Imaging of gynecological disease (6): clinical and ultrasound characteristics of ovarian dysgerminoma.

OBJECTIVES: To describe the clinical history and ultrasound findings in patients with ovarian dysgerminoma. METHODS: This was a retrospective study of patients with a histological diagnosis of ovarian dysgerminoma who had undergone preoperative ultrasound examination. The patients were identified from the databases of 11 ultrasound centers. The tumors were described by the principal investigator at each contributing center on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, three authors reviewed all available electronic ultrasound images (gray-scale images and color/power Doppler images were available for 18 patients and 14 patients, respectively) and described them using subjective evaluation of gray-scale and color Doppler ultrasound findings (here called pattern recognition). RESULTS: Twenty-one patients with ovarian dysgerminoma were identified (including one woman with bilateral masses). Twenty patients had a primary ovarian dysgerminoma (including the one with bilateral masses) and one patient had a recurrence of dysgerminoma in her retained ovary. One of the 21 patients was pregnant. All tumors except one were pure dysgerminomas, one being a mixed germinal cell tumor with 30% dysgerminoma component. Median age was 20 (range, 16-31) years. Information on clinical symptoms was available for 18 patients. In four patients, the tumor was detected incidentally, whereas 14 patients presented with one or more of the following symptoms: acute pain (n = 4), chronic pain (n = 8), bloating (n = 8), menstrual disorders (n = 5) and infertility problems (n = 1). One (5%) patient had ascites. Using the IOTA terms and definitions, all but one dysgerminoma were moderately (43%) or very well (50%) vascularized solid tumors. One tumor was multilocular-solid. According to pattern recognition, most dysgerminomas were highly vascularized, purely solid tumors with heterogeneous internal echogenicity divided into several lobules, had a smooth and sometimes lobulated contour and were well-defined relative to the surrounding organs. CONCLUSION: The ultrasound finding of a highly vascularized, large, solid, lobulated adnexal mass with irregular internal echogenicity in a woman 20-30 years old should raise the suspicion of ovarian dysgerminoma.

Thyroarytenoid muscle invasion in T1 glottic carcinoma.

We report the prevalence of thyroarytenoid (TA) muscle invasion in 109 consecutive patients with T1 glottic carcinoma submitted to endoscopic laser cordectomy between February 1997 and January 2006, in order to evaluate if routine resection of the TA is necessary. A total of 109 patients staged as T1 underwent endoscopic treatment with carbon dioxide laser (CO(2)), 36 cases were treated with type I or II cordectomies, and 73 patients underwent type III, IV or V cordectomies, with resection of all or part of the TA. Over a total of 109 patients, 6 (5.5%) cases staged as pT1 showed TA invasion. The endoscopic treatment of T1 glottic cancer should be as conservative as possible in terms of TA resection, since muscle invasion is rare. In many cases, type III and IV cordectomies can be regarded as excessive treatment. Muscle invasion found histologically after type II cordectomy can be managed by further excision.

The role of immunohistochemistry in the diagnosis of hyalinizing clear cell carcinoma of the minor salivary gland: a case report.

A case of hyalinizing clear cell carcinoma (HCCC) of the minor salivary glands of the oral cavity is reported. A 52- year-old woman presented with a growing mass at the base of the tongue. The patient underwent complete resection of the tumour. The histological picture was characterized by trabeculae or solid nests of proliferating cells with a clear cytoplasm, surrounded by a hyalinizing stroma. Tumour cells were immunoreactive for Cytokeratins 5, 6, 7, 8, 14, 17 and 18. No reactivity was observed for cytokeratin 20, vimentin, S- 100 protein, smooth-muscle actin, muscle-specific actin, and calponin. These findings confirmed the diagnosis of HCCC of minor salivary glands of the oral cavity. The clinical presentation, the immunohistochemical pattern and the role of cytokeratins in the differential diagnosis of HCCC are discussed with a review of the literature.

Gamma-amino-beta-hydroxy butyric acid stimulates prolactin and growth hormone release in normal women.

