Hysteroscopic Treatment of Primary Endometrial Marginal Zone B-cell Lymphoma (MALToma).

Primary extranodal marginal zone B-cell lymphomas (MALToma) of the endometrium are rare tumors. We report a case of MALToma diagnosed within an endometrial polyp in a patient presenting with postmenopausal vaginal bleeding. The patient underwent a conventional hysteroscopic procedure for intrauterine polyps. There was no suspicion of malignancy during the preoperative investigations or at surgery. Conventional bipolar resection of the polyps was performed. The present case demonstrates that conservative management of endometrial MALToma may be considered as a safe alternative to hysterectomy. Further data on long-term follow up is needed to confirm the safety of this conservative approach.

[Work and depression in women after the birth of a child]. / Lavoro e depressione delle donne dopo la nascita di un figlio.

OBJECTIVE: To analyze the main factors associated to depression at 8 months postpartum, looking more particularly at women's employment. METHOD: 352 women responded to a face-to-face questionnaire few days after the birth, at the Maternity Hospital "Burlo Garofolo" in Trieste, and 292 of them responded to a telephone interview 8 months later. Psychological distress 8 months after delivery was evaluated with the General Health Questionnaire (GHQ). RESULTS: 8 months postpartum, 5% of women were depressed. 32% of women were non-satisfied with their current working status, without differences among those working and those staying at home. 13% of sample reported problems related to work (such as being fired or no flexible working hours). The women's actual working status was not associated with depression, while the congruence between what the woman was doing (working/at home) and her wishes was. The relationship was still significant after adjusting for other factors associated with depression. CONCLUSIONS: Employment dissatisfaction is negatively associated with women's health after childbirth. To promote mothers' wellbeing, the question of women's employment after birth should be addressed.

Vulvar lichen sclerosus: an immunologic study.

OBJECTIVE: To investigate the seroimmunologic (CD3, CD4, CD8 lymphocytes, C3c and C4 complement fractions, and several autoantibodies) and immunohistochemical (T lymphocyte subpopulations, B lymphocytes, natural killer cells, macrophages, immunoglobulin [Ig] G, Ig M, and C3c complement fraction) characteristics of vulvar lichen sclerosus. METHODS: Serum samples from 68 women with histologically proven lichen sclerosus were compared with those from 53 healthy controls, and tissue samples from 14 of 68 women chosen at random were compared with those from 14 of 53 healthy controls. A scoring system was constructed to compare the number of cells in the tissue. RESULTS: Patients had significantly lower counts of circulating lymphocytes CD3 and CD4 than controls (P < .05) and a higher number of autoantibodies (P < .01). Analysis of the tissue samples confirmed a lower number of CD2 cells (two-tailed P = .002 in epidermis, .005 in dermis), CD3 cells (two-tailed P = .001 in epidermis and in dermis), CD4 cells (two-tailed P = .002 in epidermis, .011 in dermis), and CD8 cells (two-tailed P = .002 in epidermis, .051 in dermis) in subjects than in controls. Numbers of monocyte-macrophage cells were similar in the epidermis but different in the dermis (two-tailed P = .003). No natural killer CD56 cells or B lymphocytes (CD19-CD21) were detected in the affected areas. Deposits of IgG, IgM, and C3 were no greater in biopsy specimens of patients than in those of controls. CONCLUSION: Vulvar lichen sclerosus is not caused by a T cell-mediated response, and a viral origin is unlikely. The absence of CD19 and CD21 cells excludes local production of autoantibodies. Our data do not confirm an autoimmune pathogenesis for vulvar lichen sclerosus but help explain why systemic cortisone is of no benefit and justify the use of petroleum jelly to relieve pruritus.

Paget's disease of the vulva: diagnostic and therapeutic problems.

Two cases of Paget's disease of the vulva are presented and the complex problem of diagnosis of this neoplasia is evaluated: all the diagnosis tests used in vulvar disease (vulvar citology, toluidine blue test) are insufficient in the presence of on eventual underlying carcinoma. In view of these considerations, the therapeutic approach is total vulvectomy.

