Uterine PEComa with aggressive behavior: A review with an additional case of spontaneous vaginal expulsion.

Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal tumor originating from perivascular epitheloid cells showing melanocytic and smooth muscle differentiation. The uterus represents the second most common site of origin. A 49 years woman presented to our Hospital for a vaginal spontaneous expulsion of a mass suggestive for malignant mesenchymal tumor. The patient underwent total hysterectomy and bilateral salpingo-oophorectomy and the histopathological report was compliant with a PEComa with aggressive behavior. Medical Literature databases about PEComa were searched. The current literature identified near 90 cases of uterine PEComas and they are categorized as uncertain malignant potential or with aggressive behavior. Primary surgical excision represents the gold-standard treatment. Recently targeted therapy with mTOR inhibitors has been introduced with an important beneficial. In this paper we review the Literature about the uPEComa with aggressive behavior reporting the first case of spontaneous vaginal expulsion.

Pregnancy after kidney transplantation: two transplantation centers--Vicenza-Udine experience.

BACKGROUND: Pregnancy after kidney transplant has become possible thanks to the recent surgical and pharmacological breakthrough. MATERIALS AND METHODS: We performed a retrospective study including all childbearing women transplanted in our centers after 1997. The following variables were analyzed: type of nephropathy, patient age when dialysis started, age at transplantation, time between dialysis and transplantation and between transplantation and baby birth. We also considered immunosuppressive therapy, type of delivery, baby weight, Apgar score, and mother and baby follow-up. RESULTS: We followed up 13 pregnancies in 12 patients who were diagnosed with chronic pyelonephritis (n = 4), postpartum cortical necrosis (n = 1), immunoglobulin A GN (n = 4), diabetic nephropathy (n = 1), unknown nephropathy (n = 2). All patients received a cadaveric donor kidney. They were treated with calcium antagonists and alfamethyldopa for their high blood pressure. We observed 9 mother complications: nonnephrotic proteinuria (n = 1), urinary tract Infection (n = 1), pre-eclampsia (n = 4), internal placenta detachment (n = 1) and spontaneous abortions (n = 2); 4 fetal complications: IUGR (n = 2), acute distress respiratory syndrome (n = 1), Klinefelter syndrome (n = 1) and preterm births (n = 4). In 2 cases the child weight was lower when compared to the gestational age, and 5 babies were admitted to the neonatal intensive care unit. The mother's follow-up showed no acute rejection episodes. Breastfeeding was discouraged due to the transmission of immunosuppressive medications into breast milk. We did not observe significant disease upon child follow-up. CONCLUSION: Our data were in agreement with the literature confirming that pregnancy after kidney transplant though possible carries elevated risks. Patients therefore are referred to highly specialized centers where obstetricians, nephrologists, intensivists, and neonatologists provide surveillance and treatment.

Classification, diagnostic criteria, and treatment recommendations for orofacial manifestations in HIV-infected pediatric patients. Collaborative Workgroup on Oral Manifestations of Pediatric HIV Infection.

The criteria for diagnosis of HIV-related oral lesions in adults are well established, but corresponding criteria in the pediatric population are not as well defined. The Collaborative Workgroup on the Oral Manifestations of Pediatric HIV infection reached a consensus, based upon available data, as to the presumptive and definitive criteria to diagnose the oral manifestations of HIV infection in children. Presumptive criteria refer to the clinical features of the lesions, including signs and symptoms, whereas definitive criteria require specific laboratory tests. In general, it is recommended that definitive criteria be established whenever possible. Orofacial manifestations have been divided into three groups: 1) those commonly associated with pediatric HIV infection; 2) those less commonly associated with pediatric HIV infection; and 3) those strongly associated with HIV infection but rare in children. Orofacial lesions commonly associated with pediatric HIV infection include candidiasis, herpes simplex infection, linear gingival erythema, parotid enlargement, and recurrent aphthous stomatitis. In contrast, orofacial lesions strongly associated with HIV infection but rare in children include Kaposi's sarcoma, non-Hodgkin's lymphoma, and oral hairy leukoplakia. Treatment recommendations, specific for this age group, have been included for some of the more common HIV-related orofacial manifestations.

Serological screening for herpes simplex virus during pregnancy.

620 pregnant women living in the Province of Padua were submitted to serological screening for Herpes simplex virus antibody activity. A prevalence of 82.26% was found in the population; the Authors discuss the significance of the findings with special regard to relevant obstetric questions.

Conisation as an important point in the diagnosis and treatment of pre-invasive neoplasy.

110 cases of conisation carried out in the Obstetric and Gynecological Clinic of the University of Padua between 1.1.74 and 31.12.82 have been considered. The operations were always performed on completion of diagnostic assertions comprising colpocytology, colposcopy and biopsy, this last undertaken upon indications from both colposcopic and colpo-cytological examinations. The comparison of the histological sample with the serial on the cone, with the cytological, colposcopical and bioptic ones, correspond in the importance of the lesion in almost 90% of cases. The reliability of the diagnosis by the three methods associated and then integrated by the conisation therefore approaches 100%. Prophylaxis carried out in this way allows a personalisation in the operation which, though respecting radicality, must be as non-demolitary as possible.

Clinical staging versus operative staging in cervical cancer.

The Authors analyse the correlations between clinical staging (FIGO) and surgical staging in 152 patients affected by cervical cancer who underwent primary surgical therapy at the Gynecologic Institute of Padua University between 1974 and 1982. In the examined series clinical staging agrees with surgical staging in 2/3 of cases. The error percentage of clinical staging does not change significantly, from a statistical point of view, when staging varies. In those cases in which the two systems disagree the overstaging figure tends to decrease as staging becomes more severe while the clinical understaging figure tends to increase accordingly. On the basis of these results the Authors advocate a rational resort to operative staging in cervical cancer so as to evaluate the real topography of the original focus more accurately and plan the most adequate treatment.

Prognostic factors in cervical carcinoma.

Primary surgical treatment in cervical carcinoma offers an unrepeatable chance to assess the biologic characteristics of the neoplasia by surgical staging and pathologic examination of the surgical specimen. The detection of factors of risk for locoregional diffusion, clinical staging being equal, can guide a subsequent target radio-treatment by identifying a group of patients at higher risk for relapses. The analysis of 155 cases of cervical carcinoma treated with radical primary surgery and pelvic lymphadenectomy at the Gynecologic Institute of Padua University has stressed the statistically significant correlation (P less than 0.05) existing between lymphatic diffusion and presence of neoplastic cells in capillaro-like spaces, degree of neoplastic cervical infiltration and parametrial diffusion. According to the Authors the presence of these features is a reliable basis to select patients eligible for post-surgery radiotreatment.