The influence of gamma-amino-beta-hydroxy butyric acid (GABOB) treatment on pituitary function has been investigated in this study. Different doses (50 x 100 mg) of GABOB were iv injected into three and six normal women, respectively. PRL and GH plasma levels were measured before and after the injection. The treatment with 150 mg GABOB, performed in another two normal women, was interrupted because of side-effects (loss of consciousness etc.) due to the treatment. The treatment with 50 mg GABOB did not induce significant variations of the two hormones; however, significant increases of PRL (P less than 0.05) and GH (P less than 0.01) plasma levels were observed after injection with 100 mg GABOB. The present data suggest that gamma-amino butyric acid (GABA) itself of GABAergic drugs might play an important role in the control of hypothalamic-pituitary function.

Decrease in human plasma prolactin levels by oral prostaglandin E2 in early puerperium.

Eight milligrams of prostaglandin E2 (PGE2; 2 mg every 30 min) were given orally to 12 puerperal women on day 4 after delivery. Plasma levels of prolactin showed a significant decrease in comparison with basal levels and with those of controls sampled over a similar period. The same dose of PGE2 was ineffective in modifying the plasma prolactin levels in four puerperal women on day 30 after delivery and in four non-pregnant women with normal levels of prolactin. It is suggested that a PGE2-induced decrease in prolactin could be mediated by hypothalamic dopaminergic neurones.

Antigenic and cytochemical characterization of cells adhering to intrauterine contraceptive devices.

Eighteen copper intrauterine devices (IUDs), removed after 25 months of use, were examined to evaluate cells adhering to them (IAC). By means of monoclonal antibodies, the antigenic phenotype of IAC was studied, along with some IAC cytochemical properties. Sixty percent of IAC were identified as granulocytes based on morphological, cytochemical, and antigenic characteristics. A small proportion of IAC were shaped like large foreign-body macrophages, with multiple picnotic nuclei, and diffused alpha naphthyl acetate esterase (ANAE) activity. Some IAC identified as macrophages from a morphological view point also showed dipeptidyl-diaminopeptidase IV (DAPIV) reactivity, previously described only in T-helper lymphocytes. Most IAC identified as macrophages reacted with the monoclonal antibodies OKM1 and HLA-DR, and showed ANAE activity in the form of small multiple granules. The hypothesis that IUD-adhering macrophages with an ANAE+, DAPIV+, OKM1+, and HLA-DR+ phenotype could play a role in the inactivation of spermatozoa can be proposed.

Embryonal carcinoma in two cases of androgen insensitivity syndrome: clinical, endocrinological and pathological features.

Embryonal carcinoma in two cases of complete androgen insensitivity syndrome (CAIS) is reported. In both cases gonadectomy carried out for prophylactic purposes led to the discovery of a localized embryonal carcinoma with areas of anaplastic seminoma in one case. In non-neoplastic tissue, gonad morphology in both cases was typical of AIS. Prevalently hypotrophic aspects, especially in the interstitial gland, were found in case 2. This may explain the different endocrine profile in the two cases before gonadectomy. Our study, aside from series of psycho-sexual problems, shows, according to all Authors, that the most serious complication is the high risk of malignancy after puberty in patients with AIS.

Carcinoma IB of the endometrium: spread and prognostic factors.

The prognostic factors and their intercorrelation in 47 patients with IB endometrial cancer are presented. The data reveal the particular behaviour of the lymphatic involvement: five patients (10.6%) showed metastases to pelvic lymph nodes and six patients (12.8%) had paraaortic node metastases; altogether two women (4.2%) had histological evidence of involvement of pelvic and paraaortic nodes. Both histological grade and depth of myometrial invasion showed a characteristic relationship with the lymphatic spread: the percentage of lymph node metastases seems to bear relation to progression of myometrial penetration (M2-M3) and to histological differentiation (G2-G3).

Activity of interferon beta in condylomata with dysplastic lesion of the uterine cervix.

