Obstetric hysterectomy: a review of cases over 16 years.

Emergency peripartum hysterectomy (EPH), is performed when life-threatening obstetric conditions occur. The authors attempt to assess the incidence of EPH as well as to investigate risk factors and patients' characteristics. A retrospective study of all cases of EPH performed at the 2nd Department of Obstetrics and Gynecology, Medical School of Athens University, from 1994 to 2009 has been conducted. Data were abstracted from individual medical charts and laboratory records. Among 16,182 deliveries, 15 EPH were performed (0.92 per 1,000 deliveries). Indication was uncontrollable haemorrhage due to placenta accreta (73.3%) or uterine atony (26.6%). Incidence of 1.54 EPHs per 1,000 caesarean sections and 0.51 per 1,000 vaginal deliveries, were noted. Morbidity rate was 46.6%. One (6.6%) mother died because of pulmonary embolism. In conclusion, peripartum hysterectomy is a severe but life-saving procedure. Caesarean section increases the risk of EPH. Obstetricians should always be prepared to confront this emergency situation.

Clinical parameters linked with malignancy in endometrial polyps.

AIM: To investigate the association of different clinical parameters with the histological diagnosis and the prevalence of premalignant and malignant endometrial polyps. METHOD: The study included 516 cases from January 2002 to December 2006. Possible risk factors such as age, menopause status, abnormal bleeding, obesity, hypertension, diabetes mellitus, hormone therapy, use of tamoxifen and size of polyp were investigated in relation to their association with the malignant potential of endometrial polyps. RESULTS: All cases of endometrial polyps underwent hysteroscopic resection; 96.9% of the cases were benign, 1.2% premalignant and 1.9% malignant. Premalignant and malignant endometrial polyps were significantly associated with advanced age (>60 years), menopause, obesity and diabetes. The malignant polyps were analyzed to eight endometrioid, one serous and one clear cell carcinoma. CONCLUSION: The prevalence of premalignant and malignant endometrial polyps is very low. Advanced age, menopause, obesity and diabetes increase the risk of endometrial polyp malignancy.

Human papilloma virus molecular profile and mechanisms of cancerogenesis: a review.

Human papilloma virus (HPV) is frequently present in the genital tract. It causes various lesions at the mucosa of both sexes. It is considered as a causative factor of cervical cancer even if all women infected by HPV will not develop the disease. This article reviews aspects of HPV molecular biology and the mechanisms of cancerogenesis in HPV infected females.

A giant ovarian mucinous cystic neoplasm weighing 8,500 grams with functional stroma. A case report and literature review.

Large ovarian tumors weighing more than 5,000 g are rarely reported in the recent literature because of the improvement in health care systems. Such tumors present many challenges in diagnosis and in surgical approach due to severe circulatory and cardiopulmonary complications. The case of a 27-year-old unmarried patient, who complained of progressive increased abdominal girth of more than six months duration, metrorrhagia, constipation and dysuria is presented. A cystic ovarian tumor weighing 8,500 g (after preoperative fluid aspiration) proved to be a mucinous neoplasm of borderline malignancy with functional stroma. Problems in establishing a correct diagnosis are discussed together with a literature review.

Noncanalized horns of uterus didelphys with prolapse: a unique case in a young woman.

The authors report the unique case of a 20-year-old patient with prolapsed uterus didelphys with noncanalized horns, who complained of primary amenorrhea. Clinical examination revealed a rudimentary noncanalized cervix with a third degree prolapse and no palpable uterus. A small prolapsing remnant of a uterus didelphys with 2 noncanalized uterine horns was excised by laparotomy. Ultrastructural examination of subepithelial cervical connective tissue revealed collagen of normal structure, but of low concentration. The etiologies of both the Mullerian ducts anomalies and the genital prolapse are probably multifactorial. Low collagen concentration indicates a constitutional tissue weakness contributing to the development of genital prolapse.

Lesions of the subepithelial stromal zone of the lower female genital tract. An immunopathological study.

The stroma often fibroepithelial and ten adenomatous cervical polyps, 12 fibro-epithelial vaginal polyps, 20 non neoplastic cervices, 15 cone specimens with CIN changes and five specimens with infiltrative squamous cell carcinoma was investigated. Vimentin, desmin, actin, collagen III, CD34, ER and PgR were studied using the Ventana Automatic Immunostaining System. A subepithelial stromal layer was detected in 17/20 normal specimens, 16/20 cervical polyps, 10/12 vaginal polyps and in 6/15 cone biopsies but not in neoplastic specimens. Vimentin staining was positive in all fibroepithelial polyps, normal specimens and in 6/10 adenomatous polyps. Actin was negative in the loose subepithelial zone but positive in the underlying stroma. Desmin, alpha-1-antitrypsin and CD34 were detected in isolated cells in normal specimens. ER and PgR were observed in isolated subepithelial cells, with greater density in the cells of the fibromuscular wall. In conclusion, loose mesenchymal stroma in the lower female genital tract of a fibrohistiocytic nature was observed with minimal smooth muscle participation--which is the matrix of vaginal and cervical polyps.

