The role of gut dysbiosis in endometriosis' diagnosis and treatment approaches - case report.

BACKGROUND: Endometriosis (EM) is a chronic multifactorial disease characterized by the presence of endometrial tissue outside the uterus. The clear etiopathogenesis of EM is unclear. Increasing evidence was gathered about the crucial involvement of gut microbiota in early stages of the disease, and in its progression. CASE PRESENTATION: We report the case of a 33-year-old Caucasian woman diagnosed with EM, that presented with painful pelvic (dysmenorrhea, dyspareunia) and gastrointestinal (GI) symptomatology. The patient underwent an intestinal microbiota analysis before the surgical treatment was performed. DISCUSSIONS: The GI microbiome culture identified high levels of non-pathogen bacteria Escherichia coli, Bifidobacterium, hemolytic E. coli and potential pathogens: Hafnia alvei and Enterobacter cloacae. The mycology culture performed identified the presence of potential pathogens: Candida albicans and C. glabrata. Microscopic examination and polymerase chain reaction (PCR) analysis showed Giardia lamblia in moderate amounts. These findings were compared with the information available in the literature of specialty and they imply that the patient' intestinal microbiome is heavily disrupted. CONCLUSIONS: There are changes in the microbiota of EM patients in comparison to those not suffering from this disease. The findings addressed in this article characterize the intricate bilateral connection between the microbiota and EM. The goal of future studies ought to be to establish how the microbiome and EM are interconnected by implementing breakthrough diagnostic and treatment strategies.

Update on placenta accreta spectrum disorders by considering epidemiological factors, ultrasound diagnosis and pathological exam - literature review and authors' experience.

The aim of this paper was to correlate the circumstances that could lead to an abnormal invasion of placenta with the updated requirements to perform screening by ultrasound for all pregnant women prone to develop this pathology. To screen in the middle trimester of gestation for placenta accreta spectrum (PAS) disorders sets up an in-time referral opportunity for pregnant women prenatally detected with this pathology to a medical center with elevated level of expertise in the management of PAS disorders, able to act permanently by a multidisciplinary team (MDT) and to have access at medical resources including blood bank available. The literature review reveals especially useful data for clinical practice as regards novel explanations related to the etiology and physiopathology of PAS disorders, the composition of the MDT and the relevance of an indispensable pathologist physician at the time of Cesarean hysterectomy involved in the selection of best samples with the purpose of avoiding the possibility of losing undiagnosed cases with litigation implications. Conclusions show that the prenatal diagnosis of PAS disorders is possible so decreasing the risk of mortality and morbidity of pregnant women. Screening in the second trimester of pregnancy for PAS disorders becomes mandatory as the number of births by Cesarean section is expected to rise past three-fold until 2030. The professional expertise of the pathologist physician could be enriched by immunohistochemical staining in all suspected cases of placental invasion in myometrium wall.

Review of the biotechnologies and tests used for precancerous cervical lesions diagnosis.

This paper draws on the author's extensive experience in the clinical research focused on the implementation of the new biotechnologies able to identify precancerous cervical lesions and is intended to be a systematic approach to new achievements. The goal of this review is to provide updated information concerning the significance of each biotechnology used in clinical medicine to screen women for cervical cancer or to allow a pertinent discrimination between spontaneous remission lesions and progressive lesions. The data is arranged according to the most widely used biotechnologies and the worldwide recommendations of specialized guidelines.

Epithelioid trophoblastic tumor: a case report and literature review.

Epithelioid trophoblastic tumor (ETT) is a very rare case of malignant trophoblastic tumor, which can occur particularly during the fertile age of women with a long history of abortion and delivery. ETT originates from the intermediate trophoblastic cells of chorion laeve. The main features of this tumor include lack of vessels within the tumor, nuclear hyperchromasia and pleomorphism and a large zone of necrosis and hyalinization. The clinical features of ETT are specific to each case and often consist of vaginal bleeding or amenorrhea in the absence of other complains. The beta-human chorionic gonadotropin (ß-hCG) serum level cannot be an absolute criterion useful in defining diagnosis. The right diagnosis can only be established by a histopathological examination of the tissue picked-up via intrauterine curettage. This paper describes the case of a 35-year-old woman who required gynecological investigation for amenorrhea. The diagnosis established by biopsic curettage and the clinical evolution have influenced the physician's decision to perform hysterectomy. The only method to differentiate between the microscopic diagnosis of ETT and choriocarcinoma was the immunohistochemical staining of trophoblastic cells for cytokeratin AE1÷AE3, p63, Ki67. Despite the diagnosis of malignity, this tumor does not usually require a recommendation for chemotherapy and does not seem to have a bad prognostic. However, these data do not rule out that clinical behavior is sometimes difficult to predict. We analyzed the clinical and histology criteria in line with the data published in literature.