Carcinosarcoma in endometrial polyp. Diagnosis and treatment--case report.

This paper presents a case of carcinosarcoma localized in the endometrial polyp inside the uterus of a 74-year-old patient. This carcinosarcoma was diagnosed in the first clinical disease stage. Postoperative treatment was conducted but was not followed by additional chemo or radiotherapy due to the fact that the illness was in the first clinical stage. Secondary deposits in the abdomen and in the pelvis appeared exactly six months after surgery. Illness progression was sudden causing death three months after the appearance of secondary deposits or nine months after the illness was detected, despite attempts with chemotherapic treatment. Although uterine carcinosarcomas account for three to seven percent of all uterine malignities while malignant polyp degeneration occurs in only 0.36% cases, treatment of this malignant disease is a special challenge to all those involved in oncological gynecological practice with the aim of prolonging the progression-free interval and the overall survival of patients suffering from this rare malignity.

p16INK4a as an adjunct test in cervical cytology.

BACKGROUND: This study investigated the correlation between cervical cytology, the expression of P16INK4a, and human papilloma virus (HPV) infection. MATERIALS AND METHODS: The study included 100 subjects with suspected pathological cervical lesions. Cervical smears were analyzed for malignancy and p16INK4a. Histological finding represented "the golden standard". RESULTS: Immunocytochemical analysis of protein p16INK4a expression on epithelial cells of cervical smear demonstrated increased p16lNK4a expression in 36.0% of subjects. There was statistically significant positive correlation (Spearman r = 0.70; p < 0.001) between the pathological findings and the intensity of p16INK4a protein expression inside the epithelial cells, as well as with the histological finding (Spearman r = 0.71; p < 0.001). The intensity of p16INK4a protein expression in cytology finding was significantly higher in HPV16 positive patients (Mann- Whitney test, p = 0.0065). CONCLUSION: Good correlation between the expression rate and the severity of lesions indicates that this test might improve the results of cytology and HPV screening, as well as the results of predicting the prognosis of the disorder of the cervix.

Pulmonary embolism during delivery--treatment and outcome.

Pulmonary embolism during delivery is not a frequent occurrence. It is often impossible to ascertain whether it is a case of embolism by amniotic fluid or thromboembolism. Diagnostics of pulmonary embolism in labor is based solely on clinical symptoms. Immediate interdisciplinary treatment with cardiopulmonary resuscitation, hemodynamic stabilization, and correction of haemostasis disorders play a decisive role in prognosis. This paper presents diagnostics, treatment, and consequences of pulmonary embolism in expulsion phase during delivery in epidural anesthesia of a multiparous patient aged 37.

Recurrent multiple endometrial polyposis in patient treated by antipsychotic drugs.

Irregular uterine bleeding and profuse menstrual bleeding often occur in patients treated by antipsychotics, antiepileptics, and some antihypertensive drugs. Such bleedings represent an important problem in clinical practice, especially when related to antipsychotic treatment. Nonetheless, this problem has not been often analyzed in references. This paper describes a recurrent multiple endometrial polyposis accompanied by profuse menstrual bleeding in a patient undergoing a multi-year treatment of bipolar affective disorder by antipsychotics and discusses the possibilities of prevention of irregular and profuse menstrual bleeding in patients that must use antipsychotic therapy in order to treat a psychiatric illness.

Hysterosalpingography versus hysterscopy in intrauterine pathology research of infertile patients.

BACKGROUND: The objective of the present paper is to confirm the validity and reliability of hysterosalpingography (HSG) in intrauterine pathology research of infertile female patients by comparing the hysteroscopy (HC) findings to a "gold standard" test. AIM: To analyze HSG and HC findings in infertility patients. MATERIALS AND METHODS: The research was conducted as a prospective study at the Gynecological and Obstetrics Clinic "Narodni front" in Belgrade. RESULTS: HSG indicated pathological findings in 72.5% of patients whereas HC revealed abnormalities of uterine cavity in 77.5%. In 12.5% of patients, HSG demonstrated a normal uterine cavity, and HC confirmed pathological findings, while in 7.5% of patients with filling defects and irregular shapes on HSG images, HC reported normal findings. In 22.5% of patients normal finding as well as endometrial polyps were reported; congenital malformations (anomalies) were found in 32.5%, submucosal myomas in 12.5% and Asherman's syndrome in 10%. CONCLUSION: HC finding was crucial in final diagnosing.

Rare extrapelvic endometriosis on iliac vein wall--diagnosis and treatment.

Although endometriosis is a relatively common illness in women during the reproductive period, extrapelvic localization of endometriosis is a relatively rare finding which can pose a differential diagnostic problem. Diagnosis and surgical treatment of a patient with endometriotic tumor located on the outer wall of the left common iliac vein are discussed. Patient underwent surgery because of circulatory disorders and left leg edema. Histopathological findings verified endometriosis on the outer wall of the common left iliac vein without other localizations.

