ten (62.5%) were associated with one or more previous cesarean sections. CONCLUSIONS: Roughly one-third of EPHs performed at the present center during the last ten years were associated with placental site anomalies originating in the implantation site intermediate trophoblast (exaggerated placental site and placental site trophoblastic tumor). This association has not been described before, and should be taken into consideration when facing acute peripartum hemorrhage predisposing to EPH.

Patient age and biological aggressiveness of endometrial carcinoma.

BACKGROUND: Advanced age is associated with a significantly worse prognosis of endometrial carcinoma patients. The aim of this study was to test whether age is a poor-risk factor in endometrial carcinoma because tumors arising in older patients are biologically different from those diagnosed in patients of an earlier age. MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded samples from 136 previously untreated patients with endometrial carcinoma were studied by means of immunohistochemistry. The expression of molecular markers associated with hormone responsiveness (estrogen and progesterone receptors), proliferation (Ki67, C-ERB-B2, p53), invasiveness (E-cadherin) and apoptosis (BCL2 and p53) was analyzed. The obtained expression levels, together with all available clinical and pathological features were tested for correlations with the patients age and survival. RESULTS: Advanced patient age showed a direct correlation with tumor stage (r=0.29, p=0.0008) and mutant p53 expression (r=0.25, p=0.004), and an inverse correlation with E-cadherin expression (r=-0.28, p=0.001). Patient age above the 25th percentile (57 years) of the age distribution was significantly associated with a worse prognosis (p=0.018). CONCLUSION: It appears that with advancing age, endometrial carcinoma exhibits a more aggressive tumor phenotype, characterized by mutant p53 expression and down-regulation of E-cadherin expression, and that this, in its turn, results in tumors being diagnosed at a more advanced stage in older patients.

[Verrucous carcinoma of the larynx]. / Carcinoma verrucoso de laringe.

The present work shows a retrospective study of 11 cases of verrucous carcinoma of the larynx from data collected at Marqués de Valdecilla Hospital for ten years. All patients were males. Glottis was the most common site involved (10 cases). Eight patients were treated with partial surgery and in two cases total laryngectomy was performed. One patient refused treatment. Five-year survival rates were 100% in the ten patients treated. Verrucous carcinoma of the larynx is a well differentiated variant of squamous cell carcinoma. Surgical treatment is necessary for the primary lesion without neck dissection. Radiotherapy is not indicated because the possibility of anaplastic transformation. Prognosis is excellent after surgical treatment.

[Sphenoidal metastasis of laryngeal carcinoma]. / Metástasis esfenoidal de un carcinoma de laringe.

Metastatic tumors to the nose and paranasal sinuses are very uncommon and metastases to the sphenoid sinus are exceedingly rare. The most common tumor sites from which sphenoid metastases arise are the kidney and the lung. Distant metastases from laryngeal carcinoma are rare, the most common sites being the lungs, skeletal system, and liver. We report a patient with a supraglottic laryngeal carcinoma who had metastases to the sphenoid sinus. The management of this entity is described and cases reported in the literature are reviewed.

[Cholesterol granuloma of the petrous apex]. / Granuloma de colesterol de punta de peñasco.

Cholesterol granuloma of the petrous apex is an inflammatory granulation tissue response to the presence of cholesterol crystals. It is not generally associated with middle-ear pathology. CT and MRI are fundamental for diagnosis. MRI is more specific and shows a well-circunscribed mass with high signal intensity on both T1 and T2 weighted images. We present a case of cholesterol granuloma of the petrous apex that was previously diagnosed as cholesteatoma. We emphasize the importance of preoperatory differentiation of the lesion from cholesteatoma. Cholesterol granuloma does not require full excision of the lesion. Drainage and permanent aeration is usually sufficient.

Helicobacter pylori in Barrett's esophagus.

Barrett's esophagus is an anatomicoclinical state in which, due to the prolonged action of gastroesophageal reflux, the squamous epithelium is replaced by columnar epithelium. Helicobacter pylori has been implicated in the pathogenesis of various gastrointestinal disorders and has occasionally been observed in Barrett's esophagus. The aim of this study is to determine the incidence of H. pylori in Barrett's esophagus and try to establish its role in the pathogenesis of this disorder. H. pylori was observed in 31 biopsies (44.3%) of the 70 studied, mainly when the epithelium is of the gastric atrophic-fundic type (p less than 0.01). Its presence shows no relation to the degree of inflammatory activity and does not seem, therefore, to play an important role in the pathogenesis of the lesion.

[Morphologic findings in systemic amebiasis. Apropos of 1 case]. / Hallazgos morfológicos en amebiasis sistémica. A propósito de un caso.

Amebiasis is an uncommon infectious disease in our region. We describe the anatomopathologic findings of the autopsy of a patient who died of systemic amebiasis, briefly commenting the anatomo-clinical characteristics of this disease and its diagnosis.

Normal pregnancy and delivery two years after adjuvant chemotherapy for grade III immature ovarian teratoma.

A 27-year-old woman with grade 3 immature teratoma of the ovary was treated with unilateral salpingo-oophorectomy and VAC combination chemotherapy. She received 6 postoperative courses, although initially 12 were planned. Chemotherapy had to be discontinued because of severe bone marrow toxicity. Eighteen months later the patient became pregnant and was ultimately delivered of a normal child. This is the second report of a successful pregnancy following VAC chemotherapy for immature teratoma.

[Tubal cancer with cervix metastasis]. / Tubenkarzinom mit Zervixmetastase.

A case of tubal carcinoma is presented, which was initially misdiagnosed as an endometrial carcinoma. This was due to a superficial metastasis yielding material during the curettage which simulated an anaplastic adenocarcinoma. The difficulty of correctly diagnosing tubal carcinoma preoperatively has been discussed.