[Uterine adenosarcoma. Report of 5 cases and review of literature]. / Adenosarkoma matki. Opisanie pyati nablyudenii i obzor literatury.

Uterine adenosarcoma is an uncommon biphasic tumor with benign epithelial and malignant mesenchymal components, often presenting difficulties for morphological diagnosis. We describe 5 cases of adenosarcoma of the uterine corpus and cervix, and vaginal stump in patients aged 46-76 years. Clinical data, ultrasound results, morphological data, including immunohistochemical studies with antibodies to CD10, estrogen and progesterone receptors, desmin, smooth muscle actin, and Ki-67 are presented. Large polypoid mass of the epithelial-mesenchymal structure within the uterine cavity in women of peri - and postmenopausal age require the exclusion of malignancy of the mesenchymal component with searchig for diagnostic criteria - periglandular cuffing of the stromal cells and mitoses.

[Metastatic leiomyoma or synchronous lesion of the uteri corpus and vulva?] / Metastaziruiushchaia leiomioma ili sinkhronnoe porazhenie tela matki i vul'vy?

OBJECTIVE: To reveal the morphological characteristics of simultaneously diagnosed leiomyoma of the corpus uteri and vulva. SUBJECT AND METHODS: The paper describes a case of multiple uterine leiomyomas concurrent with vulvar leiomyoma in a 39-year-old patient with progressive tumor nodule growth over 2 years. Vulvar tumor was biopsied simultaneously with extirpation of the uterus; vulvar leiomyoma was removed six months later. Histological and immunohistochemical studies: such as hematoxylin and eosin staining, the expression of smooth muscle actin, desmin, and progesterone and estrogen receptors, S100, CD10, and determination of Ki-67 proliferation index, were conducted. RESULTS: The largest (14-cm) multiple tumor nodule in the corpus uteri had the structure of leiomyoma of uncertain malignant potential; the large (8-cm) vulvar tumor was a leiomyoma with hyalinosis. The immunohistochemical profile of uterine and vulvar leiomyoma (smooth muscle actin+, desmin+, progesterone+, estrogen+ receptors, CD117-, and Ki-67) was the same (1-3%). The vulvar leiomyoma was assumed to be a tumor of metastatic origin. CONCLUSION: Vulvar leiomyoma is rare; it can arise from smooth muscle tissue of various anatomical structures of the skin and soft tissues. The pathogenesis of the so-called metastatic leiomyoma is unclear; there are concepts of a metaplastic transformation of subcelomic mesenchyme and multifocal smooth muscle proliferation. The presented case demonstrates the synchronous development of uterine and vulvar leiomyoma.

[Features of the pathogenesis of the placenta growing in the scar after cesarean section]. / Osobennosti patogeneza vrastaniia platsenty v rubets posle kesareva secheniia.

OBJECTIVE: to investigate the structural and pathogenetic features of pathological placental attachment in the scar after cesarean section. MATERIAL AND METHODS: The investigators explored 12 uteri; 11 of which were removed with placentas at 9 to 38 weeks' gestation (one in the first trimester, three at 18-22 weeks, two at 32-35 weeks, and five at 37-38 weeks); one uterus was removed after an artificial abortion at 12 weeks' gestation in the scar, as well as the scars excised in the first trimester in non-developing (n=4) and progressive (n=2) pregnancies. For histological examination, fragments of the full-thickness uterine wall were taken from the placental bed in different areas. The sections were stained for fibrin with hematoxylin and eosin, van Gieson stain, and the Martius scarlet/blue (MSB) technique. Decidual tissue, trophoblast, vascular component, and smooth muscle tissue were identified by an immunohistochemical assay using antibodies to vimentin, pan-cytokeratin, vascular endothelium (СD31), and smooth muscle actin. RESULTS: In most cases, placental localization in the scar after cesarean section was accompanied by abnormal placental attachment: almost always placenta accreta, less frequently in combination with its ingrowth (placenta accreta/increta). The morphological substrate of placenta increta was a change in the content and ratio of normal histological components in the uterine wall, such as the mucosa, smooth muscle tissue, and vessels (the absence or thinning of decidual tissue and the myometrium, as well as its cicatricial changes). The structural criterion for placenta increta was necrosis of the walls of the large veins in the myometrium due to the replacement of their intermediate trophoblast and fibrin and to the destruction of vessel walls, leading to prolapse of the chorionic villi into the veins. CONCLUSION: In most cases, placental localization in the scar after cesarean section is accompanied by abnormal placental attachment: placenta accreta, less frequently in combination with its ingrowth (placenta accreta/increta).