Partial agenesis of corpus callosum--case study.

Agenesis of the corpus callosum is an uncommon cerebral malformation usually of unknown etiology. It can be associated with other brain abnormalities, such as ventriculomegaly, or in combination with problems with other organs, such as congenital heart defect, as well as with chromosome anomalies. Diagnosis of this rare anomaly is important not only because of possible association with other developmental anomalies but also because of postnatal treatment and evaluation of children with this disorder. This paper presents prenatal diagnosis of partial agenesis of the posterior part of corpus callosum of a fetus detected in gestational week 33 by ultrasonography as an isolated developmental disorder, i.e., not accompanied by other morphological anomalies of the fetus or chromosome aberrations or other genetic defects.

Bilateral poorly differentiated Sertoli-Leydig ovarian tumor associated with dysgerminoma: case report.

Sertoli-Leydig cell tumors are rare stromal tumors of the ovary. They account for less than 0.5% of ovarian neoplasms. From a histological point of view, they show large diversity, making their clinical symptoms diverse as well. They are mostly unilateral, with average diameter 13.5 cm at the moment of diagnosis. Histologically, poorly-differentiated Sertoli-Leydig tumors pose a diagnostic problem, often being clinically asymptomatic which makes their detection relatively late, preventing efficient treatment, and resulting in worse prognosis. This article presents a rare case of bilateral poorly-differentiated Sertoli-Leydig ovarian tumor, characterized by heterologous histological structure, without hormonal unbalance, and without signs of defeminization and/or virilization, its diagnostics, and treatment.

Amelanotic malignant melanoma of the perineum: a case report.

The case of a patient diagnosed and surgically treated for amelanotic malignant melanoma of the perineum, accompanied by several local relapses, metastases to iliac-femoral lymph nodes, and distant metastases to both lungs is presented. Survival, up to date, equals 12 years. Amelanotic malignant melanomas are very rare tumors. Perineal and perianal localization of these tumors is especially rare. References cite about 500 cases with survival limited to between six months and one year after diagnosis..

Threatened miscarriage in the first trimester and retrochorial hematomas: sonographic evaluation and significance.

BACKGROUND: Vaginal bleeding during the first half of pregnancy occurs in approximately 25% of women and about half of these pregnancies terminate in abortion. In many instances a retrochorial hematoma (RCH) is sonographically found. OBJECTIVE: The aim of the present study was to determine the frequency of a RCH in the group of threatened miscarriages and to examine the possible relationship of parity, previous miscarriages, hematoma size and localization, and duration of vaginal bleeding to pregnancy outcome. MATERIALS AND METHODS: The study group consisted of 45 women of 852 (5.2 %) referred for ultrasound examination due to vaginal bleeding in the first trimester of pregnancy, who were found to have a RCH in the presence of a singleton live embryo. The control group consisted of 807 women with the same gestational age, with vaginal bleeding, and vital singleton pregnancy without sonographically proven RCH. All were followed with repeated sonograms at seven days intervals until bleeding ceased, the RCH disappeared or abortion occurred. The authors have examined the possible relationship of duration of vaginal bleeding, hematoma size and localization, parity, and previous miscarriages to pregnancy outcome (spontaneous abortion, term or preterm delivery). RESULTS: The researches have shown that the previous miscarriages and deliveries do not affect the occurrence of RCH. In the group with a RCH on the back wall of uterus, as well as repeated bleedings affect higher frequency of spontaneous miscarriages. Hematoma size itself does not affect higher frequency of spontaneous miscarriage. CONCLUSION: Ultrasound is the method of choice for diagnosing the existence of aRCH. The frequency of RCH in the group of threatened spontaneous miscarriages is 5.2 %. A RCH on the back wall and repeated bleedings affect higher frequency of spontaneous miscarriages. Therapy procedure is based on strict bed rest and administration of: pregnyl, gestagenic drugs, progesterone, antihistamines, and sedatives.

Rare metastases of pancreatic tail carcinoma in female genital organs.

A case is presented of pancreatic tail carcinoma metastasizing to the uterus, right ovary and right sacrouterine ligament 2.5 years after the primary tumor had been detected and treated. During explorative laparotomy, performed after 3D color Doppler ultrasonographic visualization of a suspected finding in the right adnexal region, metastatic deposits in the uterus, right ovary, right sacrouterine ligament and right ureter originating from the primary adenocarcinoma of the tail of the pancreas were detected and surgically removed.

Correlation of human papilloma virus infection with cytology, colposcopy and histopathological examination of the bioptic tissue in low- and high-grade intraepithelial lesions.

