Hyperestrogenemia resulting from a granulosa cell tumor and causing pulmonary thromboembolism: a case report.

Estrogen modulates platelet activation and aggregation, and it increases the levels of the von Willebrand factor, factors II, VII, VIII, and X, and of fibrinogen, all of which increase the risk for thromboembolism. We report the case of a 59-year-old woman, postmenopausal for 4 years, not using hormone replacement therapy, who was admitted into the emergency room with shortness of breath and increased abdominal volume. After physical examination and imaging and biochemical tests, she was diagnosed with pulmonary thromboembolism and a large left adnexal tumor. The patient was promptly received full anticoagulation therapy for the pulmonary thromboembolism. High levels of estradiol (810.4 pg/mL), anti-Mullerian hormone (16.39 ng/mL), inhibin (11250 pg/mL), and suppressed FSH (<0.16 IU/L) led to a suspicion of granulosa-cell tumor. After clinical stabilization, she underwent to an exploratory laparotomy with total hysterectomy and bilateral adnexectomy to treat the pelvic tumor. Pathologic report confirmed a granulosa-cell tumor.

Evaluation of the combination of cytology and hybrid capture to safely predict the high-grade lesion status of patients treated with conization with large loop excision of the transformation zone.

OBJECTIVES: This study aimed to verify whether human papillomavirus (HPV) testing after conization treatment has some potential usefulness for predicting patients' outcome. STUDY DESIGN: One hundred and twenty women were treated for HSIL by conization with large loop excision of the transformation zone (LLETZ). Cytology, colposcopy-guided biopsy, and hybrid capture 2 (HC2) HPV DNA tests were performed before the surgical procedure and every 6 months for 2 years at follow-up. RESULTS: More than 90% of the patients tested positive for high-risk HPV prior to the surgical intervention. Six months after the cervical conization, 74.75% of the patients tested negative for high-risk HPV DNA, and 19.41% were positive. Of the women who were HC2 negative, 72 showed normal cytological smears, 3 ASC-US, 2 LSIL, and 1 HSIL. Of those who were HC2 positive, 8 showed normal smears, 2 ASC-US, 2 ASC-H, 5 LSIL, and 1 case had HSIL, AGC, and squamous cells invasive carcinoma. Clinically, the HSIL case with a negative HPV test did not show any sign of high-grade lesions, and the clinical follow-up did not show residual lesions. CONCLUSIONS: Negative HPV tests correlated with freedom from high-grade disease after 2 years of postconization follow-up, which strongly suggests that negative HPV tests predict the absence of cervical disease.

Levonorgestrel-releasing intrauterine system and iron overload syndrome.

Severe fatigue is a common complaint among patients. This report presents a clinical case of a woman complaining of fatigue associated with diarrhea and myalgia that were first attributed to emotional stress and depression. Initially, the patient was diagnosed with chronic fatigue and irritable bowel syndrome. The patient followed nutritional and physical exercise programs without any improvement. Other clinical conditions, such as nutritional deficiencies, endocrine dysfunctions, autoimmune diseases and neoplasias, were then assessed. During clinical investigation, serum ferritin and iron levels were abnormally elevated despite normal hemoglobin levels, which pointed to an iron overload syndrome later diagnosed as hemochromatosis. It is possible that the symptoms were triggered by the amenorrhea caused by the levonorgestrel-releasing intrauterine system used for contraception.