Topical testosterone propionate in the therapy of vulvar dystrophies.

187 patients with atrophic, hypertrophic and mixed vulvar dystrophy were treated with 2% testosterone propionate ointment from 18 months to 7 years. Symptoms, macroscopic, and histologic picture were evaluated before and during treatment. About 75% of the patients achieved good and excellent symptom relief. Treatment efficacy differentiates according to the type of dystrophy, and in relation to the lesion's extension and the duration of symptoms, which consist mostly of pruritus. Side effects from therapy were negligible.

Vulvar neoplasias in patients with previous cancer history.

The presence of second neoplasia in association with vulvar neoplasia is significant. We confirm the usefulness of including a screening procedure for vulvar neoplasia in the follow-up of patients with gynecological cancer, especially those with carcinoma of the portio. Patients with a first gynecological neoplasia who present vulvar viral infection, or dystrophies, or who have undergone radiotherapy or immunosuppressive treatment are considered at high risk.

Multiple tumors of the female genital tract.

The increased incidence of multiple primary tumors of genital-breast district has been evaluated, with the possibility of early diagnosis which consent greater survival in cancer patients. We found a particular high incidence of second neoplasia associated with vulval tumors (7.4%). With regard to pathogenetic factors, the oncogenic role of certain treatments is undoubtedly important, especially if they are protracted in time. It is necessary that these patients undergo complete gynecological screening for a time period that is much longer than that held sufficient to consider a patient cured.

Vulvar carcinoma: natural history.

On the basis of our clinical experience and a careful revision of the literature, we have attempted to identify the natural history of vulvar carcinoma by verifying the real evolutive possibility of these lesions, their possible genesis, the latent period between pre-invasive and invasive forms, and some events which seem to play a significant role in the onset of the invasive form in this period. These considerations indicate a new clinical and study approach to carcinoma in situ, which would thus become a pathology characterized by a more precise pathogenetic and evolutive individuality.

[Postpartum perineal evaluation. Role of the Q-tip test]. / Valutazione perineale post-partum. Il ruolo del Q-tip test.

Data reported in this study concern 56 women who were subjected, 1 and 6 months after delivery, to a perineal examination including, in addition to the functional evaluation of the levator ani muscles, the "Q-tip test". A positive Q-tip test is associated with a greater incidence of stress urinary incontinence, especially when, at the same time, the score for the functional evaluation of the levator ani muscles ("Perineal Testing") is inferior to 3. The results of this study seem to indicate a greater gravity and ventral extension of obstetric perineal injuries.

[Prevention of obstetrical damage to the perineum. Proposal for a fetal-pelvic index for the selection of parturients at risk]. / Prevenzione del danno perineale ostetrico. Proposta di un indice feto-pelvico per la selezione delle partorienti a rischio.

BACKGROUND: According to some authors, vaginal delivery always causes denervation of perineum and the greater the damage the longer the second labour phase (the so-called "delivering phase"). Therefore, it is necessary to reduce the number of too prolonged labours, but it is equally important to avoid an uncontrolled increase of cesarean sections. In order to achieve this objective, it is important to carry out a careful selection among laboring women and choose those most at risk for whom cesarean section is strongly recommended. On the basis of the data collected by the medical literature and in consideration of the pathogenetic role of the outlet dystocia, we have tried to identify a simple and effective prognostic index resulting from the different pelvimetric and ultrasonographic parameters. METHODS: In 72 full-term pregnant women, we have taken into account the ultrasonographic parameters expressing the fetal dimension (cephalic diameters, cephalic and abdominal circumferences, estimated fetal weight according to Haddlok), the outlet pelvic diameters (trans-ischial and coccygeal-pubic) and a fetal-pelvic index derived from these parameters. RESULTS: If taken individually, these parameters do not seem to have any direct connection with the length of the delivering phase, but the combination of the cephalic and external pelvimetric diameters has produced a significative statistical coefficient. CONCLUSIONS: On the basis of the data collected, it is suggested that a careful evaluation of external pelvimetric and cephalic parameters would be useful from the clinical point of view.