The effectiveness of interferon beta in the treatment of condylomata of the cervico-vaginal tract associated with CINs was evaluated in 25 patients. Human fibroblastic interferon (IFN beta) was administered by intra and perilesional infiltration at a dosage of 3 x 10(6) IU/day for 5 consecutive days the first week and every other day the second. The treatment showed: complete regression in 61.76% of CIN I and 58.69% of CIN II; partial regression in 26.47% of CIN I and 21.73% of CIN II. The picture remained unvaried in 11.76% of CIN I and 19.56% of CIN II.

Immunoperoxidase localization of HSV2 antigens in cervical dysplasia and carcinoma.

The AA. have evaluated by means of the immunohistochemical technique the incidence of herpetic phlogosis in 76 women with neoplastic pathologies of the uterine cervix. The patients were submitted to cytologic, colposcopic and histologic examination for CIN. The HSV2 positivity by immunohistochemical method was demonstrated in 53 (35.3%) cases of CIN and invasive carcinoma. The results confirm the frequent association between HSV2 and cervical carcinoma and they support a specific therapeutic approach to be made in the prevention and clinical management of the carcinoma.

A 3D study of intra and extracellular structures of liver in beta-thalassemia intermedia: an OsO4 maceration analysis.

A scanning electron microscopy study of liver changes has been carried out in three patients affected by beta-thalassemia intermedia (BTI). Applying a new osmium maceration method, recently developed in our laboratory, we had the opportunity to obtain, at SEM, tridimensional images of intra and extracellular structures. Other than the previously reported lesions in BTI, we observed the following pathological findings: disarrangement of the cell structure by a high number of hemosiderin loaded lysosomes; alterations in shape and in diameter of the nuclear pores; presence of apoptotic bodies scattered among the parenchymal cells; deposition of collagen fibers in the space of Disse to form a perihepatocytic dam; enlargement of the sinusoidal endothelial cell fenestrae of the sieve plate. By complete digestion of liver cells, we evidenced a diffuse pericellular fibrosis, made up of interlacing fibrils. Our study evidences some not yet reported morphological lesions in BT. Since patients affected by BTI do not need blood transfusions, these lesions could be considered intrinsic of the disease.

Scanning electron microscopy of chronic hepatitis C. An OsO4 maceration study on human biopsies.

A study at the scanning electron microscope (SEM) on the liver changes in chronic hepatitis C was carried out in human needle biopsies from four patients. Intracellular structures were visualized by a novel modification of the OsO4 maceration method that allows to investigate human pathological specimens. At low magnification we observed both sinusoidal and hepatic cells alterations: sinusoids appeared occluded by lymphocytes, hypertrophic Kupffer cells, activated perisinusoidal cells, necrotic material and apoptotic bodies. Some hepatocytes showed ballooning, arrangement in rosettes, and structural changes related to apoptosis: cell rounding, detachment from neighbouring cells, clustering of cytoplasmic organelles and cell fragmentation. We also found periterminal, sinusoidal, and pericellular severe fibrosis, and bile duct damage of moderate degree. At higher magnification, after removing the intracellular matrix, all the intracellular structures appeared normal, except for focal dilatation of smooth endoplasmic reticulum. Our findings clearly demonstrate the usefulness of the OsO4 maceration method for the study of chronic hepatitis and of liver disease in general. Thank to this technique, in fact, SEM becomes a diagnostic tool complementary to light microscopy and transmission electron microscopy (TEM), for its unique ability to give both low magnification panoramic views and detailed high magnification 3D images of cell organelles.

Polymorphous low-grade adenocarcinoma of the parotid gland.

Polymorphous low-grade adenocarcinoma of the salivary glands is a well-defined clinico-pathological entity which occurs almost exclusively in the oral cavity. Only few reports have documented it in the parotid gland. The authors report an additional case of de novo polymorphous low-grade adenocarcinoma of the parotid and describe the histological and immunocytochemical features of the neoplasm. The current literature is also reviewed.

[Induction of therapeutic abortion with intravenous administration of prostaglandin F 2-alpha]. / Induzione dell'aborto terapeutico con prostaglandina F2 alpha per via endovenosa.

