Multiloculated peritoneal inclusion cysts with splenic involvement: a case report.

Multilocular peritoneal inclusion cysts (MPICs) are most commonly found in women of reproductive years and involve the abdomen, pelvis, and retroperitoneum. It is commonly thought that these cysts are due to an inflammatory reaction. Patients usually present with chronic abdominal or pelvic pain and are diagnosed by ultrasound or CT scan. Although there are experimental medical treatment options surgical excision remains the current recommended primary therapy for symptomatic disease. The following case describes a pregnant female with rare MPIC involving the spleen and peritoneum. Biological behavior of MPIC and current therapy options are also discussed.

Laparoscopic removal of virilizing hilar cell tumor in a postmenopausal patient.

A postmenopausal woman experienced rapidly progressing hirsutism and signs of virilization. Hormone evaluations showed markedly elevated serum testosterone levels and no evidence of excess cortisol or dehydroepiandrosterone sulfate production. A computerized tomographic scan of the adrenals and ovaries was normal, and transvaginal ultrasound revealed a left ovary with a maximum diameter of 3.2 cm. At outpatient laparoscopic bilateral oophorectomy, the left ovary had a benign, 2.5-cm Leydig cell tumor, hilar cell variant. Laparoscopy may be useful in the diagnosis and treatment of select cases of virilizing tumors of the ovary.

Review of outcomes of atypical squamous cells of undetermined significance papanicolaou smears for 1991 and 1992, with follow-up through 1995.

OBJECTIVES: Our aim was to review 1,754 consecutive Papanicolaou (Pap) smears from 1991 to 1992 to evaluate initial findings and disease progression through December of 1995. METHODS: The study used analysis of data in the Gundersen Lutheran Medical Center Colposcopy Clinic's computerized registry. A total of 1,754 patients were followed, and findings were analyzed for progression and age-related outcomes. RESULTS: At initial evaluation by a trained ACOG member colposcopist, 11% of patients with atypical squamous cells of undetermined significance (ASCUS) Pap smears had histologically confirmed cervical intraepithelial neoplasia (CIN) I lesion and 7% a CIN II or III lesion. After a negative initial evaluation for an ASCUS Pap smear, an additional 8.4% smears went on to to demonstrate histologically confirmed CIN II or III, and an additional 4.7% revealed a CIN I. CONCLUSIONS: An ASCUS Pap smear requires evaluation by a care provider trained in colposcopy and management of abnormal Pap smears.

Spontaneously acquired, unilateral absence of the adnexa. A case report.

A free-floating, calcified cyst was found in the peritoneal cavity in association with unilateral absence of the adnexa. The evidence was that it was due to torsion and separation of the adnexa from their supporting structures. This phenomenon may be a cause of congenital absence of the ovary.

Dysplasia and cytologic findings in 4,589 young women enrolled in diethylstilbestrol-adenosis (DESAD) project.

This report presents the cytologic findings and the rates of dysplasia for 4,589 young women enrolled in the National Cooperative Diethylstilbestrol-Adenosis (DESAD) Project. Mucinous columnar cells and/or metaplastic squamous cells with or without mucinous droplets were encountered in 22% of vaginal scrape smears from all diethylstilbestrol (DES)-exposed participants identified by review of prenatal records and in 43% of women in whom vaginal epithelial changes (VEC) were observed by colposcopy or by iodine staining. The frequency of cellular findings in the vaginal scrape smears was closely related to the timing of the administration of the DES to the mother. With increasing age of the daughters, the overall frequencies of both the mucinous and metaplastic cells decreased; relative to each other, an increasing proportion was metaplastic squamous cells. These data suggest that, as the women grow older, vaginal adenosis regresses by the process of squamous metaplasia. Endometrial type cells were found in 2% of vaginal scrape smears. Their cyclical occurrence during the menstrual cycle and lack of correlation with the presence of VEC indicated an origin from the uterine corpus rather than the tuboendometrial type of adenosis. Squamous cell dysplasia of the vagina and cervix was detected by biopsy or scrape smear specimens in 1.8% of DES-exposed women in the record review group. The rate of unexposed women was twice as high. In general, the rates of dysplasia were higher in the cervix than vagina, and the more severe degrees of dysplasia were encountered only in those women who were referred to the DESAD Project or who themselves requested entry. Four patients who were referred or who themselves requested entry were found to have clear cell adenocarcinoma of the vagina. The vaginal smear provided the first clue to the presence of an abnormality in three of them.

PIP: This report presents the cytologic findings and the rates of dysplasia for 4,589 young women enrolled in the National Cooperative (DESAD) Diethylstilbestrol-Adenosis Project. Mucinous columnar cells and/or metaplastic squamous cells with or without mucinous droplets were encountered in 22% of vaginal scrape smears from all (DES) diethylstilbestrol-exposed participants identified by review of prenatal records and in 43% of women in whom (VEC) vaginal epithelial changes were observed by colposcopy or by iodine staining. The frequency of cellular findings in the vaginal scrape smears was closely related to the timing of the administration of the DES to the mother. With increasing age of the daughters, the overall frequencies of both the mucinous and metaplastic cells decreased; relative to each other, an increasing proportion was metaplastic squamous cells. These data suggest that, as the women grow older, vaginal adenosis regresses by the process of squamous metaplasia. Endometrial type cells were found in 2% of vaginal scrape smears. Their cyclical occurrence during the menstrual cycle and lack of correlation with the presence of VEC indicated an origin from the uterine corpus rather than the tuboendometrial type of adenosis. Squamous cell dysplasia of the vagina and cervix was detected by biopsy or scrape smear specimens in 1.8% of DES-exposed women in the record review group. The rate in unexposed women was twice as high. In general, the rates of dysplasia were higher in the cervix than vagina, and the more severe degrees of dysplasia were encountered only in those women who were referred to the DESAD Project or who themselves requested entry. 4 patients who were referred or who themselves requested entry were found to have clear cell adenocarcinoma of the vagina. The vaginal smear provided the 1st clue to the presence of an abnormality in 3 of them.

Corynebacterium pyogenes septic arthritis with plasma cell synovial infiltrate and monoclonal gammopathy.

A chronic septic process developed in the right knee of an elderly man with advanced degenerative arthritis of both knees. Open exploration, culture, and biopsy of the joint found that the pathogen was Corynebacterium pyogenes and that the synovium was involved with a remarkable perivascular infiltrate of plasma cells. Serum protein electrophoresis demonstrated a prominent M component. Following antimicrobial therapy, the M protein level has gradually declined, and no evolution of multiple myeloma has become apparent. The findings are consistent with a benign monoclonal gammopathy and localized plasmacytic reaction in the knee associated with infection by an unusual diphtheroid organism.