Uterus didelphys with blind hemivagina and ipsilateral renal agenesis complicated by pyocolpos and presenting as acute abdomen 11 years after menarche: presentation of a rare case with review of the literature.

BACKGROUND: Congenital anomaly of the Müllerian duct system can result in various urogenital anomalies including uterus didelphys with blind hemivagina and ipsilateral renal agenesis. The diagnosis of this condition is usually made after menarche, but its rarity and variable clinical features may contribute to a diagnostic delay for years after menarche. CASE: A 24-year-old woman presented to the emergency room of the Department of Obstetrics and Gynecology complaining of severe worsening lower abdominal pain, vomiting and pus-like vaginal discharge. Physical examination revealed acute abdomen with diffuse lower abdominal tenderness, rebound and muscular resistance. Cervical and vaginal observation was impossible because of the patient's discomfort. Bimanual gynecological examination showed high tenderness cervical motion. Transabdominal ultrasound scan was performed and the radiologist interpreted the ultrasonographic findings as existence of a pelvic mass with mixed echogenicity. The preoperative diagnosis was ruptured tubo-ovarian abscess and emergency laparotomy was performed. Free pus in the pelvis was found. Also, a double uterus with an elongated and inflammatory right fallopian tube with pus passing out of its fimbrial end was observed. Vaginal examination under general anesthesia revealed an obstructed right hemivagina with vaginal pus-like discharge from a small fistula hole on the septate vagina. The final diagnosis was uterus didelphys with unilateral imperforate right hemivagina and pyocolpos. Transvaginal resection of the vaginal septum was performed and a large amount of pus and blood was spilled out. Postoperatively, intravenous pyelography demonstrated agenesis of the right kidney. CONCLUSION: We demonstrated the difficulty in making a correct diagnosis of this rare congenital anomaly of the female genital tract, especially after many years since menarche. This condition should be considered to prevent misdiagnosis or suboptimal treatment and decrease morbidity and unnecessary surgical procedures.

Tubal ectopic pregnancy associated with an extraskeletal chondroma of the fallopian tube: case report.

Extraskeletal chondroma is a relatively uncommon benign soft tissue tumor, which usually occurs in the hands and feet. The tumor may also occur around the tendon, synovium, or joint capsule. Rare sites are the tongue, testes and liver. Chondroma of the fallopian tube is extremely rare, with only two reports in the English literature. We present the first reported case of extraskeletal chondroma of the fallopian tube causing transportation impairment of the fertilized ovum in a 32-year-old gravida 1, para 1 woman.

The use of erythropoietin in gynecologic cancer patients.

PURPOSE: To investigate the possible benefits of erythroproietin ingestion in patients with various gynecological cancers with proven severe iron deficiency anemia. METHOD: Seven patients with gynecological cancer were included in the study. Nadir hematocrit values were found to be 20-24% before the initiation of recombinant human erythropoietin treatment. Initial therapy started at 50 units/kg/dose, three times weekly for a month. The dose was modified according to the rise of hemoglobin after a month's period. The dose was modified according to the rise of hemoglobin after a month's period. If the rise was greater than 2 g/dl the dose was changed to 25 units/kg two times weekly and if it was less than 2 g/dl it was changed to 25 units/kg three times weekly per month. Five patients were simultaneously given erythropoietin therapy and iron supplementation. RESULTS: We confirmed a rise in the hematocrit values which averaged 0.5-1.5% weekly till the upper limit. Reticulocyte and hematocrit values were higher in the erythropoietin plus iron group (five cases). CONCLUSION: In this small series, erythropoietin appeared to be effective in treating severe iron deficiency in gynecologic cancer patients. Further investigation is needed to confirm these results.

A comparison in concentration of heat shock proteins (HSP) 70 and 90 on chorionic villi of human placenta in normal pregnancies and in missed miscarriages.

PURPOSE: To investigate the role of heat shock protein (HSP) on the chorionic villi of human placental cells and to compare the concentration of placental HSP70 & 90 in term deliveries and in missed miscarriages. MATERIALS AND METHODS: Fifty products of conception from women who experienced first trimester missed miscarriage and 50 placentas from women who gave birth at term were studied. An immunohistochemical investigation was carried out with which we marked the localization of heat shock proteins 70 and 90 on the syncytiotrophoblastic, cytotrophoblastic, stromal and blood vessel cells, using specific antibodies which can detect the presence of those proteins on light microscopy. We compared their expression with the normal placental tissue of term pregnancies and with material acquired from first trimester missed miscarriages. An indirect immunoperoxidase method was applied using polyclonal antibodies against HSP70 and HSP90 on formalin-fixed paraffin-embedded tissues. RESULTS: Expression of HSP90B was increased in chorionic villi of first trimester missed miscarriages concerning syncytiotrophoblasts, cytotrophoblasts, vessel and stroma cells compared to full-term placentas. There was a statistically significant increase of HSP90A expression in chorionic villi of first trimester missed miscarriages, concerning only the cytotrophoblast cells, compared to full-term placentas. Expression of HSP70 cognate protein was significantly increased in chorionic villi of first trimester missed miscarriages, concerning syncytiotrophoblastic cells only, compared to full-term placentas. Finally, HSP70 inducible protein was significantly increased in chorionic villi of first trimester missed miscarriages concerning syncytiotrophoblasts, cytotrophoblasts, vessel and stroma cells compared to full-term placentas. CONCLUSIONS: The results of the present study have sufficiently shown that there is an increase of HSP70 & 90 expression in chorionic villi of first trimester missed miscarriages compared to full-term placentas and this increase may have an important implication on the miscarriage process.

