Multiple epitheloid plexiform tumourlet leiomyoma of the uterus with focal vascular invasion.

We report the first case of multiple plexiform tumourlets showing focal vascular invasion suggesting that, unlike what the common and accepted opinion would advocate, these tumours may have a more aggressive behaviour. However, the prognosis of this variant of epithelioid leiomyoma remains unknown, due to its rarity. The main differential diagnosis of this entity are discussed, including endometrial stromal sarcoma exhibiting epitheloid cytomorphology, intravenous leiomyomatosis of epitheloid variant.

Glucocorticoid receptor expression in cervical intraepithelial neoplasia and invasive squamous cell carcinoma of the cervix.

OBJECTIVES: Glucocorticoids (GCs) are used in cancer treatment to cause programmed cell death in transformed cells of the hematopoietic system and to lessen side-effects as nausea, vomiting, edema formation and allergies to specific chemotherapeutic agents. GCs act also as cofactor with human papillomaviruses in the etiology of cervical cancer. Moreover, recently GCs were described as inhibitors of some chemotherapy or radiation-induced apoptosis. The presence or not of a glucocorticoid receptor (GR) in normal and abnormal exocervices is thus interesting. METHODS: To clarify the issue, we tested by immunohistochemistry the expression status of GR in normal cervix epithelium (n = 30), in low-grade cervical intraepithelial neoplasia (LSIL) (n = 30), in high-grade cervical intraepithelial neoplasia (HSIL) (n = 30) and in invasive squamous cell carcinoma (ISCC) (n = 30). All the patients with these lesions have a corresponding liquid-based cytology and were proved to be HPV-positive by using hybrid capture 2 methodology with probes against high-risk oncogenic HPVs. The evaluation of GR expression was performed by using the H-score system and an H-score > 50 was considered positive. RESULT: GR expression was observed in normal epithelium, LSIL, HSIL and ISCC. No statistically significant difference concerning this expression was observed. CONCLUSION: Because GCs could play a positive role in the progression of cancer, our demonstration of GR persistence in cervix cancer cells raises concern about the widespread combined use of GCs with antineoplastic drugs or agents in the clinical management of cervix cancer in women.

Topical treatment of CIN 2+ by cidofovir: results of a phase II, double-blind, prospective, placebo-controlled study.

OBJECTIVE: Randomized controlled trial evaluating a topical treatment for cervical intraepithelial neoplasia 2 and 3 (CIN 2+) using cidofovir. METHODS: Fifty-three women with a biopsy-proven CIN 2+ were randomly assigned, 6 weeks before their planned conisation, either 3 applications of 3 ml 2% cidofovir in Intrasite gel in a cervical cap or a placebo (the same volume of Intrasite alone). A cervical sample for high-risk types of human papillomaviruses (HPV) (Hybrid Capture 2 or HC2) was taken before treatment and before conisation. The cone was submitted for pathological examination, and subsequently, along with the initial biopsy, to in situ hybridization (ISH) for high-risk HPV. RESULTS: Forty-eight patients were treated and followed according to the protocol, (23 cidofovir, and 25 placebo). Fourteen of the 23 cones were free of any CIN (60.8%) in the cidofovir group. Only 5 of 25 cones were free of any CIN (20%) in the placebo group (p<0.01). The difference remained significant in the ITT group (p<0.05). In the per-protocol and ITT populations, we observed more frequent viral clearance in the cidofovir group, but the difference was significant only when evaluated by ISH and not by HC2. No systemic toxicity was observed. Cervico-vaginal side effects of cidofovir were limited, and not statistically different from placebo. CONCLUSION: The medical topical treatment with cidofovir, at this point, cannot replace conisation, but it is a promising candidate for topical chemotherapy of CIN 2+ lesions; a larger prospective randomized study is needed to confirm our results.

Primary mammary tuberculosis presenting as a voluminous abscess.

We present a case of primary mammary tuberculosis (MT), an extremely uncommon pathology, revealed by a voluminous tubercular abscess mimicking a recurrent pyogenic abscess. It was correctly diagnosed after a while because of partial response to antibiotics with a disappearance of the diffuse inflammatory components explained by the effect held concurrently by some antibiotic on a probable staphylococcic superinfection and its bactericidal effect against BK. This is the most common presentation of the mammary forms of the MT and the diagnosis particularly makes sense in this case matching several risk factors: female gender, lactation, young age, and origin from an endemic area. Furthermore the persistence of an abscess after a well driven medical treatment should always make search the presence of BK.