[CLINICO-MORPHOLOGICAL STUDY OF 68 CASES OF INVASIVE ENDOCERVICAL ADENOCARCINOMA].

UNLABELLED: Recent studies have demonstrate an increase in both relative and absolute frequency of the cervical adenocarcinoma (ECA) with incidence about 10-25% of all cervical malignancy. THE AIM: clinicopathological study of invasive ECA. MATERIALS AND METHOD: From 2007 to end of 2011, 68 cases of invasive ECA were collected. The tumors were classified according the WHO classification of tumors of Tumors of the Female Reproductive Organs 2014. RESULTS: The distribution of different histological types of ECA was as follow: Usual type-29 (42.65%); Endometroid type-15 (22.06%); Adenosquamous type-15 (22.06%); Villoglandular type-6 (8.82%); Signet-ring type-2 (2.94%); and Intestinal type-1(1.47%). The middle age of patients was 45 years and varied in large diapason 27-73 years. A synchrony presence of CIN and glandular dysplasia even to AIS in some cases with usual and adenosquamous type were detected. The clinical and morphological data of every type ECA was analised.

[A case of gynandroblastoma in a 16-year old girl and review of literature].

An ovarian tumor (gynandroblastoma) in a 16-year old girl is reported. Clinical presentation include abdominal pain, signs of virilization and irregular menstrual cycles. Ultrasound scan examination reveals a cystic mass in a left ovary. The patient underwent a left ovariosalpingectomy. Grossly, a cystic mass (73 x 42 x 36 mm) with smooth outer surface and with many cysts was found in the left ovary. The intraoperative diagnosis was ovarian adenocarcinoma. Postoperative histological examination reveals that the tumor was presented by two patterns- nodules and nests of juvenile granulose cell pattern admixed with Sertoli-Leydig pattern as tubules and cyst and scanty Sertoli cells. On immunohistochemical staining the Granulosa cells were negative for cytokeratin AE1-AE3 and positive for Vimentin. The Sertoli cells were androgen receptor positive. A year after operation the patient had no abdominal pain, the menstrual cycles are regular but the virilization persist. Histogenesis and differential diagnosis are discussed.

[Primary malignant melanoma of the vagina and treatment options: a case report].

OBJECTIVE: To present and analyze the clinical characteristics, treatment, and treatment options for a patient with primary malignant melanoma of the vagina and review of literature. CLINICAL CASE: A 71-year-old patient with a history of vaginal bleeding caused by four tumor growths located in the vagina is presented. The size of each formation was about 2 cm. Three of them were located in the proximal two-thirds of the anterior wall of the vagina and one in the distal third. Excisional biopsy was performed of the lesion located near the entrance of the vagina. Histopathological examination revealed that it was a malignant melanoma of the vagina, which was confirmed immunohistochemically. After ruling out a tumor of an unknown primary site, the patient underwent radical hysterectomy type IV total vaginectomy and pelvic lymph node dissection. Hystological examination proved a clinically asymptomatic melanoma lesion of the uterine cervix. After surgery, the patient was given chemotherapy with Dacarbasine and monthly immunotherapy with BCG vaccine. The patient survived 21 months after surgery without developing a local relapse and died of distant metastases in the spine. CONCLUSION: Radical surgery for primary melanoma of the vagina is a secure way of achieving locoregional control of multifocal disease. The wide local excision can be used in unifocal lesions with security in achieving clean surgical margins.

[Peculiarities of maternal mortality in the University Hospital of Pleven for period 1977-2001].

The authors report retrospective investigation of causes for maternal mortality in the Department of Obstetric and Gynecology in Hospital in Pleven for the period 1977-2001 and comparison between indexes for a different period of time. Objects of investigation were patient histories necropsy report and forensic expertise. Vital births were 73922 for a period of 25 years in Pleven. Dead pregnant and maternity were 45 and the rate of maternal mortality was 60,07/per 100 000 vital births. Causes of maternal mortality were divided in immediate 40 cases (88,88%) and indirect--5 cases (11,11%). The hemorrhage was the most common cause of maternal mortality--18 cases (45%). The authors mention that the absolute number of maternal losses is comparatively constant but the rate of maternal mortality in creases because of tendency of decrease of birthrate and concentration of pathology in Department of Obstetric and Gynecology in Pleven.

[Immunohistochemical analysis of epidermal growth factor receptors expression in malignant ovarian tumors].

OBJECTIVE: To study the frequency of EGFR expression in patients having malignant and benign ovarian tumors and to analyze its relation to some clinico-pathological factors. MATERIAL AND METHODS: In a prospective study 71 patients with malignant and 19 with benign ovarian tumors were included for the period 1999-2004. We utilized immunohistochemical analysis with monoclonal mouse antihuman EGFR antibody and EGFR pharm Dx kit (DAKO). RESULTS: The frequency of EGFR expression for the malignant ovarian tumours was 62.9% compared to 36.8% for the benign ones (p = 0.042). The patients with peritoneal washing positive for tumour cells and those with progressing cancer express EGFR significantly more frequently, 77% and 75%, respectively (p = 0.05). CONCLUSION: Malignant ovarian tumours have significantly greater frequency of EGFR expression compared to benign ovarian tumours.

[Primary peritoneal carcinoma: a report of two cases and a review of the literature].

Primary serous peritoneal carcinoma (PSPC) is rare tumor histologically identical to epithelial ovarian carcinoma (EOC); it is differentiated from EOC based on the extent of gross ovarian involvement and microscopic invasion of the cortex. When this tumor involves the extraovarian peritoneum significantly and the ovarian surface minimally or not at all, it is generally considered to be of peritoneal origin. We report macroscopical and histopathological findings of 2 cases of PPC, which were diagnosed, in our Department. Total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy were performed in 2 patients. PPC is a rare tumor currently managed in the same way as ovarian cancer. Primary debulking surgery and chemotherapy represent the cornerstones of treatment. Considering the limited number of patients with PPC, no definitive conclusion can be drawn concerning the prognostic factors for survival.

