A mild acute hemolytic transfusion reaction in a patient with alloanti-Ge3: a case report and review of the literature.

BACKGROUND: The clinical significance of the Gerbich antibodies has been described as variable and there are no well-documented reports of hemolytic transfusion reactions (HTRs). CASE REPORT: We present the case of a woman with a long history of documented anti-Ge3 alloantibody who received multiple units of Ge+ red blood cells (RBCs) uneventfully. During the first admission to our hospital she was transfused 8 units of Ge+ RBCs and had a negative monocyte monolayer assay (MMA) before receiving the units. Within 2 weeks of the transfusions, the anti-Ge3 became significantly stronger by indirect antiglobulin test, and the MMA increased from 2.2 to 79.5% reactivity. She returned 4.5 years later with an emergent need for blood and was transfused with 2 units of Ge+ RBCs after premedication with steroids and intravenous immunoglobulin. RESULTS: The first unit was transfused without incident; however, she developed clinical and laboratory signs consistent with an acute HTR with the second unit. CONCLUSION: After a comprehensive review of the literature, we believe this to be the first well-documented case of acute HTR due to anti-Gerbich alloantibodies.

Primary squamous carcinoma of the ovary likely arising from a monodermal cystic mucinous teratoma.

We present a 58-year-old woman with primary squamous carcinoma of the ovary likely arising from a monodermal cystic mucinous teratoma. Noninvolved ovary showed no Brenner tumor, endometriosis, transitional carcinoma, endometrioid adenocarcinoma, or typical multigerm layer classic mature teratoma. Moreover, no other primary site was possible because there were no prior or concomitant squamous carcinomas, or history of cervical intraepithelial neoplasia. The tumor showed strong positivity for p63 and CK5/6, reactivity that also extended from the squamous carcinoma into the basal-cell lining of the mucinous cyst of a likely monodermal teratoma. This basal-cell pattern was absent in a series of conventional benign and borderline cystic mucinous cystadenomas of the ovary, but clearly present in the mucinous cysts part of mature teratomas. We present this as a unique case of squamous carcinoma likely arising from a monodermal cystic mucinous teratoma. Moreover, we submit that the p63 and CK5/6 staining pattern may help to differentiate monodermal cystic mucinous teratoma from conventional cystic mucinous tumors.

Placenta accreta in a separate uterine horn.

We report the case of a 30-year-old woman who presented with intrauterine fetal demise of a 17-2/7-week male fetus. The patient failed misoprostol induction and was taken for surgical evaluation. At the time of surgery an ectopic pregnancy in a noncommunicating rudimentary uterine horn was found. Histologic examination of the excised remnant uterine horn showed there was a placenta accreta.