[Persistent gestational trophoblastic disease following ectopic molar pregnancy]. / Persistiruyushchaya gestatsionnaya trofoblasticheskaya bolezn' posle polnogo puzyrnogo zanosa pri ektopicheskoi sheechnoi beremennosti.

A case of persistent gestational trophoblastic disease that developed after ectopic (cervical) pregnancy with complete hydatidiform mole (CHM) in a 56-year-old patient is presented. The diagnosis of CHM was made retrospectively based on immunohistochemical analysis of archival material using p57 and Ki67 antibodies. Observation shows the difficulty of objective diagnosis of hydatidiform mole in early pregnancy due to the lack of typical cystic transformation of the stroma of villi, focal proliferation of villous trophoblast. Application of the p57 marker for the differential diagnosis of CHM and other variants of cystic villi transformation may be especially important in cases of ectopic pregnancy, in which morphological changes in the chorion do not always correspond to the classical picture. The presence of ectopic pregnancy with CHM in a 56-year-old patient requires special attention of clinicians.

[Metastatic leiomyoma or synchronous lesion of the uteri corpus and vulva?] / Metastaziruiushchaia leiomioma ili sinkhronnoe porazhenie tela matki i vul'vy?

OBJECTIVE: To reveal the morphological characteristics of simultaneously diagnosed leiomyoma of the corpus uteri and vulva. SUBJECT AND METHODS: The paper describes a case of multiple uterine leiomyomas concurrent with vulvar leiomyoma in a 39-year-old patient with progressive tumor nodule growth over 2 years. Vulvar tumor was biopsied simultaneously with extirpation of the uterus; vulvar leiomyoma was removed six months later. Histological and immunohistochemical studies: such as hematoxylin and eosin staining, the expression of smooth muscle actin, desmin, and progesterone and estrogen receptors, S100, CD10, and determination of Ki-67 proliferation index, were conducted. RESULTS: The largest (14-cm) multiple tumor nodule in the corpus uteri had the structure of leiomyoma of uncertain malignant potential; the large (8-cm) vulvar tumor was a leiomyoma with hyalinosis. The immunohistochemical profile of uterine and vulvar leiomyoma (smooth muscle actin+, desmin+, progesterone+, estrogen+ receptors, CD117-, and Ki-67) was the same (1-3%). The vulvar leiomyoma was assumed to be a tumor of metastatic origin. CONCLUSION: Vulvar leiomyoma is rare; it can arise from smooth muscle tissue of various anatomical structures of the skin and soft tissues. The pathogenesis of the so-called metastatic leiomyoma is unclear; there are concepts of a metaplastic transformation of subcelomic mesenchyme and multifocal smooth muscle proliferation. The presented case demonstrates the synchronous development of uterine and vulvar leiomyoma.

[Specific features of the treatment of stress urinary incontinence in patients with III-IV stage of anterior vaginal prolapse].

AIM: to improve treatment results of patients with stress urinary incontinence and severe cystocele by optimizing surgical tactics and rehabilitation methods. MATERIALS AND METHODS: a total of 56 women aged 54 to 68 years with stages III-IV of the anterior vaginal wall prolapse (according to the POP-Q classification) and urethral sphincter insufficiency were evaluated. All patients underwent a transvaginal extraperitoneal anterior mesh repair without concomitant sling procedure. The severity of prolapse, a presence or absence of stress urinary incontinence, and ultrasound signs of sphincter insufficiency were re-evaluated two months after procedure. RESULTS: in all cases, the anterior wall prolapse was eliminated or reduced to subclinical stage. Two months after procedure, 48 patients (85,7%) noted the onset of stress urinary incontinence (moderate and severe) with progressive deterioration. In the remaining cases (14,3%), patients did not have any urinary incontinence. All patients underwent active rehabilitation for 6 months. In 6 cases (12,5%), there was a decrease in the severity of urinary incontinence to the level that had virtually didnt affect the quality of life; in remaining cases, conservative treatment was considered ineffective and sling procedure was recommended. DISCUSSION: A diagnosis of latent urinary incontinence remains to be controversial. To detect this form, a cough test with a prolapse reduction is usually performed. In addition, preoperative urodynamic testing can be used, since it has good sensitivity in identifying latent urinary incontinence, but it is an expensive procedure for the routine practice. A determination of the urethral sphincter insufficiency makes it possible to predict the development of the stress urinary incontinence with a high accuracy, but this method also has a number of limitations. CONCLUSION: patients with stages III-IV of the anterior vaginal wall prolapse and ultrasound signs of sphincter insufficiency have a risk of developing stress urinary incontinence after surgical treatment. In this group of patients, a simultaneous surgery can be recommended in order to correct prolapse and to prevent subsequent urinary incontinence.