[Twin pregnancy with complete hydatidiform mole]. / Polnyi puzyrnyi zanos pri beremennosti dvoinei.

The paper describes a case of twin pregnancy with complete hydatidiform mole (CHM). According to the data available in the literature, the concurrence of CHM with a normal placenta and a viable fetus occurs in 1 per 20,000-100,000 pregnancies, requires a differential diagnosis with partial hydatidiform mole and placental mesenchymal dysplasia, and is characterized by a high rate of complications. In this concurrence, the frequency of persistent trophoblastic disease is as high as 50%. In this case, the pregnancy ended in a spontaneous abortion at 16-17 weeks of pregnancy. A morphological examination determined the fetus without congenital malformations with normal placental weight and structure and the adjacent intact placental tissue with the macro- and microscopic signs of CHM. The diagnosis was confirmed by the lack of р57 expression in the villous trophoblast and stroma in the tissue of the hydatidiform mole. The patient was diagnosed with persistent trophoblastic disease at 2 months after the abortion.

[Placental alterations in pregnant women with autoimmune polyglandular endocrinopathy].

The paper gives the results of a morphological study of 13 placentas from patients with rare autoimmune polyglandular syndrome and adrenal insufficiency, a disease history of 2 to 14 years, receiving corticosteroid replacement therapy. All pregnancies were full-term; labors were term surgical. The clinical and morphological associations suggest the placental alterations characteristic of diabetes mellitus, autoimmune diseases, uteroplacental and placentofetal ischemia.

[Massive subchorial thrombosis].

Massive subchorial thrombosis (MSCT) is a placental abnormality, the etiology and pathogenesis of which remain inadequately studied. MSCT is characterized by a clinical symptom complex comprising marked intrauterine growth retardation, oligohydramnios, and fetal distress due to placental circulatory problems. Perinatal outcomes are appreciably determined by the term of pregnancy, the degree of placental insufficiency, and neonatal status. Prolonged MSCT makes it possible to diagnose this pathology by echographic and magnetic resonance imaging studies and to attempt to treat placental dysfunction through tocolytic therapy and correction of oligohydramnios, to prolong pregnancy, and to have a viable newborn infant. The clinical and morphological diagnosis of MSCT calls for its differential diagnosis with other focal placental lesions, such as subamniotic, intraplacental, and retroplacental hematomas, cytotrophoblastic cyst, umbilical cord cysts, and chorangioma.

[The problem of study of unexplainable antenatal fetal death].

The paperpresents the data on the causes ofperinatal mortality. Particular emphasis is placed on unexplainable antenatal fetal death, the absence of uniform terminology or a consensus classification of the causes of antenatal fetal death, and the principles in placental studies and stillborn baby autopsy. Various aspects of sophisticated relations in the mother-placenta-fetus system are considered. It is pointed out that the number of unexplainable antenatal fetal deaths can be reduced when the placenta is meticulously studied. A conventional protocol for stillborn baby autopsy and placental studies is noted to be elaborated.

[Endometrial hyperplastic changes and precancerous conditions: terminology and classification].

The paper presents the data available in the literature on the debated aspects of the terminology and classification of endometrial hyperplastic lesions, precancerous conditions of the corpus uteri. Particular emphasis is laid on the low reproducibility of the histological diagnosis of endometrial changes in accordance with the WHO criteria. Focus is on the disadvantages of a morphometric study for diagnosing endometrial intraepithelial neoplasia. The authors show it expedient to simplify the WHO classification and to adopt the uniform criteria for and terms of endometrial hyperplastic changes and precancerous conditions.

