[Twin gestation with regressive partial hydatidiform mole and coexisting live fetus]. / Nerazvivayushchiisya chastichnyi puzyrnyi zanos v slitnoi dikhorial'noi platsente s normal'nym razvitiem vtorogo bliznetsa.

The case of dichorionic twin pregnancy is described, with a fused placenta, one part of which is represented by a tissue of partial hydatidiform mole (PHM) with signs of regression, the second part is a placenta of a common structure with a normal development of the second twin. The delivery took place at the term of 38 weeks with a live healthy girl weighing 3250 g. A single placental disc consisted of two fused placentas with a clear boundary between them. The placenta of a live-born girl was mature, with focal chorangiosis, the second part of the disc was represented by the PHM tissue with avascular giant bizarre villi, some of them with central cisterns, with stromal fibrosis, low proliferative activity of the villous trophoblast and a significant narrowing of the intervillous space. A genetic study was carried out on the material of paraffin blocks from two parts of the placental disc containing the tissue of the villous chorion, and the blood of the parents. Comparative analysis of DNA isolated from the paraffin block of PHM with the DNA of the parents revealed the presence of diandric dispermic triploidy. No chromosomal pathology was found in the placenta of a living girl. For hydatidiform mole in the case of multiple pregnancy, an increase in the volume of the affected placenta is characteristic compared to the normal placenta of the twin. In our observation, the presence in the placenta with PHM signs characteristic of placentas with antenatal fetal death, stromal fibrosis of the villi and low proliferative activity of the trophoblast suggests a regression of PHM.

[Uterine adenosarcoma. Report of 5 cases and review of literature]. / Adenosarkoma matki. Opisanie pyati nablyudenii i obzor literatury.

Uterine adenosarcoma is an uncommon biphasic tumor with benign epithelial and malignant mesenchymal components, often presenting difficulties for morphological diagnosis. We describe 5 cases of adenosarcoma of the uterine corpus and cervix, and vaginal stump in patients aged 46-76 years. Clinical data, ultrasound results, morphological data, including immunohistochemical studies with antibodies to CD10, estrogen and progesterone receptors, desmin, smooth muscle actin, and Ki-67 are presented. Large polypoid mass of the epithelial-mesenchymal structure within the uterine cavity in women of peri - and postmenopausal age require the exclusion of malignancy of the mesenchymal component with searchig for diagnostic criteria - periglandular cuffing of the stromal cells and mitoses.

[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.

[Placental mesenchymal dysplasia]. / Mezenkhimal'naia displaziia platsenty.

OBJECTIVE: To carry out a clinical and morphological analysis of 6 cases of placental mesenchymal dysplasia (PMD) that is not associated with Beckwith-Wiedemann syndrome. MATERIAL AND METHODS: Medical records, placental macroscopic and microscopic changes, histochemical (MSB staining) and immunohistochemical studies of placental tissue with antibodies against p57, CD34, smooth muscle actin, desmin, and Ki-67 were analyzed. RESULTS: Vascular anomalies in the chorionic plate and stem villi, the increased size and edema of the stem villi during normal formation of the terminal branches of the villous tree, the lack of proliferation of villous trophoblast were the typical signs of PMD and were noted in all cases. Comparison of the results of ultrasonography with the morphological pattern of the disease suggested that there were ultrasound signs that were typical of PMD. The characteristics of the course and outcomes of pregnancy in PMD were given. The features of morphological changes in the presence of PMD concurrent with preeclampsia were found. Significant variability in p57 expression in PMD was shown and variants of changes given. There were no substantial features of the expression of desmin and smooth muscle actin in PMD. CONCLUSION: MDP has typical morphological and ultrasound signs. The significant variability in the levels of chorionic gonadotropin and alpha-fetoprotein and in the expression of p57 does not allow their use in the differential diagnosis of PMD. The high incidence of thrombotic events in the intervillous space and fetal vessels, as well as intrauterine growth restriction, intrauterine hypoxia, and an impaired neonatal adaptation period in PMD should be taken into account when determining the management tactics for female patients and newborns.

[Twin pregnancy with complete hydatidiform mole]. / Polnyi puzyrnyi zanos pri beremennosti dvoinei.

The paper describes a case of twin pregnancy with complete hydatidiform mole (CHM). According to the data available in the literature, the concurrence of CHM with a normal placenta and a viable fetus occurs in 1 per 20,000-100,000 pregnancies, requires a differential diagnosis with partial hydatidiform mole and placental mesenchymal dysplasia, and is characterized by a high rate of complications. In this concurrence, the frequency of persistent trophoblastic disease is as high as 50%. In this case, the pregnancy ended in a spontaneous abortion at 16-17 weeks of pregnancy. A morphological examination determined the fetus without congenital malformations with normal placental weight and structure and the adjacent intact placental tissue with the macro- and microscopic signs of CHM. The diagnosis was confirmed by the lack of р57 expression in the villous trophoblast and stroma in the tissue of the hydatidiform mole. The patient was diagnosed with persistent trophoblastic disease at 2 months after the abortion.

[Maldiagnosis of giant-cell tumor of the bone in a patient with hyperparathyroid osteodystrophy].

The paper describes a case of maldiagnosis of giant-cell tumor in a patient with parathyroid osteodystrophy, in this connection elbow joint resection and replacement were made. Parathyroid adenoma with the symptoms of primary hyperparathyroidism was diagnosed only two years after surgery. Progression of diseases was accompanied by severe bone changes and the development of urolithiasis complicated by chronic renal failure. Thus, the interpretation of bone tissue changes without considering clinical and laboratory data led to the unwarranted surgical intervention and the late diagnosis of primary hyperparathyroidism. Differential diagnosis of a giant-cell tumor should be made, by obligatorily considering clinical and laboratory data, including the parameters of calcium metabolism.

