[DISSEMINATED PERITONEAL LEYOMYOMATOSIS--PRACTICAL APPROACH TO DIAGNOSIS].

Disseminated peritoneal leiomyomatosis (DPL) is a rare condition characterized by the presence of multiple histologically benign smooth muscle nodules on the surface subperitoneal tissue simulating macroscopic peritoneal carcinomatosis. This disease is rare, but in recent years, in connection with the widespread introduction of laparoscopic surgery, the reports of disseminated peritoneal leiomyomatosis occurring after laparoscopic morcellation, were frequent. The knowledge of DPL is necessary to develop methods of prevention, and individualized treatment depending on the pathogenesis and clinical manifestations in each patient.

[DISSEMINATED PERITONEAL LEYOMYOMATOSIS AFTER LAPAROSCOPIC MORCELLATION--A CASE REPORT].

We presented a case of 41-year-old patient underwent two laparoscopic Myomectomies and current laparotomy regarding suspection of necrotic leiomyoma. Intraoperative finding was suggestive of disseminated malignancy, but gefrir study showed benign smooth muscle tumors. The patient underwent total hysterectomy with right adnesectomy and total omentectomy. After histological and immunohistochemical study of the entire macroscopic material the final diagnosis was disseminated peritoneal leiomyomatosis. This disease is rare, but in recent years, in connection with the widespread introduction of laparoscopic surgery the reports of disseminated peritoneal leiomyomatosis occurring after laparoscopic morcellation, were frequent.

[Uterine smooth muscle tumors--direction of differentiation and morphological features].

Uterine smooth muscle tumors /USMT/ are the most common tumors of the female reproductive system. The main aim of the clinical histological classification and the grading of MGMT is to predict their progression. The diagnosis of USMT has of the following stages: the determination of the direction of differentiation of the tumor and the defining the morphological features (the mitotic index, the tumor necrosis and the cellular atypia). In each of them there are specific problems. This indicates, that the USMT are therapeutic and clinical challenge.

[OPPORTUNITIES OF HIFU TECHNOLOGY FOR TREATMENT FIBROIDS DISEASES SUCH AS NON-INVASIVE AND ALTERNATIVE METHOD TO SURGERY].

Concepts of medical treatment are constantly evolving and improving. This opportunity provides treatment with High Intensity Focused Ultrasound (HIFU). In Europe and Asia more than 10,000 patients with uterine fibroids have been successfully treated with HIFU technology until now. This is completely innovative technology for non-invasive extracorporeal treatment of benign and malignant tumors. Neighboring healthy tissue is not damaged. The main indication in HIFU-Center in Pleven is uterine fibroid. It is the most common solid tumor in the female pelvis and is the leading cause of hysterectomy. The methods of treatment are hysterectomy, myomectomy or embolization of uterine arteries. HIFU-methodology allows non-invasive treatment of fibroids disease.

[Uterine smooth muscle tumors--determination of clinical behavior and classification].

The establishment of the clinical behavior of uterine smooth muscle tumors /USMT/ is an essential stage of modern diagnostics. There are significant differences in the criteria determining the malignant potential of smooth muscle gynecological tumors. Generally USMT generating diagnostic problems are classified into: clinically benign tumors; clinically malignant tumors with benign morphological features; smooth muscle tumors of uncertain malignant potential (SMTUMP) and lesions whose smooth muscle differentiation is not obvious. The knowledge in this area is essential for an adequate therapeutic approach.

[Terminological and classification aspects of laparoscopic hysterectomies].

There is a great variety of terms and concepts describing laparoscopic hysterectomy in scientific literature. The term "laparoscopic hysterectomy" includes different operations where the laparoscope is used as an aid for a hysterectomy. The first classifications related to hysterectomy laparoscopic procedures were suggested by Munro and Parker (1993) Johns and Diamonds (1994) and Garry et al. (1994). Based on them is the American Association of Gynecologic Laparoscopists (AAGL) classification of 2000. Reich defined basic terms easy to use in clinical practice. The elaboration of a suitable classification system describing the size of laparoscopic intervention in hysterectomy is a prerequisite for an adequate comparison of the results of scientific researches.

[The expression of p16(INK4a) and Ki-67 in atrophic-hyperplastic and dysdysplastic lesions of the vulva].

UNLABELLED: The aim of present study is to investigate the immunohistochemical expression of tumor suppressor gene p16(INK4a) and proliferative marker Ki-67 in dysplastic vulvar lesions and nondysplastic ones. MATERIALS AND METHODS: 30 female patients (mean age = 49.5 +/- 4.5) - Ca in situ (n = 2), VIN (n = 10), lichen sclerorosus (n = 8), squamous cell hyperplasia (n = 1), mixed vulvar dystrophy (n = 5), papilloma (n = 1), condyllomata accuminata (n = 3) are separated into two groups (first group of non-dysplastic- and second group of dysplastic lesions). The immunohistochemical method with monoclonal antibody for identification of p16(INK4a) and Ki-67 was applied. RESULTS: P16(INK4a) is expressed in 1 patient (5.56%) in first group and in 8 patients (66.67%) in second group (chi2 = 84.93; p < 0.001). Ki-67 is positive in 4 patients (22.22%) in first group and in 12 of cases (100%) in second group (chi2 = 41.3; p < 0.001). CONCLUSIONS: There is a significant statistical difference between immunohistochemical expression of p16(INK4a) and Ki-67 in HPV-associated dysplastic and non-dysplastic vulvar lesions.

[A rare case of ovarian carcinosarcoma with metastasis in the uterine cervix--diagnostic and therapeutic problems].

Carcinosarcomas are rare malignant neoplasms that histologically contain both epithelial and mesenchymal components. In the female genital tract they occur mainly in uterus and rarely in cervix, ovaries and omentum. A rare case of ovarian carcinosarcoma is presented. Because of the presence of a solitary, massive metastasis in the uterine cervix, it created some serious diagnostic and therapeutic problems.