[Quantitative evaluation of the activity of nuclear Ca2+/Mg2+-dependent endonucleases in hyperplasia and cancer of the endometrium]. / Kolichestvennaia otsenka aktivnosti iadernykh Ca2+/Mg2+-zavisimykh éndonukleaz pri giperplazii i rake éndometriia.

Endometrial carcinoma is the most incident cancer of human reproductive system. There are unequivocal evidences of relationship between complex and atypical hyperplasia and development of cancer. Apoptosis plays a significant role in the maintenance of equilibrium between cell death and proliferation and contributes to prevention of tumorigenesis. Internucleosomal DNA fragmentation known as one of the most important criteria of apoptosis cannot be used for evaluating the risk of cancer development because it reflects the current level of apoptosis but is useless for evaluating the real limits of apoptosis intensity in certain types of tissue. For estimating the possibility of apoptosis development in endometrial tissues, a new method of quantitation of nuclear Ca(2+)/Mg(2+)-dependent endonuclease (NCME) activity has been developed. Fifteen samples of normal endometrial tissues at middle proliferative, secretory, premenstrual, and menstrual phases, 43 samples of hyperplastic endometrial tissues, 13 samples of endometrial polyps, and 17 samples of endometrial adenocarcinoma were collected by diagnostic curettage of the uterine cavity and by hysterectomy (carcinomas). The material was examined by 1) TUNEL method and 2) agarose gel electrophoresis of DNA cleaved by nuclear CME in isolated cell nuclei in the presence of Ca(2+) and Mg(2+) ions, followed by quantitation of CME activity. The activity of NCME was found to decrease from normal endometrium (1.1 +/- 0.12 U, without significant changes throughout the menstrual cycle) through polyps (0.9 +/- 0.15 U), cystic hyperplasia (0.45 +/- 0.06 U, p < 0.01), and adenomatous hyperplasia (0.32 +/- 0.08 U, p < 0.01) to adenocarcinoma (0.37 +/- 0.11 U, p < 0.01 for well differentiated, 0.16 +/- 0.08 U, p < 0.01 for moderately differentiated, and 0.03 +/- 0.02 U, p < 0.01 for poorly differentiated samples). The TUNEL-specific staining pattern in normal endometrium varied in a wide range during the menstrual cycle (from poorly stained individual cells in the proliferative phase to intensely stained cell clusters in the premenstrual phase). At the same time the difference between the normal endometrium in the proliferative phase and pathologically changed endometrium (hyperplasia or cancer) could not be detected by the TUNEL technique. Hence, TUNEL is useless for predicting cancer development in hyperplasia and precancer. By contrast, evaluation of NCME activity helps detect the early disorders in the proliferative processes coursing in endometrial tissues and thus prevent tumor development.

[The clinical importance of the dopplerometric study of the blood flow in the normal iliac, uterine and ovarian arteries, in myoma and in endometriosis interna of the corpus uteri]. / Klinicheskoe znachenie dopplerometricheskogo issledovaniia krovotoka v podvzdoshnykh, matochnykh i iaichnikovykh arteriiakh v norme, pri miome i vnutrennem éndometrioze tela matki.

Dopplerometric investigation of pelvic arteries was carried out in 30 women without gynecologic diseases, in 51 patients with internal endometriosis, and 48 ones with uterine myomas. Internal endometriosis of the uterus was found to be characterized by specific qualitative changes in spectral curves of bloodstream velocity in the internal iliac and uterine arteries. Moreover, progressive changes in spectral curves related to dissemination of endometrioid heterotopias were revealed. In patients with uterine myomas combined with internal endometriosis disorders of peripheral circulation typical of endometriosis predominated.

[Contraception with injectable long-acting preparation depo-provera]. / Kontratseptsiia in"ektsionnym prolongirovannym preparatom "Depo-Provera".

