Contribution of Hormonal Cytology in Girls and Adolescents to Reproductive Health: A Traditional Technique Monitoring Recent Problems.

OBJECTIVE: To study the contribution of hormonal cytology in contemporary disturbances of fertility. DESIGN: Over a 10-year period (2006-2015), 6,688 vaginal fornix cytologies of 2,350 patients were investigated. For a more detailed analysis, a 3-year period from 2013 to 2015 was chosen. Four hundred and fifty-two patients were investigated, many of them several times and for a period longer than the 3 years analyzed. RESULTS: The main disorders examined and treated via a gentle hormonal medication support and life style corrections by a pediatric gynecologist were: pubertas praecox - thelarche praecox and early menarche; dysfunctional juvenile metrorrhagia; central and peripheral endocrine disorders; eating disorders - anorexia mentalis and bulimia; obesity; excessive sport activities; autoimmune disorders, and others. Normalization of the menstrual cycle was achieved while monitoring progress with a series of hormonal cytologies in a majority of patients. CONCLUSIONS: Hormonal cytology is a non-invasive and economical method, illustrating the direct effect of steroid on target cells. It contributes to reproductive health support by: (a) indicating the possible need and type of steroid therapy; (b) monitoring the normalization of cycle disturbances; (c) ruling out or indicating the need for more detailed steroid metabolism investigation. Thus, it represents a basic but valuable means of examination in child and adolescent gynecology.

Myxoid variant of peritoneal epithelioid malignant mesothelioma. A case report.

The myxoid variant of a diffuse malignant epithelioid mesothelioma is a rare tumor. To the best of our knowledge, only three cases of this type of mesothelioma involving the peritoneum have been reported in the literature to date. Although it is rare in the peritoneal cavity, it should be included in the differential diagnosis of the more common myxoid/mucinous abdominal lesions (e.g. mucinous carcinomas or pseudomyxoma peritonei), which can myxoid MM mimic. We report the case of a 60-year-old female with a myxoid variant of malignant peritoneal mesothelioma. Histologically, the tumor consisted of medium-sized to large epithelioid cells with a moderate to abundant amount of eosinophilic cytoplasm. Some of the tumor cells contained intracytoplasmic, optically clear vacuoles. The nuclei were irregular with coarse chromatin and some exhibited prominent nucleoli. Some of the cells were multinucleated. Mitotic figures were rare. Most of the tumor cells were located within an ample myxoid background. Immunohistochemically, the tumor cells showed a diffuse positivity for cytokeratin cocktail AE1/AE3, calretinin, D2-40, and cytokeratin 7. Vimentin, HBME-1 and WT-1 were only focally positive. Progesterone receptors showed positivity in rare tumor cells (up to 5%). Other markers examined, including cytokeratin 20, estrogen receptors, BerEP4, CEA, TTF-1, GCDFP-15, and CD15 were negative.

A case of an epignathus with intracranial extension appearing as a persistently open mouth at 16 weeks and subsequently diagnosed at 20 weeks of gestation.

We report a rare case of oral mass (epignathus) with intracranial extension originally suspected antenatally at 16 weeks' gestation because of a persistent open mouth. Postmortem MRI and pathologic examination of the fetus confirmed an oral teratoma with bilateral ventricular dilatation, corpus callosum agenesis, and a neuroepithelial intracranial cyst. The relevant literature regarding this anomaly is reviewed.

Is it always possible to determine a diagnosis? Prenatal ultrasonography, post mortem magnetic resonance, autopsy.

Pathological-anatomical autopsy is the gold standard for determining of foetal abnormalities, but in some cases its role is limited (pathology of central nervous system, in particular, in case of ventricular dilatation or developed autolysis). In pathology of central nervous system, where insufficiency of autopsy can occur, additional post mortem magnetic resonance imaging (MRI) is performed to determine type of malformation. In this case report, we would like to point out the fact that although all investigating methods including post mortem magnetic resonance and autopsy (incl. imunohistochemical tests) are used, this need not necessarily result in a clear diagnostic conclusion of the aborted foetus. Post mortem MRI visualized pathology: dilatation of both lateral ventricals, more in the left and, above all, a pathological focus parasagittaly on the right with haemorrhage and cystic component; it raised a suspicion on ependymoma. However imunohistochemical test did not give an unambiguous conclusion; therefore diagnosis based on MRI could not be uniquely verified.

Benefits of examination by post mortem performed magnetic resonance imaging of foetus: haemorrhage in germinal matrix.

Post mortem magnetic resonance imaging is demonstrated as a supplementary method to classic pathological-anatomical autopsy in determining anomalies of the foetus. Frequently it plays a key role; primarily where the possibilities of performing autopsy are somehow limited (autolysis, ventricular dilatation). Specification of the final diagnosis subsequently enables us to improve prenatal diagnostics, both by means of magnetic resonance imaging and primarily by correlation with the prenatal ultrasound scan; this feedback improves the later method. This case report demonstrated that post mortem magnetic resonance imaging, in contrast with prenatal ultrasound examination, showed extensive haemorrhage in the germinal matrix, and also illustrated indirect symptoms testifying to agenesis of the corpus callosum. Prenatal ultrasound examination showed only hydrocephalus and absence of septum pellucidum. Pathological-anatomical autopsy of the brain was insufficient with regard to advanced autolysis and brain haemorrhage.

Post-mortem magnetic resonance imaging and its irreplaceable role in determining CNS malformation (hydranencephaly)--case report.

Post-mortem magnetic resonance appears to be a method supplementary to classic pathological-anatomical autopsy in determining foetal abnormalities. Frequently, it plays a key role, primarily where autopsy options are in some way limited (developed autolysis, dilatation of the ventricular system). This case report demonstrates that post-mortem magnetic resonance imaging can precisely determine the type of congenital malformation (hydranencephaly), by contrast to ultrasound, with which alobar holoprosencephaly has been described, often presenting a differential diagnosis problem. Pathological-anatomical autopsy was significantly limited due to this diagnosis and this methodology was incapable of unequivocally determining the type of malformation. We would like to demonstrate by this case report the necessity of performing post-mortem magnetic resonance imaging so that we may precisely determine the diagnosis as requested by the parents and also be able to answer the question posed by risks for future pregnancies.