[Prediction of EPH gestosis by means of the roll-over test. Clinical contribution]. / Predizione della gestosi EPH mediante roll-over test. Contributo clinico.

Roll-over test (ROT) was performed on 128 selected nulliparous women between 28 and 32 weeks of gestation. Considering the high frequency of true-positive (81.5%) and true-negative results (88.1%), ROT seems to show, in clinical practice, a good sensitivity (64.7%) and an excellent specificity (94.7%). The and an excellent specificity (94.7%). The results of this study confirm that ROT is a true predictor of pregnant women at risk for future development of EPH gestosis.

[Therapeutic proposals in vulvar dystrophy and burning vulva]. / Proposte terapeutiche nella distrofia vulvare e nella "burning vulva".

The paper reports the results of 80 cases of vulvar dystrophy and 11 cases of burning vulva. The Authors put forward a protocol for therapy which also aims to provide the basis for a comparative study of this pathology about which little is known from a clinical and research point of view.

Hormone receptors in dystrophic and neoplastic vulvar disease. Preliminary considerations.

Hormone receptor assays for testosterone, estrogens and androgens were performed on 53 biopsy specimens of vulva from 40 patients, consisting of 6 with normal tissue, 14 with atrophic type dystrophy, 13 with hypertrophic type dystrophy, and 20 with malignancy. Atrophic and hypertrophic forms showed a different receptor pattern; hypertrophic forms were characterized by consistently higher levels of progesterone receptors not correlated with estrogen receptors. Neoplastic tissue showed no significant changes in values compared to normal or dystrophic forms, but range of variability was high. The bond between neoplastic forms and hormone activity seems without doubt less important than in the corresponding endometrial and mammary forms. The study of dystrophic forms, instead, should be further explored with a larger number of cases.

Immunological study of vulvar lichen sclerosus: preliminary considerations.

Sclero-atrophic lichen (LSA) is a dermatosis that is well defined from the clinical and histological viewpoints, but the etiology remains unknown. The main symptom is a permanent pruritus which results in a gynecological consultation. We have studied the immunological status of 48 patients with LSA and 33 controls. The LSA patients showed a significant diminution of peripheral CD3 and CD1 and tissue CD2, CD3, CD1 and CD8. There was no difference of IgG, IgM or tissue C3c, or serum C3c and C4. These patients also had a higher incidence of autoantibodies.

Specific immune response against Gardnerella vaginalis hemolysin in patients with bacterial vaginosis.

OBJECTIVE: Our goal was to study the mucosal host response in bacterial vaginosis by evaluating the presence of a specific immune response elicited against the Gardnerella vaginalis hemolysin in vaginal fluids of patients and by verifying its correlation with usual criteria adopted to diagnose bacterial vaginosis. STUDY DESIGN: A total of 123 white women attending the gynecologic care unit for urogenital complaints or for screening of uterine malignancies (Papanicolaou test) aged from 20 to 60 years, nonmenstruating, were enrolled. Bacterial vaginosis was diagnosed by clinical criteria and a Gram stain score > 6. RESULTS: We performed the determination of the antibody response in vaginal fluid against the hemolysin produced by G. vaginalis, a common agent present in bacterial vaginosis. The purified G. vaginalis toxin was a suitable antigen for detecting the presence of an immune response in the vaginal fluids of patients with bacterial vaginosis regardless of the strain of G. vaginalis present. A specific immunoglobulin A response was detected in 60% of women with overt bacterial vaginosis (Gram stain score > 6) and in 18.5% of women with intermediate vaginal flora (Gram stain score 4 to 6). The specificity of the test was 91%. CONCLUSIONS: We found a correlation between the specific local immune response to G. vaginalis toxin and bacterial vaginosis. The highly purified form of the toxin is able to discriminate disorders from the opportunistic colonization by G. vaginalis.