PIP: The selection of contraception for women over the age of 35 presents significant problems. The popular IUD is often contraindicated on account of producing pathological cervical and/or uterine changes. In such women the suitable contraceptives are pure gestagen pills and injectables (Depo-Provera and norethindrone enanthate). Depo-Provera contains the active ingredient medroxyprogesterone acetate (DMPA), which imitates the activity of endogenic progesterone and increases the activity of 17-hydroxyprogesterone 6- or 7-fold. Its mechanism of action on the uterine epithelium consists of antiestrogenic and antiandrogenic activity. In 1995 approximately 3.5 million women were using DMPA. Its contraceptive effectiveness amounts to 0-1.2 pregnancies per 100 women in the course of 1 year. In a 1987 multi-centered trial it was observed that the use of 250 and 500 mg of DMPA every 9 months produced a higher incidence of pregnancy than the use of 150 mg every 3 months. The causes of discontinuation of DMPA use are irregular bleeding (10.5%), reduction of libido (1.6%), and weight gain (1.4%). A 1984 clinical study of 3905 women showed that 54% of them had no untoward effects while using DMPA. The frequency of development of amenorrhea with DMPA use varies from 8% to 72%. Its hematological parameters are good and some studies showed that DMPA does not increase the risk of development of cancer of the endometrium, ovaries, and cervix. A 1991 study suggests that the relative risk of breast cancer may increase after 4 years of use of DMPA in women under 35, however, according to a 1994 study, above this age the risk is minimal. DMPA use lowers the risk of endometrial cancer, and this protective effect lasts for 8 years after cessation of use. Higher doses of DMPA treat endometrial cancer. After halting DMPA use the average time for conception to occur is 5.5 months. DMPA use in the first trimester does not produce adverse effects on the newborn or on lactation.^ieng

[Current concepts in observation and treatment of patients with internal endometriosis of the uterus]. / Sovremennye kontseptsii sistemy obsledovaniia i lecheniia bol'nykh vnutrennim éndometriozom matki.

The paper outlines the issues of improving and systematizing clinical instrumental diagnostic and therapeutical techniques for internal endometriosis. The results of examining 220 patients with internal endometriosis, out of whom 116 were further operated on, have been prospectively and retrospectively studies. Based on the histological findings of the gross specimens intraoperatively removed, the authors analyzed the predictive value of clinical and instrumental diagnostic criteria, including those of transvaginal echography, Doppler echometry of the arteries supplying the uterus, those of hysteroscopy and the computer hysterosalping graphic technique developed by them. The ovarian morphological and receptor apparatuses were studied in internal endometriosis. The examination and treatment system for patients with internal endometriosis is presented in the paper.

[Morphofunctional characteristics of the placenta of women living in extreme conditions of the Aral cost line]. / Morfofunktsional'naia kharakteristika platsenty zhenshchin, prozhivaiushchikh v ékstremal'nykh usloviiakh Priaral'ia.

Morphologic examination of the placenta from 41 puerperants living near the Aral sea revealed an increase of its mass and changes in other parameters. The detected pathologic processes: hemodynamic disorders and dystrophic changes--are not specific and contribute to the development of placental insufficiency. The majority (85.6%) of newborns were born in asphyxia. Morphofunctional features of the placentas of multiparous women and the status of their children permit regarding this population as the best adapted to pregnancy and delivery of viable children under the said extreme conditions.

[Experimental validation of the efficacy of laser-magnetic therapy for chronic placental insufficiency]. / Eksperimental'noe obosnovanie lazeromagnitoterapii khronicheskoi platsentarnoi nedostatochnosti.

A new pathogenetically based non-medicamentous method for correction of uteroplacental bloodflow disturbances has been developed on the model of chronic placental insufficiency in rats. A single 5 min laser-magnetic exposure on day 21 of normal pregnancy resulted in a vasodilating effect with reduction of the peripheral resistance in the uterine horn vessels and with improvement of their blood supply. A new LAMA laser magneto-therapeutic device was employed. Daily 5 min sessions of laser magnetic therapy administered to rats with chronic placental insufficiency from pregnancy days 15-16 to 21 normalized uterine horn contractility and resulted in positive morphofunctional changes in the components of the uterine horns and placenta, being associated with a noticeable improvement of fetal functions. Hence, laser magnetic therapy may be regarded as an effective non-drug method for therapy of chronic placental insufficiency.