PIP: 24 women, aged 22-41, with parity 0-4, and between the 8-24 week of pregnancy, underwent therapeutic termination of pregnancy by intravenous injection of prostaglandin F2 alpha. There were 23 complete abortions in a relatively short time. No serious complications were observed, although most patients suffered from nausea, vomiting, and diarrhea. This technique proved to be much safer and effective than other techniques previously experimented.^ieng

Effect of thyrotropin-releasing hormone in pituitary-thyroid system function infertile women after surgical castration.

The Authors evaluate the effect of surgical castration on thyroid function of fertile women, and the response of TSH to TRH before and 30 days after castration.

Management, therapy and outcome of treatment in women with pelvic endometriosis.

Sixty-four cases of endometriosis treated between 1980 and 1985 were reclassified according to the R-A.F.S. Twenty-eight of the patients (43.7%) were followed for 24-39 months: in this group we evaluated the efficiency of medical treatment (Danazol), combined medical and conservative surgical or definitive surgical treatment on the basis of the persistence, complete or partial regression of the symptoms. In this group of patients the symptoms regressed completely in 39.28% of the cases; in 28.57% there was a partial regression and persistence or recurrence of the symptoms were reported in 32.14%. These results suggest that the classification system is a key to interpreting treatment.

Short term treatment with ketoconazole: effects on gonadal and adrenal steroidogenesis in women.

Ketoconazole, an imidazole derivative, is a large spectrum antifungal agent. The drug is known to cause a decrease in plasma androgens and adrenal steroids in normal men; it is also an active drug in the treatment of malignant tumors of the prostate. To examine the antiandrogenic action of this drug in women, we measured several gonadal and adrenal steroids in 21 normally menstruating women before and after receiving oral ketoconazole (200 mg twice daily) for 5 days. Plasma testosterone (T) decreased from a basal level of 0.35 to 0.25 ng/ml (+/- SEM) (P less than 0.001); dihydrotestosterone (DHT) from a basal level of 190.62 +/- 23.2 to 159.75 +/- 19.43 pg/ml (P less than 0.02); dehydroepiandrosterone sulphate (DHEA-S) from 1.42 +/- 0.44 to 1.15 +/- 0.19 micron/ml (P less than 0.02). Plasma 17 beta-estradiol (E2) decreased from a basal level of 97.42 +/- 29.37 to 54.32 +/- 9.9 pg/ml (P less than 0.05). In contrast, plasma 17-OH-progesterone (17-OHP) levels increased from a basal level of 44.81 +/- 8.21 to 71.81 +/- 15.81 ng/100 ml (P less than 0.05). These results confirm that the ketoconazole blocks the conversion of progestins into androgens. The decrease in the plasma concentration of E2 suggest a direct effect of the ketoconazole on the ovary. It is likely that the effect of the drug, both at the level of the ovaries and of the adrenal gland, is dose-dependent.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute abdomen due to rupture of mesenteric cysts. Observations on a clinical case and review of the literature]. / L'addome acuto da rottura di cisti mesenteriche. Descrizione di un caso clinico e analisi della letteratura.

Personal experience based on a clinical case of a young woman with acute abdominal pain referable to acute appendicitis is presented. The surgical procedure was performed through a Mc Burney incision and revealed the rupture of mesenteric cysts; removal of the cysts was carried out without intestinal resection. Post-operative course was uneventful and 2 years follow-up showed no recurrence. Mesenteric cysts are an uncommon pathology, mainly in adult ages. After an analysis of the incidence and etiology, the pathological features and types of clinical presentation are discussed. Diagnosis in asymptomatic cases is usually made in search of other diseases. Complications are rare: rupture, infection and intestinal obstruction. In such cases, the clinical presentation is usually attributable to the main causes of acute abdomen, unless ultrasonography or CT scan are performed. When mesenteric cyst is diagnosed, a laparoscopic approach should be performed, even if in emergency traditional surgery is justified. Total excision of the cyst is necessary to avoid recurrence and obtain a correct pathologic evaluation.