Placental chorioangioma and chorioangiosis. clinicopathological study of six unusual vascular lesions of the placenta--case reports.

The clinopathological features are presented of two cases of placental chorioangiomas and four cases of chorionagiosis diagnosed in a total of 2,400 placental specimens examined in our laboratory. The differential diagnosis, clinical effects and therapeutic approach are discussed.

Once-yearly zoledronic acid in the prevention of osteoporotic bone fractures in postmenopausal women.

Zoledronic acid is a nitrogen-containing, third-generation bisphosphonate that has recently been approved for the treatment of postmenopausal osteoporosis as an annual intravenous infusion. Zoledronic acid is an antiresorptive agent which has a high affinity for mineralized bone and especially for sites of high bone turnover. Zoledronic acid is excreted by the kidney without further metabolism. Zoledronic acid administered as a 5 mg intravenous infusion annually increases bone mineral density in the lumbar spine and femoral neck by 6.7% and 5.1% respectively and reduces the incidence of new vertebral and hip fractures by 70% and 41% respectively in postmenopausal women with osteoporosis. Most common side effects are post-dose fever, flu-like symptoms, myalgia, arthralgia, and headache which usually occur in the first 3 days after infusion and are self-limited. Rare adverse effects include renal dysfunction, hypocalcemia, atrial fibrillation, and osteonecrosis of the jaw.

Paget's disease of the vulva. A ten-year experience.

BACKGROUND: Paget's disease of the vulva is a rare neoplasmatic lesion which mainly affects postmenopausal women. RESULTS: We conducted a retrospective study during the period January 1996 till December 2005 in which 11 cases of Paget's disease were detected. The clinical manifestations, management, specific pathological features, treatment and prognosis of each patient are presented. CONCLUSION: Surgical treatment is the current standard and long-term follow-up is required.

Synchronous ovarian and endometrial carcinoma: a strong link to endometriosis?

PURPOSE: To further study the clinicopathological features of synchronous ovarian and endometrial carcinomas. METHODS: We retrospectively studied all cases of synchronous ovarian and endometrial carcinomas diagnosed in our laboratory over the last 15-year period. The pathological findings were correlated with the clinical records of the patients. RESULTS: Seven cases of synchronous primary ovarian and endometrial carcinomas were retrieved. The most common presenting symptom was abnormal vaginal bleeding (5 cases, 71.4%). Five patients (71.4%) were postmenopausal and two (28.6%) were nulliparous. All seven patients had Stage I ovarian and endometrial carcinomas of endometrioid histology. Moreover, in all seven ovarian carcinomas endometriosis foci were observed, while atypical endometriosis was found in four of them. With the exception of one patient, who received adjuvant postoperative radiation, all remaining patients were treated with surgery alone. All patients were alive and free of disease at completion of the study. CONCLUSION: The correct classification of synchronous primary ovarian and endometrial carcinomas is often problematic because of the frequent confusion with their metastatic counterparts. Although the exact etiology remains unclear, endometriosis seems to be a major risk factor for their development.

The role of ovarian transposition in patients with early stage cervical cancer--two case reports.

The aim of the study is to present two cases of premenopausal women with early stage cervical carcinoma who underwent ovarian transposition. The role and the advantages of this technique are discussed.

A case of endometrial carcinoma arising in a 36-year-old woman with uterine atypical polypoid adenomyoma (APA).

Atypical polypoid adenomyomas are tumors of low malignant potential. We present a case of endometrial carcinoma arising in a 36-year-old woman with atypical polypoid adenomyoma. The diagnosis and treatment of such a tumor is discussed through an English literature review.

Leiomyomatosis with multiple extrauterine pulmonary sites: an unusual case report.

The objective of the present study is to present a case of a 48-year-old woman with leiomyomatosis and multiple pulmonary metastases. The classification, pathophysiology, clinical signs, treatment and prognosis of this rare case are discussed. Leiomyomatosis is potentially life-threatening while patients with pulmonary metastases are usually asymptomatic and the condition is incidentally discovered. The treatment of leiomyomatosis is not standardized and many possible variations are under investigation. Still the prognosis is usually excellent.

Human papilloma virus in adolescence.

