Pitfalls in Pathology-Nodular Hyperplasia of Bartholin's Gland.

Nodular hyperplasia of the Bartholin's gland is an underreported and extremely rare entity that presents as a solid lesion potentially raising concern for malignancy clinically, most solid lesions at this location are carcinomas. They may also be mistaken for a Bartholin cyst clinically. Nodular hyperplasia is rarer than carcinoma of the Bartholin gland, and hence pathologists may not be familiar with this entity, making it a pitfall in pathologic as well as a clinical diagnosis. Here we report a case originally considered a Bartholin cyst, but raising intraoperative concern due to solid elements. Histological examination of the lesion revealed nodular hyperplasia of Bartholin's gland. Recognition of this entity is important, as it is something that may be encountered by the pathologist.

Birth Outcomes in Relation to Intimate Partner Violence.

OBJECTIVES: Intimate partner violence (IPV)during pregnancy is a significant public health problem. Approximately 324,000 IPV victimizations occur during pregnancy each year. However, research on the impact of IPV on birth outcomes yields conflicting findings. This study examines the association of IPV with birth outcomes among pregnant women. STUDY DESIGN: We used a retrospective cohort study design to analyze data from chart reviews of a random sample of 1542 pregnant women. These women were seen between 2003 and 2009 at an urban university affiliated prenatal clinic and gave birth at the on-site hospital. Victims of IPV were defined as those who scored equal to or higher than 10 on an IPV screening tool: HITS (Hit, Insult, Threaten, and Scream). Three measures were included in birth outcomes. Preterm delivery was defined as gestational age less than 37 weeks. Low birth weight was defined as infants born weighing <2500 g. Neonatal intensive care was measured by prevalence of receiving intensive care. RESULTS: The prevalence of IPV was 7.5%. Compared to non-abused women, abused women were more likely to have preterm deliveries (18.3% vs. 10.3%; p = .016). Compared to infants of non-victims, infants of victims were more likely to have low birth weight (21.5% vs. 11.0%; p = .003) and to receive neonatal intensive care (23.4% vs. 7.8%; p = .000). Results from multivariate analyses indicated that victims were more likely to have preterm deliveries than non-victims (OR = 1.72; 95% CI: 1.22-2.95). More infants of victims had low birth weight (OR = 2.03; 95% CI: 1.22-3.39) and received neonatal intensive care than those of non-victims (OR = 4.04; 95% CI: 2.46-6.61). CONCLUSIONS: Abused pregnant women had poorer birth outcomes compared to non-abused pregnant women. Healthcare providers should be trained to screen and identify women for IPV, and interventions should be designed to reduce and prevent IPV and thereby improve health outcomes for victims and their children.

Bizarre Stromal Cells in an Endometrial Polyp.

Bizarre stromal cells have been reported in vulvovaginal polyps, as well as in nongynecologic sites, with caution not to mistake them for malignancy. Similar atypical stromal cells have only rarely been reported in the endometrium. We present a case found incidentally in a postmenopausal woman, and review the literature.

Massive localized lymphedema of the vulva: report of a case and review of the literature.

BACKGROUND: Massive localized lymphedema (MLL) is a recently described entity associated with obesity, most often on the thighs. It rarely occurs on the vulva, and it may pose diagnostic difficulty for both clinician and pathologist in this setting. CASE: An obese 55-year-old woman underwent excision of bilateral polypoid vulvar masses. Histology confirmed the diagnosis of MLL. CONCLUSIONS: Although MLL is not common on the vulva, with the increasing incidence of obesity in the population, more cases can be anticipated, and an awareness of this lesion is important.

Pseudoangiomatous stromal hyperplasia of the vulva presenting as a polypoid vulvar lesion: a lesion associated with anogenital mammary-like tissue-report of a case and review of the literature.

OBJECTIVE: The study aimed to report the case of a patient with a polypoid vulvar lesion clinically thought to be an aggressive angiomyxoma. MATERIALS AND METHODS: On examination, a 4.0 × 2.0 × 1.5-cm polypoid lesion was seen on the right labium majus. RESULTS: Histopathological findings of the excised mass were consistent with pseudoangiomatous stromal hyperplasia of the vulva CONCLUSIONS: Pseudoangiomatous stromal hyperplasia is a lesion of breast tissue but can occur in anogenital mammary-like glands. It must be distinguished from low-grade angiosarcoma.

Vitamin profile of 563 gravidas during trimesters of pregnancy.

OBJECTIVE: Gestation imposes metabolic stress on the mother which heightens as pregnancy progresses. The need for quantifying circulating vitamins is important for identifying pitfalls in metabolic imbalance and nutritional status. For this reason we wanted to analyze blood vitamin concentrations of B12, thiamin, biotin, pantothenate, B6, niacin, riboflavin, folate, vitamins A, C, E and total carotenes to determine if imbalances occur during the trimesters of pregnancy. METHODS: We randomly selected 563 gravidas who volunteered for this study from the obstetrical clinic of New Jersey Medical School; 132 were in 1st trimester, 198 were in 2nd trimester, and 233 were in 3rd trimester. All were healthy, taking a good diet and supplemented with vitamins. Blood, from an antecubital vein, was analyzed for thiamin, biotin, B12, B6, pantothenate, riboflavin, nicotinate, folates, vitamins A, E, C and total carotenes. Gravidas were classified as being normovitaminemic, hypervitaminemic or hypovitaminemic compared with blood vitamins seen in healthy non-pregnant, non-vitamin supplemented women. RESULT: Hypervitaminemic levels of folate, biotin, pantothenate and riboflavin were found during any trimester of pregnancy due to vitamin supplementation. Despite the vitamin supplementation, a high percent of vitamin A, B6, niacin. thiamin and B 12 hypovitaminemia was noted during pregnancy trimesters. An especially high percentage of niacin deficiency was seen during the 1st trimester; it worsened in later trimesters; B12 deficits increased during the late trimesters. Combination deficits of niacin, thiamin, vitamins A, B6, B12 were noted in each of the trimesters. CONCLUSIONS: Despite vitamin supplementation, a vitamin profile of pregnancy indicates that vitamin deficits exist during the trimesters. Also, combination hypovitaminemias of deficient vitamins were noted; this indicates that a vitamin deficit during pregnancy does not occur in isolation.