[Congenital cervico-vaginal atresia and pelvic endometriosis. Clinical case and review of the literature]. / Angeborene zerviko-vaginale Atresie und Beckenendometriose. Klinischer Fall und Literaturübersicht.

Congenital cervico-vaginal atresia is a rare malformation; the presence of a functioning endometrium combined with this anomaly causes a retrograde menstruation and then a greater likelihood of endometriosis. Up to the present literature relates only thirteen cases in which congenital cervico-vaginal atresia was combined with a functioning endometrium. Primary amenorrhea and cyclic, cramping lower abdominal pain was the common symptoms of all the patients. In this work we report a new case of such pathology in a 23 old woman affected also by harmonic nanism. After the review of the literature the embryologic mechanisms involved in lower Mullerian tract malformations, the surgical treatment and the mechanism of formation of endometriosis in association with an outflow tract obstruction are discussed.

Fibronectin levels in pregnancy and puerperium.

Fibronectin levels were serially assayed during the third trimester of pregnancy and puerperium in a group women with uncomplicated pregnancies, and two groups with mild/severe hypertensive disorders of pregnancy. The values were found increased in the complicated pregnancies, with extremely elevated levels in cases of severe preeclamptic fits.

Multifocal extraovarian serous carcinoma. A histochemical and immunohistochemical study.

Three cases of multifocal extraovarian serous carcinoma are presented. This rare, interesting tumor is characterized by a peritoneal carcinosis with ascites and by a histological pattern similar to one of the ovarian serous carcinoma without primary involvement of the ovaries. The pathological criteria for a differential diagnosis between this condition and a localization of ovarian carcinoma are discussed. Histochemical studies show the presence of mucins and the absence of ialuronic acid in the neoplastic cells. The positivity to the low molecular weight cytokeratins is strong in the normal mesothelial cells, and weak in the hyperplastic and neoplastic cells. The meaning of these findings in the tumoral histogenesis is discussed.

Hyperparathyroidism in a pregnant woman with previous thyroid carcinoma. Case report and review of the literature.

A 29 year old woman, primipara, at 26 weeks' gestation had been undergone, five years before, a total thyroidectomy owing to a mixed papillary-follicular carcinoma of thyroid. After thyroidectomy the patient was placed on suppressive thyroxine treatment. Since she was 22 years old she suffered from recurrent renal colics and cholelithiasis. For these reasons she underwent, at the age of 27, an operation to remove bilateral renal calculi and a cholecystectomy owing to gall-stones. During her pregnancy biochemical determinations revealed slight and persistent hypercalcemia, hypophosphatemia, elevated urine calcium besides elevated serum parathyroid hormone (PTH) levels. Thus a diagnosis of primary hyperparathyroidism was taken into consideration. It was considered, but temporarily delayed, the surgical exploration of the neck. A strict clinic overseeing of the patient, which allowed her to carry out the pregnancy happily, was undertaken. Any thyroid carcinoma repercussion on pregnancy was not noted. A left inferior parathyroid adenoma was removed five months after the woman's delivery. The child psychosomatic development, at one year of age, was absolutely normal. A review of the literature indicates that when a pregnancy is complicated by hyperparathyroidism its prognosis is improved by parathyroidectomy, if possible during the second trimester. In patients with asymptomatic hypercalcemia and/or in late pregnancy surgical treatment may be postponed until after delivery. It is also demonstrated that thyroid carcinoma is not aggravated by pregnancy and that the latter can develop without any worry for mother and fetus.

Virus in gynaecological oncology.

We measured the antibody presence of eventual viral infections (Parotiditis, Cytomegalovirus, Herpes Simplex and Hepatitis B) in 51 patients affected by malignant gynaecological tumours. Ninety five women composing the control group not affected by any pathology, underwent the same tests. Even if research has utilized various indirect methods for the antibody dosage of each viral infection, we have not confirmed other Authors' reports. It might be referable to the limited number of cases in our study up to date. In order to make a comparison among different reports we look forward to a uniformity of various laboratory methods. Reliable results will be obtained only by increasing the number of clinical cases and by utilizing the method of determination of viral genome in tumoral cells. The technique is the only reliable among different methods for determining a previous viral infection.

Epidemiological factors and prophylaxis of ovarian tumors.

PIP: 2 theories explaining the common epithelial ovarian carcinoma are: 1) regular ovulations without interruptions can make the epithelium susceptible to a malignancy, and 2) when a carcinogen is introduced into the vagina, it reaches the surface ovarian epithelium through the uterus and the open tubes within 25 minutes. Premalignancy consists of 2 basic concepts, the transformation and the following spread. Important risk factors are: 1) dietary habits, especially a high fat intake; 2) presence of selected families with a familial development of epithelial ovarian tumors; 3) the lesions which are at the limits of malignancy; and 4) the cellular dysplasia of the ovarian epithelium. There is also a good relationship between socioeconomic situations, nutritional state, and increased ovarian carcinoma occurrence. Occurrence is also higher in white women which can be related to a connection between habits of living involving the socioeconomic state and the rate of ovarian neoplasms. The most frequent factors among common ovarian epithelial carcinomas are thought to be early menopause (under age 45), delayed menarche (over age 14), and a lower number of pregnancies. Pregnancy, even if not carried to its full-term, must be considered a factor decreasing the risk of a malignant ovarian neoplasm. Among the most important environmental factors studied are estrogens and viral agents. Prophylactic factors are: 1) histological and surgical diagnosis of any solid of cystic adnexal tumefaction, 2) investigation and control of any cystic mass, 3) detection and control of all cystic adnexal masses increasing their size during the observation of the group of patients in fertile age, 4) detection and control of any unilateral cystic ovarian neoplasm with a diameter lower than 10 cm, 5) control of all palpable ovaries in postmenopausal women, 6) control of all patients with adenomatoid hyperplasia of the endometrium, 7) removal of roughly pathological ovaries in women under age 35 during pelvic surgery for malignant or benign disease, 8) possible hysterectomy and bilateral ovariosalpingotomy in women having 2 or more close relations affected by ovarian neoplasm, and 9) ovaries ablation in women 35 or older who undergo pelvic surgery for a benign or malignant disease.^ieng