INTRODUCTION: It is now believed that the majority of cervical cancer is preceded by long-term infection with high-risk types of the human papilloma virus (HPV). The presence of HPV high-risk types (HR-HPV) in the cells of intraepithelial change multiplies the possibility of its progressive development to high-grade cervical precancer and invasive disease. AIM: This study examined the correlation of HPV infection with cytology, colposcopy, and histopathological examination of the bioptic tissue in low- and high-grade cervical lesions. MATERIALS AND METHODS: This research was conducted as a study section. Data collection was performed during a ten-year period, at the University Clinic of Gynecology and Obstetrics - Narodni Front in Belgrade (Serbia). The basic set included 1,927 patients. Colposcopy, cytology, histopathology, and HPV test verification was made in all patients. Statistical analysis was performed using the SPSS program, version 17.0. Contingency tables were used to assess the degree of correlation of variables and chi-square test was used to determine the level of statistical significance in this study. A p value < 0.05 was considered statistically significant. RESULTS: Among 1,927 women studied, 635 (32.95 %) had abnormal cytological findings and among these, 272 (42.83%) were HR-HPV positive. There was a statistical difference between colposcopic and cytological findings in patients with HR-HPV (x2 = 35.33, p = 0.000). There was also a statistically significant difference between histophatological and colposcopical findings in patients with HR-HPV (x2 = 10,171, p = 0.001). Only HR-HPV types 16 and 18 showed a statistical significance compared to histopathological findings, unlike other HR-HPV. An important finding was that the authors found an abnormal colposcopy in 93.30% patients with low-grade intraepithelial neoplasia and 68.05% patients with low-grade squamous intraepithelial lesion (LSIL) had normal cytology and was 70.15 % HR-HPV negative. CONCLUSION: The findings imply that among high-grade intraepithelial neoplasias, the authors found a high presence of HPV type 16 and 18, and a statistical significant presence of HPV 16 in low-grade intraepithelial neoplasia, unlike other HR-HPV types in low-grade intraepithelial findings. The authors found a significant statistical correlation with abnormal cytology and presence of HPV type 16 in both groups (LSIL and high-grade squamous intraepithelial lesion (HSIL). The authors also found an abnormal colposcopy in 93.30% of patients with low-grade intraepithelial neoplasia, while 68.05% of patients with LSIL had normal cytology and were HR-HPV negative in 70.15% of the cases.

Giant omphalocele-prenatal diagnostics, pregnancy evaluation and postnatal treatment.

This study describes prenatal diagnostics of fetal omphalocele by ultrasonographic examination, planned childbirth by cesarean section and surgical correction of the anomaly in an older primipara who became pregnant through a spontaneous menstrual cycle after a five-year long medical examination and treatment of infertility. Pregnancy was carried out to full term. Planned cesarean section performed at 40 weeks of pregnancy gave birth to an infant with a giant omphalocele 8-9 cm in size with an abdominal wall defect approximately 5 cm in size. The same day the newborn was subjected to surgery during which the hernial sac containing intestine was repositioned inside the child's abdomen and a paraumbilical defect in the abdominal wall was sutured. The newborn spent seven days in the intensive care unit on assisted ventilation in order to maintain a constant level of intraabdominal pressure. The postoperative period was complication-free. The infant was released from the hospital after 14 days completely adapted and ready for breastfeeding. The rest of the neonatal period remained without complications.

Defect of methylenetetrahydrofolate reductase in a patient with ten habitual misscarriages: a case report.

This is a case report of a 47-year-old patient that came to our Clinic due to bleeding during the 23rd week of twin pregnancy after in vitro fertilization-intracervical insemination/embryo transfer (IVF-ICI/ET) treatment. Prior to this pregnancy, this patient had had ten spontaneous miscarriages, eight of which following IVF-ICI/ET, and two following spontaneous conception, all in the eighth week of pregnancy. After several miscarriages by the age of 43, the patient was suggested to be tested for thrombophilia; it was then discovered that she had the methylenetetrahydrofolate reductase (MTHFR) gene defect, in the homozygous Tobiano (TT) form. Thus she was treated with cardiolipin and folic acid before pregnancy, and continued with folic acid after the pregnancy had been diagnosed. Fraxiparine 0.4 ml subcutaneous (s.c.) should be introduced from the second month of pregnancy until one day before delivery. It is a useful treatment for the patients with MTHFR defect, as it prevents miscarriage and promotes successful pregnancy.

Comparison of electrolytic status (Na+, K+, Ca2+, Mg2+) in preterm and term deliveries.