Human papilloma virus (HPV) is one of the most widespread sexually transmitted diseases especially in adolescence. The majority of the infections are self-sustained by the immune system. However, HPV may lead to genital warts, cervical dysplasia and cervical cancer. Sexually active adolescent females should be encouraged to obtain gynecologic screening for HPV and be well informed about HPV and the risks associated with this infection. All the efforts are now focused on the vaccines that are being developed to reduce the morbidity and mortality associated with HPV infection if administered in time.

A rare case of uneventful pregnancy in a woman with Cogan's syndrome.

Cogan's syndrome is a rare multisystem disorder of unknown etiology which is characterized by nonsyphilitic interstitial keratitis, vestibuloauditory dysfunction and systemic vasculitis. We present the clinical manifestations and the follow-up of a 39-year-old pregnant woman with Cogan's syndrome. The treatment and especially the histologic findings of the placenta are discussed.

No effect of tocolytic therapy with atosiban on maternal serum interleukin-6 and tumor necrosis factor-alpha in threatened preterm labor.

OBJECTIVES: We aimed to evaluate the effect of intravenous administration of tocolytic therapy with an oxytocin antagonist drug (atosiban) on maternal serum interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) levels in women with threatened preterm labor. METHODS: The study population consisted of 46 women with a singleton pregnancy admitted to our department with a diagnosis of threatened preterm labor at between 26 and 34 weeks of gestation. Atosiban was administered to all women. Nine women (group A) progressed to delivery within 48 hours of admission. The remaining 37 women were divided in two groups: group B consisted of 16 women who remained undelivered at 48 hours but experienced delivery within 7 days and group C consisted of 21 women who did not deliver within the next 7 days. Maternal serum IL-6 and TNF-alpha levels were assessed in duplicate by a high sensitivity ELISA kit on patient admission and again at the end of treatment with atosiban (36 hours post-admission). RESULTS: Serum IL-6 and TNF-alpha concentrations on admission were significantly higher in group A compared to those found in group B (p = 0.01) and group C (p = 0.04). Comparisons of serum IL-6 values on admission and at 36 hours after the initiation of atosiban treatment were comparable in group A (p = 0.95), group B (p = 0.39), and group C (p = 0.79). Similarly serum TNF-alpha levels on admission were not significantly different compared to those at the end of treatment in all groups (p = 0.85 for group A, p = 0.45 for group B, and p = 0.21 for group C). CONCLUSIONS: No effect of tocolytic therapy with atosiban was observed on serum IL-6 and TNF-alpha levels in women with threatened preterm labor.

Endometrial carcinoma presenting as hematometra: clinicopathological study of a rare case and literature review.

A case of a postmenopausal woman who was investigated for a large cystic peritoneal tumor which turned out to be hematometra is presented. From her clinical history, a wide excision of the uterine cervix was reported due to a high-grade intraepithelial squamous neoplasia. Laparotomy showed a greatly enlarged uterus and the histological exam revealed a hematometra with a superficial endometrioid adenocarcinoma of the uterine cavity. The remaining cervix had extensive fibrosis and complete obliteration of the cervical canal. A review of the literature revealed that hematometra in postmenopausal women should be investigated because it may harbor a cancer.

Positive association of serum interleukin-1beta and CRH levels in women with pre-term labor.

OBJECTIVE: The aim of this study was to investigate the hypothesis that interleukin-1beta (IL-1beta) might be involved in the increase of the circulating levels of placental-derived CRH leading to the initiation of pre-term labor. SUBJECTS AND METHODS: Forty-eight primigravidae with a singleton viable pregnancy between 28 and 34 weeks of gestation were studied. The subjects were divided in two groups: group A consisted of 30 pregnant women (mean age+/-SD; 22+/-1.1 yr old) presented with pre-term labor (mean gestational age+/-SD; 30.6+/-2.3 weeks) and group B consisted of 18 pregnant women (24+/-2.6 yr old) with normal pregnancies (29.8+/-3.1 weeks). CRH and IL-1beta levels were measured in blood specimens collected from all the study subjects on admission. RESULTS: Women of group A presented significantly higher serum CRH levels (mean+/-SE; 1.18+/-1.83 ng/ml) compared to those of group B (0.48+/-0.67 ng/ml) (p<0.01). Similarly, serum IL-1beta levels were significantly higher in women of group A (0.45+/-0.12 pg/ml) compared to those of group B (0.31+/-0.08 pg/ml) (p<0.01). A positive correlation was found between serum IL-1beta and CRH (r=0.68, p=0.001) in women of group A (pre-term labor). CONCLUSIONS: Our findings suggest that the increased levels of IL-1beta and CRH found in pregnant women presented with pre-term labor might be involved in the pathophysiologic mechanism of the latter. Furthermore, a positive interaction might exist between IL-1beta and placental CRH which might lead to enhanced production of the second, facilitating, thus, the onset of labor.