[Endometrial and ovarian morphology in internal uterine endometriosis]. / Morfologicheskie aspekty éndometriia i iaichnikov pri vnutrennem éndometrioze matki.

The ovaries and endometrium were examined in 66 patients with internal uterine endometriosis with various degrees of the process dissemination. A high incidence of combinations of uterine endometriosis with hyperplastic processes in the ovaries was revealed (72.7%) and a relatively low incidence of uterine body mucosa involvement (31.7%). The degree of endometriosis dissemination in the myometrium and the incidence of ovarian hyperplasia were in direct proportion. The authors emphasize the usefulness of morphologic studies of the ovaries in patients with internal uterine endometriosis.

[The clinico-morphological and cytological characteristics of the ecto- and endocervix with the use of the oral contraceptive triregol]. / Kliniko-morfologicheskie i tsitologicheskie osobennosti ékto- i éndotserviksa pri primenenii oral'nogo kontratseptiva triregol.

Cervix uteri status was examined in 55 young nulliparous women in the course of triphasic oral contraception. The status of the cervix uteri was assessed on the basis of clinical, colposcopic, cytologic, and morphofunctional examinations. Triphase oral contraception with triregol was found conducive to the formation of squamous-cell metaplasia in ectopic sites, this promoting epithelialization of the cervix uteri.

PIP: The objective of this investigation was the study of clinical-morphological characteristics of the ecto- and endocervix in young nulliparous women with pseudoerosions in the course of using the 3-phase oral contraceptive (OC) Triregol made by Gedeon Richter Inc. of Hungary, which contains ethinyl estradiol and levonorgestrel. 55 healthy women, 17-30 years old, were observed. In the anamnesis of these women there was 1 instance of induced abortion and 1 instance of self-induced abortion. 22 women were married, and the rest were not. 2 patients had a history of inflammatory disease of the uterus and of the adnexa. In addition to routine clinical examination, echographic and dilatational colposcopy was performed in all women before starting them on the preparation. The observation was performed every 3, 6, 9, and 12 months and in the course of 1-2 months after taking the OC. A piece of tissue was taken by biopsy from the cervix and scrapings from the mucous membrane of the cervical canal for morphological examination. In 11 patients (27.5%) ectopia of varying extent was diagnosed by colposcopy, and in 27 patients (67.5%) ectopia in the transformation phase was discovered. Leukoplakia occurred in 2 patients (5%). Cervical biopsies were taken from 40 patients, and glandular pseudoerosion was discovered in 36, of whom in 18 patients fulminating and/or diffusive infiltration of lymphocytes were found in the subepithelial tissues, whereas papillary pseudoerosion was found in 2 cases. After 3 months of OC use in 2 patients full epithelization of the cervix was detected with multilayered flat epithelia. In the 2 patients with leukoplakia neither positive nor negative changes were observed. In 2 out of 40 patients a section of ripe or not ripe flat celled metaplasia in the mucous of the cervical canal and in 1 patient hyperplasia of the reserve cells were discovered. It must be underlined that in none of the observations was there a progressive pathological process nor the genesis of dysplasia detected.

[The ultrastructure and electron-histochemical characteristics of the stromal cells of the endometrium]. / Ul'trastruktura i élektronno-gistokhimicheskie osobennosti kletok stromy éndometriia.

Histologic, histochemical, electron-microscopic and ultracytochemical studies of cellular populations of the endometrial stroma and the vascular component, carried out in 33 women of a productive age in various phases of the cycle (on days 5-28) showed interactions of the cellular elements (fibroblast-like cells, predecidual cells, endometrial granulocytes, endotheliocytes, cells of a hematogenic origin) within and between the populations over the course of the cycle; all the cells were found functionally heterogenic, this underlying the endometrial homeostasis maintenance. Disturbances in any of the components of these interactions may result in a pathologic process in the uterine body mucosa.