[Expression of epidermal growth factor receptors in benign ovarian tumors]. / Ekspresiia na retseptori za epidermalen rastezhen faktor pri dobrokachestveni tumori na iaichnika.

The objective of the present study was to determine the level of EGFR expression in patients having benign ovarian tumors and in morphologically normal ovarian tissue by quantitative ligand binding assays. In a prospective study 42 patients with benign ovarian tumors and 30 with normal ovaries were included. In the group of patients expressing EGFR, those having benign tumors were 23 (64%) and the ones with normal ovaries--13 (36%). The average level of EGFR expression was the highest in the cases of teratoma adultum (110 fmol/mg), followed by mucinous (97 fmol/mg) and serous (30 fmol/mg) cystadenomas. The differences between the average levels of EGFR expression in mucinous and serous benign ovarian tumors were significant (p = 0.032), as for the remaining histological variants--statistically insignificant (p = 0.086). Mucinous cystadenomas possessed higher proliferative potential compared to serous cystadenomas.

[Characteristics of maternal mortality in the university hospital of Pleven for the period of 1977-2001 years]. / Osobennosti na maichinata smurtnost v MBAL na gr. Pleven prez peroida 1977-2001 godina.

The authors report retrospective investigation of causes for maternal mortality in the Department of Obstetric and Gynecology in Hospital in Pleven for the period 1977-2001 and comparison between indexes for a different period of time. Objects of investigation were patient histories necropsy report and forensic expertise. Vital births were 73922 for a period of 25 years in Pleven. Dead pregnant and materinity were 45 and the rate of maternal mortality was 60,07/per 100 000 vital births. Causes of maternal mortality were divided in immediate 40 cases (88,88%) and indirect - 5 cases (11,11%). The hemorrhage was the most common cause of maternal mortality - 18 cases (45%). The authors mention that the absolute number of maternal losses is comparatively constant but the rate of maternal mortality in creases because of tendency of decrease of birthrate and concentration of pathology in Department of Obstertic and Gynecology in Pleven.

[Extra-neoplastic epithelial changes in cancer of the vulva]. / Izvuntumorni epitelni promeni pri rak na vulvata.

A retrospective morphological research is made on the material of 78 cases from vulva for a three years period of time. They are identified 35 cases with invasive carcinoma, 2 c. with noninvasive carcinoma, 19 c. with vulvar dystrophia and squamous intraepithelial neoplasia (VIN). The invasive carcinomas are divided: keratinizing squamous cell carcinoma--31 c.; nonkeratinizing squamous cell carcinoma--3 c; adenoid squamous cell carcinoma--1. In all operated patients are examined the changes in the tissues surrounding the tumor and in the underlying tissue. They are divided in: lichen sclerosus, squamous cell hyperplasia, mixed dystrophia and squamous intraepithelial neoplasia. The morphological variants of squamous carcinoma, the epithelial changes and the patient's age are paralleled.

[Primary carcinoma and precancerous lesions of the vagina--the diagnostic difficulties]. / Purvichnen kartsinom i prekantserozi na vlagalishteto--diagnostichni trudnosti.

A retrospective morphological research is made on material from vagina for a three years period of time. The results from 93 studied cases are divided in 3 groups: 1. Re-occurrences in vagina--52; 2. Vaginal cancer and VAIN--11; 3. Non-malignant lesions--30. The diagnostic difficulties are discussed making parallel between primary vaginal neoplasia, the so-called lower genital tract neoplastic syndrome and postirradiation dysplasia.

[Carcinoma of the cervix uteri--the morphological changes after preoperative radiotherapy]. / Kartsinom na matochnata shiika--morfologichni promeni sled predoperativna lucheterapiia.

A retrospective morphological research is made on 11 patients with squamous cell carcinoma of the cervix for a three-years period of time (1995-1997). Preoperative radiotherapy (intracavitary radiotherapy with Cs and/or external radiation) is carried out. A control group of 10 patients with cancer of uterine cervix without preoperative radiotherapy is also studied. All of the women undergo a wider hysterectomy by the method of Piver class IV. The radiation alterations in the tumor and the surrounding normal uterine tissues are also researched. A full regression of the tumor Ts size. There are demonstrative changes in the tumor and surrounding normal tissues, which are the prove the answer to the ionizing irradiation.

[Mesodermal mixed tumors of the endometrium with a report of 7 cases]. / Smeseni mezodermalni tumori na endometriuma s opisanie na 7 sluchaia.

Frequency and characteristics of mixed mesodermal tumors (MMT) and some terminology disparities in the comparatively scarce literature are discussed. The low frequency of MMT described and difficulties in diagnosing have been pointed out. A final diagnosis can be made on operative material only, since curettage contains one (more often the epithelial) of the components of biphase tumorous. The authors emphasize on guided attention to MMT, as well as the necessity of serial sections. The most important factor is depth of invasion.

[Symplastic leiomyoma combined with focal adenocarcinoma of the endometrium]. / Simplasten leiomiom sucheten s fokalen adenokartsinom na endometriuma.

It is presented a case with symplastic leiomyoma in 53-years-old women with primary infertility. Interest performs the combination with focal endometrioid adenocarcinoma. It is discussed the differential diagnosis with leiomyosarcoma and the criteria for its inclusion in benign mesenchymal tumors.