Response to comment on "Oestrogen-induced angiogenesis and implantation contribute to the development of parasitic myomas after laparoscopic morcellation".

According to the literature review, CO2 insufflation on parasitic myoma implantation is not well studied, and we concur that our study is related to "Morcellation-induced parasitic myomas." We did not compare CO2 insufflation to non-insufflation in our study. The reason is the efficacy of gasless laparoscopic myomectomy and morcellation is not well established and this modality is seldom performed. Moreover, the effects of pneumoperitoneum on mesothelial cells and the role of the entire peritoneal cavity as a cofactor in adhesion formation have become well established, the role of CO2 insufflation in the establishment of parasitic myomas has not yet been studied. As such, more in-depth and well-designed studies for the role of CO2 insufflation are needed.

[Primary intestinal parasitic fibroid, an incidental finding during gynecological laparoscopic surgery]. / Mioma parasitario intestinal primario como hallazgo durante la cirugía laparoscópica ginecológica.

Background: Uterine fibroids are the most frequent solid pelvic benign tumors in women. Their most common location is the uterine corpus, cervix and broad ligament but they can also be found in other areas, less commonly as extragenital locations and/or in a parasitic way. Clinical case: A 40 years old patient, who consulted for menorrhagia and dysmenorrhea on long evolution. On physical examination, the enlarged uterus, inflamated, hard consistency and normal mobility was identified. The sonographic features and location suggested a fibroid nodule type II (Wamsteker classification), which deformed the endometrial cavity. It was decided to perform the surgery and during the procedure the enlarged uterus, deformed at the expense of a localized fundal formation, like a intramural fibroid. By mobilizing the intestinal loops and change the position of the patient (Trendelenburg) a solid tumor, cranially separated from the internal genitals it was observed. In reviewing the insertion site, it was visualized that remained attached to antimesial of the jejunum. Total hysterectomy was performed with monopolar and bipolar energy, and vascular sealant. The postoperative was favorable, without complication. The pathological study reported a primary leiomyoma of the small intestine, while in the uterus of multiple myomas was confirmed. Conclusión: The parasitic fibroids are those located separately from the uterus that receive vascular irrigation from another organ or abdominopelvic structure. They are a very rare pathology. The diagnosis has made as an accidental event, during an abdominal surgery or during the differential diagnosis of a abdominopelvic tumor. The therapeutical choice depends on the clinical presentation, the location of the fibroid and the reproductive desires of the patient, most commonly recomending their surgycal removal.

Plasmodium falciparum parasites expressing pregnancy-specific variant surface antigens adhere strongly to the choriocarcinoma cell line BeWo.

Placenta-sequestering Plasmodium falciparum parasites causing pregnancy-associated malaria express pregnancy-specific variant surface antigens (VSA(PAM)). We report here that VSA(PAM)-expressing patient isolates adhere strongly to the choriocarcinoma cell line BeWo and that the BeWo line can be used to efficiently select for VSA(PAM) expression in vitro.

[The relationship between malignant transformation and fertilization types of hydatidiform moles].

OBJECTIVE: To study the relationship between malignant transformation and fertilization types of hydatidiform moles (HM). METHODS: Fifty four HM specimens were analyzed by using multiplex STR-PCR (9 loci) to determine the fertilization types and all patients were followed-up for the human chorionic gonadotropin (hCG) over 1 year. RESULTS: Total malignant transformation cases were 10 in all the 54 HM. Ggenetics complete hydatidiform moles (g-CHM) with DNA from only paternal origin, were observed in 38 cases including 28 homozygote and 10 heterozygote cases. In homozygote and heterozygote cases,malignant transformation occurred in 8 cases of the empty eggs fertilized by single sperms and 2 by double sperms respectively. In all the 54 HMs, 16 cases of DNA from parents were genetic partial hydatidiform moles (g-PHM), and no malignant transformation occurred in each haploidy egg fertilized by double sperms. CONCLUSION: (1)Genetic complete hydatidiform moles (g-CHM) showed a higher malignant transformation risk than genetic partial hydatidiform moles (g-PHM) (P=0.024 2); (2)There was no significant difference in malignant transformation between homozygote and heterozygote of g-CHM (P=0.699).

[Schistosomiasis of the female genital tract: anatomoclinical and histopathological aspects. Apropos of 26 cases]. / Bilharziose du tractus génital chez la femme: aspects anatomocliniques et histopathologiques. A propos de 26 cas.

The authors report 26 cases of female genital schistosomiasis. This parasitosis is observed in women of ages ranging between 17 and 70 years (mean age = 30 years) and associated with sterility (6 cases), uterine tract cancer (1 case), tubular pregnancy (1 case), benign teratoma (1 case) and serous cystadenoma (1 case). The diagnosis is based on an histological analysis which shows several lesions with schistosomiasis (Schistosoma haematobium) eggs, confirmed by ZIEHL coloration. When coupled with infections these anatomical lesions lead to dysfunctions such as sterility and extra-uterine pregnancy through tubular dysfunction.