PURPOSE OF INVESTIGATION: The objective of this study was to evaluate the electrolytic status of Na+, K+, Ca+, and Mg2+ in serum and red blood cells in idiopathic preterm and term deliveries. METHODS: The study included 105 pregnant women diagnosed with idiopathic premature delivery (study group) and 36 pregnant women with physiologically term delivery (controls). Samples of mother's blood were collected and analyzed for the level of electrolytes in the serum/plasma and red blood cells. RESULTS: Measured values of magnesium in red blood cells in the study group were far lower than physiological values, intracellular calcium levels were higher in the study group compared to levels measured in the controls. Sodium concentrations in cells were significantly lower in subjects with premature delivery. CONCLUSION: The magnesium intracellular level is the best representative value of magnesium in the body.

Rare metastases of carcinoma of uterine cervix.

This paper describes a case of cancer of the uterine cervix metastasizing in the spleen two years after the primary carcinoma was diagnosed and treated. After detailed diagnostics, the patient was subjected to surgery. Histopathological examination after splenectomy confirmed a very rare case - presence of metastases of planocellular carcinoma of the uterine cervix. Over the last ten years, references cite isolated cases of metastases of adenocarcinoma of the colon, stomach and breast in the spleen as well as lung carcinoma and malignant skin melanoma. Until now cases of uterine cervix carcinoma metastasizing to the spleen have been published as micrometastases detected in autopsy material.

Ovarian carcinoma patients--life quality analysis in the postoperative period--how to improve it?

PURPOSE OF INVESTIGATION: The objective of this research was to analyze the quality of life of patients with advanced ovarian carcinoma in the period following radical surgery and application of chemotherapy. METHODS: A random selection method was used to choose 30 patients who had previously filled out the QLQ-C30 health questionnaire. Data obtained from questionnaires were statistically analyzed. RESULTS: The percentage of the general health scores were the highest in the bottom third of the scale, where 21.9% of the patients self-scored at 0. Financial difficulties were scored the lowest at 65.6%. The impairment of physical functioning was reported by 21.9% of patients, where the score for impact of this physical impairment was reported at 0 by 18.8%, and the impact of cognitive impairment was scored at 0 by 56.3%. Nausea, vomiting and loss of appetite were completely affecting normal daily functioning of 40.6% patients, constipation was present in 59.4% cases and diarrhea in as many as 71.9% patients; 15.6% patients reported being in continuous pain. CONCLUSION: Health questionnaires should be used because they can help identify patients prone to develop psychological problems and symptoms. Early recognition of patients prone to psychosomatic problems would allow doctors to help maintain and/or improve on patients' quality of life.

Systemic chemotherapy--before or after radical surgery in treatment of patients with advanced ovarian carcinoma?

PURPOSE OF INVESTIGATION: The aim of the study was to analyze whether application of systemic chemotherapy prior to radical surgery in patients with advanced ovarian carcinoma influences the length of the progression-free period and overall survival rate. METHODS: This study analyzes two groups of patients in the period 2006-2009. The first group received systemic chemotherapy prior to radical surgery. The second group first had radical surgery after which systemic chemotherapy was administered. The therapeutic response to systemic chemotherapy was analyzed as well as progression-free survival and overall survival which was calculated according to the Kaplan-Meier method and compared using the log rank test. RESULTS: Statistical analysis showed that patients who were administered systemic chemotherapy prior to radical surgery have significantly better progression-free survival as well as overall survival. Progression-free survival in patients who were first treated with systemic chemotherapy after which radical surgery followed was equal to 28 months and was significantly longer (p = 0.001) than progression-free survival in patients who were first subjected to radical surgery; it equaled 13 months, while the overall survival equaled 43 and 36 months, respectively. CONCLUSION: Application of systemic chemotherapy prior to radical surgery has a significant influence on the length of the progression-free period and on the length of overall survival of patients affected by advanced ovarian cancer.

[Myomectomy by vaginal route].

Myomectomy by vaginal route is the least invasive of all methods for myoma removal. Compared to classical, abdominal myomectomy, it has numerous advantages, especially in cases of fundal and posterior wall myomas, but still it is relatively rarely performed. This study provides an analysis of operative and postoperative course of patients subjected to myomectomy by vaginal route in the period from 01/01/2003 to 01/11/2005 as well as the corresponding control group of patients which had undergone classical, abdominal myomectomy. The study points out to significance and advantages of application of surgical technique for removal of myoma through the posterior wall of the vagina as opposed to classical, abdominal myomectomy. Transvaginal myomectomy eliminates trauma of laparotomy, intraoperative blood loss is reduced, postoperative complications are down to minimum, postoperative recovery is shorter, and so is the number of days spent in hospital. Thus, by performing this type of surgery, a positive cost-benefit effect is obtained not only for the patient but for health authorities as well.