[The specific features of the expression of E-cadherin and beta-catenin in adenomyosis].

The expression of E-cadherin and beta-catenin in the eutopic and ectopic endometrium was studied in 40 patients with adenomyosis and 12 without this condition, by using an immunohistochemical test and enzyme immunoassay. There was increased expression of E-cadherin and beta-catenin in the eutopic and ectopic endometrium in adenomyosis. The cytoplasmic expression of beta-catenin was also revealed in the smooth muscle cells surrounding the foci of adenomyosis. The E-cadherin concentration measured by enzyme immunoassay was significantly higher in the endometrium and myometrium of patients with adenomyosis than in the controls. There was a higher expression of this protein with a longer duration of the disease. Thus, the formation of ectopic foci in adenomyosis may be argued to be unassociated with the decreased adhesion of epithelial cells. On the contrary, the authors documented the enhanced adhesion of epithelial cells in the ectopic foci, which was likely to be adaptive due to the altered microcirculation.

[Molecular biological aspects of the pathogenesis of adenomyosis].

The review of literature concerns some aspects of the pathogenesis of adenomyosis in terms of occurring molecular biological processes. It pools the literature data on endometrial capacity to be plunged into the deep myometrial layers--the expression of adhesive molecules, endometrial proteolytic activity, angiogenetic factors, and apoptosis-proliferation relationships. Evidence for the metaplastic theory of the disease is also presented. Emphasis is laid on the characteristics of a subendometrial zone whose pathology plays an important role in adenomyosis.

[Changes in the components of the extracellular matrix and its regulators in the endometrium of women with habitual abortion]. / Izmeneniia komponentov vnekletochnogo matriksa i ego reguliatorov v éndometrii zhenshchin s privychnym nevynashivaniem beremennosti.

Biopsies of the endometrium from 93 patients with habitual abortions (HA) were studied immunohistochemically. Chronic endometritis (CE) was diagnosed in 26 patients. Decreased tenascin expression in the endometrial stroma with merozin accumulation in the glandular basal membranes, covering epithelium and vessels were found in HA combined with CE. Abnormal distribution of collagen type I and III with predominance of type I collagen and appearance of merozin. This is indicative of alteration in the endometrium maturation which may result in inadequate ovum implantation and pregnancy interruption. Stromal alterations in HA with or without chronic endometritis are under multifactorial control of various mediators. High level of MMP-9 combined with low level of TFP-beta 1 may serve a prognostic criterion of successful completion of pregnancy regardless of CE. Low level of MMP-9 may increase the risk of pregnancy interruption.

[The immunological aspects of maternal-fetal interrelationships]. / Immunologicheskie aspekty materinsko-plodovykh vzaimootnoshenii.

The paper deals with different aspects of the relationships occurring between the pregnant woman and the fetus having paternal antigens. Analysis of a great deal of recent information clearly indicates that local uterine immunity plays a great role during pregnancy. The specific features of the gene expression of major histocompatibility by an invasive trophoblast and the immunosuppressive function of placental fibrinoid are discussed. A detailed account of the immunocompetent cells, including T lymphocytes, giant granular lymphocytes, and macrophages, that are involved in immunological responsiveness within the decidua is given.

[Intrauterine mycoplasmosis combined with bilateral adrenal ganglioneuroblastoma]. / Vnutriutrobnyi mikoplazmoz v sochetanii s dvustoronnei ganglioneiroblastomoi nadpochechnikov.

The paper reports lethal intrauterine mycoplasmosis in a newborn girl. Her mother suffered from genital mycoplasmosis and had blood antibodies to Myc. Hominis and Ureapl. urealyticum. Most pronounced changes are found in the liver: hepatocyte degeneration and necrosis with PAS- and azur-positive granules in the cytoplasm of hepatocytes and macrophages, lymphohistiocytic infiltration of portal tracts and parenchyma, biliary duct proliferation, cholestases. The lungs: interstitial pneumonia with minimal alteration of the bronchial epithelium. The above spectrum of alterations suggests transplacental contamination. Ganglioneuroblastoma consisting of embryonal neuroblasts found in the adrenals is considered as an independent disease. The first child of this woman died 14-days old and had morphological signs of the intrauterine infection and pronounced liver dysplasia; possible oncogenicity of mycoplasma is discussed.

[Isolated symplasts and stromal syncytial buds of the normal human placenta at 6 to 14 weeks of pregnancy]. / Izolirovannye simplasty i stromal'nye sintsitial'nye pochki normal'noi platsenty cheloveka pri 6--14 nedeliakh beremennosti.

Formation of isolated symplasts (IS) ("deported trophoblast", according to English nomenclature) and stromal syncytial buds (SSB) has been studied in 10 normal patients at pregnancy of 6-14 weeks by means of the indirect immunoperoxidase method. Monoclonal antibodies against beta-subunit of the human chorionic gonadotropin (beta-HCG), serial paraffin slices, stained with hematoxylin-eosin, semithin slices, stained with toluidin blue-pyronine and scanning electron microscopy have been used. A great amount of syncytiotrophoblastic processes and IS, analogous by their structure to syncytiotrophoblast are revealed. Presence of beta-HCG in the syncytiotrophoblast and its absence in the cytotrophoblast are proved. Concentration of beta-HCG in the IS is higher than in the syncytiotrophoblast of the villi. Maximal concentration of beta-HCG in the SSB is described for the first time. The functional role of the IS and SSB is discussed in the system mother-placenta-fetus.