Cell proiferative actitiy and mutation of P53 suppressor gene in human gestational trophoblastic disease

Cell proliferative activity and the over accumulation of P53 suppressor gene were evaluated in 26 cases of gestational trophoblastic disease and five cases with normal placentae. Formalin-fixed, paraffin-embedded histological sections were used for immunohistochemistry, utilizing the avidin-biotin-peroxidase technique and antibodies to PCNA (proliferative cell nuclear antigen) and to P53 (product of suppressor gene). Positive reactions for PCNA were graded from 1+ to 3+ (1+ - less than 10 per cent of cells; 2+ - 10 - 50 per cent ; 3+ - more than 50 per cent ). Eight of 10 cases of choriocaricinoma (80 per cent ) showed moderate to strong reactivity for PCNA (2+ and 3+). All 9 cases with hydatidiform mole and 6 of 7 cases with partial mole also demonstrated 2+ and 3+ reactions for PCNA. There was minimal or no PCNA straining in the trophoblastic cells of normal placentae. Five of 10 cases with choriocarcinoma (50 per cent ) exhibited P53 overaccumulattion as did 7 of 9 cases with hydatidiform mole (78 per cent ). In hydatidiform moles, P53 staining was limited to the areas of trophoblastic proliferation separate from chorionic villi. None of the partial moles or normal placentae showed P53 overaccumlation. It is concluded that the cell proliferative activity of choriocarcinomas as well as complete and partial hydatidiform moles are comparable. On the other hand, the mutation of P53 suppressor gene, as demonstrated by the overaccumulation of P53 protein, is seen only in true trophoblastic neoplasms, namely choriocarcinomas and hydatidiform moles.

Cell proliferative activity and mutation of P53 suppressor gene in human gestational trophoblastic disease

Cell proliferative activity and the over accumulation of P53 suppressor gene were evaluated in 26 cases of gestational trophoblastic disease and five cases with normal placentae. Formalin-fixed, paraffin-embedded histological sections were used for immunohistochemistry, utilizing the avidin-biotin-peroxidase technique and antibodies to PCNA (proliferative cell nuclear antigen) and to P53 (product of suppressor gene). Positive reactions for PCNA were graded from 1+ to 3+ (1+ - less than 10 percent of cells; 2+ - 10 - 50 percent; 3+ - more than 50 percent). Eight of 10 cases of choriocaricinoma (80 percent) showed moderate to strong reactivity for PCNA (2+ and 3+). All 9 cases with hydatidiform mole and 6 of 7 cases with partial mole also demonstrated 2+ and 3+ reactions for PCNA. There was minimal or no PCNA straining in the trophoblastic cells of normal placentae. Five of 10 cases with choriocarcinoma (50 percent) exhibited P53 overaccumulation as did 7 of 9 cases with hydatidiform mole (78 percent). In hydatidiform moles, P53 staining was limited to the areas of trophoblastic proliferation separate from chorionic villi. None of the partial moles or normal placentae showed P53 overaccumlation. It is concluded that the cell proliferative activity of choriocarcinomas as well as complete and partial hydatidiform moles are comparable. On the other hand, the mutation of P53 suppressor gene, as demonstrated by the overaccumulation of P53 protein, is seen only in true trophoblastic neoplasms, namely choriocarcinomas and hydatidiform moles (AU)

Uterine leiomyosarcoma in pregnancy.

A leiomyosarcoma was found unexpectedly during a cesarean section. The tumor was a solitary pedunculated mass and there was no evidence of spread beyond the uterus. The management of this patient, because of her age, low parity and desire for having more children, was conservative. At 3 years after cesarean section there was no evidence of recurrence.

Evidence that a toxemia-related organism (Hydatoxi lualba) is an artifact.

Preeclampsia-eclampsia and trophoblastic disease have been associated with a wormlike organism, Hydatoxi lualba, recently discovered in smears from circulating blood, trophoblastic tumor tissue, and placental tissue of toxemic patients. To investigate these findings peripheral blood smears from patients with preeclampsia-eclampsia, patients with hydatidiform mole, normal pregnant patients, and nonpregnant subjects were studied. The smears were stained with toluidine blue-O and Giemsa. The average size of wormlike forms found was 2.5 by 0.23 mm. None stained with Giemsa. The frequency of positivity for toxemic patients was 56.5% and 81.8% for normal pregnant patients. Samples from molar pregnancies were negative. Observations performed directly in fresh blood were also negative. The forms were observed not only in peripheral blood but also in serum obtained after centrifugation or passage through Millipore filters. No evidence of reproductive elements was found, and electron microscopy revealed no particular structure. The results suggest that the organism is an artifact.

Observation of an organism found in patients with gestational trophoblastic disease and in patients with toxemia of pregnancy.

This is an initial descriptive report of observations of multiple forms of an organism found in patients with gestational trophoblastic disease and in patients with preeclampsia-eclampsia. The worm-like forms most frequently observed have an average length of 1.0 to 1.5 mm. Larva-like forms have an average length of 150 mu; primordial eggs and egg-like forms in developmental stages range from 7 to 43 mu in diameter; and sperm-like forms are 3.5 mu or slightly smaller in size. These forms have been observed in contact smears prepared from 3 ml samples of peripheral circulating blood from both groups of patients, from trophoblastic tumor tissue, from contact smears prepared from placentas of patients with preeclampsia-eclampsia, and from umbilical cord blood of infants delivered of patients with preeclampsia-eclampsia. The various forms of this organism share morphologic characteristics of several orders of helminths, i.e., hookworms, roundworms and tapeworms. The taxonomy of these forms has not yet been determined. Until the time of taxonomic classification, the various forms will be referred to as Hydatoxi lualba. We have experimental evidence that this organism has biologic activity in BALB/c mice and in beagle dogs.