Expression of bcl-2 and bax in cervical intraepithelial neoplasia and invasive squamous cell carcinoma of the uterine cervix.

Bcl-2 protein together with the pro-apoptotic protein bax, are thought to function by forming homo- and heterotypic dimers which control the progression to apoptosis. In this immunohistochemical study we investigated the expression of bcl-2 and bax apoptosis related proteins in cervical intraepithelial neoplasia and invasive squamous cell carcinoma of the uterine cervix. Twenty-four cervical intraepithelial neoplasias grade 1-2 (CIN I/II), 38 grade 3 (CIN III), and 53 invasive squamous cell carcinomas (ISCC) were investigated by immunohistochemical staining for bcl-2 and bax protein. Bcl-2 immunoreactivity was found in five of the 24 CIN I/II cases (20.8%), 18 of 38 CIN II cases (47.4%) and nine of 53 ISCC cases (17%). The positivity for CIN III was significantly higher than for CIN I/II or ISCC (p=0.0351 and p=0.0018, respectively). The percentage of bax immunopositivity was somewhat higher in CIN III than in CIN I/II but this slight difference was not statistically significant. Correlation of the immunostaining results with tumor grade revealed a significant difference for bcl-2 which was more frequently immunopositive in well-differentiated tumors than in poorly-differentiated tumors. There was no significant relation between bax expression and tumor differentiation. Our results suggest that alterations of bcl-2 and bax expression may occur as a relatively early event in cervical tumorigenesis.

Immunohistochemical analysis of nm23-H1 expression in human cervical lesions.

Reduced expression of the metastasis suppressor gene nm23-H1 has been previously correlated with high tumor metastatic potential and fatal clinical outcome in several types of human carcinomas. The aim of the study was to identify the expression of nm23-H1 in a variety of premalignant and malignant cervical lesions. The study comprised 106 cervical biopsies obtained from 106 women ranging in age from 23 to 68 (median 42) years. Histologic slides stained with H&E were evaluated blindly by two pathologists and a consensus diagnosis was established for each case. In addition, immunohistochemical stain was employed and a monoclonal antibody against nm23-H1 (YLEM Rome, Italy) was used. Twenty-five of the cervical biopsies showed changes of mild dysplasia (CIN I), whereas 28 demonstrated features of moderate dysplasia (CIN II) and 28 severe dysplasia (CIN III). In 25 cases infiltrating squamous cell carcinoma was identified. Expression of nm23-H1 was evident in 9/25 (36%) CIN I, 13/28 (46%) CIN II, 22/28 (78.5%) CIN III and 17/25 (68%) infiltrating carcinoma biopsies. Statistically significant differences were observed between CIN II and CIN III (p=0.003), and CIN II and infiltrating carcinoma (p=0.002) groups. Expression of the nm23-H1 gene in premalignant and malignant cervical lesions indicates that this gene may play a substantial role in carcinogenesis and tumor progression.

Treatment results of liquid nitrogen cryotherapy on selected pathologic changes of the uterine cervix.

One hundred and eighty-two women treated with cryotherapy were included in the study. In cases of chronic cervical inflammation full recovery was observed in 86% of subjects. In cases of Naboth cysts full recovery was observed within 6 to 8 weeks in 89% of women. In cases of cervical erosions full recovery was observed within 6 to 9 weeks in 84.9% of women. In women, with cervical epithelium dysplasia full recovery was observed within 7 to 11 weeks in treated subjects. Renewal of the pathology was observed in 15% of the women with treated cervicitis and in one of the women with cervical dysplasia within 2 to 5 years of follow-up.

Vulvar neoplasia and search for human papillomavirus 16 and 18 genetic information. Short communication.

The presence of HPV 16 and 18 is frequent in cases with vulvar carcinomas and intraepithelial neoplasias.

The relation of birth weight and gestational age to biological, occupational and socioeconomic factors.

The data of the 2,040 single births, born during 1987 at the "Saint Antoine" Hospital in Paris, were analysed in order to identify the impact of various biological, occupational, and socioeconomic factors on gestational age and birth weight. Birth weight is associated with the height of the mother and the weight gained during pregnancy. It is lower for mothers with preeclampsia during the current or previous pregnancies or with urogenital infections during the current pregnancy and for mothers with one or more induced abortions. Girls weigh less than boys. Parity has a positive relation to the baby's weight, while manual work seems to have a negative one. APGAR score and duration of the pregnancy are associated with the birth weight. Placenta previa, preeclampsia and urinary infections affect the gestational age. A short pause period in work is related to a shorter gestational age. Weight gain is associated with a prolonged duration of the pregnancy. Gestational age and birth weight are associated with the nationality of the mother, especially in some ethnic groups, and with marital status.