Intrauterine contraceptive device failures in renal transplant patients.

Concern is voiced regarding sexually active renal transplant patients and their use of the IUD for contraception. Two patients of this type conceived while receiving immunosuppressive therapy. The possible mechanisms of the IUD in preventing conception are mentioned. Immunosuppression may significantly alter these actions, thus allowing fertilization and implantation to occur. Alternate means of contraception are suggested in place of IUDs for these patients.

PIP: 2 case studies are presented where patients with functioning renal transplants on immunosuppressive treatment conceived while using a copper IUD for contraception. Since ovulation recurs from between 1 and 12 months following return to normal renal function after renal transplant, the sexually active woman must utilize some form of contraception. For those women who opt for contraception of a nonpermanent nature, there are several problems. Oral contraceptives often cause a reversible elevation in blood pressure in these patients and they may also have some detrimental effects on the sodium and water balance. The diaphragm, foam, and condom may be used but without high motivation from the couple, unplanned and unwanted pregnancies often result. IUD use can open a renal patient to the risk of infection or, as in these case reports, to contraceptive failure due to a decrease in effectiveness in association with immunosuppressive therapy. In animal studies it was shown that the antifertility effect of the IUD was associated with the administration of Cytoxan and Leukeran (immunosuppressive agents) along with a decrease in IgG and IgM. Although IUD mechanism of action is not totally understood, it does seem that an intact immune system is required for effectiveness. Thus renal transplant patients should be informed about the use of other agents in order to avoid unwanted pregnancy.

A clinicopathologic study of vagina and cervix in DES-exposed progeny.

In this survey of 210 women with a history and/or gross changes of the cervix and vagina characteristic of DES exposure, changes related to vaginal adenosis were correlated with age. The mean age of women with columnar epithelium alone was 18.5 +/- 3.2 years, columnar epithelium with squamous metaplasia was 20.2 +/- 3.4 years, and squamous metaplasia alone was 23.0 +/- 2.7 years. These findings suggest that involution of vaginal adenosis occurs with increasing age. Involution of glands in the superficial stroma in most cases occurred concurrently with that of surface columnar epithelium. However, those deeply seated and complex glands in the stroma might lag in the metaplastic process and might persist. The pitfalls of misinterpretation of squamous cell changes in histologic samples were discussed. The lack of correlation between the colposcopic findings of mosaicism and/or punctuation and squamous cell neoplasia was confirmed in this study.

PIP: A clinical study was undertaken to determine whether involution of vaginal adenosis occurs at a comparable age in women with different types of adenosis. 210 women with a history and/or gross changes of the cervix and vagina characteristic of diethylstilbestrol exposure were studied by the following means: 1) palpation of the vagina; 2) direct visualization and colposcopic examination of the vagina and cervix; 3) cellular smears of the vagina and cervix; 4) staining of the vagina and cervix with 1/2-strength Lugols solution; and 5) biopsies to document abnormal findings discovered colposcopically. Microsopic findings are illustrated. Diagnostic correlations are tabulated. The involution of vaginal adenosis through squamous metaplasia was related to the age of the women, indicating that involution occurs with increasing age. The involution process is described from microscopic findings in the study. Misinterpretation of squamous cell changes is possible. In fact, misinterpretation of reserve cell hyperplasia and immature squamous metaplasia as dysplasia and overevaluation of dysplastic epithelium are the major sources of the high frequency of dysplastic findings. There is a lack of correlation between colposcopic findings of mosaicism and/or punctuation and squamous cell neoplasia.

Basal cell carcinoma of the vulva.

Basal cell carcinoma was found in eight of 61 cases of vulvar malignancy occurring over a 20-year period. This incidence of basal cell carcinoma was 13.1%, higher than the expected 2%-5% reported previously in the literature. Symptoms of a mass, usually discharge, pruritus or bleeding, were commonly ignored for long periods of time by the elderly patient. The specific location and size were difficult to ascertain from hospital records. Therapy is always surgical with wide local excision recommended. Local recurrence will be noted in 10%-20%, as vulvar basal cell carcinoma is a multicentric lesion and, therefore, long-term follow-up, as with any malignancy, is mandatory. Adequate identification and reporting may well show that this lesion is more common than has been previously thought.

Metastatic carcinoma (endometrial adenoacanthoma) to the trachea. Report of a successful resection and primary anastomosis.

The first case report of an adenoacanthoma of the endometrium with metastasis to the trachea is presented. Successful resection with primary anastomosis was done, followed by external radiotherapy. The patient has been followed for 3 years to date with no evidence of recurrence. A brief discussion of this tumor is given.